Northwood Skilled Nursing And Rehabilitation

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation and staff interview, the facility failed to ensure timely incontinence care was provided. This affected one (#72) of three residents reviewed for incontinence. The census was 76.

Findings include:Medical record review for Resident #72 revealed an admission date of 07/27/21. Medical diagnoses included disorganized schizophrenia, heart failure, Alzheimer's disease, and cerebrovascular accident. Review of the quarterly Minimum Data Set (MDS) dated [DATE REDACTED] revealed Resident #72 was severely cognitively impaired. Her functional status was set up or clean-up assistance with eating, dependent for toileting and transfers. She was substantial/maximal assistance for bed mobility. She was frequently incontinent for bladder and always incontinent for bowel. Observation of incontinence care for Resident #72 on 11/19/25 at 6:16 A.M. with Certified Nursing Assistant (CNA) #56 revealed the resident's brief was saturated and had leaked a small amount onto the incontinence pad she was lying on. The odor was pungent. Interview with the CNA #56 on 11/19/25 at 6:30 A.M. verified the brief was saturated and leaked onto the pad under the resident. She said she changed the resident at 2:15 A.M. and didn't know why she would be so wet. She confirmed the resident should be changed every two hours. This deficiency represents non-compliance discovered under Complaint Number 2642540.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northwood Skilled Nursing and Rehabilitation

2000 Villa Road Springfield, OH 45503

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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

quarterly MDS dated [DATE REDACTED] revealed Resident #5 was moderately cognitively impaired.Review of the Medication Administration Audit Report dated 11/18/25 revealed the following medications were prescribed for 9:00 P.M., Pregabalin 75 mg twice a day, Metoprolol (blood pressure medication) 25 mg two times a day and Hydroxyzine (antihistamine medication)10 mg one twice a day were given at 12:06 A.M. on 11/19/25. 6.Medical record review for Resident #39 revealed an admission date of 02/11/20. Medical diagnoses included dementia, peripheral vascular disease, and multiple sclerosis. Review of the quarterly MDS dated [DATE REDACTED] revealed Resident #39 was severely cognitively impaired.Review of Medication Administration Audit Report dated 11/18/25 revealed the following medications prescribed for 9:00 P.M. Seroquel (antipsychotic medication) 150 mg two times a day, Melatonin 5 mg one tablet, Mirtazapine (antidepressant medication) 7.5 mg, Depakote 125 mg give three tablets twice a day were given at 10:34 P.M. Interview with Licensed Practical Nurse (LPN) #116 on 11/19/25 at 6:50 A.M. revealed she was late with giving her medications last night, 11/18/25, because she had two falls. She stated she had not ask for help from anyone because there was not a unit manager and the other nursing staff had their own medications to pass. Interview with the Nurse Practitioner (NP) #115 on 11/19/25 at 12:11 P.M. revealed she had not received a call from the facility last night, 11/18/25, concerning late medications and confirmed while she was at the facility she was not informed of any late medications for last night. Review of the policy titled Administering Medications dated 04/01/19 revealed medications are to be administered in a safe and timely manner, and as prescribed. Medications are administered in accordance with prescriber orders, including any required time frame. Medications are to be administered within one (1) hour of their prescribed time, unless otherwise specified (for example, before and after meal orders).This deficiency represents non-compliance investigated under Complaint Number 2642540 and 2642363.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northwood Skilled Nursing and Rehabilitation

2000 Villa Road Springfield, OH 45503

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 0880

gloves.

Level of Harm - Minimal harm or potential for actual harm

This deficiency represents non-compliance investigated under Complaint Number 2642540.

Residents Affected - Some

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Northwood Skilled Nursing and Rehabilitation

2000 Villa Road Springfield, OH 45503

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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and

the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, review of the water temperature logs, and review of a plumbing invoice, the facility failed to ensure water temperatures were within normal limits. This affected one (#72) of three residents reviewed for water temperatures. The census was 76. Findings include:Medical

record review for Resident #72 revealed an admission date of 07/27/21. Medical diagnoses included disorganized schizophrenia, heart failure, Alzheimer's disease, and cerebrovascular accident. Review of the quarterly Minimum Data Set (MDS) dated [DATE REDACTED] revealed Resident #72 was severely cognitively impaired.

Her functional status was set up or clean-up assistance with eating, dependent for toileting and transfers.

She was substantial/maximal assistance for bed mobility. She was frequently incontinent of bladder and always incontinent for bowel. Review of an invoice from a plumbing company dated 11/11/25 revealed the mixing valve from the hot water had to be replaced. Review of the temperatures for the water for the 200-hall dated 11/18/25 revealed they were within normal limits. Review of the invoice dated 11/19/25 after

the incontinence care revealed there was a new mixing valve replaced due malfunction of the one placed

on 11/11/25. During an observation of incontinence care on 11/19/25 at 6:16 A.M. with Certified Nursing Assistant (CNA) #117 and CNA #33 revealed CNA #33 went into the bathroom to prepare water for the care but had to leave the room to go to another room to get water that was warm and came back into the room. During the care resident #72 was uncomfortable with the water temperature and she would pull away from the washcloth when the aides tried to wash under her arms, face and peri-care. The aides acknowledged the resident was cold from the cold water they were washing her with and continued with the care. Observation of the water temperature on 11/19/25 at 6:30 A.M. revealed the water temperature was taken by the Director of Nursing (DON) and the thermometer read 93.7 degrees Fahrenheit. The DON confirmed the water was too cold. Interview with CNA #33 on 11/19/25 at 6:35 A.M. revealed the water temperature had been a problem lately and the facility had someone out to fix it and it worked for a while and now it was not working anymore. She stated she tried to get warmer water by leaving the room, but it was only lukewarm. There wasn't a policy to review and the Administrator said they follow the regulatory guidelines.

Event ID:

Facility ID:

If continuation sheet