Ayden Healthcare of Madeira

Inspectors wroteBased on observations, and staff interviews, the facility failed to ensure menus were preplanned and followed for daily meals and emergency meals. This affected all 86 residents who the facility identified as receiving meals from the kitchen. The facility census was 86. Findings Include:1) Observations on 12/08/25 at 9:09 A.M. (breakfast meal), on 12/10/25 at 7:38 A.M. (breakfast meal), and 12/11/25 at 1:05 P.M. (lunch meal), revealed there were no meal spreadsheets used during the tray line meal service for residents on therapeutic diets. [...]

Inspectors wroteBased on observation, interview and record review, the facility failed to prepare and store food in a manner to prevent foodborne illness. This affected all 86 residents who the facility identified as receiving food from the kitchen. The total facility census was 86. Findings Include:Observation of the kitchen during the initial tour on 12/08/25 at 9:09 A.M. with Dietary Manager (DM) #04, revealed the following:1) At the dietary employee handwashing sink there was no soap in the dispenser, and the hand drying towels were not in a hands-free dispenser. 2) Inside the walk-in refrigerator there was an undated open container with orange liquid labeled water. There was a packaged coleslaw with an expired label of best used by 10/02/25, and an expired opened container of boiled eggs dated 12/01/25. There was an uncut watermelon which was blacked throughout the exterior. [...]

Inspectors wroteBased on observation and staff interview, the facility failed to ensure the garbage cans were covered when not in use. This affected all 86 residents receiving food from the kitchen. The total facility census was 86. Findings Include:Observation of the kitchen during the initial tour on 12/08/25 at 9:09 A.M. with Dietary Manager (DM) #04 revealed there were four garbage cans in the dish machine area and in the food preparation area of the kitchen which were not covered. The containers were nearly full of food and garbage, and the kitchen staff were not actively using the garbage containers. Interview at the same time with DM #04, verified the cans were nearly full, were not in active use and should be covered. [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure a clean, comfortable and homelike environment for residents. This affected six residents (#04, #11, #15, #19, #39, and #86) out of 15 residents reviewed for physical environment. The facility census was 86.

Inspectors wroteBased on record review, staff interviews, and policy review, the facility failed to update care plans following a change in condition. This affected four Residents (#02, #10, #25, and #60) out of 24 residents reviewed for care planning. The facility also failed to ensure care conferences were completed. This affected six Residents (#04, #09, #10, #11, #13, and #39) out of 24 residents reviewed for care planning. The facility census was 86.

Inspectors wroteBased on medical record review, review of fall investigations, observation, resident interview, staff interview, and policy review, the facility failed to ensure adequate supervision for residents who smoke. This affected three Residents (#12, #57, and #61) of three residents reviewed for smoking. The facility also failed to thoroughly investigate falls and implement appropriate fall interventions following falls to reduce and/or eliminate future falls. This affected five Residents (#01, #02, #25, #60, and #66) of five residents reviewed for falls. The facility census was 86.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure therapeutic diets were received, as ordered by the physician. This affected four Residents (#48, #51, #53 and #01) of four residents reviewed for therapeutic diets. The total facility census was 86. Findings Include:1) Record review of Resident #48 revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #48 include cerebral infarction, malnutrition, and end stage renal disease. Review of the Minimum Data Set (MDS) comprehensive assessment dated [DATE], revealed Resident #48 had intact cognition and required supervision with meals. The resident received dialysis treatments three times a week at a dialysis center. The resident received a renal diet, with double portions of protein at breakfast. [...]

Inspectors wroteNumber of residents sampled: Number of residents cited: 6 Based on chart review, observation, interview, and policy review revealed the facility failed to ensure proper infection control practices. This affected four Residents (#11, #19, #88, and #86) reviewed for infection control in the initial pool. The facility also failed to ensure hand hygiene was performed during medication administration and incontinence care. This affected two Residents (#45 and #85) out of four residents observed for medication administration and one Resident #85 out of two Residents (#09 and #85) observed for incontinence care. The in-house facility census was 86.

Inspectors wroteBased on staff interview and record review, the facility failed to provide/offer the pneumococcal vaccine to all residents. This affected five Residents (#19, #02, #04, #88, and #90) of the five residents reviewed for pneumococcal vaccines. The facility further failed to provide/offer the influenza vaccine to all residents. This affected three Residents (#19, #04, and #90) of the five residents reviewed for influenza vaccines. The facility further failed to provide/offer the Coronavirus (COVID) vaccine to all residents. This affected four Residents (#02, #19, #04, and #88) of the five residents reviewed for COVID vaccines. The facility census was 86.

Inspectors wroteBased on observations, staff interviews, and policy review, the facility failed to maintain a safe, functional, and sanitary environment. This directly affected two Residents (#56 and #59) and had the potential to affect 11 additional residents housed in the 500 hall out of 13 residents reviewed for environment. The facility census was 86.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure handrails on the Memory Care Unit (MCU) were secured to the wall. This had the potential to affect all 20 Residents (#07, #22, #25, #27, #38, #41, #43, #44, #54, #56, #58, #59, #64, #69, #75, #77, #80, #82, #85, and #88) who the facility identified as being independently mobile and residing on the MCU. The facility census was 86.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide reasonable accommodations to allow residents appropriate access to handwashing facilities. This affected three resident (Residents #13, #15 and #55) of five residents reviewed. The total facility census was 86. Findings Include:1. Record review for Resident #13 revealed the resident was admitted to the facility on [DATE] with the following diagnoses: Morbid obesity, Acute and Chronic Respiratory Failure with hypoxia, and Ventral Hernia. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require setup or clean-up assistance for personal hygiene. The resident could transfer self and ambulate a few feet independently. [...]

Inspectors wroteBased on medical record review, interview, and policy review the facility failed to ensure a discharge summary was completed. This affected one resident (Resident #94) out of three residents reviewed for discharged summaries. The facility census was 86. Findings Include:Record review for Resident #94 revealed the resident was admitted to the facility on [DATE] with the following diagnoses: Unspecified combined systolic (congestive) and diastolic (congestive) heart failure, and venous insufficiency (chronic) (peripheral). Resident #94 had a planned discharge home on [DATE]. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. [...]

Inspectors wroteBased on medical record review and staff interview, the facility failed to develop and implement a fall care plan for a resident who was at risk for falls. This affected one (Resident #66) of five residents reviewed for falls. The facility census was 86.

Inspectors wroteBased on observation, staff interviews and record review, the facility failed to provide varied activities to meet the needs and interests of residents. This affected three Residents (#15, #13 and #39) of five residents reviewed for activities. The total facility census was 86. Findings Include: Review of the activity calendars for October, November and December 2025 revealed from 9:30 A.M. to 11:30 A.M., there were three activities consisting of exercise, hydration cart, and table games for seven days of the week. Two to three times a week there was a 5:00 P.M. activity. There were no activities listed after 5:00 P.M. There was no religious program listing on Sundays or any other days of the week. Review of activity participation logs of 12/01/25 through 12/10/25 revealed 10 to 20 of the same residents attending all activities. There was no participation in the morning exercise class. [...]

Inspectors wroteBased on interview and record review the facility failed to ensure care and services were provided as planned and ordered. This affected one (Resident #15) out of three reviewed. The facility census was 86.

Inspectors wroteBased on medical record review, resident interview, and staff interview, the facility failed to arrange vision services outside of the facility as requested. This affected one (Resident #04) of one resident reviewed for vision services. The facility census was 86.

Inspectors wroteBased on medical record review, staff interview, and policy review, the facility failed to ensure weights were completed as ordered. This affected three (Residents #04, #10, and #48) of five residents reviewed for nutrition. The facility census was 86.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure a resident's gastrostomy tube (G-tube) was taken care of per physician orders. This affected one (Resident #11) out of two residents reviewed for G-tube care. The facility census was 86.

Inspectors wroteBased on record review, observation, staff interviews, and policy review, the facility failed to ensure oxygen was provided appropriately. This affected one (Resident #44) out of one resident reviewed for oxygen. The facility census was 86.

Inspectors wroteBased on observation and staff interviews, the facility failed to ensure the medication error rate was not greater than five percent (%). This affected two (Residents #13 and #19) of the three residents reviewed for medication administration. The facility census was 86.

Inspectors wroteBased on observation, staff interviews and policy review, the facility failed to ensure residents were free of significant medication errors. This affected one (Resident #90) out of the two residents reviewed for IV medication. The facility census was 86. Findings Include: Record review for Resident #90 revealed this resident was admitted to the facility on [DATE] with the following diagnoses: Osteomyelitis, Type 2 Diabetes Mellitus with Foot Ulcer, and bipolar disorder. Review of the most Minimum Data Set (MDS) assessment dated [DATE] revealed this resident had moderate intact cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 12. [...]

Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure laboratory (lab) tests were completed as ordered. This affected one (Resident #81) of one resident reviewed for laboratory services. The facility census was 86.

Inspectors wroteBased on observation, interview and record review, the facility failed to follow up timely on dental recommendations. This affected one (Resident #39) of the five residents reviewed for dental care. The total facility census was 86Findings Include:Record review for Resident #39 revealed this resident was admitted to the facility on [DATE] Diagnoses included Type 2 Diabetes Mellitus with Diabetic Neuropathy, Diabetes mellitus, and Unsteadiness of feet. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #39 had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 15. This resident was assessed to require supervision or touching assistance for eating, and supervision or touching assistance for oral hygiene. The resident had a physician order for a regular diet. [...]

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure residents received three meals a day. This affected one (Resident #19) out of three residents reviewed for meal assistance. The facility census was 86. Findings Include:Observation on 12/10/25 at 2:10 P.M., revealed Resident #19 had not received their lunch at this time. Interview on 12/10/25 at 2:11 P.M., with Resident #19 confirmed they did not receive lunch at this time. Resident #19 stated that they requested a ham sandwich and a bowl of soup from the alternative menu. Interview on 12/10/25 at 2:27 with the Director of Nursing (DON), confirmed Resident #19 did not receive their lunch. Review of the facility policy titled, Mealtimes and Frequency revealed the facility will provide at least three meals daily at regular times. [...]

Inspectors wroteBased on observation, staff interviews, and policy review, the facility failed to ensure rooms provided full visual privacy for each resident. This affected two Residents (#56 and #59) out of two residents reviewed for privacy. The facility census was 86.

Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure clean dishes were handled in a sanitary manner. This had the potential to affect all 87 residents in the facility who the facility identified all residents receiving food from the kitchen. The facility census was 87.

Inspectors wroteBased on medical record review, resident interview, staff interview, and review of the facility policy, the facility failed to provide medications as ordered by physician. This affected one resident (Resident #11) of three residents reviewed for medication administration. The facility census was 94 residents.

Inspectors wroteBased on medical record review, resident interview, staff interview, and review of the facility policy, the facility failed to accurately document medication administration. This affected one (Resident #11) of three residents reviewed for medication administration. The facility census was 94 residents.

Inspectors wroteBased on record review, facility staff interviews and policy review the facility failed to develop a complete comprehensive care plan to include activities. This affected three (Resident #9, #13, and #45) out of four residents reviewed for activities. The facility census was 88.

Inspectors wroteBased on review of the Payroll-Based Journal (PBJ) report, record review and staff interview the facility failed to have eight consecutive hours of Registered Nurse (RN) coverage in the facility. This had the potential to affect all 92 residents who resided in the facility.

Inspectors wroteBased on medical record review, observations and resident and staff interviews, the facility failed to ensure perineal care was provided for a resident. This affected one (#38) of three reviewed for incontinent care. The facility census is 87.

Inspectors wroteBased on record review and interview, the facility failed to have a Registered Nurse on duty for two days on the weekends. This affected all residents in the facility. The facility census was 87.

Inspectors wroteBased on observations, interviews, and policy review, the facility failed to ensure residents had reasonable access to menus to meet resident needs, facility failed to have alternate menus, failed to ensure residents were notified of menu substitutions, and failed to prepare meals according to the menu. This directly affected seven (Residents #3, #6 #11, #62, #29, #33 and #56) residents and had the potential to affect all residents who received food from the kitchen. The facility census was 87.

Inspectors wroteBased on observation, and interview, the facility failed to ensure the food looked appetizing and was palatable. This affected all of the residents in the facility. The census was 87.

Inspectors wroteBased on observation and interview, the facility failed to ensure opened food items were dated, staff wore hair coverings and that food was stored properly in the freezer. This had the potential to affect all residents who received food from the kitchen. The facility census was 87.

Inspectors wroteBased on record review and interview, the facility failed to implement a quality assurance performance improvement (QAPI) plan. This had the potential to affect all 87 residents residing in the facility.

Inspectors wroteBased on interview and record review, the facility failed to provide evidence a quarterly quality assessment and assurance (QAA) meeting was held. This had the potential to affect all 87 residents residing in the facility.

Inspectors wroteBased on record review, interview and policy review, the facility failed to address concerns brought forth by the Resident Council in a timely manner. This directly affected 15 residents who attended the resident council meetings and had the potential to affect all residents. The census was 87.

Inspectors wroteBased on observation, interview, and policy review, the facility failed to ensure the environment and resident equipment were in good repair. This affected four (Residents#5, #27, #29, and #33) of five reviewed for environment. The census was 87.

Inspectors wroteBased on interview, record review, and policy review, the facility failed to ensure residents had complete and accurate care plans and failed to ensure that care plans were implemented. This affected six (Residents #22, #29, #33, #76, #336, and #82) of twenty-four residents sampled for care plans. The facility census was 87.

Inspectors wroteBased on record review, observation, interview and policy review, the facility failed to ensure residents smoked in designated areas and failed to ensure smoking materials were kept secured. This affected four (Residents #45, #33, #336 and #76) of five residents reviewed for smoking. The facility identified 62 residents who smoked. The facility census was 87.

Inspectors wroteBased on observation, record review, interview, and policy review, the facility failed to ensure staff were not assigned to residents who specified they did not want that caregiver and failed to ensure residents received their phone calls. This affected two (Residents #26 and #336) of two residents reviewed for resident rights. The census was 87.

Inspectors wroteBased on record review and interview, the facility failed to complete a new Preadmission Screening and Resident Review (PASRR) when a new mental health diagnosis was given. This affected two (Residents #33 and #45) of six reviewed for PASRR. The facility census was 87.

Inspectors wroteBased on record review, interview, and policy review, the facility failed to ensure residents received quarterly care conferences. This affected two (Residents #6 and #62) of three residents sampled for care conferences. The facility census was 87.

Inspectors wroteBased on record review, interview and policy review, the facility failed to ensure showers were given. This affected two (Residents #29 and #33) of two reviewed for activities of daily living. The census was 87.

Inspectors wroteBased on record review and interview, the facility failed to ensure a pressure ulcer was monitored when hospice took over the care of the resident. This affected one (Resident #27) of two residents reviewed for pressure ulcers. The facility identified three residents with pressure ulcers in the facility. The census was 87.

Inspectors wroteBased on observation, interview, record review and policy review, the facility failed to provide incontinence care in a manner to prevent urinary tract infection. This affected one (Resident #11) resident reviewed for incontinence. The facility identified 45 residents who were incontinent. The facility census was 87.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure residents received medications as ordered. This affected three (Residents # 18, #45, and #29) of six residents sampled for medication administration. The facility census was 87.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure medications were not left at the bedside. This affected one (Resident #43) out of 21 residents the nurse administered medications to. The facility census was 87.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure dental services were provided to residents. This affected two (Residents #33 and #73) four residents reviewed for dental services. The facility census was 87.

Inspectors wroteBased on observation, record review and interview, the facility failed to provide a resident with adaptive equipment at meals. This affected one (Resident #62) resident. The census was 87.

Inspectors wroteBased on record review, observation, interview and policy review, the facility failed to implement appropriate infection control measure for residents in transmission-based precautions. This affected two (Residents #48, and #27) of four residents sampled for infection control. The facility census was 87.

Inspectors wroteBased on record review, observation, and staff interviews, the facility failed to prepare an adequate amount of food to serve all the residents and failed to follow the prepared menu. This had the potential to affect all residents residing in the facility. The facility census was 87.

Inspectors wroteBased on record review, observation and staff interview, the facility failed to store, prepare, distribute, and serve foods in accordance with professional standards for food service safety. This had the potential to affect all residents residing in the facility. The facility census was 87.

Inspectors wroteBased on observation and staff interview, the facility failed to ensure kitchen was clean and sanitary. This had the potential to affect all 88 residents residing in the facility. The facility census was 88.

Inspectors wroteBased on medical record review, and staff interviews, the facility failed to administer insulin per sliding scale as ordered resulting in a significant medication error. This affected one (#90) of three residents reviewed for diabetic management/medication administration. The facility census was 88.

Inspectors wroteBased on medical record review, observation and staff interview, the facility failed to maintain infection practices by ensuring staff completed hand hygiene between multiple dressing changes. This affected one (#28) of three reviewed for infection control. Facility census was 88.

Inspectors wroteBased on resident and staff interviews, observation, record review and review of the facility's policy, the facility failed to address the resident's concerns in a timely manner. This had the potential to affect all 91 residents residing in the facility.

Inspectors wroteBased on record review, review of personnel files, review of the Bureau of Criminal Identification and Investigation (BCI) log, review of the Ohio Attorney General's web site, review of the facility's abuse policy, and resident and staff interviews, the facility failed to implement their abuse policy to ensure employee fingerprints were obtained and sent to the Bureau of Criminal Identification and Investigation (BCI & I) for seven employees. Additionally, the facility failed to implement their abuse policy to ensure the BCI & I results were received within 30 days for four employees. The facility also failed to implement their abuse policy when a resident (Resident #1) voiced concerns of an allegation of misappropriation. This had the potential to affect all 91 residents residing in the facility.

Inspectors wroteBased on observation, resident interview, staff interview, and a tray test of food, the facility failed to provide palatable food at an appetizing temperature. This had the potential to affect all residents of the facility except Resident #5 and Resident #29 who ate nothing by mouth. The facility census was 91.

Inspectors wroteBased on review of the Dietician Food Safety and Sanitation Checklist, observations, and staff interview, the facility failed to ensure proper use of gloves, ensure hand washing facilities were available in the kitchen, and failed to date and label opened stored foods. This had the potential to affect all of the residents of the facility except two Residents (#5 and #29) who received nothing by mouth (NPO). The facility census was 91.

Inspectors wroteBased on review of the Quality Assessment and Assurance Committee (QAA) records and staff interview, the facility failed to have documentation quarterly meetings were held. This had the potential to affect all 91 residents of the facility.

Inspectors wroteBased on observation, staff interview, and review of facility policy, the facility failed to provide laundry services under proper infection control measures. Additionally, based on facility personnel records review, staff interview, and review of facility policy, the facility failed to ensure five staff (State Tested Nursing Assistants (STNAs) #16, #85, and #95, Licensed Practical Nurse (LPN) # 54, and Registered Nurse (RN) #72) of nine reviewed completed annual tuberculosis (TB) screenings. This had the potential to affect all 91 residents residing in the facility.

Inspectors wroteBased on medical record review, observation, and staff interview the facility failed to ensure residents were free of significant mediation errors. There were five medications errors observed out of 27 opportunities observed, resulting in a 18.5 % medication error. This affected three Residents (#15, #90, and #196) of 8 observed during medication administration. The facility census was 91.

Inspectors wroteBased on observation, staff and resident interviews, the facility failed to ensure the resident's wheelchairs and the glove dispensers were in good repair. This affected four (#210, #211, #212, and #216) of 99 resident rooms. The facility census was 91.

Inspectors wroteBased on medical record review, staff and resident interviews, review of the facility's Self-Reported Incidents(SRI) and review of the facility's policy, the facility failed to report an allegation of misappropriation of resident money to the Administrator and/or designee and the State Survey Agency. This affected one (Resident #1) of four residents reviewed for personal property during the investigation stage of the annual survey. The facility census was 91.

Inspectors wroteBased on medical record review, staff and resident interviews, and review of the facility's policy, the facility failed to investigate an allegation of misappropriation of resident money. This affected one (Resident #1) of four residents reviewed for personal property during the investigation stage of the annual survey. The facility census was 91.

Inspectors wroteBased on record review, observation, staff and resident interview, and review of the facility's policy, the facility failed to treat and monitor a resident's shin wound. This affected one (Resident #71) of four residents reviewed for skin/pressure wounds during the investigation stage of the annual survey. The facility census was 91.

Inspectors wroteBased on resident and staff interviews, observation, review of the facility's policy and record review, the facility failed to ensure resident's practiced safe smoking. This affected two (#33 and #81) of two residents reviewed for smoking. The facility identified 13 residents who smoked. The facility census was 91.

Inspectors wroteBased on record review, observation and resident and staff interview, the facility failed to ensure a therapeutic diet was was provided to a resident. This affected one (Resident #90) of four residents reviewed for nutrition. The facility identified four residents on a renal diet. The facility census was 91.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to ensure pharmacy recommendations were completed and those completed were acted on in a timely manner This affected two Residents (#30 and #90) of five reviewed for unnecessary medications. The facility census was 91.

Inspectors wroteBased on medical record review, staff interview, and review of facility policy, the facility failed to ensure pharmacy recommendations for dose reductions were responded to for one Resident (#90) of five reviewed for unnecessary medications. The facility further failed to discontinue a resident's psychotropic medication following a outside physician visit. This affected one Resident (#1) of five residents reviewed for unnecessary medication. The facility census was 91.

Inspectors wroteBased on medical record review, observation, staff interview, and review of facility policy, the facility failed to ensure residents were free of significant medications errors. This affected one Resident (#90) of 19 reviewed. The facility census was census was 91.

Inspectors wroteBased on observation, staff interview, and review of pharmacy information, the facility failed to remove medications when they expired. This affected one Supply Room of one reviewed for expired medications. The facility further failed to date insulin when opening a new vial. The expired medications had the potential to affect two Residents (#8 and #90) of two reviewed for insulin. The facility census was 91.

Inspectors wroteBased on medical record review, resident and staff interview, the facility failed to ensure one resident was provided annual dental care. This affected one resident (#52) of 24 reviewed for dental services. The facility census was 91.

Inspectors wroteBased on review of speciality diet list, observation, staff interview, resident interview, and review of facility policy, the facility failed to provide foods of similar nutritive value to residents who chose a speciality diet. This affected three Residents ( #79, #37 and #16) of three reviewed who requested a speciality diet. The facility census was 91.

Inspectors wroteBased on observation, staff, resident interview, and review of facility policy, the facility failed to offer snacks to residents. This affected two Residents (#1 and #30), of five residents reviewed for snacks. The facility census was 91.

Inspectors wroteBased on facility record review, review of the facility's policy and staff interview, the facility failed to provide quarterly statements to resident with Personal Resident Trust accounts. This had the potential to affected 56 residents identified with personal funds accounts. The facility census was 91.