Based on record review, observation, resident and staff interview, review of the hospital records, review of the facility's Self-Reported Incident (SRI), review of the written statements from staff, and review of the facility's policy, the facility failed to ensure staff provided appropriate care for residents with behavioral management concerns. This resulted in Actual Harm to Resident #74 when a staff member grabbed Resident #74's wrist to block a punch from the resident and when the staff let go, Resident #74 fell to the ground and sustained a wrist fracture. This affected one (#74) of three residents reviewed for behavior management. The facility census was 132. …
F741 citations in Ohio
Quality of Life and Care Deficiencies
Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2024
Ohio cites F741 less often than its own record predicts
0.64 times the national share — cited less often here than elsewhere.
Of every deficiency written in Ohio in 2024, this is the portion that was F741.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Ohio surveyors wrote
F741 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, staff interview, and review of a facility staff schedule, the facility failed to provide adequate staffing to meet the behavioral safety needs of all residents. This affected one (Resident #41) of three residents reviewed for behavior management. The census was 93.Findings Include:Review of the medical record revealed Resident #41 was admitted to the facility on [DATE]. Diagnoses included major depressive disorder, systemic inflammatory response syndrome, borderline personality disorder, postural orthostatic tachycardia, disorientation, mood disorder, suicidal ideations, convulsions, personal history of other mental and behavioral disorders, conversion disorder, anxiety disorder, headache, bipolar disorder, post-traumatic stress disorder, insomnia, muscle… …
The short window
Recent years
| Year | Share of Ohio citations | vs expected |
|---|---|---|
| 2023 | 0.02% | 0.50× |
| 2024 | 0.03% | 0.64× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Ohio surveyors cite →
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