Foundations for Living was cited for deficiencies related to the use of restraints, documentation, staff training, and family communication during an on-site investigation by the Ohio Department of Mental Health and Addiction Services (OhioMHAS). OhioMHAS wrote that the on-site investigation was triggered by the concerns of the number of law enforcement calls to the facility and allegations of lack of appropriate staff supervision and control of the facility, rioting by residents, staff abuse of residents, improper restraint techniques, and the failure to provide an adequate treatment environment. During the inspection, OhioMHAS found that the facility was not providing staff training on the proper use of restraints which led to staff members using inappropriate restraint techniques on residents. OhioMHAS found that staff members had utilized restraints in multiple incidents for residents who were listed as “kicking doors” or “destroying papers.” Also, the documentation of these same incidents does not show that a crisis or “imminent risk” of harm to self or others was present or warranted the level of restraint used. However, OhioMHAS also found that nearly all of the personnel records reviewed “did not contain consistent evidence that staff were currently up to date in all required training.” OhioMHAS noted in the report that “staff that have not completed mandatory trainings are not permitted to restrain or seclude residents.” The facility was cited for not properly documenting the initial mental health assessment that included self-identified de-escalation techniques for each youth. OhioMHAS also noted that staff did not document whether they utilized the identified methods or techniques for de-escalation prior to implementing a restraint. Finally, OhioMHAS cited the facility for not inviting or encouraging family members to participate in the debriefing process after a restraint was used. The facility submitted a plan of correction to address the cited deficiencies.