Willows Center

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based upon record review and staff interviews the facility failed to report the results of investigations within approved time frames to the state survey agency(SSA). This was discovered during the Long term care survey process, during the review of Facility reported incidents (FRIs). This was found to be true for one (1) out of thirty (30) residents reviewed. Resident #74 and #108. Census: 92 Finding include: a) Resident #74

During record review of Facility reported incidents (FRIs) on 12/17/25, file with this FRI #242295 was missing the five day follow up. The initial report was received 01/06/25. This would make the five day needing to be submitted by 01/11/25 at 11:59 PM at the latest. There was no record of it anywhere in the file or of a attempt to transmit a copy to anyone that is required to be notified ie. Fax transmittal sheet or email attachment by that deadline time. The file only contained four (4) statements, none are dated or signed by anyone either interviewed or doing the interviewing. As well as two (2) Performance improvement plans (PiPs), both were non disciplinary in nature and only suggested counseling no correction or follow up noted. When talking with the Administrator on 12/17/25 at approximately 11:44?AM about FRIs missing information and he said he will do his best to get the items that are missing for me. He knew that there are

a lot of issues with them from the previous administration and is working to do better on them since he has been over the facility. Not further items for this file were presented prior to surveyors exiting the building on

the final survey day of 12/22/25. b) Resident #108A record review found an allegation of physical abuse reported on 06/05/25 Resident #108 reported that she never received a breakfast tray and someone shoved her by the shoulders. A review of an investigation revealed that there is no documentation that the incident was reported to all required state agencies. Subsequent review found an extension Request filed

on 06/11/25. Continued review of the reportable found no witness statements from the employees or other residents residing in the facility that may have knowledge of the allegation. Subsequent review found no documented 5-day follow-up. During the interview on 12/22/25 at approximately 9:30 AM the Administrator verified that there were no documentation or statements from all staff working at the time or other residents that may have knowledge of the allegation. He stated that there was no other documentation to provide on

the incident. He also verified they have been working on other complaints that was not investigated prior to him taking over as Interim Administrator.

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

12/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Willows Center

723 Summers Street Parkersburg, WV 26101

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 0610 Level of Harm - Minimal harm or potential for actual harm

There was no evidence found during the record review that the facility had completed additional call light audits at random times as per the facility's corrective actions listed in their five (5) day follow-up.

The Administrator remained silent and made no comment.

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

12/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Willows Center

723 Summers Street Parkersburg, WV 26101

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

Based on observation, record review, resident, and staff interview. The facility failed to assist dependent Residents with activities of daily living (ADL's) in accordance with the resident's assessed needs for care.

This is true for three (3) of eight (8) residents reviewed for ADL's care. Resident Identifiers: #30, #49 and #72. Facility census: 92. Findings Included:a) Resident #49 On 12/15/23 at 11:28 AM Resident #49 stated that she does not get showers or baths as ordered or her preference. She stated that she is supposed to get two showers a week. She continued to state that the staff say they don't have enough staff to give her a shower. A review of Resident #49's ADL documentation found only two (2) showers on 11/21/25 and 12/09/25 also noted seven bed baths noted in 30 days. No Refusals noted.During an Interview on 12/17/23 at 10:30AM the Director of Nursing (DON) verified there was no documentation that Resident #49 received showers as scheduled. b) Resident #30Observation on 12/15/25 at 12:23 PM of Resident #30 found his hair appeared oily, dirty and uncombed.During an interview 12/15/25 at 12:23 PM, Resident #30 stated that

he does not get very many showers. Subsequent Observation on 12/17/25 8:45 AM found that his hair still appeared oily, dirty and uncombed. A review of Resident #30's ADL documentation found only one (1) shower on 12/02/25 and four (4) bed baths noted in 30 days. No refusals were noted. During an Interview

on 12/17/23 at 10:30AM the Director of Nursing (DON) verified there was no documentation that Resident #30 received showers as scheduled. c) Resident #72 During an interview 12/16/25 at 11:12 AM, Resident #72s medical power of attorney (MPOA) stated that the resident does not get showers. She continued to say that the staff tell her that Resident #30 does not like to get up, so they just do bed baths. She stated that her mom needed her showers and always preferred to get a shower and to be clean. A review of Resident #72's ADL documentation found only two (2) showers on 11/29/25 and 12/12/25 also eight (8) bed baths noted in 30 days. No refusals noted. During an Interview on 12/17/23 at 10:30 AM the Director of Nursing (DON) verified there was no documentation that Resident #72 received showers as scheduled.

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

12/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Willows Center

723 Summers Street Parkersburg, WV 26101

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 0686

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Level of Harm - Minimal harm or potential for actual harm

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

record review and staff interview, the facility failed to assess and treat pressure ulcers within accepted standards of care. This deficient practice had the potential to affect one (1) of five (5) residents reviewed for

the care area of pressure ulcers. Resident Identifier: #98. Facility census: 92. Findings included: a) Resident #98The facility's policy titled Skin Integrity and Wound Management with effective date 07/01/01 and revision date 09/15/25 stated wound evaluations would be performed for new in-house acquired wounds.

The resident was admitted to the facility on [DATE REDACTED] and was receiving hospice services. On 10/31/25, a nurse practitioner note stated, in part, Resident does have a stage II pressure ulcer to sacrum. No sign of infection noted .Pressure ulcer of sacral region, stage 2. Continue to cleanse with wound cleanser. Pat dry.

Apply Sure Prep to periwound and under adhesive contact areas. Cover with Optifoam Gentle every 3 days and as needed. Will monitor and manage as appropriate.The following order was written on 10/31/24, Cleanse sacrum with wound cleanser. Pat dry. Apply Sure Prep to periwound and under adhesive contact areas. Cover with Optifoam gentle every 3 days and PRN. Neither Resident #98's Treatment Administration Records (TARs) nor Medication Administration Records (MARs) for October and November 2024 included

this order. On 11/02/24 a skin check was performed which stated, in part, New skin Issue. Location: Coccyx. Issue type: Pressure ulcer / injury. Pressure ulcer staging: Stage 2 Pressure ulcer / injury - partial thickness skin loss with exposed dermis. Wound acquired in-house. Wound is new. Signs and symptoms of infection: None. Length (cm): 5.9 Width (cm): 4.6 Depth (cm): 0 Area (cm2): 14.1 Undermining: No.

Tunneling: No. Cleansing solution: Generic wound cleanser. Primary dressing: Foam. This was the first full assessment in the medical records of the coccyx pressure ulcer identified on 10/31/24.The 11/02/24 skin check also identified a new deep tissue injury to the right heel and a new blister to the left scapula. The following orders were written on 11/02/24: Cleanse area to right heel with wound cleanser and apply skin prep cover with foam dressing check every shift, change every three (3) days and as needed.Heel boots to be worn bilaterally to prevent further skin breakdown and release pressure. Check every shift and as needed. Neither of these orders were included on the resident's TAR or MAR for November 2024. Resident #98 passed away on 11/07/24. On 12/18/25 at 11:02 AM, the Director of Nursing (DON) confirmed a full assessment of the resident's coccyx pressure ulcer was not documented at the time of discovery on 10/31/24. She stated the assessment on 11/02/24 was the first documented full assessment of the pressure ulcer. The DON also confirmed the orders for treatment to the coccyx pressure ulcer and the heel pressure ulcer and for heel boots were not included on the TAR or MAR. She provided no documented evidence that the physician's orders regarding the dressing changes or application of the heel boots were followed. No further information was provided through the completion of the survey process.

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

12/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Willows Center

723 Summers Street Parkersburg, WV 26101

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 food tray temperatures and resident interviews, the facility failed to serve food to residents that was palatable and at an appetizing temperature. Based on resident interview and staff interview, the facility failed to ensure hot foods were served hot and cold foods were served cold. This failed practice was true for four (4) of five (5) hallways tested for milk temperatures on the beverage carts and food tray temperatures for one (1) of one (1) meal trays tested throughout the survey process Facility census: 92.a) This surveyor asked the Director of Dining to temp the milk that was located on the west hall beverage cart on 12/15/25 at 12:45 PM. The temp was 54 degrees F. The Director of Dining acknowledged the temp was above the Food and Drug Administration (FDA) food code temp of 41 degrees F.

Residents Affected - Some

On 12/17/25 at 12:15 PM the surveyor asked employee #152 for the temperatures of the lunch menu food items. He stated that the cook writes them on the production sheet. He then gave me a copy of the production sheet and stated that the cook did not write them down. 12/15/2025 at 12:00 PM , Resident #58 said, The food is terrible, they have not updated any meal preferences with me, I asked the manager almost (3) three months ago The food is cold, we are last to get meals sometimes they run out , I usually do not get what I ask for. When they send us food, generally it is all mixed together. 12/15/25 at 12:50PM , Resident #58's meal was served. Resident #58's meal was Turkeyburger, with lettuce, tomato and baked beans on plate, observation: baked beans running on plate under Hamburger Bun. Resident #58 informed this surveyor I wish they would have put those beans in a bowl. 12/15/25 1:30PM , Resident #58.Staff interview with Food Service Director, questioned her if she or anyone had updated Resident #58's meal preferences, she informed this surveyor, No I have not Spoke with Food Service Director (FSD), reviewed meal presentation for this lunch- she viewed the plate for Resident #58 and FSD confirmed the baked beans were running into the hamburger bun,

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

12/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Willows Center

723 Summers Street Parkersburg, WV 26101

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 0812

This surveyor made a second visit to the kitchen.

Level of Harm - Minimal harm or potential for actual harm

On 12/17/25 at 8:55 AM observation revealed the fan in the dish room was soiled with debris.

Residents Affected - Some

There were four (4) full size sheet pans sitting directly on the floor in the dish room. There was one (1) clean tray of 9 oz bowls sitting on top of the hand-washing sink in the dish room.

Employees are documenting wrong sanitizer PPM on the low temperature dish machine log. Ecolab test strips indicate these four options 10 ppm, 50 ppm, 100 ppm and 200 ppm. For the month of December, they documented 150, 160, 170, 175 and 180 for every PPM that was documented.

The surveyor spoke to the Registered Dietician (RD), Director of Dining, District Manager. The RD, Director of Dining and the District Manager acknowledged the deficient practice and said they would educate the staff on the proper way to test and document per their policy and procedure.

On 12/17/25 at 11:42 AM observation revealed the cornstarch containers lid was not on securely and Employee #81 verified it should be and fixed the issue.

On 12/17/25 at 11:48 AM the three (3) compartment sink log was not filled out for dinner ware washing on 12/16/25 or breakfast ware washing today 12/17/25. It was currently being used. Employee #152 verified that it should have been temped and the sanitizer PPM should have been documented. 12/17/25 at 12:00 PM

On 12/17/25 at 12:00 PM there was no lid on the trash can in the dish room. Employee #152 stated it should be on when not in use, and he put it on.

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

Event ID:

Facility ID:

If continuation sheet