Inspection·February 20, 2026

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to be related to the layers of paint on piping. Interview and observation of Resident #27 ' s room on 02/20/26 at 11:49 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.5. Review of the medical record for Resident #28 revealed an admission date of 01/27/26 with diagnoses of cerebral infarction, encephalopathy, seizures, dysphagia, altered mental status, and cognitive communication deficit.Observation on 02/20/26 at 9:30 A.M. of Resident #28 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #28 ' s room on 02/20/26 at 11:49 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.6. Review of the medical record for Resident #29 revealed an admission date of 02/11/26 with diagnoses of muscle weakness, adult failure to thrive, dysphagia, altered mental status, sepsis, and glaucoma.Observation on 02/20/26 at 9:30 A.M. of Resident #29 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #29 ' s room on 02/20/26 at 11:49 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.7. Review of the medical record for Resident #30 revealed an admission date of 02/05/26 with diagnoses of pulmonary hypertension, acute respiratory failure, adult failure to thrive, dysphagia, and acute kidney failure. Observation on 02/20/26 at 9:31 A.M. of Resident #30 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #30 ' s room on 02/20/26 at 11:49 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.8. Review of the medical record for Resident #16 revealed an admission date of 04/10/18 with diagnoses of Type Two Diabetes Mellitus, glaucoma, pain, acute diastolic heart failure, acute respiratory failure with hypoxia, metabolic encephalopathy, cognitive communication deficit, and dysphagia. Observation on 02/20/26 at 9:35 A.M. of Resident #16 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #16 ' s room on 02/20/26 at 11:44 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.9. Review of the medical record for Resident #71 revealed an admission date of 09/20/24 with diagnoses of chronic obstructive pulmonary disease, dysphagia, muscle weakness, hypertension, heart failure, chronic kidney disease, shortness of breath, cognitive communication deficit, and dementia. Observation on 02/20/26 at 9:38 A.M. of Resident #71 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365241 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 365241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE London Health & Rehab Center 218 Elm St London, OH 43140 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #71 ' s room on 02/20/26 at 11:41 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.10. Review of the medical record for Resident #72 revealed an admission date of 12/25/23 with diagnoses of heart failure, Type Two Diabetes Mellitus, encephalopathy, dysphagia, cerebral infarction, adult failure to thrive, and transient ischemic attack. Observation on 02/20/26 at 9:38 A.M. of Resident #72 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #72 ' s room on 02/20/26 at 11:41 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.11. Review of the medical record for Resident #14 revealed an admission date of 02/04/26 with diagnoses of dysphagia, weakness, parkinsonism, and chronic obstructive pulmonary disease. Observation on 02/20/26 at 9:41 A.M. of Resident #14 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping. Interview and observation of Resident #14 ' s room on 02/20/26 at 11:45 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.12. Review of the medical record for Resident #73 revealed an admission date of 01/29/25 with diagnoses of chronic diastolic heart failure, chronic obstructive pulmonary disease, acute kidney failure, dysphagia, traumatic subdural hemorrhage, and cognitive communication deficit.Observation on 02/20/26 at 9:42 A.M. of Resident #73 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #73 ' s room on 02/20/26 at 11:43 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.13. Review of the medical record for Resident #74 revealed an admission date of 01/02/24 with diagnoses of cerebral infarction, aphasia, muscle weakness, and dysphasia.Observation on 02/20/26 at 9:42 A.M. of Resident #74 ' s room revealed uncovered soffits located above windows with structured covered fabric window valances. When walking up to look behind the valance, pipes displayed various shapes and sizes with deep gray to black speckled staining. Pipes were covered with layers of white flaking paint-like material and some discoloration appeared to be related to the layers of paint on piping.Interview and observation of Resident #74 ' s room on 02/20/26 at 11:43 A.M. with Maintenance Director #131 confirmed various staining present on pipes above resident windows located behind the window valance.Interview on 02/20/26 at 11:42 A.M. with the Director of Maintenance confirmed the discoloration does not align with a homelike environment. He stated he is unable to remedy the discoloration with paint due to recurrence. The resolution to the issue is to install insulation and a drop ceiling to conceal the discoloration. He confirmed a contractor was in earlier in the summer season to evaluate the issue and found no immediate concerns. However, a recommendation was made to provide an aesthetic improvement. Interview on 02/20/26 at 12:11 P.M. with Contractor Director and Manager #500 revealed the staining is due (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365241 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 365241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE London Health & Rehab Center 218 Elm St London, OH 43140 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete to condensation during hot and cold months, poses no health risk to residents, and is not mold. The pipe is covered in pipe wrap which is a fiberglass substance that provides no food source for mold and is not an opportunistic material for mold growth. Interview on 02/20/26 at 12:15 P.M. with the Administrator revealed the facility had been aware of the issue since late summer or early fall. The administrator stated the project is large and pending due to staffing. The facility ensured the issue poses no health risk to residents and received vendor recommendations for aesthetic resolution including air blocks, insulation, and a drop ceiling while maintaining fireproof standards.Review of the resident handbook dated 07/14/11 revealed the facility promotes a homelike environment and will make every attempt to accommodate reasonable requests to individualize residents ' living spaces.This deficiency represents non-compliance investigated under Complaint Number 26611454. Event ID: Facility ID: 365241 If continuation sheet Page 4 of 4