Otterbein Monclova
Inspection Findings
F-Tag F0686
F 0686 Level of Harm - Minimal harm or potential for actual harm
monitor, and modify if needed strategies to attain or maintain intact skin, prevent complications, promptly identify, and manage complications. This deficiency represents non-compliance investigated under Master Complaint Number 2611062.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/26/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Otterbein Monclova
5069 Otterbein Way Monclova, OH 43542
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)
F-Tag F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, staff interview, medical record review, and policy review, the facility failed to wear appropriate personal protective equipment for residents on enhanced barrier precautions and failed to maintain proper infection control measures related to hand hygiene during wound care. This affected one (#16) of three residents reviewed for wounds. The facility census was 55.Findings include:Review of Resident #16's medical record revealed an admission date of 10/02/20. Diagnoses included hemiplegia and hemiparesis following a cerebrovascular accident, epilepsy, and cellulitis of the scrotum.Review of Resident #16's Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed the resident was cognitively intact and had one surgical wound.Review of Resident #16's hospital note dated 08/15/25 revealed the resident had a large abscess in his scrotum. A scrotal exploration, incision, and drainage was completed of the abscess.
The wound was irrigated and necrotic tissue was debrided. The wound was packed with wet to dry Iodoform gauze.Review of Resident #16's physician order dated 02/08/25 revealed the resident was to be under enhanced barrier precautions (EBPs) which included staff wearing gloves and gown with treatment and/or care.Review of Resident #16's physician's order dated 09/25/25 revealed an order to place gauze packing strips (Iodoform) one-half inch and apply once daily and as needed if saturated, soiled, or dislodged for 20 days. There were also instructions to pack the entire wound loosely.Observation on 09/26/25 at approximately 12:15 P.M. of the signage alerting visitors and staff to the EBPs for Resident #16 revealed a white magnetic sign was attached to the upper right side of the resident's door frame and the sign had the letters EBP at the top and contained pictures of handwashing, a gown, and gloves.
Observation on 09/26/25 at 12:19 P.M. of Resident #16's wound care revealed the Director of Nursing (DON) and Licensed Practical Nurse (LPN) #200 completed scrotal wound care wearing only protective gloves. Additional observations revealed LPN #200 assisted the DON with wound care and touched the tray tables, the resident's sheets, and bed then reached with the same gloved fingers into the bottle of Iodoform and pulled out the dressing. LPN #200 then handed the packing to the DON who placed the Iodoform in Resident #16's wound and packed it with a large cotton swab.Interview with the DON and LPN #200 on 09/26/25 at 12:33 P.M. verified they failed to wear gowns during Resident #16's wound care and confirmed proper infection control measures were not maintained when the same gloves used to touch contaminated surfaces were used to directly touch and handle clean wound dressing without cleansing hands and changing gloves. Review of the facility policy titled, Isolation Precautions Process, revised 08/01/22, revealed enhanced barrier precautions will be utilized for residents with wounds. Elements of enhanced barrier precautions included hand washing and gloves and gowns should be worn during high-contact resident care which included wound care (skin opening requiring a dressing). Signage will be posted at the entry to the resident's room to alert them of the need to consult the nurse prior to entering with the nurse providing appropriate personal protective equipment instruction.This deficiency represents non-compliance investigated under Master Complaint Number 2611062.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
OTTERBEIN MONCLOVA in MONCLOVA, OH inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in MONCLOVA, OH, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from OTTERBEIN MONCLOVA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.