Inspection·June 30, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 06/27/23 at 8:05 A.M. and at 8:24 A.M. of Resident #53's urinary catheter bag revealed the bag was not covered exposing the urine collected in the drainage bag and this was visible from the resident's doorway. Interview on 06/27/23 at 8:24 A.M. with Registered Nurse (RN) #261 verified the urine in Resident #53's urinary catheter bag was visible from the doorway. She verified the urine in the urinary catheter bag should not be visible for the respect and dignity of Resident #53. Review of the facility policy titled, Dignity, Respect, & Privacy, undated, revealed the facility was to provide care to residents while maintaining their dignity and privacy. Residents are to always be treated with respect and cared for in a manner that protects their privacy. This deficiency represents non-compliance investigated under Complaint Number OH00143590 and OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 2 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm Based on record review, interview and facility policy and procedure review the facility failed to ensure resident funds were appropriately managed. This affected one resident (Resident #70) of three residents reviewed for funds. The facility census was 96. Residents Affected - Few Findings included: Review of Resident #70's medical record revealed an admission date of 12/08/20 with diagnoses including type II diabetes mellitus with other specified complications, chronic obstructive pulmonary disease with acute exacerbation, morbid (severe) obesity due to excessive calories, and generalized muscle weakness. Review of Resident #70's Resident Fund Manager Service form revealed she authorized the facility to manage her funds on 01/19/21 and she would receive a $50.00 monthly allowance after her care costs were paid to the facility (directly transferred from her account to the facility). Review of Resident #70 quarterly Minimum Data Set (MDS) 3.0 assessment, dated 06/06/23, revealed the resident was cognitively intact. Review of Resident #70's financial statements, dated 02/03/21 to 06/07/23, revealed she had 14 monthly deductions starting 04/04/23 for insurance premiums. A monthly deposit from Social Security of $519.00, a monthly deduction of $264.00 for care costs and a monthly deduction of $255.00 for insurance premium, totaled $519.00. Further review of the statements revealed starting 10/12/22 through 06/07/23, Resident #70 had a monthly balance of one dollar and 33 cents. Record review revealed no evidence the resident was receiving a monthly allowance ($50.00 per month) to use for needed personal purposes. Interview on 06/27/23 at 3:05 P.M. with Resident #70 revealed the facility was taking all of her money for ancillary services insurance premiums and she would like to have her money back. She verified she was a Medicaid recipient and would like to have the $50.00 per month she was permitted to have for personal purposes. Interview on 06/28/23 at 9:40 A.M. with Receptionist #228 revealed residents who receive Medicaid were to get anywhere from $30.00 to $50.00 per month, depending on the resident. She reported the money was for residents to purchase personal items needed. Receptionist #228 reported she was directed by former Business Office Manager #341 to take the insurance premium for ancillary services out of residents' accounts who signed up for ancillary services. She reported Corporate Accounts Receivable Director (CARD) #337 was now her supervisor and overseeing the resident accounts. Telephone interview on 06/29/23 at 11:08 A.M. with CARD #337 revealed upon review of Resident #70's account, there was a deduction taken out of her funds by Social Security. Since the facility was not the resident's representative payee, the Social Security office would not release any information to the corporation regarding the reason for the Social Security deduction. CARD #337 indicated Resident #70 did not permit the facility to be the representative payee and therefore, the resident needed to contact the Social Security office to inquire about the garnishing of her monies. Interview on 06/29/23 at 11:30 A.M. with Receptionist #228 verified Resident #70 has had 14 deductions from her account for Insurance Premiums (for ancillary care) starting on 04/04/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 3 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Telephone interview on 06/29/23 at 11:39 A.M. with CARD #337 revealed she had spoken to her supervisor and the resident would be provided back pay with interest. She reported she would look at Resident #70's account and calculate since the insurance premiums started being taken out, 04/04/22, and when Social Security started garnishing her monies, what her interest would be. She verified Resident #70 should have been left with $50.00 monthly in her account for personal purposes and that the additional deductions should not have been taken. Interview on 06/29/23 at 1:00 P.M. with the Administrator revealed she had been attempting to correct Resident #70's funds concern since 04/11/23 and would be upset if she had a banking error that was not resolved timely. Review of the facility policy titled, Managing Resident Personal Funds, revised 01/20/21, revealed nursing homes residents supported by Medicaid were entitled to maintain a small personal funds account, to be used for personal preference items. A Medicaid resident had the right to a small personal allowance each month, usually from his/her Social Security income, to use for personal purposes. The resident may entrust the funds to the facility but was not required to do so. The facility was required to accept and serve as fiduciary for those residents. This deficiency is an incidental finding during investigation of Master Complaint Number OH00144114, Complaint Number OH00143590 and OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 4 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Self-Reported Incident (SRI) review, medical record review, interview and facility policy review the facility failed to prevent misappropriation of narcotics. This affected one resident (Resident #73) of three residents reviewed for abuse/neglect/misappropriation. The facility census was 96. Residents Affected - Few Findings included: Review of Resident #73's medical record revealed diagnosis including fibromyalgia. Review of the resident's medication orders revealed the resident had an order for Norco 5-325 milligrams (mg) four times a day. Review of facility self-reported incident (SRI), tracking number 234072 revealed on 04/15/23 at 3:34 A.M. the outside pharmacy delivered medications to the facility. Per Licensed Practical Nurse (LPN) #300's statement, she checked the medications in and then gave three narcotic medications (each contained in a medication card, unit dose for 30 tablets) to Registered Nurse (RN) #339 which included a 30 count card of Norco (narcotic pain medication) 5-325 milligrams (mg), Ativan (anti-anxiety medication) and tramadol (pain medication). Per LPN #340's statement, when RN #339 delivered the medications to LPN #340, only two narcotic medication cards were provided to him for the hall he was working which did not include the Norco for Resident #73. During the day shift medication administration, it was identified the Norco was missing when the last Norco was used from the previous card (for Resident #73). Pharmacy was contacted to have the medication refilled and confirmed the medication had been delivered on 04/15/23 at 3:34 A.M. and signed as received by LPN #300. Statements were obtained from LPN #300 and #340 and RN #339. RN #339 stated she believed there were only two cards of medication given to her and she gave them to LPN #340. The facility determined the allegation of misappropriation was inconclusive as they were unable to determine if medications were misappropriated by the alleged perpetrator (RN #339). It was suspected but the facility was unable to make the determination that this had occurred through witness statements. Not only was the (narcotic) card missing but also the sheet (used to sign each dose removed from the medication card) that goes with the card. Review of the investigation file revealed the facility became aware of the missing controlled narcotic (Norco) during day shift on 04/15/23 when the floor nurse (current Director of Nursing (DON)) was using the last of Resident #73's narcotic medication and reached out to the pharmacy to send the next card. Per the current DON's signed statement, the pharmacy reported the medication was delivered during night shift on 04/15/23 at 3:40 A.M. There were three nurses working and on the schedule during the time of the delivery. LPN #300, Registered Nurse (RN) #339 and LPN #340. Review of the statements revealed LPN #300 signed for Resident #73's controlled narcotic (Norco), with two other controlled substances (Ativan and tramadol) and then handed them off to RN #339 who then handed the medications off to LPN #340. RN #339's statement by telephone revealed she believed she was only handed the Ativan and tramadol by LPN #300. LPN #340's statement by email revealed he was only handed the Ativan and tramadol by RN #339. Interview on 06/29/23 at 1:42 P.M. with the DON revealed she was the nurse on duty who was working and discovered Resident #73's controlled narcotic (Norco) was missing. She reported she reached out to the pharmacy to send the next card of Norco for Resident #73 because she was using the last dose in the current card of medication. The pharmacy reported to her the Norco was delivered to the facility at 3:40 A.M. on 04/15/23. The DON and Licensed Practical Nurse (LPN) Supervisor #99 completed a whole house audit of controlled substances and Resident #73's controlled narcotic (Norco) was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 5 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0602 found. Level of Harm - Minimal harm or potential for actual harm Review of the investigation file revealed LPN #300 was urine tested on [DATE] and the results were negative, RN #339 was urine tested on [DATE] and the results were positive for cannabinoids on 04/27/23, and LPN #340 was urine tested on [DATE] and the results were negative. RN #339 was terminated on 05/02/23 related to her urine drug screen results. Residents Affected - Few On 06/29/23 at 4:10 P.M. interview with the DON and Administrator verified the Norco was delivered to the facility on [DATE] and the facility was unable to locate the Norco for Resident #73. Review of the facility policy titled, Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, dated 10/2022, revealed misappropriation of resident property was the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent. This deficiency represents non-compliance investigated under Complaint Number OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 6 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview and facility policy and procedure review, the facility failed to ensure oxygen tubing was dated and stored properly. This affected one resident (Resident #87) of seven residents reviewed for oxygen use. The census was 96 Residents Affected - Few Findings include: Review of Resident #87's medical record revealed he was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease, diabetes, and mild protein calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed his cognition was intact. He required extensive assistance of two or more staff members for bed mobility, transfers and extensive assistance of one staff member for dressing, toilet use and personal hygiene. Review of the physicians orders for June 2023 revealed orders for oxygen two to four liters by nasal cannula at night time and Xopenex (a bronchodilator) every four hours via nebulizer for shortness of breath. Review of the treatment record for June 2023 revealed to change oxygen supplies every week on Sunday. On 06/27/23 at 3:00 P.M. and 3:25 P.M. observation revealed Resident #87's oxygen tubing was dated 06/18/23 and the nasal cannula was tied to the resident's bed rail. The resident's nebulizer tubing was also not dated and the nebulizer mouthpiece was laying on a chair in the resident's room, not covered or stored to prevent possible contamination. Review of the policy and procedure Oxygen Handling revised 01/21 revealed Oxygen tubing and other equipment will be changed routinely. This deficiency is an incidental finding during investigation of Master Complaint Number OH00144114, Complaint Number OH00143590 and OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 7 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and staff interview, the facility failed to identify and treat potential incidents of pain and implement a comprehensive and individualized pain management plan for Resident #67 who was observed to experience discomfort/possible pain during care. This affected one resident Resident (Resident #67) of three residents reviewed for urinary catheters. The census was 96. Residents Affected - Few Findings include: Review of Resident #67's medical record revealed she was admitted to the facility on [DATE] with diagnoses including sepsis, encephalopathy, diabetes, Alzheimer's dementia, and mild protein calorie malnutrition. Review of the pain assessment dated [DATE] revealed the no evidence staff identified the resident had any type of pain. The resident did not have a care plan for pain. Review of the admission physician orders revealed a #16 French indwelling urinary catheter with the balloon inflated to 10 milliliters due to a neurogenic bladder, catheter care every shift, and monitor for pain (with numerical scale of 1-10) every shift. There was no order for scheduled or as needed (PRN) pain medication. Review of the five-day Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident was cognitively impaired. The assessment revealed the resident required extensive assistance from two or more staff members for bed mobility and total dependence from two or more staff members for transfers, dressing, and toilet use. On 06/27/23 at 11:10 A.M. State Tested Nursing Assistant (STNA) #242 was observed providing urinary catheter care to the resident. The STNA closed the blind and explained to Resident #67 she was going to provide the resident with catheter care. At this time, Resident #67 was heard stating, no-no-no-no. The STNA proceeded to provide care and told the resident, I know it hurts (while lowering the head of the resident's bed) but we have to lower it so care can be completed. STNA #242 provided the resident catheter care and then turned Resident #67 onto her left side at which time the resident moaned and called out. The STNA continued with the resident's care, washing the resident's buttocks, and changing the disposable incontinence pad that was underneath the resident. While replacing the pad underneath the resident and turning the resident, she again yelled out and appeared to be in pain. STNA #242 explained the need to replace the resident's bed linens. The STNA then placed a pillow between the resident's legs and the resident again moaned and yelled out; the resident appeared to be in distress during the procedure. On 06/27/23 at 11:35 A.M. interview with STNA #242 revealed she was unaware whether the resident received anything for pain. Following the surveyor's observation, review of a progress note, dated 06/27/23 at 12:09 P.M. revealed the nurse practitioner was updated of the resident yelling out during peri-care and at times throughout the shift. A new order was given for Tylenol 650 milligrams (mg) for general pain/discomfort. Review of the physician's orders revealed an order for Tylenol 650 mg every four hours as needed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 8 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 0697 for general discomfort. Level of Harm - Minimal harm or potential for actual harm On 06/27/23 at 2:30 PM. interview with the Director of Nursing (DON) and the Administrator revealed staff had reported the resident had been moaning and calling out with care but they were told this was a behavior when staff touched the resident and not necessarily pain related. The DON stated a new pain assessment had since been completed and the resident's primary care provider ordered Tylenol 650 milligrams (mg) every four hours as needed for pain. Residents Affected - Few Review of the June 2023 Medication Administration Record and progress notes revealed on 06/27/23 at 12:12 P.M. the resident received Tylenol 650 milligrams (mg) for a pain rating of five on a 0-10 pain scale (with ten being the most severe pain) and the medication was determined to be effective; on 06/28/23 at 8:00 A.M. the resident received Tylenol 650 mg (no pain rating provided) and the medication was determined to be effective; on 06/29/23 at 5:37 A.M. the resident received Tylenol 650 mg for a pain rating of 8 on a 0-10 scale and the medication was determined to be effective. On 06/29/23 at 1:24 P.M. interview with STNA #242 revealed she felt Resident #67 had been more comfortable with positioning since 06/27/23 when the Tylenol order was added and stated if the resident doesn't feel good, she called out in pain. STNA #242 reported if a resident was having pain or complains of pain, she was to stop whatever she was doing with that resident and report the resident's complaints to the nurse. She reported if the resident had pain medications ordered, the nurse could administer the medication. The STNA stated she had noticed that if Resident #67 called out, it could be time for her pain medication. On 06/29/23 at 1:24 P.M. interview with Registered Nurse (RN) #309 revealed she felt Resident #67's pain management plan was currently effective. She reported she worked with Resident #67 last week and noted she winced in pain in her shoulder. RN #309 reported she notified the physician, and an x-ray was ordered, but the physician did not want to order any pain medications until he knew what the cause was of the pain. RN #309 reported the x-ray was negative, and the physician still did not order any pain medication because he wanted to assess her for a rotator cuff injury. RN #309 reported she knows when a cognitively impaired resident is experiencing pain by signs (of pain). She reported she looks for guarding, wincing, or other facial expressions. RN #309 reported sometimes it was very difficult to determine if a resident was having pain or if it was a behavior but in these cases you do right by the resident and notify the physician of your findings. RN #309 reported the physician makes the ultimate decision of whether a resident's presentation was pain or behavioral. She reported the nurse on duty needed to provide the physician with his or her findings. The RN verified the resident currently had an order for Tylenol for pain management. The facility did not have a policy regarding pain management. This deficiency represents non-compliance investigated under Complaint Number OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 9 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, record review and policy review the facility failed to store and prepare food in a sanitary manner. This has the potential to affect 95 residents in the facility. The facility identified one resident (Resident #63) did not receive food by mouth from the kitchen The facility census was 96. Findings included: 1. Review of food temperature logs for May 2023 revealed food temperatures were not taken during preparation, and during holding for the dinner meal hot items on 05/09/23, breakfast meal and lunch meal cold items on 05/13/23, lunch meal hot items on 05/13/23, dinner meal hot items on 05/18/23, lunch meal cold items on 05/25/23, dinner meal cold items on 05/27/23, dinner meal cold items on 05/28/23, breakfast, lunch and dinner meal hot items on 05/30/23, and dinner cold items on 06/07/23. Interview on 06/27/23 at 9:25 A.M. with Dietary Manger #251 verified there was missing documentation to verify food temperatures were obtained. 2. Observation on 06/27/23 at 10:15 A.M. of the prep refrigerator revealed a partially used bag of spinach which was left open to air. An interview at the time of the observation with Dietary [NAME] #287 verified items in the refrigerator should be closed to keep food protected. 3. Observation on 06/27/23 at 10:51 A.M. of Dietary [NAME] #284 pulling tongs from overhead storage and entering the walk-in cooler to obtain hotdogs and sausage to cook for residents. Dietary [NAME] #284 placed seven hotdogs from a container in the refrigerator into a container in her hand. Observation revealed the tongs had a dried, crusty, white substance inside the arm and serving part of the tong. The Dietary [NAME] #284 verified the substance and stated, These are dirty. She then left the walk-in cooler to obtain another tong which were clean. Dietary [NAME] #284 then reentered the walk-in cooler and obtained a sausage and placed it in the container with the hotdogs. Interview on 06/27/23 at 12:15 P.M. with Dietary [NAME] #284 verified she cooked one of the hotdogs she obtained with the dirty tongs for Resident #64 and the sausage for Resident #91. Interview on 06/27/23 at 12:20 P.M. with Regional Culinary Director #333 verified the hotdogs should have been discarded after being handled with the dirty tongs and if he had known they had been touched by the dirty tongs, he would have had Dietary [NAME] #284 discard them. 4. Observation on 06/27/23 at 10:52 A.M. of Speech Therapist #302 walking into the kitchen near a food preparation table with her hair not properly contained in a hair net. She had her hair in a loose ponytail and only the upper part of her hair was contained inside a hair net. An interview at the time with Regional Culinary Director #333 verified Speech Therapist #302 was not wearing her hair net appropriately and her hair was not contained in it. 5. Observation on 06/27/23 at 10:54 A.M. of the bench can opener (large can opener attached to a counter) blade with dark, crusted substance. An interview at the time with Regional Culinary Director #333 verified the can opener was dirty. Interview on 06/27/23 at 12:30 P.M. with Dietary Manager #251 verified the bench can opener was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 10 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 dirty, and the dirt did not appear to be from use of the can opener today. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled, Cleaning Bench Can Opener, created and revised 09/08/21, revealed the bench can opener will be cleaned and sanitized after each use and as needed. Residents Affected - Many Review of the facility policy titled, General Cleaning of Equipment, created 10/01/21 and revised 10/01/21, revealed basic cleaning equipment will be maintained in a clean and sanitary condition after every yes to ensure food safety. This deficiency represents non-compliance investigated under Complaint Number OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 11 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 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 medical record review, staff interview, observation and facility policy and procedure, the facility failed to follow proper infection control procedure related to indwelling catheter care and medication administration. This affected one resident (Resident #67) of three residents reviewed for urinary catheters and one resident (Resident #88) of three residents observed for medication administration. The census was 96. Residents Affected - Few Findings include: 1. Review of Resident #67's medical record revealed she was admitted to the facility on [DATE]. Diagnoses included sepsis, encephalopathy, diabetes, Alzheimer's dementia, and mild protein calorie malnutrition. Review of the five-day Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed her cognition was not intact. She required extensive assistance of two or more staff members for bed mobility, total dependence of two or more staff members for transfers, dressing, and toilet use. On 06/27/23 at 11:10 A.M. observation revealed State Tested Nursing Assistant (STNA) #242 applied gloves, closed the window blind and explained to Resident #67 the care to be provided. STNA #242 closed the curtain around the resident's bed, removed her gloves and applied a new pair of gloves without washing her hands. STNA #242 then removed the old catheter anchor that was on the resident's right leg. The STNA then removed her gloves and applied a new pair without washing her hands. STNA #242 removed her gloves, applied new gloves without washing her hands. STNA #242 washed the resident's buttocks and then removed her gloves and applied new gloves without washing her hands. On 06/27/23 at 11:35 A.M. interview with STNA #242 verified she had not washed her hands between glove changes 2. On 06/28/23 at 7:50 A.M. during observation of medication administration for Resident #88 by Licensed Practical Nurse (LPN) #230 revealed Resident #88 dropped a pill in her bed and LPN #230 picked up the pill with her ungloved hand and gave the pill to Resident #88 to take. Then LPN #230 placed the resident's hearing aides into both ears, exited the resident's room and went back to the medication cart without washing her hands. LPN #230 then began to prepare medications for the next resident. On 06/28/23 at 8:20 A.M. interview with LPN #230 verified she had not washed her hands after providing resident care and returning to the medication cart to prepare medications Review of the policy and procedure for Hand washing dated 03/19 revealed hands should be washed after touching a resident or handling his/her belongings. This deficiency represents non-compliance investigated under Complaint Number OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 12 of 13 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 365394 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Adams Lane 1856 Adams Lane Zanesville, OH 43701 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and interview the facility failed to ensure a safe environment for the residents, staff and the public. This had the potential to affect all 13 ambulatory residents (#8, #15, #19, #22, #24, #35, #50, #52, #56, #83, #88, #89, and #100) identified by the facility. The facility census was 96. Findings included: 1. Observation on 06/27/23 at 7:55 A.M. of a large hole in the asphalt in the visitor parking lot. There was a drain noted in the center of the hole. On the lowest corner of the drain was an orange safety cone which had been flattened, cracked, and was lying flat in the hole. Resident #15 was walking around the visitor parking lot at the time of the observation. Interview on 06/27/23 at 3:30 P.M. with Receptionist #228 revealed the large hole has been present since she started working in the facility September 2022. Observation on 06/27/23 at 3:40 P.M. with the Maintenance Supervisor #214 revealed the large hole in the visitor parking lot measured four feet by three-and-one-half feet by six inches deep. The asphalt at the edge of the hole was crumbly and in the center was a drain. An interview at the time with Maintenance Supervisor #214 revealed the drain had been sinking for a long time but was unable to specifically recall when it began. He verified the area was a driving and walking hazard. 2. Observation on 06/27/23 at 3:15 P.M. of a metal cap in the floor at the beginning of the 200- hall moving and spinning as this surveyor walked on it. This surveyor tripped due to the unstable metal cap. STNA #317 verified it was a safety hazard and didn't know how long the cap had been loose. The unit was the skilled rehabilitation unit where residents had therapy to prepare to return home. Observation on 06/27/23 at 3:27 P.M. revealed Maintenance Supervisor #214 was leaning over the drain with the drain cap in his hand. He had a drill and screws to secure the cap to the floor. An interview at the time revealed the screws were taken out of the drain cap around 11:30 A.M. on 06/27/23 because he needed to put chemicals down the drain. He reported he got busy and didn't come back to put the screws back in. Further interview verified the cap not being properly secured was a safety issue. This deficiency is an incidental finding during investigation of Master Complaint Number OH00144114, Complaint Number OH00143590 and OH00143268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 13 of 13