Inspection·March 15, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the MDS assessment dated [DATE] revealed Resident #9 was cognitively impaired with a BIMS of 8 out of 15 and was dependent on staff assistance for all mobility. Observation and interview on 03/04/24 at 5:12 P.M. revealed her bedside curtain by the window was dirty with over 20 spots or brown and red splattering from four feet high to the ground. Resident also confirmed the curtain looked dirty. Observation on 03/05/24 at 10:05 A.M., 2:40 P.M., and 4:55 P.M. revealed curtain remained soiled with several brown and red spots. Observation on 03/06/24 at 11:20 A.M., 12:50 P.M., and 3:10 P.M. revealed curtain remained soiled with several brown and red spots. Observation and interview on 03/07/24 at 8:50 A.M. with STNA #259 confirmed Resident #9's curtain had numerous stains on it and was dirty. She revealed it should be taken down and washed and replaced with a clean curtain. Facility reported they have no policy related to providing and ensuring a homelike environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 2 of 34 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 03/15/2024 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interview, staff interviews, and record review ,the facility failed to ensure care conferences were held with members of the interdisciplinary team including resident participation. This affected two Residents (#57 and #64) of three reviewed for care conferences. Facility census was 117. Findings include: 1. Review of the medical record for Resident #57 revealed an admission date of 04/18/23. Diagnoses included cerebral infarction, hemiplegia and hemiparesis, diabetes, and muscle wasting and atrophy. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #57 was cognitively intact with a brief interview for mental status (BIMS) of 15 out of 15 and required substantial/maximal assist and dependence on staff for activities of daily living. Review progress notes dated 01/09/23 revealed a care conference was held with son upon request as well as a meeting on 02/07/23. Progress note dated 06/30/23 revealed family was sent an invitation to schedule a care conference. Progress note dated 09/30/23 revealed family was sent an invitation to schedule a care conference. Progress note dated 12/29/23 revealed resident and family was sent an invitation to schedule a care conference. Interview on 03/05/24 at 9:04 A.M. with Resident #57 revealed she would like to attend care conferences but revealed she does not know where they were held and when they were. She also revealed she was unsure if she could attend due to not having any shoes to wear when she leaving her room. Resident revealed she was unaware of being invited to attend or getting information about a care conference meeting being offered. 2. Review of the medical record for Resident #64 revealed an admission date of 02/01/22. Diagnoses included dementia, malnutrition, dysphagia, atrial fibrillation, muscle weakness and insomnia. Review of the MDS assessment dated [DATE] revealed Resident #64 had significant cognitive impairment with a BIMS of 99 and required partial to moderate assistance with dressing, toileting, and personal hygiene. Review of care conference forms dated 01/13/23 and 02/07/23 revealed Social Services and a Unit Manager was present. Resident's family was marked as being in attendance one of the meetings. Review progress notes dated 01/13/23 revealed a care conference was held with grandson and a second meeting was held on 02/07/23. Progress note dated 06/30/23 revealed the family was sent an invitation to schedule a care conference. Progress note dated 09/30/23 revealed resident and family was sent an invitation to schedule a care conference. Progress note dated 12/29/23 revealed resident and family was sent an invitation to schedule a care conference. Facility provided documentation (last pages of care plan) where members of the interdisciplinary team signed off each quarter indicating the care plan had been updated. Interview on 03/05/24 at 5:05 P.M. with Social Services #319 revealed care conferences are offered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 3 of 34 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 03/15/2024 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and letters are sent out to families but revealed if family did not schedule or want to attend, no care conferences were held. She confirmed facility had no documentation for who attended care conferences and what was discussed as care conferences were not held for Residents #57 and #64 since first quarter of 2023. Interview on 03/06/24 at 5:00 P.M. with Social Services #319 revealed she was unaware all residents should have quarterly care conference discussions even if the resident and family do not attend. Interview on 03/11/23 at 5:00 P.M. with Social Services #319 provided documentation that the interdisciplinary team reviewed the care plan, but confirmed the interdisciplinary team did not have a discussion regarding residents overall care as part of the quarterly process. Social Services confirmed residents were sent a letter and they can reach out to staff if they want to attend. Revealed she was trained to provide a letter to prove they were offered a care conference instead of talking with the resident to encourage them to participate in a care conference discussion. Social Services also confirmed letters were mailed 6/30/23, 09/30/23, and 12/29/23 to residents and families. Social Services was unable to provide an explanation if these letters were invitations for the following quarter or the current quarter. If the invitations were sent for the current quarter social services was unable to provide reasoning as to why invitations 24 to 72 hour to get the letter and reach out to the facility to meet the timeframe and letters likely would not have reached residents home by mail prior to the end of the quarter. If the letter invitations were for the following quarter, facility was unable to provide any evidence of facility offering or inviting residents and family for Resident #57 and #64 to attend care conferences. Interview on 03/11/23 at 5:20 P.M. with Social Services #319 confirmed again the care plan was signed off by several members of the team but had no evidence a discussion was had on each individual residents and confirmed a discussion did not take place. Interview on 03/12/24 at 6:30 P.M. with Regional Nurse #326 confirmed the employees who signed off on the care plan sheets had updated their sections of the resident's care plan but had not had a meeting or discussion of the revisions that were made. Review of appendix PP revealed the interdisciplinary (IDT) care team would meets its responsibility in developing the care plan through a means determined by the facility. Examples provided included face to face meetings, teleconference and written communication. It also states that when an IDT members participates via written communication, the medical record must reflect involvement of resident, resident representative, and other members of the interdisciplinary team meeting. The Appendix PP also states facility staff have a responsibility to assist residents to engage in care planning process including encouraging participating for resident in care planning and attending care conferences. Facility must provide advanced notice of care planning conferences to enable resident participation. Facility did not have a policy related to care conferences and interdisciplinary discussions related to resident care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 4 of 34 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 03/15/2024 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 observations, resident and staff interviews and record review, facility failed to ensure a resident with hand contracture's was provided with nail trimming and care. This affected one Resident (#8) of one reviewed for nail care for dependent residents. Facility census was 117. Residents Affected - Few Findings include: Review of the medical record for Resident #8 revealed an admission date of 12/29/21. Diagnoses included quadriplegia c5-c7 incomplete, respiratory failure, dysphagia, and contracture of multiple unspecified sites. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #8 was cognitively intact with a brief interview for mental status (BIMS) of 15 out of 15 and required substantial/maximum assistance dependence on staff for mobility and hygiene. The MDS also revealed resident had an upper extremity impairment. Review of the plan of care dated 02/14/24 revealed resident required total assistance with activities of daily living (ADL) due to decreased self-performance with diagnoses of spinal cord injury, multiple contracture's, range of motion impaired to bilateral upper and lower extremities with interventions for bathing assistance of one to two staff and grooming assistance including nails, shaving and hair required maximum assistance. Review of shower sheets dated 02/07/24, 02/10/24, 02/14/24, 02/17/24, 02/21/24 and 02/28/24 revealed staff answered no to nails being trimmed and when asked on the form to provide reasoning, staff provided no documented response why nail care was not provided each of these dates. Review of shower sheets dated 02/24/24, 03/02/24, and 03/06/24 revealed the section regarding whether nail care was provided and the section for staff to explain why it was not provided was not completed. Observations and interviews on 03/04/24 at 10:51 A.M. with Resident #8 confirmed his hands were contracted with tips of his fingers having contact with his palms. Resident had several nails that were long (over ½ inch growth past the nail bed). Resident revealed he received showers and revealed staff had not trimmed his fingernails in several weeks. Observation on 03/06/24 at 12:30 P.M. revealed resident was observed to have long fingernails. Observation and interview on 03/07/24 at 8:33 A.M. with Resident #8 revealed he had long nails and was agreeable to have them cut. Resident revealed staff had not offered recently to trim his nails. Observation and interview on 03/07/24 at 8:50 A.M. with State Tested Nursing Aide #259 confirmed Resident #8 had long nails and no protection from his nails and his palm skin. STNA spoke with resident who informed her he was agreeable to have his nails trimmed and STNA revealed she would return and trim resident's nails. Facility had no policy related to resident activity of daily living care for dependent residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 5 of 34 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 03/15/2024 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of skin grid assessments, review of the wound Certified Nurse Practitioner (CNP) notes, review of an After Visit Summary, staff interviews, and facility policy review, the facility failed to complete timely and accurate skin grid assessments, implement treatment changes timely, and follow up on the wound CNP recommendations timely for one resident (Resident #71). The facility also failed to follow up on discharge recommendations as indicated in the After Visit Summary following a hospitalization for one resident (Resident #71). This affected one resident (Resident #71) of one reviewed for non-pressure skin care. The facility census was 117. Residents Affected - Few Findings include: Review of the medical record for Resident #71 revealed an initial admission date on 01/29/24 and a discharge date on 03/08/24. Medical diagnoses included chronic respiratory failure with hypoxia, asthma, dependence on respirator (ventilator) status, tracheostomy status, anoxic brain damage, and persistent vegetative state. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #71 was in a persistent vegetative state with no discernible consciousness. Resident #71 was totally dependent on one to two staff to complete all Activities of Daily Living (ADLs). Resident #71 required suctioning, tracheostomy care, invasive mechanical ventilator, intravenous medications, intravenous access, and oxygen. Resident #71 had an open lesion other than ulcers, rashes, cuts present at the time of the assessment as well as a surgical wound. Review of the significant change MDS 3.0 assessment date 02/05/24 revealed Resident #71 had an open lesion other than ulcers, rashes, cuts present at the time of the assessment. Review of Resident #71's census revealed the resident was in the hospital from [DATE] to 11/22/23 and 01/13/24 to 01/29/24. Review of the After Visit Summary (AVS) dated 01/29/24 revealed Resident #71 was hospitalized for sepsis and discharged back to the facility on intravenous (IV) antibiotics. Discharge nursing orders included to fax labs including complete blood count (CBC), sedimentation rate (SR), c-reactive protein (CRP), and creatinine to Infectious Disease physician every Monday and to call the Infectious Disease Physician on 02/12/24 with an update to determine stop date, peripherally inserted central catheter (PICC) line plans, oral antibiotics, and a follow up appointment. Wound care instructions for peg site skin breakdown and wound included: may change outer dressing daily as needed for soilage and reapply Triad to maintain dime thickness. Otherwise, change dressing every three days. Please use a plain foam dressing cut with a slit to accommodate the tubing. Remove previous dressing and cleanse wound with mild soap and water, rinse and pat dry. Careful attention to remove all previous cream. Apply triad cream at dime thickness and cover with gauze. Date and time dressing. This will promote autolytic debridement for healing. Review of Treatment Administration Record (TAR) dated January 2024 revealed Resident #71's wound treatment was implemented to start on 01/30/24. The treatment implemented from 01/30/24 to 02/04/24 was to clean with normal saline, pat dry, and apply calcium silver alginate to small open area and apply quarter size amount of triad paste to site and surrounding area and cover with abdominal (ABD) dressing. The treatment was to be completed every shift and as needed. The treatment order was created by Wound Licensed Practical Nurse (WLPN) #195. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 6 of 34 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 03/15/2024 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Skin Grid-Non-Pressure assessment dated [DATE] (three days after readmission) and completed by WLPN #195 revealed Resident #71 had a non-pressure area at the peg site (area where gastrostomy tube was placed in the abdomen). The area was an open lesion measuring 1.1 centimeters (cm) long by 2.4 cm wide by 0.2 cm deep with moderate serosanguineous drainage note. The area was unchanged. WLPN #195 noted the area was much improved since last visit with a shallow granular base and surrounding scar tissue. There was no indication of a skin assessment being completed upon admission on [DATE] by WLPN #195. There was no indication of a treatment order for the area in the skin assessment. Review of the Wound Certified Nurse Practitioner (WCNP) #330's note dated 02/01/24 revealed Resident #71 was seen for an open lesion at the resident's peg site. The area measured 1.1 cm long by 2.4 cm wide by 0.2 cm deep. The treatment included to apply triad and silver alginate for moisture control and antimicrobial benefits. WCNP #330 ordered to apply triad first, pack the wound with alginate every shift and as needed. There was no indication to use calcium alginate on the wound or to cover the wound with an ABD dressing. Review of the TAR dated February 2024 revealed the treatment for Resident #71's peg site wound implemented on 02/04/24 was to clean with normal saline, apply triad paste first then silver calcium alginate. Cover with split gauze and secure with tape every shift and as needed. This treatment remained in place until 03/05/24. The treatment was marked as administered every shift as ordered. The treatment was created by WLPN #195. Review of the progress notes for Resident #71 dated from 01/29/24 through 03/05/24 revealed there was no indication of any contact with the Infectious Disease physician on 02/12/24 as indicated in the discharge instructions. There was also no indication of labs being drawn or faxed to the Infectious Physician every Monday as ordered in the discharge instructions on 02/05/24, 02/12/24, 02/19/24, 02/26/24, or 03/04/24. Review of the Skin Grid Non-Pressure assessment dated [DATE] and completed by WLPN #195 revealed the peg site area measured 2.4 cm long by 2.6 cm wide by 0.2 cm deep. The area had moderate serosanguineous drainage. The area was improved with a shallow pink base that was hyper granular area. The area was cauterized. The assessment did not mention any concerns with the surrounding skin. Review of WCNP #330's note dated 02/15/24 revealed Resident #71's open lesion area at the peg site measured 2.4 cm long by 2.6 cm wide by 0.2 cm deep. There was surrounding excoriation to the skin around the site. The area was cauterized. No wound treatment changes were indicated. Review of the Skin Grid Non-pressure assessment dated [DATE] and completed by WLPN #195 revealed Resident #71's peg site open lesion measured 2.2 cm long by 2.8 cm wide by 0.2 cm deep with heavy serosanguineous drainage noted. The area was unchanged but noted a large amount of drainage of tube feeding and stomach contents. Granular tissue was still visible. There was no indication of WCNP #330's recommendation for a general surgery consult or changes to the peri wound. Review of WCNP #330's note dated 02/22/24 revealed Resident #71's peg site open lesion measured 2.2 cm long by 2.8 cm wide by 0.2 cm deep with a large amount of drainage of tube feeding and stomach contents. The surrounding skin had maceration and excoriation. WCNP #330 noted the area would continue to decline until further evaluation and recommended a general surgery consult for evaluation of peg tube placement. The periwound was noted to be excoriated and macerated. WCNP #330 changed the wound treatment to apply triad first, pack wound with alginate, and cover with an ABD pad every shift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 7 of 34 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 03/15/2024 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 0684 and as needed. This wound treatment was not implemented as recommended. Level of Harm - Minimal harm or potential for actual harm Review of the Skin Grid Non-pressure assessment dated [DATE] and completed by WLPN #195 revealed Resident #71's peg site open lesion measured 8.9 cm long by 5.9 cm wide by 0.2 cm deep with heavy serosanguineous drainage noted. The area was declined and noted to be much larger with a large amount of drainage with tube feeding and stomach contents. Increased area maceration and excoriation was noted. The area was 30% granulation and 70% excoriation and maceration. There was no indication the area was cauterized, WCNP #330's recommendation for a general surgery consult, or that the area was noted to be unavoidable. Residents Affected - Few Review of WCNP #330's note dated 02/29/24 revealed Resident #71's peg site open lesion measured 8.9 cm long by 5.9 cm wide by 0.2 cm deep with heavy serosanguineous drainage. The area was noted to be declined but unavoidable. WCNP #330 again recommended a general surgery consult. Silver nitrate was used to cauterize the excess granulation tissue. There were no wound treatment changes recommended. There was no evidence of any follow up related to WCNP #330's recommendations for a general surgery consult in Resident #71's medical record. Interview on 03/07/24 at 11:49 A.M. with WCNP #330 revealed she visited the facility one time a week to assess the facility's residents with wounds, including Resident #71. WCNP #330 reported Resident #71 had several wounds upon readmission from her most recent hospitalization on 01/29/24. WCNP #330 stated the resident's peg site needed surgical intervention. Stated she did change the wound treatment today, 03/07/24, due to continued excoriation and maceration of the skin on the resident's abdomen. WCNP #330 confirmed the area declined on 02/29/24 but she did not make any new treatment recommendations until 03/07/24. WCNP #330 confirmed WLPN #195 should have completed an assessment of Resident #71's peg site prior to her visit on 02/01/24 (three days after readmission). WCNP #330 confirmed WLPN #195's skin grid assessments should be the same as her notes because they complete rounds together. WCNP #330 stated she was available for continued consultation as needed via telephone but had not received any communication from WLPN #195 other than during their weekly rounds. WCNP #330 confirmed the treatments provided to Resident #71 should match the treatment recommendations from her notes. Interview on 03/07/24 at 4:28 P.M. with WLPN #195 confirmed she was not a wound certified LPN. WLPN #195 confirmed a full skin grid assessment was not completed on Resident #71 until 02/01/24 (three days after readmission). WLPN #195 confirmed the wound treatment implemented on 01/30/24 did not match the discharge wound treatment recommendations on the After Visit Summary. WLPN #195 confirmed wound treatments for any newly identified areas or if WCNP #330 recommended a treatment change for an ongoing wound, the treatment should be implemented immediately. WLPN #195 confirmed any discharge instructions should be reviewed by herself and the unit managers when a resident was readmitted to the facility. WLPN #195 confirmed Resident #71's peg site wound was noted as declined but no treatment changes were ordered until 03/06/24 (six days later). WLPN #195 stated typically if a wound has declined, the treatment was changed. Interview via telephone on 03/11/24 at 3:15 P.M. with Infectious Disease Registered Nurse (IDRN) #332 confirmed there was not any evidence the facility had faxed any labs to the Infectious Disease Physician's office as ordered in the discharge instructions. IDRN #332 also confirmed there was not any evidence the facility had called the Infectious Disease office on 02/12/24 to determine plans for treatment of Resident #71 as ordered in the discharge instructions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 8 of 34 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 03/15/2024 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 03/11/24 at 3:37 P.M. with the Director of Nursing (DON) revealed she did not provide any oversight or assistance with resident wounds. The DON stated WLPN #195 and WCNP #330 handled all the facility's wounds. The DON confirmed the treatment order implemented on 01/30/24 for Resident #71 did not match the treatment recommendations from the discharge instructions. The DON confirmed the wound treatment implemented on 02/04/24 through 03/05/24 did not match the treatment orders recommended by WCNP #330. The DON confirmed the weekly skin assessments should include a full description of the wound area, the treatment order, any changes from the previous week's assessment, and any recommendations made by WCNP #330. The DON confirmed there was no evidence WLPN #195 had consulted with WCNP #330 in the resident's record. Review of the facility policy, Nursing Assessments, dated 03/01/24, revealed the policy stated, Licensed nurses ensure assigned nursing assessments are completed timely by evaluating residents as scheduled and per the resident needs. Licensed nurses collaborate with other members of the healthcare team to ensure appropriate interventions related to data collected for completion of nursing assessments are in place and documented per facility policy. Review of the facility policy, Skin Assessment, dated 09/2107, revealed the policy stated, at the time of admission/re-admission, the resident is evaluated for special needs related to skin care. Residents receive a weekly skin integrity check performed by licensed personnel. Resident response to preventative efforts is monitored and evaluated. Approaches are revised as appropriate. Areas of alteration in skin that are present, or which develop subsequently to admission, are treated according to medical direction and are conscientiously followed. Review of the facility policy, Skin Evaluation, revised 03/01/24, revealed the policy stated, Licensed nurses may collect patient data that includes the LPN's observation, measurement, and comparative analysis of a wound to a staging chart, and document the observation, measurement and comparative analysis in accordance with recognized standards of practice. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 9 of 34 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 03/15/2024 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the medical record for Resident #71 revealed an initial admission date on 01/29/24 and a discharge date on 03/08/24. Medical diagnoses included chronic respiratory failure with hypoxia, asthma, dependence on respirator (ventilator) status, tracheostomy status, anoxic brain damage, and persistent vegetative state. Residents Affected - Few Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #71 was in a persistent vegetative state with no discernible consciousness. Resident #71 was totally dependent on one to two staff to complete all Activities of Daily Living (ADLs). Resident #71 required suctioning, tracheostomy care, invasive mechanical ventilator, intravenous medications, intravenous access, and oxygen. Resident #71 had one facility acquired unstageable pressure ulcer noted in the assessment. Review of the significant change MDS 3.0 assessment dated [DATE] revealed Resident #71 had four stage 3 pressure ulcers present upon admission or readmission and three unstageable pressure ulcers present upon admission or readmission. Review of Resident #71's census revealed the resident was hospitalized from [DATE] to 01/29/24. Review of the progress note dated 01/29/24 at 5:24 P.M. revealed Resident #71 arrived in the facility at 5:10 P.M. The resident received care at the hospital. A routine assessment was completed on arrival. The progress note did not specify any pressure ulcers identified during the routine assessment of the resident. Review of a Clarification Progress Note dated 01/31/24 at 11:05 A.M., entered by Wound Licensed Practical Nurse (WLPN) #195, revealed clarification of Resident #71's admitting skin assessment. Resident #71 exhibited pressure on the left first knuckle that is (stage 3), left thumb that is (unstageable), right heel (Deep Tissue Injury or DTI), left heel (unstageable), lower right shin area (stage 3), sacrum that is (unstageable), right lateral side (stage 3), and right upper back (stage 3). No further details about these pressure areas were included in the note. Review of the Skin Grid-Pressure dates for Resident #71 revealed there were not any skin grids completed between 01/11/24 and 02/01/24 (three days after Resident #71 was readmitted to the facility). Review of the Skin Grid-Pressure assessments for Resident #71's pressure ulcer on the right heel dated 02/01/24, 02/08/24, and 02/15/24 and completed by Wound Licensed Practical Nurse (WLPN) #195 revealed discrepancies when compared to WCNP #330's notes. The assessment on 02/01/24 revealed an unstageable pressure ulcer to Resident #71's right heel which measured 4.1 centimeters (cm) long by 6.9 cm wide by an unable to be determined (UTD) depth. The area had scant eschar (dead tissue) and was debrided. After debridement a depth of 0.4 cm was determined. There was no indication of the wound treatment recommendation. On 02/08/24, the right heel remained an unstageable pressure ulcer which measured 4.1 cm long by 6.9 cm wide by UTD depth. The area had scant eschar and was debrided. Post debridement, a depth of 0.4 cm was determined. The area consisted of 15% tendon, 80% granulation, and 5% eschar or slough. There was no indication of wound treatment recommendation. On 02/15/24, the right heel remained an unstageable pressure ulcer which measured 3.3 cm long by 3.8 cm wide by UTD depth. There was no further information related to treatment of the wound indicated. Review of WCNP #330's notes on Resident #71's pressure ulcer on the right heel dated 02/01/24, 02/08/24, and 02/15/24 revealed on 02/01/24, WCNP #330 noted the area to be an unstageable pressure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 10 of 34 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 03/15/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ulcer which measured 4.1 cm long by 6.9 cm wide by an UTD depth. The area was debrided down to the tendon and a depth of 0.4 cm was determined post-debridement. There was moist eschar present and the area was unstable. WCNP #330 recommended anasept and oil emulsion first, then cleanse with normal saline (NS), pack the wound with alginate, apply barrier cream, cover with an abdominal (ABD) pad, wrap with kerlix. The treatment was to be completed daily and as needed. On 02/08/24, WCNP #330 noted an unstageable pressure ulcer which measured 3.6 cm long by 5.4 cm wide by UTD depth. The area had moderate gray slough and was debrided to the tendon. A post-debridement depth was not indicated. The periwound was macerated. WCNP #330 recommended to stop oil emulsion. Apply anasept first, cleanse with NS, pack with alginate, apply barrier cream, cover with ABD pad, and wrap with kerlix. Offload with heel boots daily and as needed (prn). On 02/15/24, WCNP #330 noted an unstageable pressure ulcer with visible tendon which measured 3.3 cm long by 3.9 cm wide by UTD depth. The area was 80% granular, 15% tendon, and 5% slough with a macerated periwound. The area was debrided and slough was removed. No treatment order changes were recommended. Review of the TAR dated January 2024 and February 2024 revealed a wound treatment for Resident #71's right heel was not implemented until 02/05/24 (seven days after readmission and four days after WCNP #330 completed assessment). The treatment order started on 02/05/24 and discontinued on 02/07/24, did not include to pack the wound with alginate or apply barrier cream. No treatment was administered on 02/08/24. The treatment administered from 02/09/24 through 03/05/24 was to cleanse with NS, apply anasept gel first then apply calcium alginate (not silver alginate), cover with ABD and wrap with kerlix every day shift for wound care. Review of the Skin Grid-Pressure assessments for Resident #71's pressure ulcer to her right shin dated 02/01/24, 02/08/24, 02/15/24, 02/22/24 and 02/29/24 revealed discrepancies when compared to WCNP #330's wound notes. On 02/01/24, a stage III pressure ulcer to the right shin was identified which measured 1.2 cm long by 1.4 cm wide by 0.1 cm deep. No treatment order was indicated. On 02/08/24, measurements were 1.2 cm long by 1.4 cm wide by 0.1 cm deep. On 02/15/24, measurements were 1.2 cm long by 1.4 cm wide by 0.1 cm deep. On 02/22/24, there was no indication of treatment change being recommended. On 02/29/24, measurements were 0.9 cm long by 0.9 cm wide by UTD depth. There was no indication of the area opening or a treatment change recommendation. Review of WCNP #330's wound notes for Resident #71's pressure ulcer to her right shin dated 02/01/23, 02/08/24, 02/15, 24, 02/22/24, and 02/29/24 revealed a stage III pressure ulcer area to the resident's heel was initially assessed on 02/01/24 which measured 1.2 cm long by 1.4 cm wide by 0.1 cm deep. A treatment to apply triad daily and as needed was recommended. On 02/08/24, measurements were 0.9 cm long by 1.4 cm wide by UTD depth with scabbing noted. On 02/15/24, measurements were 1.1 cm long by 1.1 cm wide by UTD depth with dry scab noted. On 02/22/24, a recommendation to apply betadine daily was recommended. On 02/29/24, measurements were 0.9 cm long by 0.9 cm wide by 0.1 cm deep. The area opened this week. A treatment to apply triad paste and cover with a silicone dressing daily was recommended. Review of the TAR dated January 2024 and February 2024 revealed no treatment orders were implemented until 02/01/24 (three days after readmission) for Resident #71's right shin. From 02/01/24 to 02/04/24, an order to apply triad, cover with ABD pad and wrap with kerlix was implemented (which did not match WCNP #330's recommended treatment). The recommendation to apply betadine daily was not implemented. The treatment ordered from 02/05/24 and discontinued on 03/05/24 was to cleanse right shin with normal saline (NS), pat dry, apply triad paste, and leave open to air every day shift. The treatment recommended on 02/29/24 was not implemented until 03/06/24. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 11 of 34 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 03/15/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Skin Grid-Pressure assessment for Resident #71's pressure ulcer on the left first knuckle and completed by WLPN #195 dated 02/01/24 and 02/29/24 revealed discrepancies when compared to WCNP #330's wound notes. On 02/01/24, the area was identified as a Stage III pressure ulcer which measured 1.1 cm long by 0.4 cm wide by 0.4 cm deep. No treatment orders were indicated. On 02/29/24, the area measured 0.6 centimeters (cm) long by 0.8 cm wide by 0.2 cm deep. The wound was noted as improved. There was no indication of the area opening or a wound treatment change recommended. Review of the Wound Certified Nurse Practitioner (WCNP) #330's note dated 02/01/24 noted the area was initially assessed and found to be a Stage III pressure ulcer which measured 1.1 cm long by 0.4 cm wide by 0.4 cm deep. A treatment to apply triad daily and as needed and offload was recommended. On 02/29/24, Resident #71's stage III pressure ulcer on her left first knuckle measured 0.6 cm long by 0.8 cm wide by 0.2 cm deep. The area was noted to have opened this week. WCNP #330 recommended a treatment change to apply triad with a silicone dressing daily and as needed. Review of the TAR dated January 2024 and February 2024 revealed no wound treatment was implemented for Resident #71's left first knuckle until 02/05/24 (six days after readmission and four days after WCNP #330's recommendation). The treatment administered from 02/05/24 to 03/04/24 was to cleanse left first knuckle with NS, pat dry and apply triad paste, leave open to air every day shift. The treatment change recommendation made by WCNP #330 was not implemented until 03/05/24. Review of the Skin Grid-Pressure assessments for Resident #71's stage III pressure ulcer to her upper back dated 02/01/24, 02/08/24, and 02/15/24 and completed by WLPN #195 revealed discrepancies when compared to WCNP #330's wound notes. On 02/01/24, the area measured 6.1 cm long by 4.2 cm wide by 0.1 cm deep. There was no indication of a treatment order. On 02/08/24, the area measured 6.8 cm long by 3.6 cm wide by 0.1 cm deep. There was no indication of a wound treatment change being recommended. On 02/15/24, the area measured 6.8 cm long by 3.6 cm wide by 0.1 cm deep. There was no indication of a wound treatment change being recommended. Review of WCNP #330's wound notes for Resident #71's stage III pressure ulcer to her upper back dated 02/01/24, 02/08/24, and 02/15/24 revealed on 02/01/24, the area was noted to be possibly a shear skin injury. A treatment to apply silver alginate and a foam dressing on Tuesday, Thursday, and Saturday and as needed (prn) was recommended. On 02/08/24, increased drainage was noted. A recommendation to stop the foam dressing and increase to daily dressing changes was made. The treatment to apply silver alginate and cover with an abdominal (ABD) pad daily and as needed was recommended. On 02/15/24, measurements were 7.3 cm long by 3.9 cm wide by 0.2 cm deep were noted. Heavy drainage was noted. A treatment change to apply triad first, pack with silver alginate and cover with ABD pad daily and prn was recommended. Review of the TAR dated January 2024 and February 2024 revealed no wound treatment for Resident #71's upper back to apply triad paste and cover with foam was administered from 02/01/24 to 02/04/24. This treatment did not match the recommended treatment by WCNP #330. No wound treatment was administered on 02/05/24. From 02/06/24 to 02/08/24, triad paste and foam Tuesday, Thursday, and Saturday was implemented. This did not match WCNP #330's recommendation. From 02/09/24 to 03/05/24, triad paste and ABD pad daily was administered to Resident #71. This did not match WCNP #330's recommendation to add silver alginate. Review of the Skin Grid-Pressure assessments of Resident #71's unstageable pressure ulcer to her coccyx dated 02/01/24, 02/08/24, and 02/29/24 and completed by WLPN #195 revealed discrepancies with WCNP #330's wound notes. On 02/01/24, there was no indication of a wound treatment recommendation. On (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 12 of 34 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 03/15/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 02/08/24, the measurements were 3.1 cm long by 4.2 cm wide by UTD depth. On 02/29/24, the area was noted to be unstageable with 95% granular and 5% tendon. Review of WCNP #330's wound notes of Resident #71's unstageable pressure ulcer to her coccyx dated 02/01/24 revealed a treatment recommendation to pack with silver alginate, cover with foam dressing, daily and leave open to air as well as offload were made. On 02/08/24, measurements were 3.4 cm long by 4.1 cm wide and UTD depth. On 02/29/24, the area was staged as a Stage IV pressure ulcer with visible tendon. Measurements were 1.9 cm long by 2.9 cm wide by 0.3 cm deep. There was 95% granulation and 5% tendon. Review of the TAR dated January 2024 and February 2024 revealed there was not an accurate wound treatment for Resident #71's coccyx wound per WCNP #330's recommendations implemented. A treatment of calcium alginate and foam dressing was implemented from 01/30/24 to 03/05/24. The recommendation was to pack the wound with silver alginate. Additionally, there was a delay in implementing wound treatments for Resident #71's pressure areas to her left heel DTI (not implemented until 02/05/24) and lower back (received inaccurate treatment from 02/05/24 to 02/07/24 and then the recommended treatment on 02/01/24 was implemented on 02/09/24). Interview on 03/07/24 at 11:49 A.M. with WCNP #330 confirmed Resident #71's pressure ulcer areas that were identified in the discharge paperwork on 01/29/24 and identified by WLPN #195 were not fully assessed until 02/01/24. WCNP #330 confirmed treatment order recommendations would be expected to be implemented immediately. WCNP #330 confirmed she and WLPN #195 completed wound rounds together weekly and their assessments should match. Interview on 03/07/24 at 4:28 P.M. with WLPN #195 confirmed there was a delay in identifying all of Resident #71's pressure ulcer areas after she was readmitted on [DATE]. WLPN #195 confirmed the admitting nurse on 01/29/24 did not identify all of the areas. WLPN #195 confirmed she did not note wound treatment recommendations made by WCNP #330 in the resident's wound assessments. WLPN #195 also did not note any wound treatment changes recommended by WCNP #330. WLPN #195 confirmed there were delays in implementing wound treatments for Resident #71 after readmission as well as wound treatments ordered which did not match the recommendations from WCNP #330. Interview on 03/11/24 at 3:37 P.M. with the Director of Nursing (DON) revealed she did not provide any oversight or assistance with resident wounds. The DON stated WLPN #195 and WCNP #330 handled all the facility's wounds. The DON confirmed there were delays in implementing wound treatments for Resident #71 after readmission. The DON confirmed all pressure areas and non-pressure areas should have been identified by the admitting nurse and a treatment should have been started. The DON confirmed there was no evidence WLPN #195 had consulted with WCNP #330 in the resident's record. Review of the facility policy, Nursing Assessments, dated 03/01/24, revealed the policy stated, Licensed nurses ensure assigned nursing assessments are completed timely by evaluating residents as scheduled and per the resident needs. Licensed nurses collaborate with other members of the healthcare team to ensure appropriate interventions related to data collected for completion of nursing assessments are in place and documented per facility policy. Review of the facility policy, Skin Assessment, dated 09/2107, revealed the policy stated, at the time of admission/re-admission, the resident is evaluated for special needs related to skin care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 13 of 34 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 03/15/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Residents receive a weekly skin integrity check performed by licensed personnel. Resident response to preventative efforts is monitored and evaluated. Approaches are revised as appropriate. Areas of alteration in skin that are present, or which develop subsequently to admission, are treated according to medical direction and are conscientiously followed. Review of the facility policy, Skin Evaluation, revised 03/01/24, revealed the policy stated, Licensed nurses may collect patient data that includes the LPN's observation, measurement, and comparative analysis of a wound to a staging chart, and document the observation, measurement and comparative analysis in accordance with recognized standards of practice. Based on record reviews, interviews, observations, and facility policies, the facility failed to ensure accurate and timely wound assessments and care was provided for three residents (#51, #71, and #89) out of four residents reviewed for wounds. The facility census was 117. Findings include: 1. Review of the medical record for Resident #51, revealed an admission date of 10/20/23. Diagnoses included: moderate protein-calorie malnutrition, vascular dementia, unspecified severity, without behavioral disturbance, psychosis disturbance, mood disturbance and anxiety, and end stage renal disease. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) of resident is rarely/never understood. The resident was assessed to be dependent with all bed mobility. Review of nursing admission skin assessment for Resident #51 dated 10/20/23 revealed three wounds. Wound #1 was sacrococcygeal moisture-associated skin damage (MASD), wound #2 was a left heel stage 1 (an observable, pressure- related alteration of intact skin whose indicators may include changes in one or more of the following parameters: skin temperature (warmth or coolness); tissue consistency (firm or boggy); sensation (pain, itching); and/or a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the injury may appear with persistent red, blue, or purple hues) pressure ulcer and wound #3 was a right heel stage 1 pressure ulcer. Review of treatment administration record (TAR), progress notes, and skilled nurse's notes, for Resident #51 revealed no documentation on wound treatments for all three wounds upon admission until 10/22/23 and resident was sent to out to the hospital on [DATE]. Review of nursing readmission skin assessment for Resident #51 dated 11/07/23 revealed three wounds. Wound #1 a sacrum stage 4 (full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling) pressure ulcer, wound #2, a surgical site to the abdomen and wound #3, a right heel deep tissue injury (purple or maroon area of discolored intact skin due to damage of underlying soft tissue. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue). Review of physician order for Resident #51 dated 11/08/23 revealed encourage/assist resident to turn and reposition as tolerated every shift. Review of nursing wound assessments for Resident #51 dated 11/09/23 revealed 6 wounds. Wound #3 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 14 of 34 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 03/15/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few now a right shoulder unstageable (dead or devitalized tissue that is hard or soft in texture; usually black, brown, or tan in color, and may appear scab-like. Necrotic tissue and eschar are usually firmly adherent to the base of the wound and often the sides/ edges of the wound.) wound, wound #5 a left heel deep tissue injury, wound #6 left buttock unstageable pressure ulcer and wound #7 a right buttock stage 2 (partial thickness loss of dermis presenting as a shallow open ulcer with a red or pink wound bed, without slough or bruising) pressure ulcers were not documented on the readmission skin assessment dated [DATE] and all stated they were acquired on admission. Review of physician's order for Resident #51 start date 12/29/23 revealed clean patient sacrum with normal saline and pack with 3 sheets of calcium alginate, then pack with fluff gauze, cover 4 ABD's secure with tape and apply triad paste to surrounding areas. every shift for wound care Review of the TAR for January 2024 for Resident #51 revealed missing treatments for the sacrum wound for day shift on the following dates: 01/20/24, 01/21/24 and 01/22/24 and for night shift on the following dates: 01/01/24, 01/04/24, 01/05/24, 01/08/24, 01/13/24, 01/14/24, 01/18/24 and 01/19/24. Review of readmission skin assessment for Resident #51 dated 02/04/24 revealed three wounds. Wound #1 a coccyx stage 2 pressure ulcer, wound #2 a sacrum stage 4 pressure ulcer and wound #3 was a skin tear. Review of nursing wound assessment for Resident #51 dated 02/05/24 revealed four wounds. Wound #1 a sacrum stage 4 pressure ulcer, wound #4 a right heel unstageable pressure ulcer, wound #5 a left heel unstageable pressure and wound #6 a right buttock stage 3 (full-thickness tissue loss into subcutaneous tissue but does not go into the muscle or bone) pressure ulcer and were all acquired on admission. Observation of Resident #51 on 03/11/24 revealed at 8:56 AM, 10:58 AM, and 2:15 PM the resident was on her back in bed. Observation of Resident #51 on 03/11/24 revealed at 9:12 AM, 11:14 AM and 3:23 PM the resident was on her back in bed. Interview on 03/11/24 at 3:24 P.M. with State Tested Nursing Aide (STNA) #313 revealed Resident #51 was on her back and had not been turned. STNA #313 was also unable to verbalize how often to turn and reposition residents. Review of the TAR for March 2024 revealed documentation of turning and repositioning resident on day shift for 03/07/24 and 03/11/24 during day shift hours. Interview on 03/12/24 at 10:49 A.M. with Licensed Practical Nurse (LPN) #195 verified Resident #51's readmissions to the facility did not contain all the residents' wounds as the facility required and verified missing treatments for the month of January with no explanation as to why they were missed. Reviewed the missing treatments for Resident #51 for admission on [DATE] and stated, That was a weekend, so the floor nurse should have called the physician for orders until Monday, and it looks like she didn't do that. 2. Review of the medical record for Resident #89, revealed an admission date of 09/15/23. Diagnoses included: quadriplegia, chronic respiratory failure, and latent syphilis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 15 of 34 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 03/15/2024 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the most recent MDS 3.0 assessment dated [DATE] revealed a BIMS of 15 out of 15. The resident was assessed to be dependent with all care including toileting and rolling left and right in bed and was assessed to have one or more unhealed pressure ulcer: one stage 3 that was present upon admission. Review of admission skin assessment for Resident #89 dated 09/15/23 revealed six wounds. Wound #1 a right posterior calf stage 3 pressure ulcer, wound #2 a left heel unstageable pressure ulcer, wound #3 a posterior head stage 2 pressure ulcer, wound #4 a sacrum stage 1 pressure ulcer, wound #5 a left ear stage 2 pressure ulcer and wound #6 a right buttock non pressure blister. Review of readmission skin assessment for Resident #89 dated 10/09/23 revealed five wounds. Wound #1 a left heel unstageable pressure ulcer, wound #2 a right posterior upper calf stage 2 pressure ulcer, wound #3 a sacrum stage 1 pressure ulcer, wound #4 left (unidentified) stage 2 pressure ulcer and wound #5 a right buttock stage 1 pressure ulcer. Review of nursing wound assessment for Resident #89 dated 10/12/23 revealed five wounds but did not include wound #5 right buttock stage 1 pressure ulcer and included a wound #4 posterior head unstageable pressure ulcer documented as being acquired on admission. Review of nursing wound assessment for Resident #89 dated 10/19/23 revealed no documentation on the right buttock stage 1 pressure ulcer documented on readmission. Review of readmission skin assessment for Resident #89 dated 10/24/23 revealed three wounds. Wound #1 a left heel unstageable pressure ulcer, wound #2 a right posterior upper calf stage 1 pressure ulcer, and wound #3 a sacrum stage 2 pressure ulcer. Review of physician's order for Resident #89 dated 10/26/23 revealed encourage/assist to turn and reposition as tolerated every shift. Review of nursing wound assessments for Resident #89 dated 11/02/23 revealed three wounds but did not include wound #3 a sacrum stage 2 pressure wound and included a wound #6 left ear stage 3 pressure ulcer. Review of nursing wound assessments for Resident #89 dated 11/09/23 revealed two wounds. Wound # 6 the left ear stage 3 pressure ulcer was not documented on. Review of Resident #89's progress notes, skilled nursing notes and MAR and TAR for November and December 2023 revealed no documentation of refusal of care. Review of dietary note for Resident #89 dated 01/11/24 revealed current diet provides adequate kcal/protein to promote wound healing. Review of nursing wound assessment for Resident #89 dated 01/18/24 revealed right posterior calf 6.7 centimeters (cm) X 3.1 cm X .4 cm to be a stage 3 pressure ulcer. Review of nursing wound assessment for Resident #89 dated 01/25/24 revealed right posterior calf 15.2 cm X 6.8 cm X .5 cm to be a stage 4 pressure ulcer. Review of dietary note for Resident #89 dated 01/25/24 revealed current diet provides adequate (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 16 of 34 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 03/15/2024 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 0686 kcal/protein to promote wound healing. Level of Harm - Minimal harm or potential for actual harm Review of progress notes, skilled nurse's notes, MAR and TAR for Resident #89 revealed no documentation of injury and refusal of care occurring to the right posterior calf to worsen wound between the dates of 01/18/24 to 01/25/24. Residents Affected - Few Observation of Resident #89 on 03/06/24 revealed the resident was on back in bed at 9:50 A.M., 11:52 A.M. and 2:15 P.M. Observation of Resident #89 on 03/07/24 revealed the resident on back in bed at 9:02 A.M., 10:31 A.M. and 2:14 P.M. Observation of Resident #89 on 03/11/24 revealed resident on back in bed at 9:34 A.M., 11:45 A.M. and 3:31 P.M. Interview on 03/11/24 at 9:09 A.M. with LPN #204 revealed unsure of how often residents should be turned and repositioned on the ventilator unit and was the nurse for part of the hall for the day. Interview on 03/11/24 at 3:32 P.M. with Resident #89 revealed she had not been turned on today and does not get turned on often by the staff. Denied refusing care for wound and turning and wanted to be turned on her side. Interview on 03/11/24 at 3:46 P.M. with LPN # 204 revealed Resident #89 wanted to be turned and verified she had not been today and stated, I will get an aide to do that. Interview/Observation on 03/11/24 at 4:12 P.M. with Resident #89 revealed the resident on her back and stated, I have not been turned yet. Interview on 03/11/24 at 4:13 P.M. with LPN #204 revealed Resident #89 had not been turned yet and stated, the aide is on break, we will get to it when we do, have a good day. Interview on 03/12/24 at 10:46 P.M. with LPN #195 verified for Resident #89 the discrepancies with documentation from the resident's readmission skin assessments to the weekly wound assessments. Also verified the residents wound worsened on the dates of 01/18/24 to 01/25/24 and denied the resident refuses care and stated sometimes, she wants us to come back at a different time, but she has never refused wound care for me. Verified the readmission assessments should match the weekly wound assessments and verified wounds are typically healed out so the facility can keep track but confirmed wound #5 right buttock stage 1 pressure ulcer and wound #3 a sacrum stage 2 pressure wound were healed out for the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 17 of 34 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 03/15/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on medical record review, observations, staff interview, and policy review, the facility failed to ensure fall interventions were implemented in a timely manner. This affected one (Resident #85) out of two residents reviewed for falls. The census was 117. Findings include: Review of the medical record for Resident #85 revealed an admission date of 12/07/22. Diagnoses included hypercholesterolemia, osteoporosis, mild cognitive impairment, artificial right and left hip joints, insomnia, and muscle weakness. Review of the progress note, dated 12/20/23, revealed Resident #85 was observed on the floor in a sitting position. The STNA informed the nurse who came to assess the resident. Resident #85 had reported she was coming from the bathroom and wanted to get in bed. An assessment was completed and no injuries were identified. The new intervention was for a call don't fall sign. Resident #85 was educated to ask for assistance when going to the bathroom. Review of the fall investigation, dated 12/20/23, revealed Resident #85 was found sitting on her bottom on the floor in her room with her legs extended outward toward the bathroom door. The fall occurred in Resident #85's room and the call light was not activated. The intervention was to educate Resident #85 to use the call light and a call don't fall sign was to be placed as a visual reminder. Review of the progress note, dated 01/08/24, revealed Resident #85 was observed to have fallen in her room and was on her buttock. Resident #85 stated she was trying to close the window. An assessment was completed and Resident #85 indicated she had left leg pain. A temporary intervention included a chair alarm and STAT (immediate) left leg x-ray was ordered due to complaint of pain. No fractures were found on the x-ray. Review of the fall investigation, dated 01/08/24, revealed Resident #85 was found sitting on her bottom on the floor by the window and the call light was not activated. Resident #85 reported she was trying to close the window but the window was found to not be open. The intervention was for a chair alarm to alert staff to resident transfers. Review of Fall Risk assessment, dated 01/24/24, revealed Resident #85 was at risk for falls. Review of the Minimum Data Set assessment, dated 02/19/24, revealed Resident #85 was cognitively impaired and required partial moderate assistance for hygiene care, substantial maximal assistance for toileting and dressing, and was dependent for putting on and taking off shoes. Review of the plan of care, dated 02/22/24, revealed Resident #85 was at risk for falls with interventions for bed in low position, care conference with residents family, encourage and remind to ask for assistance dated, encourage resident to wear non slip socks or shoes when up, ensure call light was within reach, have commonly used articles within reach, monitor and anticipate/intervene for causative factors, and therapy referral as needed, provide assist of one with transfers as needed, restorative referral as needed and staff assistance with ambulation with use of walker, and non-skid strips to bedside. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 18 of 34 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 03/15/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm Review of Resident #85's physician order, dated 03/05/24, revealed an order for a chair alarm to be placed when resident was in the chair and to check for placement and function. Observation on 03/04/24 at 5:44 P.M. revealed Resident #85 was sitting in a chair in the common area. Resident #85 had no chair alarm in place. Residents Affected - Few Observation on 03/05/24 at 12:45 P.M. revealed Resident #85 was sitting in a chair in the common area. No chair alarm was observed in place. Interview on 03/05/24 at 5:45 P.M. with Licensed Practical Nurse (LPN) #215 revealed Resident #85 did not have a chair alarm in place until 03/05/24 in the early evening time. Observation on 03/06/24 at 5:35 P.M. of Resident #85 revealed the resident was sitting in the chair in the common space with a chair alarm in place. Interview on 03/07/24 at 8:50 A.M. with State Tested Nursing Aide #259 revealed she had never seen Resident #85 using a chair alarm when she worked with Resident #85 prior to 03/07/24. Interview on 03/07/24 at 9:13 A.M. with LPN #165 confirmed Resident #85 did not have the chair alarm in place prior to 03/05/24. Interview on 03/07/24 at 5:30 P.M. with Regional Nurse #326 confirmed some of Resident #85's fall interventions were not on the care plan. Interview on 03/07/24 at 2:22 P.M. with LPN #198 revealed Resident #85 had the chair alarm put in place late afternoon on 03/05/24. She revealed Resident #85 did not have it in place prior to 03/05/24. Interview on 03/11/24 at 10:45 A.M. with the Director of Nursing (DON) confirmed Resident #85 had a fall on 12/20/23 with an intervention to place a call don't fall sign. The DON confirmed the call don't fall sign was not added to Resident #85's care plan. The DON confirmed Resident #85 had a fall on 01/08/24 with a new intervention for a chair alarm to be put in place. The DON confirmed the chair alarm was not added to the care plan and was not ordered until 03/05/24. The DON further verified the chair alarm was not put in place until 03/05/24. Review of facility policy titled Fall Management, dated 10/17/16, revealed after a fall a plan would be identified and implemented as necessary to protect the resident and/or others from reoccurrence. This includes development of a care plan to identify the needs and fall interventions and should be reevaluated to ensure resident specific interventions were incorporated as necessary into the plan of care. Fall interventions should be updated as needed and new interventions shall be communicated to care givers as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 19 of 34 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 03/15/2024 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** Based on medical record review, observation, staff interview, and facility policy review, the facility failed to ensure ventilator setting checks were completed as ordered. This affected one (Resident #71) out of four residents reviewed for respiratory care. The facility also failed to ensure respiratory equipment was clean and changed as ordered. This affected one (Resident #83) out of four residents reviewed for respiratory care. The census was 117. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #71 revealed an initial admission date of 01/29/24 and a discharge date of 03/08/24. Medical diagnoses included chronic respiratory failure with hypoxia, asthma, dependence on respirator (ventilator) status, tracheostomy status, anoxic brain damage, and persistent vegetative state. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 01/10/24, revealed Resident #71 was in a persistent vegetative state with no discernible consciousness. Resident #71 was totally dependent on one to two staff to complete all Activities of Daily Living (ADLs). Resident #71 required tracheostomy care and an invasive mechanical ventilator. Review of the physician orders dated March 2024 revealed Resident #71 had an order with a start date on 01/29/24 to complete vent checks every six hours. Review of the Ventilator Flow Sheets dated from 02/01/24 to 02/29/24 revealed ventilator setting checks were not completed every six hours as ordered on 02/10/24, 02/11/24, and 02/23/24. Interview on 03/11/24 at 3:37 P.M. with the Director of Nursing (DON) confirmed ventilator settings should be checked every six hours. The DON confirmed Resident #71's ventilator settings were not checked every six hours as ordered. 2. Review of Resident #83's medical record revealed Resident #83 was admitted to the facility on [DATE] with diagnoses including chronic respiratory failure, anoxic brain injury, heart failure, and pneumonia. Review of Resident #83's signed physician orders revealed an order, dated 02/19/24, to clean respiratory equipment and filters every night shift every Saturday and as needed if soiled. Review of Resident #83's signed physician orders revealed an order, dated 03/07/24, to change suction canister, tubing, and yankauer every night shift every Thursday. Review of Resident #83's Treatment Administration Record (TAR), dated February 2024, revealed no evidence the staff changed the suction machine canister, tubing, and yankauer as ordered. Review of Resident #83's TAR, dated March 2024, revealed on 03/07/24, there was documentation to reflect Resident #83's suction machine canister, tubing, and yankauer had been changed. Observation in Resident #83's room on 03/05/24 at 10:39 A.M. revealed there was a suction machine with canister and tubing attached to a yankauer (a hard plastic suctioning tip for tubing) which was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 20 of 34 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 03/15/2024 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 - Few located in the opened packaging bag. There was a light yellow to white colored liquid noted in the canister and the canister appeared to be almost full of the liquid. The suction tubing, yankauer, and the container were not dated to reflect a day or time of when they may have been changed. Observation in Resident #83's room on 03/06/24 at 8:18 A.M. revealed the suction machine and undated canister continued to have the same amount of light yellow to white colored liquid, and the tubing and yankauer were still in the opened undated packaging bag located in the drawer of the nightstand. Interview on 03/06/24 at 3:11 P.M. with the Administrative Registered Nurse (ARN) #190 stated we should be emptying the suction canisters when they get full or at least daily and should be changing out the canisters, tubing, and yankauer every Thursday night. ARN #190 confirmed the undated tubing, yankauer, canister, and noted the canister was almost full with a yellow to white colored liquid. Observation in Resident #83's room on 03/07/24 at 9:30 A.M. revealed the suction machine was covered with a large clear plastic bag. The undated canister continued to have the light yellow to white colored liquid, and the tubing and yankauer were still in the undated packaging bag located in the drawer of the nightstand. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 21 of 34 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 03/15/2024 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of hospital records, review of a fall investigation, resident and staff interviews, and facility policy review, the facility failed to provide timely and effective pain management as well as adequately monitor resident pain. Residents Affected - Few Actual harm occurred on 01/11/24 when Resident #65 fell, complained of pain to her right ankle, was not provided effective pain management, and was subsequently unable to get out of bed on 01/12/24 due to increased pain associated with the fall. The resident was transferred to the hospital on [DATE] at 6:52 P.M. (approximately 24 hours after the fall occurred) with complaints of right ankle pain. The resident required Oxycodone-Acetaminophen for pain. Upon assessment, the resident's ankle was resting in an extremely plantarflexed position (top of the foot pointed away from leg) with mild swelling and tenderness to palpation (indicates objective painful symptoms) about the medial and lateral ankle (the inside and outside portions of the ankle). The x-ray of the resident's right foot and ankle revealed a bimalleolar equivalent ankle fracture with medial malleoli avulsion fracture. This affected one (Residents #65) out of two residents reviewed for pain management. The facility also failed to ensure non-pharmacological pain interventions were attempted for a resident who received as needed narcotic pain medication. This affected one (Residents #424) out of two residents reviewed for pain management. The facility census was 117. Findings include: 1. Review of the medical record for Resident #65 revealed an initial admission date of 08/09/20. Medical diagnoses included unspecified sequelae of nontraumatic intra cerebral hemorrhage, secondary Parkinsonism, chronic kidney disease stage four, schizoaffective disorder bipolar type, major depressive disorder, anxiety disorder, and nondisplaced fracture of lateral malleolus of right fibula (added on 01/12/24). Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 01/10/24, revealed Resident #65 had intact cognition and scored a 15 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. The assessment revealed Resident #65 required partial to moderate assistance with transfers and required variable assistance ranging from supervision or touch assistance to substantial or maximum assistance from staff to complete other activities of daily living (ADLs). The resident received scheduled pain medications and had not received any as needed pain medications. No pain had been reported. Review of a Fall Incident Report, dated 01/11/24 at 6:50 P.M., revealed Resident #65 was in the bathroom calling out for help. Licensed Practical Nurse (LPN) #210 entered the bathroom and noted Resident #65 standing with a walker. LPN #210 cleaned the resident and assisted with putting Resident #65's pants back on. Resident #65 continued standing with a walker. LPN #210 reached for the resident's wheelchair. Resident #65 attempted to sit in the wheelchair, lost her balance, and sat on the floor. Resident #65 twisted her right ankle. Resident #65 was transferred to the bed and assessed. Resident #65 complained of pain to her right ankle. Resident #65 stated, I twisted my ankle. LPN #210 checked Resident #65's range of motion (ROM) and Resident #65 complained of pain to her right ankle. Resident #65's vital signs were within normal limits. LPN #210 used a non-verbal pain scale to determine Resident #65's pain level and documented a pain level of three on the incident report. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 22 of 34 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 03/15/2024 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 0697 Level of Harm - Actual harm Residents Affected - Few #65 was alert and oriented to person, place, time, and situation. An injury to Resident #65's right inner ankle was noted. Certified Nurse Practitioner (CNP) #329 was notified. Resident #65's brother was contacted, and a message was left to return the phone call to the facility. There was no indication LPN #210 administered any medication or non-pharmacological interventions for Resident #65's reported pain at the time of the incident. Review of the Medication Administration Record (MAR), dated January 2024, revealed Resident #65 had an order for Tylenol Extra Strength 500 milligrams (mg) with instructions to give one tablet by mouth two times daily for pain. The order had a start date of 11/24/23. This medication was administered at bedtime on 01/11/24 for what staff documented was a pain level of zero (out of 10), upon rise on 01/12/24 with a pain level of three (out of 10), and at bedtime on 01/12/24 with a pain level of six (out of 10). Resident #65 had an additional order with a start date of 11/01/23 for Tylenol 325 mg with instructions to give two tablets by mouth every eight hours as needed for pain. This medication was not administered to Resident #65 on 01/11/24 or 01/12/24. Review of the progress notes for Resident #65 revealed on 01/11/24 at 7:47 P.M., LPN #210 noted Resident #65 was in the bathroom, attempting to transfer to the wheelchair, lost balance and sat on the floor, injuring her right ankle. On 01/12/24 at 6:05 P.M., LPN #202 noted Resident #65 was not able to get out of bed today (01/12/24) due to pain in her right ankle as a result of yesterday's (01/11/24) fall. An x-ray was completed and revealed an acute fracture of the distal fibula in the right ankle. Resident #65 was to be transferred to the hospital for further evaluation. Certified Nurse Practitioner (CNP) #329, the Unit Manager (UM), and Resident #65's family were notified. Review of the care plan for Resident #65, revised on 01/12/24, revealed Resident #65 was at risk for an alteration in comfort due to acute fracture of the distal fibula in the right ankle with cast in place. Interventions included administer medications as ordered, monitor for effectiveness of interventions, monitor for increased levels of pain and notify the physician, monitor for side effects of pain and anxiety medications, notify the physician for review of or change in pain medications if needed, complete pain assessment per facility policy, and offer non-pharmacological interventions. Review of the hospital records for Resident #65 revealed the resident arrived at the emergency room on [DATE] at 6:52 P.M. (approximately 24 hours after the fall occurred) with complaints of right ankle pain. X-rays and a computed tomography (CT) scan of the resident's head and cervical spine were completed. Resident #65 was administered Oxycodone-Acetaminophen for pain. Upon assessment, the resident's ankle was resting in an extremely plantarflexed position (top of the foot pointed away from leg). Mild ankle swelling was noted. There was tenderness to palpation (indicates objective painful symptoms) about the medial and lateral ankle (the inside and outside portions of the ankle). The x-ray of the resident's right foot and ankle revealed a bimalleolar equivalent ankle fracture with medial malleoli avulsion fracture. Post splint x-rays revealed persistent anterior subluxation (partial dislocation) of the talus (the large bone in the ankle that articulates with the tibia of the leg and the calcaneum and navicular bone of the foot). Resident #65 underwent a closed reduction to improve alignment of the tibiotalar joint and splinting in the emergency department. Resident #65 was discharged back to the facility from the hospital on [DATE] at 2:02 A.M. Review of the progress notes dated 01/13/24 at 2:40 A.M. revealed Resident #65 returned to the facility at approximately 2:10 A.M. on a stretcher with two Emergency Medical Services (EMS) staff. Resident #65 returned with a new order for Oxycodone-Acetaminophen (narcotic pain medication) 5-325 mg per tablet with instructions to administer one tablet by mouth every six hours if needed for severe pain for up to three days. On 01/14/24 at 5:00 A.M., Resident #65's right ankle had a dry and intact (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 23 of 34 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 03/15/2024 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 0697 cast. Resident #65's right foot was warm, and color was within normal limits. Resident #65 was able to wiggle toes and denied pain at that time. Level of Harm - Actual harm Residents Affected - Few Interview on 03/07/24 at 12:48 P.M. with LPN #213 (the floor nurse for Resident #65) revealed according to the facility's policy, at rise medications should be administered between 5:00 A.M. and 10:00 A.M. and bed time medications should be administered between 6:00 P.M. and 11:00 P.M. Resident #65 usually received her bed time medications closer to 6:00 P.M. Interview on 03/07/24 at 1:55 P.M. with Resident #65 revealed she was in her bathroom with one staff person (was not sure if it was an aide or a nurse). Resident #65 indicated she attempted to get in her wheelchair and fell. Resident #65 stated the staff member left her alone for a very short time while she went to get help. Resident #65 stated she reported pain in her right ankle and leg. Resident #65 stated she did not receive pain medication until she went to the hospital the next day. Resident #65 stated her right ankle hurt the whole time and it wasn't mild pain. Interview on 03/11/24 at 12:59 P.M. with LPN #202 revealed she was the day shift nurse for Resident #65 on 01/12/24. LPN #202 stated she was told in report that Resident #65 had a fall on 01/11/24 and Resident #65 had an order for an x-ray. LPN #202 stated she did assess Resident #65 and the resident complained of pain when she touched the right ankle. LPN #202 stated Resident #65 refused to give an exact number on the pain scale which was not abnormal for the resident. LPN #202 stated she would consider Resident #65's pain to have been moderate per her nursing judgement. LPN #202 stated she did administer Tylenol to Resident #65 but did not recall exactly when. LPN #202 revealed the resident did not want to get out of bed on 01/12/24 due to having pain in her right ankle. LPN #202 confirmed she had not administered any as needed pain medications to Resident #65. Interview on 03/11/24 at 5:21 P.M. with LPN #210 revealed she was the nurse on duty when Resident #65 had a fall in her bathroom. LPN #210 stated she was with Resident #65 when Resident #65 attempted to pivot from standing with a walker to sit in her wheelchair and lost her balance. Resident #65 twisted her right ankle and sat on the floor. Resident #65 immediately complained of pain to her right ankle. A State Tested Nursing Assistant was called to assist and the resident was assisted off the floor and placed in her wheelchair and then transferred into bed. LPN #210 stated she completed a head-to-toe assessment on Resident #65 but was not able to complete a ROM exam on the resident's right ankle due to the resident's complaints of pain. LPN #210 denied asking the resident what her exact pain level was. LPN #210 stated she contacted CNP #329 who ordered an x-ray but did not order any additional pain medication. LPN #210 stated she administered scheduled Tylenol to Resident #65 with dinner between 5:00 P.M. and 6:00 P.M. (before the resident's fall occurred) but did not administer any additional pain medications after the fall. LPN #210 stated the x-ray had not been completed by the end of her shift. LPN #210 stated she left between 8:00 P.M. and 8:30 P.M. on 01/11/24. LPN #210 confirmed she had not assessed Resident #65 for effectiveness of the pain medication administered prior to the fall and had not administered any as needed pain medication to Resident #65 following the fall. Interview via telephone on 03/12/24 at 6:40 P.M. with LPN #230 revealed she was the night shift nurse for Resident #65 on 01/11/24 into the morning of 01/12/24. LPN #230 stated she was told in report Resident #65 had a fall during day shift on 01/11/24. LPN #230 stated she was not informed Resident #65 had any injuries or had complained of any pain following the fall. LPN #230 stated Resident #65 was alert with some confusion. LPN #230 stated the resident had a history of reporting inaccurate pain levels to the nursing staff and would often either refuse to answer or would give a random number on the pain scale. LPN #230 stated Resident #65 did complain of pain on 01/12/24 in the morning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 24 of 34 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 03/15/2024 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 0697 Level of Harm - Actual harm Residents Affected - Few but stated she did not worry about the pain scale number provided by the resident because the Tylenol medication was scheduled and would be administered to Resident #65 regardless of the pain level being reported. LPN #230 stated she administered Tylenol to Resident #65 between 6:00 A.M. and 7:00 A.M. on 01/12/24. LPN #230 stated she had not assessed Resident #65's right ankle or leg during her shift because she was not aware of any injuries or concerns. LPN #230 confirmed she had not administered any as needed Tylenol to Resident #65 or reassessed the resident for effectiveness of the Tylenol that was administered in the early morning. Review of the facility policy titled Pain Assessment and Management, dated 03/31/16, revealed the alert and oriented resident may be asked to describe his/her pain status. Pertinent information may include a numeric rating scale of 0-10; with zero being no pain and ten being the most severe pain the resident can imagine. A verbal descriptor scale including mild, moderate, severe or very severe/horrible. The resident's expectation for pain relief; can he/she live with the pain at the current level, and if not, how much relief is needed to live comfortably. Non-pharmacological methods to reduce pain in a resident may be implemented. Pharmacological interventions should be provided according to physician orders. Evaluate the resident's response to interventions. Notify the physician as needed. 2. Review of Resident #424's medical record revealed Resident #424 was admitted to the facility on [DATE] with diagnoses including fractures of bilateral upper arms, right scapula, and multiple ribs, frostbite to bilateral toes, laceration of the liver, injury to the spleen, alcohol use, anxiety, and depression. Review of the medical record revealed Resident #424 had intact cognition. Review of Resident #424's care plan, dated 03/05/24, revealed Resident #424 was at risk for alteration in comfort related to multiple fractures related to a motor vehicle accident, status post frostbite to bilateral feet with tissue necrosis, and impaired mobility. Resident #424's goals were to decrease Resident #424's pain to an acceptable level for the resident which allows for participation in ADL's, activities, therapy, and treatments. Resident #424's interventions for reaching these goals included administer medications as ordered, encourage and assist resident to turn and reposition every two hours and as needed, encourage relaxation techniques, and provide activities that the resident enjoys as a diversion from pain/discomfort. Review of Resident #424's signed physician orders revealed an order, dated 02/28/24, for Oxycodone HCL (narcotic pain medication) tablet five milligrams (mg) give one tablet by mouth every six hours as needed (PRN) for pain. The order was changed on 03/07/24 to Oxycodone HCL tablet five mg give two tablets every six hours as needed for pain. Additionally, there was an order, dated 02/28/24, for Gabapentin (anticonvulsant medication which can be used for pain) capsule 400 mg give two capsules by mouth three times a day for pain for 14 days. Review of Resident #424's MAR, dated March 2024, revealed Resident #424 was administered Oxycodone as needed on 03/01/24 at 9:01 A.M. and 8:30 P.M. for a pain level of five out of 10; on 03/02/24 at 6:34 A.M. for a pain level of four out of 10, at 12:34 P.M. for pain level of nine out of 10, and at 7:46 P.M. for pain level of four out of 10; on 03/03/24 at 9:45 A.M. for a pain level of eight out of 10, at 3:55 P.M. for a pain level of nine out of 10, at 10:33 P.M. for a pain level of eight out of 10; on 03/04/24 at 5:30 A.M. for a pain level of seven out of 10, at 11:30 A.M. for pain level of eight out of 10, at 5:41 P.M. for a pain level of seven out of 10; on 03/05/24 at 5:19 A.M. for a pain level of four out of 10, at 11:51 A.M. for a pain level of five out of 10, at 6:25 P.M. for a pain level of eight out of 10; on 03/06/34 at 3:35 A.M. for a pain level of eight out of 10, at 10:52 A.M. for a pain level of eight out of 10, at 6:38 P.M. for a pain level of five out of 10, on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 25 of 34 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 03/15/2024 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 0697 Level of Harm - Actual harm Residents Affected - Few 03/07/24 at 4:37 A.M. for a pain level at eight out of 10, at 11:08 A.M. for pain level of six out of 10, at 6:35 P.M. for pain level of seven out of 10; on 03/08/24 at 8:19 A.M. for a pain level of five out of 10, at 2:05 P.M. for a pain level of five out of 10; on 03/09/24 at 12:47 A.M. for a pain level of zero out of 10, at 9:09 A.M. for a pain level of eight out of 10, at 3:34 P.M. for a pain level of seven out of 10, at 9:35 P.M. for a pain level of three out of 10; on 03/10/24 at 5:55 A.M. for a pain level of three out of 10, at 12:23 P.M. for a pain level of seven out of 10, at 6:25 P.M. for a pain level of seven out of 10; on 03/11/24 at 12:32 A.M. for a pain level of two out of 10, and at 8:01 A.M. for a pain level of five out of 10. Review of Resident #424's progress notes, dated 02/28/24 to 03/11/24, revealed the following medication administration notes for the PRN Oxycodone without non-pharmacological interventions listed as having been attempted; on 03/11/24 at 8:01 A.M. and 6:49 A.M.; on 03/10/24 at 6:25 P.M. and 12:23 P.M.; on 03/09/24 at 3:34 P.M., 9:09 A.M., and 12:47 A.M.; on 03/08/24 at 2:05 P.M. and 8:19 A.M.; on 03/07/24 at 6:35 P.M., 11:08 A.M., and 4:37 A.M.; on 03/06/24 at 6:38 P.M., 10:52 A.M., and 3:35 A.M.; on 03/05/24 at 6:25 P.M., 3:54 P.M. and 11:51 A.M.; on 03/04/24 at 5:41 P.M., 11:30 A.M., and 5:30 A.M.; on 03/03/24 at 10:33 P.M., 3:55 P.M. and 9:45 A.M.; on 03/02/24 at 7:46 P.M., 12:34 P.M., and 6:34 A.M.; on 03/01/24 at 8:30 P.M. and 9:01 A.M.; on 02/29/24 at 6:58 P.M. and 12:58 P.M. Interview on 03/11/24 at 9:15 A.M. with Administrative Registered Nurse (ARN) #190 revealed the nurses were supposed to ask the resident their pain level and offer other non-pharmacological interventions for pain such as repositioning, ice, music, food, etc to help with relaxation or detraction from the pain. The nurses were to document the interventions on the MAR which will flow over into the progress notes. Interview on 03/11/24 at 10:30 A.M. with Resident #424 revealed the pain has been better controlled since the facility changed the pain medication order on 03/07/24. Resident #424 stated, The nurses will ask me about my pain or I will ask for the medication myself, they don't usually offer me anything else other than the medication. Interview on 03/12/24 at 8:37 A.M. with the Director of Nursing (DON) confirmed there was no evidence non-pharmacological interventions for pain were attempted for Resident #424's pain control prior to Resident #424's PRN pain medication administration. The DON stated, I see with the orders the intervention option was not activated to prompt the nurses in offering non-pharmacological interventions. Review of the facility's policy titled Pain Assessment and Management, dated 03/31/16, revealed non-pharmacological methods to reduce pain in a resident may be implemented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 26 of 34 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 03/15/2024 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 0760 Ensure that residents are free from significant medication errors. 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 residents were free from significant medication errors. This affected one (Resident #48) out of five residents reviewed for unnecessary medications. The census was 117. Residents Affected - Few Findings include: Review of Resident #48's medical record revealed Resident #48 was admitted to the facility on [DATE] with the diagnoses including diabetes mellitus (DM), heart disease, congestive heart failure, Chronic Obstructive Pulmonary Disease, and chronic kidney disease. Review of Resident #48's signed physician order, dated 06/01/22, revealed an order for insulin lispro solution (fast acting insulin) inject five units subcutaneously before meals for DM. The medication was to be held for blood sugar (BS) less than 120. Review of Resident #48's Medication Administration Record (MAR), dated January 2024, revealed on 01/01/24 at 11:00 A.M. Resident #48's BS reading was 117 and five units of insulin lispro was administered, on 01/03/24 at 4:00 P.M. Resident #48's BS reading was 99 and five units of insulin lispro was administered, on 01/15/24 at 4:00 P.M. Resident #48's BS reading was 112 and five units of insulin lispro was administered, on 01/16/24 at 6:30 A.M. Resident #48's BS reading was 104 and at 4:00 P.M. Resident #48's BS reading was 118 and five units of insulin lispro was administered at both times, on 01/22/24 at 6:30 A.M. there was no entry of BS reading or administration of insulin lispro. Review of Resident #48's MAR, dated February 2024, revealed on 02/01/24 at 6:30 A.M. Resident #48's BS was 115 and five units of insulin lispro was administered, on 02/07/24 at 4:00 P.M. Resident #48's BS was 106 and five units of insulin lispro was administered, on 02/11/24 at 11:00 A.M. Resident #48's BS reading was 91 and five units of insulin lispro was administered, on 02/04/24, 02/05/24, 02/18/24, and 02/19/24 at 6:30 A.M. there were no entries for BS readings or the administration of insulin lispro. Review of Resident #48's MAR, dated March 2024, revealed on 03/01/24 at 11:00 A.M. Resident #48's BS reading was 105 and five units of insulin lispro was administered, on 03/03/24 and 03/04/24 at 6:30 A.M. there were no BS readings documented or any insulin lispro administered. Review of Resident #48's progress notes dated 01/01/24 to 03/12/24 revealed no entry or note regarding physician or Certified Nurse Practitioner (CNP) notification of the BS readings below the ordered parameters and the administration of insulin lispro. Interview on 03/12/24 at 3:30 P.M. with Administrative Licensed Practical Nurse (ALPN) #165 confirmed Resident #48 had been administered the insulin lispro when the BS readings were below the ordered parameters. ALPN #165 stated that is a medication error with the insulin being given when the blood sugar is lower then the order requires. The CNP or physician should have been notified and the insulin held. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 27 of 34 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 03/15/2024 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 - Some 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 review of medication storage refrigerator daily temperature logs, observation, staff interview, and facility policy review, the facility failed to ensure medication storage refrigerators were maintained at an appropriate temperature and the temperature was routinely monitored. This affected one (South Unit) medication storage room out of three medication storage rooms in the facility and had the potential to affect all 25 residents (#1, #4, #5, #6, #8, #9, #11, #12, #13, #15, #19, #20, #38, #39, #56, #57, #59, #64, #78, #85, #87, #91, #92, #98, and #108) who received medications from the South Unit medication storage room. The census was 117. Findings include: Review of the South Unit medication storage refrigerator daily temperature log for January 2024 and February 2024 revealed four daily temperature entries for the entire month of January 2024 and no daily temperatures for the entire month of February 2024 Observation of the medication storage room located on the South Unit on 03/06/24 at 11:10 A.M. revealed the medication storage refrigerator daily temperature log dated March 2024 only had three daily temperatures recorded from 03/01/24 through 03/06/24. There were no other temperature logs in the medication storage room. The medication refrigerator temperature was observed to be 34 degrees Fahrenheit (F). Interview on 03/06/24 at 11:05 A.M. with Administrative Registered Nurse (ARN) #190 confirmed the temperature of the medication storage refrigerator on the South Unit was not consistently being recorded in January 2024, February 2024, and March 2024. ARN #190 stated the refrigerator temperatures should be checked daily and documented on the temperature logs. Interview on 03/06/24 at 11:15 A.M. with Administrative Licensed Practical Nurse (ALPN) #165 confirmed the daily medication refrigerator temperature logs for January 2024, February 2024, and March 2024 for the medication storage refrigerator located in the South Unit's medication storage room were incomplete and the temperature was not routinely being recorded. Review of the facility policy titled Medication Storage, dated 10/17/16, revealed medications requiring refrigeration or temperatures between 36 degrees F and 46 degrees F shall be kept in a secured refrigerator with a thermometer to allow routine temperature observations and monitoring. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 28 of 34 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 03/15/2024 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on medical record review, resident interview, staff interview, and review of meal choice sheets, the facility failed to ensure residents were consistently offered meals according to their choices and preferences. This affected two (Residents #34 and #46) out of two residents reviewed for food choices and had the potential to affect all eight Residents (#33, #34, #46, #52, #89, #95, #97, #107) living on the North Hall who receive meals from the kitchen. The census was 117. Findings include: 1. Review of the medical record for Resident #34 revealed an admission date of 06/13/23. Diagnoses included chronic respiratory failure, vent dependence, diabetes, and dysphagia. Review of Resident #34's physician orders, dated 08/22/23, revealed an active order for a regular textured diet with low concentrated sweets and no added salt. Review of the Minimum Data Set (MDS) assessment, dated 02/08/24, revealed Resident #34 was cognitively intact with a Brief Interview for Mental Status (BIMS) score of 15 and required set up assistance for eating. Review of the Plan of Care, dated 02/11/24, revealed Resident #34 had potential for alteration in nutrition and hydration with interventions to honor food preferences as able. Interview on 03/05/24 at 9:42 A.M. with Resident #34 revealed Resident #34 did not get options for food if he did not like what was being served. Resident #34 revealed he asked a staff member for alternatives and they didn't come back to give him the information on what alternatives were available. Interview on 03/06/24 at 12:35 P.M. with Resident #34 revealed staff do not go around the unit to get meal choices and he gets stuck with whatever the main special was. He revealed he has asked staff in the past to check on meal items and alternatives but they do not consistently honor alternatives/preferences and sometimes do not return to provide an update to him if his requested item was not available. 2. Review of the medical record for Resident #46 revealed an admission date of 11/16/23. Diagnoses included chronic respiratory failure, vent dependence, diabetes, pulmonary hypertension, and schizophrenia. Review of Resident #46's physician orders, dated 12/01/23, revealed an active order for a regular textured diet with low concentrated sweets and no added salt. Review of the MDS assessment, dated 02/08/24, revealed Resident #46 was cognitively intact with a BIMS score of 15 and required set up assistance for eating. Review of the Plan of Care, dated 02/12/24, revealed Resident #46 had a potential for alteration in nutrition and hydration with interventions to honor food preferences as able and obtain food preferences. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 29 of 34 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 03/15/2024 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 03/05/24 at 10:34 A.M. with Resident #46 revealed Resident #46 was concerned about getting choices for food and revealed she only gets offered the main dish. Interview on 03/06/24 at 12:30 P.M. with Kitchen Manager #151 revealed residents are asked about their food choices by the aides or activity staff (depending on the halls). He stated the North Hall had aides go room to room and take orders every few days and would discuss what was on the menu and offer an alternative from the everyday menu. Interview on 03/07/24 at 5:25 P.M. with State Tested Nursing Aide (STNA) #309 revealed activity staff was responsible for asking residents about menu choices and alternative meals. Interview on 03/07/24 at 5:30 P.M. with Licensed Practical Nurse (LPN) #160 revealed activity staff was responsible for asking residents about menu choices and alternative meals. Interview on 03/07/24 at 5:36 P.M. with Activities Director #170 and Activity Staff #180 revealed the activity staff were responsible for all halls except the North Hall and the Rehab Hall. They revealed they read off the menu for the next few days and make note for each resident if they wanted something the alternative meal or something from the every day menu. They revealed the nurse aides were responsible for taking orders and reviewing the menu with the North and Rehab Halls as those residents were typically more medically complex. The Activity Director revealed they had discussed with the Administrator related to menu choices and were working on a plan for better consistency. The Activity Direcor was not familiar with the current status or what interventions were being put in place for the North Hall. They revealed staff fill out a menu change sheet and provide a few days worth to the kitchen at one time. Interviews on 03/11/24 from 8:45 A.M. to 8:52 A.M. with STNA #342 and STNA #313 revealed activity staff was responsible to ask residents about menu choices and alternative meals. Interview on 03/12/24 at 10:30 A.M. with the Administrator revealed the STNA's, kitchen staff and activity staff were responsible for obtaining menu choices from residents. He was unsure who specifically was responsible for the North Hall and revealed they were talking about updating the process, but had no additional information about what the actual the process was. Interview on 03/12/24 at 11:10 A.M. with Diet Technician #172 revealed obtaining menu choices was not a new process and the staff should know what their responsibilities were. Diet Technician #172 revealed the STNA's should be getting meal choices from the residents on the North Hall. Review of resident meal choices sheets dated 03/06/24, 03/10/24, and 03/11/24, revealed there were no entries for the North Hall residents including Residents #34 and #46. There were no additional meal choice forms for 03/06/24, 03/10/24, and 03/11/24 that were provided for review. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 30 of 34 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 03/15/2024 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of hospital records, staff and resident interview, review of facility policy, and review of the Centers for Disease Control and Prevention guidelines, the facility failed to appropriately obtain consent and timely administer a flu and pneumococcal immunizations. Residents Affected - Few Actual harm occurred on 02/29/24, when Resident #104 was diagnosed with pneumonia and was hospitalized for ten days for treatment including intravenous antibiotic therapy. The resident's representative gave permission for the resident to receive the pneumococcal vaccination on 02/01/24 (admission); however, the facility failed to administer the vaccination to the resident. This affected two (Residents #89 and #104) of five residents reviewed for immunizations. The facility census was 117. Findings include: 1. Review of the medical record for Resident #104 revealed an original admission date of 02/01/24. Resident #104 was discharged to the hospital on [DATE] and readmitted back to the facility on [DATE]. Diagnoses included respiratory failure with hypoxia, hemiplegia and hemiparesis, dysphagia, dialysis dependence, diabetes, muscle weakness, chronic embolism, and tracheostomy. Review of Resident #104's Vaccine Consent, dated 02/01/24, revealed Resident #104's representative gave permission for the facility to administer the pneumococcal and flu immunization. Review of the Minimum Data Set (MDS) assessment, dated 02/08/24, revealed Resident #104 was cognitively intact with a Brief Interview for Mental Status (BIMS) score of 13 (out of 15). Review of Resident #104's physician orders from 02/01/24 to 02/29/24 revealed no evidence of the pneumococcal or flu immunization having been ordered or administered to Resident #104. Review of Resident #104's Medication Administration Record (MAR), dated February 2024, revealed no evidence of the flu or pneumococcal immunization having been ordered or administered. Review of Resident #104's immunization history record revealed no evidence the resident received a pneumonia or flu immunization between 02/01/24 and 02/29/24. Review of Resident #104's progress notes, dated 02/01/24 to 02/29/24, revealed no mention of the flu or pneumococcal immunization having been administered. Record review revealed the resident was transported to the hospital on [DATE]. Review of a progress note dated 02/29/24 at 2:28 P.M. revealed Resident #104 had muscle weakness present. Further review of the progress notes revealed there was no mention of what change in condition led to Resident #104 being sent to the hospital on [DATE]. Review of Resident #104's hospital paperwork, dated 02/29/24 to 03/10/24, revealed Resident #104 presented to the emergency department with tachyarrhythmia and a temperature of 102 degrees Fahrenheit. The resident was admitted to the hospital on [DATE] with an admitting diagnosis of pneumonia. Resident #104 was started on intravenous Vancomycin (antibiotic) 0.9% in sodium chloride 500 milligrams/100 milliliters piggyback three times weekly with dialysis and Zosyn 3.375 grams in sodium chloride (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 31 of 34 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 03/15/2024 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 0883 Level of Harm - Actual harm Residents Affected - Few every 12 hours. A chest Computed Tomography (CT) was done at the hospital on [DATE] which revealed Resident #104 had left lower lob infiltrate with small left pleural effusion which could represent lobar pneumonia. Review of Resident #104 progress note, dated 03/10/24, revealed the resident returned to the facility from the hospital after having been admitted with pneumonia. Interview on 03/12/24 at 11:45 A.M. with the Director of Nursing (DON) revealed Resident #104's daughter had signed the consents for the flu and pneumonia immunizations upon admission on [DATE]. The DON revealed Resident #104 was alert and oriented and should have been offered the opportunity to sign the consents herself. The DON confirmed the flu and pneumonia vaccine was never ordered or administered to Resident #104 and confirmed she was diagnosed with pneumonia during her hospital stay on 02/29/24. Upon return from the hospital, the facility spoke with Resident #104 who stated she was agreeable to receive the pneumococcal immunization but declined to receive the flu immunization. Interview on 03/12/24 at 3:10 P.M. with Resident #104 revealed if she had been offered the choice of getting the pneumococcal vaccine upon admission on [DATE], she would have been agreeable. Resident #104 indicated she was still agreeable to receive the pneumococcal vaccine. Resident #104 revealed she had not previously received a pneumococcal immunization. Interview on 03/12/24 at 5:00 P.M. with the DON revealed the admitting nurse was responsible for obtaining proper consents for immunizations upon admission and if they do not obtain them, the Unit Manager should obtain consent and the resident should be administered the immunization. The DON confirmed Resident #104 was not provided with pneumococcal immunization and was hospitalized and treated for pneumonia. Review of the facility policy titled Immunization for Pneumococcal, Influenza and COVID-19, dated 07/03/23, revealed the facility would minimize the risk of acquiring, transmitting or experiencing complications from pneumonia and influenza by offering immunizations in accordance with national standards of practice. For pneumonia vaccines: each resident shall be evaluated upon admission and each resident shall be offered the pneumococcal vaccine unless medically contraindicated. The facility would provide education and offer vaccination based on CDC guidelines. For Influenza vaccines: shall be routinely offered from October through March unless medically contraindicated. Review of the Centers for Disease Control and Prevention guidelines titled, Pneumonia Vaccine Recommendations, dated 09/12/23, revealed pneumococcal vaccines were recommended for people who have long-term health conditions, like heart disease or respiratory disease. The CDC also provided information which stated for residents who had not received any pneumococcal vaccines or the vaccination history was unknown and were between the ages of 19 and 64, give one dose of PCV15 or PCV20. If PCV20 is used, their pneumococcal vaccinations are complete. If PCV15 is used, follow with one dose of PPSV23 to complete their pneumococcal vaccinations. The recommended interval between PCV15 and PPSV23 is at least one year. The CDC also provided information which stated for residents who had not received any pneumococcal vaccines or the vaccination history was unknown and were age [AGE] or older, give one dose of PCV15 or PCV201. If PCV20 is used, their pneumococcal vaccinations are complete. If PCV15 is used, follow with one dose of PPSV232 to complete their pneumococcal vaccinations. The recommended interval between PCV15 and PPSV23 is at least one year. The minimum interval is eight weeks and can be considered in adults with immunocompromising conditions, cochlear implants, or cerebrospinal fluid leaks. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 32 of 34 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 03/15/2024 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 0883 Level of Harm - Actual harm Residents Affected - Few 2. Review of the medical record for Resident #89 revealed an admission date of 09/15/23. Diagnoses included quadriplegia, chronic respiratory failure, dependence on vent, spinal injury, tracheostomy, dysphagia, and muscle weakness. Review of Resident #89's Vaccine Consent, dated 09/15/23, revealed Resident #89's representative signed the consent for Resident #89 to receive the flu and pneumococcal immunization. Review of Resident #89's physician orders revealed an order, dated 09/20/23, for Resident #89 to receive the flu vaccine. Further review of Resident #89's physician orders revealed no evidence of a pneumococcal immunization having been ordered. Review of the MDS assessment, dated 09/22/23, revealed Resident #89 was cognitively impaired with a BIMS of 8 (out of 15). Review of Resident #89's progress notes from September 2023 through October 2023 revealed no evidence of the flu or pneumococcal immunization have been administered or withheld. Additionally, there was no evidence of Resident #89 having a fever around 09/20/23. Review of Resident #89's MAR from September 2023 through March 2024 revealed no evidence Resident #89 received a flu or pneumococcal immunization. Additionally, there was no evidence Resident #89 had a fever around 09/20/23. Interview on 03/12/24 at 11:45 A.M. with the DON revealed Resident #89's representative had signed the consents for Resident #89 to receive the flu and pneumococcal immunizations upon admission. The DON revealed she was waiting to provide Resident #89 the flu vaccine during the flu vaccine blitz on 09/20/23 and revealed it was not provided on 09/20/23 due to Resident #89 having a fever. The DON was unable to provide any information as to why the flu and pneumonia immunizations were not given including evidence of a fever. The DON was unable to explain why the pneumococcal immunization was not given. Review of the facility policy titled Immunization for Pneumococcal, Influenza and COVID-19, dated 07/03/23, revealed the facility would minimize the risk of acquiring, transmitting or experiencing complications from pneumonia and influenza by offering immunizations in accordance with national standards of practice. For pneumonia vaccines: each resident shall be evaluated upon admission and each resident shall be offered the pneumococcal vaccine unless medically contraindicated. The facility would provide education and offer vaccination based on CDC guidelines. For Influenza vaccines: shall be routinely offered from October through March unless medically contraindicated. Review of the Centers for Disease Control and Prevention guidelines titled, Pneumonia Vaccine Recommendations, dated 09/12/23, revealed pneumococcal vaccines were recommended for people who have long-term health conditions, like heart disease or respiratory disease. The CDC also provided information which stated for residents who had not received any pneumococcal vaccines or the vaccination history was unknown and were between the ages of 19 and 64, give one dose of PCV15 or PCV20. If PCV20 is used, their pneumococcal vaccinations are complete. If PCV15 is used, follow with one dose of PPSV23 to complete their pneumococcal vaccinations. The recommended interval between PCV15 and PPSV23 is at least one year. The CDC also provided information which stated for residents who had not received any pneumococcal vaccines or the vaccination history was unknown and were age [AGE] or older, give one dose of PCV15 or PCV201. If PCV20 is used, their pneumococcal vaccinations are complete. If PCV15 is used, follow with one dose of PPSV232 to complete their pneumococcal vaccinations. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 33 of 34 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 03/15/2024 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 0883 Level of Harm - Actual harm recommended interval between PCV15 and PPSV23 is at least one year. The minimum interval is eight weeks and can be considered in adults with immunocompromising conditions, cochlear implants, or cerebrospinal fluid leaks. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 34 of 34