Based on medical record review, resident interview, staff interview, review of hospital records, review of staff statements, review of hospice notes, review of an Emergency Medical Services (EMS) run report, observations, and policy review, the facility failed to provide adequate behavioral health services for one Resident (#78) who voiced suicidal ideations. This resulted in Immediate Jeopardy and the potential for serious life-threatening injury, harm, impairment, and/or death, when Resident #78 told Hospice Nurse #150 maybe someday they'll come in and find me hanging, was left unsupervised on 10/17/22 from 2:43 P.M until 3:28 P.M. and was subsequently found unresponsive with a call light cord wrapped around his neck. …
F740 citations in Ohio
Behavioral health services · Quality of Life and Care Deficiencies
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Ohio cites F740 more often than its own record predicts
1.18 times the share F740 takes of citations nationally.
Of every deficiency written in Ohio in 2025, this is the portion that was F740.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Ohio surveyors wrote
F740 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 record review, interviews, police report review, self-reported incident review, policy review, and facility assessment review, the facility failed to identify, address, and obtain appropriate services to meet the behavior health care needs of Resident #5 and failed to develop and implement an individualized comprehensive care plan to address and support the behavioral health care needs of Resident #5. Actual harm occurred on 08/03/25 when Resident #5, who had diagnoses of anxiety, intellectual disability, traumatic brain injury (TBI) and a history of self-injurious behavior of cutting, became agitated with staff during care and brandished a knife and threatened Certified Nursing Assistant (CNA) #350 that he was going to gut her. …
Based on medical record review, review of facility self-reported incidents (SRI's) and staff interviews, the facility failed to provide behavioral health services to adequately address a residents sexual behaviors. This affected one (#14) out of two reviewed for behavioral health services. The facility census was 96. Findings include: Review of Resident #14 medical record revealed an admission date of 01/03/26 with diagnoses of type 2 diabetes mellitus without complications, spinal stenosis, cervical region, chronic viral hepatitis c, paranoid schizophrenia, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety. …
The short window
Recent years
| Year | Share of Ohio citations | vs expected |
|---|---|---|
| 2023 | 0.25% | 0.93× |
| 2024 | 0.23% | 0.91× |
| 2025 | 0.31% | 1.18× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Ohio surveyors cite →
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