Addison Heights Health And Rehabilitation Center
Inspection Findings
F-Tag F0584
F 0584
about two or three months ago and have not yet been completed.
Level of Harm - Minimal harm or potential for actual harm
Interview with Director of Nursing (DON) on 09/11/25 at 9:51 A.M. confirmed the drywall repair spots and hanging repair tape from ceiling in resident #23's room.
Residents Affected - Some
Review of the facility policy titled, “Homelike Environment”, dated February 2021, revealed residents are provided with a safe, clean, comfortable and homelike environment. The facility staff and management maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics include clean, sanitary, and orderly environment.
This deficiency represents non-compliance investigated under Complaint Number 2608577 and Complaint Number 2593504.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Addison Heights Health and Rehabilitation Center
3600 Butz Rd 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)
F-Tag F0636
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0636 during a standard health inspection conducted on 2025-09-15.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-12-22.
F-Tag F0655
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0655 during a standard health inspection conducted on 2025-09-15.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-12-22.
F-Tag F0677
F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
hemorrhage, bipolar disorder, hypertension, anemia, vascular myelopathies, and fracture of fourth lumbar vertebra.
According to the most current minimum data set assessment dated [DATE REDACTED] Resident #44 was assessed with intact cognition, no resistive behaviors, range of motion impairment to the bilateral upper extremities, utilized a walker or wheelchair for mobility, independent with transferring, required substantial to maximal assistance with activities of daily living, sustained two or more falls since admission.
On 04/10/25 a nursing plan of care was developed to address Resident #44 functional abilities impaired self-care and mobility deficit. Interventions included the following; Assist with bed mobility needs. Assist with upper and lower body dressing. Assist with personal hygiene. Assist with putting on and taking off footwear.
Review of Resident #44 Activity of Daily Living (ADL) task noted showers scheduled for Mondays and Thursdays.
Review of shower sheets and ADL bathing report from 08/09/25 to 09/08/25 documented showers provided
on 08/11/25, 08/18/25, 08/25/25, and 08/28/25. This resulted in four of nine scheduled shower opportunities being provided.
On 09/08/25 at 12:52 P.M. observation noted Resident #44 seated on his bedside in his room. Resident #44 stated he was unsure who his assigned Certified Nurse Assistant was for the day. Resident #44 was observed with heavy beard growth and greasy hair and stated he was supposed to receive a shower on Monday and Thursday, and often does not get his showers as scheduled. Resident #44 stated the wound specialist left dressings off his legs due to scheduled shower today.
On 09/08/2025 at 2:52 PM interview with Certified Nurse Aide (CNA) #481 discovered to be assigned to Resident #44 care between 7:00 A.M. and 3:00 P.M. CNA #481 stated Resident #44 was scheduled for a Tuesday/Friday shower and one was not provided today. Review of activity of daily living (ADL) task documentation with CNA #481 verified Resident #44 was to receive a shower on Monday and Thursday.
Further review of ADL task lacked documentation indicating showers were provided as scheduled.
On 09/11/25 at 10:45 A.M. interview with the Director of Nursing verified all showers were not provided as scheduled.
Review of facility Activities of Daily Living (ADL) policy revised April 2025 stated appropriate care and services are provided for residents who are unable to carry out ADL's independently, with the consent of
the resident, and in accordance with the plan of care, including appropriate support and assistance with hygiene (bathing, dressing, grooming, and oral care). The residents responses to interventions are monitored, evaluated, and revised as appropriate.
This deficiency represents non-compliance investigated under Complaint Number 2593504 and Complaint Number 2608577.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Addison Heights Health and Rehabilitation Center
3600 Butz Rd 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)
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
stated the fleece boots did not belong to him. CNA #402 stated she was unaware of which boots were the residents.
Interview with Resident #45 on 09/09/25 at 10:56 A.M. revealed the resident wished to have the compression stocking applied, but staff failed to do so. The resident stated he had requested a new mattress on multiple occasions as he was lying flat on a hard surface, but that a new mattress has yet to be supplied.
Telephone interview with the wound care and hyperbaric center Wound Specialist Physician Assistant #02
on 09/11/25 at 10:26 A.M. revealed Resident #45's wounds were slow to heal and the lack of a functioning air mattress and not elevating the residents' lower extremities could contribute to the slow healing of Resident #45's wounds.
Observation of Resident #45 on 09/11/25 at 10:44 A.M. revealed a new air mattress had been placed on Resident #45's bed and was functioning. Compression stockings were in place, however the resident had no offloading boots in place.
Interview with Licensed Practical Nurse (LPN) #442 on 09/11/25 at 10:46 A.M. verified Resident #45's did not have the offloading boots in place.
The facility provided an Emerald Selectis User Manual for low air mattress model number 61057 referred to
a manufacturer website. Review of the Emerald Selectis Model #61057 alternating pressure pump and mattress User Manual found at the following website: https://d16g73uzcqb35u.cloudfront.net/img/product/6a/6a4348c9-1986-4ce3-bbaf-04adc9e0445c/6105761058airmattressu stated there was a visible indicator (yellow or red) warns that the pressure is below a preset or user-defined level. There is also an audible and visible alarm which turns on after 2.5 minutes when the pressure is low.
Also, a mute button is available to mute the audible alarm.
Review of wound care policy revised October 2010. Verify there is a physicians order for this procedure.
Review the residents care plan to assess for any special needs of the resident.
This deficiency represents non-compliance investigated under Master Complaint Number 2652561 and Complaint Numbers 2576517, 2608577, and 2593504.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Addison Heights Health and Rehabilitation Center
3600 Butz Rd 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)
F-Tag F0686
F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
for pressure ulcers, had a stage III pressure ulcer to the bilateral gluteal area and had two arterial and venous ulcers and moisture associated with skin damage. He required a pressure-reducing device for the bed and non-surgical dressings.
Review of the current physician orders for the stage III pressure ulcer to the bilateral gluteal area included for the area to be cleansed with a wound solution, zinc oxide to be applied followed by a bordered dressing three times a week. The pressure ulcer was to be offloaded using an alternating air mattress.
Observation of Resident #45 ' s buttock wound on 09/15/25 at 1:45 P.M. revealed the buttock area was red and was open to air. There were four deep red areas; two on each side of the intergluteal cleft. No dressing was in place as it was left open to air.
Review of the facility policy titled, Wound Care, dated October 2010, revealed the purpose of wound care is to provide the care of wounds to promote healing.
This deficiency represents non-compliance investigated under Complaint Numbers 2576517 and 2612561.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Addison Heights Health and Rehabilitation Center
3600 Butz Rd 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)
F-Tag F0689
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0689 during a standard health inspection conducted on 2025-09-15.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-12-22.
F-Tag F0695
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0695 during a standard health inspection conducted on 2025-09-15.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Provide safe and appropriate respiratory care for a resident when needed.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-12-22.
F-Tag F0727
F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many
FORM CMS-2567 (02/99) Previous Versions Obsolete
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on
a full time basis.
Based on staff interview, and review of facility staffing documentation, the facility failed to ensure a Registered Nurse was scheduled eight consecutive hours when the facility exceeded a census of 60 residents. This affected all 60 residents residing in the facility. Review of facility staffing documentation and related schedules between 09/01/25 and 09/07/25. Facility census was 61 current residents on 09/04/25, 09/05/25, 09/06/25. The facility Director of Nursing was listed as the only Registered Nurse in the facility. On 09/11/25 at 1:07 P.M. interview with Scheduling Coordinator (SC) #466 during a review of facility schedules between 09/01/25 and 09/07/25 verified no additional Registered Nurse was scheduled in the facility on 09/04/25, 09/05/25, 09/06/25. SC #466 also confirmed the facility exceeded a resident census of 60 on each of the three days. This deficiency represents non-compliance investigated under Complaint Number
- 2608577. Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/15/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Addison Heights Health and Rehabilitation Center
3600 Butz Rd 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)
F-Tag F0761
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0761 during a standard health inspection conducted on 2025-09-15.
Category: Pharmacy Service Deficiencies
The facility was found deficient in the following area: Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-12-22.
F-Tag F0802
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0802 during a standard health inspection conducted on 2025-09-15.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-12-22.
F-Tag F0812
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-09-15.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has plan of correction.
The facility reported correction as of 2025-10-12.
F-Tag F0880
Federal health inspectors cited ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-09-15.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 14 deficiencies cited during this inspection of ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER.
Correction Status: Deficient, Provider has plan of correction.
The facility reported correction as of 2025-10-12.
F-Tag F0925
F 0925 Level of Harm - Minimal harm or potential for actual harm
with wings that were dark in color on Resident #18's lunch tray and cups, and multiple other insects that were dark in color flying throughout Resident #18's room. 6.) Interview on 09/10/25 at 3:03 P.M. with Certified Nursing Assistant (CNA) # 468 revealed that throughout the facility small flying insects can be seen, especially in the medical storage room.
Residents Affected - Some
Observation on 09/11/25 at 12:43 P.M. with the Director of Nursing (DON) of the medical supply storage room confirmed small flying insects were present. On top of a filing cabinet was a pizza box with leftover pizza inside and coming out of the box were small flying insects. Approximately three feet from the pizza box was the residents drink cart which contained a cooler full of ice, drink cups, lids, and straws. The small flying insects were seen in the vicinity of the drink cart. All sightings in the medical storage room were verified by the DON. 7.) Observation of Resident #45's room window on 09/09/25 at 2:38 P.M. revealed the resident's window screen failed to fit properly. There was an approximate one inch gap between the screen and the window which allowed for insects to enter the room. Further observation revealed gnats were flying around the resident's bed.
Observation on 09/11/25 at 12:15 P.M. revealed Licensed Practical Nurse (LPN) #444 was speaking to Resident #45 at bedside and gnats were flying around the nurses head and the nurse had to swat them away.
Interview with Resident #45 on 09/09/25 at 2:38 P.M. revealed gnats and horse flies would enter his room often and he would like the window screen repaired to fit the window. 8.) Observation of room [ROOM NUMBER] on 09/10/25 at 12:01 P.M. revealed three gnats were on the privacy curtain and multiple gnats were flying around the resident's meal trays.
Interview with Residents #22 and #51 on 09/10/25 at 12:02 P.M. revealed gnats flew around them as they were trying to eat their meals and they wished the facility had an active pest control plan.
Review of facility pest activity report noted treatment applications completed between 06/27/25 and 08/25/25. On 06/27/25 treatment was initiated for fungus gnats in employee areas. On 07/28/25 treatment for house flies, small fruit flies in employee areas, On 08/25/25 treatments were applied for house flies and small flies in employee areas. No documented treatments included resident areas.
Continued observations throughout the survey week revealed small flying insects in the conference room,
in residents' rooms, and at the nurses' stations.
Review of the facility policy titled, “Homelike Environment”, dated February 2021, revealed residents are provided with comfortable and homelike environment.
This deficiency represents non-compliance investigated under Complaint Numbers 2593504, 2608577, and
- 2593728. FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER in MAUMEE, OH inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in MAUMEE, OH, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from ADDISON HEIGHTS HEALTH AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.