Health inspection·December 1, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on observation, resident interview, staff interview, medical record review, review of Resident Council meeting minutes, and review of facility policy, the facility failed to ensure residents who were dependent for care received showers as scheduled. This affected three (#1, #25, and #31) of three residents reviewed for showers. The facility census was 54.Findings include:1. Review of Resident #1's medical record revealed an admission date of 07/23/25. Diagnoses included atrial fibrillation, weakness, and parkinsonism (causes movement problems such as tremors, stiffness and slow movements and balance issues).Review of the Minimum Data Set (MDS) assessment, dated 10/28/25, revealed Resident #1 was cognitively intact and required maximal (staff) assistance with activities of daily living (ADLs).Review of the care plan, revised on 08/12/25, revealed Resident #1 had and ADL self-care performance deficit related to parkinsonism. Interventions included providing a sponge bath when a full bath or shower could not be tolerated, and the resident required maximum (staff) assistance for shower/bath.Review of Resident #1's bathing documentation for November 2025 revealed the resident was scheduled to receive a bed bath every Tuesday and Friday on day shift. Further review of the documentation revealed Resident #1 received a bed bath on 11/04/25 and 11/18/25 (two of eight opportunities). Additional review revealed no evidence Resident #1 was provided a bed bath on any other days in November 2025. Observation on 11/25/25 at 8:30 A.M. of Resident #1 revealed the resident had long fingernails with dirt under them. Resident #1 had dry skin on his head and face.Interview on 11/25/25 at approximately 8:35 A.M. with Resident #1, with a family member present, revealed his last bed bath was about one week ago, when his family member provided him one. Resident #1 stated he could not recall the last time that staff washed his entire body. Resident #1's family member stated the resident would go weeks without a bed bath and the concerns had been expressed to the Administrator and the Director of Nursing (DON) on multiple occasions, without resolution.Interview on 12/01/25 at 1:50 P.M. with the Director of Nursing (DON) verified that Residents #1 did not receive showers as scheduled. The DON further confirmed issues with showers had been brought to her and the Administrator's attention and education had been given to staff; however, no evidence was provided related to the education or any corrective action taken by the facility.2. Review of the medical record for Resident #25 revealed an admission date of 05/01/25. Diagnoses included dementia, muscle weakness, and depression.Review of the quarterly MDS assessment, dated 11/05/25, revealed Resident #25 was cognitively impaired. Resident #25 was assessed to require substantial (staff) assistance for toileting, bathing, and personal hygiene.Review of the care plan, dated 05/01/25, revealed Resident #25 had an ADL self-care performance deficit related to activity intolerance, dementia, fatigue, and impaired balance.Review of the shower documentation for November 2025 revealed Resident #25 was scheduled for showers on Monday and Thursdays. Further review revealed no evidence Resident #25 received showers on 11/10/25, 11/13/25 or 11/24/25.Observation on 11/25/25 at 10:30 A.M. revealed Resident #25 was sitting in the common area with food visible on his shirt and face. Interview on 12/01/25 at 1:50 P.M. with 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 6 Event ID: 366410 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 366410 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Clare Commons 12469 Five Point Road 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)