Ohio Living Swan Creek

In the surveyor’s words

From the most serious findings on record at Ohio Living Swan Creek, in the surveyor’s own words.

• Actual harm, isolatedF684Aug 27, 2025

  Based on medical record review, family interview, staff interviews, and policy review, the facility failed to ensure a resident who experienced an unwitnessed fall with injury was provided timely treatment including notifying the physician of complaints of pain, inability to fully move extended leg and obtaining an x-ray. Actual harm occurred on 05/31/25, when Resident #30 experienced an unwitnessed fall from the bed with an injury. Following the incident, the resident continually complained of pain in his hip and had limited mobility with his leg. The facility did not obtain an x-ray of the hip until nine (9) days after the fall. Subsequently, Resident #30 was transferred to the hospital for surgical repair of a broken hip from the fall. […]

• Actual harm, isolatedF692Oct 31, 2023

  Based on medical record review, staff interview, and review of facility policy, the facility failed to ensure physician orders for a nutritional supplement were followed and the physician and dietician were notified regarding a significant weight loss. This resulted in actual harm when Resident #3's ordered nutritional supplement was not available from the supplier for the facility to administer, the facility did not reach out to the physician or the dietician for an alternate supplement or different interventions, and the resident had a significant weight loss of 15.2 pounds/ 8.5 percent weight loss. Additionally, when the significant weight loss occurred the facility failed to notify the physician and dietician of the occurrence. […]

• No harm, potential for more than minimal, widespreadF812Apr 2, 2026

  Based on observation, staff interview, and review of facility policy the facility failed to store and handle food safely. This had the potential to affect all residents. The census was 32.Findings include: 1. Observation on 03/30/26 at 7:34 A.M. of the main kitchen revealed in the walk-in refrigerator baby carrots stored in a plastic container and chopped celery stored in a plastic container were not labeled or dated, two opened bags of cubed cheese were not dated, and the stand-alone freezer included an opened personal water bottle. Interview on 03/30/26 at 7:45 A.M. with Assistant Dietary Manager #350 verified the carrots, celery, and two opened bags of cubed cheese were not labeled or dated and verified the personal water bottle in the stand-alone freezer. […]

• No harm, potential for more than minimal, widespreadF921May 4, 2023

  Based on observation and staff interview, the facility failed to ensure the shower was maintained in a clean and sanitary manner. This affected all residents except two (#2 and #12) residents identified by they facility as not using the shower room. The facility census was 31. Findings include: Observation on 05/01/23 at 11:05 A.M. of the shared resident shower room revealed a black substance on the caulk on the floor near the entrance to the shower and a brown and black substance in both back corners and along the walls, near the floor of the shower. Observation on 05/02/23 at 7:34 A.M. of the shared resident shower room revealed the substance remained on the floor and walls of the shower. […]

• No harm, potential for more than minimal, patternF605Apr 2, 2026

  Based on review of the medical record, staff interview, pharmacist recommendations, and policy review, the facility failed to ensure adequate monitoring for psychotropic medication effectiveness, side effects and adverse effects. This affected four (#5, #13, #32, and #38) of five residents reviewed for unnecessary medications. This had the potential to affect 24 residents the facility identified as receiving psychotropic medications. The facility census was 32.Findings include: 1. […]