| 51 |
ATHENS HEALTH AND REHABILITATION LLC |
15016 |
611 WEST MARKET STREET |
ATHENS |
AL |
35611 |
2018-07-19 |
687 |
D |
0 |
1 |
OEFS11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure the nails of Resident Identifiers (RI) #3 and #31 were maintained in a trimmed condition. This affected two of five sampled residents for whom an observation of the feet and toes was made. Findings included: The facility policy titled, Nail Care dated (MONTH) 1, 2010, cites the purpose as: Routine nail care helps reduce the potential for infection, prevents intrusion of the nail into the skin, prevents possible injuries and promotes a feeling of well being for the resident. The standard specifies: Nail care is a routine part of grooming each day. Foot care should be provided as a part of a tub or shower bath. The policy further recommends .a Podiatrist provides foot care for residents with Diabetes or [MEDICAL CONDITION] . 1) RI #3 has resided in the facility since 11/06/17, with [DIAGNOSES REDACTED]. The Significant Change Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 07/12/18, identified RI #3 as cognitively intact. The care plan related to Activities of Daily Living for RI #3, (dated 11/07/17) included, Nail care as needed. During an interview on 07/17/18 at 8:44 AM, the surveyor questioned RI #3 about the care of his/her feet. In response, RI #3 removed his/her shoes. The toenails on RI #3's left foot were long, particularly the great toe, which extended approximately 1/2 beyond the end of the toe. When questioned further, RI #3 explained he/she had been on the list to see the facility podiatrist for nearly a year, and had made numerous requests for podiatry assistance. On 07/18/18 at 5:05 PM, the facility Administrator, Employee Identifier (EI) #1 accompanied the Surveyor to RI #3's room, and viewed his/her feet. When asked, EI #1 stated it was the nurses' responsibility to ensure each resident's toe nails were trimmed. EI #1 then affirmed the nails on the resident's left foot (particularly the great toe) were in need of a trim. EI #1 described the left great toe nail as long, thick and curled. When asked if she knew when RI #31's toenails were last trimmed and by whom, EI #1 did not know. The resident stated he/she had someone cut the toenails about three months earlier, When asked if she knew why RI #3's toenails had not been trimmed before now, EI #1 did not know--and in particular, the great toenail. In response to a question of potential harm in failing to keep RI #3's nails in a trimmed condition, EI #1 said the toenail could break and cause discomfort. The resident (RI #3) added, the toenail could curl around and cause pain. 2. RI #31 was admitted to the facility on [DATE] with [DIAGNOSES REDACTED]. Review of physician's orders [REDACTED]. On 7/18/18 at 11:21 AM, an observation of the toenails were made by the surveyor along with EI #10, RN, Unit Manager. This observation revealed that on the right foot, the right great toe and 4th toe needed cutting along with the 3rd, 4th and 5th toes on the left foot needing cutting. EI #10 stated at the time of the observation that the toes needed clipping and described the toenails as curled onto themselves and usually a Podiatrist cuts the toenails. EI #10 was asked what the potential for harm was. EI #10 stated that RI #31 could scratch him/herself, could get infected, or have ingrown toe nails. When EI #10 was asked if RI #31 should be on the Podiatrist list, she responded by saying, yes he should be. When asked how often the Podiatrist comes, RI #10 stated she though every 3 months. Review of the medical record revealed RI #31 had seen the Podiatrist on 11/1/17 and on 2/22/18. |
2020-09-01 |