Health inspection·August 23, 2024

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents receive proper treatment and care to maintain good foot health for one (Resident #1) of four residents reviewed for foot care. Residents Affected - Few The facility failed to ensure Resident #1 received foot care. This failure could place residents at risk of diminished quality of life by not receiving care and services to meet their needs. Findings included: Record review of Resident #1's Quarterly MDS, dated [DATE], revealed a [AGE] year-old female who admitted to the facility on [DATE]. Her diagnoses included heart failure, hypertension, gastroesophageal reflux disease, hyperkalemia, hyperlipidemia, Alzheimer's disease, multiple sclerosis, and seizure disorder. Her BIMS score was 3 out of 15, which revealed she was severely cognitively impaired. She required maximal assistance with mobility and dependent on staff with ADLs. Record review of Resident #1's Care Plan, updated 08/21/24, revealed her pressure ulcer prevention was skin prep to bilateral toes once a day as preventative measures. Her goal was not to develop pressure ulcers. Her interventions were pressure redistribution mattress and assess for appropriate footwear. Record review of Resident #1's August 2024 physician orders reflected: Weekly head to toe with an order date of 04/21/24 and frequency of one time weekly; Wound treatment - apply triple antibiotic ointment with an order date of 08/21/24 (the order did not specify application area); Preventative treatment - skin prep - apply skin prep to bilateral toes for preventative treatment with an order date of 08/21/24; and Preventative treatment - monitor site- monitor bilateral toes for signs and symptoms of complications (open wounds, redness, or infection) with an order date of 08/21/24. Record review of Resident #1's August 2024 treatments (08/01/24 - 08/31/24) reflected: Weekly head to toe assessments were completed on 08/02/24, 08/09/24, and 08/16/24; Page 1 of 3 676237 676237 08/23/2024 The Belmont at Twin Creeks 999 Raintree Circle Allen, TX 75013

F 0687 Level of Harm - Minimal harm or potential for actual harm included in the order); and Wound treatment - apply triple antibiotic ointment one time daily starting 08/21/24 (the order did not specify application area). Residents Affected - Few Record review of Resident #1's podiatry note dated 07/15/2024 reflected: Resident #1 was seen and evaluated on 07/15/24. A complete foot examination was performed. Resident #1's toenails of bilateral feet were provided sharp debridement using a sterile nail clipper without insult to the skin. Resident #1's toenail specimen was sent to lab for further evaluation. A complete vascular examination was also performed. Resident #1 will be seen again in three months or sooner if necessary. Record review of Resident #1's Telehealth visit summary dated 08/21/24 reflected: Reason for visit: Skin/wound issue Participating provider: Wound care physician Comments: Resident #1 had various pink areas on bilateral toes, notified Wound care physician. Per Wound Care Physician the toes did not appear open; skin prep and monitor. The Telehealth visit was conducted after Surveyor intervention on 08/21/24. Observation of Resident #1's toes on 08/21/24 at 12:20 pm revealed there were pink areas on both feet. There was flaky skin on the top of both feet and in between two of her toes on her left foot. Resident #1's toenails curled over the top of her toes on two of her toes on both feet. Resident #1 had discoloration to two of her nails on both feet. Interview with the Treatment Nurse on 08/21/24 at 12:30 pm revealed Resident #1's toes appeared better than in July 2024. The treatment nurse stated Resident #1's toes appeared better than other residents at the facility. The Treatment Nurse repeatedly stated there were no issues with Resident #1's toes. She stated Resident #1 received skin prep to toes in July 2024. The Treatment nurse stated Resident #1 was not currently receiving any wound care to her toes. Interview with the DON on 08/21/24 at 12:35 pm revealed Resident #1's toes appeared to look good. The DON stated there were no issues with Resident #1's toes. She stated Resident #1 had been seen by the podiatrist in July 2024. Interview with the SW on 08/21/24 at 1:07 pm revealed she was responsible for referring residents to the podiatrist. She stated Resident # 1 was seen by the podiatrist on 07/15/24 and will be seen again in October 2024. She stated the purpose of podiatry was to maintain proper foot care. She stated the risk to Resident #1 not receiving proper foot care was development of wounds. Interview with a Family Member on 08/21/24 at 2:45 pm revealed she last saw Resident #1's toes weeks ago. She stated in July 2024 Resident #1's toes had wounds that were weeping. She stated she should not have to come to the facility and remove Resident #1's shoes to see if care had been provided. She stated the facility should be taking care of Resident #1's toes. 676237 Page 2 of 3 676237 08/23/2024 The Belmont at Twin Creeks 999 Raintree Circle Allen, TX 75013

F 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and Interview with Resident #1 on 08/23/24 at 11:45 am revealed her toes appeared to be clean and free of flaky skin. There appeared to be scars noted on Resident #1's knuckles. There were no open areas on Resident #1's toes. On Resident #1's left foot, her second digit was discolored and appeared darker than the other toes. Resident #1 stated she was able to feel when the nurse touched her toe. Resident #1 stated her toes were not painful. Resident #1 was able to answer a few simple questions and was oriented to person only. Interview with the Treatment Nurse on 08/23/24 at 1:12 pm revealed Resident #1 would benefit from routine skin prep. She stated Resident #1 was currently receiving skin prep to her toes. She stated the purpose of skin prep was to harden Resident #1's skin on her toes. She stated there was no difference in the appearance of Resident #1's toes on 08/21/24 and 08/23/24. Interview with the DON on 08/23/24 at 4:00 pm revealed Resident #1's toes appeared the same on 08/21/24 and 08/23/24. She stated the appearance of Resident #1's toes were her baseline. She stated there was nothing wrong with Resident #1's feet. She stated the appearance of Resident #1's toes on 08/21/24 was avoidable with lotion. She stated skin prep was performed to the pink areas on Resident #1's toes for preventative measures. She stated Resident #1 had dry skin on her toes. She stated the risk to Resident #1 was skin breakdown on her toes. A podiatry policy was requested from the Administrator on 08/21/24 at 11:39 AM and was not provided. 676237 Page 3 of 3