Ayden Healthcare Of Oregon

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, medical record review, resident and staff interview, and review of a facility policy, the facility failed to maintain a clean and homelike environment. This affected two (#268 and #269) of 15 residents residing on the 200 hall. The facility census was 90.Findings include:Review of the medical record for Resident #268 revealed she was admitted on [DATE REDACTED] with diagnoses that included urinary retention, chronic pulmonary embolism, depression, hyperlipidemia, and bipolar disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #268 was cognitively intact and did not exhibit behaviors at the time of the assessment.Review of the medical record for Resident #269 revealed she was admitted on [DATE REDACTED] with diagnoses that included chronic obstructive pulmonary disease, atrial fibrillation, anxiety, depression, and hypertension Review of the MDS assessment dated [DATE REDACTED] revealed Resident #269 was cognitively intact and did not exhibit behaviors at the time of the assessment.Observation on 12/22/25 at 9:40 A.M. of the 200 hall revealed, between room [ROOM NUMBER] and room [ROOM NUMBER], there was a metal ceiling tile support track hanging down approximately three inches and two ceiling tiles with round orange-brown stains approximately three inches in diameter. Continued observation revealed two ceiling tiles with round orange-brown stains approximately six inches in diameter between room [ROOM NUMBER] and room [ROOM NUMBER], and outside room [ROOM NUMBER] and room [ROOM NUMBER] was an excess amount of dust buildup on the vents and surrounding ceiling tiles.Interview on 12/22/25 at 9:55 A.M. with Licensed Practical Nurse (LPN) #650 confirmed the

observations of the stained ceiling tiles, the ceiling tile metal support track hanging, and the excess dust build up on the vents on the 200 hall ceiling.Interview on 12/22/25 at 3:40 P.M. with Resident #268 and Resident #269 revealed they were aware of the conditions of the ceiling on the 200 hall and found the conditions to be bothersome and not homelike.Review of facility policy titled, Quality of Life - Homelike Environment, dated May 2017, revealed the facility would provide a safe, clean, and homelike environment.This deficiency represents non-compliance investigated under Complaint Number 2642376.

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

Event ID:

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

12/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ayden Healthcare of Oregon

3953 Navarre Ave Oregon, OH 43616

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 0684

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, medical record review, staff interview, and review of drug manufacturer instructions for use, the facility failed to ensure a resident was encouraged to use and offered an oral rinse after administration of an orally inhaled medication containing a steroid. This affected one (#263) of three residents reviewed for medication administration. The facility census was 90.Findings include:Review of the medical record for Resident #263 revealed he was admitted on [DATE REDACTED] with diagnoses including emphysema, hypertension, viral hepatitis C, alcohol dependence, cocaine use, and toxic encephalopathy.Review of the Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #263 was cognitively impaired and did not exhibit behaviors at the time of the assessment. Resident #263 utilized a walker and a wheelchair and required moderate assistance with activities of daily living, personal hygiene, bed mobility, and transfers.Review of physician orders for Resident #263 revealed the resident was ordered budesonide-formoterol fumarate dihydrate (Symbicort, a combination drug containing a steroid and a long-acting beta-agonist) 160-4.5 micrograms per actuation (mcg/act), two puffs inhaled orally every 12 hours for shortness of breath.Observation on 12/22/25 at 10:02 A.M. of Licensed Practical Nurse (LPN) #652 administering medications to Resident #263 revealed she administered Symbicort and did not instruct nor encourage Resident #263 to rinse his mouth after the administration of the inhaled medication.Interview on 12/22/25 at 10:15 A.M. with LPN #652 confirmed residents should rinse their mouths after using a steroid inhaler, and confirmed Resident #263 was not offered or encouraged to rinse his mouth following administration of Symbicort.Interview on 12/22/25 at 12:55 P.M. with Registered Nurse (RN) #660 revealed residents should rinse their mouths with water after using a steroid inhaler.Review of the manufacturer's instructions for Symbicort inhaler usage, dated 2018, revealed one of the ingredients was an inhaled corticosteroid budesonide. Further review revealed after inhaling the medication, the user was instructed to rinse their mouth out with water and spit the water out.This deficiency represents an incidental finding discovered

during the complaint investigation.

Residents Affected - Few

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

12/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ayden Healthcare of Oregon

3953 Navarre Ave Oregon, OH 43616

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

#263's amlodipine besylate, Eliquis, and tamsulosin hydrochloride medication cards were left on top of the medication cart in the hallway; each card had nine doses remaining. The medication cart with was out of LPN #652's view from 10:10 A.M. until 10:16 A.M. leaving the medication cards unsecured.Interview on 12/22/25 at 10:16 A.M. with LPN #652 confirmed she left Resident #263's amlodipine besylate, Eliquis, and tamsulosin hydrochloride medication cards, each with nine doses, unsecured on top of the medication cart

in the hallway while she was in Resident #263's room.Observation on 12/22/25 at 3:20 P.M. of Resident #263 revealed he was lying in bed in his room and was awake and conversational. Further observation revealed one Ventolin inhaler and one Symbicort inhaler by the pillow in his bed.Interview on 12/22/25 at 3:30 P.M. with LPN #650 confirmed Resident #263 was not permitted to have Symbicort and Ventolin stored

in his room and confirmed the presence of both medications in the resident's room.Interview on 12/22/25 at 4:00 P.M. with the DON confirmed Resident #263 was not permitted to self-administer medications.Review of facility policy titled, PCU027 - Medication Storage in the Facility, dated 2022, revealed the facility would securely store medication so it is accessible only to licensed nursing personnel.This deficiency represents non-compliance investigated under Complaint Number 2614307.

Event ID:

Facility ID:

If continuation sheet