Inspection·August 8, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, review of shower schedules, and review of a facility policy, the facility failed to ensure residents were provided with scheduled bathing. This affected three (#9, #50, and #68) of three residents reviewed for bathing. The facility census was 76. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #9 revealed an admission date of 01/06/23. Diagnoses include chronic obstructive pulmonary disease (COPD), type two diabetes mellitus, oral dysphagia, stage three chronic kidney disease, generalized muscle weakness, need for assistance with personal care, anorexia, anxiety disorder, dementia, and depression. Review of the annual Minimum Data Set (MDS) assessment, dated 07/05/24, revealed Resident #9 was severely cognitively impaired, was dependent for showering and bathing, and required substantial/maximal assistance with personal hygiene. Review of a facility shower schedule revealed Resident #9 was scheduled for showers every Wednesday and Saturday on second shift. Review of Resident #9's shower documentation for 07/10/24 through 08/08/24 revealed Resident #9 was scheduled to be bathed nine times during that time frame. Further review revealed Resident #9 only received bed baths on 07/17/24, 07/20/24, and 07/24/24, with a shower refusal documented on 07/10/24. 2. Review of the medical record for Resident #50 revealed an admission date of 07/15/24. Diagnoses include Alzheimer's disease, lumbar spinal stenosis, dizziness and giddiness, hyperlipidemia, and hypertension. Review of the admission MDS assessment, dated 07/22/24, revealed Resident #50 was moderately cognitively impaired and required setup or clean-up assistance for showering and bathing as well as all personal hygiene. Review of a facility shower schedule revealed Resident #50 was scheduled for showers every Monday and Thursday on first shift. Review of Resident #50's shower documentation for 07/15/24 through 08/08/24 revealed Resident #50 was scheduled to receive five showers during that time frame. Further review revealed Resident #50 only received showers on 07/17/24, 07/25/24, and 08/01/24. 3. Review of the medical record for Resident #68 revealed an admission date of 03/24/24. Diagnoses include hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side, dysphagia, schizoaffective disorder, anxiety, hypertension, and atrial fibrillation. (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 08/08/2024 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)