01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-04-11 | 13 | 2025-04-11 | 4 |
| Cycle 2 | 2024-02-15 | 10 | 2024-02-15 | 4 |
| Cycle 3 | 2022-11-03 | 10 | 2022-11-03 | 4 |
CMS CCN 2355182026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Maple Woods Manor
13137 North Clio Road · Clio, MI 48420 · Genesee County
Certified beds151CMS provider file
Recent citation rows45current CMS citation release
Penalty rows2current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
45 rows in the current release
5 rows carry G–L scope/severity codes; 0 carry J–L. 9 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-06-03 · HEALTHF0550Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2026-07-13 · complaint2026-06-03 · HEALTHF0804Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Correction field: Deficient, Provider has date of correction · 2026-07-13 · complaint2026-04-08 · HEALTHF0600Severity G · isolated actual harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Correction field: Deficient, Provider has date of correction · 2026-05-05 · complaint2025-08-13 · HEALTHF0584Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Correction field: Deficient, Provider has date of correction · 2025-09-22 · complaint2025-06-24 · HEALTHF0684Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-07-21 · complaint2025-04-11 · HEALTHF0553Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0578Severity E · pattern; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0657Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0676Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0686Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0693Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0700Severity E · pattern; potential for more than minimal harm
Quality of Life and Care Deficiencies
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · HEALTHF0880Severity F · widespread; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · FIREK0222Severity E · pattern; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · FIREK0345Severity F · widespread; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · FIREK0355Severity E · pattern; potential for more than minimal harm
Smoke Deficiencies
Properly select, install, inspect, or maintain portable fire extinguishes.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-04-11 · FIREK0918Severity F · widespread; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-05-202025-01-21 · HEALTHF0686Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Correction field: Deficient, Provider has date of correction · 2025-02-18 · complaint2024-02-15 · HEALTHF0658Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2024-03-18 · complaint2024-02-15 · HEALTHF0688Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Correction field: Deficient, Provider has date of correction · 2024-03-182024-02-15 · HEALTHF0689Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2024-03-18 · complaint2024-02-15 · HEALTHF0692Severity G · isolated actual harm
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Correction field: Deficient, Provider has date of correction · 2024-03-182024-02-15 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2024-03-1803 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-01-21 | Fine | $42,990 | 0 |
| 2024-02-15 | Fine | $15,593 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- DAVID LEBENBOM IRRV TROrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST17% · since 10/10/2006
- LEBENBOM, STUARTIndividual · 5% OR GREATER DIRECT OWNERSHIP INTEREST17% · since 01/16/2025
- PEPLINKSI HOLDINGS, INC.Organization · DIRECT OWNERSHIP INTERESTNOT APPLICABLE · since 01/01/2012
- ACKERMAN, AMYIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- ACKERMAN, RICKYIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- BAUMGARTEN, MICHAELIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- BAUMGARTEN, THERESEIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- PEPLINSKI, SHELIIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- PEPLINSKI, TODDIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- SCHADE, JEFFERYIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- SCHADE, TAMARAIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- THOMPSON, BRIANIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- THOMPSON, SHELLYIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTEREST7% · since 01/01/2012
- ACKERMAN, RICKYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/21/2012
- BAUMGARTEN, MICHAELIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/21/2012
- PEPLINSKI, TODDIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/21/2012
- SCHADE, JEFFERYIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 01/01/2012
- THOMPSON, BRIANIndividual · CORPORATE DIRECTORNOT APPLICABLE · since 05/21/2012
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.88per resident day
RN hours0.46per resident day
Weekend nurse hours3.53per resident day
Staff turnover43.5%CMS reported field
06 / LOCAL RECORDS
Open the Michigan ledger →Other published facilities nearby
No second facility in the same city met the directory rule.