complaint·August 16, 2023

9099C-1.. Physician's report, dated 1/22/2020 notes resident needs assistance with all ADL's, including bathing, dressing, and toileting. Administrator stated resident suffered a stroke prior to moving to the facility and has not been able to use the left hand well. Administrator stated on 6/28/23, he reached out to resident's primary care physician to request a referral to a podiatrist but the doctor's office is slow to respond. Administrator stated he cut resident's nails in the shower when resident requested it and was not able to contact the podiatrist due to not having a referral. Administrator stated on 6/28/23 to LPA "the fungus is not serious" and explained he made a second request last week and is still waiting for the doctor to schedule a phone appointment. The Administrator indicated the toe nail fungus appeared about 3 months ago, but the podiatrist has cancelled at least one appointment, and the resident was not always available to be taken to an appointment. On 8/16/23, Administrator indicated that resident had recently became upset due to continual fungus on his toenail and removed the nail from one of the big toes himself. The Administrator called the podiatrist and resident was seen for an in-person appointment on 7/24/23 where the other big toe was removed, as the resident insisted, and creme was prescribed. Caregiver stated that resident never had a toe nail infection and he was never in pain and after the appointment on 7/24/23, she used creme prescribed for (2) days until the area was healed. Administrator-Designee stated she was not aware of resident having in infection. Ombudsman conducted an inspection on 6/24/23 and noted that resident "seemed very well cared for and content", and there was "no indication he was in any pain from an infection, and he was wearing nice socks and shoes." Ombudsman stated the Administrator indicated resident has the typical toenail fungus on his toes, but his physician said there is no threatening foot infection. Resident stated to the Ombudsman he is well cared for at the facility. LPA spoke with resident on 6/28/23 who stated that Administrator cut his toenails before he went on vacation in May and explained that his sister put some fungus creme on his toe on the affected right foot, while he was visiting her. Resident agreed to allow LPA to observe his foot without a sock on. LPA did not observe any swelling, inflammation, fungus, or discoloration in the nail area and resident confirmed he does not have any pain in the toenail area. cont on 9099C-2.. 9099C-2.. Administrator stated he provides nail trimming and cleaning to non-diabetic residents as part of basic care. Administrator stated resident asked him to trim his nails on several occasions. Administrator contacted resident's physician's office during today's inspection to confirm that the facility staff can trim resident's toenails. LPA heard the staff at the doctor's office indicate that it is fine for facility staff to trim resident's nail. Administrator provided LPA with different appointments resident (R1)was taken to or attended by phone: 7/12/23- neurologist 7/19/23, 8/1/23 and 8/3/23- dental appointment 9/7/23- scheduled appointment with PCP Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There was concern also expressed about sufficient staff remaining at the facility when one staff takes a resident to medical/dental appointments. Both administrator and caregiver confirmed that there is always at least (1) staff who stays at the facility with the other residents when the Administrator takes another resident to an appointment. There was concern about activities also expressed. Administrator and caregiver stated they offer residents daily walks, television shows/movies, sporting events, holiday outings, church volunteering, movies, and residents will go on outings with families and friends on a regular basis. Exit interview conducted with the Administrator.