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Complaint Investigation

Kingston Care Center Of Sylvania

Inspection Date: October 8, 2025
Total Violations 2
Facility ID 366305
Location SYLVANIA, OH
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Inspection Findings

F-Tag F0600

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0600

DON is responsible for ongoing compliance. This deficiency represents non-compliance investigated under Complaint Number 2630679.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

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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

10/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Kingston Care Center of Sylvania

4121 King Road Sylvania, OH 43560

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)

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F-Tag F0609

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

09/23/25, LPN #277 assessed Resident #108 for injuries and psychosocial wellbeing. On 09/23/25, the DON or designee initiated re-educated for all facility staff on the abuse policy and reporting of allegations of abuse timely. Evidence was received to verify education was completed on 09/30/25. On 09/23/25, CNA #300 was suspended pending investigation and terminated on 09/24/25. On 09/23/25, the DON provided CNA #275 one-on-one education on timely reporting of potential abuse allegations or concerns. On 09/23/25, the DON or designee interviewed all interviewable residents to ensure they felt safe and there were no further concerns of abuse. On 09/23/25, the DON or designee completed head-to-toe assessments on all residents who were not interviewable. No concerns were identified. On 09/25/25, an AD-HOC Quality Assurance and Performance Improvement (QAPI) committee meeting was held to review

the incident and the corrective action implemented. Beginning on 10/01/25, the DON or designee will

interview five residents weekly for four weeks and then five residents monthly for two months to ensure residents feel safe and there were no abuse concerns. All audits will be reviewed by QAPI to ensure on-going compliance. The DON is responsible for ongoing compliance. Evidence was received to verify audits were completed on 10/01/25 and 10/06/25, with no concerns identified.This deficiency represents non-compliance investigated under Complaint Number 2630679.

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📋 Inspection Summary

KINGSTON CARE CENTER OF SYLVANIA in SYLVANIA, OH inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

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 SYLVANIA, 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 KINGSTON CARE CENTER OF SYLVANIA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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