Health inspection·August 8, 2022

F 0569 balance was above the specified limit. Level of Harm - Minimal harm or potential for actual harm 2. Resident #74 was admitted to the facility on [DATE] with diagnoses including atherosclerosis, cognitive communication deficit, acute sinusitis, venous thrombosis, muscle weakness, myocardial infarction, anxiety, depression, COVID-19, dementia, diabetes mellitus type II, hypertension, and peripheral vascular disease. Residents Affected - Some Review of the MDS 3.0 assessment, dated 07/20/22 revealed the resident had no cognitive impairment. Review of Resident #25's financial records revealed she received Medicaid. According to her current account statement, the resident had $4118.00 available in her trust account effective 08/02/22. This was over the maximum allotment of $2000.00. Record review revealed no evidence of a spend down notice being provided for Resident #74. On 08/04/22 at 1:25 P.M. interview with BM #130 verified this resident did not receive a spend down notification after the account reached $2000.00. She also verified the remaining balance was above the specified limit. 3. Resident #34 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, osteoporosis, muscle weakness, COVID-19, mononeuropathy, constipation, and bipolar disorder. Review of the MDS 3.0 assessment, dated 07/04/22 revealed the resident had severe cognitive impairment. Review of Resident #34's financial records revealed she received Medicaid. According to her current account statement, the resident had $4529.26 available in her trust account effective 08/02/22. This was over the maximum allotment of $2000.00. Record review revealed no evidence of a spend down notice being provided for Resident #34. On 08/04/22 at 1:25 P.M. interview with BM #130 verified this resident did not receive a spend down notification after the account reached $2000.00. She also verified the remaining balance was above the specified limit. 4. Resident #37 was admitted to the facility on [DATE] with diagnoses including atherosclerosis, dysphagia, COVID-19, muscle weakness, scapular fracture, cognitive communication deficit, diabetes mellitus type II, depression, anxiety, and anorexia. Review of the MDS 3.0 assessment, dated 07/02/22 revealed the resident had moderate cognitive impairment. Review of Resident #37's financial records revealed she received Medicaid. According to her current account statement, the resident had $4686.22 available in her trust account effective 08/02/22. This was over the maximum allotment of $2000.00. Record review revealed no evidence of a spend down notice being provided for Resident #37. On 08/04/22 at 1:25 P.M. interview with BM #130 verified this resident did not receive a spend down notification after the account reached $2000.00. She also verified the remaining balance was above the specified limit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 2 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, interview and facility policy and procedure review the facility failed to maintain Resident #288's privacy when the resident was not properly dressed resulting in the resident being exposed to others in the hallway from in the room. This affected one resident (#288) of one resident reviewed for dignity. Residents Affected - Few Findings Include: Review of Resident #288's medical record revealed an admission date of 07/22/22 with the admitting diagnoses of COVID-19, chronic kidney disease, congestive heart failure, atrial fibrillation and presence of pacemaker. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 07/29/22 revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10. The assessment revealed the resident required extensive assistance of two staff for bed mobility, dressing, toilet use, personal hygiene and limited assistance of two staff for transfers and ambulation. Review of the plan of care, dated 08/02/22 revealed the resident had a physical functioning deficit related to mobility impairment and self-care impairment. Interventions included call light within reach, encourage choices with care, praise efforts at participation nail care as needed, rehab therapy services as ordered and walking assistance. On 08/01/22 at 11:45 A.M., observation of Resident #288 from the hallway revealed the resident was sitting up in a chair at the bedside with no pants on and the resident's genitalia visible from the hallway. The resident waved the surveyor into the room at the time of the observation and stated, They have left me like this for a week. On 08/01/22 at 11:48 A.M interview with State Tested Nursing Assistant (STNA) #111 verified the resident was inappropriately dressed and the resident's genitalia were visible from the doorway. Review of the facility policy titled Dignity revealed the purpose of the policy was to ensure residents were cared for in a manner and in an environment that maintains or enhances resident's dignity and respect in full recognition of his/her individuality. Dignity meant that in their interactions with residents, staff carry out activities which assist the resident to maintain and enhance his/her self-esteem and self worth. Essential points include to assist with dressing resident appropriately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 3 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #288's medical record revealed an admission date of 07/22/22 with the admitting diagnoses of COVID-19, chronic kidney disease, congestive heart failure, atrial fibrillation and presence of pacemaker. Residents Affected - Few Review of the resident's clinical health status evaluation, dated 07/23/22 revealed the resident was admitted to the facility with an ostomy. Review of the resident's comprehensive Minimum Data Set (MDS) assessment, dated 07/29/22 revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 (out of 15). The assessment revealed the resident required extensive assistance of two staff for bed mobility, dressing, toilet use, personal hygiene and limited assistance of two staff for transfers and ambulation. The assessment was not coded as the resident having an ostomy. Review of the resident's plan of care failed to identify the resident's colostomy. Review of the monthly physician's orders for August 2022 failed to identify any orders for the care of the resident's colostomy. On 08/01/22 at 11:44 A.M. observation of the resident revealed the resident's colostomy was full of yellow liquid stool. On 08/04/22 at 1:44 P.M. interview Registered Nurse (RN) #118 verified the resident's ostomy was not captured/coded on the comprehensive MDS 3.0 assessment, dated 07/29/22. Based on observation, record review and interview the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were accurate for Resident #71 related to the use of anti-depressant medications and for Resident #288 related to an ostomy appliance. This affected two residents (#71 and #288) of 26 residents whose MDS 3.0 assessments were reviewed. Findings Include: 1. Record review revealed Resident #71 was admitted to the facility on [DATE] with a diagnosis of depression. Review of the physician's orders revealed an order, dated 07/12/22 for the anti-depressant medication, Lexapro 20 milligrams (mg) to be administered once daily due to a diagnosis of depression. Review of the care plan, dated 07/12/22 revealed the resident was receiving anti-depressant medication. Interventions included to observe for side effects, consult the pharmacist as needed and provide medication as ordered. Review of the Medication Administration Record (MAR) for 07/2022 revealed the resident received the Lexapro as ordered once a day from 07/13/22 through 07/19/22. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 07/19/22 revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 13 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 4 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete (out of 15). The assessment revealed the resident received no anti-depressant medications during the seven day assessment reference/ look back period. On 08/03/22 at 10:45 A.M. interview with Registered Nurse (RN) #118 verified Resident #71 received the anti-depressant medication from 07/13/22 through 07/19/22 and the use of the anti-depressant medication had not been coded accurately on the admission MDS 3.0 assessment dated [DATE]. Event ID: Facility ID: 365398 If continuation sheet Page 5 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure baseline care planning was comprehensive and included information related to activities of daily living and/or wound care. This affected two residents (#52 and #62) of 26 residents whose assessments and care plans were reviewed. Findings Include: 1. Record review revealed Resident #52 was admitted to the facility on [DATE] with diagnoses including muscle weakness, atrial fibrillation, type two diabetes and cognitive communication deficit. Review of the facility baseline care plan summary, dated 07/02/22 revealed the plan failed to include information regarding the level of assistance the resident required with activities of daily living (ADL). Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 07/08/22 revealed the resident had intact cognition as evidenced by a Brief Interview for Mental Status (BIMS) score of 15 (out of 15). The assessment revealed the resident required limited assistance from two staff members for bed mobility, toileting and transfers and supervision with set up assistance from staff for eating. On 08/04/22 at 1:35 P.M. interview with Registered Nurse (RN) #118 verified the baseline care plan completed for Resident #52 did not include information providing staff the level of assistance the resident required with ADL's. 2. Record review revealed Resident #62 was admitted to the facility on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation, non-pressure chronic ulcer of the right heel and midfoot, muscle weakness, cognitive communication deficit, peripheral vascular disease, non-pressure chronic ulcer of left heel and midfoot, type two diabetes mellitus, and chronic systolic heart failure. Review of the facility Clinical Health Status Evaluation assessment, dated 07/07/22 revealed the resident had wounds to the left and right heel and right toe which were covered with a treatment. Review of the facility baseline care plan Summary, dated 07/08/22 revealed the plan indicated the resident's skin was intact and failed to include information related to the left and right heel and right toe wounds as noted on the assessment. Review of the admission MDS 3.0 assessment, dated 07/14/22 revealed the resident had intact cognition evidenced by a BIMS assessment score of 15 (out of 15). The assessment revealed the resident required staff supervision with one person physical assistance for bed mobility, transfers and toileting, and staff supervision with set-up help only for eating. This MDS assessment revealed the resident had diabetic foot ulcers and surgical wounds. On 08/02/22 at 4:14 P.M. interview with RN #66 verified Resident #62 had wounds present since admission to the facility and verified the baseline care plan summary, dated 07/08/22 was inaccurate as it described the residents skin as being intact and did not indicate the presence of any wounds. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 6 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review and interview the facility failed to ensure a complete and accurate discharge summary was provided for Resident #13 at the time of discharge. This affected one resident (#13) of three residents reviewed for transfer/discharge. Findings Include: Review of Resident #13's closed medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including end stage renal disease, difficult ambulation, dysphagia, cognitive communication deficit, hypertension, hypothyroidism, renal dialysis, urinary tract infection, atrial fibrillation, atherosclerosis, insomnia and glaucoma. Resident #13 was discharged home on [DATE]. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 05/20/22 revealed the resident had no cognitive impairments. Review of the Discharge summary, dated [DATE] revealed the summary failed to include medications the resident was ordered/receiving, evidence of any prescriptions provided at discharge, information related to any upcoming appointments or the resident's dialysis schedule being provided. On 08/03/22 at 12:05 P.M. interview with the Administrator verified the discharge summary provided to Resident #13 did not include the above information and failed to ensure ongoing coordination of care following the resident's discharge. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 7 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to ensure residents who required staff assistance with activities of daily living received adequate and timely assistance with personal care to maintain proper hygiene/grooming/nail care. This affected three residents (#62, #75 and #288) of six residents reviewed for activities of daily living. Residents Affected - Few Findings Include: 1. Review of Resident #75's medical record revealed an admission date of 07/13/20 with the admitting diagnoses of trochanteric bursitis of left hip, generalized muscle weakness, Alzheimer's disease, dementia with behavioral disturbances, low back pain, hypertension, thoracic aortic aneurysm and hearing loss. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 07/20/22 revealed the resident had clear speech, sometimes understood others, sometimes made herself understood and had a severe cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of zero (out of 15). The assessment revealed the resident required assistance from one staff for personal hygiene including nail care. Review of the plan of care, dated 07/22/22 revealed the resident had a self-care deficit related to impaired cognition and poor balance. Interventions included nail care as needed and personal hygiene assistance from one staff. Review of the monthly physician's orders for August 2022 revealed no orders related to nail care. On 08/01/22 at 3:46 P.M. observation of Resident #75's nails revealed they were long, jagged with a large build up of brown substance under the nails. On 08/01/22 at 3:50 P.M. interview with the Administrator verified the resident's nails were long, jagged and dirty. 2. Review of Resident #288's medical record revealed an admission date of 07/22/22 with the admitting diagnoses of COVID-19, chronic kidney disease, congestive heart failure, atrial fibrillation and presence of pacemaker. Review of the resident's comprehensive MDS 3.0 assessment, dated 07/29/22 revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 (out of 15). The assessment revealed the resident required extensive assistance from two staff for bed mobility, dressing, toilet use, personal hygiene and limited assistance from two staff for transfers and ambulation. Review of the plan of care, dated 08/02/22 revealed the resident had a physical functioning deficit related to mobility impairment and self-care impairment. Interventions included call light within reach, encourage choices with care, praise efforts at participation nail care as needed, rehab therapy services as ordered and walking assistance. On 08/01/22 at 11:45 A.M. observation of Resident #288 revealed his fingernails were long, jagged (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 8 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0677 Level of Harm - Minimal harm or potential for actual harm and had a brown substance under the nails. Further observation revealed the resident had several days of facial hair growth. On 08/01/22 at 11:48 A.M. interview with State Tested Nursing Assistant (STNA) #111 verified the resident's nails were long, jagged and had a brown substance under the nail and was unshaven. Residents Affected - Few 3. Record review revealed Resident #62 was admitted to the facility on [DATE] with diagnoses including muscle weakness, cognitive communication deficit, peripheral vascular disease, type two diabetes mellitus and chronic systolic heart failure. Review of the admission MDS 3.0 assessment, dated 07/14/22 revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15 (out of 15). The assessment revealed the resident required supervision with one person physical assist for bed mobility, transfers, personal hygiene and toileting. On 08/01/22 at 10:10 A.M. Resident #62 was observed lying in bed. The resident's fingernails were observed to be approximately one quarter of an inch long with dirt underneath. On 08/02/22 at 9:22 A.M. interview with Resident #62 revealed the resident had requested staff assistance with trimming and cleaning nails but had been told only the nurse could provide nail care due to a diagnosis of diabetes. On 08/02/22 at 9:22 A.M. observation revealed Resident #62's fingernails continued to be long with dirt underneath. On 08/03/22 at 8:25 A.M. during a follow up interview, Resident #62 revealed a request had previously been made to staff to receive nail care (cleaning and trimming) every day. A night shift nurse reported staff had been unable to locate nail trimmers. On 08/03/22 at 8:25 A.M. Resident #62's continued to be long with dirt underneath with no evidence they had been trimmed or cleaned. On 08/03/22 at 8:28 A.M. interview with State Tested Nursing Assistant (STNA) #149 verified the resident's fingernails were long and dirty and needed to be trimmed and cleaned. STNA #149 revealed the nurse had to complete fingernail care for the resident due to his diagnoses of diabetes. On 08/03/22 at 8:35 A.M. interview with Licensed Practical Nurse (LPN) #112 revealed facility nurses were required to trim fingernails for all diabetic residents. On 08/03/22 at 3:00 P.M. interview with Registered Nurse (RN) #66 revealed facility STNA staff were allowed to provide care of fingernails, including trimming, for residents who had a diagnosis of diabetes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 9 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview the facility failed to develop and implement a comprehensive and individualized activity program to meet the total care needs of Resident #74. This affected one resident (#74) of three residents reviewed for activities. Residents Affected - Few Findings Include: Record review revealed Resident #74 was admitted to the facility on [DATE] with diagnoses including anxiety, muscle weakness, and cognitive communication deficit. Review of the care plan, revised 11/05/19 revealed the resident enjoyed activities including board games, trivia, bluegrass music and watching animal planet. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/20/22 revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15 (out of 15). The assessment revealed the resident required staff supervision with bed mobility, transfers, toileting and eating. On 08/01/22 at 3:30 P.M. interview with Resident #74 revealed the facility did not have enough activities. The resident stated activities occurred only twice a day with none occurring after 5:00 P.M. and only sometimes on the weekends. The resident stated there were only two activity employees and one of them often got pulled from activities to assist with providing resident care. Review of the activity schedules for 06/2022, 07/2022 and 08/2022 revealed activities were scheduled at 10:00 A.M. and 2:00 P.M. seven days a week. There were no activities scheduled to occur in the evenings. Review of the employee schedule for Activity Director #104 for 07/2022 revealed the employee was scheduled to work from 8:00 A.M. to 4:30 P.M. Monday through Friday and scheduled to be off work every Saturday and Sunday with the exception of Sunday 07/17/22 when the employee was scheduled to work from 12:30 P.M. to 3:00 P.M. Review of the employee schedule for Activity Aide #163 for 07/2022 revealed the employee was scheduled to work from 9:00 A.M. to 5:30 P.M. Monday through Friday and scheduled to be off work every Saturday and Sunday with the exception of Sunday 07/03/22 when the employee was scheduled to work from 1:00 P.M. to 3:00 P.M. Multiple observations from 08/01/22 through 08/04/22 revealed Activity Director #104 and Activity Aide #163 were observed to be assisting facility staff with resident care and services which did not include scheduled or other activities. On 08/03/22 at 12:50 P.M. interview with Activity Director #104 and Activity Aide #163 verified activities were not conducted in the evenings or on most weekend days due to no activity staff being scheduled. They stated there were times when activity employees were pulled to the floor to assist with providing resident care and services not associated with activities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 10 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, facility policy and procedure review and interview the facility failed to ensure adequate care and services were provided to residents receiving hospice care, care of non-pressure wounds and/or for diabetic blood sugar monitoring. This affected one resident (#61) of one resident reviewed for Hospice services, one resident (#62) of two residents reviewed for skin conditions and two residents (#62 and #71) of five residents reviewed for unnecessary medication use. Residents Affected - Few Findings Include: 1. Record review revealed Resident #61 was admitted to the facility on [DATE] with diagnoses including dementia, Alzheimer's disease, cognitive communication deficit and muscle weakness. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 07/13/22 revealed the resident was assessed to have moderately impaired cognition. This assessment revealed the resident was assessed to require extensive assistance from two staff members for bed mobility, transfers and toileting and extensive assistance from one staff member for eating. The assessment revealed the resident received Hospice services while residing at the facility. Review of the progress notes, dated 07/01/22 through 08/03/22, revealed there was no documentation from the Hospice provider available regarding care and services Hospice staff had provided to the resident. On 08/04/22 at 9:32 A.M. interview with Registered Nurse (RN) #66 verified the facility did not have copies of the Hospice providers visit notes available at the facility. RN #66 indicated the provider completed them electronically and did not send copies to the facility. RN #66 revealed the facility had received the physical notes by fax the day before. On 08/04/22 at 2:20 P.M. interview with Licensed Practical Nurse (LPN) #155 revealed the Hospice nurse visited Resident #61 several times a week and provided verbal updates to staff regarding care provided. LPN #155 verified there was not a way for staff members to go back and view the progress notes regarding the resident's Hospice visits as they were not maintained in the facility. 2. Record review revealed Resident #62 was admitted to the facility on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation, non-pressure chronic ulcer of the right heel and mid-foot, muscle weakness, cognitive communication deficit, peripheral vascular disease, non-pressure chronic ulcer of left heel and mid-foot, type two diabetes mellitus and chronic systolic heart failure. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 07/14/22 revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15 (out of 15). The assessment revealed the resident was assessed to require supervision with one person physical assist for bed mobility, transfers and toileting and staff supervision with set-up help only for eating. This resident was assessed to have diabetic foot ulcers and surgical wounds. a. Review of the facility Clinical Health Status Evaluation assessment, dated 07/07/22 revealed the resident had wounds to the left heel, right heel, and right great toe which were covered with a treatment. There were no measurements of the wounds or description of the wound bed, presence of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 11 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0684 drainage or presence of infection. Level of Harm - Minimal harm or potential for actual harm Review of the facility baseline care plan summary assessment, dated 07/08/22 documented the resident's skin was intact. Residents Affected - Few Review of the facility Skin and Wound Evaluation, dated 07/11/22, revealed the resident had a surgical wound present to the first digit on the right foot which measured 4.9 centimeters (cm) long by 2.7 cm wide which was stable. No depth was noted. There was no documentation of the appearance of the wound bed, presence of drainage, or presence of signs or symptoms of infection. Review of the facility Skin and Wound Evaluation, dated 07/11/22 revealed the resident had a diabetic wound present to the left heel which measured 4.3 cm long by 3.3 cm wide which was stable. No depth was noted. There was no documentation of the appearance of the wound bed, presence of drainage, or presence of signs or symptoms of infection. Review of the facility Skin and Wound Evaluation, dated 07/11/22 revealed the resident had a diabetic wound present to the right heel which measured 1.9 cm long by 1.7 cm wide which was stable. No depth was noted. There was no documentation of the appearance of the wound bed, presence of drainage, or presence of signs or symptoms of infection. Review of the care plan, dated 07/12/22 revealed the resident had a diabetic left heel ulcer-present upon admission. Interventions included to conduct weekly skin inspection, nutritional and hydration support, treatments as ordered and weekly wound assessments. Review of the care plan, dated 07/12/22 revealed the resident had a diabetic right heel ulcer-present upon admission. Interventions included to conduct weekly skin inspection, nutritional and hydration support, treatments as ordered, and weekly wound assessments. Review of the facility Skin and Wound Evaluation, dated 07/20/22 revealed the resident had a surgical wound present to the first digit on the right foot which measured 5.9 cm long by 3.1 cm wide which was stable. No depth was noted. There was no documentation of the appearance of the wound bed, presence of drainage, or presence of signs or symptoms of infection. Review of the facility Skin and Wound Evaluation, dated 07/20/22 revealed the resident had a diabetic wound present to the left heel which measured 4.5 cm long by 4.3 cm wide which was stable. No depth was noted. There was no documentation of the appearance of the wound bed, presence of drainage, or presence of signs or symptoms of infection. Review of the facility Skin and Wound Evaluation, dated 07/20/22 revealed the resident had a diabetic wound present to the right heel which measured 2.0 cm long by 1.6 cm wide. The progress of the wound was not documented. No depth was noted. There was not documentation of the appearance of the wound bed, presence of drainage, or presence of signs or symptoms of infection. Review of the Wound Care Center progress note, dated 07/26/22 revealed the resident had an amputation site to the first digit on the right foot which measured 3.0 cm long by 1.5 cm wide. Foul odor was documented to be present after cleansing. There was a large amount of slough documented to be present. There was a medium amount of purulent exudate documented which was yellow, brown, green in color. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 12 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Wound Care Center progress note, dated 07/26/22 revealed the resident had a diabetic wound to the left heel which measured 4.3 cm long by 3.3 cm wide. There was no foul odor after cleansing. There was a small among of serosanguineous drainage which was red, brown color. There was a large among of slough documented to be present. Review of the Wound Care Center progress note, dated 07/26/22 revealed the resident had a diabetic wound to the right heel which measured 2.9 cm long by 1.9 cm wide. There was no foul odor after cleansing. There was a small amount of serosanguinous drainage which was red, brown color. There was a large amount of slough documented to be present. Review of the active, discontinued, and completed physician's orders for Resident #62 revealed no treatment orders had been obtained or implemented for this resident until 07/11/22, four days after the resident was admitted to the facility. Review of the physician's orders for wound care treatments to the left heel, right heel, and right great toe, dated 07/11/22 through 07/31/22, all revealed treatments were to be completed daily as ordered. Review of the Treatment Administration Record, dated 07/2022, revealed there was no documented evidence of the treatment being completed to the resident's diabetic left heel wound on 07/14/22, 07/18/22, 07/24/22, 07/28/22, 07/30/22, or 07/31/22. There was no documented evidence of the treatment being completed to the resident's surgical wound to the right great toe on 07/14/22, 07/18/22, 07/20/22, 07/24/22, 07/28/22, 07/30/22, or 07/31/22. There was no documented evidence of the treatment being completed to the resident's diabetic right heel wound on 07/14/22, 07/18/22, 07/24/22, 07/28/22, 07/30/22, or 07/31/22. Review of the progress note, dated 07/26/22 revealed the resident returned from a scheduled wound care appointment and had a follow up appointment scheduled for 08/02/22 at 8:30 A.M. Review of the progress note, dated 08/02/22 revealed the resident's scheduled appointment with the wound care center had been rescheduled due to not having transportation available. On 08/01/22 at 10:10 A.M. Resident #62 was observed with bandages to the left and right heel and right great toe amputation site. The bandages were all observed to be loose, saturated with drainage, and were labeled with a date changed of 07/30/22. Drainage from the wounds was observed on the resident's bed sheets. At the time of the observation, interview with Resident #62 revealed the bandages were not changed the day before and were not always changed daily as ordered. Resident #62 stated he had an appointment at the wound care center the next day and was unsure if transportation had been scheduled. State Tested Nursing Assistant (STNA) #149 entered the room and informed Resident #62 that STNA #110 would be transporting him to his wound care appointment the following day. On 08/01/22 at 10:18 A.M. interview with LPN #102 verified the bandages on Resident #62's left and right heel and right great toe were loose, saturated with drainage, and were labeled with a date changed of 07/30/22. LPN #102 verified the treatments were scheduled to be changed daily. On 08/02/22 at 3:30 P.M. interview with LPN #102 and RN #139 revealed the facilities policy was to measure and assess wounds every seven days and document in the electronic medical record. They stated Resident #62 had not been able to attend the scheduled wound care appointment on 08/02/22 as STNA #110 who provided the transportation had been double booked. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 13 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0684 Level of Harm - Minimal harm or potential for actual harm On 08/03/22 at 11:10 A.M. interview with STNA #110 revealed the employee provided facility transportation for residents to appointments. STNA #110 stated Resident #62 had an appointment scheduled for the morning of 08/02/22 and so did another resident and the employee was unable to transport both at the same time. STNA #110 stated the nurse told her to transport the other resident and rescheduled the appointment for Resident #62. Residents Affected - Few On 08/03/22 at 3:00 P.M. interview with RN #66 verified there had not been wound care orders in place for the wounds to Resident #62's left heel, right heel, or right great toe surgical site until 07/11/22, four days after the resident was admitted to the facility. RN #66 verified there was no documentation of a wound assessment for these areas until 07/11/22. The Director of Nursing (DON) verified wound assessments were completed on 07/11/22 and 07/20/22 at the facility and on 07/26/22 at the wound care center. RN #66 verified wound assessments completed at the facility on 07/11/22 and 07/20/22 did not contain documentation regarding the appearance of the wound bed, presence of drainage, or presence of infection. On 08/04/22 at 10:00 A.M. interview with Nurse Practitioner #172 revealed the attending physician normally provided wound care orders. Nurse Practitioner #172 revealed wounds should not go without treatment orders for more than a day or so due to potential complications. b. Review of Resident #62's active physicians order, dated 07/26/22 revealed an order for blood sugar testing to be completed before meals and at bedtime. There were not parameters for reporting abnormal blood sugar levels present in the order. Review of the Medication Administration Record (MAR) for 07/2022 and 08/2022 revealed on 07/27/22 at 8:00 P.M. the resident's blood sugar level was documented as being 462, on 07/28/22 the resident's blood sugar level was documented as being 462, on 08/01/22 at 4:00 P.M. the resident's blood sugar level was documented as being 463, and on 08/02/22 the resident's blood sugar level was documented as being 435. Review of the progress notes, dated 07/27/22 through 08/02/22, revealed there was no documentation of reporting the elevated blood sugar results to the physician or nurse practitioner. On 08/03/22 at 9:35 A.M. interview with LPN #112 revealed orders for blood sugar monitoring were to contain parameters for abnormal results which were to be reported to the physician or nurse practitioner; the parameters were normally results below 70 or above 400 and the notification was to be documented in the resident's electronic health record. LPN #112 verified the physician' orders for Resident #62 did not contain parameters for reporting abnormal blood sugar levels. On 08/04/22 at 10:00 A.M. interview with Nurse Practitioner #172 revealed the parameters for reporting abnormal blood sugar results should be under 60 or 70 and above 400 or 450 depending upon the resident. Review of the facility undated policy titled Diabetes Management Education, revealed the following element was in place for the center to demonstrate satisfactory compliance with the guideline: physician notification parameters. 3. Record review revealed Resident #71 was admitted to the facility on [DATE] with a diagnosis including type two diabetes mellitus. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 14 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the active physician's orders revealed an order, dated 07/12/22 for blood sugar testing to be completed before meals and at bedtime. Review of the orders revealed there were no parameters for reporting abnormal blood sugar levels provided. Review of the care plan, dated 07/12/22 revealed the resident had an alteration in blood glucose. Interventions included to report abnormal results per physician parameters/guidelines. Review of the admission Minimum Data Set (MDS) 3.0 assessment, dated 07/19/22 revealed the resident had intact cognition evidenced by a BIMS assessment score of 13 (out of 15). The assessment revealed the resident was assessed to require staff supervision for eating and bed mobility and limited assistance from one staff member for transfers and toileting. Review of the MAR for 07/2022 and 08/2022 revealed on 07/30/22 at 11:00 A.M. the resident's blood sugar level was documented as being 417, on 08/01/22 at 11:00 A.M. the resident's blood sugar level was documented as being 425, and on 08/01/22 at 4:00 P.M. the resident's blood sugar level was documented as being 462. Review of the progress notes, dated 07/30/22 through 08/01/22 revealed there was no documented evidence of reporting blood sugar results to the physician or nurse practitioner. On 08/03/22 at 9:35 A.M. interview with LPN #112 revealed orders for blood sugar monitoring were to contain parameters for abnormal results which were to be reported to the physician or nurse practitioner; the parameters were normally results below 70 or above 400 and the notification was to be documented in the residents electronic health record. LPN #112 verified the physician's orders for Resident #71 did not contain parameters for reporting abnormal blood sugar levels. On 08/04/22 at 10:00 A.M. interview with Nurse Practitioner #172 revealed the parameters for reporting abnormal blood sugar results should be under 60 or 70 and above 400 or 450 depending upon the resident. Review of the facility undated policy titled Diabetes Management Education revealed the following element was in place for the center to demonstrate satisfactory compliance with the guideline: physician notification parameters. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 15 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, facility policy and procedure review and interview the facility failed to develop and implement a comprehensive pressure ulcer prevention and management program to ensure pressure ulcers were timely and accurately assessed, to ensure treatments were initiated timely and provided to promote healing of pressure ulcers and to prevent potential infection. This affected two residents (#283 and #288) of three residents reviewed for pressure ulcers. Residents Affected - Few Findings Include: 1. Review of Resident #283's medical record revealed an initial admission date of 07/22/22 with the admitting diagnoses of chronic congestive heart failure, pressure ulcer of sacral region, chronic kidney disease, malaise, diabetes mellitus, non-pressure chronic ulcer to right lower leg and left lower leg, varicose veins of right and left lower leg. Review of the paper admission skin assessment dated [DATE] revealed the resident was admitted to the facility with a Stage II (partial-thickness loss of skin with exposed dermis, presenting as a shallow open ulcer) pressure ulcer to her coccyx, a Stage I (observable, pressure- related alteration of intact skin whose indicators, as compared to an adjacent or opposite area on the body, may include changes in one or more of the following parameters: skin temperature (warmth or coolness); tissue consistency (firm or boggy); sensation (pain, itching); and/or a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the injury may appear with persistent red, blue, or purple hues) pressure ulcer to her left heel and her right heel was described as boggy. Review of the clinical health status assessment, dated 07/23/22 revealed the resident was alert and oriented to person and place. The assessment revealed the resident required physical assistance from staff for bed mobility, transfers and toilet use. The assessment indicated the resident had an indwelling urinary catheter and was incontinent of bowel. The resident reported pain to her legs at a level of four with the worst pain being 10. The assessment indicated the resident was admitted with a Stage II pressure ulcer to her coccyx and a Stage I pressure ulcer to both heels. Review of the Braden Scale score dated 07/23/22 revealed a score of 12 indicating the resident was at risk for skin breakdown. Review of the plan of care, dated 07/25/22 revealed the resident had a Stage II pressure ulcer to her coccyx. Interventions included complete Braden scale per center policy, float heels, nutritional and hydration support, provide pressure reduction/relieving mattress, skin assessment to be completed per center policy, treatments as ordered, turn/reposition with each round and as needed and weekly wound assessment. Review of the plan of care, dated 07/25/22 revealed the resident had Stage I pressure ulcer to the bilateral heels. Interventions included complete Braden scale per center policy, float heels, nutritional and hydration support, provide pressure reduction/relieving mattress, skin assessment to be completed per center policy, treatments as ordered, turn/reposition with each round and as needed and weekly wound assessment. Review of the weekly skin and wound evaluation, dated 07/26/22 revealed the resident was admitted with a Stage III pressure ulcer to the right heel. There were no measurements or description of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 16 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 wound at that time. Level of Harm - Minimal harm or potential for actual harm Review of the monthly physician's orders for August 2022 revealed an order, dated 07/28/22 for Betadine to right heel twice daily. Residents Affected - Few Review of the medical record failed to provide evidence of a complete documented assessment of the resident's Stage III pressure ulcer to the right heel. Further review revealed no assessment, description or physician's order to treat the Stage II pressure ulcer to the resident's coccyx. On 08/03/22 at 11:25 A.M. an attempt was made to observe care and visualize the resident's skin/pressure ulcers. The resident refused to allow the surveyor to observe the areas to the coccyx, left heel and right heel. On 08/04/22 at 3:15 P.M. during an interview with Registered Nurse (RN) #166, the RN provided an assessment of the pressure ulcer to the coccyx. The wound measured 0.8 centimeters (cm) in length by 0.5 cm width with 2.5 cm depth with a red wound bed and the surrounding tissue dry and flaky. The wound had no drainage or odor. The RN also provided documentation of the right heel which was 2.8 cm in length by 1.8 cm width with 0.25 cm depth with red wound bed and light blood drainage. On 08/04/22 at 3:22 P.M. interview with RN #166 verified the Stage II pressure ulcer to the resident's coccyx and the Stage III pressure ulcer to the right heel had no documented assessment and no physician ordered treatment in place for six days following the resident's admission to the facility. 2. Review of Resident #288's medical record revealed an admission date of 07/22/22 with the admitting diagnoses of COVID-19, chronic kidney disease, congestive heart failure, atrial fibrillation and presence of pacemaker. Review of the nurse's note, dated 07/22/22 at 7:11 P.M. revealed the resident was admitted to the facility with a chronic sacral ulcer and scattered bruising on the bilateral forearms. Review of the resident's clinical health status evaluation, dated 07/23/22 revealed the resident's skin assessment was not completed. Review of the Braden Scale assessment, dated 07/23/22 revealed a score of 19 indicating the resident was at risk for skin breakdown. Review of the weekly skin and wound evaluation, dated 07/25/22 revealed the resident was admitted to the facility with a Stage IV (full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling) pressure ulcer to the coccyx measuring 12.7 cm in length by 1.0 cm width with no applicable documented as the depth. The documentation included no description of the wound, treatment or interventions implemented by the facility. Review of the resident's admission body audit, dated 07/26/22 revealed the resident was admitted to the facility with a Stage IV pressure ulcer to the right buttocks and a red coccyx. Review of the plan of care, dated 07/28/22 revealed the resident was admitted to the facility with a Stage IV pressure ulcer to coccyx. Interventions included complete Braden scale per facility policy, nutritional and hydration support, provide pressure reduction/relieving mattress, provide through (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 17 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 - Minimal harm or potential for actual harm Residents Affected - Few skin care after incontinent episodes and apply barrier cream, treatment as ordered, cleanse Stage IV pressure ulcer to right buttocks with cleanser, pack with Aquacel and cover with dry dressing daily, turn and reposition with each round and as needed and weekly wound assessment. Review of the resident's comprehensive MDS 3.0 assessment, dated 07/29/22 revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 (out of 15). The assessment revealed the resident required extensive assistance of two staff for bed mobility, dressing, toilet use, personal hygiene and limited assistance from two staff for transfers and ambulation. The assessment indicated the resident was occasionally incontinent of bladder and frequently incontinent of bowel. The assessment indicated the resident was at risk for skin breakdown and was admitted to the facility with one Stage II pressure ulcer and one Stage IV pressure ulcer. The assessment revealed the facility implemented pressure ulcer/injury care, application of non-surgical dressings with or without topical medications other than to feet and applications of ointments/medications other than to feet. Review of the plan of care, dated 07/29/22 revealed the resident was admitted with a Stage II pressure ulcer to the left buttocks. Interventions included complete Braden scale per facility policy, nutritional and hydration support, provide pressure reduction/relieving mattress, provide through skin care after incontinent episodes and apply barrier cream, treatment as ordered, apply dermaseptin ointment topically to left buttocks every shift, turn and reposition with each round and as needed and weekly wound assessment. Review of the plan of care dated 07/29/22 revealed the resident had increased risk for pressure ulcer related to current skin breakdown present upon admit and need for mobility/toileting assist. Interventions included apply dermaseptin ointment topically to sacrum every shift for preventative measure, complete Braden scale per center policy, float heels, nutritional and hydration support, provide thorough skin care after incontinent episodes and apply barrier cream, skin assessment to be completed per center policy. Review of the monthly physician's order for August 2022 revealed an order (initiated 07/28/22, six days following the resident's admission to the facility) to apply dermaseptin ointment topically to sacrum every shift for preventative measures, apply dermaseptin ointment topically to left buttocks Stage II pressure ulcer every shift and cleanse Stage IV ulcer to right buttocks with cleanser, pack with Aquacel and cover with dry dressing daily at bedtime. Review of the medical record revealed no skin assessments had been completed for pressure ulcer areas to the left buttocks or the right buttocks. Review of the weekly skin and wound evaluation, dated 08/01/22 revealed the Stage IV pressure ulcer to the coccyx measured 2.3 cm in length by 0.7 cm width with not applicable documented as the depth. The evaluation had no documented description of the wound. The wound was determined to be stable. On 08/03/22 at 10:05 A.M. Licensed Practical Nurse (LPN) #136 was observed to complete the physician ordered treatment to the resident's right buttocks, coccyx and the left buttocks. The LPN entered the room, placed a barrier on the resident's bedside table and set the required supplies on the bed. The LPN then washed her hands and applied a clean pair of disposable gloves. She then positioned the resident on his right side and removed a soiled dressing (dated 08/03/22). She then sprayed the right buttocks wound and the coccyx wound with wound cleanser and used the same four by four gauze to cleanse the wound. She then changed her gloves without washing/sanitizing her hands and measured the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 18 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 - Minimal harm or potential for actual harm Residents Affected - Few right buttocks wound, which was 3.0 cm in length by 1.0 cm width. LPN #136 then stuck a green stick (a wooden stick with sharp ends used to cleanse debris from under fingernails) inside the wound and measured the depth at 1.5 cm. She then packed the wound with Aquacel and covered with a bordered foam dressing. The LPN then measured the coccyx wound, which measured 3.0 cm in length by 1.0 cm width with 100% slough tissue present. The LPN then applied dermaseptin ointment to the coccyx and left buttock wounds. The coccyx was observed having a yellow scab with the surrounding tissue being red. On 08/03/22 10:15 A.M. interview with LPN #136 verified the lack of separating the wounds to prevent the potential spread of infection and using the green stick to obtain a measurement of the wound. On 08/03/22 10:26 A.M. interview with RN #166 verified the lack of skin assessments, preventative measures and treatments for Stage IV pressure ulcer to right buttocks, Stage II pressure ulcer to left buttocks and red coccyx for six days following the resident's admission to the facility. Review of the facility policy titled Skin Care Guideline, dated 07/2018 revealed all those admitted would be observed for baseline skin condition and evaluated for risk of skin breakdown within 24 hours of admission. The findings would be documented in the electronic medical record (EMR). Weekly review of the resident's skin would be completed by the nurse and documented in the EMR. When an open area was identified implement resident specific interventions immediately. Document evaluation of wound in EMR including: location and staging, size, presence and location of undermining and tunneling, exudate if present (type, color, odor and approximate amounts), pain, wound bed color and type of tissue including evidence of healing (granulation or necrotic and reassess, re-evaluate and revise interventions when progress was not noted within 14 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 19 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, record review and staff interview the facility failed to identify, obtain a physician's order and document the care of Resident #288's colostomy. This affected one resident (#288) of one resident reviewed for bowel and bladder. Findings Include: Review of Resident #288's medical record revealed an admission date of 07/22/22 with the admitting diagnoses of COVID-19, chronic kidney disease, congestive heart failure, atrial fibrillation and presence of pacemaker. Review of the resident's clinical health status evaluation, dated 07/23/22 revealed the resident was admitted to the facility with an ostomy. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 07/29/22 revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 (out of 15). The assessment revealed the resident required extensive assistance of two staff for bed mobility, dressing, toilet use and personal hygiene and limited assistance from two staff for transfers and ambulation. The MDS assessment did not reflect the resident had an ostomy. Review of the resident's plan of care failed to identify the resident's colostomy. Review of the monthly physician's orders for August 2022 failed to identify any orders for the care of the resident's colostomy. On 08/01/22 at 11:44 A.M. observation of Resident #288 revealed the resident had a colostomy that was full of yellow liquid stool. On 08/03/22 at 3:08 P.M. interview with Registered Nurse (RN) #166 verified the resident had no orders for the care of his colostomy, no care plan and the ostomy was not coded on the MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 20 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Record review revealed Resident #62 was admitted to the facility on [DATE] with diagnoses including encounter for orthopedic aftercare following surgical amputation, non-pressure chronic ulcer of the right heel and mid-foot, muscle weakness, cognitive communication deficit, peripheral vascular disease, non-pressure chronic ulcer of left heel and mid-foot, type two diabetes mellitus and chronic systolic heart failure. Residents Affected - Some Review of documented weights revealed on [DATE] the resident weighed 143.5 pounds, on 07/11 the resident weighed 140.8 pounds, on [DATE] the resident weighed 136.8 pounds, and on [DATE] the resident weighed 136.6 pounds. Review of the care plan, dated [DATE] revealed the resident had the potential for nutritional problems. Interventions included to provide and serve supplements as ordered, provide and serve diet as ordered, monitor intake and record every meal, weigh per orders and monitor/record/report to the physician weight loss of more than three pounds in one week. Review of the admission MDS 3.0 assessment, dated [DATE] revealed the resident had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 15 (out of 15). The assessment revealed the resident was assessed to require supervision with one person physical assist for bed mobility, transfers and toileting, and supervision with staff set-up help only for eating. Review of the nurse practitioner (NP) progress note, dated [DATE] revealed the resident had a good appetite consuming 75 to 100 percent of meals in the past five days and weight had decreased. There was no documentation of additional interventions or orders to prevent additional weight loss. On [DATE] at 9:32 A.M. interview with RN #66 verified weights were not always obtained weekly. RN #66 stated a list of needed weights was put out weekly on Fridays but sometimes not obtained by facility staff. Review of the facility policy titled Weight Monitoring, dated [DATE] revealed weights were to be done upon admission and then weekly for one month and then no less often than monthly thereafter. 4. Record review revealed Resident #71 was admitted to the facility on [DATE] with diagnoses including cervical disc degeneration, unsteadiness on feet, history of falling, cognitive communication deficit, type two diabetes mellitus, acquired absence of other left toes, depression, hypertension, chronic obstructive pulmonary disorder and muscle weakness. Review of documented weights revealed on [DATE] the resident weighed 170.4 pounds. There were no additional weights documented for the resident. Review of the care plan, dated [DATE] revealed the resident had the potential for nutritional problems. Interventions included to weigh as ordered. Review of the admission MDS 3.0 assessment, dated [DATE] revealed the resident had intact cognition evidenced by a BIMS assessment score of 13 (out of 15). The assessment revealed the resident was assessed to require staff supervision for eating and bed mobility and limited assistance from one staff member for transfers and toileting. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 21 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0692 Level of Harm - Minimal harm or potential for actual harm On [DATE] at 9:32 A.M. interview with RN #66 verified weights were not always obtained weekly. RN #66 stated a list of needed weights was put out weekly on Fridays but sometimes not obtained by facility staff. Review of the facility policy titled Weight Monitoring, dated [DATE] revealed weights were to be done upon admission and then weekly for one month and then no less often than monthly thereafter. Residents Affected - Some 5. Review of Resident #26's closed medical record revealed the resident was admitted to the facility on [DATE] and had diagnoses including dysphagia, muscle weakness, and adult failure to thrive. This resident expired in the facility on [DATE]. Review of the care plan, dated [DATE] revealed the resident had nutritional problems. Interventions included to provide and serve diet as ordered, monitor intake and record every meal, weigh and record as ordered and registered dietitian to evaluate and make diet change recommendations as needed. Review of the physician's orders revealed no orders for frequency of obtaining weight. Review of recorded weights for the resident revealed on [DATE] the resident weighed 136.4 pounds, on [DATE] the resident weighed 135.8 pounds, and on [DATE] the resident weighed 127.0 pounds indicating a 6.89 percent weight loss in one month. There were no additional documented weights available for review. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated [DATE] revealed the resident had impaired cognition. The assessment revealed the resident was assessed to require extensive assistance from two staff members for bed mobility, transfers and toileting and required limited assistance from one staff member for eating. Review of the dietary progress note, dated [DATE] revealed the resident had a weight loss of 6.9 percent in one month. Recommendations included to begin weekly weights. On [DATE] at 3:00 P.M. interview with Registered Nurse (RN) #66 verified the resident had been documented to weigh 127.0 pounds on [DATE] resulting in a weight loss of over six percent in one month. The RN #66 verified there was no documentation of review of weight loss or nutrition for this resident by the Registered Dietitian until [DATE]. RN #66 verified weights were only documented on [DATE], [DATE] and [DATE]. On [DATE] at 9:32 A.M. interview with RN #66 verified weights were not always obtained weekly. RN #66 stated a list of needed weights was put out weekly on Fridays but sometimes not obtained by facility staff. Review of the facility policy titled Weight Monitoring, dated [DATE] revealed weights were to be done upon admission and then weekly for one month and then no less often than monthly thereafter. Based on record review, facility policy and procedure review and interview the facility failed to ensure weight monitoring was completed for new admissions to timely identify weight loss, failed to implement nutritional interventions to address weight loss and failed to ensure weights were obtained per facility policy and reported/acted on appropriately. This affected five residents (#26, #62, #71, #73 and #288) of seven residents reviewed for nutrition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 22 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0692 Findings Include: Level of Harm - Minimal harm or potential for actual harm 1. Review of Resident #73's medical record revealed an admission date of [DATE] with the admitting diagnoses of encounter for orthopedic aftercare, generalized muscle weakness, dysarthria and anarthria, dysphagia, presence of right artificial hip joint, adjustment disorder with depressed mood, history of traumatic brain injury, anemia, hypothyroidism and right spastic hemiplegia. Residents Affected - Some Review of the resident's clinical health status evaluation, dated [DATE] revealed the resident's admission weight was 149.3 pounds. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated [DATE] revealed the resident had clear speech, understood others, made himself understood and had no cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 15 (out of 15). The resident's weight was coded at 149 pounds, with no weight loss and receiving a therapeutic diet. Review of the plan of care, dated [DATE] revealed the resident had potential for nutritional concern related to advanced age and dysphagia. Interventions included invite the resident to activities that promote additional intake, monitor/document/report as needed any signs/symptoms of dysphagia, monitor/record/report to physician as needed signs/symptoms of malnutrition, obtain and monitor lab/diagnostic work as ordered, provide and serve diet as ordered, monitor intake and record every meal, registered dietitian (RD) to evaluate and make diet change recommendations as needed and resident reports allergies to corn, pepper, beef and caffeine. Review of the RD nutritional assessment, dated [DATE] revealed the Registered Dietician (RD) recommended to liberalize the resident's diet. Review of the monthly physician's orders identified an order, dated [DATE] for a regular diet, regular texture with thin liquids. Review of the weight provided on [DATE] revealed the resident's weight was 135.8 pounds which was a 13.5 pound (9.04%) weight loss since admission to the facility. Review of the medical record failed to provide written evidence the resident's weights were obtained and monitored weekly following the admission to the facility. On [DATE] at 9:32 A.M. interview with Registered Nurse (RN) #166 verified the facility should have obtained weekly weights for four weeks following the resident's admission to the facility. The RN verified the resident had a 13.5 pound (9.04%) weight loss with no interventions in place and no notification of the weight loss to the physician. Review of the facility policy titled Weight Monitoring, dated [DATE] revealed weights were to be done upon admission and then weekly for one month and then no less often than monthly thereafter. 2. Review of Resident #288's medical record revealed an admission date of [DATE] with the admitting diagnoses of COVID-19, chronic kidney disease, congestive heart failure, atrial fibrillation and presence of pacemaker. Review of the resident's clinical health status evaluation dated [DATE] revealed the resident's admission weight was 160.4 pounds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 23 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated [DATE] revealed the resident had clear speech, understood others, made himself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 (out of 15). The assessment revealed the resident required supervision with eating after set-up of meal. The resident's weight was coded at 160 pounds with no known weight loss. The assessment indicated the resident received parenteral/intravenous (IV) feeding and received a mechanically altered diet. The resident received 25% or less of total calories from parenteral feeding and 500 milliliters (ml) or less of average fluid intake. Review of the plan of care, dated [DATE] revealed the resident had nutritional problem or potential nutritional problem related to increased protein needs for wound healing, mechanically altered diet texture, altered nutrition related to labs requiring intravenous (IV) fluids, estimated intakes not meeting estimated nutrition needs. Interventions included administer medications as ordered, obtain and monitor lab/diagnostic work as ordered, obtain weight per order and monitor for changes, provide and serve diet as ordered and Registered Dietician to evaluate and make diet change recommendations as needed. Review of the monthly physician's orders for [DATE] revealed an order for a regular diet, dysphagia mechanical soft texture and Remeron 15 milligrams (mg) by mouth daily at bedtime for appetite stimulant. Review of the RD nutritional assessment, dated [DATE] revealed the resident weighed 160.4 pounds. The RD made the recommendations for liquid protein supplement 30 ml by mouth twice daily to aide in wound healing and Med pass 120 ml by mouth daily to meet estimated nutritional needs and for weight maintenance. Review of the resident's weight provided on [DATE] revealed the resident weighed 145.8 pounds which was a 14.6 pound (9.10%) weight loss since admission on [DATE]. Review of the medical record failed to provide written evidence the resident's weights were obtained and monitored weekly following the admission to the facility. On [DATE] at 9:32 A.M. interview with Registered Nurse (RN) #166 verified the facility should have obtained weekly weights for four weeks following the resident's admission to the facility. The RN verified the resident had a 14.6 pound (9.10%) weight loss with no interventions in place and no notification of the weight loss to the physician. Review of the facility policy titled Weight Monitoring, dated [DATE] revealed weights were to be done upon admission and then weekly for one month and then no less often than monthly thereafter. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 24 of 25 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 365398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Best Care Health and Rehabilitation 2159 Dogwood Ridge Road Wheelersburg, OH 45694 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on observation, record review and interview the facility failed to ensure meals provided to Resident #292 accommodated the resident's preferences and were nutritionally adequate. This affected one resident (#292) of seven residents reviewed for nutrition. Findings Include: Review of Resident 292's medical record revealed an initial admission date of 07/20/22 with the admitting diagnoses of fracture of lower end of right radius, difficulty walking, unsteadiness on feet, dementia, depression and insomnia. Review of the clinical health status evaluation revealed no documented diet preferences for the resident. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 07/27/22 revealed the resident had clear speech, understood others, made herself understood and had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 (out of 15). The assessment revealed the resident required supervision for eating. The resident's weight was coded as 133 pounds, with no weight loss. Review of the plan of care, dated 07/27/22 revealed the resident had nutritional problem or potential nutritional problem related to risk for unavoidable decline in cognition related to dementia and other medical diagnoses. Interventions included to administer medications as ordered, obtain weight as ordered and monitor for changes, provide and serve diet as ordered and RD to evaluate and make diet change recommendations as needed. Review of the resident's meal ticket revealed the resident liked fish. The ticket indicated, no meat, pork, chicken, turkey. Send veggie tray. No gravy. On 08/02/22 at 10:08 A.M. interview with the resident revealed she did not eat meat and the facility does not offer substitutes. She revealed dietary sends extra vegetables for her at meals. On 08/03/22 at 12:24 P.M. observation of the lunch meal revealed the resident was served peas, cucumber salad and mashed potatoes with gravy and canned peaches. The meal tray contained no protein. On 08/03/22 at 12:42 P.M. interview with Dietary Manager (DM) #135 verified the resident did not like/eat meat and was not being provided substitute food items with similar nutritive protein. The DM also verified dietary staff had not offered the resident fish and had no menu addressing the resident's primarily fruits and vegetable diet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 25 of 25