Inspection·April 7, 2025

F 0550 This deficiency represents non-compliance investigated under Complaint Number OH00163801. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 2 of 4 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 04/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, review of audio/video footage and review of Centers for Disease Control Guidelines for Enhanced Barrier Precautions, the facility failed to ensure infection control procedures were implemented to prevent the spread of infection. This affected one Resident (Resident #46) of four residents reviewed for infection control. Residents Affected - Few The facility census was 126. Findings include: Review of Resident #46's medical record revealed an admission date of 02/11/25 with diagnoses including acute and chronic respiratory failure, dependence on a ventilator, dysphagia following cerebral infarction, hemiplegia and hemiparesis following cerebral infarction unspecified side. Review of Resident #46's admission minimum data set (MDS) dated [DATE] revealed the resident to be rarely or never understood and to be dependent on staff for all activities of daily living. Further review of the MDS revealed Resident #46 had an enteral feeding tube and a tracheostomy. Review of audio/video footage taken from Resident #46's room via an audio/video monitoring camera that was placed in the resident's room with the video time stamp dated 03/18/25 at 11:51 A.M. revealed Resident #46 was receiving care from an unidentified Certified Nursing Assistants (CNA). The unidentified CNA was wearing gloves and a mask but was not wearing a gown. Resident #46 was on enhanced barrier precautions (EBP). The unidentified CNA proceeded to perform incontinence care on Resident #46 by cleansing her from back (rectum) to front (her urethra) potentially contaminating her urethra with fecal bacteria. The unidentified CNA then repositioned Resident #46 without removing his potentially soiled gloves and performing hand hygiene. In an interview on 04/07/25 at 3:23 P.M. the Director of Nursing (DON) viewed the video and confirmed the unidentified CNA was wearing gloves and a mask but was not wearing a gown. Resident #46 was on enhanced barrier precautions due to her feeding tube and tracheostomy. The unidentified CNA proceeded to perform incontinence care on Resident #46 by cleansing her from back to front potentially contaminating her urethra with fecal bacteria. The DON verified incontinence care should be from from front to back to prevent potential contamination from stool into the urinary tract. The unidentified CNA then repositioned Resident #46 without removing his potentially soiled gloves and performing hand hygiene. The DON stated they did not have an enhanced barrier precautions policy but followed the Center for Disease Control (CDC) guidelines. Review of the CDC's guidelines for Consideration for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities, dated 06/21, revealed residents known to be colonized or infected with a multidrug-resistant organisms (MDRO) as well as those at increased risk of MDRO acquisition (e.g., residents with wounds or indwelling medical devices) should use EBP including a gown and gloves to interrupt the spread of novel or targeted MRDOs. Resident-to resident pathogen transmission in skilled nursing facilities occurs, in part, via healthcare personnel, who may transiently carry and spread MRDOs on their hands or clothing during resident care activities. Residents who have complex medical needs involving wounds and indwelling medical devices are at higher risk of both acquisition and colonization by MRDOs. Examples of indwelling medical devices include but are not limited to feeding tubes and tracheostomy/ventilator. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 3 of 4 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 04/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McNaughten Pointe Nursing and Rehab 1425 Yorkland Road Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 This deficiency represents non-compliance investigated under Complaint Number OH00163801. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365195 If continuation sheet Page 4 of 4