Inspection·June 11, 2025

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and policy review, the facility failed to ensure interventions were in place for significant weight loss. This affected one (Resident #274) of four reviewed for significant weight loss. The facility census was 77. Residents Affected - Few Findings include: Review of the medical record revealed Resident #274 was admitted on [DATE]. Diagnoses include myasthenia gravis, benign prostatic hyperplasia, dementia, gastroparesis, anxiety disorder, depression, paraplegia (paraparesis), and muscle weakness. Review of the Minimum Data Set (MDS) dated [DATE], revealed the resident had mild cognitive impairment and required partial to moderate assistance for toileting and showering. Further, the resident required setup assistance for eating and personal hygiene. Review of Resident #274's weight record revealed a significant weight loss noted between the dates of 01/30/25 (admission) and 06/10/25. On 01/30/25 Resident #274 weighed 165 lbs. On 05/03/25 (prior to hospitalizations) Resident #274 weighed 147.3 lbs (-10.91% since admission) and on 06/10/25 the resident weighed 133 lbs (-19.39% since admission). Review of Resident #274's medical record revealed no interventions were in place to address the resident's weight loss. Additionally, no progress notes or assessments by the dietician or nursing staff were noted in the medical records. Interview with Unit Manager (UM) #368 on 06/10/25 at 10:57 A.M. revealed Certified Nursing Aides (CNAs) are responsible for obtaining residents weights and if any changes were noted, then the resident would be weighed more often. If there are any significant weight loss noted the dietician would be contacted for interventions. Interview with the Director of Nursing (DON) on 06/10/25 at 11:05 A.M. revealed the dietician is responsible for monitoring residents weight. The DON was not aware of Resident #274's significant weight loss. Interview with Dietician #410 on 06/10/25 at 11:31 A.M. revealed that she is in facility every Wednesday and reviews all residents weights and they are also reviewed in meetings. If weight loss is noted, then a supplemental nutrition drink is offered and medications that may cause weight loss are reviewed. Additionally, if any significant weight loss is noted, the DON is notified. Dietician #410 also stated that she didn't know why interventions were not put in place for Resident #274. (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 3 Event ID: 366060 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 366060 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Sylvania 7120 Port Sylvania Drive Toledo, OH 43617 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)