Health inspection·November 20, 2025

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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident and staff interview, and facility policy review, the facility failed to ensure dependent residents received timely bathing. This affected two (#515 and #569) of three residents reviewed for showers. The facility census was 70.Findings included:1. Review of Resident #569's medical record revealed an admission date of 05/25/24. Diagnoses included dementia, peripheral vascular disease, chronic obstructive pulmonary disease, and chronic pain syndrome. Review of Resident #569's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition and required substantial assistance with activities of daily living (ADLs).Review of Resident #569's care plan revealed the resident had an ADLs self-care deficit due to chronic obstructive pulmonary disease, dementia, depression, and obesity. Interventions include staff assistance was required to provide a bath or shower, and a sponge bath was to be completed when a full bath or shower could not be tolerated.Review of Resident #569's physician order dated 05/08/25 revealed showers or bed baths were to be administered every Monday and Friday every evening shift.Review of Resident #569's nurse aide task documentation in the electronic medical record (EMR) between 10/21/25 and 11/20/25 revealed the resident received a shower on 11/03/25 and 11/10/25, and refused a shower on 11/06/25. Further review revealed the resident was not offered a shower or bed bath on 10/24/25, 10/27/25, 10/31/25, 11/07/25, 11/14/25, and 11/17/25. Interview with Resident #569 on 11/18/25 at 1:20 P.M. revealed showers were not given on her scheduled days because staff were too busy to provide them. 2. Review of Resident #515's medical record revealed an admission date of 02/01/23. Diagnoses included hemiplegia, cerebral vascular accident, sickle-cell disease, and seizures.Review of Resident #515's quarterly MDS assessment dated [DATE] revealed she had an intact cognition and required partial to moderate assistance for showers and bathing.Review of Resident #515's most recent care plan revealed she had an ADLs care performance deficit due to hemiplegia and a cerebral vascular accident. The resident preferred showers and required staff to assist. Showers were to be given timely every Monday and Thursday on first shift.Review of Resident #515's physician order dated 05/08/25 revealed showers or bed baths were to be completed every Monday and Thursday on day shift.Review of a printed document provided by the Director of Nursing (DON) revealed Resident #515's bathing was completed on 03/03/25, 03/24/25, 04/03/25, 04/21/25, and 04/29/25 in March and April 2025. Further review revealed showers were not offered or completed on 03/06/25, 03/10/25, 03/13/25, 03/17/25, 03/20/25, 03/27/25, 04/07/25, 04/10/25, 04/14/25, 04/17/25, 04/20/25, 04/24/25, and 04/28/25.Review of the EMR dated 10/20/25 through 11/20/25 revealed Resident #515 received showers on 10/21/25, 10/27/25, 11/02/25, 11/03/25, 11/06/25, and 11/13/25.Interview with Resident #515 on 11/18/25 at 1:20 P.M. revealed showers were not completed timely and she missed having a regular shower.Interview with the DON on 11/20/25 at 10:55 A.M. verified the medical record was absent of documentation regarding shower/bath completion for Resident #569 and Resident #515 on the above listed dates for each resident. The DON could not speak to the shower Residents Affected - Few Page 1 of 8 365907 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few completion prior to November 2025 as she was not employed with the facility at that time.Interview with Certified Nurse Aides (CNA) #171 and CNA #172 on 11/20/25 at 12:06 P.M. revealed staff were to document shower completions in the task area in the residents' EMR. CNA #171 and CNA #172 verified if the documentation was blank the shower task was not completed.Review of the facility policy titled, Activities of Daily Living, dated 10/06/25, revealed the facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident abilities in ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living: Bathing, dressing, grooming and oral care.This deficiency represents non-compliance investigated under Complaint Number 2637315, Complaint Number 2610132, and Complaint Number 1305370 (OH00164351). 365907 Page 2 of 8 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of the National Library of Medicine webpage, the facility failed to ensure resident bowel movements were monitored to provide interventions to prevent constipation. This affected two (#523 and #552) of two residents reviewed for constipation. The facility census was 70.Findings included:1. Review of the medical record for Resident #523 revealed she was admitted on [DATE] with diagnoses that included chronic obstructive pulmonary disease (COPD), fracture of the sacrum, type two diabetes mellitus, heart disease, osteoarthritis, depression, and anxiety.Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #523 revealed was assessed with moderate cognitive impairment, did not refuse care, was always incontinent of bowel and bladder, and was dependent for activities of daily living.Review of the active physician orders as of 11/19/25 for Resident #523 revealed medication orders Colace 100 milligrams (mg) twice daily for the management of constipation and Bisacodyl 10 mg via rectal suppository every 24 hours as needed for constipation. Further review of the physician orders revealed an order dated 06/03/25 to monitor for medication side effects which included monitoring for constipation. Review of the task sheets for the month of November 2025 for Resident #523 revealed she did not have a bowel movement for six days between 11/12/25 through 11/17/25.Review of Resident #523's November 2025 medication administration record (MAR) revealed the resident did not receive any doses of her ordered as-needed medication for constipation.Review of the progress notes and nursing assessments for Resident #523 for the month of November 2025 revealed the absence of documentation to indicate she was assessed for constipation and offered her as-needed medication for constipation.Interview on 11/19/25 at 11:00 A.M. with the Director of Nursing (DON) confirmed the task sheets for Resident #523 indicated she did not have a bowel movement for six days. Continued interview with the DON confirmed the absence of documentation to indicate Resident #523 was assessed for constipation and offered the ordered as-needed medication for constipation.2. Review of the medical record for Resident #552 revealed he was admitted on [DATE] with diagnoses including chronic obstructive pulmonary disease, anemia in chronic kidney disease, cerebral infarction, dysphagia, malnutrition, and right hemiplegia.Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #552 revealed he was cognitively intact, did not refuse care, was always incontinent of bowel and bladder, and was dependent for activities of daily living and mobility.Review of the active physician orders as of 11/19/25 for Resident #552 revealed medication orders docusate sodium 10 milliliters twice daily for the management of constipation and Miralax 17 grams once daily for the management of constipation. Additional orders included monitoring for constipation every shift.Review of the task sheets for the month of November 2025 for Resident #552 revealed he did not have a bowel movement for five days on 11/13/25 through 11/17/25.Review of the progress notes and nursing assessments for Resident #552 for the month of November 2025 revealed the absence of documentation to indicate he was assessed for constipation.Interview on 11/19/25 at 11:00 A.M. with the DON confirmed the task sheets for Resident #552 indicated he did not have a bowel movement for five days. Continued interview with the DON confirmed the absence of documentation to indicate Resident #552 was assessed for constipation.Interview on 11/19/25 at 11:15 A.M. with the DON, the Administrator, and Registered Nurse (RN) #122 confirmed standard of practice for the management of constipation was monitoring for daily bowel movements, assessment for constipation, and beginning interventions to relieve constipation after three days without a bowel movement.Review of the National Library of Medicine Medline Plus webpage at, https://medlineplus.gov/ency/patientinstructions/000120.htm, revealed constipation is when stool is not passed as often as normal and the stool may Residents Affected - Few 365907 Page 3 of 8 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0684 Level of Harm - Minimal harm or potential for actual harm become hard and dry, making it difficult to pass. A provider should be contacted after three days without a bowel movement.This deficiency represents an incidental finding discovered during the complaint investigations and continued non-compliance from the survey dated 11/13/25. Residents Affected - Few 365907 Page 4 of 8 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy review, the facility failed to ensure adequate and timely wound assessments were completed, physician notifications were made promptly, and treatments were completed as ordered for newly discovered pressure ulcers. This resulted in actual harm when a resident (#514) was discovered to have an open wound to the skin on [DATE] with no notification to the physician made or adequate assessment of the area completed. The resident continued with no treatment orders or notification of the wound to the physician until [DATE] when the wound was assessed to be larger in size, and on [DATE], was determined to be a stage IV pressure ulcer. Subsequently, following implementation of wound treatment orders, the facility failed to complete Resident #514's wound treatments timely which inhibited the resident's wound healing progression. Additionally, the facility failed to ensure wounds were timely assessed and treatments were provided as ordered for an additional resident (#573) which did not result in actual harm. This affected two (#514 and #573) of three residents reviewed for pressure ulcers. The facility census was 70. Findings include:1. Review of Resident #514's medical record revealed an admission date of [DATE]. Diagnoses included contracture of the right hip and knee, diabetes mellitus type one, and peripheral vascular disease.Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #514 was identified with moderate cognitive impairment and assessed to require total assistance for all mobility including rolling left and right. Review of a care plan initiated on [DATE], and revised [DATE], for Resident #514 revealed, due to a self-care performance deficit, the resident was dependent on staff for bed mobility. Due to peripheral vascular disease and diabetes, the resident was to change positions frequently.Review of Resident #514's Braden scale (standardized assessment tool to determine pressure ulcer development risk) dated [DATE] revealed the resident was at a high risk for skin breakdown.Review of Resident #514's nursing progress note dated [DATE] revealed a small open area was noted on the resident's right buttock which measured approximately 0.5 centimeter (cm) in size. The resident needed to be turned on his left side more frequently to prevent the area from getting larger. Review of Resident #514's medical record revealed there was no further documentation regarding the right buttock wound dated [DATE] until [DATE].Review of Resident #514's wound care note dated [DATE] revealed there was a new skin issue at the rear right trochanter (hip) which was in-house acquired. The wound was painful and measured 3.0 cm long by (x) 5.0 cm wide. Orders were to cleanse the wound with normal saline and apply a hydrocolloid dressing daily. Staff were to encourage the resident to turn and reposition every two hours and the certified nurse practitioner was notified.Review of Resident #514's medical record revealed a physician's order dated [DATE] to cleanse the right hip stage IV pressure wound (full-thickness skin and tissue loss) with house wound cleanser, apply silver alginate to the wound bed cover with border gauze dressing and change the dressing daily and as needed if the dressing becomes saturated, loose, or soiled for skin issues (pressure ulcer).Review of Resident #514's [DATE] treatment administration record (TAR) revealed the ordered dressing was not changed on [DATE] and [DATE]. The resident was hospitalized from [DATE] through [DATE].Review of a wound evaluation and management summary dated [DATE] revealed Resident #514's wound was noted as a stage IV pressure area to the right hip measuring 4.0 cm long x 2.0 cm wide x 0.2 cm deep with 80 percent (%) slough (non-viable tissue). On [DATE] the wound measured 4.0 cm long x 2.0 cm wide x 0.3 cm deep with 80% slough, and on [DATE] the wound measurements remained the same with 40% slough. The wound remained a stage IV pressure ulcer. Review of Resident #514's medical record revealed a physician's order dated [DATE] to cleanse the right hip stage IV pressure wound with house wound cleanser, apply Santyl to the wound bed then silver Residents Affected - Few 365907 Page 5 of 8 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0686 Level of Harm - Actual harm Residents Affected - Few alginate wound dressing, cover with border gauze dressing, and change the dressing daily and as needed if the dressing becomes saturated, loose, or soiled for skin issues (pressure ulcer).Review of Resident #514's [DATE] TAR revealed the physician ordered dressing change were not completed on [DATE], [DATE], [DATE], and [DATE].Review of the wound evaluation and management summary dated [DATE] revealed Resident #514's right hip wound measured 4.5 cm long x 2.5 cm wide x 0.3 cm deep. There was 40% slough present, and the wound remained a stage IV pressure ulcer. Further review of the document revealed the wound progress was exacerbated due to generalized decline of the patient and the dressing needed to be changed timely.Review of Resident #514's [DATE] TAR revealed ordered wound treatments were not completed on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE]. Review of the wound evaluation and management summary dated [DATE] revealed Resident #514's right hip wound measured 3.5 cm long x 2.0 cm wide x 0.3 cm deep, on [DATE] the wound measured 4.0 cm long x 2.0 cm wide x 0.3 cm deep, and on [DATE] the wound measured 5.0 cm long x 3.5 cm wide x 0.3 cm deep and remained as a stage IV pressure ulcer. Review of the wound evaluation and management summary dated [DATE] revealed Resident #514's right hip pressure ulcer measured 4.5 cm long x 2.5 cm wide x 0.3 cm deep and debridement was completed. At the time of the investigation on [DATE], Resident #514 was unavailable for observation and interview.Interview with the Director of Nursing (DON) on [DATE] at 12:40 P.M. verified there was no documentation on Resident #514's October and [DATE] TARs to provided evidence of wound treatments being completed to the right hip pressure ulcer on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE]. The DON further confirmed there was no wound care treatment orders nor physician notification of the right hip wound when identified on [DATE] until [DATE] at which time the wound was assessed to be a stage IV pressure ulcer.2. Review of Resident #573's medical record revealed an admission date of [DATE]. Diagnoses included left breast cancer, pneumonia, and congestive heart failure. The resident expired in the facility on [DATE].Review of Resident #573's Minimum Data Set (MDS) assessment note dated [DATE] revealed she required total care for all activities of daily living.Review of Resident #573's care plan [DATE] revealed the resident had potential/actual impairment to skin integrity of the left breast malignant neoplasm and fragile skin. Interventions included weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate, and any other notable changes or observations. Review of Resident #573's clinical admission assessment dated [DATE] revealed the resident had no skin issues documented. Review of Resident #573's medical record revealed a physician's order dated [DATE] to cleanse the left breast stage III pressure ulcer (full-thickness skin loss) with wound cleanser, pat dry, and apply border gauze. The facility staff was to change the dressing every day shift every other day for optimal healing and as needed.Review of Resident #573's [DATE] TAR dated revealed the physician ordered wound care was not completed on [DATE] and [DATE]. Review of Resident #573's Braden scale dated [DATE] revealed she was at high risk for skin breakdown.Review of Resident #573's progress notes dated [DATE] through [DATE] revealed no documentation regarding the resident's stage III pressure ulcer to the left breast including any assessment or description of the wound. Further review of the resident's medical record revealed no documented assessment of the resident's pressure ulcer to the left breast to include measurements, description, or stage. Interview with the DON on [DATE] at 12:40 P.M. verified there was no documentation on Resident #573's [DATE] TAR to provide evidence of wound treatments being completed to the left breast pressure ulcer right hip pressure ulcer on [DATE] and [DATE]. The DON further confirmed there were no assessments of the resident's left breast pressure ulcer nor measurements completed in the medical record.Review of the facility policy titled, Wound Treatment Management, dated 365907 Page 6 of 8 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0686 Level of Harm - Actual harm Residents Affected - Few [DATE], revealed in the absence of treatment orders, the licensed nurse will notify the physician to obtain treatment orders. This may be the treatment nurse, or the assigned licensed nurse in the absence of the treatment nurse. Treatments will be provided in accordance with physician orders, including the cleansing method, type of dressing, and frequency of dressing change.This deficiency represents non-compliance investigated under Complaint Number 1305375 (OH00166629). 365907 Page 7 of 8 365907 11/20/2025 Franciscan Care Ctr Sylvania 4111 Holland Sylvania Rd Toledo, OH 43623

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 medical record review, staff interview, and review of a facility protocol, the facility failed to ensure staff received a physician's order prior to removing an indwelling urinary catheter. This affected one (#572) of six residents reviewed with urinary catheters. The facility census was 70. Findings included: Review of Resident #572's medical record revealed an admission date of [DATE]. Diagnoses included bacteremia, chronic kidney disease, and neuromuscular dysfunction of the bladder. The resident expired under hospice care on [DATE]. Review of Resident #572's Minimum Data Set assessment dated [DATE] revealed the resident had an intact cognitive function. The resident was always incontinent of bowel and bladder and dependent on staff for all activities of daily living. Review of Resident #572's care plan dated [DATE] revealed she had an indwelling Foley catheter due to a neurogenic bladder. Interventions were to monitor for pain or discomfort due to the catheter. Review of Resident #572's nursing progress note dated [DATE] at 2:47 P.M. revealed a nurse contacted urology for an order to remove the resident's urinary catheter (Foley). Further review of the nursing progress notes and physician orders for Resident #572 revealed no return call nor orders were received to remove Resident #572's Foley catheter. Review of a nursing progress note dated [DATE] revealed Resident #572 informed the nurse she was in severe urinary pain and rated her pain as a nine out of 10. The nurse administered pain medication and then the nurse then removed the Resident #572's Foley catheter per resident request. The resident was then transferred to the hospital to rule out a urinary tract infection. Interview with the Director of Nursing (DON) on [DATE] at 12:40 P.M. verified that no physician order could be located in the medical record to removed Resident #572's Foley catheter. Review of a bladder management protocol, revised [DATE], revealed staff are to confer with a provider and obtain an order for indwelling urinary catheter (IUC) if indicated. An order is needed from a physician for insertion of an IUC. If a registered nurse is uncertain as to whether to remove the IUC, the provider must be contacted. This deficiency represents an incidental finding discovered during the complaint investigations. 365907 Page 8 of 8