Based on observation, record review, Emergency Medical Services (EMS) report review, hospital documentation review, death certificate review, resident interview, staff interview, review of facility's policy for Cardio-Pulmonary Resuscitation (CPR), and review of facility's policy and procedure for In Case of Decannulation, the facility failed to ensure the necessary life-sustaining respiratory services were provided to residents who required invasive mechanical ventilation via tracheostomy (a hole in the front of the neck and into the windpipe) cannula. …
F695 citations in Ohio
Respiratory care · Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Ohio cites F695 less often than its own record predicts
0.96 times the national share — cited less often here than elsewhere.
Of every deficiency written in Ohio in 2025, this is the portion that was F695.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Ohio surveyors wrote
F695 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.
Based on medical record review, review of hospital documentation, resident interview, staff interview, and review of a facility policy, the facility failed to ensure residents ordered supplemental oxygen were provided timely care and services to maintain adequate oxygen levels and prevent a change in condition. Actual harm occurred to Resident #59 on 12/09/25 when the resident was removed from her bedroom to accommodate the need for maintenance staff to make repairs in the resident's room, and the resident was placed on an oxygen tank and taken to the dining room with no means to alert staff for clinical needs and no monitoring put into place to check the resident's condition. …
Based on review of the medical record, review of facility policy, observations of oxygen use, and interviews with staff, the facility failed to administer oxygen as prescribed. This affected one resident (#14) of one resident reviewed for respiratory care. The facility census was 45. Findings include:Review of the medical record for Resident #14 revealed admission to facility on 02/10/23 with diagnoses including Chronic Obstructive Pulmonary Disease (lung disease), malnutrition, depression, high blood pressure, gastric reflux and insomnia (inability to sleep). …
The short window
Recent years
| Year | Share of Ohio citations | vs expected |
|---|---|---|
| 2023 | 1.77% | 0.76× |
| 2024 | 1.83% | 0.83× |
| 2025 | 2.13% | 0.96× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Ohio surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction