Inspection visit
Inspection
14 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 14 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0557
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to be treated with respect and dignity and to retain and use personal
possessions.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, medical record review, and resident and staff interview the facility failed to ensure residents
were provided with personal clothing and clothing was appropriately fitting. This affected one (#2) of six
residents reviewed for clothing and personal affects in a facility census of 88.
Findings include:
Record review revealed Resident #2 admitted to the facility on [DATE]. Diagnoses included malignant
neoplasm of bone, malignant neoplasm of thyroid gland, paraplegia, and neurogenic bowel. According to
the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #2 had intact cognition, no
recorded behaviors, range of motion impairment bilateral lower extremities, utilized a wheelchair for
mobility, dependent on staff for the provision of activities of daily living (ADL), and a weight of 254 pounds.
Observation on 01/14/25 at 7:49 A.M. noted Certified Nurse Aide (CNA) #204 with CNA #205 providing
Resident #2 with morning ADL care, including dressing. Resident #2 was placed in a long sleeve front
button shirt which was ill fitting, exposing his abdomen. Both CNAs stated Resident #2 did not have any
additional clothing to place on the resident. Observation in the resident's closet identified no appropriate
clothing including pants or shirts. CNA #205 was directed by CNA #204 to look in the facility common
laundry for unclaimed lost and found pants. CNA #204 returned with pajama pants and proceeded to place
them on Resident #2. Observation with CNA #204 and CNA #205 revealed the pants were tightly fitting, but
no other pants were available in the facility. Resident #2 stated the pants appeared to be women's pants but
he wanted to be out of bed and out in facility common areas and accepted wearing the pants.
Continued observation on 01/14/25 at 8:22 A.M. noted Resident #2 seated in an electric wheelchair and
propelling himself in facility common areas, and dining room. The longsleeve button up shirt appeared as
small and exposed his abdomen and plaid colored pajama long pants were snuggly fitting to his legs and
groin area. At 11:03 A.M., Resident #2 was observed with 10 additional resident taking part in a religious
activity wearing the same clothing with his abdomen exposed.
At 1:37 P.M., Resident #2 was observed in his room and placed to bed by CNA #204, #205, and #203 using
a mechanical lift. Resident #2 was discovered to be heavily soiled with urine which soaked through his brief,
pants and mechanical lift sling. CNA #203 with the assistance of CNA #204 and CNA #205 removed the
soiled pants and provided incontinent care. Resident #2 was placed into an incontinence brief which was
tightly fitting and failed to contain his perineum. Resident #2 stated he would like to be placed back into the
wheelchair following care. CNA #204 and CNA #205 stated no replacement
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 23
Event ID:
365339
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0557
pants were available in the facility and the resident would have to remain in bed.
Level of Harm - Minimal harm
or potential for actual harm
On 01/14/25 at 2:00 P.M., interviews with the Administrator, Director of Nursing and Regional Registered
Nurse (RRN) #1 verified Resident #2 did not have sufficient personal clothing and was unable to get back
into his wheelchair.
Residents Affected - Few
On 01/14/25 at 3:00 P.M., an observation revealed Resident #1 remained in bed with no pants applied.
On 01/15/25 at 5:45 A.M., an observation revealed Resident #2 was awake and alert in bed. He was
wearing the button shirt from the previous day and an adult brief. Resident #2 confirmed he was unable to
get out of bed the following day due to the lack of pants.
On 01/15/25 at 2:15 P.M., an interview with RRN #2 revealed the facility could not determine what personal
clothing Resident #2 possessed due to the lack of an inventory sheet which should have been contained in
the medical record and was not.
This deficiency represents non-compliance investigated under Complaint Number OH00160921.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 2 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review, observation, and resident and staff interview, the facility failed to ensure residents who were
incontinent were provided with a supply of appropriately fitting incontinence garments and briefs. This
affected 43 current residents (#2, #3, #5, #6, #7, #8, #10, #14, #15, #16, #17, #18, #20, #21, #22, #23, #24,
#26, #28, #29, #30, #32, #33, #34, #35, #37, #39, #40, #41, #42, #43, #44, #45, #55, #69, #74, #76, #79,
#81, #82, #86, #87, and #89) identified by the facility to require incontinence briefs. The facility census was
88.
Residents Affected - Some
Findings include:
Record review revealed Resident #2 admitted to the facility on [DATE]. Diagnoses included paraplegia and
neurogenic bowel. According to the most current Minimum Data Set (MDS) assessment dated [DATE]
revealed Resident #2 had intact cognition, dependent on staff for incontinence care, and was incontinent of
bowel and bladder.
Observation and interview on 01/14/25 at 5:55 A.M. of the facilities central supply storage with Licensed
Practical Nurse (LPN) #302 revealed a supply of incontinence products. Inventory included medium briefs
and pull up garments including sizes extra large (XL) and medium. No incontinent briefs were available for
residents requiring XXXL, XXL, XL, large, or small. LPN #302 confirmed nursing staff was attempting to
place the residents in the available incontinence garments, but they failed to contain resident elimination
(stool or urine).
Observation and interviews on 01/14/25 at 7:49 A.M. noted Certified Nurse Aide (CNA) #204 with CNA
#205 providing Resident #2 with morning activities of daily living care. Both CNAs stated Resident #2 was
placed into a brief which would not contain his perineum and Resident #2 stated the brief was tight. Both
CNAs indicated the facility lacked a sufficient supply of incontinence briefs and used a supply which was
available.
Observation on 01/14/25 at 1:37 P.M. revealed Resident #2 was in his room and placed to bed by CNA
#204, #205, and #203 using a mechanical lift. CNA #204 and CNA #205 removed the soiled pants and
provided incontinence care. Resident #2 was placed into an incontinence brief which was tightly fitting and
failed to contain his perineum.
On 01/15/25 at 9:55 A.M., an interview with Director of Nursing (DON) identified a list of 43 residents who
required various sized incontinence briefs not including medium size. The DON confirmed the facility lacked
a supply of incontinence briefs designed to fit residents appropriately and provide containment of
elimination effectively.
This deficiency represents non-compliance investigated under Complaint Number OH00160921.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 3 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
medical record review and physician and staff interview, the facility failed to notify the physician regarding
blood glucose monitoring following admission to the facility. This affected one (#1) of six residents reviewed
for notification of physician in a facility census of 88.
Findings include:
Record review revealed Resident #1 admitted to the facility on [DATE]. Diagnoses included end stage renal
disease, type II diabetes mellitus, nephrotic syndrome, and dependence on renal dialysis. According to the
most current Minimum Data Set (MDS) assessment dated [DATE], Resident #1 had intact cognition, and
received insulin injections.
According to hospital community referral (HCR) documentation dated 12/24/24, Resident #1 was ordered to
receive Humalog KwikPen Insulin 20 to 25 units three times daily with meals. Additional insulin
administration included insulin glargine 40 units under the skin in the morning and 40 units before bedtime.
The HCR noted short acting Humalog insulin dosage sliding scale blood glucose monitoring obtained
before meals and at bedtime. Physician follow-up appointment instructions noted Physician #001 listed for
follow-up regarding insulin regimen control. No documentation contained in the medical record indicated
Physician #001 was contacted to address Resident #1's insulin management.
The medical record lacked physician notification related to the monitoring of Resident #1's blood sugar to
determine the dosage of Humalog (short acting insulin) to be administered three times daily with meals.
There was no documentation related to blood sugar level readings until 12/26/24 at 4:00 P.M. when a
physician order was implemented by Certified Nurse Practitioner (CNP) #1 for blood sugar checks to be
obtained before meals and at bedtime.
On 01/15/25 at 9:55 A.M., an interview with the Director of Nursing (DON) verified Resident #1's blood
sugar monitoring was not clarified with the physician at the time of admission and went without monitoring
until clarified on 12/26/24. The DON went on to state no policy or procedure was available directing nursing
staff on verification of admission orders and standards of practice are expected to be followed.
Telephone interview on 01/15/25 at 12:01 P.M. with Physician #001 revealed no contact had been
established with the facility regarding Resident #1's daily insulin management or related medical care.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 4 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0676
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, medical record review, resident and staff interview, and review of facility policy, the facility
failed to ensure residents who required assistance with activities of daily living (ADL) were assisted with
bathing as scheduled. This affected four (#1, #2, #5, and #6) of six residents reviewed for ADL. The facility
census was 88.
Residents Affected - Some
Findings include:
1. Record review revealed Resident #1 admitted to the facility on [DATE]. Diagnoses included end stage
renal disease, morbid obesity, congestive heart failure, and dependence on renal dialysis. According to the
most current Minimum Data Set (MDS) assessment dated [DATE], Resident #1 had intact cognition and
required supervision or touching assistance with ADL.
On 12/30/24, a nursing plan of care was implemented to address Resident #1 has an ADL self-care
performance deficit related to impaired balance. Intervention included shower days were Tuesday and
Friday on day shift. Resident required supervision by one staff with personal hygiene.
Review of the electronic bathing task documentation between 12/24/24 and 01/13/25 revealed no showers
or bed bath recorded. According to shower/bath paper documentation between 12/24/24 and 01/13/25
noted showers were administered on 12/26/24 and 01/13/25 with a bed bath on 01/09/25.
On 01/13/25 at 2:55 P.M., an interview with Resident #1 stated he received his first shower in weeks and
felt good and clean.
On 01/15/25 at 9:55 A.M., an interview with the Director of Nursing (DON) verified showers were not
provided in accordance with Resident #1's specific shower schedules.
2. Record review revealed Resident #2 was admitted to the facility on [DATE]. Diagnoses included
malignant neoplasm of bone, paraplegia, and neurogenic bowel. According to the most current Minimum
Data Set (MDS) assessment dated [DATE], Resident #2 had intact cognition, no recorded behaviors, range
of motion impairment bilateral lower extremities, and dependent on staff for ADL care.
On 03/01/23, a nursing plan of care was developed to address Resident #2's ADL self-care performance
deficit related to disease process. Resident #2 required staff assist to complete ADL tasks daily.
Intervention included Resident #2 required extensive assistance of one staff with showering two times a
week and as needed.
Review of Resident #2's electronic bathing task documentation revealed no showers or bathing recorded
between 12/15/24 and 01/13/25. According to shower/bath paper documentation between 12/15/24 and
01/13/25 noted no showers administered. The most recent date a shower was documented was on
12/10/24.
On 01/13/25 at 9:28 A.M., an interview with Certified Nurse Aide (CNA) #203 verified showers were not
provided as scheduled to Resident #2 due to lack of sufficient staff and extensive resident care needs.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 5 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0676
Level of Harm - Minimal harm
or potential for actual harm
3. Record review revealed Resident #5 admitted to the facility on [DATE]. Diagnoses included chronic
obstructive pulmonary disease, multiple sclerosis, epilepsy, vascular dementia, anxiety disorder, and major
depression. According to the most current Minimum Data Set (MDS) assessment dated [DATE], Resident
#5 utilized a wheelchair for mobility, range of motion impairment to bilateral lower extremities, and
dependent on staff for the completion of ADL.
Residents Affected - Some
On 05/31/24, a nursing plan of care was developed to address Resident #5's ADL self-care performance
deficit related to disease process. Resident #5 required staff assist to complete ADL tasks daily.
Intervention included shower days on Tuesday and Friday day shift. The resident required supervision by
one staff with personal hygiene.
Review of Resident #5's electronic bathing task documentation between 12/15/24 and 01/13/25 revealed a
shower recorded as refused on 12/27/24 at 1:29 P.M. No further showers were documented electronically
during the 30 day period. According to shower/bath paper documentation between 12/15/24 and 01/13/25
discovered no showers administered during the 30 day period.
Observation on 01/13/25 at 9:25 A.M. noted Resident #5 in bed with matted oily hair and debris under
fingernails. Resident #5 stated she had not received a shower in three weeks.
On 01/13/25 at 9:28 A.M., an interview with Certified Nurse Aide (CNA) #203 verified showers were not
provided as scheduled to Resident #5 due to lack of sufficient staff and extensive resident care needs.
4. Record review revealed Resident #6 admitted to the facility on [DATE]. Diagnoses included chronic
obstructive pulmonary disease, peripheral vascular disease, anxiety disorder, and chronic pain. According
to the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #6 had the ability to
understand and make needs known, range of motion impairment to one side upper and lower extremities,
and dependent on staff for the provision of ADL.
On 08/13/24, a nursing plan of care was revised to address Resident #6 an ADL self-care performance
deficit related to disease process. Resident #6 required staff assist to complete ADL tasks daily.
Interventions included the resident required extensive assist of one staff with showering two times a week
and as needed.
Review of Resident #6's electronic bathing task documentation between 12/15/24 and 01/13/25 revealed
showers recorded on 12/17/24 and 12/27/24. According to shower/bath paper documentation between
12/15/24 and 01/13/25 noted showers administered on 12/19/24 and 12/31/24.
Observation on 01/13/25 at 9:15 A.M. revealed Resident #6 propelling herself in a wheelchair. Her clothing
was soiled with food debris and a black brown substance observed under fingernails.
On 01/13/25 at 9:28 A.M., an interview with Certified Nurse Aide (CNA) #203 verified showers were not
provided as scheduled for Resident #6 due to lack of sufficient staff and extensive resident care needs.
On 01/14/25 at 5:54 A.M., additional staff interviews with Licensed Practical Nurse (LPN) #302 and on
01/15/25 at 5:32 A.M. with CNA #207 confirmed showers were not completed as scheduled. Both staff
indicated showers were not completed as scheduled due to lack of sufficient staff and availability of clean
washcloths and towels.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 6 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0676
Level of Harm - Minimal harm
or potential for actual harm
On 01/15/25 at 9:55 A.M., an interview with the Director of Nursing (DON) verified showers were not
provided in accordance with resident specific shower schedules.
Review of facility's undated Activities of Daily Living (ADLs) policy revealed care and services will be
provided for bathing, grooming and oral care. The facility will maintain individual objectives of the care plan.
Residents Affected - Some
This deficiency represents non-compliance investigated under Complaint Number OH00160921.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 7 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, medical record review, staff interview, review of facility staffing schedules, and facility wound
treatment policy, the facility failed to ensure wound treatments were provided as ordered by the physician.
This affected one (#3) of six residents reviewed for the application of wound treatments in a facility census
of 88.
Residents Affected - Few
Findings include:
Record review revealed Resident #3 admitted to the facility on [DATE]. Diagnoses included chronic
respiratory failure, dependence on ventilator and supplemental oxygen, tracheostomy, neuromuscular
dysfunction of bladder, quadriplegia, and injury at cervical vertebra 2 of cervical spinal cord. According to
the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #3 had severe cognitive
impairment, range of motion impairments to the bilateral upper and lower extremities, dependent on staff
for the completion of activities of daily living, incontinent of bowel and bladder, at risk for pressure ulcer
development, and admitted with 11 pressure ulcers, moisture associated skin damage, and skin tears.
Review of the wound specialist certified nurse practitioner (WCNP) #1 progress notes dated 01/06/25
revealed Resident #3 had existing wounds evaluated status post readmission from hospital following
gastrostomy tube (G-Tube) replacement. Wounds included the following; skin tear to left anterior foot, skin
tear to left knee, skin tear to right mid foot and partial thickness dermal rash to G-tube site. Resident #3 had
a history of chronic wounds and pressure ulcers.
Review of WCNP #1's physician orders dated 01/06/25 revealed wound orders included; dermal rash
cleanse with wound cleanser, apply calcium alginate to G-tube site, apply abdominal dressing (AD) to
periwound, T-drain base of wound, change twice daily and as needed (PRN), left medial knee, left anterior
foot, right mid foot, cleanse with wound cleanser, apply oil emulsion to base of wound, secure with boarder
gauze, change daily.
Observation on 01/13/25 at 8:43 A.M. with Certified Nurse Aide (CNA) #205 discovered Resident #3 in bed
with multiple wound dressings in place. Wound dressings were dated 01/11/25 with initials JR written on the
surface of the dressings. These dressings were applied to the G-tube site, left anterior foot, left knee and
right mid foot.
On 01/13/25 at 11:20 A.M., an observation noted Resident #3 in bed with a dressing to the left elbow in
place. The dressing was discovered with the date modified from a 1 to a 2 and initials remained JR.
On 01/13/25 at 11:36 A.M., an interview with Licensed Practical Nurse (LPN) #306 stated she utilized the
initials JR and she assumed care of Resident #3 at 6:00 A.M. LPN #306 stated she had not made any
attempt to change Resident #3's dressings since assuming care. Review of facility staffing schedules with
LPN #306 noted LPN #306 to be scheduled on 01/11/25 and assigned to Resident #3's care. LPN #306
stated she had changed the dressings on 01/11/25 and did not work at the facility on 01/12/25.
On 01/13/25 at 11:38 A.M., an interview with Unit Manager LPN #303 during a review of staffing schedules
confirmed no staff member utilizing the initials JR had been assigned to work as a nurse at
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 8 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0684
the facility since 01/11/25.
Level of Harm - Minimal harm
or potential for actual harm
On 01/13/25 at 12:18 P.M., an observation with Unit Manager LPN #303 during wound dressing change
observation verified the dressings applied to Resident #3 had the date modified from a 1 to a 2 with the
initials JR placed on the surface of the dressings. LPN #303 confirmed the wound dressings were not
changed as ordered by the WCNP.
Residents Affected - Few
Review of facilities undated Wound Treatment Management policy revealed wound treatments will be
provided in accordance with physician orders, including cleansing method, type dressing, and frequency of
dressing change. Dressing changes may be provided outside of frequency when soiled or wet.
This deficiency represents non-compliance investigated under Complaint Number OH00160878.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 9 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, medical record review, staff interview, review of facility staffing schedules, and facility wound
treatment policy, the facility failed to ensure pressure ulcer wound treatments were provided as ordered by
the physician. This affected one (#3) of six residents reviewed for the application of wound treatments in a
facility census of 88.
Residents Affected - Few
Findings include:
Record review revealed Resident #3 admitted to the facility on [DATE]. Diagnoses included chronic
respiratory failure, dependence on ventilator and supplemental oxygen, tracheostomy, neuromuscular
dysfunction of bladder, quadriplegia, and injury at cervical vertebra 2 of cervical spinal cord. According to
the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #3 had severe cognitive
impairment, range of motion impairments to the bilateral upper and lower extremities, dependent on staff
for the completion of activities of daily living, incontinent of bowel and bladder, at risk for pressure ulcer
development, and admitted with two stage II (partial thickness loss of dermis presenting as a shallow open
ulcer with a red-pink wound bed, without slough), six stage III (full thickness tissue loss. Subcutaneous fat
may be visible but bone, tendon or muscle is not exposed), three stage IV pressure ulcers (full thickness
tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the
wound bed).
Review of wound specialist certified nurse practitioner (WCNP) #1's progress notes dated 01/06/25 noted
Resident #3 had existing wounds evaluated status post readmission from hospital following gastrostomy
tube replacement. Pressure ulcers included the following; left medial heel stage III, left elbow stage III, right
lateral lower extremity stage IV. Review of Resident #3 had a history of chronic wounds and pressure
ulcers.
Review of the wound orders dated 01/06/25 revealed WCNP #1 wound orders included; left medial heel
cleanse with wound cleanser, apply oil emulsion to base of wound, secure with boarder gauze, change
daily. Left elbow cleanse with wound cleanser, apply medical grade honey to base of wound, secure with
boarder gauze, change daily. Right lateral lower extremity cleanse with wound cleanser, apply oil emulsion
to base of wound, secure with boarder gauze, change daily.
Observation on 01/13/25 at 8:43 A.M. with Certified Nurse Aide (CNA) #205 revealed Resident #3 lying in
bed with multiple wound dressings in place. Wound dressings were dated 01/11/25 with initials JR written
on the surface of the dressings. These dressings were applied to the left elbow, left medial heel, and right
lateral lower knee (extremity). The right lateral lower knee was observed to be heavily soiled with blood
tinged drainage penetrating the dressing onto bed linen.
On 01/13/25 at 11:20 A.M., observation noted Resident #3 in bed with the dressing to the left elbow in
place. The dressing was discovered with the date modified from a 1 to a 2 and initials remained JR.
On 01/13/25 at 11:36 A.M., an interview with Licensed Practical Nurse (LPN) #306 revealed she utilized the
initials JR and she assumed care of Resident #3 at 6:00 A.M. LPN #306 stated she had not made any
attempt to change Resident #3's dressings since assuming care. Review of facility staffing schedules with
LPN #306 noted LPN #306 to be scheduled on 01/11/25 and assigned to Resident #3's care. LPN #306
stated she had changed the dressings on 01/11/25 and did not work at the facility on
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 10 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0686
01/12/25.
Level of Harm - Minimal harm
or potential for actual harm
On 01/13/25 at 11:38 A.M., an interview with Unit Manager LPN #303 during a review of staffing schedules
confirmed no staff member utilizing the initials JR had been assigned to work as a nurse at the facility since
01/11/25.
Residents Affected - Few
On 01/13/25 at 12:18 P.M., observation with Unit Manager LPN #303 during wound dressing change
observation verified the dressings applied to the resident had the date modified from a 1 to a 2 with the
initials JR placed on the surface of the dressings. LPN #303 confirmed the wound dressings were not
changed as ordered by the WCNP.
Review of the facilities undated Wound Treatment Management policy revealed wound treatments will be
provided in accordance with physician orders, including cleansing method, type dressing, and frequency of
dressing change. Dressing changes may be provided outside of frequency when soiled or wet.
This deficiency represents non-compliance investigated under Complaint Number OH00160878.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 11 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate
catheter care, and appropriate care to prevent urinary tract infections.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, medical record review, resident and staff interview, and review of facility incontinence policy,
the facility failed to provide residents with timely incontinence care and application of related and
appropriate incontinence products. This affected one (#2) of three residents reviewed for incontinence care
in a facility census of 88.
Findings include:
Record review revealed Resident #2 admitted to the facility on [DATE]. Diagnoses included malignant
neoplasm of bone, malignant neoplasm of thyroid gland, paraplegia, and neurogenic bowel. According to
the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #2 had intact cognition, no
recorded behaviors, dependent on staff for the provision of activities of daily living (ADL), incontinent of
bowel and bladder, and was at risk for pressure ulcer development with no skin breakdown.
On 03/01/23, a nursing plan of care was implemented to address Resident #2's ADL self-care performance
deficit related to disease process. Resident #2 required staff assistance to complete ADL tasks. Resident
#2 was totally dependent on two staff for toileting. On 12/13/23, a nursing plan of care was revised to
address Resident #2's functional bladder incontinence related to paralysis and inability to recognize need
for voiding. Interventions included the resident utilized adult disposable briefs for comfort and dignity. Clean
peri-area with each incontinence episode. Check the resident, during rounds and as required for
incontinence. Wash, rinse and dry perineum. Apply barrier cream. Change clothing as needed (PRN) after
incontinence episodes.
The physician orders dated 06/20/24 revealed to apply barrier cream to peri-area and buttocks during care
rounds every shift and as needed (PRN) as a preventative to promote skin health.
Observation on 01/14/25 at 7:49 A.M. noted Certified Nurse Aide (CNA) #204 with CNA #205 providing
Resident #2 with morning activities of daily living, including toileting. Both CNAs stated Resident #2 was
placed into a brief which would not contain his perineum and Resident #2 stated the brief was tight. Both
CNAs stated the facility lacked a sufficient supply of incontinence briefs and used a supply which was
available.
Continued observations on 01/14/25 between 8:22 A.M. and 1:02 P.M. noted Resident #2 remained seated
in an electric wheelchair. No observed attempts to provide Resident #2 with incontinence checks or care.
Interview with Resident #2 at 1:02 P.M. confirmed nursing staff had not provided any attempts to check him
for incontinence. Resident #2 went on to state he was checked once every eight hour shift and provided
incontinence care. He stated multiple occasions urine leaks through his brief into his clothing.
On 01/14/25 at 1:15 P.M., an interview with CNA #204 confirmed Resident #2 will tell staff when he needs
checked and he had not received a incontinence check or change since getting out of bed at approximately
8:00 A.M.
On 01/14/25 at 1:37 P.M., Resident #2 was observed in his room and placed to bed by CNA #204, #205,
#203 using a mechanical lift. Resident #2 was discovered to be heavily soiled with urine, which
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 12 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0690
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
soaked through his brief, pants and mechanical lift sling. CNA #203 with the assistance of CNA #204 and
CNA #205 removed the soiled pants and provided incontinence care. There was a lack of barrier cream
applied to the residents peri-area and buttocks. CNAs concluded incontinence care without applying barrier
cream and began to close the brief. Surveyor intervention at the time revealed CNA #204 reported she was
unable to locate the barrier cream when getting the resident out of bed this morning and did not apply the
cream as ordered. Resident #2 and CNA #204 verified the resident was placed into an incontinence brief
which was tightly fitting and failed to contain his perineum. Resident #2 stated due to the brief size
sometimes he urinates out the sides and top, and soiling his clothing.
Additional interview following the observation with CNA #203, CNA #204, and CNA #205 stated they were
unaware Resident #2 required checks during regular rounds. The CNAs confirmed regular rounds were not
completed every two hours for Resident #2.
On 01/14/25 at 2:00 P.M., an interview with the Director of Nursing verified Resident #2 was to be checked
every two hours for incontinence during regular rounds.
Observation on 01/15/25 at 5:45 A.M. noted Resident #2 awake and alert in bed. He stated he was wearing
the ill fitting incontinence brief and was recently checked for incontinence around 5:00 A.M.
Review of the facilities undated incontinence policy revealed all residents that are incontinent will receive
appropriate treatment and services. Residents that are incontinent of bladder or bowel will receive
appropriate treatment to prevent infections and to restore continence to the extent possible.
This deficiency represents non-compliance investigated under Complaint Number OH00160921.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 13 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0725
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in
charge on each shift.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, medical record review, resident and staff interview, and facility staffing documentation, the
facility failed to schedule sufficient nursing staff to ensure resident care and treatment was provided as
indicated. This affected four residents (#1, #2, #5, and #6) and had the potential to additionally affect 32
residents (#3, #4, #7, #8, #9, #10, #11, #13, #14, #15, #16, #17, #18, #19, #22, #23, #70, #72, #73, #74,
#75, #76, #77, #79, #81, #82, #83, #84, #85, #86, #87, and #88). The facility census was 88.
Findings include:
1. There was an inadequate staffing issue to provide residents with routine bathing as scheduled.
1a. Resident #1's shower days were Tuesday and Friday on day shift and the resident required supervision
by one staff with personal hygiene. Resident #1's shower/bath paper documentation between 12/24/24 and
01/13/25 revealed showers were administered on 12/26/24 and 01/13/25 with a bed bath on 01/09/25.
1b. Resident #2 required extensive assistance of one staff with showering two times a week and as
needed. Resident #2's shower/bath paper documentation between 12/15/24 and 01/13/25 noted no
showers administered. The most recent date a shower was documented was on 12/10/24.
1c. Resident #5 had shower days on Tuesday and Friday day shift and the resident required supervision by
one staff with personal hygiene. Resident #5's electronic bathing task documentation between 12/15/24
and 01/13/25 revealed a shower recorded as refused on 12/27/24 at 1:29 P.M. The shower/bath paper
documentation between 12/15/24 and 01/13/25 discovered no showers administered during the 30-day
period.
Observation on 01/13/25 at 9:25 A.M. noted Resident #5 in bed with matted oily hair and debris under
fingernails. Resident #5 stated she had not received a shower in three weeks.
1d. Resident #6 required extensive assist of one staff with showering two times a week and as needed.
Resident #6's electronic bathing task documentation between 12/15/24 and 01/13/25 revealed showers
recorded on 12/17/24 and 12/27/24. According to shower/bath paper documentation between 12/15/24 and
01/13/25 noted showers administered on 12/19/24 and 12/31/24.
Observation on 01/13/25 at 9:15 A.M. revealed Resident #6 had a black brown substance observed under
fingernails.
On 01/13/25 at 9:28 A.M., an interview with Certified Nurse Aide (CNA) #203 verified showers were not
provided as scheduled for Residents #1, #2, #5, and #6 due to lack of sufficient staff and extensive resident
care needs.
On 01/14/25 at 5:54 A.M., additional staff interviews with Licensed Practical Nurse (LPN) #302 and on
01/15/25 at 5:32 A.M. with CNA #207 confirmed showers were not completed as scheduled. Both staff
indicated showers were not completed as scheduled due to lack of sufficient staff and availability of clean
washcloths and towels.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 14 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0725
Level of Harm - Minimal harm
or potential for actual harm
On 01/15/25 at 9:55 A.M., an interview with the Director of Nursing (DON) verified showers were not
provided in accordance with resident specific shower schedules.
2. On 01/14/25 at 8:45 A.M., an interview with the Director of Nursing (DON) revealed the DON reviewed
the resident care levels needs for the three of the five units of the facility: house, pulmonary and main unit.
Residents Affected - Some
•
The house pulmonary unit had twelve residents residing on the unit with three residents (#3, #13, and #14)
on ventilators, three residents (#19, #22, and #23) with tracheostomies, and nine residents (#3, #14, #15,
#16, #17, #18, #19, #22, and #23) who required two staff assistance with care.
•
The [NAME] unit had 16 residents residing on the unit with four residents (#10, #81, #82, and #86) who
required two staff assistance with care and 10 residents (#1, #7, #8, #9, #11, #83, #84, #85, #87, and #88)
who required one staff assistance with care.
•
The main unit had 15 residents residing on the unit and four residents (#2, #4, #74, and #79) who required
two staff assistance for all care and eight residents (#5, #6, #70, #72, #73, #75, #76, and #77) who required
one staff assistance with all care.
Review of the staffing schedules from 01/13/25 and 01/14/25 revealed during the 6:00 A.M. to 2:00 P.M.
shift, one certified nursing assistant (CNA) was scheduled to the [NAME] unit, one CNA was scheduled to
the Main unit, and two CNAs assigned to the House unit and Pulmonary unit.
Interview on 01/13/25 at 2:25 P.M. with Resident #4, who resided on the main unit, stated residents were
not getting put back into bed for extended periods of time due to the lack of staff to assist them.
Interview on 01/14/25 at 6:25 A.M. with Resident #14, who resided on the pulmonary unit, stated he was
not getting showers due to lack of towels, wash clothes and limited staff availability.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494,
Complaint Number OH00160878, and Complaint Number OH00160313.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 15 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, medical record review, physician and staff interview, and review of policy, the facility failed to
ensure medications were administered as ordered by the physician. This affected two (#1 and #4) of four
residents reviewed for medication administration. The facility census was 88.
Findings include:
1. Record review revealed Resident #1 admitted to the facility on [DATE]. Diagnoses included end stage
renal disease and type II diabetes mellitus. According to the most current Minimum Data Set (MDS)
assessment dated [DATE], Resident #1 had intact cognition and received insulin injections.
According to hospital community referral form (CRF) documentation dated 12/24/24, Resident #1 was
ordered to receive Humalog KwikPen Insulin 20 to 25 units three times daily with meals. The CRF noted
short acting Humalog insulin dosage sliding scale blood glucose monitoring obtained before meals and at
bedtime. Physician follow-up appointment instructions noted Physician #001 listed for follow-up regarding
insulin regimen control.
Resident #1's medical record lacked physician notification related to the monitoring of Resident #1's blood
sugar to determine the dosage of Humalog (short acting insulin) to be administered three times daily with
meals. The medical record lacked documentation indicating Resident #1 received Humalog administration
or monitoring from 12/24/24 until 12/26/24 at 4:00 P.M.
On 01/15/25 at 9:55 A.M., an interview with the Director of Nursing (DON) verified Resident #1's Humalog
administration and blood sugar monitoring was not provided as ordered per the CRF from the time of
admission and went without monitoring until clarified on 12/26/24 with Certified Nurse Practitioner (CNP)
#1.
Telephone interview on 01/15/25 at 12:01 P.M. with Physician #001 verified the facility did not contact him to
establish Resident #1's daily insulin management or related medical care.
Review of the facilities undated Medication Administration policy revealed medications are administered by
licensed nurses and staff legally authorized, as ordered by the physician.
2. Review of Resident #4's medical record revealed Resident #4 admitted to the facility on [DATE] with the
diagnoses including type II diabetes mellitus, end stage renal disease (ESRD), and dependence on renal
dialysis. According to the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #4
had intact cognition and received renal (Hemo) dialysis.
2a. Review of the physician orders dated 08/27/24 revealed an order for Sevelamer Carbonate oral tablet
(used to lower phosphorous levels in the blood if you have ESRD with dialysis) 800 milligrams (mg) give
four tablets by mouth with meals (morning, afternoon, evening) related to end stage renal disease.
Review of Resident #4's medication administration records (MAR) between 01/05/25 through 01/13/25
revealed Sevelamer Carbonate 800 mg was recorded as not administered to Resident #4.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 16 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Review of the nursing notes revealed an entry on 01/05/25 noting Sevelamer Carbonate 800 mg to be
administered once obtained from pharmacy. No entries from 01/05/25 to 01/13/25 noted the medication
available or administered.
Observation on 01/14/25 at 7:38 A.M. noted Licensed Practical Nurse (LPN) #300 obtaining and preparing
Resident #4's medications from the medication cart. LPN #300 was unable to locate the medication
Sevelamer Carbonate 800 mg tablets within the cart. LPN #300 proceeded to summons Unit Manager LPN
#303 and attempted to obtain Sevelamer 800 mg tablets from the facilities contingency (in-house) supply.
Unit Manager LPN #303 reviewed the contents of the contingency supply and stated Sevelamer Carbonate
800 mg tablets were not available in the facility and would have to be ordered from the pharmacy.
Interview on 01/14/25 at 7:54 A.M. with LPN #303 during review of the medical record confirmed Sevelamer
Carbonate 800 mg was not available or administered to Resident #4 since 01/05/25.
2b. Additional review of the medical record revealed a physician order dated 02/21/24 for the administration
of Oxycodone-Acetaminophen oral tablet 10-325 mg give one tablet by mouth four times a day for pain.
The MAR from January 2025 revealed there were doses omitted on 01/05/25 between 7:00 P.M. to 11:00
P.M., and on 01/06/24 upon rising, afternoon, and evening.
The nursing notes on 01/06/25 at 9:44 P.M. revealed the medication was not available.
Interview on 01/15/25 at 9:55 A.M. with Director of Nursing during medical record review confirmed
Resident #4's medications were not obtained or administered as ordered by the physician.
Review of the facilities undated Medication Administration policy revealed medications are administered by
licensed nurses and staff legally authorized, as ordered by the physician.
Review of the facilities undated pharmacy services policy revealed the facility will provide pharmaceutical
services to include procedures that assure accurate acquiring, receiving, dispensing, an administering of all
routine and emergency drugs and biologicals to meet the needs of each resident.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494 and
Complaint Number OH00160313.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 17 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0760
Ensure that residents are free from significant medication errors.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, medical record review, staff interview, and facility policy review, the facility failed to ensure
medications were administered according to the physician orders to the residents without any significant
medication errors. This affected one (#4) of four residents reviewed for medication administration. The
facility census was 88.
Residents Affected - Few
Findings include:
Review of Resident #4's medical record revealed Resident #4 admitted to the facility on [DATE] with the
diagnoses including type II diabetes mellitus, end stage renal disease (ESRD), and dependence on renal
dialysis. According to the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #4
had intact cognition and received renal (Hemo) dialysis.
Review of the physician orders dated 08/27/24 revealed an order for Sevelamer Carbonate oral tablet (used
to lower phosphorous levels in the blood if you have ESRD with dialysis) 800 milligrams (mg) give four
tablets by mouth with meals (morning, afternoon, evening) related to end stage renal disease.
Review of Resident #4's medication administration records (MAR) between 01/05/25 through 01/13/25
revealed Sevelamer Carbonate 800 mg was recorded as not administered to Resident #4.
Review of the nursing notes revealed an entry on 01/05/25 noting Sevelamer Carbonate 800 mg to be
administered once obtained from pharmacy. No entries from 01/05/25 to 01/13/25 noted the medication
available or administered.
Observation on 01/14/25 at 7:38 A.M. noted Licensed Practical Nurse (LPN) #300 obtaining and preparing
Resident #4's medications from the medication cart. LPN #300 was unable to locate the medication
Sevelamer Carbonate 800 mg tablets within the cart. LPN #300 proceeded to summons Unit Manager LPN
#303 and attempted to obtain Sevelamer 800 mg tablets from the facilities contingency (in-house) supply.
Unit Manager LPN #303 reviewed the contents of the contingency supply and stated Sevelamer Carbonate
800 mg tablets were not available in the facility and would have to be ordered from the pharmacy.
Interview on 01/14/25 at 7:54 A.M. with LPN #303 during review of the medical record confirmed Sevelamer
Carbonate 800 mg was not available or administered to Resident #4 since 01/05/25.
Interview on 01/15/25 at 9:55 A.M. with Director of Nursing during medical record review confirmed
Resident #4's medications were not obtained or administered as ordered by the physician.
Review of the facilities undated Medication Administration policy revealed medications are administered by
licensed nurses and staff legally authorized, as ordered by the physician.
Review of the facilities undated pharmacy services policy revealed the facility will provide pharmaceutical
services to include procedures that assure accurate acquiring, receiving, dispensing, an administering of all
routine and emergency drugs and biologicals to meet the needs of each resident.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494 and
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 18 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0760
Complaint Number OH00160313.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 19 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0804
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, staff interview, review of facility dietary spreadsheets and resident dietary order
documentation, the facility failed to ensure dietary meal portions were provided as required. This affected
60 residents (#1, #2, #4, #6, #7, #8, #9, #10, #11, #12, #13, #14, #17, #18, #20, #21, #22, #25, #26, #29,
#30, #33, #35, #37, #43, #44, #46, #48, #49, #51, #53, #54, #55, #57, #58, #59, #60, #61, #62, #63, #64,
#65, #66, #68, #69, #70, #71, #73, #74, #75, #76, #77, #78, #79, #80, #83, #84, #85, #87, and #88) of 86
residents who were on a regular diet and 15 of the residents who were on a no concentrated sweets diet
(NCS). The facility census was 88.
Residents Affected - Some
Findings include:
Observation in the facilities kitchen on 01/14/25 at 11:45 A.M. with Dietary Director #1 revealed the lunch
meal items were placed to the steam table which included meatloaf, gravy, mashed potatoes, french cut
green beans, apple crisp. Dietary Director #1 confirmed dietary was utilizing a three-ounce slotted spoodle
(cross between a serving spoon and a ladle) for french cut green beans and a four-ounce spoodle for apple
crisp. Dietary staff was observed to utilize the serving portions to provide 86 residents their lunch meal.
Review of the the facilities therapeutic spreadsheet for 01/14/24 for the lunch meal revealed dietary should
serve four ounces of french cut green beans and four ounces of apple crisp. Residents receiving a NCS
diet were to receive two ounces of apple crisp desert.
Review of the resident's physician dietary orders revealed 60 residents (#1, #2, #4, #6, #7, #8, #9, #10,
#11, #12, #13, #14, #17, #18, #20, #21, #22, #25, #26, #29, #30, #33, #35, #37, #43, #44, #46, #48, #49,
#51, #53, #54, #55, #57, #58, #59, #60, #61, #62, #63, #64, #65, #66, #68, #69, #70, #71, #73, #74, #75,
#76, #77, #78, #79, #80, #83, #84, #85, #87, and #88) were on a regular diet and only received three
ounces of green beans vs. the four ounces that was supposed to be administered. There were 15 residents
(#1, #4, #6, #30, #46, #59, #62, #73, #74, #76, #77, #80, #83, #85, and #87) who were ordered a NCS diet
and these residents received four ounces of apple crisp vs. the two ounces that was supposed to be
administered.
On 01/14/25 at 12:55 P.M., an interview with Dietary Director #1, following the meal service, verified all
residents receiving the meal other than puree and residents requesting no vegetable did no receive the
required portion sizes indicated on the approved therapeutic spreadsheets.
On 01/15/25 at 11:01 A.M., an interview with the facilities Registered Dietitian (RD) #2 and Diet Technician
#3, during a review of 01/14/25 lunch menu with associated spread sheets, confirmed residents were not
provided with required vegetable portions and NCS restricted diets were provided with a double portions of
desert on 01/14/25.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 20 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, staff interview, and review of facility policy, the facility failed to ensure soiled linen
was contained to prevent cross contamination with clean linen. This had the potential to affect all 88
residents receiving laundry services. The facility census was 88.
Residents Affected - Many
Findings include:
Observation of the facility laundry on 01/14/25 at 6:40 A.M. with Housekeeper/Laundry Staff (HLS) #800
revealed the facility was equipped with two commercial washing machines and four commercial dryers. HLS
#800 stated the facility was down to one operating washing machine and three commercial dryers. Located
next to the dryers identified three wheeled laundry bins with soiled clothing and linens mixed together. The
soiled laundry was mounted over the top of the bins and spilling to the floor. Two large piles of soiled
laundry were located on the floor of the laundry room placed in front of the dryers. HLS #800 verified soiled
linens were mixed with resident personal clothing and associated facility laundry. HLS #800 also stated the
soiled laundry was piled on the floor in front of the dryers in preparation to place into washer and confirmed
clean laundry was placed into the dryers from the washer in the same location of the soiled laundry.
On 01/14/25 at 2:10 P.M., an interview Environmental Director #1 confirmed the facility was using one
washer due to plumbing concerns with second washer. ED #1 verified facility laundry was to be contained
in laundry bins and not placed on the floor of the laundry room. Resident personal clothing and laundry was
to be sorted from soiled linens.
Review of the facility's undated handling of soiled linen policy revealed linen can become contaminated with
pathogens from contact with intact skin, body substances, or from environmental contaminants.
Transmission of pathogens can occur through direct contact with linens or aerosols generated by sorting
and handling contaminated linen. Linen should not be allowed to touch the uniform or floor and should be
handled as little as possible, with minimum agitation to avoid contamination of air, surfaces, and persons.
Used or soiled linen shall be collected at the bedside and placed in a linen bag or designated linen
receptacle. The bag shall be closed securely and placed in the soiled utility room. If linen is heavily soiled,
wet and/or presents risk of leakage or soaking through, the linen shall be double bagged. Soiled linen shall
be kept separate from clean linen.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 21 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0917
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground
level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, medical record review, and resident and staff interview, the facility failed to ensure residents
were provided with a bed of appropriate size and comfortable, intact mattress. This affected one (#1) of six
residents observed for the provision of furniture and room furnishings. The facility census was 88.
Findings include:
Record review revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included morbid
obesity. According to the most current Minimum Data Set (MDS) assessment dated [DATE], Resident #1
had intact cognition. Resident #1's height was six foot two inches and weight of 282 pounds.
There was no documentation indicating Resident #1's bed was assessed for proper size or if the mattress
was examined for designed pressure relieving properties.
Observation on 01/14/25 at 6:13 A.M. revealed Resident #1 was lying in bed resting on his back with both
feet pressed against the foot board and his head at top of mattress. On 01/15/25 at 5:55 A.M., Resident #1
was observed in bed, alert and awake. Resident #1's right foot had a wound dressing in place which was
pressed against the foot board and left foot was resting on the top of the foot board, over the edge of the
mattress. Resident #1 was also observed with the mattress compressed to the bed springs through the
mattress. Resident #1 stated the mattress and bed were not comfortable and his buttock was pressing
against the springs.
On 01/15/25 at 2:30 P.M., an interview with the Director of Nursing verified she was unable to provide
evidence indicating Resident #1's bed was assessed for proper fit or comfort.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 22 of 23
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
365339
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Park Terrace Rehabilitation Center
2735 Darlington Rd
Toledo, OH 43606
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0921
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and
the public.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations and staff interview, the facility failed to ensure wash clothes and towels were provided to
residents. This had the potential to affect all 88 residents residing in the facility.
Findings include:
Observation on 01/14/25 at 6:04 A.M. with Certified Nurse Aide (CNA) #206 noted the main unit linen
storage room supplied with seven washcloths and nine bath towels. Observation inside the house unit clean
linen storage room discovered no clean washcloths or towels. Interview with CNA #206 stated frequently no
washcloths or towels were available and staff cut linen (sheets and bath blankets) to cleanse residents.
Observation on 01/14/25 at 6:09 A.M. with CNA #202 revealed the [NAME] unit clean linen storage room
lacked any available clean washcloths or towels. CNA #202 stated staff will cut large size linens to cleanse
residents.
Observation on 01/14/25 at 6:40 A.M. with Housekeeping/Laundry staff (HLS) #800 during a tour of the
facility laundry noted the facility utilizing one washing machine and the second was out of service. HLS
#800 was observed with a bin of clean bed linen in the clean section of the laundry room. However, no
clean washcloths or towels were available. Continued tour identified in the main laundry storage located in
the basement two packs of new wash cloths containing 12 each. No new towels were available.
Observation on 01/14/25 at 6:57 A.M. of the Cove unit clean linen storage room with CNA #201 revealed
there were two towels and four washcloths. Interview with CNA #201 stated she was unsure what to do
about providing residents with morning activities of daily living (ADLs) due to the lack of clean towel and
washcloth supply.
Observation on 01/14/25 at 7:02 A.M. revealed the Garden unit linen closet was equipped with no
washcloths or towels. At 7:05 A.M., an interview with CNA #200 revealed when no washcloths or towels
were available, the care staff have to cut up bath blankets. CNA #200 stated using cut up bed linen made it
difficult to get resident's clean.
Observation on 01/14/25 at 1:37 P.M. revealed Resident #2 was in his room and placed to bed by CNA
#204, #205, and #203 using a mechanical lift. Resident #2 was discovered to be heavily soiled with urine,
which soaked through his brief, pants and mechanical lift sling. CNA #203 with the assistance of CNA #204
and CNA #205 removed the soiled pants and provided incontinence care. During the incontinence care
procedure CNA #203 was observed to use a bath towel to cleanse the resident's perineum. Interviews with
CNA #204, #205, and #203 stated there no washcloths available and a towel was used to cleanse the
resident.
On 01/14/25 at 2:10 P.M., an interview with Environmental Director (ED) #1 confirmed the facility was using
one washer due to plumbing concerns with second washer. ED #1 verified the lack of clean washcloths and
towels.
This deficiency represents non-compliance investigated under Master Complaint Number OH00161494.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365339
If continuation sheet
Page 23 of 23
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Back to topCitations
14 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F557 - Respect and Dignity
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
F580 - Notification of Changes
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
F676 - Based on the comprehensive assessment of a resident and consistent with
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
F725 - Nursing Services
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F760 - Residents are free of any significant medication errors
Ensure that residents are free from significant medication errors.
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
F917 - Private closet space in each resident room, as specified in §483
Make sure each resident has 1) at least one window to the outside in a room; 2) a room at or above ground level; 3) adequate bedding; 4) furniture that meets the resident's needs; or 5) adequate closet space.
F921 - Other Environmental Conditions
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
FAQ · About this visit
Common questions about this visit
What happened during the January 15, 2025 survey of PARK TERRACE REHABILITATION CENTER?
This was a inspection survey of PARK TERRACE REHABILITATION CENTER on January 15, 2025. The surveyor cited 14 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at PARK TERRACE REHABILITATION CENTER on January 15, 2025?
Yes, 14 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.