Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0641
Ensure each resident receives an accurate assessment.
Level of Harm - Minimal harm
or potential for actual harm
Based on medical record review and staff interview, the facility failed to ensure accurate assessments were
completed. This affected one (#65) of three residents reviewed for assessments. The facility census was
76.Findings include:Review of the medical record for Resident #65 revealed an admission date of 02/20/25
with diagnoses including, but not limited to, psychotic disorder with delusions, Parkinson's disease, anxiety,
depression, dementia, and neurocognitive disorder with Lewy bodies.Review of the Nursing admission
Assessment completed on 02/20/25 revealed the resident had natural teeth, with missing teeth and no
dentures.Review of the Oral Status and Dental assessment completed on 02/21/25 revealed the resident
had natural teeth, with missing teeth and no dentures.Review of the Oral Status and Dental assessment
completed on 05/22/25 revealed the resident had natural teeth, with missing teeth and no dentures.Review
of the Minimum Data Set (MDS) assessment, dated 11/04/25, revealed the resident had severe cognitive
impairment. The assessment indicated Resident #65 had no broken or loosely fitting full or partial dentures.
The resident had no mouth or facial pain, discomfort, or difficulty chewing.Interview on 12/08/25 at 11:24
A.M. with Certified Nursing Assistant (CNA) #308 revealed that Resident #65 had partial dentures.Interview
on 12/08/25 at 1:35 P.M. with Unit Manager (UM) #290 verified the dental assessments completed for
Resident #65 stated the resident had natural teeth and did not have dentures. This deficiency represents
non-compliance investigated under Master Complaint Number 2669641.
Residents Affected - Few
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:
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
12/08/2025
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 0686
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Review of the
medical record for Resident #19 revealed an admission date of 07/12/25 with diagnoses including, but not
limited, to seborrheic dermatitis, pressure ulcer of sacral region stage three (full thickness to fat), pressure
ulcer of right buttock stage three, pressure ulcer of left buttock stage three, and paraplegia.Review of the
Minimum Data Set (MDS) assessment, dated 12/02/25, revealed the resident was cognitively intact.
Resident #19 had two stage three pressure ulcers that were present on admission.Review of the care plan
dated 07/16/25 revealed the resident had two stage three pressure ulcers upon admission and
dermatitis/fungal infection related to disease processes- paraplegic, non-compliant with care and getting up
out of bed. Interventions included administer treatments as ordered, low air loss (LAL) alternating pressure
mattress, and weekly treatment documentation to include measurement of each area of skin breakdown's
width, length, depth, and type of tissue and exudate.Review of the weekly skin assessment dated [DATE]
revealed the stage three pressure to the right buttock measured 5.0 centimeters (cm) in width by (x) 2.1 cm
in length x 0.1 cm in width. Wounds number two and three were measured together, with the
measurements being a combined 8.0 cm width x 8.1 cm in length x 0.1 cm in depth. Wounds number three
and four were measured together, with a combined measurement of 8.9 cm in width x 4.9 cm in length x 0.1
cm in depth. The stage three pressure ulcer to the left buttock was resolved. There was a moderate amount
of serosanguinous drainage to all areas. Treatment included Silvadene to all areas and cover with
abdominal (ABD) pads. Wound beds were beefy red with much improvement noted. Review of the weekly
skin assessment dated [DATE] revealed the stage three pressure to the right buttock measured 5.0
centimeters (cm) in width by (x) 2.1 cm in length x 0.1 cm in width. Wounds number two and three were
measured together, with the measurements being a combined 8.0 cm width x 8.1 cm in length x 0.1 cm in
depth. Wounds number three and four were measured together, with a combined measurement of 8.9 cm in
width x 4.9 cm in length x 0.1 cm in depth. The stage three pressure ulcer to the left buttock was resolved.
There was a moderate amount of serosanguinous drainage to all areas. Treatment included Silvadene to all
areas and cover with abdominal (ABD) pads. Wound beds were beefy red with much improvement noted.
Interview on 12/04/25 at 2:30 P.M. with Unit Manager (UM) #290 revealed she completed wound rounds
with the NP weekly. UM #290 stated the NP usually came on Fridays to do wound rounds. UM #290 stated
the NP always came on Mondays to do regular rounds and she would do wound rounds if she knew she
would not be in on Friday. UM #290 stated she was always present in the room when the NP completed
wound rounds and would write down the measurements. UM #290 verified the NP came in and completed
rounds on 11/03/25 and when the weekly skin assessment came up in the electronic record on 11/06/25,
she documented the same measurement as 11/03/25 during rounds. UM #290 verified on 11/06/25 she did
not remeasure or assess the wounds. This deficiency represents non-compliance investigated under
Complaint Number 2668796.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
365458
If continuation sheet
Page 2 of 2
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Back to topCitations
2 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.
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
FAQ · About this visit
Common questions about this visit
What happened during the December 8, 2025 survey of WOOD HAVEN HEALTH CARE SENIOR LIVING & REHAB?
This was a inspection survey of WOOD HAVEN HEALTH CARE SENIOR LIVING & REHAB on December 8, 2025. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at WOOD HAVEN HEALTH CARE SENIOR LIVING & REHAB on December 8, 2025?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure each resident receives an accurate assessment."
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.
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.