Inspection·July 23, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few incidents or behaviors were discussed during the visit. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset.Review of Resident #500's progress note dated 01/09/25 at 7:09 A.M., revealed Resident #500 was noted in another resident's room undressing. Resident #500 was redirected by staff and Resident #500 displayed increased behaviors towards staff. Staff gave Resident #500 time to calm down and Resident #500 was redirected out of the other resident's room by staff. Review of Psychiatric NP #802's progress note dated 05/09/25 at 9:50 A.M., revealed Resident #500's Cimetidine was discontinued during the pharmacy meeting in April 2025. Resident #500 was recently found trying to kiss another female resident and was trying to put her arm around her in the lounge on the couch in a suggestive manner. Review of Resident #500's progress note dated 05/15/25 at 6:37 P.M., revealed Resident #500 was caught by the Certified Nursing Assistant (CNAs) in an empty room with another female resident whose pants were down. The CNAs pulled the resident's pants up and Resident #500 was telling the CNAs to keep them down. The staff redirected the residents out of the room and separated the residents. Review of Resident #500's physician order dated 05/15/25, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth two times a day for sexually inappropriate behaviors. Review of Resident #500's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was severely cognitively impaired and Resident #500 required assistance or supervision with activities of daily living (ADLs). Review of the police report dated 06/30/25 at 11:28 P.M., revealed the nursing staff found Resident #71 and Resident #500 in the same bed together. Resident #500 was fully clothed, but Resident #71 was in the bed with his pants off.Review of Resident #500's telehealth visit dated 06/30/25 at 1:00 P.M., revealed NP #901 was called by the nurse on duty stating another resident (#71) was observed lying next to Resident #500 that evening. Both residents had clothing on and there was no inappropriate touching. Review of Registered Nurse (RN) #207's witness statement dated 06/30/25, revealed Resident #500 and Resident #71 were lying in bed beside each other. Resident #500 was fully dressed, and Resident #71 had a shirt on and without pants. No one was seen touching the other. Review of Resident #500's progress note dated 07/01/25 at 2:16 A.M., revealed Resident #500 was in the bed beside another resident (#71). The residents were immediately separated with no injuries. A head-to-toe assessment was completed. The family, Director of Nursing (DON), regional nurse, police and Administrator were notified. Review of Resident #500's progress note dated 07/01/25 at 12:36 P.M., revealed Resident #500's physician was notified of the incident. Review of the facility's SRI created on 07/01/25 for a sexual abuse allegation that was discovered on 06/30/25, revealed the staff noted Resident #500 and Resident #71 laying side by side in bed on 06/30/25. Resident #500 was fully dressed, and Resident #71 was without his pants and underwear. No touching was noted, and the residents were immediately separated. Head-to-toe skin assessments were completed on the residents without injuries noted. The SRI was unsubstantiated. Review of Resident #500's progress note dated 07/03/25 at 3:05 P.M., revealed Resident #500 was found in bed with another resident (#64) on 06/30/25 at 9:30 P.M. The staff observed Resident #500 in bed with a male resident fully clothed. Resident #500 had dementia and wandering behaviors with the belief that the male resident was her boyfriend. The residents were immediately separated, and no injuries were noted.Review of a police report dated 07/13/25 at 1:50 P.M., revealed a sexual contact was reported to the police when they responded to the facility on [DATE] at 9:00 A.M. The staff stated the two residents in the mental health wing were observed to be engaging in sexual contact on 07/13/25. The staff stated that both residents were diagnosed with dementia and both POAs were contacted and informed of the incident. The staff stated that Resident #500 was foundling Resident #64's genital (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 2 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few area. This report was filed for reporting purposes only. Review of Resident #500's progress note dated 07/13/25 at 4:15 P.M., revealed an incident was reported to LPN #178 while doing her rounds that a staff entered another resident's room and noted a male resident was sitting in his chair while Resident #500 was massaging his genitals. The CNA instantly removed Resident #500 from the male resident's room and made LPN #178 aware. LPN #178 notified the unit manager. The CNA had recently witnessed Resident #500 in her room while picking up her lunch tray. Resident #500 was placed on one-on-one (1:1) observation until further notice and her daughter was made aware. Review of Resident #500's progress note dated 07/13/25 at 4:31 P.M., revealed the on-call physician was made aware of the behavior. Review of Resident #500's progress note dated 07/14/25 at 9:32 A.M., revealed a report was given to the police regarding the sexual encounter between Resident #500 and Resident #64. Review of Resident #500's physician order dated 07/14/25, revealed Resident #500 was to be on 1:1 observation until further notice. Review of the facility's SRI created on 07/14/25 for a sexual abuse allegation that was discovered on 07/13/25, revealed Resident #64 and Resident #500 were found alone in Resident #64's room together. Resident #500 was fully dressed and Resident #64's pants and underwear were down. Resident #500 was noted touching Resident #64's groin area. The residents were separated, assessed, and interviewed. Resident #64 denied any penetration or injury. Resident #500 could not recall the incident and denied penetration or injury. Resident #500 was placed on 1:1 observation and all appropriate parties were notified. The police were contacted and found the residents were not in any immediate danger, and no legal action was required. The SRI was unsubstantiated. Review of Resident #500's physician order dated 07/17/25 revealed Resident #500 may discharge to another skilled nursing facility on 07/18/25. Review of Resident #500's progress note dated 07/18/25, revealed Resident #500 was discharged to another skilled nursing facility. A cab came for Resident #500 at about 3:30 P.M. The face sheet and medication lists were given. Review of Resident #64's chart revealed Resident #64 admitted to the facility on [DATE] with chronic obstructive pulmonary disease, unspecified dementia unspecified severity with other behavioral disturbance, neurocognitive disorder with Lewy bodies, delirium due to known physiological condition, bell's palsy and paranoid schizophrenia. The resident was moderately cognitively impaired. Review of Resident #64's progress note dated 07/13/25 at 4:33 P.M., revealed LPN #178 was informed that another resident (#500) was in Resident #64's room. Resident #64 was sitting in his chair, and the other resident was massaging his genitals. The staff immediately removed the other resident from Resident #64's room and stayed with the other resident. The staff notified LPN #178 and LPN #178 notified the unit manager. The on-call physician was notified, and a head-to-toe assessment was completed with no findings. LPN #178 spoke with Resident #64's wife and made her aware of the incident.Review of CNA #231's hand-written witness statement dated 07/13/25, revealed CNA #231 was going to check on Resident #64. When CNA #231 walked in the room, Resident #500 was being sexually inappropriate massaging Resident #64's private parts. CNA #231 separated them and informed the nurse of their behavior. Review of LPN #178's witness statement dated 07/13/25, revealed LPN #178 and another CNA were giving care to another resident. When LPN #178 and the CNA returned to the nurse's station, another CNA reported that she witnessed Resident #500 in Resident #64's room. Resident #64 was sitting in his chair with his pants down and Resident #500 was inappropriately massaging Resident #64's private area. The CNA immediately separated the residents and informed LPN #178 who informed the unit manager. LPN #178 placed Resident #500 on 1:1 observation and head-to-toe skin assessments were completed with no findings. The on-call physician was made aware.Review of Resident #64's progress note dated 07/14/25 at 9:30 A.M., revealed a report was given to the police regarding the sexual encounter involving Resident #64 and the other female resident. Observation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 3 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of Resident #64 on 07/22/25 at 9:53 A.M., revealed Resident #64 was sitting in his wheelchair in the common area. Resident #64 was clean and dressed appropriately. Interview with Resident #64 in his room on 07/22/25 at 9:53 A.M., revealed Resident #64 had not been sexually abused in the facility. Resident #64 denied having any sexual or intimate relationships in the facility. Interview with CNA #236 on 07/22/25 at 9:57 A.M., revealed she did not witness the incident between Resident #500 and Resident #64, but she was working on that date. CNA #236 reported Resident #500 was placed on 1:1 observation until she was discharged from the facility. CNA #236 stated she was not aware of Resident #500 or Resident #64 having sexually inappropriate behaviors prior to the incident. Interview with CNA #231 on 07/22/25 at 10:00 A.M., revealed CNA #231 was going to Resident #64's room to do a check and change on the date of the incident. CNA #231 stated Resident #64 was sitting in his wheelchair and Resident #500 was sitting in the recliner when she entered the room. CNA #231 reported Resident #64 had his penis out and Resident #500 was stroking Resident #64's erect penis. CNA #231 stated Resident #64's pants and brief were down to his thigh. CNA #231 reported she told the residents that they cannot be doing this and CNA #231 separated the residents by getting Resident #500 out of the chair, wiping Resident #500's hands and taking Resident #500 to the common area. CNA #231 stated she went back to Resident #64's room to assist him with pulling up his brief and pants after Resident #500 was removed from the room. CNA #231 asked Resident #64 if he wanted to stay in his room or go to the common area and Resident #64 stated he wanted to stay in his room. CNA #231 stated Resident #64 was upset with CNA #231 for stopping the incident and he stated, Don't talk to me anymore. CNA #231 also reported Resident #64 stated that he did not appreciate that because he was not finished. CNA #231 stated she reported the incident to LPN #178 after she removed Resident #500 from the situation but before returning to Resident #64's room to assist him with his pants. CNA #231 reported Resident #500 did not say anything about the incident, but she was hollering and screaming because she wanted to stay in Resident #64's room. CNA #231 reported that Resident #500 was placed on 1:1 observation and she continued to try to rub Resident #64's thigh after he decided to go back to the common area that day. CNA #231 stated that Resident #500 had a history of sexual behaviors and Resident #500 had been found in bed with other male residents in the past. Interview with LPN #178 on 07/22/25 at 10:19 A.M., revealed she was working on 07/13/25 when CNA #231 informed her that she was doing room checks and entered Resident #64's room and found him sitting in his wheelchair with his pants down and Resident #500 was massaging his penis. LPN #178 stated that CNA #231 separated the residents and Resident #500 was with CNA #231 when CNA #231 reported the incident to LPN #178. LPN #178 reported the incident occurred around 2:00 P.M. LPN #178 stated Resident #500 was upset that she was removed from the situation and Resident #64 was also upset that Resident #500 was removed from his room. LPN #178 reported that Resident #500 was placed on 1:1 observation, head-to-toe assessments were completed on Resident #500 and Resident #64 with no injuries noted and administrative staff were notified. LPN #178 stated she was not aware of Resident #500 or Resident #64 having any prior sexual behaviors. LPN #178 reported that the police were notified a skin sweep was completed on all the residents on the unit with no negative findings. Interview with Registered Nurse (RN) #202 via telephone on 07/22/25 at 2:22 P.M., revealed RN #202 could not remember the dates of the incident because it had been a while and she did not usually work on the memory care unit. RN #202 stated that Resident #500 would walk around and was clinging towards the male residents. RN #202 reported that Resident #500 would try to kiss, touch or hug male residents and CNAs would have to redirect her. RN #202 stated that management was informed of Resident #500's sexually inappropriate behaviors. Interview with the Administrator and Regional Director of Clinical Operations (RDCO) #801 on 07/22/25 at 2:28 P.M., revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 4 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the Administrator was not aware of Resident #500 attempting to kiss, hug and touch male residents on 09/01/25 or the incident on 05/15/25 where Resident #500 was found in an empty room with another female resident with her pants pulled down. The Administrator confirmed the facility did not complete an SRI or investigate the 05/15/25 incident per the abuse policy. The Administrator stated an SRI was completed on 06/30/25 after staff found Resident #500 lying in bed with Resident #71 during rounds. Resident #71 was noted without any pants or brief on, and Resident #500 was fully clothed. The Administrator stated the staff separated the residents and Resident #500 was placed on 1:1 observation for three days after the incident. A medication review was also completed and Resident #500's room was moved to the opposite side of the unit. The Administrator stated the staff were educated on abuse. The Administrator stated Resident #500 was observed in Resident #64's room on 07/13/25. Resident #500 was fully clothed, and Resident 64 was sitting in his chair with his pants down. The Administrator reported staff witnessed Resident #500 touching Resident #64's penis with her hands. The Administrator stated the staff separated the residents and Resident #500 was placed on 1:1 observation. The Administrator reported Resident #500 and Resident #71 were both upset that they were separated but then did not recall the incident at a later time. The Administrator reported Resident #500 stayed on 1:1 observation until she was discharged to a female dementia unit. The Administrator stated that interviews of staff and residents and skin checks of residents were completed with no issues. The Administrator reported an SRI was filed on the 07/13/25 incident and laboratory tests (labs) were obtained on Resident #500 to rule out infection. The Administrator verified the facility did not care plan Resident #500 for sexually inappropriate behaviors until after the 07/13/25 incident. The Administrator confirmed Resident #500 had been prescribed Cimetidine for sexually inappropriate behaviors dating back to 11/25/24. Observation of Resident #71 on 07/22/25 at 3:53 P.M., revealed Resident #71 was sitting in a recliner in the common area. Resident #71's hand was on top of Resident #62's hand. Interview with Resident #71 on 07/22/25 at 3:53 P.M., revealed Resident #71 denied being sexually abused at the facility. Resident #71 denied having any intimate relationships at the facility. Interview with RDCO #801 and Divisional Director of Risk Management (DDRM) #803 on 07/23/25 at 12:02 P.M., revealed Resident #500 had made attempts at making contact with male residents on 09/01/24 but contact was never made. RDCO #801 stated Resident #500 had a urinary analysis pending on 09/01/24 and the facility thought that Resident #500's behaviors were from an infection on that date. RDCO #801 stated that a gradual dose reduction was completed on Resident #500's Cimetidine 200 mgs and the medication was discontinued on 04/14/25. RDCO #801 stated that Resident #500 was seen by Psychiatric NP #802 on 05/09/25 and it was reported that Resident #500 was trying to kiss another female resident, but no contact was made. RDCO #801 stated that Resident #500's was observed in a room with her pants down with another female resident on 05/15/25. RDCO #801 stated that no contact was made, and Resident #500 was ordered her Cimetidine 200 mgs two times a day for sexually inappropriate behaviors. RDCO #801 reported Resident #500 was found in bed with a male resident with his pants and brief off on 06/30/25 and the incident was reported to telehealth as sexually inappropriate behavior. RDCO #801 stated no contact was made between Resident #500 and Resident #71, but a medication review was completed and Resident #500's Lexapro was increased from 10 mgs to 15 mgs for anxiety and depression on 07/08/25. Interview with Psychiatric NP #802 via phone on 07/25/25 at 1:16 P.M., revealed she started working for the company in March 2025. Psychiatric NP #802 reported she saw Resident #500 on 04/07/25 and she documented that Resident #500's Cimetidine 200 mgs one time a day was effective for managing her sexually inappropriate behaviors. Psychiatric NP #802 reported Resident #500's Cimetidine 200 mgs was discontinued on 04/14/25 due to a gradual dose reduction. Psychiatric NP #802 stated she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 5 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete saw Resident #500 on 05/09/25 and it was reported to her by staff that Resident #500 recently tried to put her arm around and kiss another female resident. Psychiatric NP #802 stated that Resident #500's Cimetidine was ordered after Resident #500 was found in a room disrobing with another female resident on 05/15/25. Psychiatric NP #802 reported that Resident #500's Cimetidine was restarted on 05/15/25 and was increased from the previous dose of Cimetidine 200 mgs one time a day to Cimetidine 200 mgs two times per day because she did not feel that Cimetidine 200 one time a day was a therapeutic dose for hypersexual behaviors. Psychiatric NP #802 reported she saw Resident #500 on 06/13/25 and Resident #500 had no new inappropriate sexual behaviors. Psychiatric NP #802 reported she was notified that Resident #500 was found in bed with a male resident on 06/30/25 and her Lexapro was increased on 07/08/25 to decrease her hypersexual behaviors. Psychiatric NP #802 stated that she spoke with Resident #500's daughter in June 2025 and she stated that she had always had hypersexual behaviors prior to her dementia diagnosis. Review of the facility's undated abuse, neglect and misappropriation policy revealed the facility's intent was to prevent abuse, mistreatment or neglect of residents and to provide guidance to direct staff to manage any concerns or allegations of abuse. In the event that a situation is identified as abuse, an investigation by executive leadership will immediately follow up. All alleged violations involving abuse are reported immediately but not later than two hours after the allegation is made. The self-report will be made by the executive director to the state survey agency. This deficiency represents non-compliance investigated under Incident Number 2567007 . Event ID: Facility ID: 365081 If continuation sheet Page 6 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, review of Self-Reported Incidents (SRIs) and record review, the facility failed to implement their abuse policy for an allegation of resident to resident sexual abuse. This affected one (#500) of six residents reviewed for abuse. The facility census was 106. Review of Resident #500's chart revealed Resident #500 was admitted to the facility on [DATE] with Alzheimer's disease, dementia in other diseases classified elsewhere unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, primary generalized osteoarthritis, major depressive disorder, alcohol abuse, anxiety disorder, mixed hyperlipidemia, depression and history of falling. Resident #500 discharged from the facility on 07/18/25. Review of Resident #500's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was severely cognitively impaired.Review of Resident #500's behavior care plan dated 03/18/24 and revised on 07/16/25, revealed Resident #500 had a behavior problem related to Resident#500 being noted in bed unclothed with male residents at times, wandering into male resident rooms and exhibiting sexual behaviors. Interventions included encourage resident to participate in activities of choice, intervene as necessary to protect the rights and safety of others, minimize potential for disruptive behaviors by offering tasks that divert attention, monitor behavioral episodes and attempt to determine the underlying cause, resident had one on one supervision, communicate with the resident and resident representative regarding behaviors and treatment, encourage the resident to express feelings and encourage active support by family. Further review of Resident #500's care plan reviewed Resident #500 did not have a care plan for her sexual behaviors prior to 07/16/25.Review of Resident #500's progress note dated 09/02/24 at 6:07 A.M., revealed Resident #500 made frequent attempts at kissing, hugging and touching other male residents in the sitting area on 09/01/25 from the beginning of shift until Resident #500 went to bed. Each time, the residents were separated or redirected from the other resident who either attempted to hit her or shout at her.Review of Resident #500's psychiatry note dated 11/16/24, revealed Resident #500 was seen by Nurse Practitioner (NP) #900. Resident #500 was seen for a chronic psychiatric medication visit for dementia, depression, insomnia and inappropriate sexual behaviors. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Resident #500 was ordered to start Cimetidine 200 mgs by mouth daily.Review of Resident #500's physician order dated 11/25/24, revealed Resident #500 was ordered Cimetidine oral tablet 200 milligrams (mgs) give one tablet by mouth a day for inappropriate sexual behaviors. The order was discontinued on 04/14/25. Review of Resident #500's psychiatry notes dated 12/16/24 and 01/13/25, revealed Resident #500 was seen by NP #900. Resident #500 presented for medication management and discussion of symptoms of dementia, depression, insomnia and inappropriate sexual behaviors. Resident #500 was on Cimetidine 200 mgs daily for inappropriate sexual behaviors. Resident #500's inappropriate sexual behaviors were mentioned as a concern, and they were currently being treated with Cimetidine 200 mgs daily. However, no specific incidents or behaviors were discussed during the visit. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Review of Resident #500's progress note dated 01/09/25 at 7:09 A.M., revealed Resident #500 was noted in another resident's room undressing. Resident #500 was redirected by staff and Resident #500 displayed increased behaviors towards staff. The staff gave Resident #500 time to calm down and Resident #500 was redirected out of the room by staff. Review of Psychiatric NP #802's progress note dated 05/09/25 at 9:50 A.M., revealed Resident #500's Cimetidine was discontinued during the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 7 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete pharmacy meeting in April 2025. Resident #500 was recently found trying to kiss another female resident and was trying to put her arm around her in the lounge on the couch in a suggestive manner. Review of Resident #500's progress note dated 05/15/25 at 6:37 P.M., revealed Resident #500 was caught by the Certified Nursing Assistant (CNAs) in an empty room with another female resident and the CNAs had to pull the pants of the resident up. The resident was telling them to keep them down. Staff redirected them out of the room and separated the residents.Review of Resident #500's physician order dated 05/15/25, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth two times a day for sexually inappropriate behaviors. The order was discontinued 07/21/25. Interview with the Administrator and Regional Director of Clinical Operations (RDCO) #801 on 07/22/25 at 2:28 P.M., revealed the Administrator was not aware of the incident on 05/15/25 where Resident #500 was found in an empty room with another female resident with her pants pulled down. The Administrator confirmed the facility did not implement their abuse policy when the two residents were observed in a room with the resident's pants pulled down. The Administrator verified the facility did not create an SRI or investigate the 05/15/25 incident per the abuse policy. Interview with Psychiatric NP #802 via telephone on 07/25/25 at 1:16 P.M., revealed she started working for her company in March 2025. Psychiatric NP #802 reported she saw Resident #500 on 04/07/25 and she documented that Resident #500's Cimetidine 200 mgs one time a day was effective for managing her sexually inappropriate behaviors. Psychiatric NP #802 reported Resident #500's Cimetidine 200 mgs was discontinued on 04/14/25 due to a gradual dose reduction. Psychiatric NP #802 stated she saw Resident #500 on 05/09/25 and it was reported to her by staff that Resident #500 recently tried to put her arm around and kiss another female resident. Psychiatric NP #802 stated that Resident #500's Cimetidine was ordered after Resident #500 was found in a room disrobing with another female resident on 05/15/25. Psychiatric NP #802 reported that Resident #500's Cimetidine was restarted on 05/15/25 and was increased from the previous dose of Cimetidine 200 mgs one time a day to Cimetidine 200 mgs two times per day because she did not feel that Cimetidine 200 one time a day was a therapeutic dose for hypersexual behaviors. Review of the facility's undated abuse, neglect and misappropriation policy revealed the facility's intent was to prevent abuse, mistreatment or neglect of residents and to provide guidance to direct staff to manage any concerns or allegations of abuse. In the event that a situation is identified as abuse, an investigation by executive leadership will immediately follow up. All alleged violations involving abuse are reported immediately but not later than two hours after the allegation is made. The self-report will be made by the executive director to the state survey agency. This deficiency represents non-compliance investigated under Incident Number 2567007. Event ID: Facility ID: 365081 If continuation sheet Page 8 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, review of Self-Reported Incidents (SRIs), and record review, the facility failed to report an allegation of resident to resident sexual abuse to the state surveying agency. This affected one (#500) of the six residents reviewed for abuse. The facility census was 106. Review of Resident #500's chart revealed Resident #500 was admitted to the facility on [DATE] with Alzheimer's disease, dementia in other diseases classified elsewhere unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, primary generalized osteoarthritis, major depressive disorder, alcohol abuse, anxiety disorder, mixed hyperlipidemia, depression and history of falling. Resident #500 discharged from the facility on 07/18/25. Review of Resident #500's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was severely cognitively impaired. Review of Resident #500's behavior care plan dated 03/18/24 and revised on 07/16/25, revealed Resident #500 had a behavior problem related to Resident#500 being noted in bed unclothed with male residents at times, wandering into male resident rooms and exhibiting sexual behaviors. Interventions included encourage resident to participate in activities of choice, intervene as necessary to protect the rights and safety of others, minimize potential for disruptive behaviors by offering tasks that divert attention, monitor behavioral episodes and attempt to determine the underlying cause, resident had one on one supervision, communicate with the resident and resident representative regarding behaviors and treatment, encourage the resident to express feelings and encourage active support by family. Further review of Resident #500's care plan reviewed Resident #500 did not have a care plan for her sexual behaviors prior to 07/16/25. Review of Resident #500's progress note dated 09/02/24 at 6:07 A.M., revealed Resident #500 made frequent attempts at kissing, hugging and touching other male residents in the sitting area on 09/01/24 from the beginning of shift until Resident #500 went to bed. Each time, the residents were separated or redirected from the other resident who either attempted to hit her or shout at her. Review of Resident #500's psychiatry note dated 11/16/24, revealed Resident #500 was seen by Nurse Practitioner (NP) #900. Resident #500 was seen for a chronic psychiatric medication visit for dementia, depression, insomnia and inappropriate sexual behaviors. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Resident #500 was ordered to start Cimetidine 200 mgs by mouth daily. Review of Resident #500's physician order dated 11/25/24, revealed Resident #500 was ordered Cimetidine oral tablet 200 milligrams (mgs) give one tablet by mouth a day for inappropriate sexual behaviors. The order was discontinued 12/04/25. Review of Resident #500's physician order dated 12/05/24, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth at bedtime for inappropriate sexual behaviors. The order was discontinued 04/14/25. Review of Resident #500's psychiatry notes dated 12/16/24 and 01/13/25, revealed Resident #500 was seen by NP #900. Resident #500 presented for medication management and discussion of symptoms of dementia, depression, insomnia and inappropriate sexual behaviors. Resident #500 was on Cimetidine 200 mgs daily for inappropriate sexual behaviors. Resident #500's inappropriate sexual behaviors were mentioned as a concern, and they were currently being treated with Cimetidine 200 mgs daily. However, no specific incidents or behaviors were discussed during the visit. The staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Review of Resident #500's progress note dated 01/09/25 at 7:09 A.M., revealed Resident #500 was noted in another resident's room undressing. Resident #500 was redirected by staff and Resident #500 displayed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 9 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete increased behaviors towards staff. The staff gave Resident #500 time to calm down and Resident #500 was redirected out of the room by staff. Review of Psychiatric NP #802's progress note dated 05/09/25 at 9:50 A.M., revealed Resident #500's Cimetidine was discontinued during the pharmacy meeting in April 2025. Resident #500 was recently found trying to kiss another female resident and was trying to put her arm around her in the lounge on the couch in a suggestive manner. Review of Resident #500's progress note dated 05/15/25 at 6:37 P.M., revealed Resident #500 was caught by the Certified Nursing Assistant (CNAs) in an empty room with another female resident and the CNAs had to pull the pants of the resident up. The resident was telling them to keep them down. Staff redirected them out of the room and separated the residents. Review of Resident #500's physician order dated 05/15/25, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth two times a day for sexually inappropriate behaviors. The order was discontinued 07/21/25. Interview with the Administrator and Regional Director of Clinical Operations (RDCO) #801 on 07/22/25 at 2:28 P.M., revealed the Administrator was not aware of the incident on 05/15/25 where Resident #500 was found in an empty room with another female resident with her pants pulled down. The Administrator confirmed the facility did not complete an SRI or investigate the 05/15/25 incident per the abuse policy. Interview with Psychiatric NP #802 via telephone on 07/25/25 at 1:16 P.M., revealed she started working for her company in March 2025. Psychiatric NP #802 reported she saw Resident #500 on 04/07/25 and she documented that Resident #500's Cimetidine 200 mgs one time a day was effective for managing her sexually inappropriate behaviors. Psychiatric NP #802 reported Resident #500's Cimetidine 200 mgs was discontinued on 04/14/25 due to a gradual dose reduction. Psychiatric NP #802 stated she saw Resident #500 on 05/09/25 and it was reported to her by staff that Resident #500 recently tried to put her arm around and kiss another female resident. Psychiatric NP #802 stated that Resident #500's Cimetidine was ordered after Resident #500 was found in a room disrobing with another female resident on 05/15/25. Psychiatric NP #802 reported that Resident #500's Cimetidine was restarted on 05/15/25 and was increased from the previous dose of Cimetidine 200 mgs one time a day to Cimetidine 200 mgs two times per day because she did not feel that Cimetidine 200 one time a day was a therapeutic dose for hypersexual behaviors. Review of the facility's undated abuse, neglect and misappropriation policy, revealed the facility's intent was to prevent abuse, mistreatment or neglect of residents and to provide guidance to direct staff to manage any concerns or allegations of abuse. In the event that a situation is identified as abuse, an investigation by executive leadership will immediately follow up. All alleged violations involving abuse are reported immediately but not later than two hours after the allegation is made. The self-report will be made by the executive director to the state survey agency and will be thoroughly investigated. This deficiency represents non-compliance investigated under Incident Number 2567007. Event ID: Facility ID: 365081 If continuation sheet Page 10 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews, Review of Self-Reported Incidents (SRI) and review of facility policy, the facility failed to investigate an allegation of resident to resident sexual abuse. This affected one (#500) of six residents reviewed for abuse. The facility census was 106.Review of Resident #500's chart revealed Resident #500 was admitted to the facility on [DATE] with Alzheimer's disease, dementia in other diseases classified elsewhere unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, primary generalized osteoarthritis, major depressive disorder, alcohol abuse, anxiety disorder, mixed hyperlipidemia, depression and history of falling. Resident #500 discharged from the facility on 07/18/25. Review of Resident #500's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was severely cognitively impaired. Review of Resident #500's behavior care plan dated 03/18/24 and revised on 07/16/25, revealed Resident #500 had a behavior problem related to Resident#500 being noted in bed unclothed with male residents at times, wandering into male resident rooms and exhibiting sexual behaviors. Interventions included encourage resident to participate in activities of choice, intervene as necessary to protect the rights and safety of others, minimize potential for disruptive behaviors by offering tasks that divert attention, monitor behavioral episodes and attempt to determine the underlying cause, resident had one on one supervision, communicate with the resident and resident representative regarding behaviors and treatment, encourage the resident to express feelings and encourage active support by family. Further review of Resident #500's care plan reviewed Resident #500 did not have a care plan for her sexual behaviors prior to 07/16/25. Review of Resident #500's progress note dated 09/02/24 at 6:07 A.M., revealed Resident #500 made frequent attempts at kissing, hugging and touching other male residents in the sitting area on 09/01/24 from the beginning of shift until Resident #500 went to bed. Each time, the residents were separated or redirected from the other resident who either attempted to hit her or shout at her. Review of Resident #500's psychiatry note dated 11/16/24, revealed Resident #500 was seen by Nurse Practitioner (NP) #900. Resident #500 was seen for a chronic psychiatric medication visit for dementia, depression, insomnia and inappropriate sexual behaviors. The staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Resident #500 was ordered to start Cimetidine 200 mgs by mouth daily. Review of Resident #500's physician order dated 11/25/24, revealed Resident #500 was ordered Cimetidine oral tablet 200 milligrams (mgs) give one tablet by mouth a day for inappropriate sexual behaviors. The order was discontinued 12/04/25. Review of Resident #500's physician order dated 12/05/24, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth at bedtime for inappropriate sexual behaviors. The order was discontinued 04/14/25. Review of Resident #500's psychiatry notes dated 12/16/24 and 01/13/25, revealed Resident #500 was seen by NP #900. Resident #500 presented for medication management and discussion of symptoms of dementia, depression, insomnia and inappropriate sexual behaviors. Resident #500 was on Cimetidine 200 mgs daily for inappropriate sexual behaviors. Resident #500's inappropriate sexual behaviors were mentioned as a concern, and they were currently being treated with Cimetidine 200 mgs daily. However, no specific incidents or behaviors were discussed during the visit. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Review of Resident #500's progress note dated 01/09/25 at 7:09 A.M., revealed Resident #500 was noted in another resident's room undressing. Resident #500 was redirected by staff and Resident #500 displayed increased behaviors towards staff. Staff gave Resident #500 time to calm down Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 11 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and Resident #500 was redirected out of the room by staff. Review of Psychiatric NP #802's progress note dated 05/09/25 at 9:50 A.M., revealed Resident #500's Cimetidine was discontinued during the pharmacy meeting in April 2025. Resident #500 was recently found trying to kiss another female resident and was trying to put her arm around her in the lounge on the couch in a suggestive manner. Review of Resident #500's progress note dated 05/15/25 at 6:37 P.M., revealed Resident #500 was caught by the Certified Nursing Assistant (CNAs) in an empty room with another female resident and the CNAs had to pull the pants of the resident up. The resident was telling them to keep them down. Staff redirected them out of the room and separated the residents. Review of Resident #500's physician order dated 05/15/25, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth two times a day for sexually inappropriate behaviors. The order was discontinued 07/21/25. Interview with the Administrator and Regional Director of Clinical Operations (RDCO) #801 on 07/22/25 at 2:28 P.M., revealed the Administrator was not aware of the incident on 05/15/25 where Resident #500 was found in an empty room with another female resident with her pants pulled down. The Administrator confirmed the facility did not complete an SRI or investigate the 05/15/25 incident per the abuse policy. Interview with Psychiatric NP #802 via telephone on 07/25/25 at 1:16 P.M., revealed she started working for her company in March 2025. Psychiatric NP #802 reported she saw Resident #500 on 04/07/25 and she documented that Resident #500's Cimetidine 200 mgs one time a day was effective for managing her sexually inappropriate behaviors. Psychiatric NP #802 reported Resident #500's Cimetidine 200 mgs was discontinued on 04/14/25 due to a gradual dose reduction. Psychiatric NP #802 stated she saw Resident #500 on 05/09/25 and it was reported to her by staff that Resident #500 recently tried to put her arm around and kiss another female resident. Psychiatric NP #802 stated that Resident #500's Cimetidine was ordered after Resident #500 was found in a room disrobing with another female resident on 05/15/25. Psychiatric NP #802 reported that Resident #500's Cimetidine was restarted on 05/15/25 and was increased from the previous dose of Cimetidine 200 mgs one time a day to Cimetidine 200 mgs two times per day because she did not feel that Cimetidine 200 one time a day was a therapeutic dose for hypersexual behaviors. Review of the facility's undated abuse, neglect and misappropriation policy, revealed the facility's intent was to prevent abuse, mistreatment or neglect of residents and to provide guidance to direct staff to manage any concerns or allegations of abuse. In the event that a situation is identified as abuse, an investigation by executive leadership will immediately follow up. All alleged violations involving abuse are reported immediately but not later than two hours after the allegation is made. The self-report will be made by the executive director to the state survey agency and will be thoroughly investigated. This deficiency represents non-compliance investigated under Incident Number 2567007. Event ID: Facility ID: 365081 If continuation sheet Page 12 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 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 staff interview, record review and review of facility policy, the facility failed to ensure a resident and the resident's power of attorney (POA) received a discharge notice. This affected one (#500) of the three residents reviewed for discharges. The facility census was 106. Review of Resident #500's chart revealed Resident #500 was admitted to the facility on [DATE] with Alzheimer's disease, dementia in other diseases classified elsewhere unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, primary generalized osteoarthritis, major depressive disorder, alcohol abuse, anxiety disorder, mixed hyperlipidemia, depression and history of falling. Resident #500 discharged from the facility on 07/18/25. Review of Resident #500's chart from 03/11/24 to 07/19/25, revealed no documentation that Resident #500 or Resident #500's POA initiated Resident #500's discharge from the facility on 07/18/25. Further review of Resident #500's chart revealed Resident #500 did not have a discharge notice on file for her 07/18/25 discharge from the facility.Review of Resident #500's behavior care plan dated 03/18/24 and revised on 07/16/25, revealed Resident #500 had a behavior problem related to Resident#500 being noted in bed unclothed with male residents at times, wandering into male resident rooms and exhibiting sexual behaviors. Interventions included encourage resident to participate in activities of choice, intervene as necessary to protect the rights and safety of others, minimize potential for disruptive behaviors by offering tasks that divert attention, monitor behavioral episodes and attempt to determine the underlying cause, resident had one on one supervision, communicate with the resident and resident representative regarding behaviors and treatment, encourage the resident to express feelings and encourage active support by family. Further review of Resident #500's care plan reviewed Resident #500 did not have a care plan for her sexual behaviors prior to 07/16/25 and no documented care plan for discharging the resident. Review of Resident #500's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was severely cognitively impaired. Review of a police report dated 07/13/25 at 1:50 P.M., revealed a sexual contact incident was reported to the police on 07/14/25 at 9:00 A.M. when they responded to the facility. The staff stated that two residents in the mental health wing were observed to be engaging in sexual contact on 07/13/25. The staff stated that both residents were diagnosed with dementia and both medical power of attorneys (POAs) were contacted and informed of the incident. The staff stated that Resident #500 was foundling Resident #64's genital area. This report was filed for reporting purposes only. Review of Resident #500's progress note dated 07/13/25 at 4:15 P.M., revealed an incident was reported to Licensed Practical Nurse (LPN) #178 while doing her rounds that a staff entered another resident's room and noted a male resident was sitting in his chair while Resident #500 was massaging his genitals. The CNA instantly removed Resident #500 from the male resident's room and made LPN #178 aware. LPN #178 notified the unit manager. The CNA had recently witnessed the resident in her room while picking up her lunch tray. Resident #500 was placed on one on one (1:1) observation until further notice and her daughter was made aware. Review of Resident #500's progress note dated 07/13/25 at 4:31 P.M., revealed the on call physician was made aware of the behavior.Review of Resident #500's progress note dated 07/14/25 at 9:32 A.M., revealed a report was given to the police regarding the sexual encounter between Resident #500 and a male resident. Review of Resident #500's physician order dated 07/14/25 and discontinued 07/21/25, revealed Resident #500 was to be on a 1:1 observation until further notice. Review of the facility's SRI for sexual abuse created on 07/14/25 for a sexual allegation that was discovered on 07/13/25, revealed Resident #64 and Resident #500 were found alone in Resident #64's room together. Resident #500 was fully dressed and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 13 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 Resident #64's pants and underwear were down. Resident #500 was noted touching Resident #64's groin area. The residents were separated, assessed, and interviewed. Resident #64 denied any penetration or injury. Resident #500 could not recall the incident and denied penetration or injury. Resident #500 was placed on a 1:1 observation and all appropriate parties were notified. The police were contacted and found the residents were not in any immediate danger, and no legal action was required. The SRI was unsubstantiated.Review of Resident #500's physician order dated 07/17/25, revealed Resident #500 may discharge to another skilled nursing facility on 07/18/25.Review of Resident #500's Discharge summary dated [DATE], revealed Resident #500 was on prophylactic antibiotics for urinary tract infection (UTI) prevention. Resident #500 resided on a secured dementia unit. Resident #500 discharged to another skilled nursing facility on 07/18/25. Review of Resident #500's progress note dated 07/18/25, revealed Resident #500 was discharged to another skilled nursing facility. A cab came for Resident #500 at about 3:30 P.M. The face sheet and medication lists were given. Interview with the Administrator and Regional Director of Clinical Operations (RDCO) #801 on 07/22/25 at 2:28 P.M., revealed Resident #500 was placed on 1:1 observation due to her behaviors until she was discharged . The Administrator and RDCO #801 verified Resident #500 or Resident #500's POA was not given a discharge notice prior to her discharge from the facility on 07/18/25. The Administrator and RDCO #801 confirmed Resident #500 was discharged to a female dementia unit at another facility on 07/18/25. The Administrator and RDCO #801 were not aware of which staff member initiated or discussed Resident #500's discharge plans with Resident #500 or Resident #500's POA. The Administrator and RDCO #801 verified Resident #500 was discharged related to her inappropriate sexual behaviors. Interview with Social Services (SS) #247 on 07/22/25 at 3:58 P.M., revealed SS #247 was not aware of how Resident #500's discharge was initiated. SS #247 stated that he called Resident #500's daughter (POA) and stated the facility initiated two referrals to two different skilled nursing facilities. SS #247 reported Resident #500's daughter was on vacation at the time and stated she just stated she wanted to get back to her vacation. SS #247 was not aware of a discharge notice being given. Interview with Social Services Director (SSD) #241 on 07/22/25 at 4:10 P.M., revealed SSD #241 never discussed Resident #500's discharge with her POA and SS #247 arranged Resident #500's discharge. SSD #241 verified she was not involved in Resident #500's discharge from the facility.Review of email correspondence with the Administrator on 07/29/25 at 12:01 P.M., verified the receiving facility set up the transport by a cab for Resident #500. Review of email correspondence with the Administrator on 07/29/25 at 6:59 P.M., revealed the DON accompanied Resident #500 to ensure she was safe during transport to the receiving facility. Review of the facility's undated transfer and discharge policy revealed the facility will notify the resident and resident's representatives of the transfer or discharge and the reasons for the move in writing and in a language or manner they understand. The facility will send a copy of the notice to the Ombudsman. The facility will assist with transportation arrangements to the new facility. Event ID: Facility ID: 365081 If continuation sheet Page 14 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, record review, and review of facility policy, the facility failed to develop and implement a comprehensive, person-centered care plan for a resident who exhibited inappropriate sexual behaviors towards other residents. This affected one (#500) of six residents reviewed for care planning. The facility census was 106.Review of Resident #500's chart revealed Resident #500 was admitted to the facility on [DATE] with Alzheimer's disease, dementia in other diseases classified elsewhere unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, primary generalized osteoarthritis, major depressive disorder, alcohol abuse, anxiety disorder, mixed hyperlipidemia, depression and history of falling. Resident #500 discharged from the facility on 07/18/25. Review of Resident #500's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was severely cognitively impaired. Review of Resident #500's behavior care plan dated 03/18/24 and revised on 07/16/25, revealed Resident #500 had a behavior problem related to Resident#500 being noted in bed unclothed with male residents at times, wandering into male resident rooms and exhibiting sexual behaviors. Interventions included encourage resident to participate in activities of choice, intervene as necessary to protect the rights and safety of others, minimize potential for disruptive behaviors by offering tasks that divert attention, monitor behavioral episodes and attempt to determine the underlying cause, resident had one on one supervision, communicate with the resident and resident representative regarding behaviors and treatment, encourage the resident to express feelings and encourage active support by family. Further review of Resident #500's care plan reviewed Resident #500 did not have a care plan for her sexual behaviors until 07/16/25. Review of Resident #500's progress note dated 09/02/24 at 6:07 A.M., revealed Resident #500 made frequent attempts at kissing, hugging and touching other male residents in the sitting area on 09/01/24 from the beginning of shift until Resident #500 went to bed. Each time, the residents were separated or redirected from the other resident who either attempted to hit her or shout at her. Review of Resident #500's psychiatry note dated 11/16/24, revealed Resident #500 was seen by Nurse Practitioner (NP) #900. Resident #500 was seen for a chronic psychiatric medication visit for dementia, depression, insomnia and inappropriate sexual behaviors. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Resident #500 was ordered to start Cimetidine 200 milligrams (mgs) by mouth daily. Review of Resident #500's physician order dated 11/25/24 revealed Resident #500 was ordered Cimetidine oral tablet 200 milligrams (mgs) give one tablet by mouth a day for inappropriate sexual behaviors. The order was discontinued 04/14/25. Review of Resident #500's psychiatry notes dated 12/16/24 and 01/13/25, revealed Resident #500 was seen by NP #900. Resident #500 presented for medication management and discussion of symptoms of dementia, depression, insomnia and inappropriate sexual behaviors. Resident #500 was on Cimetidine 200 mgs daily for inappropriate sexual behaviors. Resident #500's inappropriate sexual behaviors were mentioned as a concern, and they were currently being treated with Cimetidine 200 mgs daily. However, no specific incidents or behaviors were discussed during the visit. Staff reported inappropriate sexual behaviors with males and Resident #500 would try to kiss them or bring them to her. Resident #500 would not redirect easily and would become upset. Review of Resident #500's progress note dated 01/09/25 at 7:09 A.M., revealed Resident #500 was noted in another resident's room undressing. Resident #500 was redirected by staff and Resident #500 displayed increased behaviors towards staff. Staff gave Resident #500 time to calm down and Resident #500 was redirected out of the room by staff. Review of Psychiatric NP #802's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 15 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few progress note dated 05/09/25 at 9:50 A.M., revealed Resident #500's Cimetidine was discontinued during the pharmacy meeting in April 2025. Resident #500 was recently found trying to kiss another female resident and was trying to put her arm around her in the lounge on the couch in a suggestive manner. Review of Resident #500's progress note dated 05/15/25 at 6:37 P.M., revealed Resident #500 was caught by the Certified Nursing Assistant (CNAs) in an empty room with another female resident and the CNAs had to pull the other resident's pants up. Resident #500 was telling them to keep them down. The staff redirected them out of the room and separated the residents. Review of Resident #500's physician order dated 05/15/25, revealed Resident #500 was ordered Cimetidine oral tablet 200 mgs give one tablet by mouth two times a day for sexually inappropriate behaviors. The order was discontinued 07/21/25. Review of Resident #500's telehealth visit dated 06/30/25 at 1:00 P.M., revealed NP #901 was called by the nurse stating that another resident was lying next to Resident #500 that evening. Both residents had clothing on and there was no inappropriate touching. Review of the police report dated 06/30/25 at 11:28 P.M., revealed the nursing staff found Resident #71 and Resident #500 in the same bed together. Resident #500 was fully clothed, but Resident #71 was in bed with his pants off. Review of Registered Nurse (RN) #207's witness statement dated 06/30/25, revealed Resident #500 and Resident #71 were lying in bed beside each other. Resident #500 was fully dressed, and Resident #71 had only his shirt on without pants. No one was seen touching the other. Review of Resident #500's progress note dated 07/01/25 at 2:16 A.M., revealed Resident #500 was in bed beside another resident (#71). The residents were immediately separated with no injuries. A head-to-toe assessment was completed. The family, Director of Nursing (DON), regional nurse, police and Administrator were notified. Review of Resident #500's progress note dated 07/01/25 at 12:36 P.M., revealed Resident #500's physician was notified of the incident. Review of the facility's SRI created on 07/01/25 for a sexual abuse allegation that was discovered on 06/30/25, revealed the staff noted Resident #500 and Resident #71 laying side by side in bed on 06/30/25. Resident #500 was fully dressed, and Resident #71 was without his pants and underwear. No touching was noted, and the residents were immediately separated. Head-to-toe skin assessments were completed on the residents without injuries noted. The SRI was unsubstantiated. Review of Resident #500's progress note dated 07/03/25 at 3:05 P.M., revealed Resident #500 was found in bed with another resident (#64) on 06/30/25 at 9:30 P.M. The staff observed Resident #500 in bed with a male resident fully clothed. Resident #500 had dementia and wandering behaviors with the belief that the male resident was her boyfriend. The residents were immediately separated, and no injuries were noted. Review of a police report dated 07/13/25 at 1:50 P.M., revealed a sexual contact was reported to the police when they responded to the facility on [DATE] at 9:00 A.M. The staff stated the two residents in the mental health wing were observed to be engaging in sexual contact on 07/13/25. The staff stated that both residents were diagnosed with dementia and both POAs were contacted and informed of the incident. The staff stated that Resident #500 was foundling Resident #64's genital area. This report was filed for reporting purposes only.Review of Resident #500's progress note dated 07/13/25 at 4:15 P.M., revealed an incident was reported to LPN #178 while doing her rounds that a staff entered another resident's room and noted a male resident was sitting in his chair while Resident #500 was massaging his genitals. The CNA instantly removed Resident #500 from the male resident's room and made LPN #178 aware. LPN #178 notified the unit manager. The CNA had recently witnessed Resident #500 in her room while picking up her lunch tray. Resident #500 was placed on one-on-one (1:1) observation until further notice and her daughter was made aware. Review of Resident #500's progress note dated 07/13/25 at 4:31 P.M., revealed the on call physician was made aware of the resident's behavior.Review of CNA #231's hand-written witness statement dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365081 If continuation sheet Page 16 of 17 Printed: 05/15/2026 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 365081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Rivers Healthcare Center 7800 Jandaracres Drive Cincinnati, OH 45248 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 07/13/25, revealed CNA #231 was going to check on Resident #64. When CNA #231 walked in the room, Resident #500 was being sexually inappropriate massaging Resident #64's private parts. CNA #231 separated them and informed the nurse of their behavior.Review of LPN #178's witness statement dated 07/13/25, revealed LPN #178 and another CNA were giving care to another resident. When LPN #178 and the CNA returned to the nurse's station, another CNA reported that she witnessed Resident #500 in Resident #64's room. Resident #64 was sitting in his chair with his pants down and Resident #500 was inappropriately massaging Resident #64's private area. The CNA immediately separated the residents and informed LPN #178 who informed the unit manager. LPN #178 placed Resident #500 on 1:1 observation and head-to-toe skin assessments were completed with no findings. The on-call physician was made aware. Review of Resident #500's progress note dated 07/14/25 at 9:32 A.M., revealed a report was given to the police regarding the sexual encounter between Resident #500 and Resident #64. Review of the facility's SRI created on 07/14/25 for a sexual abuse allegation that was discovered on 07/13/25, revealed Resident #64 and Resident #500 were found alone in Resident #64's room together. Resident #500 was fully dressed and Resident #64's pants and underwear were down. Resident #500 was noted touching Resident #64's groin area. The residents were separated, assessed, and interviewed. Resident #64 denied any penetration or injury. Resident #500 could not recall the incident and denied penetration or injury. Resident #500 was placed on 1:1 observation and all appropriate parties were notified. The police were contacted and found the residents were not in any immediate danger, and no legal action was required. The SRI was unsubstantiated. Interview with CNA #236 on 07/22/25 at 9:57 A.M., revealed she did not witness the incident between Resident #500 and Resident #64, but she was working on that date. CNA #236 reported Resident #500 was placed on 1:1 observation until she was discharged from the facility. CNA #236 stated she was not aware of Resident #500 or Resident #64 having sexually inappropriate behaviors prior to the incident. Interview with Registered Nurse (RN) #202 via telephone on 07/22/25 at 2:22 P.M., revealed RN #202 could not remember the dates of the incidents because it had been a while and she did not usually work on the memory care unit. RN #202 stated that Resident #500 would walk around and was clinging towards the male residents. RN #202 reported that Resident #500 would try to kiss, touch or hug male residents and CNAs would have to redirect her. RN #202 stated that management was informed of Resident #500's sexually inappropriate behaviors. Interview with the Administrator and Regional Director of Clinical Operations (RDCO) #801 on 07/22/25 at 2:28 P.M., revealed the Administrator was not aware of Resident #500 attempting to kiss, hug and touch male residents on 09/01/25 or the incident on 05/15/25 where Resident #500 was found in an empty room with another female resident with her pants pulled down. The Administrator verified Resident #500 had inappropriate sexual behaviors directed towards other residents noted from September 2024. The Administrator verified the facility did not develop and implement a person centered care plan for Resident #500's sexually inappropriate behaviors until after the 07/13/25 incident. The Administrator confirmed Resident #500 had been prescribed Cimetidine for sexually inappropriate behaviors dating back to 11/25/24. Review of the facility's undated plan of care overview policy revealed the facility will provide resident centered care that meets the psychosocial, physical and emotional needs and concerns of the residents. Event ID: Facility ID: 365081 If continuation sheet Page 17 of 17