Foundation Park Care Center

Review of the witness statement from Licensed Practical Nurse (LPN) #270 revealed she came into Resident #12's room when requested by CNA #283 to assist with transferring Resident #12 back into his chair after he had a behavior and was lowered to the ground. LPN #270 observed Resident #12 laying on the floor anxiously fidgeting when she entered.

This was noted to be normal behavior for Resident #12. LPN #270 and CNA #283 assisted Resident #12 back into his chair. It was noted Resident #12 showed no sign of injury or pain while on the floor, during or after transfer.

There were no notifications documented as being made to Resident #12's spouse or hospice provider on 10/16/25.

Interview on 11/25/25 at 7:04 A.M. with LPN #270 verified she was called to assist Resident #12 on 10/16/25 after he had been lowered to the ground from his lift. LPN #270 explained Resident #12 had gotten his arm out and under the sling which had been supporting him in the lift. Resident #12 had been caught and lowered to the floor while his legs were still secured in the lift. Resident #12 was then transferred to his wheelchair with the assistance of two staff. LPN #270 stated she had not made notifications of the incident to Resident #12's family or hospice provider on 10/16/25.

Interview on 11/25/25 at 8:52 A.M. with RN #238 verified she had been in Resident #12's room with the wound care team on 10/16/25 when Resident #12 got his arm under the lift support sling and was lowered to the ground. RN #238 reported Resident #12 threw himself to the side before they were able to get his legs unstrapped. He had been released and transferred by two staff members back to his chair. RN #238 reported LPN #270 would have made notifications to the family, physician, and hospice, and verified she had not made any notifications regarding the incident on 10/16/25.

Interview on 11/25/25 at 9:20 A.M. with Hospice RN #312 verified the facility had not notified Resident #12's hospice provider of the incident when Resident 12 was lowered to the floor on 10/16/25.

Review of the facility policy titled, Notify of Changes (Injury/Decline/Room/Etc.), revised January 2023, revealed it was the policy of the facility to notify the resident, physician, and resident representative when there was a change in treatment, accident, significant change in status and or the decision to transfer or discharge the resident.

Review of the facility policy titled, Free of Accidents/Hazards/Supervision, Devices, revised May 2024, revealed a fall was defined as unintentionally coming to rest on the ground, floor, or other lower level but not as a result of an overwhelming force. If a fall occurred the resident was to be assessed for injuries, notify the physician, and provide treatment as necessary and notify the resident representative.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/25/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Foundation Park Care Center

1621 S Byrne Rd Toledo, OH 43614

SUMMARY STATEMENT OF DEFICIENCIES