Inspection·July 12, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of a nurse note dated 06/29/23 at 7:41 P.M. revealed Resident #65 was found on floor sitting with her back against the foot of the chair. Resident #65 stated, I just slid out of my chair and ended up on the floor. Resident #65 was assisted up off the floor by three staff members. A new intervention was implemented to put dycem on the resident's recliner. Review of the medical record revealed on 07/01/23 at 11:30 P.M. Resident #65 was found laying on her back on the middle of the floor. Neurological tests were started due to the resident slid out of bed. The new intervention was dycem to bed. Observation on 07/12/23 at 6:15 P.M. with the Director of Nursing (DON) revealed Resident #65 was sitting in her recliner. The resident stood up with assist of the DON and holding onto the walker handles. There was no dycem on her recliner. The DON lifted the blanket that was on the recliner. There was no dycem under the blanket. The DON checked the resident's bed. There was no dycem on the fitted mattress sheet, under the fitted mattress, under the waffle padding on the top of the mattress nor on either side of the mattress. There was one blue dycem in the closet. The DON verified the dycem was not in place as ordered. 2. Review of Resident #30's medical record revealed a 06/02/23 admission with diagnoses including Parkinson's disease, type 2 diabetes, hallucinations, mild protein calorie malnutrition, paroxysmal atrial fibrillation, ,atherosclerotic heart disease, myocardial infarction, bipolar disorder, depression, Alzheimer's disease, muscle weakness, dementia with psychotic disturbance, malignant neoplasm of prostate, hypertension, repeated falls, transient ischemic attack and obstructive sleep apnea. Review of the medical record revealed the resident had a high risk for falls plan of care on admission related to deconditioning, gait/balance problems, incontinence, and unaware of safety needs. Interventions included Dycem to wheelchair seat when occupied. Review of the 06/08/23 admission MDS included the resident was independent for daily decision making with no behaviors. The resident required extensive assist of two for bed mobility, transfers, toileting, limited assist of one for walking in room, always incontinent of urine and frequently incontinent of bowel movement. Review of the resident record revealed the resident had three falls since admission. Review of a 6/20/23 at 12:10 A.M. progress note included when making rounds the resident was found sitting on the floor beside his bed. Resident #30 state, I slid off. New interventions included to move bed against wall and get a physical therapy evaluation. Review of the medical record revealed on 06/27/23 at 6:31 P.M. Resident #30 was heard yelling out, found sitting on floor in between bed and wheelchair. Resident #30 stated he forgot to lock his wheelchair brakes before sitting. Staff reminded the resident to ask for assistance and put brightly colored sign within view to remind resident to pull call light for assistance. Review of the record revealed on 07/05/23 at 3:30 P.M. Resident #30 was noted laying on the floor in front of his wheelchair beside his recliner chair. Resident #30 stated he was getting up. A new order was implemented for dycem to wheelchair seat. Review of the physician orders revealed an order dated 07/06/23 for dycem to wheelchair when occupied. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 2 of 3 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 07/12/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Observation on 07/12/23 at 6:23 P.M. with the DON revealed Resident #30 was sitting in his wheelchair at the dining table in the common area. The resident stood up with the assist of the DON. There was no dycem on his wheelchair seat above or under the pressure reducing cushion. The DON and Licensed Practical Nurse (LPN) #221 verified there was no dycem on the wheelchair as ordered. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00144345 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 3 of 3