Health inspection·March 25, 2024

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical resident interview, staff interview, review of shower schedules and shower documentation, and review of a facility policy, the facility failed to ensure residents were showered as scheduled. This affected one (#70) of three residents reviewed for showers. The facility census was 71. Findings include: Review of the medical record for Resident #70 revealed an admission date of 03/03/24 with diagnoses of subarachnoid hemorrhage and assistance needed for personal care. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #70 required moderate assistance with showering. Review of the care plan dated 03/08/24 for Resident #70 revealed she had an activities of daily living (ADLs) self-care performance deficit related to subarachnoid hemorrhage and required staff assistance with showering. Review of the shower schedule for Resident #70 revealed she was to have a shower on first shift on Wednesdays and Sundays. Review of the shower sheets for Resident #70 revealed no shower sheets were completed for Sunday, 03/10/24, and Wednesday, 03/13/24. Review of the nurses notes for Resident #70 revealed no documentation of refusals of showers for 03/10/24 and 03/13/24. Interview on 03/25/24 at 7:54 A.M. with Resident #70 stated she only received one shower since being admitted to the facility and was not being bathed as scheduled. Interview on 03/25/24 at 3:02 P.M. with the Director of Nursing (DON) verified Resident #70 did not have a shower on 03/10/24 and 03/13/24 per the resident's shower schedule. Further interview with the DON verified there was no documentation in the nurses notes for Resident #70 refusing her showers. Review of a policy for resident showers, revised March 2022, revealed the facility is to assist residents with bathing to maintain proper hygiene, stimulate circulation, and help prevent skin issues as per current standards of practice. The residents will be provided showers as per request or as (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 2 Event ID: 365907 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 365907 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 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)