Inspection·September 6, 2023

F 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm Based on medical record review and interview, the facility failed to ensure a significant change assessment was initiated when a resident was admitted to hospice services. This affected one (Resident #91) of 21 residents who were reviewed regarding requirements for significant change assessments. The census was 100. Residents Affected - Few Findings include: Review of Resident #91's medical record revealed diagnoses including malignant neoplasm of the prostate, secondary malignant neoplasm of the bone, abnormal weight loss, and depression. Review of hospice notes revealed an initial visit was made on 08/02/23. On 08/03/23 an order was written to admit Resident #91 to hospice. There was no evidence the facility initiated a significant change Minimum Data Set (MDS) assessment. On 08/29/23 at 8:57 A.M., Regional Nurse #206 verified Resident #91 had an order admitting him to hospice dated 08/03/23 and a significant change MDS had not been initiated but should have been. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 2 of 11 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 09/06/2023 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NONCOMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based on closed medical record review, review of an emergency medical services (EMS) report, interviews with facility staff and review of facility Code Status policy the facility failed to immediately initiate cardiopulmonary resuscitation (CPR) for Resident #94. This resulted in Immediate Jeopardy and the actual serious life-threatening harm and death on [DATE] beginning at 5:22 A.M. when Resident #94, who had advance directives for cardiopulmonary resuscitation/full code status, was found unresponsive, without a pulse, and was not provided CPR. The facility notified EMS for hospital transport without completing a comprehensive assessment of the resident ' s status. Resident #94 was assessed to be deceased by EMS without evidence of having received life saving measures. This affected one resident (#94) of two residents reviewed for an emergent change in condition and death. The facility identified 51 residents with a full code status. The facility census was 100. On [DATE] at 3:50 P.M., the Administrator, Regional Director of Clinical Operations #300, Regional Registered Nurses (RN) (#206, #207, and #208), and the Director of Nursing (DON) were notified Immediate Jeopardy began on [DATE] at 5:22 A.M. when State Tested Nursing Assistant (STNA) #100 found Resident #94 unresponsive. STNA #100 notified Licensed Practical Nurse (LPN) #101 of the resident ' s status, however LPN #101 failed to complete a comprehensive assessment of the resident and failed to immediately initiate CPR despite the resident ' s wishes for a full code status. LPN #101 notified EMS of the need to transport the resident to the hospital however the resident was pronounced deceased upon EMS arrival (exact time unknown but EMS arrived at the facility at 5:38 A.M.). The Immediate Jeopardy was removed, and the deficiency corrected on [DATE] when the facility implemented the following corrective actions. • On [DATE], Resident #94 expired in the facility. • On [DATE] at 6:25 A.M., the DON immediately educated Licensed Practical Nurse (LPN) #101 on the facility's Code Status Policy. • On [DATE] at 10:00 A.M., Human Resources Manager #194 audited employee files for all licensed nurses to ensure they had valid, active CPR certification. • On [DATE] at 11:17 A.M., the facility completed an ad hoc Quality Assurance and Performance Improvement (QAPI) plan related to the abatement. The Administrator, Medical Director #301, and the DON were in attendance. The plan was approved by the committee including ongoing compliance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 3 of 11 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 09/06/2023 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 0678 • Level of Harm - Immediate jeopardy to resident health or safety On [DATE] at 12:00 P.M., the DON, RN #160 and LPNs (#115 and #171) audited all hard copies of advanced directives in current resident's medical records to ensure they were present, appropriately signed and had a physician's order in place. Residents Affected - Few • On [DATE] from 8:30 A.M. to 4:33 P.M., the DON educated all 31 licensed nursing staff on the facility CPR policy and steps to take when finding a resident without vital signs. • Beginning [DATE] the facility implemented a plan for the DON/designee to ensure nursing staff understood the Code Status Policy and when finding a resident without vitals to ensure adherence to Code Status Policy. Audits were completed three times per week for two weeks, then two times per week for two weeks, and then weekly for two weeks, then as determined necessary. Audits were completed ongoing every two weeks since original schedule completion. • Between [DATE] and [DATE] no additional resident concerns were identified related to CPR. • On [DATE] between 10:45 A.M. and 11:20 A.M. interviews with the Administrator, DON, RN (#160 and #304), LPN (#124, #171, #191, and #192), STNA (#122, #190, and #209) verified they were educated on the facility CPR policy. Findings include: Review of Resident #94's closed medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including anxiety disorder, dementia, fibromyalgia, osteoarthritis, muscle weakness, and repeated falls. Review of a physician order, dated [DATE], revealed Resident #94 was a full code. Review of Resident #94's medical record from [DATE] through [DATE] revealed no documentation of Resident #94 or Resident #94's physician changing Resident #94's code status from a full code. Review of Resident #94 ' s care plan, dated [DATE], revealed Resident #94 desired to be a full code with cardiopulmonary resuscitation (CPR) initiated with the absence of pulse, respirations, and/or blood pressure. Interventions included supporting Resident #94/family with their decision and to honor their preference. Review of Resident #94's quarterly Minimum Data Set (MDS) 3.0 assessment, dated [DATE], revealed the resident had severe cognitive impairment. The assessment revealed the resident required extensive, one-person physical assistance from staff for bed mobility. The resident required supervision from staff for eating, transfers, toileting, and personal hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 4 of 11 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 09/06/2023 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of Resident #94 ' s nursing progress note, dated [DATE] at 5:22 A.M. and authored by LPN #101, revealed State Tested Nursing Assistant (STNA) #100 called LPN #101 into Resident #94 ' s room, the resident was without vital signs by verification of two nurses (identified as LPN #101 and LPN #102) (the progress note did not provide additional details regarding how this was verified). The progress note indicated EMS was notified. EMS arrived and the resident was with vital signs on electrocardiogram (EKG). The deputy was called due to the inability to reach the medical doctor. Resident #94 ' s sister was notified by the deputy. The note also indicated the coroner ' s office would be en route after the notification. Review of an emergency medical services (EMS) report, dated [DATE], revealed EMS were dispatched to the facility on [DATE] at 5:26 A.M., were reroute at 5:31 A.M., and at the scene at 5:38 A.M. Upon arrival, Resident #94 was found lying in bed, unresponsive and apneic (not breathing). The resident was cold to the touch with lividity and the initial stages of rigor. Facility nurse stated the resident was a full code, was found this way just prior to the call to EMS, and CPR was not performed due to the resident ' s obvious death. The resident was last seen approximately two hours prior. The facility was unable to reach their medical director. An EKG was obtained and revealed asystole (cessation of electrical activity of the heart) in three leads. The communication center notified the county sheriff ' s office and a deputy arrived on scene, took over, and contacted the coroner. Review of Resident #94's nursing progress note, dated [DATE] at 7:40 A.M. and authored by the Director of Nursing (DON), revealed there was an order to release the body to the funeral home as requested by the family. Review of LPN #101's witness statement, dated [DATE], revealed her last rounds were at 3:00 A.M. At 5:20 A.M., STNA #100 called her to the memory care unit for a resident without vital signs. EMS was called at 5:22 A.M. A second nurse, (identified as LPN #102), verified there were no vital signs. Review of STNA #100 ' s witness statement, dated [DATE], revealed Resident #94 went to bed at 10:45 P.M. During rounds, STNA #100 checked on the resident at 1:00 A.M. and observed her in bed, lying on her side and sleeping. STNA #100 checked on the resident again at 3:05 A.M. and the resident was still on her side and sleeping. During STNA #100 ' s last round at 5:15 A.M., the resident was lying on her back in bed. STNA #100 attempted to wake the resident with no response and notified the nurse (identified as LPN #101). During interview on [DATE] at 11:24 A.M., LPN #101 stated she was working on Hallway 100 or 200 (on [DATE]) when STNA #100 alerted her that Resident #94 was cold and unresponsive. LPN #101 stated she tapped on the resident ' s shoulder and called her name and there was no response. LPN #101 stated the only vital sign that she obtained was a radial pulse, which was absent, she then left the resident ' s room to get help and called EMS from the nursing station. During this time, LPN #101 stated she asked LPN #102 to check on Resident #94 to verify there was no pulse. LPN #101 stated she did not administer oxygen or start CPR because as soon as she started back into the room, EMS had arrived. LPN #101 stated that she was unsure of how many minutes passed from the time she was notified by STNA #100 of Resident #94 being unresponsive until EMS arrived, but that it felt like a matter of minutes. LPN #101 verified Resident #94 was a full code and CPR should have been administered. An additional interview on [DATE] at 2:23 P.M. with LPN #101 verified her nursing progress note, dated [DATE] at 5:22 A.M., contained a documentation error. LPN #101 indicated Resident #94 did not have any vital signs on EKG as indicated in the progress note. During interview on [DATE] at 11:51 A.M., STNA #100 stated she was doing her morning rounds and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 5 of 11 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 09/06/2023 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few getting residents up when she noticed, from the doorway, that Resident #94 was uncovered. STNA #100 stated she walked into the room to check on the resident and noticed the resident was not moving, and her hand was cold. STNA #100 attempted to contact LPN #101 on her handheld, two-way radio, without success, and then went to get her on the 100 Hallway. STNA #100 revealed she did not return to Resident #94 ' s room because she stayed at the door awaiting EMS. During interview on [DATE] at 12:18 P.M., Regional RN #207 revealed the facility knew this incident was an issue and stated they identified it immediately after CPR was not initiated on Resident #94 who was a full code. During interview on [DATE] at 6:08 P.M., LPN #102 stated Resident #94 was not provided CPR and that she did not obtain any vital signs because the resident was unresponsive and cold. This surveyor asked LPN #102 if CPR should have been initiated for Resident #94 after being found unresponsive and without a pulse. LPN #102 stated yes, CPR should have been started and that she knows that now, after receiving the facility in-service education on CPR. During interview on [DATE] at 11:22 A.M., Physician #301 stated that although he was unsure if Resident #94 would have survived CPR efforts, it was unfortunate the staff did not follow the resident's advanced directive order. Review of the facility undated policy titled, Code Status, revealed in accordance with the State of Ohio Do Not Resuscitate (DNR) Comfort Care Protocol the facility would ensure a resident ' s wishes were carried out as they desire. Every effort to maintain a resident ' s wishes and dignity would be carried out as requested by the resident/or resident representative or family. Full Code was when a resident was identified as a full code and the facility staff would provide emergent measures in attempt to resuscitate the patient. This may involve chest compressions, electric shocks, and emergency medications that act to temporarily keep blood moving to essential organs such as the brain. All measures would be attempted to maintain the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 6 of 11 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 09/06/2023 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 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. 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, financial record review, and staff interview, the facility failed to provide an adequate plan to spend down resident finances when funds were above the Medicaid allowable limit. This affected three (Residents #19, #23, and #37) of six resident financial information reviewed. The census was 100. Residents Affected - Few Findings Include: 1. Resident #19 was admitted to the facility on [DATE]. Her diagnoses included atherosclerotic heart disease, major depressive disorder, anxiety disorder, and cognitive communication deficit. Review of her Minimum Data Set (MDS) assessment, dated 07/16/23, revealed she had a significant cognitive impairment. Review of Resident #19's quarterly financial statements, dated 07/01/22 to 06/30/23, revealed her total amount in her resident account varied between $2986.96 and $7191.37; it was never below $2000. Review of Resident #19's medical records, which included progress notes, social service notes, and care plans, revealed no documentation to support the facility had a plan in place to assist Resident #19 with spending her money in hopes of not losing her Medicaid insurance benefits, due to her resident financial account being more than $2000. Review of Resident #19's spend down notices revealed the facility sent notices to Resident #39 on 08/25/22, 09/26/22, 10/27/22, 11/29/22, 12/28/22, 01/24/23, 03/29/23, 04/45/23, 05/22/23, and 06/27/23. On each spend down notice, it stated, this letter is to notify you that your current Resident Fund balance is within $200 or exceeding what is allowable under Medical Assistance. Please contact your social worker within the next seven days to discuss ways to assure continuance of Medicaid benefits. There was no evidence the facility followed up to create a spend down plan. 2. Resident #23 was admitted to the facility on [DATE]. His diagnoses included atherosclerotic heart disease, atrial fibrillation, major depression, cognitive communication deficit, psychosis, and hypertension. Review of his MDS Assessment, dated 05/23/23, revealed he was cognitively intact. Review of Resident #23's quarterly financial statements, dated 10/01/22 to 03/31/23, revealed his total amount in his resident account varied between $3419.47 and $8141.47; it was never below $2000. Review of Resident #23's medical records, which included progress notes, social service notes, and care plans, revealed no documentation to support the facility had a plan in place to assist Resident #23 with spending his money in hopes of not losing his Medicaid insurance benefits, due to his resident financial account being more than $2000. Review of Resident #23 spend down notices revealed the facility drafted the notice form for Resident #23 on 08/25/22, 09/26/22, 10/27/22, 11/29/22, 12/28/22, and 03/29/23. On each spend down notice, it stated, this letter is to notify you that your current Resident Fund balance is within $200 or exceeding what is allowable under Medical Assistance. Please contact your social worker within the next seven days to discuss ways to assure continuance of Medicaid benefits. There was no evidence the facility followed up to create a spend down plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 7 of 11 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 09/06/2023 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3. Resident #37 was admitted to the facility on [DATE]. His diagnoses included chronic obstructive pulmonary disease, peripheral vascular disease, cerebral infarction, hypertension, and anxiety disorder. Review of his MDS assessment, dated 08/01/23, revealed he was cognitively intact. Review of Resident #37's quarterly financial statements, dated 07/01/22 to 06/30/23, revealed his total amount in his resident account varied between $3971.83 and $9574.78; it was never below $2000. Review of Resident #37's medical records, which included progress notes, social service notes, and care plans, revealed no documentation to support the facility had a plan in place to assist Resident #37 with spending his money in hopes of not losing his Medicaid insurance benefits, due to his resident financial account being more than $2000. Review of Resident #37 spend down notices revealed the facility drafted the notice form for Resident #37 on 08/25/22, 09/26/22, 10/27/22, 11/29/22, 12/28/22, 03/29/23, 04/24/23, 05/22/23, 06/27/23, and 07/20/23. On each spend down notice, it stated, this letter is to notify you that your current Resident Fund balance is within $200 or exceeding what is allowable under Medical Assistance. Please contact your social worker within the next seven days to discuss ways to assure continuance of Medicaid benefits. There was no evidence the facility followed up to create a spend down plan. Interview with Social Worker Designee #174 on 08/30/23 at 12:20 P.M. confirmed she was not aware that she was to help with a spend down plan until not long ago when a family member called her and asked what to do. She has helped residents and families look through magazines and web sites to spend money as needed, but she was not aware she was the primary person to help with spend downs. Interview with Regional Nurse #206, Regional Nurse #207, and Regional Nurse #208 on 08/30/23 at 12:24 P.M. confirmed they are not completely sure what the policy/procedures are for spending down resident finances. They also confirmed resident finances should not be above $2000 when the resident utilized Medicaid. Interview with Administrator on 08/30/23 at 12:46 P.M. confirmed all three residents had a personal funds account that was above $2000. She confirmed they will be enforcing their policy of having the social work designee take lead on developing a plan and implementing a spend down process for any resident having more than $2000 in their funds account. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 8 of 11 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 09/06/2023 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, policy review, review of drug reference information and interview, the facility failed to ensure medications were appropriately labeled and stored. This affected six residents (Resident #21, #29, #65, #67, #89 and #93) of 100 residents residing in the facility. Findings include: 1. On [DATE] at 8:54 A.M., Licensed Practical Nurse (LPN) #124 was observed preparing and administering medication to Resident #67. There was no expiration date on the bottle of enteric coated aspirin 81 milligram (mg) dose. LPN #124 verified she was unable to locate an expiration date on the aspirin bottle at the time of preparation/administration. 2. On [DATE] at 10:16 A.M., observation of the 400 hall medication cart revealed there was an open/used insulin pen for Resident #65 which was not dated. There was a box with an open vial of Humulin 70/30 insulin which was undated with no name. On [DATE] at 10:16 A.M., LPN #157 verified Resident #65's insulin pen did not contain a date when it was opened. LPN #157 stated the Humulin 70/30 was being used for Resident #21, stating his name must have gotten torn off the box. LPN #157 verified the Humulin 70/30 vial did not contain information regarding the date it was opened. 3. On [DATE] at 10:25 A.M., observation of 200 hall medication cart revealed Resident #93 had an opened insulin glargine dated [DATE]. Resident #89 had an open vial of insulin glargine with two dates on it ([DATE] and [DATE]) and an open vial of insulin aspart dated [DATE]. Resident #29 had insulin glargine and novolog pens which were not dated and had expired and had an open lantus pen with no date indicating the date it was opened. On [DATE] at 10:25 A.M., Registered Nurse (RN) #156 verified the dates Resident #89's and #93's insulin was opened and verified Resident #29 had two insulin pens which were not dated but expired and one insulin pen without the date indicating when it was opened. Review of the Medscape web site revealed the insulin could be stored for a maximum of 28 days at room temperature when opened or unrefrigerated. Review of the facility's Storage of Medications policy, dated [DATE], revealed the facility should not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs should be returned to the dispensing pharmacy or destroyed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 9 of 11 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 09/06/2023 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 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 medical record review, staff interview, and facility policy review, the facility failed to ensure antibiotic stewardship guidelines were followed prior to antibiotic use. This affected one (Resident #299) of one resident reviewed for antibiotic stewardship. The census was 100. Residents Affected - Few Findings Include: Resident #299 was admitted to the facility on [DATE]. Her diagnoses were sepsis, rectal abscess, difficulty walking, type II diabetes, muscle weakness, chest pain, obesity, anemia, vitamin D deficiency, tobacco use, hypertension, major depressive disorder, osteoarthritis, fibromyalgia, and headache. Review of her Minimum Data Set (MDS) assessment, dated 08/14/23, revealed she was cognitively intact. Review of Resident #299 physician orders revealed she was prescribed Doxycycline Hyclate Oral Tablet 100 milligrams, twice daily for seven days. Initially, this medication justification was for infection, but then it was clarified to be for an abscess to her buttocks. Review of Resident #299 medication administration record (MAR), dated August 2023, confirmed she was administered the Doxycycline twice daily as ordered. Review of Resident #299 and facility infection control documentation and progress notes, dated 08/25/23 to 08/29/23, revealed Resident #299 had a McGeer's assessment completed on 08/29/23. According to facility documentation, she did not meet criteria for an antibiotic, which was relayed to the nurse practitioner on that same day. The nurse practitioner decided to keep her on this medication for the remainder of the order. There was no documentation prior to 08/29/23 to determine if or what type of antibiotic should be used for her infection. Interview with Regional Nurse #206 and Regional Nurse #207 on 08/30/23 at 9:35 A.M. both stated they have to follow the antibiotic stewardship policy prior to ordering/administering an antibiotic. They both agreed that doxycycline was ordered prior to McGeer's assessment being completed for Resident #299. Interview with Registered Nurse (RN) #160 on 08/30/23 at 11:13 A.M. confirmed McGeer's was not completed prior to the ordered/administering of Doxycycline for Resident #299. She confirmed she is the person who does the McGeer's assessment and was not in the building during the time it was initially ordered/administered. Review of facility Antibiotic Stewardship policy, dated December 2017, revealed the CDC has reported that antibiotic resistance is one of the major threats to human health, especially because some bacteria have developed resistance to all known classes of antibiotics. The antibiotic stewardship team will review infections and monitor antibiotic usage patterns on a quarterly basis, obtain and review various reports from pharmacy for institutional trends, monitor antibiotic resistance patterns and report on number of antibiotics prescribed and the number of residents treated each month. Facility will evaluate and communicate clinical signs and symptoms when a resident is first suspected of having an infection. Use of diagnostic testing to optimize tracking and treatment of infections. A method of flagging residents with multidrug-resistant organisms will be instituted by the laboratory. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 10 of 11 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 09/06/2023 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 0881 Level of Harm - Minimal harm or potential for actual harm Review of facility Antibiotic Stewardship Plan, dated 10/19/18, revealed standardized practices to address care for suspected infections and the use of standardized definitions and criteria. This facility will utilize McGeer's criteria for monitoring, and reporting infections for surveillance and treatment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365394 If continuation sheet Page 11 of 11