Inspection·September 15, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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, staff interviews, wound clinic staff interview, and review of facility policy, the facility failed to ensure wound care treatments and follow-up appointments were completed as ordered. This affected three (#127, #134, and #160) of four residents reviewed for wound care. The facility census was 58.Findings include:1. Review of the medical record for Resident #127 revealed he was admitted on [DATE] with diagnoses that included atherosclerotic heart disease, peripheral vascular disease, hypertension, and atherosclerosis of native arteries of the left leg with ulceration of the heel and midfoot. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #160 was cognitively intact and did not refuse care. Review of the current care plan for Resident #127 revealed Resident #127 had an open chest lesion. The interventions included treatment to chest per orders.Review of the physician orders and treatment administration records (TAR) for Resident #127 revealed active orders, beginning on 02/21/25, for daily wound care to his chest wound to cleanse with normal saline, pat dry and apply collagen with silver to the wound bed and cover with a boarder dressing. Further review of the TARs revealed wound care was not completed on 03/03/25, 04/23/35, 05/02/25, 05/10/25, 05/22/25, 06/03/25, 06/05/25, 06/07/25, 06/21/25, 06/22/25, 06/30/25, 07/31/25, 08/10/25, and 08/23/25. 2. Review of the medical record for Resident #134 revealed he was admitted on [DATE] with diagnoses that included disorder of lipoprotein, myelodysplastic syndrome (disorder affecting bone marrow), and non-pressure chronic ulcer of the right heel and midfoot with the fat layer exposed. Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #160 was moderately cognitively impaired, and he did not refuse care.Review of the current care plan for Resident #134 revealed he had impaired skin integrity. The interventions included wound treatment as ordered.Review of the physician orders and TARs for Resident #134 revealed orders beginning on 08/21/25 for daily wound care to a diabetic foot ulcer on his right foot to cleanse with normal saline, pat dry, apply petroleum jelly, apply Xeroform (a petroleum infused dressing), and cover with boarder gauze. Further review of the TAR revealed wound care was not completed on 08/23/25, 08/24/25, and 08/28/25.Continued review of the physician orders and TARs for Resident #134 revealed orders beginning on 08/28/25 for daily wound care to a diabetic foot ulcer on his right foot to cleanse with normal saline, pat dry, apply hydrogel, apply Xeroform, and cover with a foam dressing. Further review of the TAR revealed wound care was not completed on 08/28/25.Interview on 09/11/25 at 4:10 P.M. and 5:20 P.M. with the Director of Nursing (DON) confirmed wound care was not completed for Resident #127 on 03/03/25, 04/23/35, 05/02/25, 05/10/25, 05/22/25, 06/03/25, 06/05/25, 06/07/25, 06/21/25, 06/22/25, 06/30/25, 07/31/25, 08/10/25, and 08/23/25 as ordered, and for Resident #134 on 08/23/25, 08/24/25, and 08/28/25 as ordered. 3. Review of the medical record for Resident #160 revealed he was admitted on [DATE] with diagnoses that included cerebral palsy, lymphedema, and cellulitis of bilateral lower extremities. Review of the admission MDS assessment dated [DATE] revealed Resident #160 was Residents Affected - Few (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 3 Event ID: 365624 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 365624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Majestic Care of Perrysburg 28546 Starbright Blvd Perrysburg, OH 43551 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)