Inspection visit

InspectionMarch 30, 2023

WOOD HAVEN HEALTH CARE SENIOR LIVING & REHABCMS #36545828 citations on this visit

28 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 28 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, resident representative interview ,staff interview, and review of the facility policy, the facility failed to ensure residents received their choice of showers or bed baths. This affected two (#34 and #54) of two residents reviewed for choices. The facility census was 74. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #34 was admitted on [DATE]. Diagnoses included chronic kidney disease stage three, dementia moderate with psychotic disturbance, anxiety disorder, restlessness and agitation, and muscle weakness. Review of the care plan, dated 08/22/22, revealed Resident #34 required assistance with activities of daily living and preferred his showers two days per week and as needed on first shift. Review of the Minimum Data Set (MDS) assessment, dated 02/03/23, revealed Resident #34 was moderately cognitively impaired. Resident #34 was totally dependent on staff for bathing. Review of the facility's shower/whirlpool/bed bath documentation, dated 03/01/23 to 03/30/23, revealed Resident #34 received one shower on 03/30/23. Review of the documentation revealed 56 bed baths were documented in the record, many were documented once on each shift on the same day. Interview on 03/27/23 at 10:49 A.M. with Resident #34 revealed staff will tell him it was his shower day but then he will not get one or they will tell him his blood sugar was too low to have one. Resident #34 stated he has not had a shower in a long time. Interview on 03/30/23 at 9:47 A.M. with State Tested Nursing Assistant (STNA) #528 verified according to the documentation, Resident #34 has not had a shower in the last 30 days. STNA #528 stated Resident #34 was a confused and when they were short staffed, showers were more likely to be provided for the residents that were nagging about it. Interview on 03/30/23 at 12:13 P.M. with Resident #34 verified he would much rather have a shower then a washcloth to clean himself. Resident #34 stated he could not believe it but he received a shower this morning and it felt great. Resident #34 verified every evening staff provide him a washcloth and soap for him to clean up. Resident #34 verified staff do not give him the bed bath. 2. Review of the medical record revealed Resident #54 was admitted on [DATE]. Diagnoses included Alzheimer's disease, anxiety disorder, epilepsy, restlessness and agitation, and dementia without behavioral disturbance psychotic disturbance. (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 22 Event ID: 365458 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the MDS Assessment, dated 02/14/23, revealed Resident #54 was unable to complete the interview. Resident #54 required extensive two-person assistance with bathing. Review of the care plan, dated 05/07/22, revealed Resident #54 required assistance with activities of daily living and interventions included to assist Resident #54 with all bathing needs based on the resident's preference. Resident #54 preferred her showers two days per week and as needed second shift. Review of the facility's shower/whirlpool/bed bath documentation, dated 03/01/23 to 03/30/23, revealed Resident #54 received three showers on 03/01/23, 03/15/23, and 03/23/23. Review of the documentation revealed 52 bed baths were documented in the record, many were documented once on each shift on the same day. Interview on 03/28/23 at 12:11 P.M. with Resident #54's personal aide verified Resident #54 was not able to refuse showers and showers were beneficial for the resident. Interview on 03/29/23 at 4:11 P.M. with State Tested Nursing Assistant (STNA) #583 verified Resident #54's shower documentation for the last 30 days showed three showers have been provided. Review of the facility policy titled Resident Showers, dated 09/22/22, revealed the residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety. Partial baths may be given between regular shower schedules as per facility policy. This deficiency represents non-compliance investigated under Master Complaint Number OH00141590 and Complaint Number OH00141316. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 2 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff and resident interviews, and review of facility policy, the facility failed implement the facility policy for self-medication administration for Resident #76 and further failed to obtain physician orders for the medications being self-administered by Resident #76. This affected one (Resident #76) of three residents reviewed for choices. The facility census was 74. Residents Affected - Few Findings include: Review of the medical record for Resident #76 revealed an admission date of 03/06/23. Diagnoses included a displaced intertrochanteric fracture of left femur, and macular degeneration. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #76 was cognitively intact. Further review of the medical record from 03/06/23 to 03/27/23 revealed there was no medication self-administration for Resident #76. There was no physician order for Resident #76 to self-administer his medications until 03/27/23. Observation on 03/27/23 at 9:24 A.M. revealed a bottle of over the counter eye drops and an over the counter bottle eye vitamins sitting on the right hand corner of the tray table in Resident #76's room. Additional observation made on 03/27/23 at 10:05 A.M. revealed the over the counter eye drops and an over the counter bottle eye vitamins were no longer on the tray table. Interview with Resident #76 on 03/27/23 at 10:05 A.M., at the time of the observation revealed the nurse removed the eye drops and eye vitamins explaining to Resident #76 they could no be kept at bedside. Resident #76 was visibly upset and did not understand why the eye drops and vitamins could not remain at the bedside since they had been at the bedside since admission. Interview with Licensed Practical Nurse (LPN) #518 on 03/27/23 at 11:00 A.M. verified the bottle of over the counter eye drops and an over the counter bottle of eye vitamins had been removed the tray table in Resident #76's room. LPN #518 stated orders did not exist for the medications and a medication self-assessment was not available for Resident #76. Further observation on 03/29/23 at 8:00 A.M. revealed the over-the-counter eye drops and the over-the-counter eye vitamins were on the tray table in Resident #76's room. Interview with Resident #76 at the time of the observation on 03/29/23 at 8:00 A.M. revealed the nurse had returned the eye drops and vitamins after an order had been obtained. Further review of the medical record for Resident #76 on 03/29/23 at 8:30 A.M. revealed a medication self-administration assessment was scanned into the electronic medical record on 03/28/23 and physician orders dated 03/27/23 for an eye vitamin (Preservision AREDS 2), one tablet twice a day and cooling comfort ophthalmic eye drops, two drops each eye as needed for dry, may keep at bedside. Review of the facility policy titled Resident Self-Administration of Medication, dated 06/15/22, revealed a resident may only self-administer medications after the facility's interdisciplinary team has determined which medications may be self-administered, is care planned and an order exists for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 3 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0554 the medications being self-administered. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 4 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, resident and staff interviews, and review of the facility policy, the facility failed to ensure call lights were answered timely and the residents requiring assistance had access to call lights. This affected four (#10, #22, #54, and #60) of four residents reviewed for call lights. The facility census was 74. Residents Affected - Some Findings include: 1. Review of Resident #10's medical record revealed Resident #10 was admitted on [DATE]. Diagnoses included spastic hemiplegic cerebral palsy, mixed hyperlipidemia, pure hypercholesterolemia, essential (primary) hypertension, and unspecified convulsions. Review of the Minimum Data Set (MDS) assessment, dated 01/02/23, revealed Resident #10 was cognitively intact. Resident #10 required extensive one person assistance with bed mobility, transfers, walking in room, walking in corridor, dressing, toilet use, and personal hygiene. Resident #10 was always continent of bowel and bladder. Review of the care plan, updated 02/08/19, revealed Resident #10 was at risk for falls. Interventions included to ensure the call light was within reach, encourage the resident to transfer and change positions slowly, and to ambulate with gait belt and one assist. Continuous observation on 03/28/23 from 7:09 A.M. to 7:36 A.M. revealed Resident #10's call light turned on at 7:09 A.M. and the call light remained on until it was answered at 7:36 A.M. (27 minutes). Interview on 03/28/23 at 7:43 A.M. with State Tested Nursing Assistant (STNA) #582 verified it took staff a longer time to answer the call light at times but was not aware of the exact amount of time a resident would have to wait. STNA #582 stated Resident #10 utilized the call light for assistance out of bed to use the bathroom and did not become incontinent while waiting. Interview on 03/28/23 at 12:36 P.M. with Resident #10 verified this morning she pressed her call light to get up and use the bathroom but had to wait a while. Resident #10 did not know how long but stated that it was nothing compared to the weekends which were really lousy. 2. Review of Resident #54's medical record revealed Resident #54 was admitted on [DATE]. Diagnoses included Alzheimer's disease, anxiety disorder, essential (primary) hypertension, epilepsy, restlessness and agitation, and dementia without behavioral disturbance psychotic disturbance. Review of the MDS assessment, dated 02/14/23, revealed Resident #54 was unable to complete the interview. Resident #54 required extensive two person assistance with bed mobility and transfers and was required total dependence with locomotion on and off the unit, dressing, eating, toileting, personal hygiene, and bathing. Review of the care plan, dated 05/07/22, revealed Resident #54 required assistance with activities of daily living and one intervention was to keep the call light within reach at all times. Observation on 03/27/23 at 10:32 A.M. revealed Resident #54 was lying in bed with the call light on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 5 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0558 the floor next to the bed and out of reach. Level of Harm - Minimal harm or potential for actual harm Interview on 03/27/23 at 10:35 P.M. with the Director of Nursing (DON) verified the call light was out of reach of Resident #54. Residents Affected - Some 3. Review of the medical record for Resident #22 revealed an admission date of 07/19/21. Diagnoses included Alzheimer's disease with late onset, dementia, overactive bladder, sensorineural hearing loss, and anxiety disorder. Review of the MDS assessment dated [DATE] revealed Resident #22 had severely impaired cognition. Resident #22 required extensive assist of one for activities of daily living. Resident #22 required extensive assist of two for transfers. Observation on 03/29/23 at 2:29 P.M. of the call light for Resident #22 revealed the call light was dangling down towards the floor from the bedside enabler bar out of reach of the resident. Interview on 03/29/23 at 2:30 P.M. with Resident #22 verified she could not reach the call light and did not know where it was. Interview on 03/29/23 at 2:36 P.M. with Licensed Practical Nurse (LPN) #519 verified Resident #22's call light was not in reach. LPN #519 stated that she was unsure if Resident #22 could utilize the call light. 4. Review of the medical record for Resident #60 revealed an admission date of 10/28/21. Diagnoses included type two diabetes mellitus, major depressive disorder, dementia, altered mental status, and history of falling. Review of the MDS assessment dated [DATE] revealed Resident #60 was severely impaired cognition. Resident #60 required extensive assist of one for activities of daily living. Observation on 03/29/23 at 2:29 P.M. revealed Resident #60 was up in wheelchair facing away from the bed. Resident #60's call light was laying on the bed with the activator facing the wall. Interview on 03/29/23 at 2:36 P.M. with LPN #519 verified the call light was out of reach of Resident #60. LPN #519 asked Resident #60 what she would do if she could not use her call light and Resident #60 did not respond. LPN #519 cued Resident #60 to call out if she needed help if her call light was not within reach. Review of the facility policy titled Call Lights: Accessibility and Timely Response, reviewed 01/17/23, revealed staff will ensure the call light is within reach of the resident and secured as needed. This deficiency represents non-compliance investigated under Master Complaint Number OH00141590 and Complaint Number OH00141316. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 6 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff and resident interview, and review of the facility policy, the facility failed to develop a comprehensive care plan to address a resident's psychosocial needs. This affected one (Resident #37) of four residents reviewed for care planning. The facility census was 74. Findings include: Review of the medical record for Resident #37 revealed an admission date of 01/20/23. Diagnoses included acute on chronic heart failure, chronic kidney disease, and peripheral vascular disease. Review of the physician order dated 01/20/23 revealed an order for psychiatric services for evaluation or follow up. services. Review of the baseline care plan for Resident #37 dated 01/24/23 revealed it was silent for psychological or behavioral health needs. Review of the comprehensive Minimum Date Set (MDS) 3.0 assessment dated [DATE] revealed Resident #37 was cognitively intact, had experienced little interest or pleasure in doing things for the last 12 to 14 days, felt down or depressed two to six days and felt tired and had little to no energy the last seven to 11 days prior to the assessment. Review of the care conference summary dated 02/01/23 revealed Resident #37 was feeling down, tired, had changes in moving, and was feeling bad about self. Review of Resident #37's comprehensive care plan dated 02/07/23 revealed the care plan was silent for psychological or behavioral health needs. Interview on 03/28/23 at 10:30 A.M. with Licensed Practical Nurse (LPN) #518 verified Resident #37 refused care and LPN #518 stated Resident #37 was just giving up. Interview on 03/30/23 at 9:55 A.M. with Resident #37 revealed feeling down, having no energy and acknowledgement of refusals of care. Resident #37 stated willingness to talk to someone about the feelings. Interview with the Assistant Director of Nursing (ADON) #600 on 03/30/23 at 9:30 A.M. verified there was not a comprehensive care plan developed to meet the psychological needs of Resident #37. Review of the facility policy titled Provisions of Quality Care, dated 10/01/22, stated based on comprehensive assessment, the facility will ensure the resident receives treatment and care by qualified persons in accordance with professional standards of practice and a comprehensive person-centered care plans will be developed for each resident to ensure care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 7 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations, resident representative and staff interview, and review of the facility policy, the facility failed to ensure a resident received activities upon the preference of the resident and choices of activities. This affected one (Resident #54) of one resident reviewed for activities. The facility census was 74. Residents Affected - Few Findings include: Review of the medical record revealed Resident #54 was admitted on [DATE]. Diagnoses included Alzheimer's disease, anxiety disorder, epilepsy, major depressive disorder recurrent, restlessness and agitation, and dementia without behavioral disturbance psychotic disturbance. Review of the Minimum Data Set (MDS) assessment, dated 02/14/23, revealed Resident #54 was unable to complete the interview. Resident #54 required extensive two-person assistance with bed mobility and transfers and required total dependence from staff with locomotion on and off the unit and personal hygiene. Review of the care plan, dated 05/18/22, revealed Resident #54 was care planned for specific music preferences including religious music, ABBA, 50's music, and finds comfort with prayer. The goal was to hear preferred types of music daily in her room as desired. Interventions include to arrange spiritual room visits as tolerated, assist and praise all efforts to participate in music as needed, invite the resident outside to the courtyard for music when the weather was nice as she tolerates, provide CDs with preferred type of music, keep radio on 99.5 FM, and send/escort resident to group musical activities that were appropriate and fit with the resident's taste. Review of the activity progress note, dated 08/18/22, revealed the note was a care conference note for the care conference meeting held on 08/18/22. Resident's behavior was disruptive due to her yelling out and grabbing. Activities will continue to provide room visits with music and stimulation. Review of the activity progress note, dated 11/09/22, revealed the note was a care conference note for the meeting to be held on 11/10/22. Resident #54 showed satisfaction in spiritual visits and music. Activities will continue to provide Resident #54 with room visits as tolerated to include music and hand massages/aromatherapy. Review of Resident #54's medical record revealed there was no documentation that Resident #54 attended any activities from 11/20/22 to 03/27/23. Observation on 03/27/23 at 10:32 A.M. of Resident #54 revealed the resident was lying in bed awake, and alone in her room with no music playing. Subsequent observations on 03/27/23 at 2:05 P.M. revealed Resident #54 awake and alert and alone in her room. Resident #54 was in a broda chair with no music playing. Resident #54 alternated between appearing calm and restless in the room. Observation on 03/27/23 at 3:40 P.M. revealed Resident #54 awake, alert and alone in her room with the television on to an unknown channel. Interview on 03/28/23 at 10:05 A.M. with State Tested Nursing Assistant (STNA) #537 verified they had not observed Resident #54 involved in activities in or out of the resident room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 8 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 03/28/23 at 12:00 P.M. with Resident #54's personal aide reported she comes to the facility everyday and spends time with the resident. Resident #54 was always in her room and does not see staff offer activities to Resident #54. Interview on 03/29/23 at 11:34 A.M. with Activities Director #578 verified Resident #54 does better in a smaller group settings and one-on-one visits. Activities Director #578 verified all activity department resident documentation was documented in the resident progress notes. Activities Director #578 did not know the last date Resident #54 had activities participation. Interview on 03/29/23 at 11:41 A.M. with Activities Aide #580 reported Resident #54 had a personal aide and the family come in and then verified there were no documented activities with Resident #54. Review of the facility's undated policy titled Activities revealed it was the policy of the facility to provide ongoing program to support the residents in their choice of activities based on their comprehensive assessment, care plan, and preferences of each resident. Activities will be designed with the intent to enhance the resident's sense of well-being, belonging, and usefulness. Activities may be conducted in different ways including one-to-one programs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 9 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff and resident interviews, and review of the facility policy, the facility failed to provide care and services to assist a resident to maintain hearing devices. This affected one resident (Resident #55) of four residents reviewed for vision and hearing. The facility census was 74. Residents Affected - Few Findings include: Review of the medical record for Resident #55 revealed an admission date of 04/16/21. Diagnoses included Alzheimer's disease, cataract extraction right eye and left eye (status post on 07/26/21), anxiety disorder, dementia, and hearing loss. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #55 was cognitively impaired and had adequate hearing with the use of a hearing aid device. Speech was clear and the resident understands and was understood. Review of the care plan revealed Resident #55 had a hearing impairment affecting the resident's ability to communicate. Interventions included hearing to be evaluated upon request and nursing to track on the treatment administration record that hearing aides are charged at night and returned to the resident in the morning. Review of the nurse practitioner (NP) note dated 02/17/23 revealed family requested ears to be checked due to decreased hearing. The NP noted decreased hearing related to impacted cerumen, left ear and ordered Debrox ear drops, five drops every day followed by irrigation for five days. Review of the nurse progress note dated 03/08/23 revealed Resident #55's hearing aids were not charging. Review of additional nurse progress note dated 03/24/23 revealed the hearing aids were placed back on the charger due to the resident complaining of the hearing aids not working. There was no mention of a intervention to get the hearing aides assessed, ie. referral to social services, hearing appointment, etc. Observation and interview on 03/27/23 at 1:58 P.M. of Resident #55 revealed the resident holding right ear forward in attempt to hear. Resident #55 stated the staff took the hearing aids and the resident was not sure what was going on with them but stated cannot hear. Interview on 03/28/23 at 10:04 A.M. with Registered Nurse (RN) #509 revealed the hearing aids were not keeping a charge. RN #509 was unaware of any audiology appointments scheduled. Interview on 03/28/23 at 11:20 A.M. with Social Worker (SW) #579 revealed no knowledge of the hearing aids for Resident #55 not keeping a charge. SW #579 was unaware of the 02/17/23 request by family of Resident #55 to have hearing checked. SW #579 further verified an audiology appointment for Resident #55 had not been scheduled. Review of the facility policy titled Provisions of Quality Care, dated 10/01/22 stated based on comprehensive assessment, the facility will ensure the resident receives treatment and care by qualified persons in accordance with professional standards of practice and a comprehensive person-centered care plans will be developed for each resident to ensure care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 10 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident and staff interview, and review of the facility policy, the facility failed to provide timely assistance to prevent a fall with injury and failed to complete a thorough fall investigation. This affected one (Resident #45) of five residents reviewed for falls. The facility census was 74. Findings include: Review of Resident #45's medical record revealed the resident was admitted on [DATE]. Diagnoses included anxiety disorder, repeated falls, and general weakness. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #45 was cognitively intact. Resident #45 required extensive assistance from staff with transferring and toilet use and required supervision for walking in the room and walking on and off the unit. Review of Resident #45's plan of care, undated, revealed Resident #45 was at risk for falls related to unsteady gait and history of falls. The goal was for Resident #45 not to sustain an injury from falls. Interventions included were to encourage Resident #45 to wear proper and non-slip footwear and to assist Resident #45 with toileting. On 10/05/22, therapy reminded Resident #45 to ask for assistance and it was updated on 03/04/22 for Resident #45 to ask for assistance and placed a sign to remind Resident #45 to ask for assistance. Review of the Fall Risk assessment dated [DATE] revealed Resident #45 at a high risk for falls. Review of the progress notes dated 03/04/23 revealed Resident #45 sustained an unwitnessed fall with injury and was sent to the emergency room for evaluation. Review of the facility's incident report revealed Resident #45 fell on [DATE] at 7:58 A.M. Resident #45 was found by an STNA on the floor and hit her head. Resident #45 had a bump noted to her forehead and was complaining of pain to left hand and left forehead. Resident #45 stated her walker got away from her and she fell. Resident #45 was given non-slip socks, reminded to use call light and to ambulate with assistance. There was no mention if Resident #45's call light was on or off at the time Resident #45 was found on the floor. Review of the physician orders revealed Resident #42 was to receive assistance with ambulation (walking) and non-slip socks when ambulating. Observation and interview on 03/27/23 at 12:02 P.M. revealed Resident #45 had bruising to the left inner corner of her eye. Resident #45 stated she remembered falling on 03/04/23 and stated she placed her call light on and waited for 45 minutes and then couldn't wait any longer to use the restroom and got up on her own. Resident #45 stated she fell, hit her face and head, and was sent out to the emergency room. Resident #45 stated she timed her call light waiting time by watching the clock in her room. Interview on 03/28/23 at 7:43 A.M. with State Tested Nursing Assistant (STNA) #582 revealed she was working on 03/04/23 and was the only STNA on the hall when Resident #45 had tried to get up and fell on the floor. STNA #582 stated she was the only STNA on the hall and could not get to Resident #45 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 11 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0689 timely. Level of Harm - Minimal harm or potential for actual harm Observation on 03/28/23 at 9:30 A.M. revealed Resident #45's clock in her room displayed the accurate time of day and appeared to be functioning. Residents Affected - Few Review of the staffing schedule, dated 03/04/23, revealed three agency STNAs were scheduled for the hall Resident #45 resided on and two of the STNAs were marked as call offs. Interview on 03/30/23 at 10:02 A.M. with Licensed Practical Nurse (LPN) #519 verified on 03/04/23, two agency aides had called off on Resident #45's hall. LPN #519 verified according to the schedule, there was only one STNA working on Resident #45's hall and there were three STNAs assigned to work on the hall on 03/04/23. Review of the facility policy titled Fall Prevention Program, dated 02/2023, revealed each resident will be assessed for fall risk and will receive are and services in accordance with their individualized level of risk to minimize the likelihood of falls. A resident that meets high risk protocol will be placed on the facility's fall risk prevention program, implement interventions from low/moderate risk protocols, provide interventions that address unique risk factors measured by the risk assessment tool: medications, psychological, cognitive status, or recent change in functional status. This deficiency represents non-compliance investigated under Master Complaint OH00141590 and Complaint Number OH00141316. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 12 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, and review of the facility policy, the facility failed to ensure the care and management for an indwelling urinary catheter for Resident #40. This affected one (Resident #40) of three resident reviewed for having an indwelling urinary catheter. The facility identified 10 residents with indwelling or external catheters. The facility census was 74. Findings include: Review of the medical record for Resident #40 revealed an admission date of 02/02/23. Diagnoses included a cerebral infarct on 02/10/23, obstruction and reflux uropathy, hydronephrosis with renal and urethral calculous and a bladder neck obstruction. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #40 was moderately cognitively impaired. Resident #40 was always continent of bowel and required the use of an indwelling urinary catheter. Review of the care plan dated 02/06/23 revealed an indwelling urinary catheter due to the inability to empty bladder completely due to obstructive uropathy. Interventions included to change the indwelling catheter monthly and to change drainage bag monthly. Review of the physician's orders for Resident #40 revealed orders written on 02/10/23 for catheter care every shift and the urinary drainage bag to be changed once a month on the tenth day of the month. Review of the treatment administration record for Resident #40 for February 2023 and March 2023 remained silent for the urinary drainage bag being changed as ordered. Interview on 03/30/23 at 9:35 A.M. with Resident #40 revealed the urinary drainage bag had not been changed since admission. Observation on 03/30/23 at 10:05 A.M. of the urinary drainage bag for Resident #40 revealed there was no date on the bag so show when it was last changed. Interview on 03/30/23 at 10:15 A.M. with the Assistant Director of Nursing (ADON) #524 verified no evidence existed of the urinary drainage bag being changed as ordered for Resident #40. Review of the facility policy titled Indwelling Catheters, dated 12/17/21, revealed indwelling urinary catheters will be utilized only when a resident's clinical condition demonstrates necessary and the use of the indwelling catheter will be maintained in accordance with physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 13 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, resident, resident representative, and staff interviews, record reviews, review of resident council notes, review of staff schedules, and review of facility policies, the facility failed to ensure there was sufficient nursing staff to meet the resident care needs. This affected three residents (#10, #34, and #45), and had the potential to affect all 74 residents residing in the facility. Findings include: Review of the Facility Assessment Tool, updated 01/05/23, revealed the competent staffing support to provide care for the resident population every day and during emergency range from three to nine direct care nurse aides per shift and two to four direct care nurses per shift. Review of the facility's Resident Census and Conditions of Residents dated 03/27/23 revealed 65 of 74 residents required staff assistance with transferring, 71 of 74 residents required assistance with toileting, and 74 residents required staff assistance with bathing. 1. Review of Resident #45's medical record revealed the resident was admitted on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #45 was cognitively intact and required extensive assistance from staff with transferring and toilet use. Review of the progress notes dated 03/04/23 revealed Resident #45 sustained an unwitnessed fall with injury and was sent to the emergency room for evaluation. Review of the facility's incident report revealed Resident #45 fell on [DATE] at 7:58 A.M. Resident #45 was found by an STNA on the floor and hit her head. Resident #45 had a bump noted to her forehead and was complaining of pain to left hand and left forehead. There was no mention if Resident #45's call light was on or off at the time Resident #45 was found on the floor. Observation and interview on 03/27/23 at 12:02 P.M. revealed Resident #45 had bruising to the left inner corner of her eye. Resident #45 stated she remembered falling on 03/04/23 and stated she placed her call light on and waited for 45 minutes and then couldn't wait any longer to use the restroom and got up on her own. Resident #45 stated she fell, hit her face and head, and was sent out to the emergency room. Resident #45 stated she timed her call light waiting time by watching the clock in her room. Interview on 03/28/23 at 7:43 A.M. with State Tested Nursing Assistant (STNA) #582 revealed she was working on 03/04/23 and was the only STNA on the hall when Resident #45 had tried to get up and fell on the floor. STNA #582 stated she was the only STNA on the hall and could not get to Resident #45 timely. Observation on 03/28/23 at 9:30 A.M. revealed Resident #45's clock in her room displayed the accurate time of day and appeared to be functioning. Review of the staffing schedule, dated 03/04/23, revealed three agency STNAs were scheduled for the hall Resident #45 resided on and two of the STNAs were marked as call offs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 14 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Interview on 03/30/23 at 10:02 A.M. with Licensed Practical Nurse (LPN) #519 verified on 03/04/23, two agency aides had called off on Resident #45's hall. LPN #519 verified according to the schedule, there was only one STNA working on Resident #45's hall and there were three STNAs assigned to work on the hall on 03/04/23. Residents Affected - Many 2. Review of Resident #34's medical record revealed the resident was admitted on [DATE]. Review of the care plan, dated 08/22/22, revealed Resident #34 required assistance with activities of daily living and preferred his showers two days per week and as needed on first shift. Review of the Minimum Data Set (MDS) assessment, dated 02/03/23, revealed Resident #34 was moderately cognitively impaired. Resident #34 was totally dependent on staff for bathing. Review of the facility's shower/whirlpool/bed bath documentation, dated 03/01/23 to 03/30/23, revealed Resident #34 received one shower on 03/30/23. Interview on 03/30/23 at 9:47 A.M. with State Tested Nursing Assistant (STNA) #528 verified according to the documentation, Resident #34 has not had a shower in the last 30 days. STNA #528 stated Resident #34 was a confused and when they were short staffed, showers were more likely to be provided for the residents that were nagging about it. Interview on 03/30/23 at 12:13 P.M. with Resident #34 verified he would much rather have a shower then a washcloth to clean himself. 3. Review of Resident #10's medical record revealed Resident #10 was admitted on [DATE]. Review of the Minimum Data Set (MDS) assessment, dated 01/02/23, revealed Resident #10 was cognitively intact. Resident #10 required extensive one person assistance with bed mobility, transfers, and toilet use. Continuous observation on 03/28/23 from 7:09 A.M. to 7:36 A.M. revealed Resident #10's call light turned on at 7:09 A.M. and the call light remained on until it was answered at 7:36 A.M. (27 minutes). Interview on 03/28/23 at 7:43 A.M. with State Tested Nursing Assistant (STNA) #582 verified it took staff a longer time to answer the call light at times but was not aware of the exact amount of time a resident would have to wait. STNA #582 stated Resident #10 utilized the call light for assistance out of bed to use the bathroom. Interview on 03/28/23 at 12:36 P.M. with Resident #10 verified this morning she pressed her call light to get up and use the bathroom but had to wait a while. Resident #10 did not know how long but stated that it was nothing compared to the weekends which were really lousy. 4. Interview on 03/27/23 at 9:45 A.M. with Resident #7 revealed there were not enough staff and there were supposed to be two state tested nursing aides (STNA) on the hall. Interviews on 03/27/23 revealed at 9:56 A.M., Resident #61 stated he has recently waited up to one hour for his call light to be answered. At 10:05 A.M., Resident #1 stated it takes a long time to get to the bathroom because of waiting on call lights. At 10:09 A.M., Resident #62 stated she has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 15 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many waited over 30 minutes for call lights, and it usually occurred on third shift. At 10:18 A.M., Resident #6 stated she had her call light on for one hour and ten minutes this morning (03/27/23) at 6:20 A.M. to go to the bathroom. Resident #6 reported when staff came into the resident room they took her roommate to the bathroom first and she did not even have her call light on and can walk to the bathroom herself. Interview on 03/27/23 at 12:00 P.M. with Resident #23's Resident Representative revealed the facility was very short of staff and every time they leave, they worried about Resident #23. Interview on 03/27/23 at 12:12 P.M. with Resident #26 revealed sometimes she waits so long for help she just does it herself. Resident #26 stated she knows she should not do it herself, but she gets tired or waiting or cannot wait any longer. Interview on 03/27/23 at 1:50 P.M. with Resident #35 revealed the facility was short staffed on second shift. Interview on 03/28/23 at 8:00 A.M. with STNA #587 revealed it was really difficult to meet the resident needs when there were only two STNAs working on a hall with about 30 residents when most of them required Hoyer lifts for transferring and were dependent on staff for care. Interview on 03/28/23 at 2:31 P.M. with Licensed Practical Nurse (LPN) #514 revealed the facility was often short of staff and agency staff called off frequently. LPN #514 reported they do their best but call lights can be on as long as 30 minutes. LPN #514 denied the residents had to wait one hour. Interview on 03/29/23 at 4:11 P.M. with STNA #583 verified she has worked first and second shift at the facility and had two halls (approximately 30 residents) to provide care to by herself. Interview on 03/30/23 at 9:47 A.M. with STNA #528 stated the facility often utilized agency staff and agency staff often called off or does not show up. Interview on 03/30/23 at 10:02 A.M. with LPN #519 revealed the first shift and second shift were ideally staffed with four nurses and eight to ten STNAs with a bare minimum of three nurses and five STNAs. Third shift was ideally staffed with three nurses and five aides. LPN #519 stated the schedule was posted four to six weeks in advance but the facility had a lot of as needed (PRN) staff. LPN #519 will contact PRN staff a week or two in advance to have them fill in. The facility utilized agency staff and LPN #519 stated they were attempting to to make them more accountable and send replacement staff if someone calls off. The agency was on-call 24 hours and LPN #519 communicated with them about their staffing needs. Interview on 03/30/23 at 1:50 P.M. with Resident #54's Resident Representative revealed concerns of staffing related to Resident #54's care. Resident #54 has a personal aide for 30 hours a week to ensure the minimum care and services were provided and there were continued concerns for staffing when they cannot be at the facility. Interview on 03/30/23 at 12:22 P.M. with the Administrator revealed the facility has prioritized recruiting new employees and discussed retention plans. The Administrator verified there has been challenges utilizing agency staff, specifically related to call offs, and has talked to the owner but has not had the positive result they hoped for. The Administrator discussed staffing expectations (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 16 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many stating the facility expects to have an eight to one staff ratio on first and second shifts and a ten or twelve to one resident to staff ratio on third shift but when the facility goes below the state minimum or there were call offs, they send out a mass text to the leaders of the facility. The Administrator reported staffing has been the main priority. Review of the Resident Council Meeting Minutes, dated 12/27/22, revealed concerns included STNAs and nurses being understaffed and the Northwest hall needed more help with care. One resident stated she was left to finish sitting down alone as there was only one STNA available. Review of the facility policy titled Provision of Quality of Care, dated 10/11/22, revealed the facility will ensure residents receive treatment and care by qualified persons in accordance with professional standards of practice, the comprehensive person-centered care plans, and the residents' choices. Review of the facility policy titled Nursing Department- Staffing, dated 02/08/22, revealed the facility employs sufficient staff with the appropriate competencies and skill sets to carry out the functions of the nursing department, taking into consideration the resident assessments, individual plans of care and the number, acuity and diagnosis of the facility's resident population in accordance with regulations and the facility assessment. The facility will provide sufficient support personnel to safely and effectively carry out the supportive functions of the nursing department. This deficiency represents non-compliance investigated under Master Complaint Number OH00141590 and Complaint Number OH00141316. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 17 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff and resident interview, and review of the facility policy, the facility failed to ensure a resident received mental health services and psychiatric services per physician orders to attain the highest practicable mental well-being. This affected one resident (Resident #37) of one resident reviewed for mental health. The facility census was 74. Findings include: Review of the medical record for Resident #37 revealed an admission date of 01/20/23. Diagnoses included acute on chronic heart failure, chronic kidney disease, and peripheral vascular disease. Review of the physician order dated 01/20/23 revealed an order for psychiatric services for evaluation or follow up services. There was no evidence in the medical record this was completed from 01/20/23 to 03/27/23. Review of the social service admission assessment dated [DATE] revealed Resident #37 lived in an apartment and used a walker and wheelchair and required a hospital admission on [DATE] due to edema and congestive heart failure. A chest radiography (x-ray) revealed nodules with possible masses, the resident refused further work up, and was started on oxygen. There was no mention of Resident #37's mental well-being at the time of the assessment and did not address the physician order for psychiatric services. Review of the comprehensive Minimum Date Set (MDS) 3.0 assessment dated [DATE] revealed Resident #37 was cognitively intact, had experienced little interest or pleasure in doing things for the last 12 to 14 days, felt down or depressed two to six days and felt tired and had little to no energy the last seven to 11 days prior to the assessment. Review of the baseline care plan for Resident #37 dated 01/24/23 revealed it was silent for psychological or behavioral health needs. Review of the care conference summary dated 02/01/23 revealed Resident #37 was feeling down, tired, had changes in moving, and was feeling bad about self. Review of Resident #37's comprehensive care plan dated 02/07/23 revealed the care plan was silent for psychological or behavioral health needs. Review of the progress notes from 02/10/23 through 03/29/23 revealed refusals of care, including medications and the refusal to get out of bed. Review of the medical record remained silent for any psychological assessments by psychiatry or social work follow up. Observation on 03/27/23 at 12:20 P.M. of Licensed Practical Nurse (LPN) #518 taking a meal tray into the room of Resident #37 revealed Resident #37 refusing the meal tray and LPN #518 exiting the resident's room with untouched meal tray in hand. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 18 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 03/28/23 at 10:30 A.M. with Licensed Practical Nurse (LPN) #518 verified Resident #37 refused care and LPN #518 stated Resident #37 was just giving up. Interview on 03/29/23 at 4:50 P.M. with Social Worker #579 revealed no knowledge of Resident #37 refusals of care. Social Worker #579 verified no psychological assessments have been conducted for Resident #37 and further verified psychiatry services have not been consulted for Resident #37. Interview on 03/30/23 at 9:55 A.M. with Resident #37 revealed feeling down, having no energy and acknowledgement of refusals of care. Resident #37 stated willingness to talk to someone about the feelings. Review of the facility policy titled Behavioral Health Services, dated 09/29/22, revealed the facility is to offer all residents behavioral health services to assist them in reaching and maintaining and ensuring their highest level of mental and psychosocial functioning. Behavioral health encompasses a resident's whole emotional and mental well-being, which includes, but is not limited to the prevention and treatments of mental and substance use disorders, psychosocial adjustment difficulty and trauma or post-traumatic stress disorder. The facility will ensure that necessary behavioral health care services are person centered and reflect the resident's goals for care, while maximizing the resident's dignity, autonomy, privacy, socialization, independence, choice, and safety. Social Services Director shall serve as the facility's contact person regarding behavioral services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 19 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, and policy review, the facility failed to ensure medications were dated when opened and medications were used within the expiration date, and failed to store medications in a locked compartment. This affected two of three medications carts reviewed and one of two medication storage rooms. This affected one (Resident #26) of 21 residents observed for the physical environment. The facility census was 74. Findings include: 1. Observation on 03/28/23 at 7:56 A.M. of Northwest two medication cart revealed there were five eye drop containers without an open date. Brimonidine tartrate solution 0.15%, Dorzolamide HCL-Timolol Mal PF solution 2-0.5 %, Refresh Optive Advanced Ophthalmic solution 0.5-1-0.5%, Latanoprost ophthalmic emulsion 0.005% and Xalatan Solution 0.005%. Interview on 03/28/23 at 7:59 A.M. with Licensed Practical Nurse (LPN) #519 verified the five eye drops containers were not dated when opened. Review of the facility policy titled Administration of Eye Drops or Ointments, revised 07/16/22, revealed label new bottle with date opened and follow facility policy or manufacturer's instructions for when to discard and replace. 2. Observation on 03/28/23 at 8:17 A.M. of Southwest Long hall medication cart revealed insulin degludec (Tresiba) pen was not dated with an open date. Interview on 03/28/23 at 8:18 A.M. with Registered Nurse (RN) #507 verified the insulin pen was not dated. Review of the facility policy titled Insulin Pen, revised 07/19/22, revealed insulin pens must be clearly labeled with the resident name, physician name, date dispensed, type of insulin, amount to be given, frequency, and expiration date. Insulin pens should be disposed of after 28 days or according to manufacturer's recommendation. Review of the manufacturer's recommendation for Tresiba flex touch U-100 revealed expiration date once opened was eight weeks. 3. Observation on 03/30/23 at 10:30 A.M. of Northwest medication room revealed five bottles of multivitamin with no iron with expiration date of 11/2021. A Tuberculin solution bottle in the refrigerator was not dated when opened and was half empty. Interview on 03/30/23 at 10:32 A.M. with RN #513 verified Tuberculin solution was not dated when opened and verified that it had been used. RN #513 stated Tuberculin solution had not been used recently. RN #513 verified five bottles of multivitamin with no iron were outdated. RN #513 stated the multivitamins came in with a resident and were not used. RN #513 stated they used facility stock. 4. Review of the medical record for Resident #26 revealed a readmission date on 10/09/20. Diagnoses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 20 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few included rheumatoid arthritis, anxiety disorder, disorder of brain, and major depressive disorder recurrent. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #26 was cognitively intact. Review of the physician orders for March 2023 for Resident #26 revealed the following morning medications ascorbic acid (vitamin) 500 milligrams (mg), cholecalciferol (vitamin) 75 microgram (mcg), folic acid (vitamin) one mg, loratadine (antihistamine) 10 mg, prednisone (steroid) five mg, calcium carbonate (vitamin) 600 mg, docusate sodium (treats constipation) 100 mg, metoprolol tartrate (treats high blood pressure) 37.5 mg, Omeprazole delayed release (treats gastroesophageal reflux disease) 40 mg, and lactase enzyme (helps digest dairy) tablet. There was no physician order for Resident #26 to self-administer medications. Observation on 03/29/23 at 6:48 A.M. of Resident #26 revealed there was a cup of morning medications at bedside with water. Interview on 03/29/23 at 6:51 A.M. with LPN #517 verified she had just given Resident #26 her morning medications and left the room. LPN #517 stated Resident #26 usually downs it right away and was unaware she did not take her medications already. Review of the facility policy titled Medication Administration, revised 06/15/22, revealed the staff are to observe the residents' consumption of medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 21 of 22 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 365458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wood Haven Health Care Senior Living & Rehab 1965 E Gypsy Lane Rd Bowling Green, OH 43402 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview, and review of the facility policy, the facility failed to ensure foods were properly sealed, labeled, and dated in the freezer and failed to maintain the refrigerator and freezer in a sanitary condition. This had the potential to affect all 74 residents identified by the facility as reviewing food from the kitchen. The facility census was 74. Findings include: Observations on 03/27/23 at 9:00 A.M. in the upright freezer revealed there were opened and unlabeled foods including a bag of grilled chicken breast, bag of chicken tenders. There was an opened, unlabeled, and undated food items which included bag of chocolate chip cookies and bag of french fries. Interview with Dining Services Manager (DSM) #559 at the time of the observation verified the opened, unlabeled and undated food items. Observations on 03/27/23 at 9:10 A.M. in the walk-in freezer revealed there was frost build up at the bottom of the fan unit inside the walk-in freezer with a nearby pipe with water that dripped and froze into two separate icicles hanging down. Interview with DSM #559 at the time of the observation verified findings. Observations on 03/27/23 at 9:12 A.M. in the walk-in cooler revealed metal storage racks with white crusty looking build-up on two separate racks, and milk crates containing gallons of milk seated directly on the floor. Interview with DSM #559 at the time of the observation verified findings. Review of the facility policy titled Date and Marking for Food Safety, dated 01/2023, revealed the facility adheres to a date marking system to ensure the safety of ready to eat, time/temperature control for food safety. The guidelines for staffing indicate the marking system shall consist of a color-coded label, the day/date of opening and the day/date the item must be consumed or discarded. Review of the facility policy titled Food Safety Requirements, dated 01/2023, revealed the food will be stored, prepared, distributed, and served in accordance with professional standards for food service safety. The policy guidelines revealed for food will be stored in a manner that helps prevent from deterioration or contamination of the food including growth from microorganisms. Review of the facility policy titled Routine Cleaning and Disinfecting of Cooler/Freezer Racks, dated 11/2022, revealed the facility to ensure the provision of routing cleaning and disinfection in order to provide a safe, sanitary environment and to prevent the development of transmission of infections to the extent possible. The policy guidelines indicated routine cleaning and disinfection of cooler/freezer racks or visibly soiled surfaces will be performed quarterly or as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365458 If continuation sheet Page 22 of 22

Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.

Citations

28 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0211GeneralS&S Epotential for harm
Keep aisles, corridors, and exits free of obstruction in case of emergency.
0222GeneralS&S Fpotential for harm
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
0225GeneralS&S Fpotential for harm
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
0241GeneralS&S Fpotential for harm
Have correct number of accessible exits for each story.
0252GeneralS&S Epotential for harm
Provide at least two remote exits on each floor or fire section of the building.
0311GeneralS&S Fpotential for harm
Have an enclosure around a vertical opening shaft.
0324GeneralS&S Fpotential for harm
Provide properly protected cooking facilities.
0345GeneralS&S Fpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
0351GeneralS&S Fpotential for harm
Install an approved automatic sprinkler system.
0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
0363GeneralS&S Fpotential for harm
Install corridor and hallway doors that block smoke.
0374GeneralS&S Epotential for harm
Install smoke barrier doors that can resist smoke for at least 20 minutes.
0015GeneralS&S Fpotential for harm
Address subsistence needs for staff and patients.
0781GeneralS&S Fpotential for harm
Have restrictions on the use of portable space heaters.
0920GeneralS&S Fpotential for harm
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.
0923GeneralS&S Epotential for harm
F923 - Have adequate outside ventilation by means of windows, or mechanical
Have proper medical gas storage and administration areas.
0552GeneralS&S Dpotential for harm
F552 - Planning and Implementing Care
Ensure that residents are fully informed and understand their health status, care and treatments.
0554GeneralS&S Dpotential for harm
F554 - The right to self-administer medications if the interdisciplinary team, as
Allow residents to self-administer drugs if determined clinically appropriate.
0690GeneralS&S Dpotential for harm
F690 - Incontinence
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
0725GeneralS&S Fpotential for harm
F725 - Nursing Services
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
0761GeneralS&S Dpotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0558GeneralS&S Epotential for harm
F558 - The right to reside and receive services in the facility with reasonable
Reasonably accommodate the needs and preferences of each resident.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0679GeneralS&S Dpotential for harm
F679 - Activities
Provide activities to meet all resident's needs.
0685GeneralS&S Dpotential for harm
F685 - Vision and hearing
Assist a resident in gaining access to vision and hearing services.
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0740GeneralS&S Dpotential for harm
F740 - Behavioral health services
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

FAQ · About this visit

Common questions about this visit

What happened during the March 30, 2023 survey of WOOD HAVEN HEALTH CARE SENIOR LIVING & REHAB?

This was a inspection survey of WOOD HAVEN HEALTH CARE SENIOR LIVING & REHAB on March 30, 2023. The surveyor cited 28 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at WOOD HAVEN HEALTH CARE SENIOR LIVING & REHAB on March 30, 2023?

Yes, 28 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Keep aisles, corridors, and exits free of obstruction in case of emergency."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Inspection·March 30, 2023