Health inspection·May 25, 2023

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) five residents reviewed for foot care. Residents Affected - Few The facility failed to ensure Resident #1, whose toenails were long, was seen by the podiatrist routinely. This failure could place residents at risk for not receiving foot care which is consistent with professional standards of practice. Findings included: Review of Resident #1's MDS dated [DATE] revealed the resident was a [AGE] year-old male admitted to the facility on [DATE]. The resident's diagnoses included diabetes, hyperlipidemia, non-Alzheimer's dementia, Parkinson's disease, and cognitive communication deficit. The MDS further reflected Resident #1 had long- and short-term memory impairment, was rarely understood, and rarely understood others. Review of Resident #1's care plan initiated on 04/13/22 reflected the resident required assistance with ADLs. Approaches included provide level of support to complete dressing and personal hygiene needs every shift. Interview on 05/25/23 at 1:48 PM with CNA A revealed the podiatrist made routine visits at that facility but Resident #1 was not being seen. The CNA stated they filled out a shower sheet for each resident and for about three weeks she had been marking that Resident #1 needed his toenails clipped because they were long. After the showers sheet were completed they were turned into the charge nurses for them to review. Observation on 05/25/23 at 3:45 PM of Resident #1 revealed he was sitting in the hallway in his wheelchair next to his room. LVN B took off Resident #1's sock to his left foot and his toenails were long on each toe measuring about a quarter inch. LVN B then took off the sock to the right foot and 2 of his toenails were observed to also be about a quarter inch long. The resident was asked if his toenails were hurting or bothering him and he shook his head no. Review of Resident #1's shower sheets dated 05/13/23, 05/16/23, 05/25/23, completed by CNA A revealed Resident #1 needed his toenails clipped. Interview on 05/25/23 at 2:52 PM with LVN B revealed the podiatrist made routine visits but she was Page 1 of 2 676466 676466 05/25/2023 Cheyenne Medical Lodge 750 Highway 352 Mesquite, TX 75149

F 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not aware Resident #1 was not being seen. LVN B said if a resident was noted to have long toenails, the aides shoujldlet the charge nurses know and they will then have the Social Worker make the referral to the podiatrist . The LVN also said no one had made her aware Resident #1's toenails were long and the morning shift nurses would have been the ones to read the resident's shower sheets. Interview on 05/25/23 at 3:31 PM with the Social Worker revealed the podiatrist made routine visits to the facility and the residents that required services were seen every 72 days unless the resident was having issues, in that case they would make a special visit. The Social Worker stated Resident #1 had been on routine podiatry services and she did not know why the resident had not been seen recently. Review of Resident #1's podiatry progress notes provided by the Social Worker on 05/25/23, revealed the resident had last been seen by the podiatrist on 11/17/22. Interview on 05/25/23 at 4:16 PM with the DON revealed residents who met criteria for podiatry services were seen routinely every 72 days. The DON said Resident #1 did meet criteria for podiatry services because he was diabetic. She stated Resident #1 has been seen by the podiatrist in November 2022 and she did not know why he had been missed during the recent visits. The DON also stated the shower sheets were turned into the charge nurses to be reviewed and she believed Resident #1's sheets were not acted on because they assumed he was already on podiatry services. The DON said the risk of residents not being seen by the podiatrist included injury and infection. Review of the facility's undated policy titled Nail Care - Fingernails and Toenails reflected the following: Purpose: 1. To promote cleanliness 2. To prevent injury 3. To prevent infection .Procedure .6. Nurse aides do not trim toenails, nails of diabetic residents 676466 Page 2 of 2