Inspection·August 1, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and resident interview, the facility failed to ensure residents had a safe, clean, comfortable environment. This affected one resident (#35) and had the potential to affect an additional 36 residents (#1, #2, #3, #4, #5, #6, #7, #9, #10, #11, #12, #13, #14, #15, #17, #19, #20, #21, #22, #23, #25, #26, #27, #29, #31, #32, #33, #34, #38, #39, #40, #42, #43, #44, #45, #46, ) residing in the facility. The facility census was 47. Findings include: Review on 07/24/24 at approximately 2:00 P.M. revealed Resident #35 was admitted on [DATE] with diagnoses of severe protein-calorie malnutrition, non-ST elevation myocardial infarction (NSTEMI), acidosis, peripheral vascular disease (PVD), unsteadiness on feet, adult failure to thrive, anorexia, right foot drop, hypertension (HTN), drug induced constipation, cognitive communication deficit, muscle wasting and atrophy, muscle weakness, dysphagia, difficulty in walking, hypomagnesia, and depression. Review of the most recent Minimum Data Set (MDS) dated [DATE] revealed intact cognition. Further review of the MDS revealed Resident #35 utilized a manual wheelchair. Observation on 07/24/24 at 7:45 A.M. of the north hall revealed five wheelchairs, one BrodaChair, three walkers, and one lift lining the right side, and one dining cart and two isolation carts on the left side of the north hall. Interview on 07/24/24 at 7:51 A.M. with the Director of Nursing (DON) verified these findings. Observation on 07/24/24 at 7:52 A.M. revealed Resident #35 was unable to wheel themself down the north hall in their wheelchair due to the equipment lining the hall. Interview on 07/24/24 at 7:52 A.M. with Resident #35 revealed it is common for this to occur as there is frequently a lot of equipment lining the hall. Observation on 07/24/24 at 8:15 A.M. revealed four wheelchairs, five walkers, three lifts, 3 isolation carts, and one portable vital sign machine lining the left side of the south hall. Interview on 07/24/24 at approximately 8:20 A.M. with the DON verified these findings. Interview on 07/24/24 at 8:27 A.M. with Resident #27 revealed they frequently have trouble (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 5 Event ID: 365330 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Wauseon 303 W Leggett St Wauseon, OH 43567 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)