Canfield Healthcare Center: Immediate Jeopardy Fall Risk - OH
Federal inspectors cited Canfield Healthcare Center, located at 2958 Canfield Rd in Youngstown, with an immediate jeopardy violation following a complaint inspection completed September 17, 2025. Immediate jeopardy is the most serious finding CMS issues, reserved for situations where a facility's failure has placed a resident in serious danger of harm or death, or already caused it.
The resident at the center of the finding, identified in inspection records as Resident 61, had been assigned a one-to-one aide, meaning a single staff member dedicated exclusively to him, responsible for keeping eyes on him at all times. When inspectors visited the unit, CNA 822 was there, seated in a chair to the left of the doorway to his room. That part was working.
What wasn't working was how the facility counted her.
Inspectors determined that CNA 822, despite being assigned solely to Resident 61, was also being included in the count of floor aides, the nursing assistants responsible for the broader resident population on that unit. That accounting error, or policy failure, meant the facility believed it had more hands available for the floor than it actually did. The aide watching Resident 61 could not simultaneously respond to other residents. She was one person, in one chair, with one assignment. But on paper, she was covering two jobs.
The implications depend entirely on what Resident 61 needed that constant watch for, and the inspection report, as released, does not specify his diagnosis or the nature of the risk. What it does say is that the level of harm was classified as immediate jeopardy, and that the failure affected a small number of residents.
Inspectors also interviewed LPN 858 on August 27, 2025, at 2:07 in the afternoon. The report cuts off before her full statement is captured in the available narrative, but her interview was part of the investigation into how the one-to-one assignment was being managed and documented.
The distinction between being assigned to one resident and being counted among the floor staff is not a paperwork technicality. Floor aide ratios determine how many residents each CNA is responsible for, how quickly call lights get answered, how often someone checks whether a resident has shifted dangerously in a wheelchair or tried to get out of bed alone. When a facility counts a one-to-one aide as a floor aide, the floor looks adequately staffed on a spreadsheet while actually running short. The residents who need help with meals, repositioning, or toileting are waiting on someone who is not coming, because that person is outside Room 61 and cannot leave.
Canfield Healthcare Center is a for-profit facility operating in a part of northeast Ohio where nursing home oversight has drawn scrutiny in recent years. This inspection was triggered by a complaint, meaning someone, a resident, a family member, or a staff member, contacted regulators before inspectors arrived.
The facility's plan of correction was not included in the materials reviewed for this report. CMS instructs facilities to submit correction plans directly to the state survey agency, and those documents are not always immediately public.
What the record does show is a resident who needed someone watching him every minute, and a system that was counting that watcher as though she were somewhere else.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Canfield Healthcare Center from 2025-09-17 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 19, 2026 · Our methodology
CANFIELD HEALTHCARE CENTER in YOUNGSTOWN, OH was cited for immediate jeopardy violations during a health inspection on September 17, 2025.
When inspectors visited the unit, CNA 822 was there, seated in a chair to the left of the doorway to his room.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.