Inspection·March 30, 2022

F 0561 04:29 PM., 03/24/22 9:35 A.M., and 03/28/22 9:14 A.M. revealed Resident #59 to be laying in bed. Level of Harm - Minimal harm or potential for actual harm Interview on 03/23/22 at 4:34 P.M. State Tested Nurse Assistant (STNA) #326 stated it depends on time what time of day it is, but sometimes there is not enough hoyers or staff to get residents out of bed when they want, specifically if the resident requires assistance of two staff to get up. Residents Affected - Some 2. Review of the medical record for Resident #38 revealed an admission date of 01/24/21. Diagnoses for Resident #38 included non-traumatic intracerebral hemorrhage (stroke), chronic respiratory failure, morbid (severe) obesity, neuromuscular dysfunction of the bladder, bipolar disorder and major depressive disorder. Review of the quarterly MDS assessment dated [DATE], revealed Resident #38 required extensive assistance of one staff member for bed mobility, transfer activity did not occur, and she was totally dependent for dressing and toilet use. Review of the plan of care dated 03/22/22, revealed Resident #38 requires assistance with ADLs and chooses to remain in bed most all the time. Interventions included to utilize a Hoyer lift for transfers. Review of the plan of care did not reveal set times to assist Resident #38 out of bed. Interview on 03/22/22 at 3:12 P.M. with Resident #38 during Resident Council revealed she can't always get assistance out of bed when she asks. Resident #38 shared that some of the facility's hoyer lifts need maintenance, that the batteries are out. Resident #38 stated that when she asks to get up staff have to go look for they hoyer lift, then the battery is dead and she states she has to wait. Resident #38 further shared she doesn't ask that often and staff do not encourage her to get up or ask if she wants assistance getting up. Resident #38 states she has set days to get up but staff don't follow the plan and she has been told there are not enough staff to get her up. Observation on 03/22/22 at 3:52 P.M. revealed two handwritten signs on Resident #38's wall. The first sign stating Ask to get up daily. The second handwritten sign stated Getting up goals, Tuesday, Thursday and Saturday. Interview on 03/23/22 at 4:34 P.M. with STNA #326 revealed the aides can't always get residents who require two staff assistance up out of bed, depending on what time of day it is. STNA #326 further stated sometimes, if a lot of residents who require Hoyer lifts want to get up, there are not enough staff and at times, not enough Hoyers, and residents can't always get up when they want to. Observation on 03/28/22 at 8:56 A.M. revealed Resident #38 to be in bed. 3. Review of the medical record for Resident #102 revealed he has a diagnosis of quadriplegia, Chronic respiratory failure, dependence on a respirator (ventilator), chronic heart failure, and diabetes mellitus. He also has a diagnosis of depression, anxiety, and requires a tracheotomy. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #102 alert and oriented, was usually able to be understood, usually understands others, and has an intact cognitive status. He requires total assist of one to two staff for most aspects of activities of daily living (ADL) and only able to get out of bed by Hoyer lift. A review of the plan of care for Resident #102 revealed he was to receive range of motion (ROM) to upper and lower extremities during ADL care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 2 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0561 Level of Harm - Minimal harm or potential for actual harm A review of the ADL task documentation for Resident #102 revealed all documentation for ADL care in the month of March was marked not applicable. On 03/22/22 at 8:26 A.M. an interview with Resident #102 revealed he wished he was getting therapy. Resident #102 further stated he normally doesn't leave the room and rarely is out of bed. Residents Affected - Some On 03/22/22 at 2:14 P.M. a follow up interview with Resident #102 was conducted. Resident #102 again stated staff rarely get him out of bed. He stated he wanted to have therapy to get some kind of exercise. Resident #102 stated he does not remember any staff performing range of motion during care. On 03/23/22 at 9:48 A.M. an interview with State Tested Nursing Assistant (STNA) #321 and Licensed Practical Nurse (LPN) #299 revealed range of motion of upper and lower extremities is part of normal ADL care that is performed daily but stated it is only documented if a resident is on a restorative program. On 03/23/22 at 12:48 P.M. an interview with Therapy Manager #324 revealed Resident #102 was screened upon admission to the facility but was not appropriate for skilled physical or occupational therapy. Therapy Manager #324 stated she would talk to Resident #102 and offer a restorative therapy plan for him. Therapy Manager #324 further stated during routine activities of daily living (ADL) care, ROM is supposed to be performed. Interview on 03/23/22 at 4:34 P.M. with STNA #326 revealed aides can't always get residents who require two staff assistance up out of bed, depending on what time of day it is. STNA #326 further stated sometimes, if a lot of residents who require Hoyer lifts want to get up, there are not enough staff and at times, not enough Hoyers, and people can't always get up when they want to. A review of the facility's undated policy regarding ROM addressed care plan interventions for ROM was delivered through the restorative program. No information about routine ROM documentation was available. 4. Medical record review for Resident #22 revealed an admission date of 07/03/18. Medical diagnoses included debility, cardiorespiratory conditions. Review of quarterly MDS assessment dated [DATE], revealed Resident #22 was cognitively intact. His functional status was extensive assistance with bed mobility, toilet use and eating was supervision. Transfers did not occur during this timeframe. He was on oxygen, tracheostomy, suctioning, and a ventilator. Review of transferring documentation from 02/27/22 through 03/27/22 revealed out of 24 entries he did not get out of bed 24 times. Observations of Resident #22 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. and 3:05 P.M. revealed he was lying in his bed. He had a wheelchair sitting in his room. Observations and interview with Resident #22 on 03/21/22 at 11:44 A.M. revealed he used to get out of bed all of the time, but he didn't think there was enough staff to get him out of bed and the staff didn't like to get him out of bed either. He said he asked for help to get him up, but they don't return to get him out of bed. He said he couldn't remember when the last time he got out of bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 3 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was. A subsequent interview on 03/22/22 at 3:07 P.M. revealed he didn't ask to get up this morning, because he didn't see enough staff to help him get up. Interview on 03/23/22 at 4:34 P.M. with STNA #326 revealed the aides can't always get residents who require two staff assistance up out of bed, depending on what time of day it is. STNA #326 further stated sometimes, if a lot of residents who require Hoyer lifts want to get up, there are not enough staff and at times, not enough Hoyers, and residents can't always get up when they want to. 5. Medical record review for Resident #80 revealed an admission date of 11/04/20. Medical diagnoses included traumatic brain dysfunction. Review of quarterly MDS assessment dated [DATE], revealed Resident #80 was moderately impaired. His functional status was extensive assistance for bed mobility, independent for eating, total dependence for toileting, transfers did not occur on this assessment. He was coded for oxygen, suctioning, tracheostomy, and a ventilator. Review of transferring documentation from 02/27/22 through 03/27/22 out of 28 opportunities the activity did not occur all 28 times for the getting resident out of bed. Observations of Resident #80 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. revealed he was lying in his bed. Interview with Resident #80 on 03/21/22 at 9:51 A.M. revealed he was lying in bed and would like to get up for the day, but when he asks to get up they tell him no and he continues to ask and they tell him no. He didn't know who told him no. A subsequent interview on 03/22/22 at 2:22 P.M. revealed he was in bed and someone came into the room and asked him if he would like to get up and they brought in the Hoyer lift and it was broken so he didn't get up. Interview on 03/23/22 at 4:34 P.M. with STNA #326 revealed aides can't always get residents who require two staff assistance up out of bed, depending on what time of day it is. STNA #326 further stated sometimes, if a lot of residents who require Hoyer lifts want to get up, there are not enough staff and at times, not enough Hoyers, and people can't always get up when they want to. Review of policy entitled, Resident [NAME] of Rights, revised 1990, revealed the resident had the right to a dignified existence, self determination, and communication with adequate access to persons and services inside or outside of the facility. The residents will also have access to opportunities that enable them to achieve their highest potential. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 4 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. Based on staff interview, resident interview, medical record review, and facility policy review, the facility failed to accurately reflect Resident #21 and Resident #119's chosen advanced directives in the residents' medical records. This affected two residents (Resident #21 and Resident #119) of two residents reviewed for advanced directives. Findings include: 1. Review of the medical record for Resident #119 revealed an admission date of 08/24/20. Diagnoses included cerebral infarction (stroke), pressure ulcer, anxiety disorder, chronic obstructive pulmonary disease (COPD), stable burst fracture of the fourth lumbar vertebra, type two diabetes mellitus (DM2), chronic kidney disease, seizures, atrial flutter, noncompliance with other medical treatment and regimen, disorder of kidney and ureter, chronic pain, hyperlipidemia, hypertension (HTN), and other symptoms and signs concerning food and fluid intake. Review of Resident #119's quarterly Minimum Data Set (MDS) assessment, dated 03/07/22, revealed the resident had intact cognition with a Brief Interview of Mental Status (BIMS) score of 15 out of 15 (no impairment). Review of the plan of care dated 03/04/22, revealed Resident #119's advanced care planning was reviewed with the resident/responsible party/power of attorney (POA) determined the residents code status to be DNRCCA. Interventions included code status and orders reviewed as needed and review of advanced care planning wished upon admission, quarterly, and as needed. Review of Resident #119's electronic medical record revealed an order dated 08/25/20 for Do Not Resuscitate-Comfort Care Arrest (DNR-CCA) (you continue to treat the patient as a full code up until time the patient cardiac arrests). Review of Resident #119's hard (paper) chart revealed a DNR identification form dated 04/17/20, identifying the resident as do not resuscitate-comfort care (DNR-CC) (resident received any care that eased pain and suffering, but no resuscitative measures to save or sustain life were undertaken). Interview on 03/22/22 at 5:09 P.M. with Director of Nursing (DON) and Regional Registered Nurse (RN) #337 confirmed Resident #119 electronic medical record order was DNRCCA and her hard chart revealed she was a DNRCC. 2. Review of the medical record for Resident #21 revealed an admission date of 07/31/16. Diagnoses included Alzheimer's Disease, schizophrenia, bipolar disorder, schizoaffective disorder, major depressive disorder, and Dementia with behavioral disturbance. Review of Resident #21 paper medical record (hard chart) revealed the resident's code status, dated 11/12/19, was Do Not Resuscitate-Comfort Care (DNRCC). Review of the progress note dated 11/29/21 at 12:38 P.M. by Social Worker #256 revealed a care conference was held and the resident remained a full code. Review of the plan of care dated 12/28/21 revealed advanced care planned was reviewed with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 5 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few guardian and Resident #21's code status was a full code revised on 09/29/16. Interventions included code status and orders were to be reviewed as needed and services per his advanced care planning choices were coordinated. Review of Resident #21's annual Minimum Data Set (MDS) assessment, dated 01/05/22, revealed the resident's cognition was severely impaired with a Brief Interview of Mental Status (BIMS) score of two out of 15 His behaviors included inattention and other behavioral symptoms not directed towards others. Review of physician orders for March 2022 identified an order created 11/01/19 for a full code. This order was discontinued on 03/21/22 after surveyor intervention and a new order was placed on 03/21/22 for a DNRCC. Review of the progress note dated 03/21/22 at 5:59 P.M. by Social Worker #256 revealed she spoke with the resident's guardian who confirmed the residents code status to be a DNRCC. Interview on 03/22/22 at 5:09 P.M. with the Director of Nursing (DON) and Regional Registered Nurse (RN) #337 confirmed Resident #21's electronic medical record order was full code and his hard chart revealed he was a DNRCC. Review of the facility policy titled, Resident's Rights: Treatment and Advance Directives dated 11/26/26, revealed the facility would identify, clarify, and review with the resident or legal representative whether they desire to make any changes related to Advance Directives. Further review of the policy revealed the residents Advance Directives would be copied, placed in the resident's chart and relayed to staff. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 6 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm Based on staff interview, resident interview, observation, medical record review, and facility policy review, the facility failed to assist Resident #57 with her communication needs due to her hearing impairment. This affected one resident (#57) of three resident reviewed for communication/sensory needs. Residents Affected - Few Findings include: Review of the medical record for Resident #57 revealed an admission date of 06/24/21. Diagnoses included Chronic Obstructive Pulmonary Disease (COPD), heart failure, schizophrenia, bipolar disorder, major depressive disorder, dementia without behavioral disturbance, anxiety disorder, and schizoaffective disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/07/21, revealed the resident had moderate difficulty with the use of a hearing aid or other hearing appliance. Further review of the MDS revealed the resident was sometimes understood and sometimes understood verbal communication. Review of the quarterly Minimum Data Set (MDS) assessment, dated 02/07/22, revealed the resident had intact cognition with a Brief Interview of Mental Status (BIMS) score of 15 out of 15. She had moderate difficulty hearing, did not have hearing aids used during the assessment, was sometimes understood, and sometimes understood verbal communication. The resident required supervision and one-person physical assistance with bed mobility, limited assistance of one staff member for transfers and toilet use, extensive assistance of one staff member for dressing, and set up and supervision for eating and personal hygiene. Further review of the MDS revealed the resident received oxygen therapy. Review of the plan of care dated 02/01/22, revealed Resident #57 had hearing loss, she was sometimes understood, and she sometimes understood what was being said to her. She wore hearing aids that she occasionally refused to give to staff at night. She would fall asleep in her hearing aids in, lose them in the bed or chair in her room, and occasionally hid her hearing aids in tissues in her room. Interventions included asking the resident questions that required one- or two-word answers, provide reassurance and patience when communicating with the resident, and have the resident seen by the nurse practitioner to have her ears checked. Review of the plan of care dated 02/01/22 revealed the resident had impaired communication related to her hearing deficit. She had moderate hearing deficits depending on if she had her hearing aids in or not. She was sometimes understood and sometimes understood what was being said to her. Interventions included deepen voice tones and encourage the use of non-verbal's and gestures. Review of Resident #57's progress notes dated 01/25/22 at 4:33 P.M. by Activities Director #268, revealed the resident liked to have conversations but she continued to have difficulty with her hearing, and it made communicating with her challenging. She was able to read and write so that was helpful. Review of Resident #57's progress notes dated 02/07/22 at 2:54 P.M. by Social Worker #256, revealed the resident was hearing impaired and did not always wear her hearing aids. Review of the progress note dated 03/04/22 at 12:51 P.M. by Social Worker #256, revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 7 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident continued to lose glasses, hearing aids, teeth. She would get confused and hide them in places. She kept them in old plastic cups or items that she hoarded. She balled items up in tissue or put in tissue boxes that she saved. She forgot where she put the items. She allowed the writer to search for her hearing aids which she continued to lose. She had refused to give to nursing at night or when she napped and then would lose them or put them places and not remember. She did not remember the last time she had them and thought she may have accidentally thrown them in the trash. Social Worker #256 searched the room and was not able to locate her hearing aids at this time. She had trash items that she hoarded and would not allow staff to clean or discard. She could communicate well with gestures or talking loudly and could read and respond to written communication well. At times she could hear very well with no louder volume possibly due to cognition and auditory hallucinations making it more difficult for her to hear at times. Social Worker #256 reached out to 360 regarding replacement of her hearing aids since she had multiple replacements do to losing or breaking them. Review of the electronic message (email) provided by the Director of Nursing (DON) dated 03/04/22 at 12:51 P.M. by Social Worker #256 to Care Coordinator #777 revealed Social Worker #256 inquired about replacement hearing aids for Resident #57. A response to the email was received from Care Coordinator #777 on 03/07/22 at 8:43 P.M. when she confirmed a replacement for Resident #57's hearing aids, was being placed. Review of the electronic message (email) provided by the DON on 03/22/22, from Care Coordinator #999, undated, revealed 360 cares, approved two replacement hearing aids for the resident on 03/02/20 and 04/14/21, new hearing aids were provided on 09/17/21 and she had not had a replacement since receiving her new hearing aids, so the replacement request had been approved. A request for documentation regarding the resident's noncompliance with hearing aids was made to the DON who provided one progress note dated 03/04/22 by Social Worker #256, which confirmed the resident would lose, hide, and refuse to provide staff with her hearing aids. The DON also provided a copy of the resident's care plan which revealed she would lose, hide, and refuse to provide staff with her hearing aids. There was no further behavior documentation supporting the resident would lose, hide, and refuse to provide staff with her hearing aids. Observation on 03/22/22 at 1:37 P.M. revealed State Tested Nursing Assistant (STNA) #205 talking to Resident #57 while in the resident's closet going through her clothes. Resident #57 kept repeating herself several times and the aide kept repeating herself. There was no written communication or other form of communication. There was no paper or pencils or stationary products visible that could have been used for communication purposes. The STNA wore her mask the entire time. There was no care provided. It was unclear if the resident was able to understand what was being said to her. Observation and interview on 03/22/22 at 1:38 P.M. with Resident #57 revealed she was unable to understand verbal communication. When questions were typed into the computer and shown to the resident, she would answer questions appropriately, without hesitation, and without difficulty. She confirmed she was supposed to wear hearing aids but was unable to locate them. She also revealed her hearing aids had been missing for four or five months. She confirmed the facility informed her that they would get her new hearing aids, but she had yet to receive them. She confirmed staff used verbal communication when talking to her, but she was not always able to understand them. She denied other forms of communication attempts by staff such as sign language and written. She stated she was able to understand verbal communication by staff on occasion but was not able to understand when their back was towards her. She confirmed she had concerns with not being able to hear staff and as a result they did not help her with care except bringing her food and medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 8 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 03/22/22 at 1:39 P.M. with STNA #329 revealed the resident was very hard of hearing and the STNA communicated with her by speaking close to her. STNA #329 also confirmed the resident had hearing aids but still had issues hearing with them. The STNA did not know if she still had hearing aids but confirmed the resident was not wearing any. Interview and observation on 03/22/22 at 2:05 P.M. with Director of Clinical Registered Nurse (RN) #336 and Regional RN #337 confirmed the resident was hard of hearing (HOH) but was unsure how staff communicated with her. During the observation, RN #337 attempted to speak to the resident verbally, but the resident was not hearing so she began to gesture the need for the resident's finger to check her oxygen saturation. The resident provided her finger but it apparent the resident was not understanding what was occurring, why the State Surveyor, Federal Surveyor, and the two RNs were in her room. Interview on 03/22/22 at 2:10 P.M. with Resident #57 via typed words on the computer screen revealed she was unable to hear the RN's when they were speaking to her. Interview on 03/22/22 at 2:23 P.M. with DON revealed Resident #57 had at least two pairs of hearing aids in the last three years and continued to misplace them in her room. She stated the resident placed them in tissue boxes, and other places that staff cannot find them. When asked if there were any interventions in place to prevent the loss of the hearing aids the DON said there was nothing that could be done since the resident was independent in taking the hearing aids out. Observation on 03/24/22 at 7:36 A.M. revealed Resident #57 was sleeping in bed with no lights on. Observation on 03/24/22 at 7:37 A.M. revealed Unit Manger #237 reminded Resident #57 to wear her oxygen by using verbal communication only when entering the room with her meal tray. No lights were turned on. The resident did not apply her oxygen nor get up to eat her breakfast. Interview on 03/24/22 at 9:25 A.M. with STNA #205 revealed she would try and write things down for Resident #57 with a pen from the resident's cup of pens and a random piece of paper she finds if the resident did not understand her attempts at verbal communication (which she confirmed was most of the time). Interview on 03/24/22 at 9:28 A.M. with Regional RN #337 revealed written communication was used to communicate with Resident #57. She also revealed the resident was able to read lips and when staff socially distanced, removed their mask, and left on a face shield the resident was able to read lips. She also revealed Social Worker #256 informed her that the resident can understand verbal communication without difficulty on occasion and Social Worker #256 was unsure if the residents hearing was an actual impairment or was more related to her known auditory hallucinations. Review of the facility policy titled, Deaf or Hearing-Impaired Patient, revised 04/2002 revealed staff should not shout or speak directly into the resident's ear as it may distort the message and hide visible cues. Further review of the policy revealed the resident should be encouraged to use hearing aids and contact Social Services if the resident needed repair of the hearing aid. Lastly, staff were to teach the resident care of her hearing aid. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 9 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure Resident #52 and Resident #59 received sufficient bathing assistance, Resident #3 and Resident #59 received assistance with nail care, Resident #71 received assistance with dressing, Resident #119 received assistance with hair washing, and Resident #21 received assistance with personal hygiene. This affected six residents (Resident #3, Resident #21, Resident #52, Resident #53, Resident #59, and Resident #118) of seven residents reviewed for activities of daily living (ADLs) care. Residents Affected - Some Findings include: 1. Review of the medical record for Resident #59 revealed an admission date of 10/30/21. Diagnoses for Resident #59 included spondylosis, cervical region, spinal stenosis, cervical region, chronic obstructive pulmonary disease, neuralgia and neuritis, major depressive disorder and dependence on wheelchair. Review of the Minimum Data Set 3.0 (MDS) assessment dated [DATE], revealed Resident #59 to have mildly impaired cognition. Resident #59 was noted to require extensive assistance of one staff for bed mobility, toileting, hygiene and bathing. Review of the plan of care dated 01/31/22, revealed Resident #59 required total assistance with activities of daily living (ADLs). Interventions included to assist with bathing, grooming and incontinence care. No preferences were noted for a bathing schedule in the care plan. Review of the ADL bathing tasks for the past 30 days, revealed Resident #59 received showers or baths on 02/26/22, 03/04/22, 03/11/22, 03/12/22 and 03/18/22. Review of the paper shower sheets, revealed no shower sheets for Resident #59. During an interview on 03/21/22 at 10:25 A.M., Resident #59 stated he has only had two showers since he's been here. Resident #59 shared that he should get a shower once a week and he does not. Resident #59 further shared he gets bed bath less that once per week. During the interview, Resident #59's fingernails were observed to be long (approximately a fourth of an inch long from the tip of his finger) with a brown substance under the nails. Resident #59's hair was also noted to appear oily. Additional observation on 03/22/22 at 8:18 A.M., 03/23/22 at 8:25 A.M., 03/23/22 at 4:29 P.M., 03/24/22 at 9:35 A.M., and 03/28/22 at 9:14 A.M. Resident #59 was in bed, fingernails long dirty, hair greasy. Interview on 03/23/22 at 8:25 A.M. State Tested Nurse Assistant (STNA) #205 revealed she started about two months ago and does showers for residents. STNA #205 shared that she cannot always find fingernail clippers to use on residents. STNA #205 confirmed Resident #59's fingernails appeared to be long and dirty and his hair appeared to be greasy. Interview on 03/23/22 at 10:37 A.M. with Regional Registered Nurse (RN) #337 confirmed the lack of shower sheets for Resident #59. Interview on 03/23/22 at 4:34 P.M. with STNA #326 revealed staff can not get showers completed all the time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 10 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Review of the medical record for Resident #52 revealed an admission date of 09/21/21. Diagnoses for Resident #52 included diabetes, Chronic Obstructive Pulmonary Disease (COPD), major depressive disorder, and dementia. Review of the MDS assessment dated [DATE], revealed Resident #52 requires extensive assistance of one staff for transfers and limited assistance of one staff for dressing, hygiene, and bathing. During an interview on 03/21/22 at 9:42 A.M., Resident #52 stated he should get a shower twice a week and only gets one every two weeks. Resident #52 stated he has been in wet depends all morning. Review of the ADL bathing tasks for 30 days, revealed Resident #52 received baths on 03/01/22, 03/04/22, 03/08/22, 03/18/22, 03/22/22, 03/25/22 and 03/26/22. No refusals were noted. Interview on 03/23/22 at 10:37 A.M. with Regional Registered Nurse (RN) #337 confirmed the lack of shower sheets for Resident #52 Interview on 03/23/22 at 4:34 P.M. with STNA #326 revealed staff can't get showers completed all the time. 3. Review of the medical record for Resident #3 revealed an original admission date of 09/09/20 with most recent admission of 02/16/22. Diagnoses for Resident #3 include chronic respiratory failure with hypoxia, dependence of respirator, diabetes, anxiety, anoxic brain damage, acute kidney failure and persistent vegetative state. Review of the Minimum Data Set 3.0 (MDS) assessment dated [DATE], revealed Resident #3 required total dependence on one staff for bathing and hygiene. During an interview on 03/21/22 at 11:23 A.M., Family Member # 600 stated he asked for Resident #3's fingernails to be trimmed, several weeks ago and they've not been trimmed yet. Observations on 03/21/22 at 12:00 P.M., 03/21/22 at 1:47 P.M., and 03/23/22 at 8:19 A.M. revealed Resident #3's fingernails were observed to be long. During an interview on 03/21/22 at 1:47 P.M., RN #296 confirmed Resident #3's fingernails were too long. During an interview on 03/23/22 at 8:25 A.M., STNA #205 revealed aides trim fingernails for residents but cannot always find fingernail clippers. Interview on 03/23/22 at 2:30 P.M. with RN #293 confirmed Resident #3's fingernails were too long, that the resident did not have the ordered palm guard on her right hand, and that there was potential for Resident #3 to puncture her hand or otherwise sustain a skin concern due to the length of her fingernails. 4. Review of the medical record for Resident #71 revealed an admission date of 12/16/21. Diagnoses included Chronic Obstructive Pulmonary Disease (COPD), emphysema, Alzheimer's Disease, major depressive disorder, Dementia, generalized anxiety disorder, moderate protein-calorie malnutrition, and constipation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 11 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the quarterly Minimum Data Set (MDS) assessment, dated 02/11/22, revealed the resident's cognition was moderately impaired and had no documented behaviors. The resident required extensive assistance of one staff for all activities of daily living (ADLs) including urinal use and dressing. He was frequently incontinent of bowel and bladder. Review of the plan of care dated 03/22/22 revealed Resident #71 required assistance with ADLs and may be at risk for developing complications associated with decreased ADL self-performance, disease processCOPD, emphysema, chronic respiratory failure, dementia, weakness, risk for fluctuations and further decline to be expected related to terminal disease process. Interventions included supervision with dressing, resident was incontinent of bladder, and toileting assistance as needed. Interview and observation on 03/21/22 at 12:34 P.M. of Resident #71 revealed he was sitting in a Geri chair (large, padded chair that is designed to help seniors with limited mobility), reclined with his pants and under garments pulled down around his ankles, and genitals exposed. The blinds to his window were opened to the courtyard area where a female was walking. Interview and observation on 03/21/22 at 12:40 P.M. with State Tested Nursing Assistant (STNA) #262 confirmed the resident pants and undergarments were down and around his ankles. She confirmed the curtain was pulled to provide the resident with privacy from the hall, but the window blinds were open, and the resident was exposed. She stated the resident was using the urinal and was usually independent in pulling his pants up. She then assisted the resident in pulling up his pants. 5. Review of the medical record for Resident #119 revealed an admission date of 08/24/20. Diagnoses included cerebral infarction (stroke), pressure ulcer, anxiety disorder, chronic obstructive pulmonary disease (COPD), stable burst fracture of the fourth lumbar vertebra, type two diabetes mellitus (DM2), chronic kidney disease, seizures, atrial flutter, noncompliance with other medical treatment and regimen, disorder of kidney and ureter, chronic pain, hyperlipidemia, hypertension (HTN), and other symptoms and signs concerning food and fluid intake. Review of Resident #119's task titled ADL-Bathing from 02/23/22 through 03/21/22 revealed the resident received bathing assistance nine days out of the 30 on 02/25/22, 02/26/22, 03/02/22, 03/05/22, 03/07/22, 03/09/22, 03/13/22, 03/16/22, and 03/18/22. There was no documentation regarding hair washing. Review of Resident #119's plan of care dated 03/04/22, revealed the resident was at risk for further alteration in skin integrity related to apathy/lack of concern, cognitive impairment, diabetes, incontinence, mobility impairment, nutritional impairment, obesity, pain, and actual skin impairment/pressure injury. The resident was non-compliant with repositioning and declined getting out of bed most all the time. Interventions included provide assistance with activities of daily living (ADL's) as needed. Review of Resident #119's plan of care dated 03/04/22 revealed the resident was noncompliant with showers-baths. Interventions included documentation of education attempts made with resident in relation to compliance and notify the physician of non-compliance. Review of the quarterly Minimum Data Set (MDS) assessment, dated 03/07/22, revealed the resident had intact cognition with a Brief Interview of Mental Status (BIMS) score of 15 out of 15. Her behaviors included rejection of care. The resident required extensive assistance of one to two or more staff with bed mobility, dressing, and personal hygiene, transfers did not occur, and she required total (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 12 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm assistance of one to two or more staff members for toilet use and bathing. She required set up and supervision for meals. Interview on 03/21/22 at 11:41 A.M. with Resident #119 revealed her hair had not been washed in about one month. Her hair appeared greasy (had a wet appearance) and unkept. Residents Affected - Some Interview on 03/24/22 at 8:46 A.M. with STNA #205 revealed residents' hair was supposed to be washed with showers or bathing unless resident requested otherwise. She confirmed hair was washed with a water basin and shampoo with bed baths. Interview and observation on 03/24/22 at 8:50 A.M. with Resident #119, with LPN #336 present, revealed the resident last had her hair washed about one month ago. The resident's hair appeared greasy and unkept. The resident stated she received a bath during the night, but her hair was not washed because staff was too busy. LPN #336 did not dispute any of the observations. Interview on 03/24/22 at 9:07 A.M. with STNA #258 confirmed residents' hair was washed with bathing regardless of bath or shower. She confirmed hair washing was documented in the resident's electronic chart. She stated she was unfamiliar with Resident #119, and she could not say when her hair was last washed. Interview on 03/24/22 at 1:00 P.M. with DON confirmed the facility did not have evidence of hairwashing for Resident #119. 6. Review of the medical record for Resident #21 revealed an admission date of 07/31/16. Diagnoses included Alzheimer's Disease, schizophrenia, bipolar disorder, schizoaffective disorder, major depressive disorder, and dementia with behavioral disturbance. Review of Resident #21's annual Minimum Data Set (MDS) assessment, dated 01/05/22, revealed the resident's cognition was intact. His behaviors included inattention and other behavioral symptoms not directed towards others. The resident was independent with all activities of daily living (ADL's) but required physical help limited to transfer only for bathing and bathing support provided was one-person physical assist. Review of Resident #21's plan of care dated 12/28/21 revealed ADL decline and/or fluctuations may be expected related to cognitive deficit, disease process of Alzheimer's, schizophrenia, bipolar, peripheral vascular disease (PVD) and extrapyramidal & movement disorder. He was able to participate in care and received assistance completing tasks as needed. Interventions included bathing per resident preference, assistance with bathing, set up assistance was needed for nail care, shaving, and hair care. Interview and observation on 03/21/22 at 1:10 P.M. with Resident #21 revealed he complained his head was itching intermittently on days he had not showered, but he did not report it. His fingernails were long, over the tips of his fingers, and he confirmed he would like them clipped. He also reported he liked to be clean shaven, and his lip and chin were growing hair. Interview and observation on 03/21/22 at 1:24 P.M. with Licensed Practical Nurse (LPN) #299 confirmed Resident #21's nails were long and needed trimmed. She confirmed the facial hair stubble present on the resident's lip and chin and stated personal care including shaving was completed daily. The resident informed her about his itching scalp, and he stated it was from not washing his hair (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 13 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 routinely. The nurse did not dispute his statement. Level of Harm - Minimal harm or potential for actual harm Review of the task titled, ADL-Bathing from 02/22/22 through 03/23/22 revealed Resident #21 was bathed 02/24/22, 02/28/22, 03/04/22, 03/07/22, 03/10/22, 03/12/22, 03/17/22, 03/18/22, and 03/21/22. There was no documentation regarding hair washing. Residents Affected - Some Interview on 03/24/22 at 1:00 P.M. with the Director of Nursing (DON) confirmed the facility did not have any hair washing documentation for any residents. Review of the facility policy titled, Care of Fingernails and toenails, dated 10/18/01, revealed nail care included daily cleaning and regular trimming. Review of the facility policy titled, Bathing/Shower, dated 10/18/01, revealed showers would be provided to provide cleanliness and comfort, stimulate circulation and observe the condition of the resident and include washing hair as indicated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 14 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, review of activity calendar, and record review, the facility failed to provide activities based on the resident preferences and comprehensive assessments. This affected six residents (Resident #12, Resident #22, Resident #66, Resident #80, Resident #102, and Resident #118) of seven residents reviewed for activities. Residents Affected - Some Findings include: 1. Medical record review for Resident #66 revealed an admission date of 08/27/21. Medical diagnoses included traumatic brain dysfunction. Review of Resident #66's care plan dated 08/29/21, revealed the resident was unable to to pursue her interests due to her physical condition. The resident was willing to interact with others and participate in activities as her condition allowed. The following interests were important to the resident: arts and crafts, bingo, computer activities, gardening, music, religious activities, and spending time outside. Interventions were to offer activity program directed toward specific interests and needs of the resident, and one on one visits one time a week. Review of Resident#66's activity assessment dated [DATE] revealed the facility would continue to offer one time per week activity visits. Review of Resident #66's progress notes dated 01/01/22 through 03/29/22 revealed no evidence of activities offered to Resident #66. Review of Resident #66's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #66 was rarely or never understood. Her functional status was total dependence for bed mobility, eating, toilet use and transfers did not occur. Review of the activity calendar for 03/21/22 revealed the activity at 9:00 A.M. was music, 10:30 A.M. was word of the day, 2:00 P.M. was jackpot, 3:00 P.M. was snack and chat, and 3:30 P.M. was music. Further review of the calendar revealed on 03/22/22 activity at 9:00 A.M. was music, 10:00 A.M. was store, 10:30 A.M. was card bingo, and 2:00 P.M. was birthday party with a singer. Observations of Resident #66 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. revealed she was lying in her bed and no one from activities came to the hallway for any invitations or interaction with the resident. Interview with family member on 03/21/22 at 11:11 A.M. revealed they didn't know of any activities that were provided to the resident. Interview with the Activity Director (AD) #268 on 03/23/22 at 9:53 A.M. revealed the facility wasn't holding any activities for the residents in the facility due to isolation for the staff for COVID-19 and even though Resident #66 was vaccinated for the virus the activities were not provided in December 2021 and January 2022. She said Resident #66 was scheduled once a week for one on one visits but she didn't have any documentation to show this was completed and said she only has two other staff members besides herself to help out with the activities. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 15 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Medical record review for Resident #22 revealed an admission date of 07/03/18. Medical diagnoses included debility, cardiorespiratory conditions. Review of care plan dated 12/31/21 revealed Resident #22 had a potential or alteration in activities due to impaired mobility. He was interested in arts and crafts, bingo, cards, computers, puzzles, reading, socializing, movies, and music. Interventions were to encourage to attend group activities and give verbal reminders of activity commencement of activities. Review of Resident #22's progress notes dated 01/01/22 through 03/29/22 revealed there was evidence of activities offered to Resident #22. Review of quarterly MDS dated [DATE], revealed Resident #22 was cognitively intact. His functional status was extensive assistance with bed mobility, toilet use and eating was supervision. Transfers did not occur during this timeframe, and resident received ventilator treatment. Review of the activity calendar for 03/21/22 revealed the activity at 9:00 A.M. was music, 10:30 A.M. was word of the day, 2:00 P.M. was jackpot, 3:00 P.M. was snack and chat, and 3:30 P.M. was music. Further review of the calendar revealed on 03/22/22 activity at 9:00 A.M. was music, 10:00 A.M. was store, 10:30 A.M. was card bingo, and 2:00 P.M. was birthday party with a singer. Observations of Resident #22 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. revealed he was lying in his bed and no one from activities came to the hallway for any invitations or interaction with the resident. Interview with Resident #22 on 03/21/22 at 11:44 A.M. revealed he used to go to activities, but because no one liked to get him up out of bed he didn't go to them anymore. He denied there was any activities on the ventilator unit. He said he was only placed on the ventilator at night time. Interview with AD #268 on 03/23/22 at 9:28 A.M. revealed she saw Resident #22 once a week, but didn't have documentation for the visits. She said he doesn't get out of bed due to his weight. She said of the residents on the ventilator unit, she knew who wanted to come to activities, but confirmed he not was invited to the above listed activities, because he would be a resident who was only invited to the big activities such as the holidays. Interview with Resident #22 on 03/22/22 at 3:08 P.M. revealed he didn't get invited to the activities on this day. 3. Medical record review for Resident #80 revealed an admission date of 11/04/20. Medical diagnoses included traumatic brain dysfunction. Review of activity notes from 01/01/22 through 03/29/22 revealed there was no evidence Resident #80 was offered activities. Review of Resident #80's activity assessment dated [DATE] revealed he loved to socialize and loved people. He enjoyed playing cards with family, listening to music, painting, coloring, and fishing. He was very social and really loved talking and being around others. He loved being outdoors. He also loved cooking and working in the yard. The assessment further revealed it would be great if the resident could be placed in a chair so activities could bring him to an event. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 16 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of care plan dated 02/16/22 revealed Resident #80 revealed he was a sociable person and liked to participate in various activities. The activities that were important to the resident were arts and crafts, music and spending time outside. Review of quarterly MDS assessment dated [DATE] revealed Resident #80 was moderately impaired. His functional status was extensive assistance for bed mobility, independent for eating, total dependence for toileting, and transfers did not occur on this assessment. Resident #80 received ventilator treatment. Review of the activity calendar for 03/21/22 revealed the activity at 9:00 A.M. was music, 10:30 A.M. was word of the day, 2:00 P.M. was jackpot, 3:00 P.M. was snack and chat, and 3:30 P.M. was music. Further review of the calendar revealed on 03/22/22 activity at 9:00 A.M. was music, 10:00 A.M. was store, 10:30 A.M. was card bingo, and 2:00 P.M. was birthday party with a singer. Observations of Resident #80 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. revealed he was lying in his bed and no one from activities came to the hallway for any invitations or interaction with the resident. Interview with Resident #80 on 03/21/22 at 1:27 P.M. revealed he wanted to get out of bed to participate in activities, but when he asked to get up they tell him he can't get up. He says he didn't receive any activities last month and if and when they do come in to talk to him they don't stay very long. He said he was only on the ventilator at night time. He has a wheelchair in his room. Interview with the AD #268 on 03/23/22 at 9:57 A.M. revealed Resident #80 says he wanted to come to activities, but sometimes he wasn't feeling well. She said the staff do not place him in a wheelchair to come. She said he is very conversational and fun, but they see him in his room, but did not have any documentation for one on one activities or refusals for him. She said Resident #80 wouldn't be invited to the small activities only to the bigger ones such as the big holidays. 4. Medical record review for Resident #118 revealed an admission date of 11/07/19. Medical diagnoses included a traumatic spinal cord dysfunction. Review of Resident #118's activity care plan dated 03/04/22, revealed she was unable to pursue her interests due to her physical or cognitive condition. Interventions were to provide friendly visits, bring resident music, inform resident of religious services, offer to read books, magazines, and newspapers. Review of Resident #118's activity assessment dated [DATE], revealed she enjoyed television shows, gospel music and videos, some crafts, religious activity, traveling when able, being outdoors, cooking, socializing, cats, and family. She communicated with her eyes, preferences were not defined but she seemed to enjoy company. She would try to speak or would make nods to participate in conversation. Review of MDS assessment dated [DATE], revealed Resident #118 was rarely or never understood. Functional status was total dependence for bed mobility, transfers, eating and toilet use. Resident #118 received ventilator treatment. Review of the activity calendar for 03/21/22 revealed the activity at 9:00 A.M. was music, 10:30 A.M. was word of the day, 2:00 P.M. was jackpot, 3:00 P.M. was snack and chat, and 3:30 P.M. was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 17 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some music. Further review of the calendar revealed on 03/22/22 activity at 9:00 A.M. was music, 10:00 A.M. was store, 10:30 A.M. was card bingo, and 2:00 P.M. was birthday party with a singer. Observations of Resident #118 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. revealed she was lying in her bed and no one from activities came to the hallway for any invitations or interaction with the resident. Interview with the AD #268 on 03/23/22 at 9:53 A.M. revealed the facility wasn't holding any activities for the residents in the facility due to isolation for the staff for COVID-19 and even though Resident #118 was vaccinated for the virus the activities were not provided in December 2021 and January 2022. She said the Resident #118 was scheduled once a week for one on one visits but she didn't have any documentation to show this was completed, and said she only has two other staff members besides herself to help out with the activities. 5. Medical record review for Resident #12 revealed an admission date of 08/20/20. Her medical diagnoses included debility, cardiorespiratory conditions. Review of care plan dated 03/15/22, revealed Resident #12 was unable to pursue her interests due to physical and or cognitive condition. Interventions were to offer activity program directed specific to interests/needs of the resident, and play music for resident during room visits. Review of Resident #12's activity assessment dated [DATE] revealed there continue to be no changes to the resident's activity level participation. Activities would continue to provide music and or other usable items upon family's request, and will continue to monitor her for changes. Review of the activity calendar for 03/21/22 revealed the activity at 9:00 A.M. was music, 10:30 A.M. was word of the day, 2:00 P.M. was jackpot, 3:00 P.M. was snack and chat, and 3:30 P.M. was music. Further review of the calendar revealed on 03/22/22 activity at 9:00 A.M. was music, 10:00 A.M. was store, 10:30 A.M. was card bingo, and 2:00 P.M. was birthday party with a singer. Review of Resident#12's quarterly MDS assessment dated [DATE], revealed she was persistent vegetative state. Her functional status was total dependence for bed mobility, eating and toilet use, and transfer did not occur. Resident #12 received ventilator services. Observations of Resident #12 on 03/21/22 at 10:25 A.M., 10:46 A.M., 1:45 P.M. to 2:00 P.M. and on 03/22/22 at 8:55 A.M. revealed she was lying in her bed and no one from activities came to the hallway for any invitations or interaction with the resident. Interview with the AD #268 on 03/23/22 at 9:53 A.M. revealed the facility wasn't holding any activities for the residents in the facility due to isolation for the staff for COVID-19 and even though Resident #12 was vaccinated for the virus, activities were not provided in December 2021 and January 2022. She said Resident#12 was scheduled once a week for one on one visits but she didn't have any documentation to show this was completed, and said she only has two other staff members besides herself to help out with the activities. Interview with Director of Nursing (DON) on 03/24/22 at 2:15 P.M. revealed she didn't have an activities policy for the facility. 6. Review of the medical record for Resident #102 revealed he has a diagnosis of quadriplegia, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 18 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chronic respiratory failure, dependence on a respirator (ventilator), chronic heart failure, and diabetes mellitus. He also had a diagnosis of depression, anxiety, and requires a tracheostomy. Review of the comprehensive care plan dated 02/22/22, revealed Resident #102 was a sociable person and liked to participate in various activities. The activity care plan also stated Resident #102 was unable to pursue his interests on his own due his physical limitations. The activity care plan stated playing cards, computer activities , music, and spending time outside was important to him. Review of the MDS assessment dated [DATE] for Resident #102, revealed he was alert and oriented, was usually able to be understood, usually understood others, and had an intact cognitive status. Section F of the MDS revealed reading newspapers, books, and magazines was very important to him. It also revealed news, animals, music, being in groups, going outside, and practicing religion where important but he could not do on his own. Review of Resident #102's medical record revealed no documentation that 1:1 activity visits had been conducted. The progress notes revealed no documentation that Resident #102 had been offered any other activities. On 03/22/22 at 8:26 A.M. an interview with Resident #102 revealed he wished to be involved with more activities. Resident #102 further stated he normally doesn't leave the room and only watches television for entertainment. Resident #102 stated no one offers to do anything else activity wise. On 03/22/22 between 1:29 P.M. and 1:48 P.M., an observation of Resident #102 revealed he was awake and watching TV. The activity calendar was posted on the closet door but not visible from Resident #102's bed. On 03/22/22 at 2:06 P.M. an observation of the atrium revealed a birthday party with a guest singer performing. On 03/22/22 at 2:14 P.M., a follow up interview with Resident #102 was conducted. Resident #102 stated he was not aware of the activity that started at 2:00 P.M. and he was not invited. Resident #102 stated he never noticed the activity calendar on his closet door but it didn't matter because he cannot see it without glasses. Resident #102 stated he has never had a 1:1 visit with any activity staff. Resident #102 stated staff rarely get him out of bed. Interview with the Director of Nursing (DON) on 03/24/22 at 2:15 P.M. revealed there wasn't a policy for activities. Interview with the AD #268 on 03/24/22 at 3:04 P.M. revealed a resident activity participation log for Resident #102 was unavailable. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 19 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview the facility failed to ensure range of motion was provided for Resident #118 who had impairment to her upper extremities, and failed to ensure Resident #3's splint devices were in place as ordered. This affected two residents (Resident #3 and Resident #118) out of seven reviewed for range of motion. Findings include: 1. Medical record review for Resident #118 revealed an admission date of 11/07/19. Medical diagnoses included a traumatic spinal cord dysfunction. Review of Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #118 developed impairment in her upper extremities for the first time since admission into the facility. Review of MDS assessment dated [DATE], revealed Resident #118 was rarely or never understood. Functional status was total dependence for bed mobility, transfers, eating, and toilet use. She had impairment to her upper extremities. Review of Resident #118's restorative passive range of motion (PROM) nursing program revealed a program for PROM for at least 15 minutes per day up to seven days a week. The PROM documentation for Resident #118 from 02/27/22 through 03/27/22 revealed out of 30 opportunities there was only four documented entries the program was completed and two days marked not applicable. Observation of Resident #118 on 03/21/22 at 10:07 A.M. revealed she had limited range of motion in her hands. Observation at 1:45 P.M. revealed she was lying in bed. Observation on 03/22/22 at 9:24 A.M. revealed she was lying bed and no PROM was observed. Interview with Licensed Practical Nurse (LPN) #244 on 03/28/22 at 1:02 P.M. revealed the PROM was supposed to be completed 15 minutes a day and documented under tasks, but confirmed it was not completed on a regular basis. Interview with the Therapy Manager (TM) #324 on 03/28/22 at 2:42 P.M. revealed there was no measurements taken of the resident's hands, but staff were to perform PROM with care and the aides or the nurses were supposed to do the program. 2. Review of the medical record for Resident #3 revealed an original admission date of 09/09/20 with most recent admission of 02/16/22. Diagnoses for Resident #3 include chronic respiratory failure with hypoxia, dependence of respirator, diabetes, anxiety, anoxic brain damage, and persistent vegetative state. Review of the MDS assessment dated [DATE] revealed Resident #3 required total dependence on staff for all activities of daily living. The MDS further revealed Resident #3 to have a functional impairment in both upper extremities. Review of the physician's orders dated 02/16/22 revealed orders to apply bilateral resting hand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 20 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0688 splints as tolerated. Level of Harm - Minimal harm or potential for actual harm Review of the Treatment Administration Record (TAR) for Resident #3 revealed the hand splints were marked by the nurse as being in place during 03/21/22 day shift. Residents Affected - Few Observations of Resident #3 on 03/21/22 at 8:50 A.M. and 12:00 P.M. revealed the resident to be lying in bed with her hands resting at her sides. Both hands were observed to be contracted and no splints or other devices were observed to be in place on Resident #3's hands. Interview on 03/21/22 at 01:47 P.M. with Registered Nursing (RN) #296 revealed she was the nurse caring for Resident #3 today and she was unsure if Resident #3 was ordered hand splints and if they were currently in place. RN #296 was then observed to check the medical record for Resident #3 and confirmed she did mark her initials in the TAR, indicating Resident #3 had hand splints on that morning. RN #296 confirmed that she marked the TAR off without ensuring the hand splints were applied for the resident. RN #296 further revealed she thinks the aides apply hand splints when they are ordered but that is she is unsure. Observation of Resident #3 on 03/23/22 at 2:30 P.M. revealed the resident to by lying in bed with a splint on her left hand and nothing on her right hand. Interview on 03/23/22 at 2:33 P.M. with RN #293 confirmed Resident #3 was wearing a splint on her right hand and nothing on her left hand. RN #293 was then observed to place a palm guard on Resident #3's right hand stating the order was changed on 03/21/22 from a splint to a palm guard. Observation of Resident #3 on 03/24/22 at 9:43 A.M. with Licensed Practical Nurse (LPN) #337 revealed Resident #3 was again wearing a splint on her left hand and nothing on her right hand. LPN #337 revealed she did not yet check to see if Resident #3 was wearing a palm guard on her right hand. LPN #337 stated she should have got this information in report and did not. LPN #337 stated she was not sure where Resident #3's palm guard was. Observation on 03/24/22 at 9:52 A.M. revealed STNA #321 to bring the palm guard into Resident #3's room and place it on the resident. The facility stated they did not have a policy regarding hand splints or palm guards for residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 21 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the failed to ensure Resident #29's urinary tract infection (UTI) was identified and treated promptly. This affected of one resident (Resident #29) of two residents reviewed for UTI's. Findings include: Review of the medical record revealed Resident #29 was admitted on [DATE]. Diagnoses for Resident #29 included major depressive disorder, chronic obstructive pulmonary disease, diabetes, obesity, congestive heart failure, and chronic kidney disease. Review of the physician progress note dated 11/16/21 revealed Resident #29 was seen by a nurse practitioner (NP) for altered mental status and multiple recent falls. Labs, including basic metabolic panel (BMP), complete blood count (CBC), arterial blood gases (ABG), and a urine analysis culture and sensitivity (UA C&S) were ordered for Resident #29. A UA C&S is a urine culture to check for UTI. Review of the lab results dated 11/17/21 revealed no concerns. However, the UA C&S was not available in the medical record. Review of the nurse progress notes dated 11/25/21 revealed Resident #29 was started on an antibiotic to treat a UTI on this date, nine days after the resident presented with altered mental status and reviewed for multiple falls. Review of the plan of care dated 01/05/22, revealed Resident #29 to be incontinent of bowel and bladder. Interventions included to monitor for signs and symptoms of UTI including elevated temperature, flank pain, dysuria, foul smelling urine, and report to physician to seek diagnoses and treatment promptly. Review of Resident #29's MDS assessment dated [DATE], revealed Resident #29's cognition was intact and was always incontinent of bowel and bladder. Interview with the Director of Nursing (DON) on 03/29/22 at 5:21 P.M. confirmed the UA C&S results were not obtained in a timely manor and the treatment for the UTI was not started until nine days after the lab was ordered for Resident #29. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 22 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to ensure Resident #80's peripherally inserted central (PICC) line dressing was changed before it was charted as completed in the Treatment Adminstration Record (TAR). This affected of one resident (Resident #80) one reviewed for PICC line dressings. Residents Affected - Few Findings include: Medical record review for Resident #80 revealed an admission date of 11/04/20. Medical diagnoses included traumatic brain dysfunction. Review of quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #80 was moderately impaired. His functional status was extensive assistance for bed mobility, independent for eating, total dependence for toileting, and transfers did not occur on this assessment. He was coded for oxygen, suctioning, tracheostomy, and ventilator treatment. Review of physician orders dated 03/21/22 revealed to change the PICC line dressing every seven days. Review of Treatment Administration Record (TAR) dated 03/21/22 revealed the PICC dressing had been marked as changed. Observation of Resident #80's left antecubital on 03/21/22 at 9:51 A.M. revealed a PICC line to his arm that wasn't dated. Interview and observation of the PICC line dressing for Resident #80 on 03/21/22 at 1:56 P.M. revealed Licensed Practical Nurse (LPN) #244 confirmed the PICC line dressing wasn't changed and wasn't dated and thought she made a mistake in signing off on the dressing. She said it wasn't her practice to sign off on a treatment before actually doing the treatment. Interview with the Director of Nursing (DON) on 03/24/21 at 2:15 P.M. revealed the facility didn't have a policy for PICC line dressings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 23 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Medical record review for Resident #66 revealed an admission date of 08/27/21. Medical diagnoses included traumatic brain dysfunction. Residents Affected - Some Review of Resident #66's care plan dated 08/29/21, revealed respiratory insufficiency/failure requiring artificial ventilation. Intervention was to keep ambu bag readily available at the bedside at all times. Review of Resident #66's quarterly MDS assessment dated [DATE], revealed Resident #66 was rarely or never understood. Her functional status was total dependence for bed mobility, eating, toilet use and transfers did not occur. Resident #66 received ventilator treatment. Review of the Ventilator Check Sheet for Resident #66 dated 03/22/22 at 7:55 A.M. revealed it was checked marked an ambu breathing bag was in the room. Observation on 03/22/22 at 10:04 A.M. revealed there wasn't an ambu breathing bag in the room. Interview with Respiratory Therapist (RT) #214 on 03/22/22 at 10:15 A.M. confirmed there was not an ambu bag in the resident's room and there should have been. A subsequent interview with RT #214 on 03/29/22 at 2:36 P.M. confirmed the Ventilator Check Sheet said it was documented an ambu bag was in the room and there wasn't and there wasn't any medical emergencies with the resident recently. She said the supplies in the room were checked at least every shift if not more. Based on record review, observation, staff interview, resident interview, and facility policy and procedure review, the facility failed to ensure Resident #25 and #44's oxygen tubing was dated or changed per physician orders, failed to ensure Resident #44's respiratory medications were available and able to be administered per physician orders, and failed to ensure a Ambu breathing bag was placed in Resident #66's room. This affected two residents (Resident #25 and Resident #44) out of two residents reviewed for oxygen therapy, and one Resident (Resident #66) out of two residents reviewed for respiratory care. Findings include: 1. Review of the medical record for Resident #25 revealed an admission date of 11/11/21 and the diagnoses of dementia with lewy bodies, need for assistance with personal care, morbid obesity, depression, and acute and chronic respiratory failure. Review of the Resident #25's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a Brief Interview of Mental Status (BIMS) of 15 indicating intact cognition and she required extensive assistance of one staff for personal hygiene and bed mobility and extensive assistance of two staff for transfers and toilet use. Review of the care plan dated 01/11/22, revealed Resident #25 required oxygen as needed and a Bipap for obstructive sleep apnea (OSA) and shortness of breath with interventions to administer oxygen as ordered, medications as ordered, and observe for dyspnea. Review of Resident #25's physician orders revealed she had orders to change oxygen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 24 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm tubing/cannula/mask every week on night shift and continuous oxygen from 1 to 5 liters (L) to maintain oxygen above 90% via nasal cannula. The oxygen tubing was signed off as completed/changed on 03/06/22, 03/13/22, and 03/20/22. Observation on 03/21/22 at 11:20 A.M. revealed Resident #25's oxygen tubing was dated 02/26/22. Residents Affected - Some Observation and interview on 03/22/22 at 7:57 A.M. with Licensed Practical Nurse (LPN) #224 confirmed Resident #25's oxygen tubing was not changed for multiple weeks, she stated she thought the tubing was changed weekly on the night shift. Interview on 03/24/22 at 1:08 P.M. with Director of Nursing (DON) confirmed the inaccurate documentation for Resident #25's oxygen tubing. Review of the facility policy and procedure titled, Infection Control: Respiratory - Oxygen Equipment, Cleaning/Disinfecting, dated 01/26/06, revealed oxygen tubing/masks/nasal cannula's should be changed weekly and as needed. 2. Review of the medical record for Resident #44 revealed and initial admission date of 12/05/18, a readmission date of 11/19/21, and the diagnoses of Chronic Obstructive Pulmonary Disease (COPD), chronic respiratory failure, pneumonia, schizoaffective disorder, insomnia, Parkinson disease, kidney disorder, seasonal allergies, adjustment disorder, dyspnea, and obstructive sleep apnea (OSA). Review of the quarterly MDS assessment dated [DATE], revealed the resident had a Brief Interview of Mental Status (BIMS) of 14 indicating intact cognition and he was independent for activities of daily living. Review of Resident #44's care plan dated 11/01/19 revealed he required oxygen/Bipap due to COPD and chronic respiratory failure with interventions to administer oxygen as ordered, aerosol treatments as ordered, inhalers as ordered, medications as ordered, and to observe for signs of dyspnea. Review of Resident #44's physician orders revealed orders to titrate oxygen from 1 to 5 liters (L) via nasal cannula to maintain oxygen above 90%, change oxygen tubing/cannula/mask every week on the night shift, and Symbicort Aerosol 160-4.5 micrograms/actuation with instructions to inhale two puffs twice daily for COPD. The medications were not signed off as administered on 03/22/22 (9:00 P.M. dose) and both doses on 03/23/22. Review of the nurses notes revealed on 03/22/22 the Symbicort medication was not given due to pharmacy was to deliver it, and the nurse practitioner was aware. On 03/23/22 the medication was not given, pharmacy was to deliver and the nurse practitioner was aware. Observation and interview on 03/22/22 at 8:07 A.M. with Registered Nurse (RN) #265 revealed Resident #44's oxygen tubing was without a date. Review on 03/22/22 at 3:33 P.M. of Resident #44's medication order supply information revealed the Symbicort medication was last reordered on 03/05/22 and the received section was blank (without a date) indicating it was not received/dispensed. Interview on 03/22/22 at 3:33 P.M. with Registered Nurse (RN) #265 revealed she thinks Resident #44 took his Symbicort by himself and kept it in his room, they made sure he took it when they took him (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 25 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some his other medications. She stated she went into his room for his 9:00 A.M. medications and asked him if he took his Symbicort, he said he took it but she didn't see him do it. She confirmed the supply system stated the medication was ordered on 03/05/22 but the received section was blank, indicating the medication had not been received. Observation on 03/22/22 at 3:40 P.M. with RN #265 revealed Resident #44 didn't have the Symbicort in his room or in the medication cart. Interview on 03/22/22 at 3:40 P.M. with Resident #44 and RN #265 present, revealed Resident #44 stated he had not had his Symbicort, that he had been out a few days or so. RN #265 stated to him that she would reorder it again. Interview on 03/23/22 at 7:44 A.M. with Resident #44 revealed he didn't receive his Symbicort medication last night (03/22/22). On 03/29/22 at 10:14 A.M., review of the medication order supply information revealed the medication was dispensed and received on 03/23/22. Review of the facility policy and procedure titled, Medication Administration, dated 06/21/17, revealed staff should never leave a medication in a residents room without orders to do so, and it also revealed if a medication was unavailable, the pharmacy should be contacted and staff should document accordingly. Review of the facility policy and procedure titled, Infection Control: Respiratory - Oxygen Equipment, Cleaning/Disinfecting, dated 01/26/06, revealed oxygen tubing/masks/nasal cannula's should be changed weekly and as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 26 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and observation, the facility failed to monitor for psychotropic side effects and provide planned behavioral health interventions for Residents #29. This affected one resident (Resident #29) of two residents reviewed for mood and behavior. Findings include: Review of the medical record revealed Resident #29 was admitted on [DATE]. Diagnoses for Resident #29 included major depressive disorder, chronic obstructive pulmonary disease, obesity, congestive heart failure, and chronic kidney disease. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #29 to have intact cognition and did not note any concerns with mood or behaviors. a. Review of the plan of care dated 01/05/22 revealed Resident #29 to be at risk for adverse effects related to psychoactive medication use for depression and anxiety. Interventions include to assess for adverse effects including sedation and non-drug approaches to deal with problem behaviors report changes in behavior or mood. Review of Resident #29's physician orders dated 03/19/22 revealed orders for Paxil 30 milligrams (mg) take two tablets each morning and Buspar 15 mg, take one tablet twice per day for anxiety, and hydroxyzine 26 mg, take one tablet three times daily for anxiety. The medical record did not reveal evidence that adverse effects related to psychoactive medications were being monitored for Resident #29. b. The plan of care further revealed Resident #29 has history of depression and or anxiety. Interventions include to monitor for causing factors, provide activities of interest and refer for counseling as needed. Review of the activity assessment dated [DATE], revealed Resident #29 continued to show no interest in any activities that are offered and verbalized interest in doing beading. The note stated activities would continue to encourage her to take part in activities and will offer beading supplies for in-room activity. Interview with Resident #29 on 03/22/22 at 1:45 P.M. revealed she had history of depression and anxiety and saw a psychiatric nurse practitioner for it. Resident #29 revealed she told a nurse she thought the medication was making her sleepy a couple weeks ago and that she did not remember which nurse. The resident revealed she was unsure if the medication was changed or not. The resident further revealed activities was going to bring beads for her to craft with in her room, but never did. Observations of Resident #29 on 03/21/22 at 8:00 A.M., 10:00 A.M., 1:42 P.M., 4:00 P.M., on 03/22/22 at 8:23 A.M., and 12:00 P.M. revealed the resident to be in bed asleep. Interview on 03/28/22 at 9:00 A.M. with Activities Assistant #311 revealed she thinks the beads for Resident #29 were on order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 27 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on staff interview, resident interview, observation, medical record review, and facility policy review, the facility failed to ensure medication was secured at all times. This had the potential to affect two residents (Resident #23 and Resident #58) of two residents reviewed for medication storage. Findings include: Review of the medical record for Resident #23 revealed an admission date of 07/26/17. Diagnoses included paranoid schizophrenia, type II diabetes mellitus (DM2), hyperlipidemia, hypertension (HTN), generalized anxiety disorder, and unspecified psychosis. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/07/21, revealed Resident #23 had impaired cognition with a Brief Interview of Mental Status (BIMS) score of seven out of 15 (severe cognitive impairment). His behaviors included other behavioral symptoms not directed towards others. The resident was independent with all activities of daily living (ADL's) except required supervision and set up for bed mobility and eating. He did not require any mobility devices. He was always continent of bowel and bladder. Further review of the MDS revealed the resident was receiving insulin, antipsychotic medication, antianxiety medication, antidepressant medication, and diuretic medication. Review of Resident #23's plan of care dated 01/01/22, revealed the resident was at risk for bleeding, bruising, abnormal laboratory related to the use of anticoagulant/thrombolytic medications (aspirin). Interventions included administer medications as ordered. Review of Resident #23's medical record revealed no evidence the resident could self administer medications. Interview on 03/22/22 at 12:21 P.M. with Resident #23 revealed no concerns except they won't let him go out the front door. Observation on 03/22/22 at 12:22 P.M. revealed a pink pill and half of a white pill on the floor in Resident #23's room near and under his bed. Interview and observation on 03/21/22 at 12:57 P.M. with Licensed Practical Nurse (LPN) #299 revealed Resident #23 took his medications whole and his roommate (Resident #58) took his medications crushed. She confirmed a half of a white pill with HI imprinted on it, a pink pill with a 5 imprinted on one side and 894 imprinted on the other side, and med cups were on the floor of the resident's room. She revealed the medication could not have been from her shift since she watched the resident take and swallow the medication she administered. Interview and observation on 03/22/22 at 9:41 A.M. with LPN #295 confirmed fenofibrate (Antihyperlipidemic) 120 milligrams (mg) was the only white pill with HI stamped into it and there was no pink pill in the resident's ordered medications. Interview on 03/24/22 at 11:00 A.M. with Regional Registered Nurse (RN) #337 confirmed the half of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 28 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a white pill with HI imprinted on it was fenofibrate 120 milligrams (mg) and the pink pill with a 5 imprinted on one side and 894 imprinted on the other side was Eliquis five mg. She confirmed Resident #23 was not ordered Eliquis, but his roommate (Resident #58) was ordered Eliquis. Review of the facility policy titled, Medication Administration, dated 06/21/17, revealed the nurse administering the medication should remain with the resident while the medication was swallowed and never leave the medication in a resident's room without orders to do so. Review of the facility policy titled, Medication Storage, dated 07/23/19, revealed medications were to be stored safely, securely, and properly and accessible only to licensed nursing personnel, pharmacy personnel, or staff members authorized to administer medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 29 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure labs were drawn for Resident #76 and Resident #118. This affected two residents (Resident #76 and Resident #118) out of six residents reviewed for labs. Residents Affected - Few Findings include: 1. Medical record review for Resident #76 revealed an admission date of 01/29/19. Medical diagnoses included debility and cardiorespiratory conditions. Review of Resident #76's quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed he was cognitively intact. Review of Resident #76's physician orders dated 02/27/22 revealed Thyroid Stimulating Hormone (TSH), Complete Blood Count (CBC), and Basic Metabolic Panel (BMP) labs were to be collected on the first Wednesday of the month. Review of standing order daily log dated 03/02/22 revealed Resident #76's BMP and CBC labs were drawn on 03/02/22. The was no evidence the TSH lab was drawn and no evidence the results of CBC and BMP lab draws were reported. Interview with Director of Nursing (DON) on 03/28/22 at 2:30 P.M. confirmed the facility was in the midst of changing laboratory services and she didn't have the results of the lab results for this resident. She revealed there was not a laboratory services policy either. 2. Medical record review for Resident #118 revealed an admission date of 11/07/19. Medical diagnoses included a traumatic spinal cord dysfunction. Review of MDS assessment dated [DATE], revealed Resident #118 was rarely or never understood. Review of Resident #118's physician orders dated 02/18/22 revealed a CBC and BMP lab was to be collected every Wednesday. Review of standing order daily log dated 03/02/22 revealed Resident #118's labs were listed on the the log. Review of results dated 02/18/22 through 03/29/22 for CBC and BMP labs revealed there Resident #118's lab results were not reported. Interview with DON on 03/29/22 via telephone at 10:34 A.M. revealed the labs for Resident #118 just dropped out and they were consistent until 02/18/22 and doesn't know what happened. She revealed she didn't have any results for the resident's labs and said she didn't have a lab policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 30 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, observation, and facility policy review, the facility failed to food was properly stored. This had the potential to affect 85 residents who received meals from the kitchen, as 31 residents in the facility received nothing by mouth. The facility census was 116. Findings include: Observation on 03/21/22 at 7:44 A.M. revealed an opened, unsealed, undated, frozen bag of [NAME] dean sausage links. Interview at this time with Diet Technician #302 confirmed the observation. Observation on 03/21/22 at 7:49 A.M. of the walk-in refrigerator revealed an open and unsealed bag containing heads of lettuce. Observation on 03/21/22 at 7:52 A.M. of the free-standing refrigerator revealed an open and undated gallon of orange pineapple drink and unlabeled and undated yellow liquid in pitcher. Observation on 03/21/22 at 7:53 A.M. of the other side of the free-standing refrigerator revealed opened and undated cottage cheese and chicken salad. Interview on 03/21/22 at 7:54 A.M. with Dietary Manager #290 confirmed the above observations. Observation on 03/21/22 at 8:03 A.M. with Dietary Manager #290 revealed an opened, unlabeled, unsealed, and tan ground up appearing substance that was confirmed by the Dietary Manager #290 as pasta. Observation on 03/24/22 at 8:27 A.M. of the walk-in freezer, revealed an opened and unsealed bag of mixed frozen vegetables. This observation was confirmed immediately with the Dietary Manager #290. Observation on 03/24/22 at 8:28 A.M. of the walk-in refrigerator, revealed an unsealed bag of head of lettuce. The observation was confirmed immediately with the Dietary Manager #290. Review of a list of resident diets, revealed 85 residents received food from the kitchen, and 31 residents received nothing by mouth (NPO). Review of the facility policy titled, Food Storage-Labeling and Dating, revised 07/2018, revealed all food must have a date that included month, day, and year on the package indicating the date when the food entered the facility. Further review of the policy revealed all items must be dated after opening with an open dated and a use by date. All foods should be properly labeled with the food name unless it was unmistakably recognized. All food should be securely closed to avoid being exposed to the air. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 31 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview, and facility policy and procedure, the facility failed to maintain infection control, related to personal protective equipment (PPE) use, proper hand hygiene, and glove use. This affected two residents (Resident #67 and Resident #220) with the potential to affect all residents in the facility. Residents Affected - Many Findings include: 1. Review of the medical record for Resident #220 revealed an admission date of 03/18/22 and the diagnoses of metabolic encephalopathy, Parkinson disease, insomnia, muscle weakness, ataxic gait, malaise, and chronic kidney disease. Review of the admission nursing assessment dated [DATE] revealed Resident #220 was alert and oriented, but confused, and her lungs were clear with a regular respiratory rate. Review of the admission Minimum Data Set (MDS) assessment dated [DATE], revealed the resident had a Brief Interview of Mental Status (BIMS) of 10 indicating impaired cognition and the resident required extensive two staff assistance for bed mobility and transfers, extensive assistance of one staff for personal hygiene, toilet use and dressing, and limited assistance of one staff for eating. Review of the care plan dated 03/18/22 revealed Resident #220 was at risk for impaired respiratory function or respiratory infection related to not being fully vaccinated for COVID-19 and the potential for the COVID-19 virus due to possible exposure with interventions to test as indicated and if on droplet transmission based precautions, the room door may be open for supervision and as requested by the resident for psychosocial wellbeing. Review of the physician orders revealed orders for Resident #220 to be on contact and droplet isolation for seven days, from 03/18/22 through 03/25/22. Interview on 03/21/22 at 10:28 A.M. with Licensed Practical Nurse/Unit Manager (LPN/UM) #313 revealed Resident #220 was on droplet precautions for being a new admission. She stated everyone goes through the precautions for the first week. Observation on 03/22/22 at 8:16 A.M. revealed State Tested Nurse Assistant (STNA) #274 walk into Resident #220's side of the room with only a surgical mask on for personal protective equipment (PPE). She came out of the room with the residents breakfast tray. There were no eye protection or N95 masks in the isolation equipment cart outside of the residents room. Interview on 03/22/22 at 8:18 A.M. with STNA #274 and LPN/UM #313 revealed they were to utilize a gown, gloves, eye protection, and an N95 mask in droplet precaution rooms. LPN/UM #313 confirmed there were no N95 masks or eye protection in the PPE cart. She also stated staff did not utilize N95 masks in Resident #220's room though she requires droplet precautions. STNA #274 confirmed the only PPE worn was the surgical mask in Resident #220's room which required droplet precautions. Observation and interview on 03/23/22 at 7:56 A.M. revealed Physical Therapist (PT) #255 was in Resident #220 room talking to her without eye protection worn. PT #255 confirmed the observation and stated he was just talking to her about their plan for her therapy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 32 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 2. Review of the medical record for Resident #67 revealed an admission date of 02/02/22 and the diagnoses of quadriplegia, dysphagia, gastrostomy status, adult failure to thrive, and personal history of traumatic brain injury (TBI). Review of the care plan dated 02/03/22 revealed Resident #67 had an alteration in chewing/swallowing related to dysphagia and on 03/24/22 it was updated to say the resident could not have anything by mouth (NPO). Interventions included to administer the tube feed as ordered and monitor weight loss/dehydration/aspiration pneumonia and notify the physician of concerns or changes. The care plan dated 02/10/22 revealed the resident required total assistance with activities of daily living (ADLs) and may be at risk for developing complications associated with decreased ADL self-performance related to cognitive impairment, disease process/condition, mood/behavior problems, weakness, quadriplegia due to TBI, dypshagia with new PEG tube for nutrition, urinary retention with interventions to utilize attends and provide peri-care for incontinence of bowel and bladder. Review of Resident #67's admission Minimum Data Set (MDS) assessment dated [DATE], revealed the resident had a Brief Interview of Mental Status (BIMS) of 00 indicating he was rarely/never understood and he required extensive two staff assistance for bed mobility, total dependence of two staff for transfers, and total dependence of one staff for dressing, eating and personal hygiene. The resident was incontinent of bowel and bladder and the resident utilized a feeding tube for nutrition. Review of Resident #67's physician orders revealed the resident was ordered Isosource 1.5 calories liquid supplement with instruction sot give 250 milliliters (ml) via PEG Tube bolus five times a day (due at 10:00 A.M.) and 200 ml water flush five times a day (due at 10:00 A.M.). Observation on 03/23/22 at 10:20 A.M. with Licensed Practical Nurse (LPN) #299 revealed an observation of PEG tube administration for Resident #67. Resident #67 was in bed and the LPN completed her tube feed administration. LPN #299 mixed water with the supplement during the administration and followed it up with a water flush at the end. Some of the water dripped onto her gloves and onto a towel she placed next to the resident. LPN #299 touched the residents bedside remote, cleaned up her area, then washed the syringe and plunger with water, and dried them with a paper towel, utilizing the same contaminated gloves. LPN #299 only washed her hands for eight seconds prior to the tube feed administration. Interview on 03/23/22 at 10:30 A.M. with LPN #299 confirmed she was suppose to wash her hands for 15 to 20 seconds, and she confirmed all other infection control breaches, including disinfection with contaminated gloves. Review of the facility policy and procedure titled, Infection Prevention and Control Program (IPCP), dated 08/18/10, revealed all staff should perform hand hygiene between resident contacts, after handling contaminated objects, after PPE removal and before going off duty. Staff should also perform hand hygiene before and after performing resident care procedures. The policy further stated gloves were to be changed and hand hygiene was performed before moving from contaminated body site to a clean body site during resident care. The policy also revealed staff should use PPE according to the facility policy governing the use of PPE. Review of the facility policy and procedure titled, Hand Hygiene, dated 11/28/17, revealed hand hygiene with soap and water should be completed by vigorously rubbing hands together for at least 20 seconds, covering all surfaces of the hands and fingers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 33 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm 3. Observation on 03/22/22 at 7:38 A.M. revealed a vendor delivering bread in kitchen without a facial covering. Observation on 03/22/22 at 7:40 A.M. revealed Kitchen Staff Member #341 with his mask below nose and chin on the tray line. Residents Affected - Many Observation on 03/22/22 at 7:42 A.M. revealed a vendor delivering milk with without a facial covering. Interview on 03/22/22 at 7:44 A.M. with Diet Technician #302 confirmed the above observations. Interview on 03/22/22 at 8:06 A.M. with Dietary Manager #290 confirmed all kitchen staff and vendors were required to wear a facial covering inside the building. Review of the facility policy titled, Novel Coronavirus Prevention and Response, revised 03/19/21, revealed staff were to wear face masks in accordance with regulatory requirements. Further review of the policy revealed all visitors were to be educated on wearing face coverings and personal protective equipment use through verbal reminders, signage, etc. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 34 of 35 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 365195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, review of infection control logs, review of Food and Drug Administration (FDA) information, review of a HealthDay News Study, and facility policy review, the facility failed to provide adequate justification for the use of antibiotics as a treatment measure for COVID-19. This affected 13 residents (#11, #13, #15, #24, #33, #34, #43, #59, #224, #225, #226, #227, and #228) out of 31 residents who tested positive for COVID-19 from December 2021 through February 2022. Residents Affected - Some Findings include: Review of the infection control logs and medical record reviews from December 2021 through February 2022 revealed 13 residents (#11, #13, #15, #24, #33, #34, #43, #59, #224, #225, #226, #227, and #228) in December 2021 and January 2022 who tested positive for COVID-19 were prescribed Azithromax/Azithromycin. Interview on 03/29/22 at 10:40 A.M. with Director of Nursing (DON) and the Infection Preventionist/Registered Nurse #293 revealed their COVID-19 positive protocol included Zinc, Vitamin C, Pepcid, an antibiotic, and a steroid. They stated their normal nurse practitioner was out during that time period and the physician was the one who put everyone on those medications, they were not sure why he did that, that was not a normal practice for their facility, and they were not sure if he was asked why he placed residents on an antibiotic for a viral disease. They confirmed all of the COVID-19 positive residents from December 2021 through February 2022 were placed on antibiotics though they did not have a bacterial infection. Review of information on the FDA website (https://www.fda.gov) revealed the following FDA response to the question, Are antibiotics effective in preventing or treating COVID-19? No. Antibiotics do not work against viruses; they only work on bacterial infections. Antibiotics do not prevent or treat COVID-19, because COVID-19 is caused by a virus, not bacteria. Some patients with COVID-19 may also develop a bacterial infection, such as pneumonia. In that case, a health care professional may treat the bacterial infection with an antibiotic. In addition, an article from HealthDay News, dated 08/04/20 revealed the following: Early in the U.S. Coronavirus pandemic, many people landing in the hospital may have been given unnecessary antibiotics, a new study suggests. The findings come from one of the hard-hit hospitals in New York City, the initial epicenter of the U.S. pandemic. Researchers there found that of COVID-19 patients admitted between March and May, just over 70% were given antibiotics. That's despite the fact that COVID-19 is caused by a virus, and very few of those patients actually had a coexisting bacterial infection. Antibiotics kill bacteria, but are useless against viral infections such as the common cold, the flu and COVID-19. Review of the facility policy and procedure titled, Antibiotic Stewardship Program, dated 11/28/17, revealed attending physicians should prescribe appropriate antibiotics in accordance with standards of practice and facility protocols. It further stated the McGreer Criteria would be used to define infections and the Loeb Minimum Criteria would be used to determine whether or not to treat and infection with antibiotics. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 35 of 35