Inspection·September 15, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and review of the facility Quality Assurance plan, the facility failed to ensure resident possessions were maintained securely and treated with respect. This affected three residents (#41, #42 and #43) of three closed resident records reviewed.Findings Include:Review of the complaint log revealed the facility lockbox was misplaced affecting Resident's #41 and #42. The result stated it was believed facility lock box was thrown away when the office was cleaned. The resident's families were notified. The Police were notified. The residents' families did not state they felt anything was stolen.The facility was asked for an investigation into the missing lockbox. The paperwork provided included a progress note from Resident #41's record. Review of the progress note indicated the resident expired on [DATE] at 8:45 AM. Eyeglasses, wristwatch and a signet ring were sent with the remains at 1:30 PM. On [DATE] at 4:01 P.M. social service spoke with the resident's granddaughter and resident's son-in-law who came to collect personal belongings. On [DATE] at 11:35 A.M. there was a progress note by Registered Nurse (RN) #51. The progress note revealed:This nurse helped clean out the office when a new social service designee started towards the end of May. There was a medium size lockbox in the cabinet. I set it on top of paperwork to be stored in medical records. This week staff went to look for the lock box and it had been misplaced. I did look with the administrator for the missing lockbox and it has not been found as of now. Resident had a wallet placed in the lock box in March because he was leaving it throughout the facility. We did tell the granddaughter last evening that the lock box has been misplaced and she understood. Today the son-in-law stopped wanting the wallet and the administrator expressed to him that we are doing everything we can to find the lockbox. Son-in-law did express there was nothing significant in the wallet maybe a Social Security card but he did not know what was in there. Will continue to look for lock box.Review of the facility investigation revealed Resident #42‘s progress notes were included which indicated on [DATE] at 3:20 P.M. the administrator called son to inform him that the facility lockbox that contained the resident's checkbook had been misplaced when the social service designated office was cleaned out for a new social service designee to come in. Resident's son stated he would call the bank and cancel all checks for the time being until a new checkbook could be ordered. Resident's son informed that facility will reimburse for new checkbook. The investigation included a Police report that was obtained on [DATE] that revealed Resident #41's family notified the police of the missing lock box on [DATE]. The facility did not notify the police of the missing lock box. The police report dated [DATE] at 10:15 A.M. included the Administrator believed the lockbox was accidentally thrown out. The police informed the Administrator the family would like the wallet back because of sentimental value.Review of the investigation revealed Housekeeping Staff #53 had an undated written statement in the paperwork provided. The statement included she threw away office garbage, whatever management asked her to. She did not recall throwing away a lock box or brown box. She took labeled boxes for medical (continued on next page) 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 Page 1 of 3 Event ID: 365579 Printed: 05/15/2026 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 365579 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carroll Healthcare Center Inc 648 Longhorn Street Carrollton, OH 44615 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)