Health inspection·October 29, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm receive necessary treatment and services to promote healing, prevent infection, and prevent new injuries from developing which was consistent with professional standards of practice.This deficiency represents non-compliance investigated under Complaint Number 2649063. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 2 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

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 record review and interview, the facility failed to ensure physician orders were obtained and wound care provided for Resident #28's pressure ulcer wounds. This finding affected one resident (Residents #28) of four residents reviewed for wounds.Findings include:Review of Resident #28's medical record revealed the resident was admitted on [DATE] with diagnoses including muscle weakness, other abnormalities of gait and mobility and cerebral palsy.Review of Resident #28's Alteration in Skin Integrity Care plans dated 10/10/25 revealed to assess for pain and provide treatments per the physician's order. Review of Resident #28's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited severe cognitive impairment.Review of Resident #28's Wound #1 Pressure Skin Grid form dated 10/06/25 revealed the resident had a stage one sacrum pressure wound first identified 10/02/25 (earliest stage of skin damage caused by pressure with intact, non-blanchable erythema and/or pain) which measured 5 centimeters (cm) length by 4 cm width by 0 cm depth. The resident was admitted with the sacrum pressure wound.Review of Resident #28's Wound #2 Pressure Skin Grid form dated 10/06/25 revealed the resident had a right ankle deep tissue injury (DTI) first identified on 10/02/25 which measured 2 cm length by 2.5 cm width by undermined depth (a DTI was a localized area of damage to the skin and underlying soft tissue, caused by intense and/or prolonged pressure, or pressure combined with shear). The resident was admitted with the right ankle pressure wound.Review of Resident #28's Wound #3 Pressure Skin Grid form dated 10/06/25 revealed the resident had a left ankle stage three pressure wound (a full-thickness skin loss involving damage of subcutaneous tissue that may extend into underlying muscle) first identified 10/02/25 which measured 2 cm length by 1 cm width by 0.2 cm depth. The resident was admitted with the left ankle pressure wound.Review of Resident #28's Wound #4 right plantar foot blister first identified on 10/06/25 which measured 2.9 cm length by 1.9 cm width by 0.1 cm depth with moderate serous drainage. The blister was in facility acquired.Review of Resident #28's Wound #5 left planter foot blister first identified on 10/06/25 which measured 3.5 cm length by 3.5 cm width by 0 cm depth. The blister was in facility acquired.Review of Resident #28's medication administration records (MARS) and treatment administration records (TARS) and physician orders from 10/03/25 to 10/27/25 did not reveal evidence of a physician order or wound care to the left ankle on 10/03/25, 10/04/25 and 10/05/25; the DTI to the right ankle on 10/03/25, 10/04/25 or 10/05/25; or the stage one to the sacrum on 10/03/25, 10/04/25 or 10/05/25.Interview on 10/27/25 at 1:58 P.M. with Registered Nurse (RN) Wound Nurse (WN) #902 confirmed wound care orders or treatments were not in place for Resident #28's pressure wounds to the sacrum, the right ankle or the left ankle from 10/03/25 to 10/05/25.Review of the Skin Assessment policy revised 03/15/24 revealed it was the intent of the facility to provide necessary care to prevent the development of pressure injuries unless the resident's clinical condition demonstrates that the development was unavoidable. Residents with pressure injuries shall receive necessary treatment and services to promote healing, prevent infection, and prevent new injuries from developing which was consistent with professional standards of practice.This deficiency represents non-compliance investigated under Complaint Number 2649063. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 3 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

F 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure Resident #12 received podiatry services in a timely manner. This finding affected one (Resident #12) of four resident records reviewed for auxiliary services.Findings include:Review of Resident #12's medical record revealed the resident was initially admitted on [DATE], sent out to the hospital on [DATE], sent to a rehab center on 08/04/25 and readmitted to the facility on [DATE] with diagnoses including muscle weakness, vascular dementia and epilepsy. Review of Resident #12's auxiliary services form dated 10/14/25 revealed a consent for vision, podiatry, dental and audiology. Observation on 10/27/25 at 9:24 A.M. with Certified Nursing Assistants (CNAs) #806 and #850 of Resident #12's activities of daily living (ADLs) including dressing and incontinence care did not reveal concerns. The resident appeared clean, and the fingernails appeared clean. Further observations revealed the resident's right and left great toes were long with thickened, yellow toenails.Interview on 10/27/25 at 9:28 A.M. with CNA #806 confirmed Resident #12 had thickened yellowed toenails on the bilateral great toes.Interview on 10/27/25 at 10:49 A.M. with Social Services Designee (SSD) #883 revealed Resident #12 was a skilled patient who was admitted on [DATE], went out to the hospital on [DATE] for a suspected cerebrovascular accident (CVA), was transferred to another facility for rehab on 08/04/25 and transferred back to the current facility on 09/03/25. She stated she was unaware the resident required dental or podiatry services until a care conference which was completed on 10/24/25.A second interview on 10/27/25 at 1:44 P.M. with SSD #883 confirmed a consent for auxiliary services was not obtained when the resident was admitted on [DATE]. She confirmed a consent for services was obtained on 10/14/25 for Resident #12 to see the dentist, audiologist, podiatrist and optometrist. Interview on 10/27/25 at 2:08 P.M. with Regional Nurse (RN) Regional #904 revealed the facility did not have a specific policy related to podiatry services.Interview on 10/27/25 at 2:24 P.M. with the Administrator confirmed the podiatrist's last visit to the facility was on 09/30/25 and the next visit should be 10/28/25.This deficiency represents non-compliance investigated under Complaint Number 2649063. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 4 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, policy review, and interview, the facility failed to develop and implement a comprehensive, individualized and effective nutrition/hydration plan to prevent weight loss and dehydration for Resident #12. This affected one resident (#12) of three residents reviewed for significant weight loss. The census was 65. Actual harm occurred on 10/01/25 when Resident #12, who had moderate cognitive impairment, was at moderate risk for malnutrition, required cues and assist with eating, and had a care-planned intervention to monitor and provide hydration as prescribed, was assessed to weigh 189.4 pounds representing a 17.3 pound or 8.3 percent (%) severe weight loss in two weeks. The resident was transferred to the hospital (on 10/01/25) and admitted with a change in mental status secondary to dehydration with a five-day hospital stay requiring intravenous fluids. Prior to the hospitalization, the facility failed to ensure ongoing weight monitoring was completed and failed to implement adequate interventions to address the resident's decrease in meal intakes resulting in the weight loss. Findings include:Review of the medical record for Resident #12 revealed an original admission date of 06/10/25, discharge date of 07/27/25 to the hospital, then readmission date of 09/03/25 from another skilled nursing facility (SNF). Resident #12's diagnoses included dementia, cognitive communication deficit, hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, diabetes, muscle weakness, epilepsy and chronic viral hepatitis C. Resident #12 resided on the secured memory care unit.Review of the weight summary from Resident #12's prior admission of 06/10/25 to 07/27/25 in the weights/vitals tab in the electronic medical record (EMR) revealed the resident weight 211 pounds on 06/10/25, 215 pounds on 06/24/25, 215.5 pounds on 07/01/25 and 215.3 pounds on 07/15/25.Review of an admission Assessment and Baseline Care Plan dated 09/03/25 (with a lock date of 09/18/25) revealed Resident #12 was confused, unaware of safety needs and needed assistance with meals. Resident #12's most recent weight was documented to be 206.5 pounds from 09/17/25. There was no evidence that Resident #12 was edematous upon admission.Review of the physician orders from September 2025 revealed Resident #12 was ordered hydrochlorothiazide (a diuretic medication) oral capsule 12.5 milligrams give one capsule by mouth once time a day for edema. The order began on 09/04/25.Review of the Skilled Nursing Note dated 09/06/25 timed 5:51 A.M. revealed there was no evidence Resident #12 had worsening edema or a change in fluid intake.Review of the Skilled Nursing Note dated 09/06/25 timed 11:12 P.M. revealed there was no evidence Resident #12 had worsening edema or a change in fluid intake.Review of the Skilled Nursing Note dated 09/07/25 timed 8:20 P.M. revealed there was no evidence Resident #12 had worsening edema or a change in fluid intake.Review of the Skilled Nursing Note dated 09/10/25 timed 5:44 P.M. revealed there was no evidence Resident #12 had worsening edema.Review of the encounter note dated 09/10/25 timed 11:09 A.M. for date of service of 09/05/25 authored by Nurse Practitioner (NP) #906 revealed there was no evidence Resident #12 was edematous.Review of an encounter note dated 09/10/25 timed 11:10 A.M. for date of service of 09/09/25 authored by NP #906 revealed there was no evidence Resident #12 was edematous.Review of the Minimum Data Set (MDS) 3.0 admission assessment dated [DATE] revealed Resident #12 was moderately cognitively impaired, used a walker and a manual wheelchair for mobility, had no natural teeth and required (staff) setup or clean-up assistance with eating. There was not a recorded weight included in the assessment.Review of a Malnutrition Risk assessment dated [DATE] revealed Resident #12 was at moderate risk for malnutrition.Review of the Nutrition assessment dated [DATE] authored by Diet Technician Registered (DTR) #860 revealed Resident #12's most recent weight was 215.3 pounds from 07/15/25. The assessment revealed Resident #12 had fair-good intake majority of meals per nursing aide intake records. The resident fed self meals with cues Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 5 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

F 0692 Level of Harm - Actual harm Residents Affected - Few and assist as needed. Resident #12's estimated calorie, protein, and fluid requirements were not calculated. DTR #860 wrote would assess estimated needs when admission weight available. Goals: weight without unplanned significant changes (5% in 30 days, 10% in 180 days) and intakes of at least 75% most meals provided. There was no evidence Resident #12 had edema/accumulation of fluid.Review of the potential for alteration in nutrition and hydration care plan dated 09/11/25 revealed Resident #12 was at risk for malnutrition with a goal of no signs or symptoms of dehydration/electrolyte imbalance/fluid overload. Interventions included: assistance with meals as needed, monitor for signs and symptoms of dehydration and weights per protocol.Review of the Skilled Nursing Note dated 09/12/25 timed 8:42 P.M. revealed there was no evidence Resident #12 had worsening edema or a change in fluid intake.Review of an encounter note dated 09/14/25 timed 4:38 P.M. for date of service of 09/12/25 authored by NP #906 revealed there was no evidence Resident #12 was edematous.Review of an activities of daily living (ADL) care plan dated 09/14/25 revealed Resident #12 may require assistance with ADL's and may be at risk for developing complications associated with decreased ADL self-performance related to hemiplegia, diabetes, vascular dementia, epilepsy and hepatitis C. Interventions included: eating - supervision and cueing.Review of an alteration in elimination care plan dated 09/14/25 revealed Resident #12 was frequently incontinent of bowel and bladder. Interventions included to monitor and provide hydration as prescribed.Review of the medical record revealed required hydration levels were not prescribed and no interventions were implemented to monitor the resident's hydration (as noted in the plan of care). Review of the weight summary in the weights/vitals tab in the electronic medical record revealed Resident #12 weighed 206.5 pounds on 09/17/25.Review of the encounter note dated 09/17/25 timed 3:41 P.M. for date of service of 09/15/25 authored by NP #906 revealed there was no evidence Resident #12 was edematous.Review of the Nutrition and Fluids recording for September 2025 in the task tab of EMR revealed there was no fluid intake amounts recorded for the entire month of September 2025 and revealed the following decreased meal intakes on the following dates:25% of lunch and 1% to 25% of dinner on 09/23/251% to 25% of breakfast and lunch on 09/24/2525% of breakfast and 1% to 25% of lunch on 09/25/251% to 25% of breakfast and lunch and there was no amount recorded for dinner on 09/26/25Refused breakfast on 09/27/2525% of breakfast and there was no amount recorded for dinner on 09/29/251% to 25% at breakfast and there were no amounts recorded for lunch or dinner on 09/30/25There was no evidence of any updates to the resident's plan of care or new interventions during this time to address the resident's decreased meal intakes. Review of a health status note dated 09/23/25 timed 1:54 P.M. revealed family spoke with this nurse regarding resident changes noted. The resident's family felt the resident had something going on with him related to speaking less, eating less and having no motivation in therapy. This nurse spoke with nurse practitioner (NP) who ordered labs and a urinalysis and culture and sensitivity. The NP also stated she would review the resident's medications and see if an antidepressant was needed.Review of the resident's medical record revealed no evidence DTR #860 was notified of the decrease in meal intakes.Review of a speech therapy treatment encounter note dated 09/24/25 authored by Speech Language Pathologist (SLP) #908 revealed saw resident during breakfast on this date. Resident with intake of only cold cereal. Provided moderate cueing to increase oral intake, but resident refused anything else on tray today.Review of an encounter note dated 09/24/25 timed 11:18 AM. for date of service of 09/23/25 authored by NP #906 revealed no evidence Resident #12 was edematous.Review of the Lab Results Report dated 09/24/25 revealed Resident #12's blood urea nitrogen (BUN) was 31 (7 to 25 normal range) and BUN/creatinine ratio was 28 (6 to 22 normal range).Review of the health status note dated 09/25/25 timed 4:48 A.M. revealed NP #906 notified of lab results. Awaiting response.Review of the health status note dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 6 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

F 0692 Level of Harm - Actual harm Residents Affected - Few 09/26/25 timed 8:43 A.M. revealed NP #906 was in today. New order for Citalopram (anti-depressant) 20 milligrams daily. Resident appeared to be sad and food intake had decreased. Spoke with resident's daughter who was in agreement with new order.Review of the encounter note dated 09/27/25 timed 8:09 P.M. for a date of service of 09/26/25 authored by NP #906 revealed per nursing staff, the resident appeared to be depressed with low mood and decreased engagement noted. There was no evidence of weight change. Plan: start Citalopram (an anti-depressant medication) 20 milligrams daily to augment depression treatment and continue Remeron (an anti-depressant medication) 15 milligrams at bedtime.Review of the psychiatry physician progress note dated 09/29/25 revealed staff noted Resident #12 had been weak and unable to sit unsupported in bed and was mostly in bed. Resident #12's appetite was low. Assessment/plan: Vascular dementia with mood disturbance - suspect that prior to seizure patient might have had another cerebrovascular accident (CVA). Suspect that resident was not suffering from underlying depression but rather apathy related to cerebrovascular accident (CVA).Review of the speech therapy treatment encounter notes dated 09/29/25 authored by SLP #908 revealed upon arrival, resident with a full plate in front of him and no attempt to eat anything. SLP asked resident if he would like any of the food and resident just shrugged his shoulders. Attempted to provide resident with bites via spoon from SLP. Resident made a face that would suggest he did not like it. When SLP asked, he just shrugged his shoulders and stated that would be fine but did not attempt to feed self anymore and did not accept any more bites from SLP. Provided resident with several food options and resident shrugged shoulders for all options. Attempted to put ice in his Boost that he had available to make it more palatable, but resident continued to make a digested face when drinking. Educated on importance of continued intake and resident stated he would agree to continue taking sips of his Boost throughout morning. SLP discussed decreased intake with nurse who reported the resident had recently started a depression medication and believed him to be depressed which may be affecting intake.Review of the speech therapy treatment encounter notes dated 10/01/25 authored by SLP #908 revealed Resident #12 provided with a snack this morning which he required mod-max cues to self-feed. Resident with increased mastication time for regular textures, but adequate prior to swallow. Saw resident at lunch on this date as well. Resident with minimal attempts to self-feed. Was able to use head nods to let SLP know which foods he would like to eat and was agreeable to allow SLP to provide bites via spoon. SLP educated nurse on need for increased assistance with feeding. Record review revealed no new nutritional/hydration interventions were initiated at this time.Review of the weight summary in the weights/vitals tab in the electronic medical record revealed Resident #12 weighed 189.2 pounds on 10/01/25 (a 17.3-pound or 8.3% weight loss in two weeks).Review of the health status note dated 10/01/25 timed 2:24 P.M. revealed Resident #12 chewed up food then spit out food, flat affect. This nurse notified Physician #905 requesting electroencephalogram (EEG) (a procedure that measured the electrical activity of the brain). The note revealed the nurse was waiting on return call.Review of a health status note dated 10/01/25 timed 4:04 P.M. revealed Resident #12 was confused, not eating, unable to walk, not talking. The NP ordered for the resident to go to emergency room for evaluation (recent cerebrovascular accident (CVA), possible recent seizure). 911 called and resident transferred to hospital for evaluation.Review of a hospital After Visit Summary revealed Resident #12 was admitted to the hospital from [DATE] to 10/05/25 with diagnosis and treatment of altered mental status suspect secondary to dehydration. The note included initially urinary tract infection (UTI) was suspected but was ruled out. The resident was also noted to have dehydration with an elevated BUN to creatinine ratio. Urine specific gravity > 1.04. The hospital record included the resident's daughter reported that patient was started on diuretics for leg edema in last one week at extended care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 7 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

F 0692 Level of Harm - Actual harm Residents Affected - Few facility (ECF). Currently not on any diuretics. Treated with intravenous hydration. At discharged , no diuretics. Currently no edema.Review of Resident #12's medical record revealed the resident returned to the facility on [DATE] and was not weighed on this date of readmission. Review of a Nutrition assessment dated [DATE] authored by DTR #860 revealed Resident #12 was at risk for malnutrition due to.diuretic treatment, recent hospitalization, UTI, decreased intake, and significant weight loss (SWL). Resident #12 had a weight loss of 5% or more in the last month or loss of 10% or more in the last six months and was not on a prescribed weight-loss regimen. The resident was flagging as a significant weight loss of 5.2%/10.9 pound loss in 30 days. Weight loss was not desirable. Resident had moisture-associated dermatitis on buttocks upon readmission. Supplement recommended to support skin healing. Nutritional interventions included weights as ordered and a recommendation to start 240 milliliter of nutritional supplement, Boost Glucose Control once a day. Review of Resident #12's physician orders revealed diabetic house supplement (Boost) was started 10/14/25, nine days after being readmitted to the facility. Review of the weight summary in the weights/vitals tab in the EMR revealed Resident #12 weighed 190.3 pounds on 10/14/25 and weighed 189.4 pounds on 10/21/25. Observation on 10/27/25 at 6:50 A.M. revealed Resident #12 was lying in bed and had no bottom teeth. There were no fluids observed within the resident's reach.Observation on 10/27/25 at 8:14 A.M. revealed CNA #840 served Resident #12's breakfast meal. CNA #840 placed a clothing protector on Resident #12 and the resident's bed was raised to a higher position. CNA #840 put jelly on the toast and placed the tray over top of the bed. The meal consisted of oatmeal, toast, a banana, milk, orange juice and water. Resident #12 was able to eat the banana independently. The resident began eating in bed. At 8:25 A.M., CNA #840 was standing next to the resident's bed feeding oatmeal to him. Observation on 10/27/25 at 8:43 A.M. revealed Resident #12 was lying in bed. There were no fluids within reach.Interview on 10/27/25 at 9:45 A.M with DTR #860 revealed it was facility protocol to obtain weekly weights for four weeks after admission for all residents. DTR #860 verified the facility did not obtain an admission weight for Resident #12, verified Resident #12's weight was not obtained until 09/17/25 and verified a weight was not obtained on or around 09/24/25. DTR #806 requested a weight via email from the Director of Nursing, Assistant Director of Nursing (ADON) #825 and ADON #909 on 09/08/25. ADON #825 and ADON #909 responded on the same day, and they were writing up the staff who did not get his weight, they were furious and they would make sure the weight was done. DTR #860 verified Resident #12 had a 17.3 pound weight loss from 09/17/25 to 10/01/25.Observation on 10/27/25 at 9:50 A.M. revealed Resident #12 was observed for wound care. There were no fluids within the resident's reach.Observation on 10/27/25 at 10:54 A.M. revealed Resident #12 was lying in bed with his eyes closed. There were no fluids within the resident's reach.Observation on 10/27/25 at 11:45 A.M. revealed Resident #12 was lying in bed with his eyes closed. There were no fluids within the resident's reach.Interview on 10/27/25 at 12:00 P.M. with SLP #908 revealed around 09/24/25, Resident #12 had decreased meal intake, was staring off into space and wasn't being himself.Interview on 10/27/25 at 12:50 P.M. with the Administrator (with the DON present) verified the facility did not obtain an admission weight for Resident #12 and verified a weight was not obtained until 09/17/25. The Administrator reported a belief that the scale used to weigh Resident #12 was inaccurate/ off. However, the Administrator was unable to provide a reason why the two weights on different dates were stable 189 to 190 pounds following the resident's readmission on [DATE].Interview on 10/27/25 at 2:30 P.M. with Resident #12's mother revealed she had noticed whenever she would bring food into Resident #12, he would eat like he hadn't been eating. The mother indicated on 10/01/25, Resident #12 wasn't feeling good, he wasn't' responding and Resident #12's mother talked to the nurse to notify the nurse that something was wrong. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366479 If continuation sheet Page 8 of 9 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 366479 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Timberland Ridge Nursing & Rehabilitation 3558 Ridgewood Road Fairlawn, OH 44333 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)

F 0692 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During the interview, Resident #12's mother stated, they (the staff) would set his food tray out and leave him to feed himself.Interview on 10/27/25 at 2:45 P.M. with the DON verified Resident #12 had a decrease in meal intake around 09/24/25 and verified DTR #860 was not notified of the resident's decreased meal intake.Interview on 10/27/25 at 3:45 P.M. with Resident #12's daughter (first emergency contact) revealed Resident #12 needed assistance with meals and set-up assistance with meals. Resident #12's daughter voiced concerns the resident's meals would be left on his bedside table and the lid would sometimes be left on.Interview on 10/27/25 at 4:55 P.M. with the DON verified Resident #12's weight was not obtained when he readmitted on [DATE] and a weight was not obtained until 10/11/25. The DON did not provide a reason as to why a readmission weight was not obtained. Interview on 10/28/25 at 11:10 A.M. with Physician #905 revealed Resident #12 had very slight edema during September 2025. Resident #12 was prescribed hydrochlorothiazide for blood pressure control. Physician #905 revealed he was notified Resident #12 had a 17 pound weight loss and was aware the resident had decreased oral intake and indicated speech therapy was working with the resident. When Physician #905 was asked if 12.5 milligrams of hydrochlorothiazide would cause a 17 pound weight loss in two weeks with very slight edema, Physician #905 responded, no.Review of the facility's Weight Monitoring policy revealed the facility would ensure all residents maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrated that that was not possible or resident preference indicate otherwise. A comprehensive nutritional assessment was completed upon admission to identify those at risk for unplanned weight loss/gain or compromised nutritional status. Information gathered from the nutritional assessment and current dietary standards of practice were used to develop an individualized care plan to address the resident's specific nutritional needs, including the resident's personal goals and preferences. Interventions were implemented, monitored and modified (as appropriate), consistent with the resident's assessed needs, choices, preferences, goals and current professional standards to maintain acceptable parameters of nutritional status. A weight monitoring schedule was developed upon admission for all residents. Newly admitted residents' weight will be monitored as close to weekly as possible for the initial 4 weeks and at least monthly thereafter. At the direction of the practitioner in collaboration with the facility, weights may be monitored more frequently as clinically indicated. Newly recorded weights were compared to the previous recorded weights. A significant weight change is defined as:a. 5% change in one monthb. 7.5% change in three monthsc. 10% change in six monthsSignificant changes in weight are reported to the practitioner.This deficiency represents non-compliance investigated under Complaint Number 2649063. Event ID: Facility ID: 366479 If continuation sheet Page 9 of 9