Inspection·June 28, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Observation on 06/27/23 at 2:30 P.M. revealed Resident #47 was not wearing his glasses and had no recliner chair for his use. Resident #47 revealed it was hard to see at night and hard to see distances. Resident #47 confirmed he has had falls in the past. Resident #47 revealed he was not sure where his glasses were but thought they were still at his home. Resident #47 confirmed he had no recliner chair, but would like to try one. Residents Affected - Few Observation and interview 06/27/23 at 2:43 P.M. with Resident #47's charge nurse, Licensed Practical Nurse (LPN) #839 revealed Resident #47 had a history of falls in the past. LPN #839 revealed Resident #47 was able to ambulate and did not always call for assistance. Resident #47 was able to follow direction but was forgetful. LPN #839 revealed she was unaware Resident #47 was to wear glasses and verified he had no recliner. LPN #839 verified she worked with Resident #47 since his admission. Observation revealed LPN #839 searched Resident #47's room and could not find his glasses. Interview on 06/27/23 at 2:50 P.M. with State Tested Nurse Aides (STNA) #922 and #894 revealed they worked with Resident #47 many times in the past and were unaware Resident #47 was to wear his glasses. STNA #922 and #894 confirmed Resident #47 never had a recliner chair for his use. Interview on 06/27/23 at 2:57 P.M. with Licensed Social Worker (SW) #800 revealed Resident #47 never requested to see an eye doctor so she was unaware he was to wear glasses. Interview on 06/27/23 at 4:07 P.M. with MDS Nurse #827 revealed she completed Resident #47's care plan to include Resident #47 was at risk for falls. MDS Nurse #827 confirmed Resident #47 was at risk for falls and staff were to encourage Resident #47 to wear his glasses. MDS Nurse #827 confirmed Resident #47 had no recliner chair for his use on his side of the room. Interview on 06/27/23 at 4:20 P.M. with the Director of Nursing (DON) confirmed the nurses should have read the care plan for Resident #47 to know that Resident #47 wore glasses and that they were to encourage him to wear the glasses. They would also have known Resident #47 was to have a recliner chair for fall preventions. The DON confirmed Resident #47 had one fall while at the facility, on 06/23/23, and was at risk for falls. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 2 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure advance directives were updated per resident preference. This affected two of 26 residents reviewed for advance directives. the facility census was 73. Findings Include: 1. Review of the medical record for Resident #32 revealed an admission dated of [DATE]. Diagnosis Include delusional, altered mental status, suicidal ideations, and anxiety. Review of the hard chart for Resident #32 revealed no Do Not Resuscitate (DNA) paperwork in hard chart. Review of the initial Resident Care Conference dated [DATE], for Resident #32 revealed the resident wants to be a Do Not Resuscitate Comfort Care (DNRCC), per resident and family. Interview on [DATE] at 7:35 A.M. with Licensed Practical Nurse (LPN) #330 revealed if a resident codes the nurse would first look in the hard chart to see if there was a DNR paper, if there wasn't a DNR paper in the resident's hard chart then CPR would be started. Interview on [DATE] at 8:30 A.M. with Licensed Social Worker (LSW) #856 stated Resident #32 was to be a DNR and the family wanted to bring in the DNR paperwork but has not. The resident has been in the facility six weeks and still no DNR paperwork signed. LSW #856 verified the facility did not follow up with the residents family to bring in the signed DNR paperwork, so the resident has been a full code since admission. Review of the facility policy Advance Directives, dated 10/2016 revealed should the resident indicate that he or she has issued advance directives about his or her care and treatment, documentation must be recorded in the medical record of such directive and a copy of such directive must be included in the resident's medical record. 2. Review of the medical record revealed Resident #10 was admitted to the facility on [DATE]. The paper medical record identified a code status of Do Not Resuscitate Comfort Care Arrest (DNRCCA) dated [DATE]. Review of the electronic medical record identified a code status of Full Code as of [DATE]. Interview on [DATE] at 5:15 P.M. with the Director of Nursing (DON) confirmed the advanced directive wishes of each resident should be in both medical records (paper and electronic), and match. The DON confirmed the advance directives did not match for Resident #10. Interview on [DATE] at 8:47 A.M. with Licensed Social Worker (LSW) #856 revealed Resident #10 had a care conference dated [DATE] and full code was elected. LSW #856 revealed Nurse Practitioner (NP) #926 was in the facility and updated Resident #10 code status and placed in the paper chart dated [DATE], the day before the care conference. LSW #856 revealed care conference members were responsible for ensuring the code status of each resident was reflected in the paper chart. LSW #856 confirmed the advance directives did not match as of [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 3 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on [DATE] at 3:07 P.M. with Registered Nurse (RN) #815 revealed during an emergency, advance directives were located in the paper chart and that determined the next steps. Interview on [DATE] at 11:13 A.M. with NP #926 revealed she met with Resident #10 on [DATE] and at that time she elected for DNRCCA. NP #926 revealed she informed facility staff and placed the updated form in the paper chart. NP #926 revealed Resident #10 had the right to rescind her code status at any time and her paper chart would be updated. Review of the facility policy titled Advance Directives, dated [DATE] revealed upon each resident admission each resident would be provided written information to formulate their wishes regarding end of life care. The policy identified documentation must be recorded in the medical record of such directive and a copy of the directive must be included so that appropriate orders can be documented in the residents medical record and plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 4 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure Residents #14 and #30 were free from verbal abuse including intimidation. This affected two residents (Residents # #14 and #30) of four residents (#14, #27, #30 and #61) reviewed for abuse, neglect, and misappropriation. The facility census was 73. Findings include: Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #14 was cognitively intact and required extensive assistance of two staff for mobility and transfer. Further review of the MDS revealed no behaviors. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #30 was cognitively intact and required extensive assistance of two staff for mobility, supervision with one staff for transfer and extensive assistance with one staff for toileting and personal hygiene. Further review of the MDS revealed no behaviors. Interview on 06/25/23 at 3:14 P.M. with Resident #30 revealed that she was upset because of a State Tested Nurse Aide (STNA) #857 being mean to her and another resident (Resident #14) and felt that nothing was being done because STNA #857 continued to be mean. Resident #30 stated that a week ago STNA #857 called her and another resident (Resident #14) liars while they were smoking outside. Review of the statement from Hospitality Aide (HA) #886 dated 06/20/23 revealed HA #886 took Resident #14 and Resident #30 outside to smoke. HA #886 stated that STNA #857 came outside where residents #14 and #30 were smoking and asked Resident #30, Why are you telling people that I'm being too rough with you and I'm not. Resident #30 replied to STNA #857 that she was rough with her and arguing occurred between STNA #857 and Resident #30. STNA #857 then pointed her finger at Resident #14 and Resident #30, called the residents liars and told HA #886 not to believe the residents. Resident #14 stated that STNA #857 broke her glasses and STNA #857 responded that she didn't break Resident #14's glasses. STNA #857 kept arguing with Residents #14 and #30 until two nurses came outside and broke up the arguing with STNA #857 going back into the facility. Interview on 06/26/23 at 1:55 P.M. with the Administrator and Director of Nursing (DON) revealed that statements of the incident were in the DON's mailbox on 06/20/23 from HA #886, STNA # 857, and Licensed Practical Nurse (LPN) #813's statement taken from Resident #14 and Resident #30. The Administrator felt it wasn't abuse because interviews conducted with Residents #14 and #30 stated that they did not feel it was abuse. Review of the facility policy dated 2016 titled, Abuse, Mistreatment, Neglect, Misappropriation of Resident Property and Exploitation, revealed abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment resulting in physical harm, pain, or mental anguish. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 5 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to reassess one resident, Resident #13 for restraint reduction and failed to release restraints on Resident #13 every two hours and with meals while in use per the physician orders. This affected one resident, Resident #13 of two residents reviewed for restraints. The facility census was 73. Residents Affected - Few Findings include: Record review for Resident #13 revealed an admission date of 04/03/19. Diagnosis included epilepsy not intractable, without status epilepticus, cognitive communication deficit, muscle weakness, lack of coordination, weakness, cerebral palsy, and abnormal posture. Record review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #13 was severely cognitively impaired. Resident #13 required extensive assistants of two assists for bed mobility, dressing, total dependence of two for transfers, and extensive assist of one for eating. Resident #13 had no functional limitation in range of motion to bilateral upper extremities. Resident #13 had impairment on both sides to bilateral lower extremities. Resident #13 used a wheelchair for mobility and required extensive assistants of two for locomotion. Resident #13 did not use physical restraints. Record review of the Enabler/Resident Observation form dated 06/26/23 at 11:23 A.M. completed by Regional Clinical Coordinator Registered Nurse (RN) #925 revealed Resident #13 used a butterfly harness and seat belt to the custom wheelchair to assist with proper positioning. Foot box was also present. The identified reason for use was weakness and decreased safety awareness. (Resident #13) was unable to remove the device. The device was an enabler and restraint. Review of the care plan dated 05/15/23 revealed Resident #13 had impaired ability to perform or participate in daily activity of daily care. Approaches included Resident #13 used assistive devices for mobility, encourage/assist Resident #13 to wear butterfly harness and seat belt to tilt-n-space custom wheelchair to assist with proper positioning. Foot box present. Release every two hours and with meals. Review of the physician orders for June 2023 revealed orders to encourage/assist Resident #13 to wear butterfly harness and seat belt to tilt-n-space custom wheelchair to assist with proper positioning with elevating leg rest and foot box, release every two hours and with meals. There was no documentation in the record indicating attempts at a restraint reduction for Resident #13. Observation on 06/25/23 at 10:59 A.M. revealed Resident #13 was up in a tilt -n-space chair, tilted back, with a butterfly harness across her chest and a seat belt. Resident #13 confirmed she was unable to release the harness, seat belt or adjust the chair to a sitting position. Resident #13 confirmed and demonstrated she would be unable to reach her lower extremities if she had an itch. Interview on 06/27/23 at 2:25 P.M. with State Tested Nurse Aide (STNA) #894 confirmed Resident #13 was unable to remove her restraints, and revealed she had them due to a history of seizures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 6 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 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 0604 Level of Harm - Minimal harm or potential for actual harm Interview on 06/27/23 at 2:39 P.M. with Licensed Practical Nurse (LPN) #839 confirmed Resident #13 was unable to release her restraints. LPN #13 revealed the restraints were used for positioning, due to her trying to lean forward in her chair and scoot. LPN #839 confirmed Resident #13 had a butterfly harness restraint, a seat belt and was tilted back in her chair. LPN #839 revealed Resident #13's last seizure was 02/24/23 and Resident #13 never had a fall. Residents Affected - Few Interview on 06/27/23 at 3:23 P.M. with the Director of Nursing (DON) confirmed Resident #13 never had a fall in the more the four years she resided at the facility. Resident #13 was admitted to the facility with the butterfly harness and seat belt. The DON verified there were no attempts to reduce the restraint since being admitted . Interview on 06/27/23 at 3:26 P.M. with Therapy Director #927 revealed Resident #13 was admitted with a personalized chair, lap belt and harness. The personalized chair she had never tilted. At that time, Resident #13 was able to release the restraints. Therapy Director #927 revealed she was unsure when Resident #13 was no longer able to release the restraints and why no restraint reduction was attempted. Interview on 06/28/23 at 8:53 A.M. with Physical Therapist (PT) #928 revealed on 05/10/ 23 Resident #13 was provided a customized tilt and space chair due to leaning side to side and needing to elevate/support feet due to extensor tone (unable to bend knees). The new chair tilts back, the belt prevents Resident #13 from sliding forward, the butterfly positions from leaning to side, and also added a molded back support. The back support assist with breaking the tone and assisting with proper body alignment. PT #928 revealed Resident #13 was never assessed by therapy for her ability to release the restraints and was never evaluated for a restraint reduction. Resident #13 also had an abductor cushion between her legs. Interview on 06/28/23 at 9:18 A.M. with RN #860 revealed Resident #13 never had her restraints released while up in her chair. Resident #13 required the restraints to be on at all times while up in the chair. Review of the physician order with RN #860 confirmed Resident #13's orders included encourage/assist Resident #13 to wear butterfly harness and seat belt to tilt-n-space custom wheelchair to assist with proper positioning with elevating leg rest and foot box, release every two hours and with meals. RN #860 confirmed she signed the order off that the butterfly harness and seat belt was released every two hours and with meals. RN #860 revealed when she signed off the order, she never read the part to release the seat belt and harness. Interview on 06/28/23 at 9:27 A.M. with Resident #13's primary physician revealed he would expect Resident #13's restraints to be released every two hours while up in the chair. Observation on 06/28/23 at 11:40 A.M. of the lunch meal for Resident #13 revealed Resident #13 was in the dining room. STNA #930 was assisting Resident #13 with eating. The butterfly harness and seatbelt were both intact. Neither device was released during the meal. STNA #930 revealed she does not release Resident #13's restraints during the meal or at any time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 7 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on record review, review of facility's Self-Reported Incidents, review of facility policy and staff interview, the facility failed to implement its abuse policy regarding allegations of verbal abuse including intimidation. This affected two residents (Residents #14 and #30) of four residents (#14, #27, #39 and #61) reviewed for abuse, neglect, and misappropriation. The facility census was 73. Residents Affected - Few Findings include: Interview on 06/25/23 at 3:14 P.M. with Resident #30 revealed that she was upset because of a State Tested Nurse (STNA) #857 being mean to her and another resident (Resident #14) and felt that nothing was being done because STNA #857 continued to be mean. Resident #30 stated that a week ago STNA #857 called her and another resident (Resident #14) liars while they were smoking outside. Review of the statement from Hospitality Aide (HA) #886 dated 06/20/23 revealed HA #886 took Resident #14 and Resident #30 outside to smoke. HA #886 stated that STNA #857 came outside where residents #14 and #30 were smoking and asked Resident #30, Why are you telling people that I'm being too rough with you and I'm not. Resident #30 replied to STNA #857 that she was rough with her and arguing occurred between STNA #857 and Resident #30. STNA #857 then pointed her finger at Resident #14 and Resident #30, called the residents liars and told HA #886 not to believe the residents. Resident #14 stated that STNA #857 broke her glasses and STNA #857 responded that she didn't break Resident #14's glasses. STNA #857 kept arguing with Residents #14 and #30 until two nurses came outside and broke up the arguing with STNA #857 going back into the facility. Review of the personnel file for STNA #857 revealed that a final warning was issued to STNA #857 on 06/26/23 for non-compliance related to arguing with two alert and oriented residents. The disciplinary action also stated that STNA #857 called residents a liar and this is unacceptable. Review of STNA's timecard from 06/19/23 through 06/26/23 revealed that STNA #857 worked third shift with no days off. Interview on 06/26/23 at 1:55 P.M. with the Administrator and Director of Nursing (DON) revealed that statements of the incident were in the DON's mailbox on 06/20/23 from HA #886, STNA # 857, and Licensed Practical Nurse (LPN) #813's statement taken from Resident #14 and Resident #30. The Administrator felt it wasn't abuse because interviews conducted with Residents #14 and #30 stated that they did not feel it was abuse. Administrator stated that STNA #857 was given a final warning for being unprofessional earlier today for the incident on 06/20/23. Review of the facility policy dated 2016 titled, Abuse, Mistreatment, Neglect, Misappropriation of Resident Property and Exploitation, subtitled response, revealed if a staff member is accused or suspected of Abuse, Neglect, Exploitation, Mistreatment or Misappropriation of resident property, Facility should immediately remove that staff member from the facility and the schedule pending the outcome of the investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 8 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on record review, resident interviews and staff interview, the facility failed to ensure an allegation of verbal abuse including intimidation was reported to the state agency as required This affected two residents (Residents #14 and #30) of four residents (#14, #27, #39 and #61) reviewed for abuse, neglect, and misappropriation. The facility census was 73. Findings include: Interview on 06/25/23 at 3:14 P.M. with Resident #30 revealed that she was upset because of a State Tested Nurse Aide (STNA) #857 being mean to her and another resident (Resident #14) and felt that nothing was being done because STNA #857 continued to be mean. Resident #30 stated that a week ago STNA #857 called her and another resident (Resident #14) liars while they were smoking outside. Review of the statement from Hospitality Aide (HA) #886 dated 06/20/23 revealed HA #886 took Resident #14 and Resident #30 outside to smoke. HA #886 stated that STNA #857 came outside where residents #14 and #30 were smoking and asked Resident #30, Why are you telling people that I'm being too rough with you and I'm not. Resident #30 replied to STNA #857 that she was rough with her and arguing occurred between STNA #857 and Resident #30. STNA #857 then pointed her finger at Resident #14 and Resident #30, called the residents liars and told HA #886 not to believe the residents. Resident #14 stated that STNA #857 broke her glasses and STNA #857 responded that she didn't break Resident #14's glasses. STNA #857 kept arguing with Residents #14 and #30 until two nurses came outside and broke up the arguing with STNA #857 going back into the facility. Review of the Ohio Department of Health's Gateway system revealed no self-reported incident related to the allegation of intimidation or verbal abuse by Resident #14 and Resident #30. Interview on 06/26/23 at 1:55 P.M. with the Administrator and Director of Nursing (DON) revealed that statements of the incident were in the DON's mailbox on 06/20/23 from HA #886, STNA # 857, and Licensed Practical Nurse (LPN) #813's statement taken from Resident #14 and Resident #30. The Administrator felt it wasn't abuse because interviews conducted with Residents #14 and #30 stated that they did not feel it was abuse. Administrator stated that STNA #857 was given a final warning for being unprofessional earlier today for the incident on 06/20/23. Review of the facility's policy dated 2016 titled, Abuse, Mistreatment, Neglect, Injuries of Unknown Source, and Misappropriation of Resident Property, subtitled Initial Report revealed the Administrator or his/her designee will notify the Ohio Department of Health (ODH) of all alleged violations involving mistreatment, neglect, abuse, exploitation, misappropriation of resident property and injuries of unknown source as soon as possible, but in no event later than 24 hours from the time the incident/allegation was made known to the staff member. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 9 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on resident interview, staff interview, review of the Self-Reported Incident (SRI), review of the facility investigation, and policy review the facility failed to complete a thorough investigation of alleged verbal abuse. This affected two residents Resident (#14 and #30) of four reviewed for abuse. The facility census was 73. Residents Affected - Few Findings include: Interview on 06/25/23 at 3:14 P.M. with Resident #30 revealed that she was upset because of a State Tested Nurse Aide (STNA) #857 being mean to her and another resident (Resident #14) and felt that nothing was being done because STNA #857 continued to be mean. Resident #30 stated that a week ago STNA #857 called her and another resident (Resident #14) liars while they were smoking outside. Review of the statement from Hospitality Aide (HA) #886 dated 06/20/23 revealed HA #886 took Resident #14 and Resident #30 outside to smoke. HA #886 stated that STNA #857 came outside where residents #14 and #30 were smoking and asked Resident #30, Why are you telling people that I'm being too rough with you and I'm not. Resident #30 replied to STNA #857 that she was rough with her and arguing occurred between STNA #857 and Resident #30. STNA #857 then pointed her finger at Resident #14 and Resident #30, called the residents liars and told HA #886 not to believe the residents. Resident #14 stated that STNA #857 broke her glasses and STNA #857 responded that she didn't break Resident #14's glasses. STNA #857 kept arguing with Residents #14 and #30 until two nurses came outside and broke up the arguing with STNA #857 going back into the facility. Interview on 06/26/23 at 1:55 P.M. with the Administrator and Director of Nursing (DON) revealed that statements of the incident were in the DON's mailbox on 06/20/23 from HA #886, STNA # 857, and Licensed Practical Nurse (LPN) #813's statement taken from Resident #14 and Resident #30. The Administrator felt it wasn't abuse because interviews conducted with Residents #14 and #30 stated that they did not feel it was abuse. Administrator and DON could not provide evidence that other residents were interviewed and non-interviewable residents were assessed regarding the allegation of abuse. Review of the facility's policy dated 2016 titled, Abuse, Mistreatment, Neglect, Injuries of Unknown Source, and Misappropriation of Resident Property, subtitled Investigate revealed once the Administrator and ODH are notified, an investigation of the allegation or suspicion will be conducted. The investigation must be completed within five (5) working days, unless there are special circumstances causing the investigation to continue beyond 5 working days. Interview the resident, the accused, and all witnesses. Witnesses generally include anyone who: witnessed or heard the incident; came in close contact with the resident the day of the incident (including other residents); and employees who worked closely with the accused employee and/or alleged victim the day of the incident and evidence of the investigation should be documented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 10 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews the facility failed to ensure all residents received showers per the shower schedule. This affected three of four residents reviewed for showers (Resident #10, #16 and#19.) The facility census was 73. Residents Affected - Few 1. Review of the medical record for Resident #19 revealed an admission date on 10/08/19. Diagnosis included anxiety, heart failure, depression and Excoriation Disorder (picking skin disorder). Review of annual Minimal Data Set (MDS) dated [DATE] revealed Resident #19 stated it is very important to choose between a tub bath, shower, bed bath, or sponge bath. Review of the shower schedule for the 300 unit revealed showers were to be given twice a week on Wednesday and Saturday for Resident #19. Review of the shower sheets revealed on 05/27/23, 06/07/23, 06/10/23, 06/17/23, 06/21/23 and 06/24/23, the showers were not given. Interview on 06/26/23 at 2:45 P.M. with Registered Nurse (RN) #855 verified on 05/24 through 05/31 Resident #19 did not receive a shower or complete bed bath. From 06/03/23 through 06/12/23 Resident #19 did not receive a shower for eight days. On 06/14/23 through 06/25/23 Resident #19 did not receive a showers. RN #855 verified Resident #19 did not receive shower twice a week per shower schedule. 3. Record review for Resident #16 revealed an admission date of 04/29/13. Diagnosis included a history of cerebral vascular accident (CVA), lack of coordination, and muscle weakness. Record review of the care plan dated 06/16/23 revealed Resident #16 needed assistants from staff to meet activities of daily living (ADL) needs daily related to weakness, history of CVA, dementia and age related changes. Interventions included to provide assistants with all ADL care as needed/anticipate residents needs as able. Shower two times a week, partial bath in A.M./P.M., provide and set up water, washcloth, towel, and soap to enable resident to assist with or provide own care. Provide incontinent care as needed. Record review of the shower schedule revealed Resident #16 was scheduled to receive showers every Wednesday and Saturday. State Tested Nurse Aide (STNA) #894 verified Resident #16 was to receive showers every Wednesday and Saturday. Record review of the Point of Care shower history and the nursing assistant bathing and skin tool for April, May, and June 2023 revealed Resident #16 did not receive a shower as scheduled on 04/05/23, 04/12/23, 04/19/23, and 04/26/23, 05/03/23, 05/13/23, 05/27/23, 05/31/23, 06/07/23, 06/10/23, 06/14/23, and 06/21/23. Review of the progress notes reveled no documentation of Resident #16 refusing showers. Observation on 06/25/23 at 1:01 P.M. revealed Resident #16 sitting up in his bed. Resident #16 had a strong foul body odor, his hair was very oily, dishful and his beard was unkept. Resident #16's finger nails. all 10, were long, uneven, and fully impacted with a dark brown substance. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 11 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 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 revealed he baths himself and staff did not assist him. Level of Harm - Minimal harm or potential for actual harm Observation on 06/26/23 at 8:45 A.M. revealed Resident #16 was lying in bed. Resident #16 continued to have a strong body odor, his hair was very oily, disheveled and his beard was unkept. Resident #16's finger nails. all 10, were long, uneven, and fully impacted with a dark brown substance. Residents Affected - Few Observation on 06/26/23 at 1:40 P.M. revealed Resident #16 was lying in bed. Resident #16 continued to have a strong body odor, his hair was very oily, disheveled and his beard was unkept. All of resident #16's finger nails were long, uneven, and fully impacted with a dark brown substance. Interview and observation on 06/26/23 at 1:44 P.M. with Licensed Practical Nurse (LPN) #839 verified Resident #16 had a strong body odor, his hair was very oily, disheveled and his beard was unkept. Resident #16's fingernails. were long, uneven, and fully impacted with a dark brown substance. LPN #839 stated the dark brown substance under Resident #16's fingernails was stool. LPN #839 revealed Resident #16 was incontinent of stool and required assistants with peri care after the incontinent episodes. LPN #839 revealed Resident #16 at times refused showers but would usually take them if offered a snack. LPN #839 verified she had been Resident #16's charge nurse for the shift, noted the body odor throughout the shift but did not look at his fingernails. Interview on 06/26/23 at 2:12 P.M. with STNA #883 verified she worked day shift on 06/25/23 and 06/26/23 during the entire shift with Resident #16. STNA #883 revealed she had no seance of smell and didn't notice the odor on Resident #16. STNA #883 revealed Resident #16 will usually shower with snack bribes but he was due on second shift so it would not have been her shower to do. STNA #883 confirmed she documented Resident #16 received a partial bed bath in the medical records. STNA #883 revealed incontinent care was considered a partial bath for each resident and she also cleaned his abdominal fold. STNA #883 revealed she did not notice Resident #16's fingernails and revealed Resident #16 dug in his stool sometimes after having a bowel movement. Interview on 06/26/23 at 2:26 P.M. with Director of Nursing (DON) revealed he would expect the staff to clean Resident #16 as needed. DON reviewed and verified showers for Resident #16 was not received on the scheduled days and there was no documentation of the showers being offered. 2. Review of the medical record revealed Resident #10 was admitted to the facility on [DATE]. Diagnoses included periprosthetic fracture around internal prosthetic joint and fall. Review of the quarterly, Minimum Data Set (MDS) assessment, dated 06/06/23 revealed Resident #10 was alert and oriented and was an extensive assist to total dependence for activities of daily living (ADLs). Review of the physician orders dated 03/07/22 revealed Resident #10 required extensive assistance of one for bathing. Interview on 06/25/23 at 10:30 A.M. with Resident #10 revealed she had not had a shower in two weeks. Review of the shower sheets dated 06/04/23 to 06/13/23 and 06/15/23 to 06/25/23 no showers were provided for Resident #10. Interview on 06/26/23 at 3:07 P.M. with Registered Nurse (RN) #815 revealed Resident #10 showers were documented in the shower book and were accurate as of the date. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 12 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 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 observation, interview and record review, the facility failed to ensure the dressing to one resident, Resident #18's, dialysis port was secured to prevent exposure and potential infection to the insertion site. This affected one resident, Resident #18, of one resident reviewed for assessment and treatment of dialysis ports insertion sites. The facility census was 73. Residents Affected - Few Findings include: Record review for Resident #18 revealed an admission date of 01/11/19. Diagnosis included chronic kidney disease, end stage renal disease, type two diabetes mellitus and weakness. Record review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #18 was cognitively intact. Resident #18 required supervision with activities of daily living and used a wheelchair for mobility. Record review of the care plan dated 06/25/23 revealed Resident #18 will have no complications with access site and will receive renal dialysis without complications in coordination between dialysis center and facility. Interventions included treatment to access site as ordered - see physician order. Record review of the physician orders for Resident #18 revealed Resident #18 received dialysis every Monday, Wednesday, and Friday 7:00 A.M. to 11:00 A.M. Orders included dressing to dialysis port to be changed at the dialysis center. May reinforce if needed. Monitor dressing to the dialysis port every shift and report any abnormal findings to physician/dialysis center. Observation on 06/25/23 at 12:47 P.M. revealed Resident #18 had an Intravenous port in his right chest. Resident #18 was not wearing a shirt, the dressing to the port was loose on the entire bottom portion of the dressing. Resident #18 verified the port was used for his dialysis. Observation on 06/25/23 at 4:50 P.M. revealed Resident #18 was lying on his side. Resident #18 had no shirt on. The port insertion site to the right chest was totally exposed. The top portion of the dressing was intact and the bottom and sides of the dressing were lifted exposing the insertion site. Interview on 06/25/23 at 4:52 P.M. with Registered Nurse (RN) #836 confirmed the insertion site for Resident #18's dialysis port should be covered and secured. RN #836 revealed he would change the dressing but it was not his resident. Interview and observation on 06/25/23 at 4:55 P.M. with Licensed Practical Nurse (LPN) #813 confirmed the insertion site to Resident #18's dialysis port was exposed. LPN #813 confirmed she was Resident #18's charge nurse, Resident #18 had not worn a shirt all day, and she had worked with him several times throughout the day but did not notice. Interview on 06/27/23 at 11:26 A.M. with Certified Nurse Practitioner (CNP) #926 revealed she would expect if a dressing was not secure to the dialysis port insertion site, the staff would address the ares immediately and secure the dressing. CNP #926 revealed the risk of exposure to the insertion site would be infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 13 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 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 Review of the facility policy titled, Dressing change and care of central venous catheter undated included dressings are changed and site care given weekly or immediately if the integrity of the dressing is in any way compromised. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 14 of 15 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 365268 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Wadsworth 147 Garfield St Wadsworth, OH 44281 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interview and record review, the facility failed to ensure that the kitchen was clean and sanitary. This had the potential to affect 72 out of 73 residents in the facility. Resident #69 was identified as being nothing by mouth (NPO). Findings include: A tour of the kitchen on 06/25/23 from 8:06 A.M. through 8:25 A.M. with Dietary Manager (DM) #833 revealed there was ice buildup in the walk-in freezer that had ice forming on the boxes of frozen supplements and a container of Canadian bacon. In the walk-in refrigerator there was cole slaw not labeled or dated. The ceiling was peeling in the dry storage room. In the kitchen area, there was paper, food residue, dishes, and a steam table lid was on the floor behind the cooking equipment, the dish dolly, where clean plate lids were stored, had dried food residue on it, and the microwave was dirty with food residue inside. Interview on 06/25/23 at 11:30 A.M. with Dietary Manager (DM) #833 revealed that dietary had been short staffed lately and there were no sanitation policies for the kitchen. DM #833 stated that there was one resident (#69) that was NPO. Review of the facility policy dated 01/2021 titled, Dietary Manager Responsibilities revealed that the facility must store, prepare distribute and serve food in accordance with professional standards for food safety. Review of the facility policy dated 08/12/20 titled, Dating Foods revealed that opened items and leftovers will be labeled and dated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 15 of 15