Health inspection·January 17, 2025

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure residents were prepared a safe and orderly discharge. This affected Residents #8 and #9 reviewed for discharge. The facility census was 76. Residents Affected - Few Findings included: 1. Review of Former Resident (FR) #8's medical record revealed an admission date of 12/11/24 and was discharged to home on [DATE]. Diagnoses included left femur fracture, atrial fibrillation, and dementia. Review of FR #8's discharge Minimum Data Set (MDS) dated [DATE] revealed her cognition was intact. The resident required moderate assistance with toileting, shower/bathing, lower body dressing, chair to bed transfers, toilet transfer, and walking up to 50 feet. Review of FR #8's care plan revealed she required assistance with discharge planning for a home goal and to arrange outside services and equipment needs prior to discharge. Review of FR #8's Notice of Medicare Non-Coverage (NOMNC) revealed an end of service date of 12/29/24. The resident denied an appeal and chose to discharge to home. The form was signed on 12/27/24. Review of FR #8's medical record revealed a physician's note dated 12/29/24 to discharge home with home healthcare for skilled nursing, occupational therapy, physical therapy, and speech therapy. Review of FR #8's Social Service note dated 12/27/24 revealed Social Service Designee (SSD) #100 met with the resident and her daughter to discuss the discharge. The daughter informed SSD #100 that she would pick up FR #8 on 12/30/24 at 12:00 P.M. and SSD #100 was also informed the resident would need Home Health Care (HCC) and informed the SSD which companies they chose. Review of FR #8's assessment note dated 12/30/24 revealed the resident was discharged to home. Review of FR #8 Social Service note dated 12/31/24 revealed a HHC referral was sent to the HHC Company. Interview with HHC Employee #400 on 01/17/25 at 10:09 A.M. revealed the company received an email from SDD #100 on 12/31/24 requesting home care for FR #8. Due to the holiday the resident was failed to be contacted until 01/03/25. HHC Employee revealed the company required long term care facilities to complete referrals earlier to ensure medical durable equipment and care were scheduled for the (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 01/17/2025 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)