Inspection·February 11, 2025

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** Based on review of the medical record, staff interview, resident interview, and policy review, the facility failed to ensure wound care treatments were completed per physician orders. This affected one resident (#18) of three residents reviewed for wound care. The facility identified five residents with wounds. The facility census was 44. Residents Affected - Few Findings include: Review of the medical record for Resident #18 revealed an admission date of 09/05/24. Diagnoses included paraplegia, chronic obstructive pulmonary disease, pressure ulcer of sacral region stage four, and hypertension. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #18 had intact cognition. The resident was at risk for pressure ulcers and had a stage four pressure ulcer present on admission. Review of the skin risk assessment dated [DATE] revealed the resident was at moderate risk for skin breakdown. Review of a physician order dated 01/29/25 revealed to cleanse sacral wound with wound cleanser, apply calcium alginate to wound bed, pack remaining space with normal saline gauze and cover with border gauze every Monday, Wednesday, Friday and as needed. Review of a nurse practitioner (NP) wound note dated 02/05/25 revealed the resident had a stage four pressure ulcer to the sacrum. The NP noted the wound dressing was removed but there was no primary dressing present on the wound at this time. The wound measured two centimeters (cm) in length, 7.5 cm in width, and 1.5 cm in depth. The wound was 30 percent epithelial tissue, 40 percent granulation tissue, 20 percent slough and zero percent eschar. The wound edges were unattached. There was a moderate amount of serosanguineous drainage. The surrounding skin was fragile, had scarring, was red, and macerated. The NP ordered a new wound treatment to cleanse wound with wound cleanser, apply collagen, calcium alginate to base of wound, secure with bordered gauze, change daily and as needed. Review of a nurses note by Licensed Practical Nurse (LPN) #386 dated 02/09/25 at 6:12 P.M., revealed the resident's wound dressing change was done as needed due to being soiled. Review of a physician order dated 02/09/25 at 10:53 P.M. revealed to cleanse the sacral wound with wound cleanser, place collagen to immediate wound bed, then pack remaining wound space with calcium alginate and secure with border gauze every dayshift and as needed for wound care. (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: 365952 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 365952 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood Manor 3231 Manley Road Maumee, OH 43537 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)