Health inspection·December 22, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on staff interviews, review of facility investigation, review of a police report, review of the facilities Self-Reported Incidents (SRIs), and review of the facility policy, the facility failed to report an allegation of neglect by a nurse to the State Survey Agency, Ohio Department of Health. This had the potential to affect 13 residents (#3, #5, #16, #18, #25, #32, #34, #47, #56, #60, #65, #66, and #67) in which the nurse was responsible for the night of the allegation of neglect. The facility census was 64.Findings include: Review of the facility provided timeline for 12/12/25 revealed Licensed Practical Nurse (LPN) #200 punched in for work on 12/12/25 at 10:20 P.M. and received report from the off-going LPN, LPN #152, at approximately 11:00 P.M. At approximately 11:12 P.M. on 12/12/25 LPN #152 and Certified Nursing Assistant (CNA) #144 drove LPN #200 to the gas station and he did not return to the facility until 11:27 P.M. on 12/12/25. Review of the police report revealed on 12/12/25, a resident of the nursing home called emergency 9-1-1 and reported her nurse was intoxicated and smelled like alcohol. Upon police arrival, LPN #200 had glossy eyes, slurred and abnormal speech. Police asked Registered Nurse (RN) #158 to contact a supervisor and RN #158 reported she contacted administrative staff. Due to LPN #200's impairment, policy began an investigation to determine if resident neglect had occurred, was occurring, or was going to occur. On 12/13/25 at 12:45 A.M., LPN #200 was arrested for disorderly conduct: public intoxication; offensive behavior or to cause alarm.Review of the facilities SRI revealed the facility did not report the allegation of neglect by LPN #200 to the State Survey Agency.Interview on 12/22/25 at 10:46 A.M. with CNA #144 revealed LPN #200 convinced LPN #152 to take him to the gas station. She stated that she observed a strong smell of alcohol on LPN #200 and called the facilities Administrator and left a voicemail. She stated that she also called the facility and spoke to RN #158 that was working in the facility at that time. Interview on 12/22/25 at 12:03 P.M. with the Administrator verified the facility did not file a SRI for this incident.The facility identified LPN #200 was responsible for 13 residents (#3, #5, #16, #18, #25, #32, #34, #47, #56, #60, #65, #66, and #67) on 12/12/25.Review of the facility policy titled Abuse, Neglect, and Exploitation, dated 05/22/25, revealed report all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies within specified timeframes, not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury.This deficiency represents non-compliance investigated under Complaint Number 2696625. 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 12/22/2025 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)