Health 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. Page 1 of 3 365752 365752 10/02/2023 Foundation Park Care Center 1621 S Byrne Rd Toledo, OH 43614

F 0585 Level of Harm - Minimal harm or potential for actual harm Interview on 10/02/23 at 4:09 P.M. with Environmental Services Director #203 verified he had not followed up on Resident #65's missing clothing and did not have a list of what was missing. This deficiency represents non-compliance investigated under Complaint Number OH00146336. Residents Affected - Few 365752 Page 2 of 3 365752 10/02/2023 Foundation Park Care Center 1621 S Byrne Rd Toledo, OH 43614

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, staff interview, and review of facility policy the facility failed to ensure resident rooms and resident equipment were appropriately clean. This affected three residents (#10, #65 and #79) of four residents reviewed for a clean environment. The facility census was 84. Findings include: Observation on 10/02/23 at 9:42 A.M. of Resident #65's room revealed the air conditioning unit vents had a thick layer of dust, the floor of the corners of the room had dead bugs, debris, and cobwebs, and the base of the bedside table had a thick layer of dirt. Interview on 10/02/23 at 9:52 A.M. with Registered Nurse (RN) #200 verified Resident #65's room condition and stated housekeeping does not thoroughly clean the resident's rooms. Observation on 10/02/23 at 10:00 A.M. revealed resident's (#10 and #79) room had cobwebs with dirt and debris in the corners near the floor and the air conditioning vents had a thick layer of dust. Interview on 10/02/23 at 10:01 A.M. with State Tested Nursing Assistant (STNA) #201 verified the cobwebs in the corners of the room with dirt and debris in addition to the air conditioning being dirty. Review of facility document Job Specifications, dated 02/14/20, verified once every 24 hours resident rooms are to be completely cleaned including to dust and damp mop floors daily and damp dust nightstands and tables. Once per month clean all ceiling vents and blinds. This deficiency represents non-compliance investigated under Complaint Number OH00146336. 365752 Page 3 of 3