Health inspection·July 24, 2025

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete activities because she was pulled to the floor to assist with resident care because she was also a certified nursing assistant (CNA). An interview on 07/24/25 at 10:00 A.M. with Receptionist #216 stated that she only printed out the census and delivered the mail when AD #259 was not in the building. An interview on 07/24/25 at 10:10 A.M. with the Administrator revealed that she could only find activity tracking for Resident #4 for March 2025. She stated that she called in a CNA that does activities on the weekend to come in and have activities and do one-on-one with residents and other activities when she gets to the facility. Review of the facility policy titled, Resident Activity Preferences, dated 03/01/19, revealed resident activity preferences will be readdressed throughout a resident's stay in the facility during care conference process. This deficiency represents noncompliance investigated under Complaint Number 1396911 (OH00166942). Event ID: Facility ID: 365268 If continuation sheet Page 2 of 10 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 07/24/2025 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 Based on record review and interviews with staff and Resident #70's wife, the facility failed to document and adequately address Resident #70's complaints of change in condition. This affected one (Resident #70) out of three residents reviewed for change in condition. The facility census was 65. Findings include: A review of Resident #70's clinical record revealed and admission date of 03/17/23 with diagnoses including hydrocephalus with normal pressure, gastronomy with tube feeding, obstructive sleep apnea, spinal stenosis, chronic sinusitis, low blood pressure, and hypothyroidism.Resident #70's electronic clinical record contained the following documentation on 07/11/25 from 4:41 P.M. to 4:39 A.M. on 07/12/25: 4:41 P.M. the Director of Nursing (DON) checked for tube feed residual. 5:34 P.M. the DON administered medications to Resident #20 and blood pressure (92/52) was documented. The tube feeding rate was signed off and gastronomy placement was checked. Ensured the head of bed (HOB) was elevated. Administered enteral flush. 6:49 P.M. Certified Nursing Assistant (CNA) charted on Resident #70's activities of daily living. 9:10 P.M. Registered Nurse (RN) #291 administered medication. 9:14 P.M. Resident #70's blood pressure (132/74) was documented by RN #291. 12:31 A.M. RN #291 flushed Resident #70's gastronomy tube and administered medication. 4:39 A.M. Resident #70 complained of coughing and unable to catch his breath. The nurse called 9-1-1 and suctioned Resident #70. Resident #70 had a Do Not Resuscitate Comfort Care Arrest (DNRCC-A) advance directive. The emergency medical services (EMS) arrived at 4:46 P.M. and verified Resident #70's absence of vital signs. Resident #70's time of death was 4:46 A.M. The physician and family were notified, and a call was placed to the funeral home. There was no documentation in Resident #70's medical record to indicate he was coughing and producing phlegm, was having behaviors or of a full complement of vital signs was obtained including oxygen saturation levels on 07/11/25 from 5:00 P.M. to 5:00 A.M. on 07/12/25.Interviews on 07/23/25 between 1:45 P.M. and 3:31 P.M. with CNA #288, Licensed Practical Nurse (LPN) #214, DON revealed on 07/11/25 between 5:00 P.M. to 11:00 P.M. Resident #70 had complained of trouble breathing, was coughing and producing clear to brown phlegm. The DON stated she worked on 07/11/25 from 5:00 P.M. to 6:30 P.M. and was informed by a CNA (unnamed) that Resident #70 was coughing and complaining that he was having trouble breathing. The DON stated she listened to Resident #70's lungs and obtained his oxygen saturation which was in the 90s percent range. The DON stated she did not document her assessment or Resident #70's vital signs in Resident #70's electronic record or that Resident #70 did not want to go to the hospital. The DON stated she was not informed Resident #70's wife wanted Resident #70 to go to the hospital. The DON stated the facility did not initiate an investigation of Resident #70's death.An interview with CNA #256 and CNA #231 on 07/23/25 at 3:07 P.M. revealed CNA #256 was assigned to provide care for Resident #70 on 07/11/25 from 3:00 P.M. to 7:00 P.M. CNA #231 stated she answered Resident #70's call light, and he complained of coughing and was struggling to breathe. CNA #231 told the DON that Resident #70 was having a hard time breathing. CNA #231 checked on Resident #70 a little while later and he was still struggling to breathe and had vomited brown phlegm on the floor. CNA #256 stated Resident #70 had vomited brown phlegm on the floor which looked like chocolate. CNA #256 stated she told the DON that Resident #70 was getting worse during the evening hours from 3:00 P.M. to 11:00 P.M., and that Resident #70's wife wanted the facility to send Resident #70 to the hospital.An interview with Hospitality Aide (HA) #271 on 07/23/25 at 3:46 P.M. stated she answered Resident #70's call light two times on 07/11/25 during the evening hours between 6:00 P.M. to 11:00 P.M. Resident #70 was coughing and complaining he was having trouble breathing. HA #271 stated she informed RN #291 that Resident #70 was complaining he was having trouble breathing. RN #291 informed HA #271 that Resident #70 had possibly eaten candy he was not supposed to eat because Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 3 of 10 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 07/24/2025 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 Residents Affected - Few he had a risk of aspiration, and his oxygen saturation was 95 percent. RN #291 informed HA #271 that Resident #70 was not supposed to consume anything orally. HA #271 stated when she saw Resident #70 a little while later, he was coughing up brown phlegm. Resident #70 then seemed to recover from the coughing jag and told RN #291 he was ready for bed. An interview with RN #291 on 07/24/25 at 8:08 A.M. revealed RN #291 was employed by a staffing agency and was assigned to provide care for Resident #70 on 07/11/25 from 6:30 P.M. to approximately 1:30 A.M. RN #291 stated she received report from the DON of Resident #70's coughing episode and he had possibly eaten candy and was at risk for aspiration. RN #291 stated Resident #70 had a slight cough and was in no distress and thought maybe this was a behavior. RN #291 stated she checked his vital signs, and he was holding a tissue and producing clear phlegm during his coughing episode. RN #291 stated she checked Resident #70 again during the evening medication administration between 8:00 P.M. and 11:00 P.M. and Resident #70 had stopped coughing. At approximately 10:30 P.M. RN #291 told Licensed Practical Nurse (LPN) #272 that Resident #70 might need a chest x-ray and was told that this incident was a behavior of Resident #70. RN #291 stated she did perform an assessment but had not charted the assessment. An interview with Resident #70's wife on 07/24/25 at 8:53 A.M. revealed on 07/11/25 from 5:00 P.M. to 11:00 P.M. Resident #70 was coughing a lot and was in distress. Resident #70's wife was Resident #70's roommate and stated he did not eat any of the candy she had on her over-the-bed table. Resident #70's wife stated Resident #70 was not allowed to consume any food orally. Resident #70's wife stated Resident #70 had phlegm building up and caused him to cough up the phlegm and staff were in and out of the room often during the night to check on him.On 07/24/25 at 9:22 A.M. an interview with LPN #272 revealed RN #291 had informed her of Resident #70's coughing episode. RN #291 had assessed Resident #70 and told her that he may need a chest x-ray in the morning. LPN #272 stated LPN #283 came in to work at approximately 1:15 A.M. and assumed the care of Resident #70. LPN #272 stated RN #291 told LPN #283 that Resident #70 might need a chest x-ray in the morning. LPN #283 stated she did not enter any information regarding Resident #70's change in condition in Resident #70's electronic medical record.An interview with LPN #283 on 07/24/25 at 10:27 A.M. revealed she had worked on 07/12/25 from 1:00 A.M. to 8:15 A.M. and was assigned to care for Resident #70. LPN #283 stated RN #291 had informed her of Resident #70's coughing episodes during the evening on 07/11/25 between 5:00 P.M. and 11:00 P.M. LPN #283 stated she was informed that Resident #70 had been coughing and producing a lot of phlegm and may need an x-ray. Resident #70 may have eaten candy but there was no proof he had consumed the candy. LPN #283 stated she did perform an assessment of Resident #70 but admitted she had not documented her assessment. LPN #283 stated Resident #70 had no coughing episodes until approximately 4:30 A.M. on 07/12/25 when a CNA (unnamed) had alerted her that Resident #70 was coughing/choking and she entered Resident #70's room and turned off his tube feeding solution infusing via his gastronomy tube. LPN #283 stated she told the CNA to stay in Resident #70's room and exited the room and ran to the front of the building to sign a pharmacy invoice to receive narcotic medication for another resident. The CNA (unnamed) yelled for her to come back to Resident #70's room because he had stopped breathing and was turning blue. LPN #283 called 9-1-1 and pushed the code cart down to Resident #70's room. LPN #283 stated she looked at Resident #70's electronic record and located Resident #70's DNRCC-A advance directive and decided to try and suction Resident #70's phlegm orally. LPN #283 stated Resident #70 did not respond to her attempts to suction his secretions, and he died from a sudden heart attack before the EMS personnel arrived. A review of Resident #70's Death Certificate dated 07/17/25 indicated the cause of death was a sudden cardiac event. An interview with DON and Regional RN on 07/24/25 at 9:30 A.M. verified the above information and verified there was no documentation in Resident #70's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 4 of 10 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 07/24/2025 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 Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete electronic medical record of Resident #70's complaints of coughing/choking on 07/11/25 or of the assessments the staff performed of Resident #70 on 07/11/25. Review of the facility policy and procedure titled Change in the Residents Condition or Status, dated 05/01/2025, revealed the policy was to ensure the resident's attending physician, and the residents authorized representative or interested family member are notified of changes in the resident's physical, mental, or psychosocial status. 1. Procedure for Notification of Changes The Nurses will immediately notify the resident; consult with the resident's attending physician, on call physician, nurse practitioner, physician assistant or clinical nurse specialist and notify the resident's authorized representative or interested family member when there is: a. An accident or incident involving the resident, which results in an injury and has the potential for requiring physician intervention b. A significant change in the residents' physical, mental, or psychosocial status (i.e. a deterioration in health, mental, or psychosocial status in either life threatening condition or clinical complications). c. Lab, radiology or other diagnostic testing results that fall outside of clinical reference ranges d. A need to alter the resident's medical treatment significantly, i.e. need to discontinue an existing form of treatment due to adverse consequences (e.g. a reaction to a medication), or to commence a new form of treatment (e.g. refusal of treatment or medications (2) or more consecutive times e. A need to transfer or discharge the resident from the facility to a hospital/treatment center (this includes transfers to the hospital as well as discharges against medical advice). 3. Procedure for Documentation of changes in the medical record The nurse will record in the resident's medical record information relating to changes in the resident's medical/mental condition or status (e.g. assessment, appropriate notifications, interventions, and response). 4. Procedure for Significant Change Assessment If a significant change in the resident's physical or mental condition occurs, a comprehensive assessment of the resident's condition will be conducted as required by the RAI instruction Manual 5. Procedure for Updating of Resident Family and Sponsor Information A representative of the business office will periodically update the address, telephone number of the resident's authorized representative or interested family member and notify the resident and the resident's authorized representative or interested family member if there is a change in the resident's billing. This deficiency represents non-compliance investigated under Complaint Number 2565377. Event ID: Facility ID: 365268 If continuation sheet Page 5 of 10 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 07/24/2025 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews and facility policy review, the facility did not ensure food was served at palatable temperatures. This had the potential to affect 64 residents that received meals from the facility. The facility identified one resident (Resident's #9) that received nothing by mouth. The facility census was 65. Findings include: Observation of tray line on 07/23/25 from 4:40 P.M. through 5:34 P.M. revealed food was above 165 degrees Fahrenheit (F) on the tray line. Further observation revealed that the plate warmer was not turned on and the hot bottoms were on but Dietary Aide (DA) #255 did not use them for the entire line. The food truck left the kitchen at 5:23 P.M. and arrived at the unit within a minute. When the last tray on the cart was delivered on 07/22/25 at 5:36 P.M., the Dietary Manager (DM) #246 went to take the temperature of the food and stated that the temperature for the chicken tender was 108 degrees F, French fries were 104.9 degrees F, and the green beans were 106.9 degrees F. DM #246 stated that DA #255 forgot to put on the hot bottom for the test tray. Interviews on 07/22/25 from 11:07 A.M. and 4:30 P.M. with Resident #8 and #19 stated that the food is served cold. Review of the undated facility policy titled, Trayline Food Temperatures and Guidelines, revealed the temperature of the food as it is served to the resident shall be palatable per resident's preference. This deficiency represents non-compliance investigated under Complaint Number 1396911 (OH00166942). Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 6 of 10 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 07/24/2025 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 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 record review, observation, interview and facility policy review, the facility failed to ensure staff performed hand hygiene to prevent cross contamination of germs during Resident #1's and Resident #3's medication administration and failed to remove the soiled wound treatment gauze from Resident #2's room after wound care and failed to ensure staff properly cleaned wound care equipment after use during Resident #2's wound treatment procedure. This affected two (Residents #1 and #3) out of three residents observed for medication administration and one (Resident #2) out of three residents reviewed for wound care. The facility census was 65. Findings include: 1. A review of Resident #1's clinical record revealed an admission date of 05/13/25 with diagnoses including [NAME] Syndrome (colonic pseudo-obstruction, is the acute dilatation of the colon in the absence of any mechanical obstruction in severely ill patients), chronic constipation, anemia, vascular implant, deep vein thrombosis, gastrointestinal hemorrhage, duodenal ulcer with hemorrhage, diarrhea, malaise, gastric ulcer with hemorrhage, acute cystitis, schizophrenia, dysphagia, atherosclerosis, respiratory failure, nicotine dependence, cervical disc degeneration, anxiety fibromyalgia, bullous pemphigoid (A rare skin condition causing large, fluid-filled blisters.), esophageal stricture, ileus, chronic obstructive pulmonary disease, pharynx/larynx disease, and neuromuscular bladder. Review of Resident #1's physician orders dated 07/01/25 to 07/30/25 indicated to administer the following medications between 7:00 A.M. and 11:00 A.M.: Acetaminophen 1,000 milligrams (mg) orally (analgesic) Ariprazole 10 mg orally (antipsychotic) Azo D-Mannose 500 mg orally (supplement to support urinary tract health) Vitamin B12 1,000 micrograms (mcg) orally (supplement) Hair, Skin, Nails Biotin 2,500 mg orally (supplement) Hydroxyzine 25 mg orally (antihistamine) Myrbetriq Extended Release 25 mg orally (medication to treat overactive bladder) Multivitamin one tablet orally (supplement) Pantoprazole 40 mg orally (medication to treat excessive stomach acid) Docusate sodium/senna 50 mg/8.6 mg orally (combination of a stool softener and a laxative) Symbicort inhaler one puff (inhaler to treat chronic obstructive pulmonary disease) Potassium chloride 20 milliequivalent (mEq) orally (supplement) Tramadol 25 mg orally (opioid pin medication) Miconazole powder to affected area (antifungal) An observation on 07/23/25 at 7:35 A.M. of Licensed Practical Nurse (LPN) #211 administering the above listed medications to Resident #1 revealed a failure to perform hand hygiene. LPN #211 approached the medications cart and dispensed the medications listed above into a medication cup. LPN #211 then proceeded to enter Resident #1's room and administered the medications to Resident #1. LPN #211 exited the room and did not perform hand hygiene. An interview with LPN #211 on 07/23/25 at 8:32 A.M. verified the above findings and agreed she should have performed hand hygiene before dispensing Resident #1's medications and after administering the medications to Resident #1. 2. A review of Resident #3's clinical record revealed a admission date of 10/24/24 with diagnoses including syncope and collapse, Alzheimer's disease with early onset, diabetes mellitus, high blood pressure, diabetic neuropathy, high cholesterol, dysphagia, obstructive sleep apnea, depression, scoliosis, obesity, kidney disease, heart arrhythmia with cardiac pacemaker, cerebral amyloid angiopathy, and heart failure. Resident #3's physician orders dated 07/01/25 to 07/30/25 indicated to administer the following medications to Resident #3 between 7:00 A.M. and 11:00 A.M.: Acetaminophen 1,00 mg orally Duloxetine 60 mg orally (antidepressant) Lisinopril 20 mg orally (angiotensin-converting enzyme (ACE) inhibitor) Eliquis 5 mg orally (blood thinner) Metformin 500 mg orally (treats high blood sugar) Docusate sodium/senna 50 mg /8.6 mg orally Sotalol 120 mg orally (antiarrhythmic) Gabapentin 600 mg orally (anticonvulsant) An observation of LPN #211 administering the above listed medications to Resident #3 on 07/23/25 at 7:55 A.M. revealed a failure to perform hand hygiene. LPN #211 exited Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 7 of 10 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 07/24/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #1's room and did not perform hand hygiene and proceeded to obtain the above listed medications from the medication cart and dispensed the medications in a medication cup. When LPN #211 had completed dispensing the medications into the medication cup LPN #211 was asked to perform hand hygiene prior to entering Resident #3's room to administer the medications. An interview with LPN #211 on 07/23/25 at 8:32 A.M verified the above findings. LPN #211 agreed she should have performed hand hygiene after exiting Resident #1's and before obtaining and dispensing Resident #3' medications. 3. A review of Resident #2's clinical record revealed an admission date of 05/28/25 with diagnoses including diabetes mellitus with diabetic neuropathy/cataracts/polyneuropathy, diverticulosis, cognitive communication deficit, kidney disease, depression and diabetic peripheral angiopathy. Resident #2's physician order dated 07/15/25 revealed indicated to cleanse the left lateral shin wound with wound cleanser, pat dry, apply Skin-Prep (forms a protective barrier) to wound bed, cover with a non-adhesive pad and wrap the leg wound dressing with gauze. An observation on 07/23/25 at 10:30 A.M. of LPN #211 perform Resident #2's wound treatment procedure revealed a failure to perform hand hygiene and clean equipment used for the wound care appropriately. LPN #211 gathered the supplies needed for the wound treatment procedure and placed the supplies on Resident #2's over-the-bed table covered with a clean towel. LPN #211 proceeded to remove Resident #2's wound treatment and applied the physician ordered wound treatment. Upon completion of the task, LPN #211 removed the scissors she used to cut off Resident #2's soiled dressing and placed the scissors in the wound treatment cart without cleaning/sanitizing the scissors. LPN #211 discarded the soiled wound treatment in a waste receptacle lined with a plastic bag and did not remove the soiled wound treatment plastic bag from Resident #2's room upon completion of the task. An interview with LPN #211 on 07/23/25 at 11:02 A.M. verified she had failed to clean/sanitize the scissors she used during Resident #2's wound treatment procedure and failed to remove the soiled wound treatment from Resident #2's room after completing the wound treatment procedure and exiting the room. A review of the facility policy titled: Handwashing-Hygiene, updated 11/2019, revealed the policy was for the employees to conduct proper hand hygiene that will aid in the prevention and transmission of infectious diseases. General guidelines included:Hand washing with soap and water must be performed under the following conditions When hands are visibly dirty or oiled with blood or other body fluids After contact with blood, body fluids, secretions, mucous membranes, or non-intact skin After handling items potentially contaminated with blood, body fluids, or secretions Before eating After using the bathroom Exposure to infectious diarrhea (Clostridium Difficile, Norovirus) If exposure to Bacillus Anthracis is suspected or provenAlcohol/Antimicrobial hand rub may be used in the following situations: Before direct contact with a resident Before donning gloves Before performing any non-surgical invasive procedure Before preparing or handling medications Before moving from a contaminated body site to a clean body site during resident care After contact with resident's intact skin After handling used dressings, contaminated equipment, etc. After contact with inanimate objects (e.g. medical equipment) in the immediate vicinity of the resident After removing gloves.The use of gloves does not replace hand washing or hand sanitizingKeep fingernail tips trimmed to no more than1/4 inch long The Minnesota Department of Health's guidelines titled Wound Care Infection Prevention Recommendations for Long Term Care Facilities followed the Centers for Disease Control's recommendations including for wound care equipment and supplies: Any reusable equipment (e.g., bandage scissors, flashlight, mirror) and supplies that come in contact with non-intact skin, mucous membranes, or any bodily fluids or drainage, including fluids on bedding or gloved health care workers' hands, are considered semi-critical instruments. Either: 1. Perform high-level disinfection (HLD) before use on another residentOR 2. Discard wound care equipment or products (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 8 of 10 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 07/24/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete when no longer needed for an individual resident. When HLD (or sterilization) is not available and dedicated equipment is used for each resident, it is important to clean and disinfect each piece of equipment after each use on the same resident to reduce bio load per manufacturer's instructions for use.3. Dispose of dedicated equipment (if disposable equipment is used) or arrange to have dedicated equipment appropriately processed after no longer needed for care of the designated resident.This deficiency was an incidental finding identified during the complaint investigation. Event ID: Facility ID: 365268 If continuation sheet Page 9 of 10 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 07/24/2025 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation and interview, the facility failed to ensure Resident #4's wheelchair was maintained in a safe operational condition. This affected one (Resident #4) out of three residents reviewed for wound care. The facility census was 65. Findings include: A review of Resident #4's clinical record revealed an admission date of 11/20/24 with diagnoses including dementia with behaviors, bipolar disorder, depression, anxiety, insomnia, stroke, Alzheimer's disease, peripheral vascular disease, heart disease, gastroenteritis/colitis, diarrhea, malnutrition, osteoarthritis, high blood pressure and cholesterol, cognitive communication deficit, dysphagia and viral wart. Resident #4's occupational therapy notes dated 02/21/25 indicated Resident #4 was provided with a drop seat wheelchair. Resident #4 demonstrated good upright posture at all times utilizing bilateral leg rests. A review of the Concern Log dated 03/03/25 indicated Resident #4's daughter voiced a concern regarding Resident #4's wheelchair. Resident #4's daughter requested an update from therapy regarding Resident #4's wheelchair. The investigation summary revealed therapy had provided a drop seat wheelchair for safety. An interview with Certified Occupational Therapist Assistant (COTA) #295 on 07/24/25 at 10:57 A.M. revealed Resident #4 was provided with a standard wheelchair upon admission to the facility. COTA #295 stated Resident #4 kept throwing herself out of the wheelchair because she wanted to recline. The facility provided a Broda chair. Resident #4's daughter asked to have the Broda chair removed and provide a custom wheelchair. COTA #295 stated Resident #4 was provided with a drop seat wheelchair which would recline for her comfort and safety. An observation of Resident #4's wheelchair with Physical Therapy Director (PTD) #293 and COTA #295 on 07/24/25 at 11:07 A.M. revealed the left arm of the wheelchair was missing the foam padding and was wrapped with an ace bandage wrap. The right leg rest had a missing calf pad with a broken sharp piece of plastic exposed to where the calf pad attached to the leg rest. COTA #295 stated the wheelchair was not in this condition when Resident #4 was provided with the wheelchair. PTD #293 verified the wheelchair needed repair. Both staff indicated they were unaware of the condition of Resident #4's wheelchair or Resident #4's daughter's recent concerns.This deficiency was an incidental finding identified during the complaint investigation. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365268 If continuation sheet Page 10 of 10