Health inspection·September 17, 2025

F 0635 Provide doctor's orders for the resident's immediate care at the time the resident was admitted. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview and medical record review the facility failed to ensure physician orders were in place for Resident #68 foley catheter. This affected one (Resident #68) of one resident resident reviewed for foley catheters. The facility census was 79.Findings include: Review of the medical record for Resident #68 revealed an admission date of 08/21/25 with diagnoses including atrial fibrillation, congestive heart failure, liver cirrhosis, diabetes mellitus type two, chronic kidney disease with dialysis. Review of the physician orders dated 09/25 revealed no orders in place for Resident #68 indwelling foley catheter.Review of the discharge return not anticipated Minimum Data Set (MDS) most recent completed, dated 08/28/25 revealed Resident #68 was cognitively intact with no behaviors. Resident #68 was dependent on staff for toileting hygiene, bed mobility, and transfers and required substantial assistance with bathing. Resident #68 had an indwelling catheter.Review of the nursing progress notes for Resident #68 revealed no documentation of physician orders for Resident #68 indwelling foley catheter.Review of the Certified Nursing Assistant documentation revealed care was provided for Resident #68 indwelling foley catheter. Review of the plan of care revealed no plan of care for Resident #68 indwelling foley catheter.Interview on 09/17/25 at 2:55 P.M. with the Director of Nursing confirmed Resident #68 had no physician orders for indwelling foley catheter.Observations made during the survey revealed Resident #68 had an indwelling foley catheter to bedside drainage bag with privacy cover.The facility did not have a policy related to physician orders for indwelling foley catheter.This was an incidental finding discovered during investigation of Master Complaint Number 2603203 and Complaint Number 1382712. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 2 of 5 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 09/17/2025 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 - Few 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 medical record review , interview, and facility policy review, the facility failed to ensure medications on admission were received from pharmacy and administered to the residents timely. This affected three Residents (#42, #68 and #120) of five residents reviewed for medication administration. The facility census was 79.Findings include:1.Review of the closed medical record for Resident #120 revealed an initial admission date of 08/12/25 with diagnoses including pleural effusion, chronic kidney disease stage three, cirrhosis of the liver, atrial fibrillation diabetes mellitus type two and Clostridium difficile (C-diff). Review of the Medication Administration Record (MAR) dated 08/25 revealed Resident #120 was ordered on 08/12/25 Vancomycin hydrochloride capsule 125 milligrams (mg) by mouth four times daily for C-diff, Sulcralfate 1 gram by mouth four times daily for gastroesophageal reflux disease (GERD), and Gabapentin 100 mg by mouth three times daily for pain. The MAR indicated Resident #120 did not receive the Sulcralfate and Gabapentin until the morning dose on 08/14/25. The MAR indicated Resident #120 did not receive the Vancomycin 125 mg by mouth up to her discharge back to the hospital on [DATE] for chest pain. Review of the nursing progress notes revealed a note dated 08/13/25 at 9:39 A.M. awaiting pharmacy, a note dated 08/13/25 at 4:29 P.M. awaiting pharmacy, a noted dated 08/13/25 4:29 P.M. Sulcralfate 1 gram by mouth four times day for GERD, awaiting pharmacy, a note dated 08/13/25 at 4:29 P.M. Gabapentin 100 mg by mouth three times day for pain, awaiting pharmacy, a note dated 08/13/25 4:30 P.M. Vancomycin hydrochloride (hcl) oral capsule 125 mg by mouth four times a day for infection for four days, awaiting pharmacy, a note dated 08/14/25 at 6:02 P.M. Vancomycin hcl 25 mg per milliliter (ml) solution reconstituted, give 5 ml by mouth four times day for C-diff for 8 days, awaiting on pharmacy, and no documentation the physician or Nurse Practitioner (NP) was notified for instructions. Review of the Minimum Data Set (MDS) revealed Resident #120 had two admission assessments (limited information) and two discharge return not anticipated assessments. Interview on 09/17/25 at 12:54 P.M. with Licensed Practical Nurse (LPN) #21 confirmed there was a problem getting medications from pharmacy timely especially with admissions. LPN #21 confirmed Resident #120 missed doses of medication for several days after admission. LPN #21 stated if a resident missed a medication the procedure was to call the pharmacy, notify the Nurse Practitioner (NP) or physician, and document. The facility has a Pixus system with medications on hand but does not always have what the resident was ordered. LPN #21 stated the facility was working on a new pharmacy. Interview on 09/17/25 at 1:15 P.M. with NP (on site) revealed Resident #21 had no adverse effects from missing the medications.Interview on 09/17/25 at 2:55 P.M. with the Director of Nursing (DON) confirmed Resident #21 did not receive the medication Vancomycin oral tablets for three days after admission. DON confirmed there was no documentation in nursing progress notes the physician or NP was notified.2.Review of the medical record for Resident #42 revealed an admission date of 09/03/25 with diagnoses including weakness, chronic obstructive pulmonary disorder cirrhosis of liver, chronic viral Hepatitis C, diabetes mellitus type two and congestive heart failure.Review of the MAR dated 09/25 for Resident #42 revealed the following orders dated 09/03/25 on admission: Clopidogrel bisulfate 75 milligrams (mg) by mouth daily not administered until 09/05/25, Lantus insulin Solostar injector pen 100 units/milliliter (ml) inject 8 units subcutaneously daily not administered until 09/05/25, Nicotine patch 21mg/24 hours apply in the morning and remove in the evening not administered until 09/05/25, Sertraline hydrochloride 100 mg by mouth daily not administered until 09/05/25, Trelegy ellipta inhalation powder 100-62.5-25 micrograms one puff daily for 90 days not administered until 09/05/25, Cefazolin intravenous 2.0-0.9 grams/100 ml every 8 hours for 15 days not administered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 3 of 5 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 09/17/2025 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 - Few until 09/05/25, and Creon 36000-114000 units give 2 capsules by mouth three times daily not administered until 09/15/25.Review of the nursing progress notes for Resident #42 revealed the following: 09/03/25 at 8:39 P.M. the physician and family was notified of Resident #42 admission to the facility. The resident had no known allergies. Resident #42 tolerated transfer well, oriented to call light, bed controls and television remote. The resident had a midline intravenous site to left upper extremity and a supra pubic catheter. Also noted a wound to coccyx covered with mepilex. The skin assessment was completed. Resident #42 was a full code and was alert and oriented to person, place and time. A note dated 09/04/25 at 4:54 P.M. medications not delivered by pharmacy. A note dated 09/04/25 at 11:46 A.M. Cefazolin in sodium chloride intravenous solution 2.0-0.9 grams/100 ml was not available. A note dated 09/05/25 1:21 P.M. Creon oral capsule delayed release 36000-114000 units give two capsules by mouth three times daily was on order. A noted dated 09/05/25 at 3:25 P.M. Creon capsule delayed release 36000-114000 units 2 capsules by mouth three times daily was on order. A note dated 09/06/25 9:33 A.M. Creon capsule delayed release 36000-114000 units 2 capsules by mouth three times daily was on order. A note dated 09/07/25 at 7:15 A.M. Creon capsule delayed release 36000-114000 units 2 capsules by mouth three times daily was on order. A noted dated 09/09/25 at 3:05 P.M. Creon capsule delayed release 36000-114000 units was not provided. A note dated 09/10/25 at 8:38 A.M. Creon capsule delayed release 36000-114000 units 2 capsules by mouth three times daily was on order. A note dated 09/11/25 at 7:11 A.M. Creon capsule delayed release 36000-114000 unit give 2 capsules by mouth three times daily was on order. A note dated 09/12/25 at 7:27 A.M. Creon oral capsule delayed release 36000-114000 unit 2 capsules by mouth three times daily was on order. A note dated 09/12/25 7:27 A.M. Creon oral capsule delayed release 36000-114000 unit give 2 capsules by mouth three times daily, the nurse received an order to hold the medication until arrival from pharmacy.Review of the admission Minimum Data Set (MDS) dated [DATE] revealed Resident #42 was cognitively intact with no behaviors. Interview on 09/17/25 at 9:20 A.M. with Resident #42 revealed there was a medication she did not receive after being admitted . Resident #42 stated the nurse explained that she had contacted the pharmacy and was waiting on the pharmacy to bring it. Resident #42 stated she now received the medication and has no problems with getting her medications. Interview on 09/17/25 at 12:46 P.M. with LPN # 68 confirmed Resident #42 did not receive scheduled medication Creon as ordered for several days. The medication was then placed on hold. Resident #42 now receives the medication. Interview on 09/17/25 at 1:15 P.M. with NP (on site) revealed Resident #42 had no adverse effects from missing the medications. The NP stated she was not notified of the missing doses of medication until 09/12/25 and she gave the order to hold the Creon until available from the pharmacy. The medication Creon has since been started and administered as ordered. Interview on 09/17/25 at 2:55 P.M. with the Director of Nursing (DON) confirmed Resident #42 did not receive the medications Plavix, Lantus insulin, Nicotine patch, Sertraline, Trelegy inhaler, Cefazolin and Creon for several days until it was place on hold. 3.Review of the medical record for Resident #68 revealed an admission date of 08/21/25 with diagnoses including atrial fibrillation, congestive heart failure, liver cirrhosis, diabetes mellitus type two, chronic kidney disease with dialysis. Review of the MAR dated 08/25 revealed on admission Resident #68 was ordered lactulose solution 10 grams/15 ml give 30 ml by mouth two times daily for cirrhosis. The medication was not administered on the following dates: 08/22/25 and 08/23/25.Review of the discharge return not anticipated Minimum Data Set (MDS) most recent completed, dated 08/28/25 revealed Resident #68 was cognitively intact with no behaviors.Review of the nursing progress notes for Resident #68 revealed the following: a note dated 08/21/25 at 6:05 P.M. admit [AGE] year old male to room [ROOM NUMBER] A from local hospital and arrived at the facility via ambulance on a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365398 If continuation sheet Page 4 of 5 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 09/17/2025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stretcher. The resident was assisted from stretcher onto the bed with assistance of five people. Resident was oriented to room, call light and bed controls. A note dated 08/22/25 at 11:16 A.M. lactulose solution 10 grams/15 milliliters (ml) give 30 ml by mouth two times daily, awaiting from pharmacy. A note dated 08/23/25 at 8:56 A.M. lactulose solution 10 grams/15 ml give 30 ml by mouth two times daily, not available will call the pharmacy for delivery of medication. Interview on 09/17/25 at 9:45 A.M. with Resident #68 revealed no concerns with medication now, however, when the resident was first admitted he did not receive the medication he takes for his bowels. Resident #68 denied any adverse effects from not having the medication.Interview on 09/17/25 at 12:46 P.M. with LPN #68 confirmed Resident #68 did not receive scheduled lactulose medication for two days after admission. LPN #68 stated he called the pharmacy about the medication and was not sure it was documented in nursing notes. Interview on 09/17/25 at 12:54 P.M. with LPN #21 confirmed there was a problem getting medications from pharmacy timely especially with admissions. LPN #21 stated if a resident missed a medication the procedure was to call the pharmacy, notify the Nurse Practitioner (NP) or physician, and document. The facility has a Pixus system with medications on hand but does not always have what the resident was ordered. LPN #21 stated the facility was working on a new pharmacy. Interview on 09/17/25 at 1:15 P.M. with NP (on site) revealed Resident #68 had no adverse effects from missing the medication.Interview on 09/17/25 at 2:55 P.M. with the Director of Nursing (DON) confirmed Resident #68 did not receive the medication lactulose for three days after admission. The DON confirmed there was no documentation in the nursing progress notes the physician or NP were notified. Observation of Resident #68 on 09/17/25 at 9:45 A.M. revealed no concerns related to not receiving medication upon admission.Review of the facility policy titled Medication Administration with effective date of 06/17/17 revealed during medication administration if the medication was unavailable, the nurse would contact the pharmacy and document accordingly.This deficiency represents non compliance investigated under Master Complaint Number 2603203. Event ID: Facility ID: 365398 If continuation sheet Page 5 of 5