Timberland Ridge Nursing & Rehabilitation

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.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/29/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Timberland Ridge Nursing & Rehabilitation

3558 Ridgewood Road Fairlawn, OH 44333

SUMMARY STATEMENT OF DEFICIENCIES

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.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

10/29/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Timberland Ridge Nursing & Rehabilitation

3558 Ridgewood Road Fairlawn, OH 44333

SUMMARY STATEMENT OF DEFICIENCIES

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.

Facility ID: