Based on medical record review, review of hospital medical records, staff interview, and facility policy and procedure review, the facility failed to ensure a dependent resident (Resident #57) received adequate nail care. This resulted in Immediate Jeopardy on 03/08/23 when Resident #57 was found to have his fingernails grown into his palm, forming an abscess. Resident #57 was subsequently sent to the hospital and found to be severely septic (severe infection) and diagnosed with tenosynovitis (inflammation of a tendon) of the right middle finger and gas gangrene (highly lethal infection)/necrotizing fasciitis (a rare bacterial infection that spreads quickly in the body and can cause death) of the right middle finger. …
F677 citations in Ohio
ADL care for dependent residents · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Ohio cites F677 more often than its own record predicts
1.31 times the share F677 takes of citations nationally.
Of every deficiency written in Ohio in 2025, this is the portion that was F677.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Ohio surveyors wrote
F677 findings written in Ohio, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on record review, facility policy review and interview, the facility failed to ensure Resident #99's received assistance with activities daily living (ADLs) to maintain adequate and necessary personal and oral hygiene. Actual harm occurred on 06/21/24 when Resident #99, who was totally dependent on staff assistance for ADLs, did not receive sufficient hygienic care and developed maggots in her mouth and nose, requiring hospitalization . This affected one resident (#99) of three residents reviewed for ADL care. The facility census was 47. …
Based on observation, interview and record review the facility failed to ensure showers and bed baths were given to three residents (#41,#70, #75) of six residents reviewed for activities of daily living (ADL) and choices. The facility census was 69.Findings include: 1. Record review of Resident #41 revealed an admission date on 07/10/19 with diagnoses of spondylosis, major depressive disorder, and normal pressure hydrocephalus. Review of the Minimum Data set (MDS) 3.0 assessment 06/03/26 revealed the resident was cognitively impaired and was dependent on staff for ADL. Review of Resident #41's care plan 06/05/26 revealed she preferred to have showers on Monday, Wednesday, Friday during dayshift. …
The short window
Recent years
| Year | Share of Ohio citations | vs expected |
|---|---|---|
| 2023 | 3.71% | 1.33× |
| 2024 | 3.17% | 1.31× |
| 2025 | 2.96% | 1.31× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Ohio surveyors cite →
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