Inspection·December 4, 2025

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident and staff interview, medical record review, review of shower sheets, review of designated smoking times, and review of facility policies, the facility failed to maintain a resident's choice for bathing and smoking when the facility failed to ensure these activities were provided as scheduled. This affected one (#19) of two residents reviewed for activities of daily living and two (#29 and #51) of four residents reviewed for smoking. The facility census was 45.Findings include: 1. Review of Resident #19's medical record revealed an admission date of 11/01/22. Diagnoses included traumatic brain injury, hypertension, and legal blindness. Review of Resident #19's Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15 indicating the resident was cognitively intact. Resident #19 required set up with showering and bathing. Resident #19 displayed rejection of care behaviors four to six days during the review period. Review of Resident #19's care plan revised 11/20/25 revealed supports and interventions for impaired visual function, potential for falls, and self-care deficit. Self-care deficit supports included providing assistance with bathing/showering. Review of Resident #19's shower sheets for the last 30 days revealed on 12/01/25 Resident #19 shower was documented as not applicable. Observation on 12/01/25 at 9:03 A.M. of Resident #19 found her hair appeared unwashed and uncombed. Interview on 12/01/25 at 9:07 A.M. with Resident #19 found her to be alert and aware. Resident #19 reported her shower days were Mondays and Thursdays on first shift. Resident #19 stated she had not gotten a shower yet and with it being after 9:00 A.M. she most likely would not be getting one that day. Resident #19 stated when she was showered it was earlier in the day. Resident #19 stated she was not able to shower without assistance. Observation on 12/02/25 at 8:08 A.M. of Resident #19 found her to be seated in her chair in her room. Resident #19 was wearing the same clothes as the previous day and her hair continued to be unwashed. Interview on 12/02/25 at 8:09 A.M. with Resident #19 verified she did not get her shower yesterday as scheduled. Resident #19 reported she wanted a shower but no one ever came in to get her for her scheduled shower. Resident #19 stated she would have to wait until Thursday now since that was her scheduled shower day. Resident #19 stated she washed herself up in the sink but did not get the shower (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 12/04/2025 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)