Inspection·February 1, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, fall investigation review, staff interview, and policy review, the facility failed to ensure staff members exercised care and caution around residents following a fall incident and failed to ensure fall incidents were thoroughly and accurately investigated. This affected one (#1) of three residents reviewed for falls. The facility census was 69. Findings Included: Review of Resident #1's medical record revealed an admission date of 10/26/23. Diagnoses included cellulitis of the left lower limb, sepsis with septic shock, non-pressure chronic ulcer of the left calf with fat layer exposed, contusion of left lower limb, acute kidney failure, coronary artery disease and respiratory failure. Review of Resident #1's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was assessed with intact cognition, required a substantial/maximum assist for all transfers, and required oxygen therapy at all times. Review of Resident #1's most recent care plan revealed the resident was at risk for injury related to falls due to deconditioning, gait/balance problems, and psychoactive drug use. Interventions included to assist with toileting and transfers, ensure the call light was within reach, and encourage her to use it before attempting to transfer. Resident #1 was at risk for skin breakdown due to a history of chronic non-pressure ulcer on left calf and immobility. Review of Resident #1's nursing progress note dated 11/12/23 at 2:19 A.M. revealed the resident was found by a nursing assistant lying on her left side. The resident indicated she was trying to get up and walk. Agency Nurse #4 began to obtain Resident #1's vital signs when the nurse tripped over the resident's oxygen tubing. When the nurse fell, the nurse stepped on Resident #1's leg causing a 20 centimeter (cm) long by 3.0 cm skin tear on the resident's right lower leg. Resident #1 then sat up and vital signs were taken which were stable. The resident's right lower leg was cleansed, wrapped with an absorbent bandage, and wrapped with kerlix and a compression bandage. The on-call hospice nurse was contacted and was sent to the facility to assess the resident. Review of the fall investigation dated 11/12/24 revealed the investigation contained no information regarding Agency Nurse #4 tripping over Resident #1's oxygen tubing and falling onto the resident causing a skin tear. Review of Resident #1's skin assessment dated [DATE] revealed an impaired skin condition was noted (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: 366279 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 366279 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosary Care Center 6832 Convent Boulevard Sylvania, OH 43560 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)