Inspection·January 2, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, resident and staff interview, and facility policy the facility failed to ensure clean and sufficient laundry was available to residents. This affected three (Residents #60, #64, and #68) of three residents reviewed. The facility census was 74. Findings include: Observation on 12/26/23 and 12/28/23 revealed a common area inaccessible to residents with an abundant of both hung, folded, and unfolded clothing and blankets. Interview on 12/26/23 at 10:56 A.M. with State Tested Nursing Assistant (STNA) #202 revealed the only concern they have at the facility is supplies, specifically towels and resident laundry. STNA #202 reported they always needed to hunt down resident laundry so the resident has something to wear. Interview on 12/26/23 at 11:28 A.M. with Laundry and Housekeeping Supervisor #203 verified the common area inaccessible to residents was used as a folding area. Laundry and Housekeeping Supervisor #203 verified other than what aides were able to do in their spare time laundry had not been folded since last Saturday (3 days). Laundry and Housekeeping Supervisor #203 verified residents have run out of clothing and needed to wear gowns or aides have had to hunt through stacks of clothing. Interview on 12/26/23 at 12:44 P.M. with Resident #64 verified she had allowed another resident to wear her pair of pants because the resident did not have any pants to wear and wanted to get out of bed. Interview on 12/26/23 at 10:05 A.M. with Resident #60 revealed she had be admitted with ten pairs of pants but had no clean pants to wear today so Resident #64 allowed her to wear hers. Interview on 12/28/23 at 4:45 P.M. with Resident #68 verified she had no clean clothing that fit her and had to wear the same clothing as the day prior. Review of the Resident Rights policy, dated December 2016, verified residents have the right to a dignified existence. This deficiency represents non-compliance investigated under Complaint Number OH00148660. 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: 365617 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 365617 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Waterville 8885 Browning Drive Waterville, OH 43566 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)