Franciscan Care Ctr Sylvania

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Based on observations, resident interviews, staff interviews, and review of facility policy, the facility failed to ensure foul odors were maintained on A, B and C halls. This had the potential to affect all 54 residents on halls A, B, and C. The facility census was 70. Observation on 10/06/25 between 11:45 A.M. and 12:30 P.M.

on A, B, and C halls revealed an intermittent foul urine odor throughout each hallway not associated with a resident, resident rooms, or soiled utility room.Observation on 10/07/25 at 11:15 A.M. on A hall revealed an intermittent foul urine odor throughout the hallway and into the adjacent dining room. The odor was not associated with a resident, adjacent resident rooms or soiled utility rooms.Observation on 10/08/25 at 9:10 A.M. at B hall nurse station revealed a foul urine odor in the hallway not associated with a resident, adjacent resident rooms or soiled utility rooms. Observation on 10/14/25 at 2:25 P.M. on A hall revealed an intermittent foul urine odor throughout the hallway and into the adjacent dining room. The odor was not associated with a resident, adjacent resident rooms or soiled utility rooms.Interview on 10/07/25 at 11:15 A.M. with Licensed Practical Nurse #559 confirmed A hall had a foul urine odor throughout the hallway and into the adjacent dining room. Continued interview revealed the urine odor was common on most days.

Interview on 10/14/25 at 2:26 P.M. with Activities Assistant #550 confirmed there was a foul urine odor in

the dining room adjacent to A hall, and the odor was common on most days.Interview on 10/14/25 at 2:40 P.M. with Resident #97's representative revealed the facility often had a bothersome foul urine odor throughout the hallways.Interview on 10/14/25 at 4:15 P.M. with Resident #37 revealed the facility often had

a bothersome foul urine odor throughout the hallways.Review of facility policy dated 10/06/25 and titled Safe and Homelike Environment revealed the facility would provide a clean and homelike environment with general consideration to be given to minimize odors by reporting lingering odors and bathrooms needing cleaning to Housekeeping Department. Review of facility policy dated 10/07/25 and titled Routine Cleaning and Disinfection revealed the facility would ensure routine disinfection to provide a sanitary environment.This violation represents non-compliance investigated under Master Complaint Number 2630848 and Complaint Numbers 1305372, 2582511, and 2625891.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Based on review of facility documents, staff interviews, and review of facility policy the facility failed to ensure resident concerns and grievances were addressed timely. This had the potential to affect all residents. The facility census was 70. Review of the grievance logs and reports for April 2025 through September 2025 revealed 30 of 75 grievances filed had not been followed up on. Review of the Resident Council meeting minutes for June 2025 revealed resident concerns related to untimely medication administration and undercooked food. The concerns were not addressed or followed up on.Review of the Resident Council meeting minutes for July 2025 revealed resident concerns related to staffing, staff approach, and showers were not addressed or followed up on.Review of the Resident Council meeting minutes for August 2025 revealed a report Licensed Practical Nurse (LPN) #522 had been counseled for being untimely with medication administration.Review of the Resident Council meeting minutes for October 2025 revealed resident concerns related to staffing, medication times, and care preferences were not addressed or followed up on. Review of LPN #522 personnel file revealed no documentation to support LPN #522 being counseled for untimely medication administration. Interview on 10/08/25 at 4:45 P.M. with

the Director of Nursing confirmed LPN #522 had not been counseled for untimely medication administration as indicated in the Resident Council meeting minutes from August 2025. Interview on 10/09/25 at 8:50 A.M. with the Administrator confirmed 30 grievances between April 2025 and September 2025 had not been followed up on. Continued interview confirmed the above noted resident concerns raised during Resident Council meetings in June, July, August and October 2025 had not been addressed or followed up on.

Review of facility policy dated 03/05/25 titled Resident and Family Grievances revealed the Administrator was the designated Grievance Official, would be responsible for oversight of the grievance process through its conclusion, and would issue written grievance decisions.Review of facility policy dated 05/22/25 titled Resident Council Meetings revealed the facility would act upon concerns of the Council, attempt to accommodate recommendations, and communicate decisions to the Council.This violation represents non-compliance investigated under Master Complaint Number 2630848 and Complaint Numbers 1305376 and 2617497.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on record review, staff interview, review of the facility Self-Reported Incident (SRI), and review of the facility policy the facility failed to timely report an allegation of abuse. This affected one (#105) of one resident reviewed for timely reporting. The facility census was 70. Review of the medical record revealed Resident #105 had an admission date of 08/21/24 with a diagnosis of dementia. Resident #105 was discharged on 06/23/25. Review of the quarterly Minimum Data Set (MDS) assessment, dated 06/04/25, revealed Resident #105 was cognitively impaired. Interview on 10/16/25 at 11:10 A.M. with the Administrator stated on 05/19/25 the Former DON #610 met with Resident #105's daughter and the incident of alleged abuse was reported to Former DON #610. The Administrator further stated she was notified on 05/22/25 of the incident by Former DON #610 and she immediately suspended the alleged perpetrator Former Licensed Practical Nurse (LPN) #601 pending an investigation. Former DON #610 was also suspended pending the investigation for not timely reporting. Further interview with the Administrator stated the Former DON #610 had access into the SRI system to initiate a report of alleged abuse and to start the investigation. The Administrator verified that the alleged abuse incident was not reported timely.

Review of SRI 260722 incident summary revealed an alleged abuse incident was reported to the former Director of Nursing (DON) #610 by Resident #105's family on 05/19/25. The incident details were not reported to the Administrator until 05/22/25, at which time the SRI was reported and the investigation was started. Review of the facility policy titled Abuse, Neglect, and Exploitation revised 07/22 revealed the facility will report all alleged violation to the Administrator, stated agency, and adult protective services within specified time frames according to the following: immediately, but not later than two hours after the allegation is made, if the event that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the event that cause the allegation do not involve abuse and do not result in serious bodily injury. This violation represents non-compliance investigated under Complaint Number

1. 2572811. 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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0610

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of the facility self-reported incidents (SRI), staff interviews, and review of the facility policy the facility failed to complete thorough investigations for five of five SRIs reviewed. This affected six (#39, #46, #54, #85, #105, and #108) residents reviewed for facility self-reported incidents. The facility census was 70. Review of the five facility reported self-reported incidents (SRI)'s: 259637 dated 04/23/25, 259639 dated 04/23/25, 259788 dated 04/28/25, 260722 dated 05/22/25, and 262712 dated 07/12/25 revealed thorough investigations were not completed to include any or all of the following: staff interviews and/or statements, resident statements, assessments of like residents, and/or staff education. 1.

Review of the medical record for Resident #39 revealed an admission date of 09/20/24 with diagnoses of chronic obstructive pulmonary disease (COPD), diabetes mellitus, and congestive heart failure (CHF).

Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #39 was cognitively intact. 2. Review of the medical record revealed Resident #46 had an admission date of 12/26/24 with diagnoses of COPD, cerebral vascular accident (CVA) (stroke), high blood pressure, and systemic lupus. Review of the quarterly MDS assessment, dated 08/18/25 for Resident #46 revealed he was cognitively intact. 3. Review of the medical record for Resident #54 revealed an admission date of 01/20/23 with diagnoses of diabetes mellitus, dementia, and heart failure. Review of the annual MDS dated [DATE REDACTED] for Resident #54 revealed had cognitive impairment. 4. Review of the medical record for Resident #85 revealed an admission date of 01/30/25 with diagnoses of congestive heart failure (CHF), peripheral vascular disease (PVD) and diabetes mellitus. Review of the quarterly MDS assessment dated [DATE REDACTED] revealed Resident #85 had impaired cognition. 5. Review of the medical record revealed Resident #105 an admission date of 08/21/24 with diagnosis of dementia. Resident #105 was discharged on 06/23/25.

Review of the quarterly MDS assessment, dated 06/04/25, revealed Resident #105 had impaired cognition.

1. 6. Review of the medical record for Resident #108 revealed had an admission date of 07/08/25 with

diagnoses of vascular dementia and disorientation. Resident #108 was discharged on 07/30/25. Review of

the discharge MDS assessment, dated 07/30/25, revealed the resident was moderately cognitive impaired.

Interview on 10/16/25 at 11:10 A.M. with the Administrator verified staff interviews or statements were not obtained for all of the investigations. Additionally, the Administrator verified resident interviews were not conducted, assessments of like residents were not conducted, and staff educated were not completed.

Review of the facility policy titled Abuse, Neglect, and Exploitation revised 07/22 revealed the facility will complete an immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect, or exploitation occur. Procedures for the investigation included identifying and interviewing all involved person, including the alleged victim, alleged perpetrator, witnesses, and others who might have knowledge of the allegations, providing complete and thorough documentation of the investigation. This violation represents non-compliance investigated under Complaint Number 2572811.

Residents Affected - Some

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0645

PASARR screening for Mental disorders or Intellectual Disabilities

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, staff interview and review of the facility policy, the facility failed to notify the appropriate state agency (The Ohio Department of Mental Health) of a significant change in a resident's mental health condition as required. This affected one Resident (#77) of one resident reviewed for pre admission screening and resident review (PASRR) assessment. The facility census was 70. Review of the medical

record revealed Resident #77 was admitted to the facility on [DATE REDACTED] with diagnoses including chronic obstructive pulmonary disease, protein-calorie malnutrition, anxiety, sarcopenia, and epilepsy. Review of

the significant change minimum data set (MDS) assessment dated [DATE REDACTED] revealed Resident #77 had intact cognition. Resident #77 had moderately impaired vision and required supervision for mobility and received antipsychotic, antidepressant, and anticonvulsant medications. Review of medical record for Resident #77 revealed a new diagnosis of disorganized schizophrenia in March 2025. In April 2025, a diagnosis of schizophrenia was added. Neither diagnosis was accompanied by and updated PASRR, and

the medical record contained no evidence that the appropriate state agency (The Ohio Department of Mental Health) was notified of the new diagnoses for PASRR review as required. Interview on 10/09/25 at 1:14 P.M. with the Director of Nursing (DON) verified there was no updated PASRR completed in March or April 2025 and therefore the required state agency was not notified. The DON further verified a PASRR should have been completed with the new diagnoses of schizophrenia and the increase in behaviors exhibited by Resident #77. Review of Policy titled Resident Assessment-Coordination with PASRR Program, reviewed 10/09/25, revealed any resident who exhibits a newly evident or possible serious mental disorder, intellectual disability, or a related condition will be referred promptly to the state mental health or intellectual disability authority for a level II resident review. Examples include: -A resident who exhibits behavioral, psychiatric, or mood related symptoms suggesting the presence of a mental disorder (where dementia is not the primary diagnosis). -A resident whose intellectual disability or related condition was not previously identified and evaluated through PASRR. -A resident transferred, admitted , or readmitted to the facility following an inpatient psychiatric stay or equally intensive treatment.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, medical record review, resident interview, staff interview, and review of facility policy, the facility failed to ensure wound care orders were accurate and completed as ordered. This affected one (#60) of three residents reviewed for wound care. The facility census was 70. Review of the medical record for Resident #60 revealed an admission date of 07/01/25, diagnoses included disruption of wound healing, infection following procedure, dehiscence of amputated stump, gangrene, acidosis, and peripheral vascular disease. Review of the Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #60 was cognitively intact, did not refuse care, and required assistance with activities of daily living. Review of physician orders for Resident #60 revealed right leg above the knee amputation (RAKA) wound care order dated 09/09/25 for betadine to be applied to the surgical incision and wrapped with fluff gauze once daily.

Review of Resident #60's after visit summary with the vascular surgeon dated 10/06/25, obtained by staff

on 10/15/25, revealed wound care orders to the RAKA site were to paint the surgical site with Betadine twice daily. Review of the treatment administration record for Resident #60 revealed LPN #507 documented

the dressing change to Resident #60's RAKA site on 10/12/25. Continued review revealed Registered Nurse (RN) #560 documented the dressing change to Resident #60's RAKA site on 10/13/25. Interview on 10/14/25 at 8:40 A.M. with Resident #60 revealed wound care was not completed to her RAKA site on 10/13/25. Continued interview revealed the wound care orders for Resident #60's RAKA had been changed to twice daily on 10/06/25 when she saw the vascular surgeon, however the facility was only completing wound care once daily. Observation on 10/14/25 at 10:50 A.M. of the dressing change to Resident #60's RAKA site revealed the existing dressing was dated 10/12/25 and signed by Licensed Practical Nurse (LPN) #507. Concurrent interview with LPN #545 confirmed this observation. Interview on 10/14/25 at 2:10 P.M. with the Administrator confirmed the documentation of wound care on 10/13/25 completed by RN #560 was not accurate as the dressing had not been changed on 10/13/25. Continued interview with the Administrator confirmed the current wound care orders for Resident #60's RAKA site was incorrect and should have been updated on 10/06/25 to reflect the new order written by the vascular surgeon. Interview

on 10/14/25 at 2:20 P.M. with LPN #545 confirmed the current wound care orders for Resident #60's RAKA site was incorrect and did not reflect the most current order written on 10/06/25. LPN #545 stated the wound care order should have been updated on 10/06/25. Interview on 10/15/25 at 11:50 A.M. with Resident #60's Vascular Surgeon Nurse #606 revealed the RAKA site wound care orders were changed on 10/06/25 and facility staff were notified via phone. Review of facility policy dated 05/22/25 titled Wound Treatment Management revealed the facility would provide wound treatments in accordance with physician orders. This violation represents non-compliance investigated under Master Complaint Number 2630848 and Complaint Number 2617497.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0689

Number 2630848 and Complaint Numbers 2617726, 2617497, 2609625, 2572811, 1305377, 1305376, and

1. 1305372. Level of Harm - Immediate

jeopardy to resident health or safety 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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0712

Ensure that the resident and his/her doctor meet face-to-face at all required visits.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility policy, the facility failed to ensure a resident was seen by a provider during the duration of the admission from 05/07/25 through discharge on [DATE REDACTED]. This affected one resident (#104) reviewed for physician services. The facility census was 70. Review of the medical record for Former Resident #104 revealed an admission date of 05/07/25 and a discharge date of 08/21/25. Review of the five-day Minimum Data Set (MDS) assessment dated [DATE REDACTED] for Resident #104 revealed she was cognitively intact. Review of the medical record for Resident #104 for physician notes revealed there were no physician progress notes for the resident from admission to discharge. Review of

the Facility assessment dated stated residents should expect a standard of care from medical practitioners and other healthcare professionals necessary to provide the level and types of support and care needed.

This deficiency represents non-compliance investigated under Complaint Number 2572811.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Resident #60 revealed weekend staffing was low, and they would sometime have to urinate in their brief while waiting for help. Interview on 10/14/25 at 2:40 P.M. with Resident #37's representative revealed there were not enough staff to provide needed care for Resident #37, as the call light was not answered timely on most occasions. The representative stated Resident #37 often had a soaked brief that would need to be changed when visiting, and medications were often administered late. Additionally, Resident #37's representative stated there were no certified nurse assistants on duty the evening of 04/08/25. Interview on 10/15/25 at 9:37 A.M. with LPN #506 revealed some days staffing was an issue, and resident care suffered

during those days, but they did the best they could. Interview on 10/15/25 at 9:45 A.M. with the Administrator confirmed the absence of documentation to support any daily living cares had been provided for Residents #37, #86, and #97 on 04/08/25 between the hours of 3:00 P.M. and 7:00 P.M., and on multiple days and shifts during the month of April. Continued interview revealed the Administrator was unable to confirm if any daily living cares had been provided for Residents #37, #86, and #97 during the month of April other than what was documented. Review of timecards on 04/08/25 revealed no CNAs were on duty in

the facility between the hours of 3:00 P.M. and 7:00 P.M. Review of the Facility Assessment Tool dated 09/25/25 revealed direct care staffing ratios needed to provide competent support and care were: one Certified Nurse Assistant (CNA) for every 10 to 12 residents on day shift, one CNA for every 12 to 15 residents on evening shifts, and one CNA for every 15 to 18 residents on night shifts. This violation represents non-compliance investigated under Master Complaint Number 2630848 and Complaint Numbers 2625891, 2617726, 2617497, 2582511, 2577752, 2572811, 1305377, 1305376, and 1305372.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

P.M. with Psychiatric Nurse Practitioner #602 revealed that he had seen Resident #77 through June 2025 and again just recently on 10/08/25. NP #602 indicated that Resident #77 had schizophrenia with disorganized thoughts and paranoia. NP #602 was unaware of the recent events surrounding Resident #77's hospitalizations but added Resident #77 was noted to be having an increase in behaviors back in March and April of 2025. On 10/06/25 at 2:44 P.M., interview with the Administrator indicated the resident would hoard random items in his room which had been picked up when the resident was moving around the facility. The Administrator stated the resident knew he was not to have facility chemicals and when was educated by staff when hazardous chemicals were found in his room. The Administrator verified there was no evidence the interdisciplinary team attempted to address the resident's increase in behaviors and further verified there was no evidence the facility attempted to implement a psychosocial plan of care. Interview on 10/08/25 at 8:50 A.M. with CNA #521 stated that on 09/02/25 sometime around 2:00 P.M. she responded to Resident #77's call light and upon entering the resident's room, Resident #77 complained that his feet were hurting and when she looked down, she noticed Resident #77's socks were soaking wet. Upon removing

the socks, the top of both of Resident #77's feet were bright red, inflamed, and blistered looking. CNA #521 said she called for LPN #578 to assess Resident #77 after which the resident went to the hospital. Review of policy titled Behavioral Health Services, dated 03/16/22 and last approved on 10/09/25 revealed the facility will ensure that necessary behavioral health care services are person-centered and reflect the resident's goals for care, while maximizing the resident's dignity, autonomy, privacy, socialization, independence, choice, and safety. The facility will ensure that a resident who, upon admission was not assessed or diagnosed with a mental or psychosocial adjustment difficulty or a documented history of trauma and/or PTSD does not develop patterns of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors while residing in the facility. The resident's care plan shall maximize the resident's dignity, autonomy, privacy, socialization, independence, and safety and shall be reviewed as needed, such as when interventions are not effective or when the resident experiences a change in condition. This violation represents non-compliance investigated under Master Complaint Number 2630848 and Complaint Numbers 2617726, 2617497, 2609625, and 1305377.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

#601's stated indicated that medications administered and the treatments were both signed off at the same time and LPN #601 did not go back and document the refusal of the wound care by FR #106.

Review of the facility policy titled Wound Treatment Management, dated 05/22/25 stated wound treatments will be provided in accordance with physician orders and treatments will be documented in the resident's medical record to include the effectiveness of the treatment.

This violation represents non-compliance investigated under Master Complaint Number 2630848 and Complaint Number 2617497.

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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Franciscan Care Ctr Sylvania

4111 Holland Sylvania Rd Toledo, OH 43623

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on observations, staff interview, and review of facility policy, the facility failed to ensure meal trays were served in a clean and sanitary manner. This affected eight (#34, #48, #51, #53, #54, #58, #65, and #81) of eight residents observed during meal tray service. The facility census was 70. Observation on 10/06/25 between 12:25 and 12:45 revealed Certified Nurse Assistant (CNA) #525 delivering meal trays to residents. CNA #525 did not perform hand hygiene before she retrieved a meal tray from the cart in the hallway and delivered it to Resident #81's bedside table. CNA #525 touched the bedside table and set up

the meal tray for Resident #81; she opened silverware, removed lids from bowls and plates, and inserted a straw into a cup. CNA #525 did not perform hand hygiene before leaving Resident #81's room. CNA #525 returned to the meal tray cart in the hallway, did not perform hand hygiene, and retrieved another meal tray for Resident #51. CNA #525 delivered the meal tray to Resident #51's bedside table. CNA #525 touched

the bedside table and did not perform hand hygiene prior to leaving Resident #51's room. CNA #525 returned to the meal tray cart in the hallway, did not perform hand hygiene, and retrieved another meal tray for Resident #58. CNA #525 delivered the meal tray to Resident #58's bedside table. CNA #525 touched

the bedside table and set up the meal tray for Resident #58; she opened silverware, removed lids from bowls and plates, and inserted a straw into a cup. CNA #525 brought Resident #58's dirty water cup out of

the room and placed it on the top of the meal tray cart in the hallway. CNA #525 did not perform hand hygiene. CNA #525 closed the meal tray cart, walked to the nurses' station, obtained a cup of ice from the cooler used to pass water to residents, filled the cup with water, and delivered the cup to a visitor. CNA #525 did not perform hand hygiene. CNA #525 went to a supply room to obtain straws, delivered straws to Resident #64 and Resident #48, and placed the remaining handful of straws on top of the meal tray cart.

CNA #525 did not perform hand hygiene. CNA #525 retrieved a meal tray and delivered it to Resident #53's bedside table. CNA #525 set the meal tray up: she opened silverware, removed lids from bowls and plates, and inserted a straw into a cup. CNA #525 touched Resident #53's bedside table, wheelchair, and picked up a piece of paper from the floor. Resident #53 requested CNA #525 cut up her food. CNA #525 did not perform hand hygiene prior to using the silverware on the meal tray to cut the food into bite sized pieces.

CNA #525 exited Resident #53's room and did not perform hand hygiene. CNA #525 returned to the meal tray cart in the hallway, did not perform hand hygiene, and retrieved a meal tray for Resident #34. CNA #525 delivered the meal tray to Resident #34's bedside table, assisted with cleaning up fluid on the floor with paper towels, removed a full trash bag from the trash can, then set up Resident #34's meal tray. CNA #525 did not perform hand hygiene before she touched two cups and inserted straws into the cups on Resident #34's meal tray. CNA #525 retrieved the bag of trash and left Resident #34's room. CNA #525 took the trash bag to the soiled utility room, did not perform hand hygiene, returned to the meal tray cart, touched her face, then retrieved a meal tray for Resident #54. CNA #525 delivered the meal tray to Resident #54's bedside table and set the tray up; she opened a soda can, put a straw into a cup, opened silverware, and moved the plate closer to Resident #54. CNA #525 exited Resident #54's room and did not perform hand hygiene. Interview on 10/06/25 at 12:47 P.M. with CNA #525 confirmed the above noted

observations of meal tray service to Residents #34, #48, #51, #53, #54, #58, #65, and #81. CNA #525 confirmed she did not perform hand hygiene during the observation as she should have between residents,

after cleaning the floor, and after handling trash. Review of facility policy dated 09/16/25 and titled Hand Hygiene revealed all staff would perform proper hand hygiene to prevent the spread of infection to staff, visitors, and residents. The policy indicated hand hygiene would be performed between resident contacts and after handling contaminated objects.

Residents Affected - Some

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

Event ID:

Facility ID:

If continuation sheet