Stellar Care Center

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

accounting system that reflects the operating cost of the facility; review and interpret monthly financial statements and provide such information to the regional director of operations; ensure that adequate financial records and cost reports are submitted to authorized government agencies as required by current regulations; keep abreast of the economic condition and situation and make adjustments as necessary to assure the continued ability to provide quality care; and report suspected or known incidents of fraud relative to false [NAME], filing or false cost reports, receipt and payment of kickbacks to appropriate agencies.Review of the Facility Assessment (last revised 06/17/25) revealed the facility's residents were at

a clinically complex and special high categories who oftentimes have one or more chronic or comorbid conditions including their acuity. Residents of the facility were at risk for falls, pressure ulcers, infections, incontinence, increased disability, weight loss, depression, and other potential areas of decline. This deficiency demonstrates non-compliance investigated under Complaint Number 2618783, 1398691, 1398691, 1398689 and 1398688.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review and interview the facility failed to ensure comprehensive discharge instructions were provided and failed to ensure documentation of a discharge was located in the medical record. This affected one (Resident #27) of one resident reviewed for discharge process. The census was 35.Findings Include: Closed record review revealed Resident #27 discharged from the facility on 07/24/25 with diagnoses including cerebral infarction, type two diabetes mellitus, cognitive communication deficit, chronic kidney disease, hypertension, hyperlipidemia, heart failure, gastro-esophageal reflux disease, hyperkalemia, and insomnia.Review of Resident #27 Multidisciplinary discharge summary revealed Resident #27 was discharged on 07/24/25 to their home. Review of Resident #27 discharge summary revealed an incomplete discharge instructions with no evidence of education regarding diet or activities provided to Resident #27 or their representative. Record review revealed no documentation of a discharge note being completed for Resident #27 for discharge on [DATE REDACTED].Interview on 09/22/25 at 11:22 A.M. with Director of Nursing confirmed there is incomplete documentation of Resident #27 discharge from 07/24/25.This is an incidental finding discovered during the complaint investigation.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, interview, and facility policy review, the facility failed to ensure a baseline care plan was completed within 48 hours of admission to the facility. This affected two (#8 and #27) of two residents reviewed for care planning. The facility census was 35. Findings include:1. Record review revealed Resident #8 admitted to the facility on [DATE REDACTED] with diagnoses including chronic obstructive pulmonary disease, congestive heart failure, and metabolic encephalopathy.

Review of an assessment titled Care Conference Summary dated 09/16/25 revealed attendees included Resident #8, dietary staff, social services, activities, and therapy. The plan of care was reviewed with Resident #8.

Review of Resident #8 ' s care plan revealed the dietary care plan was initiated on 09/15/25, but the rest of

the care plan was not completed until 09/23/25.

Interview on 09/23/25 at 3:05 P.M. with Administrator confirmed baseline care plans should be completed with 48 hours of admission to the facility. Administrator confirmed Resident #8 admitted to the facility on [DATE REDACTED] and her care plan was not completed until 09/23/25 and the care conference was completed on 09/16/25 with no evidence of a baseline care plan within 48 hours.

1. 2. Record review revealed Resident #27 admitted to the facility on [DATE REDACTED] with diagnoses including cerebral

infarction, type two diabetes mellitus, cognitive communication deficit, chronic kidney disease, hypertension, hyperlipidemia, heart failure, gastro-esophageal reflux disease, hyperkalemia, and insomnia.

Review of Resident #27 care conference revealed the resident was admitted on [DATE REDACTED] and care conference was completed on 09/16/25. Review of care conference summary revealed no signatures of family, resident, or resident representative being involved in the conference.

Review of Resident #27 care plan revealed one care plan for a potential for nutrition/ hydration risk related to acute/ chronic disease, diuretic drug use, and therapeutic diet initiated on 09/15/25. No other care plans are observed or documented.

Interview on 09/16/25 at 1:40 P.M. with Director of Nursing (DON) confirmed Resident #27 care plan was not completed fully or timely.

Review of facility policy reviewed 04/28/25 titled Care Planning Revealed the care plan is based on the residents comprehensive assessment and is developed by a care planning/ interdisciplinary team.

This deficiency is an incidental finding discovered during the complaint investigation.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0677

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

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

record review, interview, and facility policy review, the facility failed to ensure showers were given to residents based on their preferences and shower schedules. This affected two (#24 and #28) of five residents reviewed for activities of daily living (ADLs). The facility census was 35. Finding include:1. Record

review revealed Resident #24 admitted to the facility on [DATE REDACTED] with diagnoses including Alzheimer ' s disease, chronic obstructive pulmonary disease, and hypertension.Review of a minimum data set (MDS) dated [DATE REDACTED] revealed Resident #24 had no behaviors and was dependent on staff for bathing.Review of a care plan initiated on 09/05/25 revealed Resident #24 was at risk or had an ADL self-performance deficit related to cognition deficit, impaired vision, and weakness. Interventions included but were not limited to use a mechanical lift and assist of two staff, dependent on staff for toileting, and dependent on staff for bathing.Review of a shower schedule revealed Resident #24 receives showers on Wednesdays and Saturdays.Review of shower sheets revealed Resident #24 did not receive a shower on 07/05/25, 07/09/25, 07/12/25, 08/06/25, and 09/10/25.2. Record review revealed Resident #28 admitted to the facility on [DATE REDACTED] with diagnoses including dementia, abnormalities of gait and mobility, and a new diagnosis on 05/05/25 of displaced avulsion fracture of left talus.Review of a care plan dated 12/31/23 revealed Resident #28 had an ADL self-care performance deficit related to disorder of bone density and structure, anxiety, history of left hip pain, dermatitis, history of falling, abnormalities of gait and mobility, mild protein calorie malnutrition, hyperosmolality and hyponatremia, hypokalemia, alcohol dependence, nicotine dependence and urinary tract infection. Interventions included but were not limited to dependence to supervision/touching assist of one staff for bathing.Review of an MDS dated [DATE REDACTED] revealed Resident #28 had no behaviors and was dependent on staff for bathing.Review of a shower schedule revealed Resident #28 received showers on Wednesdays and Saturdays.Review of shower sheets revealed Resident #28 did not receive a shower on 07/05/25, 07/09/25, 07/12/25, 08/23/25, 08/30/25, and 09/10/25.Interview on 09/16/25 at 10:08 A.M. with Anonymous Staff (AS) #178 revealed she was concerned about Resident #28 since she moved from the memory care unit to the first floor because she can have behaviors or be a little feisty so they won ' t change her or shower her some days.Interview on 09/22/25 at 10:18 A.M. with Director of Nursing (DON) confirmed Resident #24 and #28 each had missed multiple showers and there was no additional documentation to show they received showers.Review of a policy titled, Bathing Policy dated 04/28/25 revealed residents have the option to take a bath/shower/bed bath as often as they would like and choose what time of bath they want.This deficiency demonstrates non-compliance investigated under Complaint Number 1398689 and 1398688.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

reassess as needed; encourage resident to experience and learn new activities as able; invite/escort to activities of interest; monitor participation; post activity calendar in room; and provide items needed for self-directed activities as indicated.

Interview on 09/15/25 at 3:10 P.M. with Resident #30 revealed there were not enough activities to meet his needs. Resident #30 stated some days, there aren ' t any activities and he just sits in his chair and watches television. Resident #30 stated he would like to have things to do because he gets tired of sitting around all day. Resident #30 stated they will play cards or Bingo but he had never heard of sit & chat.

Interview on 09/17/25 with Certified Nurses Aide (CNA) #5 revealed Resident #30 impresses them with how much he wants to participate and socialize, get out and about. CNA #30 states this is something that is very important to Resident #30, socialization and participation.

Interview on 09/16/25 at 3:11 P.M. with AD #16 revealed she was the only member of the activity department and was required to assist residents to the salon for the beauty shop so there is not time to do any other activities from 8:30 A.M. to 3:30 P.M. on Mondays and confirmed it is a paid service, not a provided activity. On Wednesdays, resident shopping is the main activity but the resident don ' t actually get to go shopping. Residents give AD #16 a list of items they would like, then she does the shopping for them.

AD #16 stated the activity room is not available to residents at all times and is locked when she is gone for

the day. AD #16 confirmed the activity calendars have the same activities of beverage cart and sit and chat five times a week, with one main activity in the afternoon consisting of a game or movie. AD #16 stated she did not know what other activities could be offered but she felt the beverage cart was an activity because

she gets to check in on the residents as well. AD #16 also revealed the memory care unit does not have a separate activity calendar.

Review of a job description for Activity Director dated 05/24/22 revealed the AD supervises an activity program appropriate to meet the physical, social, cultural, spiritual, emotional, and recreational needs and interests of each residents; provides the opportunity for residents to engage in normal pursuits; as well as promoting a successful and well-balanced leisure lifestyle. The AD plans quality of like of each resident as well as maintaining an open working relationship with the resident ' s family. The AD should plan, develop, organize, implement, evaluate and direct the activity program; assess individual and group needs and develops related meaningful morning, afternoon, evening and special programs; prepares and posts a monthly schedule of activities, and coordinates, directs and conducts all planned activities.

This deficiency demonstrates non-compliance investigated under Complaint Number 1398688

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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

Review of nursing notes from 08/28/25 through 09/08/25 did not reveal evidence a provider was notified of Prostat being unavailable or alternate options being available.

Interview on 09/15/25 at 1:27 P.M. with CNA #79 revealed she orders supplies for the facility. CNA #79 stated she places orders every Thursday and about three weeks prior, she had placed a large order which included Prostat which should have come in the following Wednesday or Thursday. CNA #79 stated part of

the order came to the facility, but Prostat did not so she reached out to the person for procurement and notified them it did not come. CNA #79 stated she specifically ensured Prostat was on the order but did state sometimes orders will get declined. CNA #79 stated she waited for the order to come after contacting procurement, but it did not so she placed a new order and the Prostat arrived a day later. CNA #79 stated

they did not receive the Prostat for over a week.

Interview on 09/16/25 at 11:05 A.M. confirmed Resident #24 did not have Prostat from 08/28/25 through 09/08/25 per nursing notes and there was not evidence of a physician being made aware or alternates being offered.

This deficiency demonstrates non-compliance investigated under Master Complaint Number 2624018, Complaint Number 2623116, 2618783, 1398689 and 1398688.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

unlocked and staff were not in the area. There was nail polish, a bottle of nail polish remover, a bottle of Rx Destroyer Med Disposal (a compound used to destroy medications), a spray bottle of Clorox bleach, NOW Disinfectant wipes, Bar Keepers Friends stainless steel cleaner, Ajax Oxygen Bleach cleanser, and needles capped and in plastic packaging. Interview on 09/17/25 at 2:49 P.M. with Licensed Practical Nurse (LPN) #8 confirmed the cabinets were left unlocked and unattended and hazardous chemicals were accessible. LPN #8 confirmed all residents on the unit wandered and had access to the chemicals. LPN #8 confirmed she and the other staff on the unit were in a residents room at the time of the observation.Review of the Material Safety Data Sheet (MSDS) for NOW Disinfectant Wipes revealed contact with eyes, skin, and clothing should be avoided as this product may produce irritation. Do not allow this product to contact acidic materials as hazardous chlorine gas may be released.Review of the MSDS for nail polish remover revealed

the vapors may be irritating to eyes, nose, throat and lungs, and may cause central nervous system depression. It stated ingestion may cause gastrointestinal upset, nausea, vomiting and diarrhea, may cause adverse kidney and liver effects.Review of the MSDS for Ajax revealed it could cause eye irritation.Review of the MSDS for Clorox revealed it may cause moderate eye irritation, inhalation of high concentrations may cause irritation of the respiratory tract, headaches, dizziness, nausea, vomiting and malaise.This deficiency demonstrates non-compliance investigated under Complaint Number 2623116, 1398691 and 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0690 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

03/25/25 by Physician Assistant (PA) #300 (who works for general surgery at a hospital). On 06/17/25 Resident #05 attended a follow up with PA #300 because the catheter was leaking. The DON revealed this was the last appointment he attended regarding the catheter and the facility was told by PA #300 they switched the catheter out, however they never received information confirming documentation it was changed out. Review of Resident #05's medical record including nursing notes revealed there was no

record or nursing notes of the suprapubic catheter being placed during the visit on 03/25/25 or changed

during a follow-up medical visit on 06/17/25. Interview with LPN #84 on 09/25/25 at 7:50 A.M. revealed the LPN had never personally changed Resident #05's suprapubic catheter. During the interview, the LPN denied having received training on how to do it and stated he/she wouldn't know how. To the LPNs knowledge the resident never had a physician order to change the catheter. Interview on 09/25/25 at 8:45 A.M. with the DON revealed she had spoken with LPN #84 and LPN #69 who revealed they had signed the catheter change as being completed because they thought it was just for the catheter bag (urinary collection bag) itself (not the actual catheter). The DON stated she believed there may have been confusion due to the facility not regularly changing indwelling Foley catheters due to the risk of infection.Interview on 09/25/25 at 1:54 P.M. with Medical Intensive Care Unit Physician #803 revealed Resident #05 was currently still under his care in the ICU. Physician #803 stated Resident #05's suprapubic catheter not being changed as ordered and catheter care not being completed as it should, led to the development of a UTI causing Resident #05 to become septic and in the condition he was in.Review of facility policy reviewed 04/28/25 titled Catheter Care revealed upon completion of catheter care document care was given. Notify the supervisor if the resident refused the procedure, any problems or complaints were made by the resident related to the procedure. Report other information in accordance with facility policy and standards of practice. This deficiency demonstrates non-compliance investigated under Master Complaint Number 2624018, Complaint Number 2618783, 1398689 and 1398688.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0695

Provide safe and appropriate respiratory care for a resident when needed.

Level of Harm - Minimal harm or potential for actual harm

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

record review, observation and interview, the facility failed to ensure oxygen was administered under a physician order. This affected one (#8) of one resident reviewed for oxygen. The facility census was 35.

Findings include: Record review revealed Resident #8 admitted to the facility on [DATE REDACTED] with diagnoses including chronic obstructive pulmonary disease, congestive heart failure, and metabolic encephalopathy.

Review of a nursing note dated 09/09/25 at 6:15 P.M. by Licensed Practical Nurse (LPN) #8 revealed Resident #8 admitted to the facility by ambulance with oxygen in place at 2 liter per minute (lpm).Review of

a Minimum Data Set, dated [DATE REDACTED] revealed Resident #8 received oxygen therapy. Review of Resident #8's orders revealed there was no order in place for oxygen.Interview and observation on 09/22/25 at 3:57 P.M. with Resident #8 revealed she had an oxygen concentrator set to 2 liters per minute (lpm) and was wearing

a nasal cannula. Resident #8 confirmed she had oxygen in place, and the tubing had just been changed

the previous night.Interview on 09/23/25 at 8:48 A.M. with the Administrator revealed someone who has oxygen in place should have an order.Interview on 09/23/25 at 8:58 A.M. with Director of Nursing (DON) confirmed Resident #8 did not have an oxygen order in place but should have.Review of a policy titled Oxygen Administration dated 04/2023 revealed oxygen is administered under the orders of a physician except in the case of an emergency.This deficiency represents non-compliance investigated under Complaint Number 2623116 and 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0697

Provide safe, appropriate pain management for a resident who requires such services.

Level of Harm - Minimal harm or potential for actual harm

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

record review, interview and facility policy review, interview, the facility failed to ensure that residents receive the treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the resident's choices related to pain management. This affected one (Resident #2) of one resident reviewed for pain management. The census was 35. Findings include:Resident #2 admitted to the facility on [DATE REDACTED] with diagnoses including lung cancer, chronic obstructive pulmonary disease, type two diabetes mellitus, brain cancer, weakness, chronic pain, and heart failure. Record review revealed an order placed on 09/10/25 for Tramadol 50 milligram (mg) (opioid pain medication) tablet one tablet by mouth every six hours as needed for pain. Record review revealed an order placed 09/10/25 for acetaminophen one tablet (analgesic) by mouth every eight hours as needed for pain of head, neck, and trunk extremities.

Record review of Facility Audit report revealed Tramadol 50 mg was ordered from the pharmacy for Resident #2 on 09/15/25 and delivered to the facility on [DATE REDACTED]. Record review of Resident #2 pain ratings revealed a pain rating of six on a scale of zero to ten, ten being the worst on 09/15/25 at 1:39 A.M., six out of ten on 09/17/25 at 2:22 A.M., six out of ten on 09/17/25 at 10:21 A.M., four out of ten on 09/17/25 at 5:44 P.M., four out of ten on 09/18/25 at 1:23 A.M., four out of ten on 09/18/25 at 5:51 P.M., four out of ten on 09/19/25 at 12:03 A.M., four out of ten on 09/19/15 at 5:57 P.M., four out of ten on 09/19/25 at 7:14 P.M., six out of ten on 09/20/25 at 2:24 A.M., and four out of ten on 09/21/25 at 6:15 A.M. Record review reveals no documentation of alternative pain relief medications or methods for administered while Resident #2 was experiencing pain on 09/15/15, 09/16/25, 09/17/25, 09/18/25, 09/19/25, 09/18/25 and 09/21/25 when Resident #2 reported pain. Interview on 09/22/25 at 12:18 P.M. revealed Resident #2 stated she was always in pain due to a bad hip and back. Resident #2 stated there were a few days, but cannot recall the exact dates, sometime over the past week she was told they were out of her pain medication. Resident #2 stated the nurses told her they were out, and they were trying to make phone calls and get something in to relieve the pain. Resident #2 stated her pain got worse and she felt sick. Interview on 09/22/25 at 2:00 P.M. with Director of Nursing (DON) confirmed Tramadol 50 mg for Resident #2 was ordered on 09/15/25 and was not received by the facility from the pharmacy service until 09/21/25 with seven days between ordered date and delivery date. The DON confirmed there was no documentation of alternative pain management methods used for Resident #2 while they were experiencing pain from 09/15/25 until 09/21/25. (The facility was unable to state why the Tramadol order was not sent to the pharmacy when it was ordered by the physician on 09/10/25). Review of facility policy titled Pain Assessment and Management reviewed 08/2022 revealed pain management is based on a facility wide commitment to appropriate assessment and treatment of pain, based on professional standards of practice, the comprehensive care plan, and the residents' choices related to pain management. This deficiency demonstrates non-compliance investigated under Complaint Number 2623116, and 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

lift and over 25 residents total to provide care for during a shift. Nurses are pulled to help but then their medication passes are late. Interview on 09/23/25 at 12:54 P.M. with CNA #9 revealed call lights can take at least 30 minutes to answer, sometimes longer if the resident would require more than one staff member for care. CNA #9 reported the facility had a lot of residents who were dependent or required two staff members to assist with care. CNA #9 reported they were aware residents were not getting care completed timely due to a lack of staffing. Interview on 09/23/25 at 12:56 P.M. with anonymous staff member #161 revealed there was not enough staff to get all assigned resident care and tasks completed during their shift. Interview on 09/23/25 at 2:34 P.M. with Regional Director of Operations #1011 revealed there should be two staff members upstairs (on the memory care unit) at all times. The facility was budgeted for an appropriate amount of staff daily but were utilizing their staffing incorrectly. RDO #1011 reported when the nurse goes downstairs to pass medications, an aide from downstairs should then come upstairs to be the second staff member present. Observation on 09/24/25 from 7:29 A.M. until 7:41 A.M. revealed there were five call lights going off on the A and B halls. Two CNAs were present and working on the units and were observed answering call lights and assisting residents. There were no other staff members visualized or available. At 7:37 A.M., Resident #28 was seen self-propelling her wheelchair in the hallway and stated hey can you help me to CNA #86 who was passing by. CNA #86 replied just a minute, to which Resident #28 responded I thought this place was supposed to help you, they don't do nothing; I have an awful itch, I'm so thirsty, and I can't get my food open. Review of the most recent facility wide assessment, page nine, for assistance with activities of daily living revealed the facility can care for five residents dependent on staff for dressing, five residents dependent on staff for bathing, five residents dependent on staff for transferring, and five residents dependent on staff for toileting.Review of facility wide assessment revealed the facility requires four full time registered nurses (RNs), four full time licensed practical nurses (LPNs), and fourteen full time certified nurse aides (CNAs), and one part time CNA to care for five residents dependent on staff for dressing, five residents dependent on staff for bathing, five residents dependent on staff for transferring, and five residents dependent on staff for toileting.Interview with the Director of Nursing (DON) confirmed full time direct resident care staff include five LPN's, one Registered Nurse, twelve CNAs, and part time direct care staff include one LPN and One CNA.Interview on 09/17/25 at 3:55 P.M. with the DON and Facility Administrator confirmed based on the current facility assessment the facility does not have an adequate amount of staff to care for the current resident population, and current resident needs, with timeliness, and quality.This deficiency demonstrates non-compliance investigated under Complaint Number 2618783, 1398691, 1398690, 1398689 and 1398688.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

working relationship with the resident's family. The AD should plan, develop, organize, implement, evaluate and direct the activity program; assess individual and group needs and develop related meaningful morning, afternoon, evening and special programs; prepares and posts a monthly schedule of activities, and coordinates, directs and conducts all planned activities. Review of a policy titled Dementia dated 04/28/25 revealed the staff and physician will review the current physical, functional and psychosocial status of individuals with dementia and will summarize the individual's condition, related complications, and functional abilities and impairments. This deficiency demonstrates non-compliance investigated under Complaint Number 2623116, and 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

sometimes he had to miss meetings when things came up, but they would not allow staff to transport him or approve new staff to be on the insurance for the facility bus. LPN #8 stated AA was the only thing Resident #30 has to do, he knows the other attendees and related to them, and it was very important for him to go.

LPN #8 stated when Resident #30 cannot go to AA, he is down in the dumps and assumes the facility staff does not like him. Review of a Social Services job description dated 12/02/24 revealed the social worker is responsible for assisting residents in the achievement and maintenance of maximum psychosocial functioning and independence; addressing difficulties with emotional adjustment to the facility through interviews, counseling, and referrals when indicated and consults with other disciplines as appropriate; ensures that social services are coordinated with other facility services; coordinates behavior management programs with the assistance of other departments; provides timely and appropriate psychosocial intervention for residents as required and documents; assess the social, emotional, and spiritual needs of

the residents and ensure the social services intervention is a part of the plan of care; ensure required social services interventions are provided directly through the department or outside referrals; and participates in mandatory in-services and annual conducts at least one in-service designed to increase the facility staff's awareness of the social and emotional needs of the residents. This deficiency represents non-compliance investigated under Complaint Number 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

emergency box because pharmacy wasn't always quick to send things. They recently switched to a new pharmacy, and things arrive slowly, you have to keep calling them. Interview on 09/16/25 at 7:25 A.M. with RN #34 stated there were issues receiving medications from the pharmacy; you order something, and it doesn't show up; it seems like there was always an issue with the pharmacy and receiving medications.

OTC medications have been an issue; it was not consistent. The facility had to buy OTC medications from

an outside pharmacy because items don't come in, or don't arrive on time. Interview on 09/22/25 at 2:00 P.M. with the DON confirmed Tramadol 50 mg for Resident #2 was ordered on 09/15/25 and was not received by the facility from the pharmacy service until 09/21/25 with seven days between ordered date and delivery date. (The facility was unable to state why the Tramadol order was not sent to the pharmacy when

it was ordered by the physician on 09/10/25). Review of the facility policy tilted Administering Medications revised 04/28/25 revealed medications must be administered in accordance with orders, including any required time frame.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0804

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, record review and interview, the facility failed to ensure residents received nutritive, palatable food. This affected two Residents (Resident #23 and Resident #28) of two residents reviewed for food. The census was 35.Findings include: 1. 1. Record review revealed Resident #23 admitted to the facility 12/10/24 with diagnoses including osteoarthritis, chronic obstructive pulmonary disease (COPD) , anemia, heart failure, urinary tract infection, and adjustment disorder.Record review of Resident #23's quarterly Minimum Data Set (MDS) assessment completed 08/08/25 revealed severe cognitive impairment, no displayed or exhibited behaviors, and the resident has an ordered mechanically altered diet and an ordered therapeutic diet. Resident #23 had a weight loss of five percent or more in the last month or loss of ten percent or more in the last six months and was not on a physician prescribed weight loss regimen.

Record review of Resident #23's care plan revised 09/05/25 revealed the residents at risk for malnutrition/ alteration in nutritional status related to receiving mechanical altered diet, COPD anemia, and heart failure.

Goals included the resident will maintain adequate nutritional status throughout the review date.

Interventions included providing and serving diet as ordered, .Record review of Resident #23's orders revealed an order placed on 09/01/25 for a pureed texture diet.Observation on 09/11/25 at 11:10 A.M. with Dietary Director (DD) #39 and Dietary [NAME] (DC) #35 revealed they were preparing pureed food for Resident #23. Resident #23's menu included sugar snapped peas, breaded fish, and roasted potatoes.

Observation revealed DC #23 placed an eight ounce (oz) scoop of sugar snapped peas and eight oz. of water into a blender, checked consistency and added one scoop of thickener. Upon taste test after completion of pureeing sugar snap peas, the pea puree was stringy and had no flavor which was verified with DD #39. Observation of pureeing of Resident #23's breaded fish revealed the fish was a very watery consistency with clumps. One scoop of thickener was added and the consistency was still lumpy which was verified with DC #23 and DD #39. Observation of pureeing of Resident #23's roasted potatoes revealed water was added and then blended. The consistency was checked and revealed lumps in the mixture and upon taste test there was no flavor. It was confirmed at the time of the observations with DC #23 and DD #39 the pureed foods for Resident #23 were not not palatable. 2. Record review of Resident #28 revealed

an admission date of 12/14/23 with diagnoses including anxiety, obstructive sleep apnea, dementia, vitamin D deficiency, hypokalemia, and hyponatremia.Review of Resident #28's quarterly MDS assessment completed 07/03/25 revealed no displayed or exhibited behaviors during the review period except wandering.Review of Resident #28's care plan, revised on 09/08/25, for at potential nutrition/ hydration risk related to mild protein-calorie malnutrition, Body Mass Index (BMI) indicates an underweight status, and therapeutic diet in place to help meet estimated needs. Interventions include assist with meals as needed, provide snacks, and diets as ordered per preference.On 09/16/25 at 12:35 P.M. Resident #28 was observed to be eating lunch in the dining room. Resident #28's meal contained Tex Mex casserole and black beans.

Interview with Resident # 28 revealed the lunch had no flavor, and they might as well eat dirt.This deficiency demonstrates non-compliance investigated under Complaint Number 1398690 and 1398688

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, record review, and facility policy review, the facility failed to ensure food was prepared in a form to meet individual resident needs. This affected two residents (Resident #5, and Resident #23 ) of two residents reviewed for food. The facility census was 35.Findings include: 1.Record

review revealed Resident #05 admitted to the facility on [DATE REDACTED] with diagnoses including type two diabetes mellitus, hypertension, vitamin D deficiency, vitamin B deficiency, hyperlipidemia, gastro-esophageal reflux disease (GERD), neuromuscular bladder dysfunction, and benign prostatic hyperplasia.Record review of Resident #05's quarterly Minimum Data Set (MDS) 3.0 assessment completed 08/01/25 revealed cognitive impairment, a mechanically altered diet and therapeutic diet. Review of Resident #05's orders revealed an order placed 12/08/24 for a low concentrated sweets diet (LCS), with mechanical soft texture.Review of Resident #05's care plan revealed a plan of care revised on 09/15/25 stating Resident #05 was at risk for malnutrition/ alteration in nutritional status related to anemia, GERD, dysphagia, and barrettes esophagus.

Goals included the resident will maintain adequate nutritional status. Interventions include to give medications as ordered, and provide diets as ordered.Record review revealed no documentation Resident #05 had refused their modified texture diet.Observation on 09/11/25 at 12:20 P.M. revealed Resident #05's tray was plated with a whole hot dog on it. The tray was then taken to the dining room and served to Resident #05 who was sitting at a table in the dining room. After brought to the staff's attention, the whole hot dog was removed from Resident #05 so the mechanical soft texture could be provided. An interview with Dietary [NAME] (DC) #25 at the time of the observation confirmed Residnet #05 was a ordered a mechanical soft diet and was served a whole hot dog.2. Record review revealed Resident #23 admitted to

the facility 12/10/24 with diagnoses including osteoarthritis, chronic obstructive pulmonary disease (COPD) , anemia, heart failure, urinary tract infection, and adjustment disorder.Record review of Resident #23 quarterly MDS completed 08/08/25 revealed severe cognitive impairment.Record review of Resident #23 orders revealed an order placed on 09/01/25 for a pureed texture diet.Observation on 09/11/25 at 11:10 A.M. with Dietary Director (DD) #39 and Dietary [NAME] (DC) #35 revealed they were preparing pureed food for Resident #23. Resident #23's menu included sugar snapped peas, breaded fish, and roasted potatoes. Observation revealed DC #23 placed an eight ounce (oz) scoop of sugar snapped peas and eight oz. of water into a blender, checked consistency and added one scoop of thickener. Upon taste test after completion of pureeing sugar snap peas, the pea puree was stringy and had no flavor which was verified with DD #39. Observation of pureeing of Resident #23's breaded fish revealed the fish was a very watery consistency with clumps. One scoop of thickener was added and the consistency was still lumpy which was verified with DC #23 and DD #39. Observation of pureeing of Resident #23's roasted potatoes revealed water was added and then blended. The consistency was checked and revealed lumps in the mixture and upon taste test there was no flavor. It was confirmed at the time of the observations with DC #23 and DD #39 the pureed foods for Resident #23 were not at a smooth consistency for a pureed diet. Review of undated facility policy dated 2023 titled Texture and Consistency Modified Diets revealed texture and consistency modified diets should be individualized with modifications made by the speech language pathologist (SLP) and physician in conjunction with a registered dietician. This deficiency demonstrates non-compliance investigated under Complaint Number 1398690, and 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0835

two dietary aides and DD #39 covering as both a cook and dietary aide .

Level of Harm - Minimal harm or potential for actual harm

An interview on 09/16/25 at 4:09 P.M. with DT #205 verified they only came to the facility every two weeks,

they did not work in the kitchen and there was a plan to train dietary staff but it had not been done yet.

Residents Affected - Many

An interview on 09/17/25 at 3:55 P.M. with the Director of Nursing and the Administrator confirmed the dietary department was not currently staffed according to the staffing plan in the facility assessment.

This deficiency demonstrates non-compliance investigated under Complaint Number 2618783 and

1. 1398688. 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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

review of the Facility Assessment, interviews, record reviews, and observations the facility failed to conduct

an accurate and thorough facility assessment to determine appropriate resources were available to provide necessary care and services the residents required during both day-to-day operations and emergencies, including nights and weekends. This had the potential to affect all residents. The facility census was 35.Findings include: Review of [NAME] Care Center Resident Analyzer and Resident Minimum Data Set (MDS) information revealed there were 15 residents (Residents #3, #5, #7, #9, #10, #20, #22, #24 #23, #25, #26, #30, #31, #33, and #34) who were dependent on staff for toileting . Review of [NAME] Care Center Resident Analyzer and Resident Minimum Data Set (MDS) information revealed there were 14 residents (Residents #3 , #4, #5, #6, #9, #10, #22, #24, #25, #26, #30, #31, #33, and #34) who were dependent on staff for dressing . Review of [NAME] Care Center Resident Analyzer and Resident Minimum Data Set (MDS) information revealed there were 14 residents (Residents #3, #5, #9, #10, #20, #22, #24, #25, #26, #29, #30, #31, #33, and #34) who were dependent on staff for showering/ bathing.Review of [NAME] Care Center Resident Analyzer and Resident Minimum Data Set (MDS) information revealed there were nine (9) residents who were dependent on staff for transferring (Residents #5, #25, #3, #23, #9, #31, #34, #24, and #30).Review of the most recent facility wide assessment, page nine, for assistance with activities of daily living revealed the facility is able to care for five residents dependent on staff for dressing, five residents dependent on staff for bathing, five residents dependent on staff for transferring, and five residents dependent on staff for toileting.Review of facility wide assessment revealed the facility requires four full time registered nurses (RNs), four full time licensed practical nurses (LPNs), and fourteen full time certified nurse aides (CNAs), and one part time CNA to care for for five residents dependent on staff for dressing, five residents dependent on staff for bathing, five residents dependent on staff for transferring, and five residents dependent on staff for toileting.Interview with the Director of Nursing (DON) confirmed full time direct resident care staff include five LPN's, one Registered Nurse, twelve CNA's, and part time direct care staff include one LPN and One CNA.Review of the facility assessment revealed for dietary staff to meet the needs of the residents include three full dietary cooks, two full time dietary aides, and one part time dietary aide.Interview on 09/11/25 at 1:46 P.M. with Dietary Director revealed they currently had two full-time cooks and two full time aides. Interview on 09/17/25 at 3:55 P.M. with the DON and Facility Administrator confirmed based on the current facility assessment the facility does not have an adequate amount of staff to care for the current resident population, and current resident needs, with timeliness, and quality. Interview on 09/17/25 at 3:55 P.M with the DON and Facility Administrator revealed they did not accurately complete the facility wide assessment. This deficiency is an incidental finding discovered during

the complaint investigation.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

confirmed they did not change a suprapubic catheter during their shift, and stated that would be something

they remembered doing. He stated he knows they are short staffed and recalls the facility being very short

on aides that day.Interview on 09/25/25 at 8:45 A.M. with the Director of Nursing (DON) confirmed they had spoken with LPN #84 and LPN #69 who stated they signed the catheter change as completed because

they thought it was just for the catheter bag itself (not the actual catheter). The DON confirmed the catheter exchange was documented as being completed, but was never physically done.Interview with LPN #84 on 09/25/25 at 7:50 A.M. revealed they have never personally switched Resident #05's suprapubic catheter out. LPN #84 stated they had no training on how to do it and wouldn't know how. To their knowledge it was never an order. This deficiency demonstrates non-compliance investigated under Master Complaint Number 2624018, Complaint Number 1398691, and 1398689.

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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Stellar Care Center

47045 Moore Ridge Road Woodsfield, OH 43793

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

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

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

observation and interview, the facility failed to ensure infection control practices were in place when a resident's catheter bag was oberved on the ground. This affected one (#9) of two residents reviewed for catheter care. The facility census was 35. Findings include:Record review revealed Resident #9 was admitted to the facility on [DATE REDACTED] with diagnoses including quadriplegia, pure hypercholesterolemia, and neuromuscular dysfunction of bladder. Review of an order dated 02/28/25 revealed Resident #9 had an indwelling catheter with 18 french and 30 cc balloon in place to be changed every 30 days and as needed.Review of a care plan dated 08/08/25 revealed Resident #9 had severely impaired cognition and was frequently incontinent of bladder.Observation on 09/16/25 at 9:38 A.M. revealed Resident #9 was resting with his bed in a low position and his catheter bag was laying on the floor.Observation on 09/16/25 at 10:15 A.M. revealed Resident #9 was resting in bed and his catheter bag remained on the floor.Observation on 09/18/25 at 1:09 P.M. revealed Resident #9 was resting in bed and his catheter bag was on the floor.Interview on 09/18/25 at 1:10 P.M. with Licensed Practical Nurse (LPN) #8 confirmed Resident #9's catheter bag was on the floor.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet