Based on observation, record review, interviews with staff, residents, and a family member, facility document review, and review of the Facility Assessment, the facility failed to ensure designated and consistent staffing was provided on one (500-Hall) of five total halls in the facility to ensure sufficient staff to provide needed care and services to the 13 residents that resided on the 500-Hall. This resulted in Immediate Jeopardy and the potential for serious injury, harm, impairment and/or death, when observations during the survey on 10/07/24 and 10/08/24 revealed times where the residents were left unattended on the 500-Hall with no staff members in the area. …
F725 citations in Ohio
Sufficient nursing staff · Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Ohio cites F725 more often than its own record predicts
1.00 times the share F725 takes of citations nationally.
Of every deficiency written in Ohio in 2025, this is the portion that was F725.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Ohio surveyors wrote
F725 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 observations, resident and staff interviews, medical record reviews, and review of facility policies, the facility failed to provide adequate nursing staff to provide wound treatments, turning and repositioning, timely and adequate bathing assistance, transfer assistance, assistance with response to resident call lights, incontinence care, and complete necessary COVID-19 respiratory assessments. This resulted in Actual Harm to one resident (#34) when facility staff did not provide wound treatments and turning and repositioning as physician ordered and did not complete timely monitoring of Resident #34's left hip pressure ulcer and Resident #34's left hip wound subsequently deteriorated into a Stage IV pressure ulcer (Full thickness tissue loss with exposed bone, tendon or muscle. …
Based on review of the facility's staffing schedules, resident and staff interviews, record review, and policy review, the facility failed to ensure sufficient staffing was provided to meet residents' care needs. This affected eight (Residents #80, #3, #7, #64, #77, #4, #31, and #15) and had the potential to affect all 104 residents residing in the facility.Findings include:1. An interview with Resident #80 on 08/17/26 at 11:48 A.M. revealed he hadn't been shaved or showered in over a week because there wasn't enough staff on the floor.Record review showed Resident #80 required extensive assistance with all activities of daily living (ADL). Interview on 08/17/26 revealed he had not been shaved in a week and had not received a shower since 08/11/26, despite being scheduled twice weekly. …
The short window
Recent years
| Year | Share of Ohio citations | vs expected |
|---|---|---|
| 2023 | 0.44% | 0.55× |
| 2024 | 0.82% | 1.02× |
| 2025 | 0.78% | 1.00× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Ohio surveyors cite →
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