Ohio Living Swan Creek

F 0684 Level of Harm - Actual harm Residents Affected - Few

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

assessment. Interview on 08/27/25 at 2:24 P.M. with hospice NP #202 revealed the hospice nurse initially assessed Resident #30 and reported to her Resident #30 did not have reproducible pain and she could not assess a difference in the lengths of his legs. Review of the policy titled, Change of Condition: Observing, Recording and Reporting, dated 08/07/24, revealed the facility will record and report any change in condition to the nurse in charge and attending physician so proper treatment will be implemented. This deficiency represents non-compliance investigated under Complaint Numbers 2566353 and 1358032.

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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

08/27/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ohio Living Swan Creek

1650 Swan Creek Lane Toledo, OH 43614

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

Manager #113 stated there was nothing brought up for there to be a need to have an order to offload heels

on admission. They stated that on 05/28/25 Resident #31 was changed from a Hoyer Lift (a mechanical device designed to assist caregivers in safely transferring individuals with limited mobility) to a [NAME] Steady (a sit to stand manual lift aid) and they feel the offloading of heels order was place at this time in response to this change. Unit Manager #113 and QDMC #203 verified Resident #31's pressure ulcer that was documented on 06/14/25 was facility acquired. Interview on 09/04/25 at 2:30 P.M. with the Administrator verified there was a physician order placed on 05/28/25 to offload Resident #31's heels and there was not an order to offload Resident #31's prior to 05/28/25. He also verified that there was a care plan in place that was dated 05/19/25 to offload Resident #31's heels. He stated that the MDS nurse is relatively new to her role and put the care plan in preventatively on 05/19/25. He stated that the facility has educated her that when a preventative care plan is put in place, there needs to be a physician order that is written so that the preventative measures are enacted by the treatment team. He further stated there is no documented evidence of the offloading of the heels from 05/19/25 to 06/14/25, until after the pressure sore was discovered. Review of the facility policy titled, Prevention, Detection, and Treatment of Pressure Ulcers, dated 07/25/25, revealed a pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, because of pressure in combination with shear and/or friction. A suspected deep tissue injury is purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue and /or shear; the area may be preceded by tissue that is painful, firm, boggy, warmer or cooler as compared to adjacent tissue. This deficiency represents non-compliance investigated under Complaint Number 2566353.

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

08/27/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ohio Living Swan Creek

1650 Swan Creek Lane Toledo, OH 43614

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

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

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

observation, medical record review, and staff interview, the facility failed to ensure interventions were implemented timely to address incontinence. This affected one (#11) of four residents reviewed for timely care and treatment in a facility census of 29. Findings include:Review of the medical record revealed Resident #11 admitted to the facility on [DATE REDACTED] with the diagnoses including, left humerus fracture, history of fall, rhabdomyolysis, muscle weakness, unspecified kidney injury, urinary tract infection, cerebral infarction, aphasia, coronary artery disease, atrial fibrillation, and congestive heart failure. Review of the most current Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #11 was assessed with severe cognitive impairment, was dependent on staff for the provision of activities of daily living (ADLs), and was incontinent of bowel and bladder.Review of a nursing plan of care dated 07/16/25 revealed

a focus area to address Resident #11's bladder incontinence related to requiring assistance with toileting, transfers, and hygiene. Interventions included to provide staff assistance for toileting task, apply a moisture barrier to the skin, and provide incontinence care after each incontinent episode. Observation on 09/23/25 at 10:44 A.M. with Licensed Practical Nurse (LPN) Unit Manager (UM) # 300 discovered Resident #11 in bed. LPN UM #300 removed Resident #11 top sheet and noted Resident #11 to be heavily soiled with urine and a moderate amount of stool. A pervasive urinary odor was also detected. Interview with LPN UM #300 at the time of the observation confirmed the odor and Resident #11's urinary and bowel incontinence soaking through an adult brief and a Chux (a disposable and absorbent incontinence underpad) pad, and onto the resident's bed linen. LPN UM #300 stated the resident would require a complete bed change and bed bath. LPN UM #300 verified Resident #11 appeared to have been left incontinent for an extensive time.

On 09/23/25 at 10:48 A.M. interview with Certified Nurse Aide (CNA) #200 stated Resident #11 was last checked for incontinence at 7:30 A.M. and at that time Resident #11 refused to get out of bed. CNA #200 stated she did not inform the assigned nurse (LPN #301) of the resident's refusal. CNA #200 went on to verify Resident #11 had not been checked for incontinence or re-approached for care since 7:30 A.M. CNA #200 verified Resident #11 was heavily soiled with urine and stool. On 09/23/25 at 10:54 A.M. interview with LPN #301 revealed the nurse was unaware Resident #11 would not allow CNA #200 to check or change her for incontinence since 7:30 A.M.Review of the facility incontinence briefs and pad handling, long-term care guideline, reviewed 11/18/24, revealed to help prevent pressure injuries, nursing staff members should minimize folds and wrinkles when applying incontinence product, regularly check for wetness, change product frequently, and inspect the residents skin when changing the product. Nursing staff should promptly report any changes in the residents skin integrity. Staff should explain the procedure to the resident and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation. Include the importance of checking the briefs or pad frequently (at least every two hours) and changing it when it is soiled to prevent skin breakdown.

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Facility ID:

If continuation sheet