Inspection·June 26, 2025

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review and staff interview the facility failed to ensure residents with reclining wheelchairs were assessed for possible restraint use. This affected two (Resident #12 and #34) of two residents reviewed for possible restraint use. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #12 revealed an admission date of 01/05/21 with diagnoses that included end stage renal disease with hemodialysis, diabetes mellitus and atrial fibrillation. Review of the physician's orders for Resident #12 revealed on 10/17/24 that while resident is up in tilt-in-space wheel chair (wheelchair which can recline for comfort and positioning) to tilt resident back to 30-40 degrees every hour for 5-20 minutes as tolerates to relieve pressure off coccyx and sacrum. No evidence was found in the medical record to determine when the tilt-in-space wheelchair was initiated and no evidence of an assessment to determine if the tilt and space wheelchair was a restraint. Observation of Resident #12 on 06/23/25 at 10:44 A.M. revealed the resident was reclined in a tilt-in-space wheelchair. Interview with the Director of Nursing on 06/23/25 at 3:55 P.M. verified Resident #12 was not assessed for potential use of a restraint with the tilt-in-space wheelchair. The Director of Nursing further indicated the resident had utilized the tilt-in-space wheelchair for a prolonged period. 2. Review of the medical record for Resident #34 revealed an admission date of 04/15/23 with diagnoses that included Alzheimer's disease with dementia, diabetes mellitus and post-traumatic stress disorder. Review of the physician's orders for Resident #34 revealed on 10/17/24 that while resident is up in tilt-in-space wheel chair, to tilt the resident back to 30-40 degrees every hour for 5-20 minutes as tolerates to relieve pressure off coccyx and sacrum. No evidence was found to determine when the tilt-in-space wheelchair use was initiated. Further review of the medical record revealed no assessment was completed to determine if the use of the tilt-in-space wheelchair was a potential treatment. Observation of Resident #34 on 06/23/25 at 1:29 P.M. revealed the resident was reclined in a (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 4 Event ID: 365496 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 365496 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Woodsfield 37930 Airport Road Woodsfield, OH 43793 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)