Inspection·February 29, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of a nursing progress note revealed on 12/20/23 at 6:33 A.M. Resident #36 was complaining of left ankle pain when staff attempts to move left leg. No redness or swelling noted. Physician contacted and an order for a left ankle x-ray was given. Review of a nursing progress note revealed on 12/20/23 at 4:13 P.M. Resident #36 had x-ray completed today due to complaints of pain in left ankle/leg. Nurse practitioner at bedside and wanted resident to be sent to the hospital due to x-ray results. Resident transported to hospital. Review of the x-ray report of the left ankle from 12/20/23 revealed an acute nondisplaced oblique (at an angle) fracture of the distal tib-fib (the ankle end of the two long bones in the leg). Review of hospital records from 12/20/23 revealed the resident arrived with a left leg fracture after a fall. It stated the resident had a fracture of tibia and fibula after a fall at the nursing home. A splint was applied to the left leg and instructions were given to follow up with orthopedics. Interview with Nursing Assistant #170 on 02/27/24 at 2:45 P.M. confirmed a couple months ago she was transferring Resident #36 from the bed to the chair by herself. She stated the resident slid to the mat on the floor by the bed. She stated the resident was supposed to be a two person transfer but she did not know that at the time. She stated the resident then had a broken foot a few days later. She stated the resident was now to be a two person transfer. Interview with the Director of Nursing (DON) and MDS Registered Nurse #197 on 02/28/24 at 8:15 A.M. revealed the fracture diagnosed for Resident #36 on 12/20/23 was attributed to the fall on 12/18/23. The DON stated Nursing Assistant #170 did not use a gait belt to transfer Resident #36 from bed to chair, and should have. She stated that after the fall, she told Nursing Assistant #170 not to transfer the resident by herself. They confirmed the plan of care and [NAME] used by the nursing assistants did not specify if Resident #36 was to be transferred by one staff or two. This deficiency is based on incidental findings discovered during the course of this complaint investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 2 of 8 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 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview, and policy review, the facility failed to monitor Resident #36's skin under a splint/boot on the left foot to prevent the development of a pressure ulcer. Residents Affected - Few Actual harm occurred on 12/26/23 when Resident #36, who was cognitively impaired was identified to have a deep tissue injury (DTI) pressure ulcer (described as intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration due to damage of underlying soft tissue) to the left foot caused by a splint. The splinting device had been implemented following a fracture on 12/18/23. However, staff failed to monitor/assess the resident's skin integrity under the splint resulting in the DTI pressure ulcer development. On 01/2224 the pressure ulcer was assessed to be unstageable (full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because the wound bed is obscured by slough or eschar). This affected one resident (#36) of three residents reviewed for pressure ulcers. The facility census was 92. Findings include: Review of the medical record for Resident #36 revealed an admission date of 07/07/22 and diagnoses including cerebrovascular disease, dementia, and diabetes. The resident resided on the secured dementia unit. Review of a quarterly Minimum Data Set assessment dated [DATE] revealed the resident had a brief interview for mental status score of five (5), indicating severe cognitive impairment. The assessment also reflected the resident required substantial/maximal assistance with bed to chair transfers and walking was not attempted (during the assessment period) due to medical condition/safety. Review of a nursing progress note revealed on 12/18/23 at 4:15 P.M. (documented as a late entry on 12/20/23 at 8:46 P.M. by Licensed Practical Nurse (LPN) #139) the nurse was called to Resident #36's room by aide. The resident had sustained a fall. The resident was subsequently transported to the hospital for an evaluation and treatment. Review of hospital records from 12/20/23 revealed the resident arrived (to the hospital) with a left leg fracture after a fall. The record noted the resident had a fracture of tibia and fibula after a fall at the nursing home. A splint was applied to the left leg and instructions were given to follow up with orthopedics. The hospital instructions further stated to monitor for any swelling or breakdown around the splint. Review of a nursing progress note dated 12/20/23 at 10:20 P.M. revealed Resident #36 returned from the hospital. Review of physician's orders revealed an order dated 12/21/23 for an ace bandage to lower left extremity. The order indicated to leave in place until follow up with orthopedic (the order did not address the splint that was applied at the hospital on [DATE]). There was no order written to monitor the skin around or under the brace at that time (and as per the hospital instructions). A plan of care dated 12/21/23 revealed the resident had a fractured left tib/fib, had impaired skin integrity or was at risk for altered skin integrity. The care plan did not include monitoring the resident's skin under the splint/boot (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 3 of 8 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 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 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 0686 Level of Harm - Actual harm Residents Affected - Few A nursing progress note dated 12/22/23 at 9:45 A.M. revealed the resident was out of the facility for appointment with orthopedics. On 12/22/23 at 12:00 P.M. the resident returned from the appointment. However, the facility did not have any physician notes from this orthopedic appointment. Review of Resident #36's medical record revealed there was no evidence the skin under the brace was monitored until 12/26/23 when the wound nurse practitioner noted a deep tissue injury (DTI) to the top of the left foot measuring 2.0 centimeters (cm) long by 3.0 cm wide acquired on 12/26/23. On 12/26/23 the wound nurse practitioner recommended to cleanse the top of the left foot DTI with wound cleanser, apply skin prep, and leave open to air. The resident's plan of care was updated on 12/26/23 to monitor for skin breakdown under the splint/boot when check skin every two hours under brace and notify physician of any concerns was added to the plan of care. On 12/26/23 staff also documented on the care plan the resident had acquired an unstageable pressure ulcer of the left foot in the facility from an orthotic boot. An order was written on 12/26/23 to check skin every two hours under brace and notify physician of any concerns (six days after a splint was applied and after a pressure ulcer had already developed). Review of physician's orders and the treatment administration records (TAR) from December 2023 and January 2024 revealed a treatment was not initiated until 01/10/24 (15 days after the wound nurse practitioner made a treatment recommendation) to cleanse top of left foot pressure wound with in house wound cleanser, pat dry, apply Betadine and cover with ABD (padded gauze) for protection from Ortho boot. Review of wound nurse practitioner notes revealed on 01/02/24 the area on the top of the left foot was larger (3.5 cm long by 3.5 cm wide) with the same treatment recommended as on 12/26/23 (not implemented until 01/10/24). Review of a nursing progress note dated 01/02/24 at 12:49 P.M. revealed Resident #36 returned without a follow up summary from an orthopedic appointment. Orthopedic office attempted to be contacted to request details of appointment without success. Review of orthopedic physician consult notes dated 01/02/24 revealed Resident #36 was placed in a short leg walking boot with instructions to remove the boot for hygiene as well as evaluation of the decubitus ulcer. Review of a nurse's progress note dated 01/05/24 at 10:11 A.M. revealed Resident #36 would need to return for another orthopedic appointment in four weeks. Resident #36 was placed in a short leg walking boot with instructions to remove boot for hygiene and wound treatments. Review of the medical record and orders revealed the order for the ace bandage to lower left extremity with instructions to leave in place until follow up with orthopedics originally dated 12/21/23 was not discontinued until 01/05/24 (even though the resident had been wearing either a splint or boot since 12/20/23). There were no physician's orders for a splint/boot of any kind in the medical record until 01/05/24, when an order was written for a short leg walking boot to left leg/foot. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 4 of 8 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 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 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 0686 Level of Harm - Actual harm Residents Affected - Few An assessment by the wound practitioner on 01/09/24 revealed a the resident was assessed to have a Stage II pressure ulcer (defined as a partial-thickness loss of skin with exposed dermis, presenting as a shallow open ulcer. The wound bed is viable, pink or red, moist, and may also present as an intact or open/ruptured blister) on the top of the left foot measuring 3.2 cm long by 2.8 cm wide with the same treatment recommended as on 12/26/23 (not implemented until 01/10/24). Review of the medical record revealed a wound nurse practitioner note dated 01/16/24 revealed the top of the left foot was a Stage II pressure ulcer measuring 4 cm long by 3 cm wide with 75-99 percent epithelial tissue. Review of the wound nurse practitioner note dated 01/22/24 revealed the top of the left foot was assessed to be an an unstageable pressure ulcer (defined as full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because the wound bed is obscured by slough or eschar) measuring 4.2 cm long by 3.5 cm wide with 75-99 percent eschar. Review of the wound nurse practitioner note dated 02/20/24 revealed the top of the left foot was an unstageable pressure ulcer measuring 4 cm long by 2.2 cm wide with 75-99 percent eschar. Observation on 02/27/24 at 1:08 P.M. revealed Resident #36 was in bed on her back. She was observed to have an approximate 3 cm long by 3 cm wide dry, black scabbed area of eschar on the top of the left foot. Interview with the Director of Nursing (DON) on 02/28/24 at 10:45 A.M. confirmed there were no physician's orders to monitor the skin around or under the splint/boot until 12/26/23. She stated the nurse who wrote the order on 12/21/23 to leave the ace bandage in place did not know there was a splint under it. The DON confirmed the facility did not have any physician notes from the orthopedic visit on 12/22/23. She stated the hospital had applied a fiberglass splint to the left ankle on 12/20/23 and she did not know if the orthopedic physician left that splint on or applied a different type on 12/22/23. She stated at some point, the resident had a short leg walking boot applied. The DON confirmed a treatment to the top of the left foot did not start until 01/10/24 (15 days after a treatment order was received). Review of the undated facility policy titled Daily Skin Care for Skin Care and Wound Management revealed staff were to monitor skin in contact with adaptive equipment for areas of pressure. This deficiency is based on incidental findings discovered during the course of this complaint investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 5 of 8 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 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and policy review, the facility failed to ensure Resident #36 received adequate staff assistance during a staff assisted transfer from bed to chair to prevent a fall with injury. Actual harm occurred on 12/18/23 when Resident #36, who was cognitively impaired, at risk for falls and required substantial/maximal assistance from staff for transfers sustained a fall during a one-person staff assisted transfer. At the time of the transfer, the nursing assistant, (NA) #170 failed to use a gait belt and the resident fell to the floor with a resulting fracture of the left ankle. This affected one resident (#36) of four residents reviewed for falls. The facility census was 92. Findings include: Review of the medical record for Resident #36 revealed an admission date of 07/07/22 and diagnoses including cerebrovascular disease, dementia, and diabetes. The resident resided on the secured dementia unit. Review of the plan of care revealed on 04/09/22 the resident was noted to be at risk for falls related to impaired cognition, history of stroke, history of falls, safety awareness, and weakness. The plan of care on 04/09/22 and revised on 10/10/23 revealed the resident required substantial/maximal assistance for bed to chair transfers and helper does more that half the effort. It did not specify if the transfer was to be completed by one or two staff. Review of a fall risk assessment dated [DATE] revealed the resident was at risk for falls. Review of a quarterly Minimum Data Set assessment dated [DATE] revealed the resident had a brief interview for mental status score of 5, indicating severe cognitive impairment. The assessment revealed the resident required substantial/maximal assistance with bed to chair transfers and walking was not attempted due to medical condition/safety. Review of nursing progress note revealed on 12/18/23 at 4:15 P.M. (documented as a late entry on 12/20/23 at 8:46 P.M. by Licensed Practical Nurse (LPN) #139) the nurse was called to Resident #36's room by an aide. Resident noted to be sitting on the floor on the fall mat. Back was resting against the bed. Legs extended out in front of resident with arms crossed over her chest when this nurse entered the room. Head to toe assessment completed. No complaints of pain. No bruising or discolorations noted at this time. Vital signs obtained and all within normal limits. Interview with the Director of Nursing on 02/28/24 at 10:45 A.M. revealed that LPN #139 did not document the fall on 12/18/23 as she originally did not consider it a fall. She stated the nurse was later educated that this was considered a fall. Review of a written statement from Nursing Assistant #170 revealed on 12/18/23 at approximately 4:40 P.M. she was transferring Resident #36 from the bed to her wheelchair for dinner. The statement included she (the nursing assistant) sat her (the resident) up in bed before placing her hand on her back and then using her other hand to make sure her wheelchair was locked. As she reached to do so, she (the resident) began to slide off the bed. Her (the resident's)legs were bent and got stuck under (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 6 of 8 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 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 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 her until her bottom hit the ground and she straightened her legs and extended them outward. LPN #139 came in to help her get the resident up. LPN #139 said that since Nursing Assistant #170 saw it happen and she was on her mat, it was not a fall. The resident's bed was in the lowest position when this happened and Nursing Assistant #170 stated she did not recall the resident screaming out in pain or complaining about being hurt. The statement was dated 12/21/23. Review of a nursing progress note revealed on 12/20/23 at 6:33 A.M. Resident #36 was complaining of left ankle pain when staff attempts to move left leg. No redness or swelling noted. Physician contacted and an order for a left ankle x-ray was given. Review of a nursing progress note revealed on 12/20/23 at 4:13 P.M. Resident #36 had x-ray completed today due to complaints of pain in left ankle/leg. Nurse practitioner at bedside and wanted resident to be sent to the hospital due to x-ray results. Resident transported to hospital. Review of the x-ray report of the left ankle from 12/20/23 revealed an acute nondisplaced oblique (at an angle) fracture of the distal tib-fib (the ankle end of the two long bones in the leg). Review of hospital records from 12/20/23 revealed the resident arrived (to the hospital) with a left leg fracture after a fall. The hospital records noted the resident had a fracture of tibia and fibula after a fall at the nursing home. A splint was applied to the left leg and instructions were given to follow up with orthopedics. Review of a nursing progress note revealed on 12/20/23 at 10:20 P.M. Resident #36 returned from the hospital. Resident has a tibia and fibula fracture. It is recommended that an appointment be scheduled for resident to see orthopedics. On 12/21/22 at 9:22 A.M. it was documented that an appointment was scheduled with orthopedics on 12/22/23 at 10:00 A.M. Nursing progress notes on 12/22/23 at 9:45 A.M. stated the resident was out of the facility for appointment with orthopedics. On 12/22/23 at 12:00 P.M. the resident returned from the appointment. However, the facility did not have any physician notes from the orthopedic appointment. Interview with the Director of Nursing on 02/28/24 at 10:45 A.M. confirmed the facility did not have any physician notes from the orthopedic visit on 12/22/23. She stated the hospital had applied a fiberglass splint to the left ankle on 12/20/23 and she did not know if the orthopedic physician left that splint on or applied a different type on 12/22/23. She stated at some point, the resident had a short leg walking boot applied. Resident #36 was seen again by the orthopedic physician on 01/02/24. An x-ray on 01/02/24 showed stable alignment of tibial and fibular fractures without significant interval healing. The physician notes stated evaluation of nondisplaced spiral type fracture to the left distal third of the tibial shaft as well as associated fracture to the left distal fibular shaft. The resident was placed in a short leg walking boot with instructions to remove the boot for hygiene as well as evaluation of the decubitus ulcer. Continue short leg walking boot immobilization. Return in four weeks. Review of a nursing progress note on 01/02/24 at 12:49 P.M. revealed Resident #36 returned without a follow up summary from the orthopedic appointment. Orthopedic office attempted to be contacted to request details of appointment without success. Voicemail left. On 01/05/24 at 10:11 A.M. notes indicated the resident will need to return for another orthopedic appointment in four weeks. Resident was placed in a short leg walking boot with instructions to remove boot for hygiene and wound treatments. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 7 of 8 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 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 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 There were no physician's orders for a splint/boot of any kind in the medical record until 01/05/24, when an order was written for a short leg walking boot to left leg/foot. Level of Harm - Actual harm Residents Affected - Few Review of a nursing progress note on 01/30/24 at 8:46 A.M. revealed the resident left for an orthopedic appointment. On 01/30/24 at 1:38 P.M. the resident returned with new orders to discontinue the walking boot and encourage to float heels. Next appointment 02/27/24 with x-ray prior. The facility did not have any written notes from the orthopedic physician for the visit on 01/30/24. This was confirmed by the Director of Nursing on 02/28/24 at 10:45 A.M. Review of a nursing progress note on 02/27/24 at 9:17 A.M. revealed the resident left for an orthopedic appointment. On 02/27/24 at 10:43 A.M. the resident returned. It stated a visit summary was unavailable. Office contacted for findings or new orders. Office provided doctor referral to wound care with no other details available. Interview with Nursing Assistant #170 on 02/27/24 at 2:45 P.M. confirmed a couple months ago she was transferring Resident #36 from the bed to the chair by herself. She stated during the transfer, the resident slid to the mat on the floor by the bed. She stated the resident was supposed to be a two person transfer but she did not know that at the time. She stated the resident then had a broken foot a few days later. Interview with the Director of Nursing (DON) and MDS Registered Nurse #197 on 02/28/24 at 8:15 A.M. revealed the fracture diagnosed for Resident #36 on 12/20/23 was attributed to the fall on 12/18/23. The DON stated Nursing Assistant #170 did not use a gait belt to transfer Resident #36 from bed to chair, and should have. She stated that after the fall, she told Nursing Assistant #170 not to transfer the resident by herself. They confirmed the plan of care and [NAME] used by the nursing assistants (prior to the incident) did not specify if Resident #36 was to be transferred by one staff or two. The DON stated Resident #36 had always been a one staff assist for transfers but that Nursing Assistant #170 couldn't do it by herself. Interview with the DON on 02/28/24 at 10:45 A.M. revealed Nursing Assistant #170 was educated to use a gait belt for transfers after Resident #36's fall on 12/18/23. In addition, during the interview, the DON revealed the facility did not have any written notes from the orthopedic physician for the visit on 02/27/24. Review of the facility undated policy on Using a Gait Belt revealed using a gait belt while transferring or walking a patient would provide you and the patient increased safety and security. You can control a patient's balance and can keep the patient from falling by using a gait belt. This deficiency represents non-compliance investigated under Master Complaint Number OH00150944. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365313 If continuation sheet Page 8 of 8