Inspection·October 2, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, family interview, and staff interview, the facility failed to ensure resident/family concerns were resolved timely. This affected one resident (#65) of three residents reviewed for grievances. The facility census was 84. Findings include: Review of the medical record for Resident #65 revealed the resident was admitted to the facility on [DATE]. Diagnoses included unspecified dementia, delusional disorders, essential (primary) hypertension, and major depressive disorder. Review of the Minimum Data Set (MDS) assessment 3.0 dated 09/06/23 revealed the resident was rarely understood. Review of a communication progress note for Resident #65 completed by Social Services #207, dated 09/21/23, revealed the family was in for a scheduled care conference. The note detailed the family's concern related to continued missing clothing including warm up pants black in color with light blue stripe down the side, a set black hoodie with black pants with gray camouflage stripe down the side. It was reported the concerns would be documented in the resident progress notes and addressed in the morning meeting on 09/22/23 with the management team. Interview on 10/02/23 at 12:14 P.M. with Resident #65's family member and Power of Attorney (POA) revealed she had provided a list of missing clothing to the facility with no follow-up. Interview on 10/02/23 at 1:55 P.M. with Resident #65's other family member revealed the family has bought her socks and labeled them only to find them gone the next week. Interview on 10/02/23 at 3:15 P.M. with the Administrator revealed Resident #65's family had called him twice regarding lost clothing. The Administrator verified there was no concern form completed. Interview on 10/02/23 at 3:58 P.M. with Social Services #207 verified she had not followed up or talked further regarding Resident #65's missing clothing but stated that Registered Nurse (RN) #208 had. Interview on 10/02/23 at 4:05 P.M. with RN #208 verified Resident #65's family concerns, including missing clothing, was discussed in morning meeting and the clothing concerns would have been investigated by Environmental Services Director #203. (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 3 Event ID: 365752 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 365752 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Foundation Park Care Center 1621 S Byrne Rd Toledo, OH 43614 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)