Franciscan Care Ctr Sylvania

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

completion prior to November 2025 as she was not employed with the facility at that time.Interview with Certified Nurse Aides (CNA) #171 and CNA #172 on 11/20/25 at 12:06 P.M. revealed staff were to document shower completions in the task area in the residents' EMR. CNA #171 and CNA #172 verified if

the documentation was blank the shower task was not completed.Review of the facility policy titled, Activities of Daily Living, dated 10/06/25, revealed the facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident abilities in ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living: Bathing, dressing, grooming and oral care.This deficiency represents non-compliance investigated under Complaint Number 2637315, Complaint Number 2610132, and Complaint Number 1305370 (OH00164351).

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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

11/20/2025

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 Level of Harm - Minimal harm or potential for actual harm

become hard and dry, making it difficult to pass. A provider should be contacted after three days without a bowel movement.This deficiency represents an incidental finding discovered during the complaint investigations and continued non-compliance from the survey dated 11/13/25.

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

11/20/2025

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 0686 Level of Harm - Actual harm Residents Affected - Few

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

[DATE REDACTED], revealed in the absence of treatment orders, the licensed nurse will notify the physician to obtain treatment orders. This may be the treatment nurse, or the assigned licensed nurse in the absence of the treatment nurse. Treatments will be provided in accordance with physician orders, including the cleansing method, type of dressing, and frequency of dressing change.This deficiency represents non-compliance investigated under Complaint Number 1305375 (OH00166629).

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

11/20/2025

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of a facility protocol, the facility failed to ensure staff received a physician's order prior to removing an indwelling urinary catheter. This affected one (#572) of six residents reviewed with urinary catheters. The facility census was 70. Findings included: Review of Resident #572's medical record revealed an admission date of [DATE REDACTED]. Diagnoses included bacteremia, chronic kidney disease, and neuromuscular dysfunction of the bladder. The resident expired under hospice care on [DATE REDACTED].

Review of Resident #572's Minimum Data Set assessment dated [DATE REDACTED] revealed the resident had an intact cognitive function. The resident was always incontinent of bowel and bladder and dependent on staff for all activities of daily living.

Review of Resident #572's care plan dated [DATE REDACTED] revealed she had an indwelling Foley catheter due to a neurogenic bladder. Interventions were to monitor for pain or discomfort due to the catheter.

Review of Resident #572's nursing progress note dated [DATE REDACTED] at 2:47 P.M. revealed a nurse contacted urology for an order to remove the resident's urinary catheter (Foley).

Further review of the nursing progress notes and physician orders for Resident #572 revealed no return call nor orders were received to remove Resident #572's Foley catheter.

Review of a nursing progress note dated [DATE REDACTED] revealed Resident #572 informed the nurse she was in severe urinary pain and rated her pain as a nine out of 10. The nurse administered pain medication and then the nurse then removed the Resident #572's Foley catheter per resident request. The resident was then transferred to the hospital to rule out a urinary tract infection.

Interview with the Director of Nursing (DON) on [DATE REDACTED] at 12:40 P.M. verified that no physician order could be located in the medical record to removed Resident #572's Foley catheter.

Review of a bladder management protocol, revised [DATE REDACTED], revealed staff are to confer with a provider and obtain an order for indwelling urinary catheter (IUC) if indicated. An order is needed from a physician for insertion of an IUC. If a registered nurse is uncertain as to whether to remove the IUC, the provider must be contacted.

This deficiency represents an incidental finding discovered during the complaint investigations.

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

Event ID:

Facility ID:

If continuation sheet