Health inspection·February 1, 2024

F 0567 available at times the business office was not open. Level of Harm - Minimal harm or potential for actual harm Interview with the Administrator on 01/31/24 at 10:00 A.M. confirmed the facility policy did not address residents having access to petty cash in the evening or on weekends when the business office was not open. Residents Affected - Some This deficiency represents non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 2 of 17 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 02/01/2024 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 Based on observations, staff interview, resident interview, medical record review, and grievance review, the facility failed to ensure that residents who are unable to carry out activities of daily living received the necessary services to maintain good personal hygiene. This affected 24 of 26 residents on Station 1 who were incontinent of bowel and/or bladder (Residents #9, #10, #11, #20, #21, #29, #32, #33, #38, #42, #43, #45, #47, #49, #51, #52, #53, #60, #65, #67, #72, #74, #76, and #80). The facility census was 80. Residents Affected - Some Findings include: Observations on 01/31/24 at 4:30 A.M. revealed there were two nurses (one Licensed Practical Nurse (LPN) and one Registered Nurse (RN) and five nursing assistants on duty for 80 residents. The facility is split up into three sections (Station 1, where 26 residents resided; Station 2, where 30 residents resided; and Station 3, where 24 residents resided). There were two nursing assistants on Station 1 for 26 residents, one nursing assistant on Station 2 for 30 residents, and two nursing assistants on Station 3 for 24 residents. The facility identified on a census report that there were 24 residents on Station 1 who were incontinent of bowel and/or bladder (Residents #9, #10, #11, #20, #21, #29, #32, #33, #38, #42, #43, #45, #47, #49, #51, #52, #53, #60, #65, #67, #72, #74, #76, and #80). Interview with LPN #106 on 01/31/24 at 4:30 A.M. revealed the facility would typically have six nursing assistants on duty for the night shift but only had five at that time as one of the nursing assistants had went home at midnight, leaving five. Interview with Nursing Assistants #90 and #98 on 01/31/24 at 5:10 A.M. revealed they were the two nursing assistants working on Station 1 with 26 residents. They stated there were 24 residents who were incontinent and with only two nursing assistants it was not possible to check everyone and provide incontinence care every two hours as they were supposed to. They stated it was often four hours in between checks for incontinence. Observations on 01/31/24 from 5:15 A.M. to 5:30 A.M. of incontinence care for Resident #51 (Station 1) revealed it took both nursing assistants (#90 and #98) to perform incontinence care for the resident. The incontinent brief removed from the resident was heavily saturated with urine. Nursing assistant #90 indicated the resident had not been changed since around 1:30 A.M. and was a heavy wetter. She stated this resident required a two person assist and took longer to perform incontinence care for. Observations on 01/31/24 at 5:58 A.M. of incontinence care for Resident #49 (Station 1) by Nursing Assistant #90 revealed the resident had been incontinent of urine when her incontinent brief was removed. Nursing Assistant #90 stated the resident had last been changed around 1:00 A.M. Interview with LPN #124 on 01/31/24 at 7:40 A.M. revealed there were times when she came on duty for day shift at 6:00 A.M. when residents had not been provided with incontinence care on night shift and their incontinent brief and beds were saturated with urine. She confirmed that most of the residents on Station 1 were incontinent of bowel and/or bladder. Interview with RN #111 on 01/31/24 at 8:05 A.M. revealed residents are sometimes very wet from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 3 of 17 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 02/01/2024 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 Residents Affected - Some incontinence from night shift when she comes on duty for day shift at 6:00 A.M. She stated she had seen residents with their incontinent briefs and bed linens saturated with urine. She stated it was more that what could happen in a two hour period. Interview with Nursing Assistant #134 on 01/31/24 at 11:15 A.M. revealed residents are to be checked for incontinence every two hours and changed at that time if needed. She confirmed that there were 24 residents who were incontinent on Station 1. She stated that she had also found residents heavily incontinent from night shift with brown stains on their linens when coming on duty for day shift at 6:00 A.M. on Station 1. She stated it had been reported to the Administrator and Director of Nursing. Interview with Nursing Assistant #144 on 01/31/24 at 11:30 A.M. revealed she normally worked day shift on Station 1. She stated residents were noted to be heavily incontinent when she comes on duty for day shift at 6:00 A.M. She stated she did not always get report from the night shift aides on Station 1 as they sometimes had already clocked out and were not on the floor when she comes on duty. Review of a Grievance/concern form revealed on 08/15/23 Resident #51 had stated her call light was ignored and she lays in a soaked brief all night. She stated this happens during night shift hours. The Director of Nursing documented that she talked with the resident and resident reports of often refusing care. Resident agreed to allow staff to clean her when they are making rounds. There was no further follow up documented. (Record review did not reveal any documentation regarding refusal of care). Interview with Resident #51 on 01/31/24 at 11:50 A.M. revealed she does not get incontinence care timely on night shift. She stated she goes up to 12 hours sometimes without incontinence care. She stated after she voiced her grievance in August 2023, care got better for a while but was now happening again. Interview with Resident #43 on 01/31/24 at 12:00 P.M. revealed she does not get incontinence care timely on night shift. She stated she gets checked and changed about two times between 6:00 P.M. and 6:00 A.M. She stated she would like changed more often. Interview with LPN #125 on 02/01/24 at 6:35 A.M. revealed she works from 6:00 P.M. to 6:00 A.M. on Station 1. She stated there is often only two nursing assistants for Station 1 at night. She stated it was very difficult to provide checks and changes for incontinent residents every two hours as they should. She stated it was more like every four hours. She stated the nursing assistants also have showers to do in the evening and are also called to other halls at times. She stated there were some residents on Station 1 who were heavy wetters and needed changed more often. Interview with Resident #10 on 02/01/24 at 6:50 A.M. confirmed she was incontinent of bowel and bladder. She stated a lot of times she was not changed at all during the night. (Resides on Station 1). Interview with Resident #49 on 02/01/24 at 10:50 A.M. confirmed she was incontinent of bowel and bladder. She stated she goes to bed at 9:00 P.M. and is not checked for incontinence until around 5:30 A.M. (Resides on Station 1). She stated her bottom is sore a lot of the time and she would like to be checked more often. Review of the medical record for Resident #10 revealed an admission date of 01/11/24 and diagnoses including diabetes, hypertension, peripheral vascular disease, and chronic obstructive pulmonary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 4 of 17 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 02/01/2024 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 Residents Affected - Some disease. Review of a Minimum Data Sets (MDS) assessment completed 01/18/24 revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. It indicated she was frequently incontinent of bowel and bladder, was dependent for mobility, and required moderate assistance with toileting. Review of the plan of care dated 01/12/24 revealed the resident required assistance with activities of daily living. The plan of care stated the resident had episodes of incontinence and had a history of refusing to allow staff to provide incontinence care. The nurse was to be notified if this occurred. There was no documentation in the medical record of any refusals. The care plan said to check the resident for incontinence with each round and as needed. Provide incontinence care after each episode. Interview with Assistant Director of Nursing #95 on 02/01/24 at 10:15 A.M. revealed checking at every round means every two hours. She further stated the facility did not have a policy on when to provide incontinence care. Interview with the Director of Nursing on 02/01/24 at 10:35 A.M. revealed Resident #10 had not had any refusals of care at the facility. Review of the medical record for Resident #49 revealed an admission date of 06/09/23 with diagnoses including cerebral infarction and hypertension. A MDS completed 12/07/23 stated a BIMS score of 12 (8-12 moderately impaired cognition, 13-15 intact cognition). The MDS stated the resident was frequently incontinent of bowel and bladder and required substantial/maximal assistance with toileting. Review of the plan of care dated 06/20/23 revealed the resident had episodes of incontinence and staff should check for incontinence with each round and as needed. Provide incontinence care after each episode. Review of the medical record for Resident #43 revealed an admission date of 06/21/19 with diagnoses including diabetes and multiple sclerosis. A MDS completed 12/14/23 stated a BIMS score of 15, indicating intact cognition. The MDS stated the resident was always incontinent of bowel and bladder and was dependent for toileting. The plan of care dated 04/19/21 stated the resident had bladder incontinence and was to be checked for incontinence with each round and as needed. Provide incontinence care after each episode. Interview with the Director of Nursing on 02/01/24 at 11:05 A.M. confirmed there was no evidence of any non compliance with care in Resident #43's record. Review of the medical record for Resident #51 revealed a readmission date of 11/30/23 with diagnoses including chronic pain, lymphedema, and heart failure. A MDS completed 12/23/23 stated a BIMS score of 14, indicating intact cognition. The MDS stated the resident was always incontinent of bowel and bladder and was dependent upon staff for toileting. The plan of care dated 12/12/23 stated the resident had bladder incontinence and to clean peri-area with each incontinent episode. This deficiency represents non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 5 of 17 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 02/01/2024 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observations, medical record review, staff interview, and policy review, the facility failed to ensure a gastrostomy tube was checked for placement prior to the administration of fluids and medication. This affected one of three residents observed for medication administration (Resident #54). The facility census was 80. Findings include: Review of the medical record for Resident #54 revealed an admission date of 01/18/24 with diagnoses including adult failure to thrive and diabetes. Record review revealed the resident's medications were ordered to be given by mouth. However, observations on 01/31/24 at 5:35 A.M. revealed Registered Nurse (RN) # 149 to administer Levothyroxine 88 micrograms through Resident #54's gastrostomy tube in her stomach. RN #149 flushed the tube with water, administered the medication, then followed with an additional flush of water. RN #149 did not check for proper placement of the gastrostomy tube prior to administering the fluids and medication. Interview with RN #149 confirmed she did not check placement of the gastrostomy tube prior to administering the medication and fluids. She stated she had previously checked placement of the tube at 10:00 P.M. (7.5 hours earlier) but did not do it this time. She stated it should be checked each time it is used. Interview with the Director of Nursing on 01/31/24 at 8:35 A.M. confirmed the gastrostomy tube should be checked for placement prior to the administration of medications. Review of the facility policy titled Confirming Placement of Feeding Tubes dated November 2018 revealed to observe for symptoms of elevated gastric residual volume. It further stated to observe and check the pH of aspirate. If the above suggests improper tube positioning, do not administer feeding or medication. This deficiency represents an incidental finding of non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 6 of 17 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 02/01/2024 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on observations, record review, staff interview, resident interview, review of a grievance form, review of resident council meeting minutes, and review of staffing schedules and time sheets, the facility failed to maintain sufficient levels of staff to meet the total care needs of all residents. This affected 24 of 26 residents on Station 1 who were incontinent of bowel and/or bladder (Residents #9, #10, #11, #20, #21, #29, #32, #33, #38, #42, #43, #45, #47, #49, #51, #52, #53, #60, #65, #67, #72, #74, #76, and #80) and had the potential to affect all 80 residents residing in the facility. Findings include: Observations on 01/31/24 at 4:30 A.M. revealed there were two nurses (one Licensed Practical Nurse (LPN) and one Registered Nurse (RN) and five nursing assistants on duty for 80 residents. The facility is split up into three sections (Station 1, where 26 residents resided; Station 2, where 30 residents resided; and Station 3, where 24 residents resided). There was two nursing assistants on Station 1 for 26 residents, one nursing assistant on Station 2 for 30 residents, and two nursing assistants on Station 3 for 24 residents. The facility identified on a census report that there were 24 residents on Station 1 who were incontinent of bowel and/or bladder (Residents #9, #10, #11, #20, #21, #29, #32, #33, #38, #42, #43, #45, #47, #49, #51, #52, #53, #60, #65, #67, #72, #74, #76, and #80). Interview with LPN #106 on 01/31/24 at 4:30 A.M. revealed the facility would typically have six nursing assistants on duty for the night shift but only had five at that time as one of the nursing assistants had went home at midnight, leaving five. Interview with Nursing Assistants #90 and #98 on 01/31/24 at 5:10 A.M. revealed they were the two nursing assistants working on Station 1 with 26 residents. They stated there were 24 residents who were incontinent and with only two nursing assistants it was not possible to check everyone and provide incontinence care every two hours as they were supposed to. They stated it was often four hours in between checks for incontinence. Observations on 01/31/24 from 5:15 A.M. to 5:30 A.M. of incontinence care for Resident #51 (Station 1) revealed it took both nursing assistants (#90 and #98) to perform incontinence care for the resident. The incontinent brief removed from the resident was heavily saturated with urine. Nursing assistant #90 indicated the resident had not been changed since around 1:30 A.M. and was a heavy wetter. She stated this resident was a two person assist and took longer to perform incontinence care for. Observations on 01/31/24 at 5:58 A.M. of incontinence care for Resident #49 (Station 1) by Nursing Assistant #90 revealed the resident had been incontinent of urine when her incontinent brief was removed. Nursing Assistant #90 stated the resident had last been changed around 1:00 A.M. Interview with LPN #124 on 01/31/24 at 7:40 A.M. revealed there were times when she came on duty for day shift at 6:00 A.M. when residents had not been provided with incontinence care on night shift and their incontinent brief and beds were saturated with urine. She confirmed that most of the residents on Station 1 were incontinent of bowel and/or bladder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 7 of 17 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 02/01/2024 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with RN #111 on 01/31/24 at 8:05 A.M. revealed residents are sometimes very wet from incontinence from night shift when she comes on duty for day shift at 6:00 A.M. She stated she had seen residents with their incontinent briefs and bed linens saturated with urine. She stated it was more that what could happen in a two hour period. Review of Resident Council meeting minutes for the past six months revealed on 11/14/23 the notes indicated the residents state they sometimes wish they had more staff on night shift. The facility follow up response was: We continue to recruit and hire new folks. Healthcare staffing is difficult everywhere. Interview with Activity Director #200 on 01/31/24 at 10:10 A.M. revealed she was present at the Resident Council meetings. She stated she did not remember the specifics of what was said related to staffing on night shift and did not know what residents had concerns. The Administrator was present at the time of the interview and did not provide any additional information related to the concerns with staffing on night shift. Interview with Nursing Assistant #134 on 01/31/24 at 11:15 A.M. revealed residents are to be checked for incontinence every two hours and changed at that time if needed. She confirmed that there were 24 residents who were incontinent on Station 1. She stated that she had also found residents heavily incontinent from night shift with brown stains on their linens when coming on duty for day shift at 6:00 A.M. on Station 1. She stated it had been reported to the Administrator and Director of Nursing. Interview with Nursing Assistant #144 on 01/31/24 at 11:30 A.M. revealed she normally worked day shift on Station 1. She stated residents were noted to be heavily incontinent when she comes on duty for day shift at 6:00 A.M. She stated she did not always get report from the night shift aides on Station 1 as they sometimes had already clocked out and were not on the floor when she comes on duty. Review of a Grievance/concern form revealed on 08/15/23 Resident #51 had stated her call light was ignored and she lays in a soaked brief all night. She stated this happens during night shift hours. The Director of Nursing documented that she talked with the resident and resident reports of often refusing care. Resident agreed to allow staff to clean her when they are making rounds. There was no further follow up documented. (Record review did not reveal any documentation regarding refusal of care). Interview with Resident #51 on 01/31/24 at 11:50 A.M. revealed she does not get incontinence care timely on night shift. She stated she goes up to 12 hours sometimes without incontinence care. She stated after she voiced her grievance in August 2023, care got better for a while but was now happening again. Interview with Resident #43 on 01/31/24 at 12:00 P.M. revealed she does not get incontinence care timely on night shift. She stated she gets checked and changed about two times between 6:00 P.M. and 6:00 A.M. She stated she would like changed more often. Interview with LPN #125 on 02/01/24 at 6:35 A.M. revealed she works from 6:00 P.M. to 6:00 A.M. on Station 1. She stated there is often only two nursing assistants for Station 1 at night. She stated it was very difficult to provide checks and changes for incontinent residents every two hours as they should. She stated it was more like every four hours. She stated the nursing assistants also have showers to do in the evening and are also called to other halls at times. She stated there were some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 8 of 17 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 02/01/2024 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 0725 residents on Station 1 who were heavy wetters and needed changed more often. Level of Harm - Minimal harm or potential for actual harm Interview with Resident #10 on 02/01/24 at 6:50 A.M. confirmed she was incontinent of bowel and bladder. She stated a lot of times she was not changed at all during the night. (Resides on Station 1). Residents Affected - Some Interview with Resident #49 on 02/01/24 at 10:50 A.M. confirmed she was incontinent of bowel and bladder. She stated she goes to bed at 9:00 P.M. and is not checked for incontinence until around 5:30 A.M. (Resides on Station 1). She stated her bottom is sore a lot of the time and she would like to be checked more often. Review of the medical record for Resident #10 revealed an admission date of 01/11/24 and diagnoses including diabetes, hypertension, peripheral vascular disease, and chronic obstructive pulmonary disease. Review of a Minimum Data Sets (MDS) assessment completed 01/18/24 revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating intact cognition. It indicated she was frequently incontinent of bowel and bladder, was dependent for mobility, and required moderate assistance with toileting. Review of the plan of care dated 01/12/24 revealed the resident required assistance with activities of daily living. The plan of care stated the resident had episodes of incontinence and had a history of refusing to allow staff to provide incontinence care. The nurse was to be notified if this occurred. There was no documentation in the medical record of any refusals. The care plan said to check the resident for incontinence with each round and as needed. Provide incontinence care after each episode. Interview with Assistant Director of Nursing #95 on 02/01/24 at 10:15 A.M. revealed checking at every round means every two hours. She further stated the facility did not have a policy on when to provide incontinence care. Interview with the Director of Nursing on 02/01/24 at 10:35 A.M. revealed Resident #10 had not had any refusals of care at the facility. Review of the medical record for Resident #49 revealed an admission date of 06/09/23 with diagnoses including cerebral infarction and hypertension. A MDS completed 12/07/23 stated a BIMS score of 12 (8-12 moderately impaired cognition, 13-15 intact cognition). The MDS stated the resident was frequently incontinent of bowel and bladder and required substantial/maximal assistance with toileting. Review of the plan of care dated 06/20/23 revealed the resident had episodes of incontinence and staff should check for incontinence with each round and as needed. Provide incontinence care after each episode. Review of the medical record for Resident #43 revealed an admission date of 06/21/19 with diagnoses including diabetes and multiple sclerosis. A MDS completed 12/14/23 stated a BIMS score of 15, indicating intact cognition. The MDS stated the resident was always incontinent of bowel and bladder and was dependent for toileting. The plan of care dated 04/19/21 stated the resident had bladder incontinence and was to be checked for incontinence with each round and as needed. Provide incontinence care after each episode. Interview with the Director of Nursing on 02/01/24 at 11:05 A.M. confirmed there was no evidence of any non compliance with care in Resident #43's record. Review of the medical record for Resident #51 revealed a readmission date of 11/30/23 with diagnoses including chronic pain, lymphedema, and heart failure. A MDS completed 12/23/23 stated a BIMS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 9 of 17 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 02/01/2024 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some score of 14, indicating intact cognition. The MDS stated the resident was always incontinent of bowel and bladder and was dependent upon staff for toileting. The plan of care dated 12/12/23 stated the resident had bladder incontinence and to clean peri-area with each incontinent episode. Review of staffing schedules and review of time sheets on 02/01/24 for 01/24/24 through 01/30/23 revealed on 01/25/24 there were six nursing assistants on duty after 8:30 P.M. until 3:30 A.M. (two on each of the three units) then there were five until 6:00 A.M. On 01/26/24 there were five nursing assistants on duty from 10:00 P.M. to 6:00 A.M. (one on Station 1). On 01/27/24 there were seven nursing assistants on duty from 6:00 P.M. to 6:30 A.M. (2 on Station 1). On 01/28/24 and 01/29/24 there were six nursing assistants on duty on night shift (2 on Station 1). On 01/30/24 there were five nursing assistants on duty after midnight until 6:30 A.M. (two on Station 1). The staffing schedules and time sheets were verified by the Administrator on 02/01/24. This deficiency represents non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 10 of 17 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 02/01/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, staff interview, and policy review, the facility failed to provide pharmaceutical services to meet the needs of each resident. This affected 20 of 27 residents who received narcotic medications (Residents #2, #4, #12, #14, #15, #20, #22, #24, #25, #33, #45, #51, #53, #55, #59, #61, #64, #67, #72, and #76) and one of three closed records reviewed (Resident #85). The facility census was 80. Findings include: 1. Review of the controlled medication shift change log for the four medication carts on Station 1 and Station 2 on 01/31/24 at 6:15 A.M. revealed nurses were to count the number of narcotic sheets in the cart at shift change to ensure that count sheets had not been removed inappropriately since the last shift. Review of all four shift change logs revealed that there were multiple missing count totals. Therefore, it would be difficult to determine if a narcotic sheet had been removed from the cart inappropriately during the shift. Station 1 had two carts titled Station 1 and 2A. The Station 1 shift change log did not have a sheet count from 01/28/24 to 01/30/24. (Seven shift changes). The 2A shift change log did not have a sheet count from 01/29/24 to 01/31/24 (Six shift changes). Station 2 had two carts titled 2AA and 2B. The 2AA shift change log did not have a sheet count from 01/26/24 to 01/30/24. (Nine shift changes). In addition, the sheet count was marked out on 01/30/24, 01/31/24, and 02/01/24 (a line drawn through 18 four different times with no number to replace it until 02/01/24/ when 16 was placed beside the 18. The 2B shift change log did not have a sheet count on five shifts between 01/29/24 and 01/31/24. The facility identified 20 residents as having narcotics stored in the four medication carts on Station 1 and 2 (Residents #2, #4, #12, #14, #15, #20, #22, #24, #25, #33, #45, #51, #53, #55, #59, #61, #64, #67, #72, and #76). Review of the facility Controlled Substances Policy dated 06/21/17 and 08/27/18 revealed it did not address the counting of narcotic sheets at shift change. Interview with Assistant Director of Nursing #95 on 01/31/24 at 6:30 A.M. confirmed narcotic sheet counts were to be done every shift, in addition to counting the narcotics. Interview with the Director of Nursing on 01/31/24 at 6:45 A.M. confirmed the narcotic sheet counts were not done each shift and documentation was sloppy. 2. Interview with Registered Nurse (RN) #111 on 01/31/24 at 8:05 A.M. revealed former Resident #85 had reported to her sometime during his stay (12/23/23 to 01/06/24) that he was routinely given Trazodone (an antidepressant and sedative medication) by a nurse without a physician's order. He reported that it made him sleepy the next day. She said that he described the nurse as a fat nurse on nights. She stated that she reported this to the Assistant Director of Nursing at the time he reported it. Interview with Assistant Director of Nursing #95 on 02/01/24 at 1:30 P.M. revealed she was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 11 of 17 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 02/01/2024 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some aware of the allegation until 01/31/24, when RN #111 told her. She stated she would have investigated the concern had she been aware. Review of the medical record for Resident #85 revealed an admission date of 12/23/23 and diagnoses including diabetes, chronic kidney disease, and hypertension. Review of a Minimum Data Set assessment on 01/05/24 revealed a Brief Interview for Mental Status score of 15, indicating intact cognition. Record review revealed no physician's order for Trazodone during his stay and no documentation to indicate it was given or that he had reported it was. He was transferred to a different nursing home on [DATE]. This deficiency represents an incidental finding of non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 12 of 17 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 02/01/2024 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on staff interview, medical record review, and policy review, the facility failed to ensure residents were free from significant medication errors. This affected two of 80 residents residing in the facility (Residents #64 and #75). Residents Affected - Few Findings include: 1. Interview with Licensed Practical Nurse (LPN) #106 on 01/31/24 at 4:35 A.M. revealed she had already given Resident #64 his Haldol (antipsychotic medication) that was scheduled at 6:00 A.M. She confirmed it was given early. She did not have a reason other than there was only two nurses working that night and she had other duties to do between 5:00 A.M. and 6:00 A.M. Review of the medical record for Resident #64 revealed an admission date of 10/23/23 with diagnoses of cirrhosis of the liver and anxiety disorder. He had a physician's order dated 01/07/24 for Haldol 2 milligrams every six hours at 12:00 A.M., 6:00 A.M., 12:00 P.M. and 6:00 P.M. for agitation. Review of the medication administration record for Resident #64 revealed LPN #106 documented that Haldol was administered on 01/31/24 at 1:05 A.M. and 5:37 A.M. (even though she stated the medication was already given at 4:35 A.M. for the 6:00 A.M. dose). This would indicate only approximately 3.5 hours between doses (1:05 A.M. to 4:35 A.M.). Interview with Assistant Director of Nursing #95 on 02/01/24 at 9:50 A.M. confirmed the times documented for the Haldol on 01/31/24. She confirmed medications should be given up to one hour before or one hour after the ordered time. Interview with LPN #124 on 02/01/24 at 11:10 A.M. revealed she did not observe Resident #64 to have any adverse effects related to his Haldol doses being administered too close together on 01/31/24. (She worked on day shift on 01/31/24). Interview with Resident #64 on 02/01/24 at 11:15 A.M. revealed he was not aware of what times he received the Haldol on 01/31/24 and did not report any adverse affects. Review of the facility policy titled Medication Administration Schedule (dated November 2020) revealed scheduled medications are administered within one hour of the prescribed time, unless otherwise specified. The policy titled documentation of medication administration (dated April 2007) revealed administration of medication must be documented immediately after (never before) it is given. 2. Interview with Registered Nurse (RN) #149 on 01/31/24 at 4:45 A.M. revealed she had already given Resident #75 her narcotic pain pill that was due at 6:00 A.M. She stated the resident had asked for it early. Review of the medical record for Resident #75 revealed an admission date of 01/19/24 and a diagnosis of malignant neoplasm of the mouth. A nurses note on 01/29/24 indicated the resident was alert and oriented to person, place, and time. The resident had a physician's order for oxycodone 10 milligrams (opioid, narcotic pain medication) every six hourse at 12:00 A.M., 6:00 A.M., 12:00 P.M., and 6:00 P.M. for pain. Review of the medication administration record for Resident #75 revealed RN #149 documented the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 13 of 17 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 02/01/2024 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Oxycodone was administered on 01/31/24 at 12:36 A.M. and 7:00 A.M. (even though she stated the 6:00 A.M. dose was already given at 4:45 A.M. This would be approximately four hours between doses (12:36 A.M. to 4:45 A.M.). Review of the controlled drug disposition form revealed RN #149 signed that she gave the Oxycodone on 01/31/24 at 12:00 A.M. and 6:00 A.M. Interview with Assistant Director of Nursing #95 on 02/01/24 at 10:04 A.M. confirmed the medication administration record and the controlled drug sign out form did not match for times and should. She stated RN #149 told her she gave the Oxycodone at 4:40 A.M. Interview with Resident #75 on 01/31/24 at 1:00 P.M. revealed she did not ask for her pain medication early on the morning of 01/31/24. Review of the facility policy titled Medication Administration Schedule (dated November 2020) revealed scheduled medications are administered within one hour of the prescribed time, unless otherwise specified. The policy titled documentation of medication administration (dated April 2007) revealed administration of medication must be documented immediately after (never before) it is given. The policy further stated that scheduled medications designated as time-critical (medications that may cause harm or subtherapeutic affect if administered before or after the scheduled time) are administered at the scheduled time or within 30 minutes of the scheduled time. Time critical medications include scheduled opiods used for chronic pain or palliative care. The exact time of medication administration is documented in the medication administration record. This deficiency represents non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 14 of 17 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 02/01/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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. Based on observations, staff interview, and policy review, the facility failed to ensure only authorized personnel had access to the medication storage room. This had the potential to affect 80 of 80 residents residing in the facility. Findings include: Interview with Licensed Practical Nurse (LPN) #124 on 01/31/24 at 7:40 A.M. revealed the business office was supposed to place a petty cash box in the medication room each day when they left so that residents had access to petty cash in the evening or on weekends. Observations on 01/31/24 at 7:40 A.M. revealed there was a key pad lock on the medication room door on Station 1. Interview with the Director of Nursing on 01/31/24 at 7:45 A.M. confirmed the business office was to put the money box in the medication room every day so that money was available for residents in the evening and on weekends. Interview with Business Office Manager #201 on 01/31/24 at 7:50 A.M. revealed that she placed the money box in the Station 1 medication room every day when she leaves. At that time, she stated that she had the code to the medication room door. Observations on 01/31/24 at 8:00 A.M. revealed there were unlocked medications in the Station 1 medication room to access if you had the code to the medication room door. Medications included phenergan, insulin, IV antibiotics, buspar, eliquis, venlafaxine, and flexaril. Review of the facility policy titled Storage of Medications (dated November 2020) revealed only persons authorized to prepare and administer medications have access to locked medications. Interview with the Director of Nursing on 01/31/24 at 8:00 A.M. confirmed only nurses should have access to the medication room. This deficiency represents an incidental finding of non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 15 of 17 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 02/01/2024 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on medical record review, observations, staff interview, and policy review, the facility failed to ensure medical records were accurately documented. This affected three of 12 sampled residents (Residents #54, #64, and #75). The facility census was 80. Findings include: 1. Interview with Licensed Practical Nurse (LPN) #106 on 01/31/24 at 4:35 A.M. revealed she had already given Resident #64 his Haldol (antipsychotic medication) that was scheduled at 6:00 A.M. She confirmed it was given early. She did not have a reason other than there was only two nurses working that night and she had other duties to do between 5:00 A.M. and 6:00 A.M. Review of the medical record for Resident #64 revealed an admission date of 10/23/23 with diagnoses of cirrhosis of the liver and anxiety disorder. He had a physician's order dated 01/07/24 for Haldol 2 milligrams every six hours at 12:00 A.M., 6:00 A.M., 12:00 P.M. and 6:00 P.M. for agitation. Review of the medication administration record for Resident #64 revealed LPN #106 documented that Haldol was administered on 01/31/24 at 1:05 A.M. and 5:37 A.M. (even though she stated the medication was already given at 4:35 A.M. for the 6:00 A.M. dose). Interview with Assistant Director of Nursing #95 on 02/01/24 at 9:50 A.M. confirmed the times documented for the Haldol on 01/31/24. Review of the policy titled documentation of medication administration dated April 2007 revealed administration of medication must be documented immediately after it is given. The exact time of medication administration is documented in the medication administration record. 2. Interview with Registered Nurse (RN) #149 on 01/31/24 at 4:45 A.M. revealed she had already given Resident #75 her narcotic pain pill that was due at 6:00 A.M. She stated the resident had asked for it early. Review of the medical record for Resident #75 revealed an admission date of 01/19/24 and a diagnosis of malignant neoplasm of the mouth. A nurses note on 01/29/24 indicated the resident was alert and oriented to person, place, and time. The resident had a physician's order for oxycodone 10 milligrams (opioid, narcotic pain medication) every six hourse at 12:00 A.M., 6:00 A.M., 12:00 P.M., and 6:00 P.M. for pain. Review of the medication administration record for Resident #75 revealed RN #149 documented the Oxycodone was administered on 01/31/24 at 12:36 A.M. and 7:00 A.M. (even though she stated the 6:00 A.M. dose was already given at 4:45 A.M. Review of the controlled drug disposition form revealed RN #149 signed that she gave the Oxycodone on 01/31/24 at 12:00 A.M. and 6:00 A.M. Interview with Assistant Director of Nursing #95 on 02/01/24 at 10:04 A.M. confirmed the medication administration record and the controlled drug sign out form did not match for times and should. She stated RN #149 told her she gave the Oxycodone at 4:40 A.M. The policy titled documentation of medication administration dated April 2007 revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 16 of 17 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 02/01/2024 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 0842 Level of Harm - Minimal harm or potential for actual harm administration of medication must be documented immediately after it is given. The exact time of medication administration is documented in the medication administration record. 3. Observations on 01/31/24 at 5:35 A.M. revealed RN #149 to administer Levothyroxine 88 micrograms to Resident #54. Residents Affected - Some Review of the medication administration record for Resident #54 revealed the Levothyroxine was documented as given at 8:00 A.M. by RN #111. Interview with RN #111 on 02/01/24 at 7:30 A.M. confirmed that she did not administer the Levothyroxine on 01/31/24 but documented that she did. She stated that she did this because RN #149 changed the time of administration from 6:00 A.M. to 8:00 A.M., even though she administered the medication at 5:35 A.M. Interview with the Director of Nursing on 02/01/24 at 7:35 A.M. revealed RN #149 should not have changed the time for the Levothyroxine and should have documented that she gave the medication. This deficiency represents an incidental finding of non-compliance investigated under Complaint Number OH00149842. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 17 of 17