Inspection·March 7, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, review of policy for incontinence, and review of staff correction form, the facility failed to ensure a resident who was dependent on staff for care, was provided incontinence care in a timely manner. This affected one (#10) of four residents reviewed for incontinence care. The census was 82. Residents Affected - Few Findings included: Review of medical record for Resident #10 revealed admission date of 08/25/20, with a readmission date of 02/17/22. The resident was admitted with diagnoses including schizoaffective disorder, bipolar disorder, muscle weakness, cognitive communication deficit and unsteady feet. Review of the minimum data set (MDS) assessment dated [DATE], revealed the resident was moderately cognitively impaired. The resident was assessed as the need for toileting as being dependent and for chair to bed or bed to chair transfer as dependent. Review of the care plan relative to the risk in decline for activity of daily living (ADL) function revealed interventions which included the use of Hoyer lift with all transfers. A care plan relative to being at risk for impaired skin integrity with interventions which included assist resident to turn and reposition as well as incontinence care at routine intervals and as needed. Observation on 03/05/24 at 9:50 A.M., revealed Resident #10 was sitting in the common areas, near the nurse's station. Resident #10 was relatedly calling out for someone to help her with her incontinence care. Licensed Practical Nurse (LPN) #303 was overheard speaking to another nurse at the nurse's station, stating she is going to write up State Tested Nurse Aide (STNA) #400 because she had told her three times to assist Resident #10. At 10:00 A.M., LPN #303 and STNA #444, took Resident #10 to her room for incontinence care. When transferring Resident #10 from her chair to her bed, Resident #10's pants were visibly soiled with urine. The incontinence pad in the chair was also saturated with urine. Resident #10 was provided incontinence care for urine and bowel movement by the staff. Interview with LPN #303 and STNA #444, at the time of the observation, verified the residents' pants in the back and front were saturated with urine and as well as the incontinence pad was saturated. LPN #303 verified STNA #400 was aware the resident was in need of incontinence care as she had instructed her several times to assist the resident. Interview on 03/05/24 at 10:35 A.M., with STNA# 400 verified she was going to take the resident to check and changed after her lunch break which was over at 10:30 A.M. STNA #400 stated the last time she had provided a check and change was at 7:15 A.M. STNA #400 stated she was unaware of how long (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 2 Event ID: 365453 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 365453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Oregon 3953 Navarre Ave Oregon, OH 43616 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)