Health inspection·March 27, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on medical record review, resident and staff interview, review of x-ray images, review of orthopedic records, review of therapy notes, review of physician notes, and review of facility corrective action, the facility failed to ensure residents who required assistance with transfers were safely transported in their wheelchair to prevent injury. Actual harm occurred to Resident #10 when a dental provider staff member was transporting the resident in his wheelchair and pushed the resident's right foot into a door frame which resulted in excruciating pain and a subsequent distal posterior tibial fracture to the right foot. Resident #10 required orthopedic follow-up appointments, was required to wear a protective boot, and was non-weight bearing to the right foot until the fracture healed. This deficient practice affected one (#10) of three residents reviewed for accidents. The facility census was 70. Findings include: Review of Resident #10's medical record revealed an initial admission date of 02/27/19. Diagnoses included type II diabetes mellitus, congestive heart failure, chronic kidney disease, and anxiety. Review of the most recent quarterly Minimum Data Set assessment dated [DATE] revealed Resident #10 was cognitively intact. The resident utilized a wheelchair and was dependent on staff for mobility. Review of the physical therapy notes dated 06/26/24 revealed Resident #10 was being wheeled into the therapy gym by a dental assistant and the dental assistant ran the resident's right leg rest into the doorframe with the resident indicating he was in severe pain, and he felt like his foot was broken. The resident also stated it felt like when he previously broke the foot on the opposite leg. Nursing was notified and an order to obtain an x-ray was given. Review of the health status progress notes dated 06/26/24 and timed 11:42 A.M. revealed Resident #10 stated the dental assistant ran his right foot into the wall on the way to therapy. The resident was yelling out that the foot was broken. There was no redness, swelling, or warmth noted to the resident's right foot. The physician was notified and ordered an x-ray of the resident's right foot. Review of Resident #10's x-ray results dated 06/26/24 revealed images were taken due to pain and trauma. Further review of the x-ray results revealed an acute distal posterior fibial fracture and mild soft tissue swelling. An x-ray of the right foot also identified a questionable fourth proximal phalanx fracture. A new order was given to consult with orthopedic care. (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: 366426 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 366426 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woods on French Creek Nursing & Rehab Center The 37845 Colorado Avenue Avon, OH 44011 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)