Health inspection·October 23, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few that stated Resident #7 spilled a cup of tea onto (her) lap. (The resident's) left thigh was red and (a) blister formed and burst almost immediately. Cold water was applied to the area, clothes were changed, and (the resident's left) leg was assessed. Director of Nursing (DON), Primary care physician (PCP) and family was notified. Waiting on new orders from (the) provider. Resident reporting some discomfort to (the) left thigh. (The pain was rated a 1 on a scale of 0-10 (0 represents no pain and 10 represents the worst pain ever reported by the resident). Review of Resident #7's progress note dated 09/19/25 at 6:14 P.M., authored by RN #86, revealed Resident #7 had complaints of increased pain due to a beverage burn. Ibuprofen 400 milligram (MG) oral (PO) three times a day (TID) as needed (PRN) ordered. (There was no assessment of the resident's pain at this time).Record review revealed a wound assessment completed 09/19/25 revealed Physician #1004 was notified of a burn in house acquired to Resident #7's left upper thigh, pink epithelia present and wound appeared moist. Small amount of serosanguinous drainage was noted. The wound was 15 centimeters (cm) in length, nine cm in width, peri wound was red with irregular edges. Treatment plan for Silver sulfadiazine External Cream 1.0 % Apply to left thigh topically every shift for burn to left thigh, cleanse with normal saline, apply cream, telfa pads and kerlix. Review of Therapist #6's statement dated 09/19/25 revealed she had just prepared hot tea for the resident and another (unidentified) resident. As she was sitting beside Resident #07 and preparing for the therapy session, the resident began to take a drink (of the hot tea). The therapist believed the resident attempted to balance the cup on her lap, on the dish she had also been holding, resulting in the cup spilling on her leg. Immediately she was able to intervenepulling the resident's wet clothing up off her skin and the therapist yelled for help and (illegible name) was able to immediately intervene with applying cold water to the area. They (not identified) then took Resident #7 for further assessment, interventions and change of clothes. Review of Resident #7's progress note dated 09/23/25 at 12:50 P.M., authored by RN #106, revealed the resident was on restorative program for communication, toileting, and active range of motion (AROM) to bilateral upper extremities, AROM to bilateral lower extremities, transfer, and ambulation. Resident participated in above program for 15 minutes a day, six to seven days a week. The note included would continue to encourage the resident to participate with the goal of maintaining resident's current level of functional ability. (This had been in place since 03/06/25).Review of Resident #7's progress notes dated 09/23/25 at 3:30 P.M., authored by Registered Nurse (RN) #99, revealed Resident #7's family requested to obtain an order for Tylenol and Ibuprofen alternating to address the resident's pain from the burn. (However, there was no assessment of the resident's pain at this time). Review of Resident #7's progress note dated 09/23/25 at 4:48 P.M., authored by RN #99, revealed Physician #1004 stated it was ok to alternate Tylenol and ibuprofen every three hours.Review of Resident #7's progress note dated 09/23/25 at 7:47 P.M., authored by RN #99, revealed the resident's family requested the resident to be dressed in gowns during the day instead of sweat pants due to the burn on the leg. Review of Resident #7's progress note dated 09/24/25 at 7:13 P.M., authored by the Director of Nursing, revealed Resident #07 was seen in house by Physician #1005 for assessment of left thigh burn. Physician #1005 gave directions to continue same treatment and was informed of and understood daughter's thoughts on changing dressing change to three times a day (TID) rather than twice a day (BID). Physician #1005 explained best practice for Silvadene was to change the dressing and apply Silvadene BID. I (the author of the note) spoke to the resident's daughter and gave her the doctor's orders and explanations and she expressed understanding and was agreeable with this plan. Review of Resident #7 Occupational Therapy (OT) discharge summary revealed Resident #7 was discharged from OT on 10/02/25. The summary revealed the resident had reached her highest practical level of function.Record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365271 If continuation sheet Page 2 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Actual harm Residents Affected - Few review of Resident #7 wound assessment completed on 10/14/25 revealed the resident's wound appeared to be healing, treatment was complete with Silver sulfadiazine External Cream 1%, apply to left thigh topically every shift for burn to Left thigh, cleanse with normal saline, apply cream, telfa pads and kerlix. Peri skin appears deep pink, all healed over with pink scar tissue except two open areas on largest site, area 1) 3 cm in length, 2 cm in width, and 0.1 cm in depth. Area 2) 2 cm in length, 2 cm in width, and 0.1 cm in depth. Wound appears beefy red and pink with some yellow centers.On 10/14/25 at 8:34 A.M. interview with Resident #7's power of attorney (POA), POA #1738 revealed on 09/19/25 she received notification Resident #7 suffered a small burn from a hot drink that spilled. The next day, POA #1738 went to visit and was shown the burn, and it was not small and it was in more than one spot. The POA said it looked like a second-degree burn. Resident #07 was handed a Styrofoam cup without a lid; the burn was bad and no one in upper management contacted the family about the incident. The POA said it took a while for the wounds to heal since she's a diabetic. Interview on 10/14/25 at 2:30 P.M. with Registered Nurse (RN) #46 revealed there was recently a situation a Resident was burned by a hot drink. There was no lid on the cup at the time it was in Resident #7's possession, and it spilled onto her leg. The next day when the burn was seen by staff it looked clean, but it was significant. There were blisters, and they had burst she seemed to be bothered by the burn the most during dressing changes. When the drink was initially spilled, another nurse came and dumped cool water on her leg and then Resident #7 was taken to their room. Interview on 10/14/25 at 2:58 P.M. with Registered Nurse # 86 revealed Resident #7 was working with speech therapy at the time of the burn incident. RN #86 heard a shout; Resident #7 had spilled the coffee/tea on herself. RN #86 believed she was trying to set it on her lap possibly. Another nurse poured cold water on her to stop the burning. RN #86 stated Resident #7 was wearing sweat pants at the time, initially the wound looked red/slightly pink, all skin was intact, a while later it was looked at and appeared to be blistering, then she started to peel the skin, she was trying to take the bandage off after the dressing was applied. At the time of the incident Resident #7's power of attorney (POA) #1002 was called but they did not answer, so staff called POA #1003, and Resident #7's primary care physician (PCP) #1004 was notified. RN #86 stated at the time Resident #7 was given the hot beverage there was no lid on the cup, it was a Styrofoam coffee cup. RN #86 stated at that time they had a hot drink dispenser for the hot water, after the incident the Director of Nursing (DON) stated the water coming out of the machine was too hot, all beverages come from the kitchen. Interview on 10/14/25 at 3:02 P.M. with Therapist #6 confirmed therapy staff were working with Resident #7 at the time the drink spilled on her leg. Therapist #6 stated they got Resident #7 tea in a Styrofoam cup that was provided on the floor; using hot water from the hot water dispenser. They sat down, with another resident present, to do their speech therapy session. Therapist #6 confirmed there was no lid on the cup at the time Resident #7 had it. Therapist #7 stated they were working and suddenly the cup spilled, a nurse dumped cold water onto Resident #7's leg and proceeded to take her to her room to get changed and assessed. All water dispensers were made out of order and cannot be used, for hot water. Therapist #6 stated they spoke with DON in Quality Assurance Performance Improvement (QAPI) and they recommended all hot liquids for residents have a lid. The therapist stated it happened so fast, she wasn't sure what the resident was doing with the cup prior to the tea being spilled on her leg. Interview on 10/14/25 at 3:33 P.M. with Certified Nursing Assistant (CNA) #26 revealed on 09/19/25 Resident #25 did spill a cup of hot liquid onto her leg causing a burn. Initially the area was just red, nothing was open, but after some time it did begin to bubble and blister. When it happened, a nurse dumped cool water onto her leg, Resident #7 was then taken to her room to get changed and be assessed by the nurse. CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365271 If continuation sheet Page 3 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Actual harm Residents Affected - Few #26 confirmed there was no lid on Resident #7's cup at the time it spilled. CNA #26 confirmed there was no way to regulate the temperature from the hot water machine, they couldn't check the temperature. The CNA reported the resident generally received hot liquids in a mug with a handle, given from the kitchen. Interview on 10/14/25 at 3:36 P.M. with CNA # 31 revealed on 09/19/25 Resident #7 was working with speech therapy. Speech therapy and Resident #7 were sitting with another resident at that time (at a table). Suddenly everyone got up and went towards Resident #7, who had spilled hot liquid on her leg. The liquid was in a smaller Styrofoam cup, and there was no lid. Resident #7 was immediately taken to their room to be changed and assessed. At the time there were hot water dispensers available on the floor, they are no longer allowed to use them. The CNA reported the resident generally received coffee from the kitchen, in a mug with a handle during breakfast and not in a Styrofoam cup. The CNA was unsure if lids for the Styrofoam cups were available where the hot water dispenser was located.Interview on 10/15/25 at 8:55 A.M. with Dietary Director #49 revealed the kitchen did not do temperature monitoring on the hydroz hot water dispenser (where the water was obtained for Resident #7's tea). The facility current policy was that all hot liquids must come from the kitchen. Director #49 stated they were not sure what the policy was for hot liquid temperatures but they would look into it. The Dietary Director never provided additional information. Interview on 10/15/25 at 9:00 A.M. with Maintenance Director #603 revealed maintenance did not monitor or regulate the hot water dispensers for resident beverages. Director #603 stated the dispenser comes pre-set and how they come is how they stay, they can't manipulate the settings. Observation on 10/15/25 at 10:57 A.M. of Licensed Practical Nurse (LPN) #18 changing Resident #7 dressing to the burn on the left thigh. LPN #18 cleansed the area with normal saline, applied Silver sulfadiazine External Cream 1%, applied telfa, secured the dressing with Medi pore tape. Observation of Resident #7 wound revealed a red area to the left lateral thigh, two open areas that were moist and beefy red. There were intact, reddened skin areas spread from lateral to medial thigh. Observation on 10/15/25 at 11:06 A.M. with Registered Nurse #107 revealed hot water temperature from the Hydroz machine into a Styrofoam cup was verified with a thermometer from the facility's kitchen. RN #107 confirmed the temperature of the water from the machine was 176 degrees Fahrenheit Review of Hydroz H20-2500 manufacturer guide revealed heating of the hot water tank was up to 180 degrees Fahrenheit. Review of facility policy titled Safety of Hot Liquids implemented 10/2014 revealed residents would be evaluated for safety concerns and potential injury from hot liquids upon admission, readmission and on change of condition. Appropriate precautions would be implemented to maximize choice of beverages while minimizing the potential for injury. The potential for burns from hot liquids was considered an ongoing concern among residents with weakened motor skills, balance issues, impaired cognition, and nerve or musculoskeletal conditions. Interventions include serving hot beverages in a cup with a lid, maintaining a hot liquid serving temperature of no more than 180 degrees, encouraging residents to sit at a table while drinking or eating hot liquids and staff supervision or assistance with hot beverages. Food service staff would monitor and maintain food temperatures that comply with food safety requirements but do not exceed recommended temperatures to prevent scalding. In addition, review of Resident #7's active care plans revealed the resident had a care plan in place for the potential for falls related to a history of falls, medication use, and requiring assistance with transfers. The goal was for the resident to remain free of falls. Interventions included the use of Dycem (a tacky piece of material placed in a chair to prevent sliding out of the chair) to her wheelchair. Review of Resident #7's physician's orders revealed the resident had an order (originated 05/24/24) for the use of Dycem to the resident's wheelchair. On 10/14/25 at 2:31 P.M., an observation of Resident #7 revealed the resident was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365271 If continuation sheet Page 4 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete sitting up in her wheelchair. CNA #104 was asked to take the resident back to her room so she could be assisted into a standing position out of her wheelchair, to see if fall prevention interventions, including the use of Dycem to her wheelchair were in place. CNA #104 received assistance from the facility's Director of Nursing (DON) to stand the resident up from a seated position in her wheelchair. A gait belt and the assistance of the CNA and DON were used to have the resident stand from her wheelchair. The resident was observed to only have a cushion in the seat of her wheelchair with no evidence of Dycem being above or below her cushion. There was a piece of Dycem draped over the armrest of a stationary chair in her room. Findings were verified by the DON.On 10/14/25 at 2:40 P.M., an interview with CNA #104 revealed the resident was assisted up into her wheelchair by the night shift staff, as the resident was already up when she came on duty at 6:00 A.M. She had not known the resident to fall in the month or so that she had been there, but did feel the resident was at risk for falls. She acknowledged the resident's plan of care for fall prevention included the use of Dycem when she was up in her wheelchair and was not sure why it was not in place. This deficiency demonstrates non-compliance investigated under Complaint Number 2630029. Event ID: Facility ID: 365271 If continuation sheet Page 5 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and staff interview, the facility failed to ensure a resident at risk for dehydration had water maintained at her bedside. This affected one (Resident #7) of three residents reviewed for dehydration. Findings include: Review of Resident #7's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included Alzheimer's disease with a late onset, unspecified dementia, adult onset diabetes mellitus, personal history of malignant neoplasm of the pancreas, malignant neoplasm of an unspecified part of an unspecified bronchus/ lung with metastasis to the brain, chronic kidney disease, unsteadiness on feet, and a history of falls. Review of Resident #7's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident did not have any communication issues and her cognition was severely impaired. She was not indicated to have displayed any behaviors and was not known to reject care. She required a partial to moderate assist with transfers and ambulation. The resident was coded as having received a diuretic medication during the seven day assessment period. Review of Resident #7's care plans revealed the resident had the potential for fluid imbalance related to kidney disease and diuretic use. The goal was for the resident to demonstrate adequate hydration as evidenced by laboratory values within normal range for the resident. The interventions included the need to maintain water at the resident's bedside.On 10/14/25 at 2:31 P.M., an observation of Resident #7 noted her to not have any water made available to her in her room as per her plan of care. There was no evidence of her being provided a Styrofoam cup, with a lid and straw, as was noted in other residents' rooms providing them with ice water. Her room was absent of any cups or other sources of a beverage for her to drink to help keep her hydrated per her plan of care. Findings were verified by Certified Nursing Assistant (CNA) #104. On 10/14/25 at 2:40 P.M., an interview with CNA #104 revealed she had provided Resident #7 with ice water earlier that morning, when they were getting residents up for the day. She denied she had assisted Resident #7 with getting up that morning, as she was already up when she came on duty at 6:00 A.M. She reported night shift got Resident #7 up that morning. She was not able to locate a Styrofoam cup for the resident in her room or any other beverage for the resident to drink when she wanted. She suspected that maybe housekeeping had thrown it away when they were in the resident's room cleaning it earlier. She acknowledged housekeepers were in other residents' rooms cleaning their rooms without throwing their Styrofoam cups away. She further acknowledged Resident #7's plan of care indicated the staff were to maintain water at her bedside at all times. On 10/15/25 at 8:40 A.M., further observations of Resident #7 noted her to be lying in bed in her room. She was noted to have a Styrofoam cup dated 10/15/25 that had water in it, but the Styrofoam cup was sitting on the overbed table that was placed near the entry door to the room and out of the resident's reach. On 10/15/25 at 8:43 A.M., an interview with CNA #26 confirmed Resident #7's water that was in a Styrofoam cup on her overbed table was not left in the resident's reach. She further confirmed with the placement of the overbed table away from the resident's bed, the resident would not be able to reach her Styrofoam cup if she wanted or needed a drink. This deficiency demonstrates non-compliance investigated under Complaint Number 2630029. Event ID: Facility ID: 365271 If continuation sheet Page 6 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure an effective antibiotic stewardship program was implemented, when a resident returned from the hospital on an antibiotic for the treatment of a urinary tract infection, and the facility's infection preventionist failed to ensure an appropriate antibiotic was ordered to adequately treat the infection. This affected one (Resident #7) of three resident's reviewed. Findings include: Review of Resident #7's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included Alzheimer's disease with late onset, unspecified dementia, and chronic kidney disease. Review of Resident #7's nurses' progress notes revealed the resident was sent to the emergency room (ER) on 08/26/25 at 5:00 P.M. for complaints of chest pain. She complained of mid-sternum burning and heaviness. She returned to the facility on [DATE] at 1:40 A.M. with the diagnoses of a urinary tract infection (UTI). She returned to the facility with a new order for Keflex 500 milligrams (mg) by mouth every eight hours for seven days for the treatment of a UTI.Review of Resident #7's hospital records for her emergency room (ER) visit on 08/26/25 revealed the resident was seen for complaints of chest pain not relieved by gastroesophageal reflux disease (GERD) medications. She was diagnosed with a UTI and was started on Keflex 500 mg by mouth every eight hours for seven days for a UTI. Review of a urinalysis (U/A) with a culture and sensitivity (C&S) that was collected on 08/26/25 at 10:31 P.M., while Resident #7 was in the hospital, revealed the resident's U/A showed her urine was positive for nitrites (typically caused by a bacterial infection in the urinary tract) and was also positive for bacteria. The final culture report on 08/29/25 revealed the resident's urine had greater than a 100,000 colony count/ milliliter of heavy Enterobacter Cloacae (gram negative bacterium that's a natural part of the human gut, but could cause various infections including UTI's). The sensitivity report indicated Keflex was not one of the seven antibiotics that the organism causing the resident's UTI was sensitive to. Review of an Antibiotic Time Out report for Resident #7 dated 08/29/25 at 2:07 P.M. pertaining to the resident's use of Keflex 500 mg by mouth three times a day revealed the resident was sent to the ER for chest pain and returned with a UTI diagnosis. The resident was indicated to be showing no signs or symptoms of a UTI, but the U/A C&S returned positive for Escherichia Coli (E. coli). The Antibiotic Time Out report did not accurately reflect the organism identified on the C&S as having caused the UTI, which was Enterobacter Cloacae. The report further showed the antibiotic use was reviewed with the physician, but informed him of the incorrect organism identified as causing the infection. The physician responded on 09/02/25 (the day the seven day course of the antibiotic treatment was completed) and provided instructions to finish and complete the antibiotic, when she only had one dose of the antibiotic left to take. Review of Resident #7's medication administration record (MAR) for August and September 2025 revealed the resident received the full course of the ordered antibiotic (Keflex) for seven days between 08/27/25 and 09/02/25. The first dose was given on 08/27/25 at 2:00 P.M. and the last dose was administered on 09/02/25 at 10:00 P.M. There was no evidence of the antibiotic being changed to one of the seven antibiotics identified on the sensitivity report as being effective in treating the UTI caused by the specific organism identified on the culture report. The resident received a full seven day course of Keflex that was not effective in treating a UTI caused by Enterobacter Cloacae. On 10/15/25 at 10:35 A.M., an interview with LPN #62 revealed she was the facility's acting Infection Preventionist (IP) when Resident #7 was treated for a UTI following her ER visit on 08/26/25. She reported she was responsible for reviewing residents who were sent to the hospital and was started on an antibiotic to treat an infection as part of her IP role. She stated she reviewed to see if an antibiotic had been started and also obtained the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365271 If continuation sheet Page 7 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 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 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete labs to ensure an antibiotic was warranted. She claimed to have identified Resident #7 was started on an antibiotic for the treatment of a UTI, after the resident returned from the hospital on [DATE]. She reported she identified the organism causing the resident's UTI was not sensitive to the antibiotic that had been ordered at the hospital. She indicated she completed an antibiotic time-out and reached out to the resident's physician. She stated the physician wanted to continue the antibiotic as ordered even though it was not an effective treatment for the organism identified. She further indicated that particular physician, who was their prior medical director at the time, was one of the few physicians she dealt with that was not good about following the facility's ATB Stewardship program. He would often want antibiotics continued that had been ordered without supporting documentation confirming the resident had an active infection. He also did not always change the antibiotic that had been previously ordered when it was made know that antibiotic was not effective in treating the infection. She acknowledged the Antibiotic Time Out report improperly identified the organism that was causing the resident's UTI as being E. coli, which Keflex would have been an appropriate antibiotic to treat a UTI caused by that organism. She further acknowledged the physician's response to her Antibiotic Time Out was not received until 09/02/25, after the antibiotic therapy had already been completed. Review of the facility's Antibiotic Stewardship Program policy revised 05/30/23 revealed it was the policy of the facility to implement an Antibiotic Stewardship program as part of the facility's overall infection prevention and control program. The purpose of the program was to optimize the treatment of infections while reducing the adverse events associated with antibiotic use. The Medical Director and the facility's Director of Nursing (DON) was to serve as leaders of the Antibiotic Stewardship program. The Medical Director was to set the standards for antibiotic prescribing practices for all healthcare providers prescribing antibiotics, overseeing adherence to antibiotic prescribing practices, and was to review antibiotic use data and ensure best practices were followed. The IP was to utilize expertise and data to inform strategies to improve antibiotic use to include tracking of antibiotic starts, monitoring adherence to evidence-based published criteria during the evaluation and management of treated infections. Monitoring of the antibiotic was to include monitoring the response to antibiotics, and laboratory results, when available, to determine if the antibiotic was still indicated or adjustments should be made. Antibiotics orders obtained from emergency providers should be reviewed for appropriateness. This is an incidental finding discovered during the complaint investigation. Event ID: Facility ID: 365271 If continuation sheet Page 8 of 9 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 365271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Carriage Inn of Steubenville 3102 St Charles Drive Steubenville, OH 43952 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and review of maintenance work orders the facility failed to maintain a safe and comfortable home like environment. This had the potential to affect one (Resident #07) of five residents rooms observed. the census was 78. Observation on 10/15/25 at 10:02 A.M. revealed a hole in the wall behind the head of Resident #7's bed. The hole was observed to be located behind the head of the resident's bed, near the baseboard. The hole was approximately eight inches by eight inches.Review of facility maintenance work orders for the past six months revealed no documentation of an order to repair the hole in the wall of Resident #7's room.Interview on 10/15/25 at 10:48 A.M. with Certified Nurses Assistant (CNA) #42 and Licensed Practical Nurse (LPN) #18 confirmed there was a larger hole in the wall of Resident #7's room. The hole was located behind the head board near the bottom of the wall. CNA #42 and LPN #18 stated they had not noticed the hole in the wall prior to it being pointed out. This deficiency demonstrates non-compliance investigated under Complaint Number 2630029. Event ID: Facility ID: 365271 If continuation sheet Page 9 of 9