Health inspection·January 11, 2024

F 0684 Level of Harm - Minimal harm or potential for actual harm and discontinued [DATE], Quetiapine Fumarate 50 mg with instructions to give one tablet in the morning for one week dated [DATE] and discontinued [DATE], and Quetiapine Fumarate 25 mg with instructions to give one tablet in the morning dated [DATE] and discontinued [DATE] due to hospice. Additionally, Resident #59 had an order for Trazodone Hydrochloride (HCl) 50 mg with instructions to give 25 mg by mouth at bedtime for insomnia dated [DATE] and discontinued [DATE] per the hospice Certified Nurse Practitioner (CNP). Residents Affected - Few Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #59 had severely impaired cognition and scored a zero out of 15 on the Brief Interview for Mental Status (BIMS) assessment. Resident #59 was dependent on facility staff to complete Activities of Daily Living (ADLs). Review of the progress notes dated from [DATE] to [DATE] revealed on [DATE] at 4:41 P.M., Resident #59 admitted to the facility and was transported by the family. Vital signs were within normal limits. There was no indication of the resident receiving hospice services upon admission. The first progress note which mentioned contact with hospice was dated [DATE] (seven days after admission) at 7:32 P.M., Certified Nurse Practitioner (CNP) was notified of x-ray results. The nurse also left a voicemail with hospice. No new orders at this time. Resident denied pain. Power of Attorney (POA) aware. Further review of the progress notes dated from [DATE] to [DATE] revealed on [DATE] at 11:02 A.M. and 11:03 A.M., notification of order change notes stated Resident #59 and the resident's representative were updated on new orders. Risk/Benefits were explained for Trazodone HCl 50 mg with instructions to give 25 mg by mouth at bedtime for insomnia, Seroquel tablet 100 mg with instructions to give one tablet by mouth daily, and Seroquel 50 mg with instructions to give one tablet in the evening for dementia with behaviors. The start dates for the medication were [DATE] and [DATE]. Resident #59 and the resident's Power of Attorney (POA) were made aware. There was no indication the resident's hospice provider was notified of the medication changes. Review of the care plan dated [DATE] revealed Resident #59 had a terminal prognosis related to hospice services for Parkinson's Disease with declines in condition expected. Interventions included Capital City Hospice, all care must be preauthorized: all new medications-call before contacting contracted company, all new treatments-medical equipment, labs, diagnostic tests, x-rays, transport from the facility, condition change, hospice will call the resident's physician unless other arrangements are made with hospice staff. The interventions were resolved on [DATE]. On [DATE], interventions included Transitions Hospice was initiated. Additional intervention included coordinate all care with hospice and work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical and social needs are met (dated [DATE]). Review of the Encounter Summary-Progress Note completed by the facility's Certified Nurse Practitioner (CNP), CNP #150, dated [DATE] at 1:47 P.M. revealed Resident #59 was seen for an acute visit due to behaviors including restlessness, impulsivity, yelling out during the day and night, and difficulty with redirecting the resident. CNP #150 planned to increase Seroquel to 100 mg daily at bedtime and add Trazodone 25 mg daily at bedtime to address dementia with psychotic disturbances. The resident's instructions included the same and to continue to follow with hospice. There was no indication the hospice provider was notified of the medication changes. Review of Plan of Care Conference, dated [DATE] (nine days after medication changes), revealed Resident #59's POA/spouse, the resident's daughter and son-in-law, Hospice Executive Director ([NAME]) #105, Licensed Social Worker (LSW) #112, and the Director of Nursing (DON) attended the care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365399 If continuation sheet Page 2 of 7 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 365399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westerwood Rehabilitation 5757 Ponderosa Drive Columbus, OH 43231 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 conference. Nursing Services noted the current plan of care, behaviors, falls, and interventions were reviewed. Nursing agreed with the current plan and medication education was provided. Resident #59's family reported medication tweaks and environmental adjustments were still occurring. The care conference did not indicate what medications were reviewed or what medications the resident's family received educated about. Residents Affected - Few Further review of the medical record for Resident #59 revealed there were not any hospice communication notes included in the medical record. Interview on [DATE] at 1:08 P.M. via telephone with CNP #103 revealed she was the on-call CNP for Resident #59's hospice provider. CNP #103 stated the facility's CNP (CNP #150) increased Resident #59's Seroquel shortly after the resident was admitted and thinks CNP #150 also adjusted or added some other medication as well that she was not notified of until she attended a care conference via telephone to discuss Resident #59 on [DATE] and reviewed Resident #59's medications. CNP #103 recommended Resident #59's antipsychotic medication be reduced again at that time. CNP #150 stated she did not attend a care conference on [DATE] for Resident #59. Interview on [DATE] at 10:21 A.M. via telephone with [NAME] #105 revealed the facility's CNP (CNP #150) adjusted Resident #59's medications, including Seroquel, without notifying the hospice provider/hospice CNP (CNP #103). [NAME] #105 stated CNP #103 became aware of the medication adjustments/changes on [DATE] when CNP #103 attended a care conference via telephone to discuss Resident #59 and she reviewed the resident's medications. CNP #103 requested to have the medications reduced again at the time of the care conference. [NAME] #105 denied medications were discussed during the care conference held on [DATE]. Interview on [DATE] at 11:12 A.M. with the DON confirmed there were some communication issues between the facility and the hospice provider for Resident #59. The DON stated the facility conducted two care conferences for Resident #59 during her stay at the facility. The DON stated one was completed in November and the other was completed in [DATE]. The DON stated a hospice representative attended both care conferences and the resident's medications would have been reviewed at each care conference. The DON confirmed there was no documentation the hospice provider was notified of any medication changes for Resident #59 prior to [DATE] (nine days later). Further interview on [DATE] at 11:52 A.M. with the Director of Nursing (DON) confirmed Resident #59's medical record only included plans of care from the hospice provider and did not include any progress/visit notes from the hospice provider. Interview on [DATE] at 2:10 P.M. with LSW #112 confirmed a care conference was completed on [DATE] for Resident #59 (nine days after the medication changes). LSW #112 stated she was not able to remember exactly what was discussed during the care conference but the resident's medications would have been reviewed as that was standard procedure for all care conferences. LSW #112 confirmed [NAME] #105 attended the care conference on [DATE] via telephone but CNP #103 did not attend. LSW #112 stated there was a family meeting held on [DATE] per the family's request as well but she was not able to attend that meeting and was not aware what occurred during that meeting. Review of the facility policy, Hospice Program, undated, revealed the policy stated, The hospice agency retains overall professional management responsibility for directing the implementation of the plan of care related to the terminal illness and related conditions. All hospice services are provided under contractual arrangement. Complete details outlining the responsibilities of the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365399 If continuation sheet Page 3 of 7 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 365399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westerwood Rehabilitation 5757 Ponderosa Drive Columbus, OH 43231 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 and the hospice agency are contained in this agreement. Level of Harm - Minimal harm or potential for actual harm Review of the hospice contract, dated [DATE], revealed the contract stated, Nursing Facility and Transitions will each maintain and make available to each other for inspection and copying, detailed clinical records concerning each Transitions Hospice Patient in accordance with good professional practice, federal and state laws and regulations, and applicable Medicare and Medicaid guidelines. The contract also revealed 3.3 Notification Agreement. The facility will immediately notify the hospice about the following: significant change in the patient's physical, mental, social, or emotional status. Clinical complications that suggest a need to alter the plan of care. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00149558. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365399 If continuation sheet Page 4 of 7 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 365399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westerwood Rehabilitation 5757 Ponderosa Drive Columbus, OH 43231 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews, review of the hospice contract, and facility policy review, the facility failed to follow the hospice agreement in place for one resident's (Resident #59) hospice provider. This affected one (Resident #59) of three residents reviewed for hospice services. The facility census was 61. Findings Include: Review of the closed medical record for Resident #59 revealed an admission date on [DATE] and a discharge date on [DATE] due to the resident passing away. Medical diagnoses included Parkinson's Disease with dyskinesia (uncontrolled, involuntary muscle movement), dementia with psychotic disturbance and anxiety, epilepsy (seizures), anxiety disorder, supraventricular tachycardia (a faster than normal heart rate beginning above the heart's two lower chambers), cognitive communication deficit, presence of neurotransmitter, and dystonia (involuntary muscle contractions that cause repetitive or twisting movements). Review of Resident #59's census revealed the resident was admitted under a hospice payer. Review of the Patient Information Report from the hospice provider date [DATE] revealed Resident #59 was admitted to hospice on [DATE] (prior to the resident's admission to the facility). Review of the physician orders for Resident #59 revealed the resident had the following hospice orders: Hospice-Transitions Hospice (dated [DATE] and discontinued [DATE]), Hospice-Transitions Hospice (dated [DATE] and discontinued [DATE] with reason to add a diagnosis), Hospice-Transitions Hospice with diagnosis Parkinson's Disease (dated [DATE] and discontinued [DATE] with no reason indicated), Hospice-Transitions Hospice with diagnosis Parkinson's Disease (dated [DATE] and discontinued [DATE]), and Hospice-Transitions Hospice with diagnosis Parkinson's Disease (dated [DATE] and discontinued [DATE] due to the resident being deceased ). Review of the physician orders for Resident #59 revealed the resident had the following medication orders: Quetiapine Fumarate (Seroquel) (an antipsychotic medication) 50 milligrams (mg) with instructions to give one tablet every eight hours as needed for severe agitation dated [DATE] and discontinued [DATE], Quetiapine Fumarate 50 mg with instructions to give one tablet twice a day (BID) dated [DATE] and discontinued [DATE], Seroquel 50 mg with instructions to give one tablet in the evening for dementia with behaviors dated [DATE] and discontinued [DATE], Seroquel 100 mg with instructions to give one tablet daily for dementia with behaviors dated [DATE] and discontinued [DATE], Quetiapine Fumarate 25 mg with instructions to give one tablet in the evening for one week dated [DATE] and discontinued [DATE], Quetiapine Fumarate 50 mg with instructions to give one tablet in the morning for one week dated [DATE] and discontinued [DATE], and Quetiapine Fumarate 25 mg with instructions to give one tablet in the morning dated [DATE] and discontinued [DATE] due to hospice. Additionally, Resident #59 had an order for Trazodone Hydrochloride (HCl) 50 mg with instructions to give 25 mg by mouth at bedtime for insomnia dated [DATE] and discontinued [DATE] per the hospice Certified Nurse Practitioner (CNP). Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #59 had severely impaired cognition and scored a zero out of 15 on the Brief Interview for Mental Status (BIMS) assessment. Resident #59 was dependent on facility staff to complete Activities of Daily (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365399 If continuation sheet Page 5 of 7 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 365399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westerwood Rehabilitation 5757 Ponderosa Drive Columbus, OH 43231 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 0849 Living (ADLs). Level of Harm - Minimal harm or potential for actual harm Review of the progress notes dated from [DATE] to [DATE] revealed on [DATE] at 11:02 A.M. and 11:03 A.M., notification of order change notes stated Resident #59 and the resident's representative were updated on new orders. Risk/Benefits were explained for Trazodone HCl 50 mg with instructions to give 25 mg by mouth at bedtime for insomnia, Seroquel tablet 100 mg with instructions to give one tablet by mouth daily, and Seroquel 50 mg with instructions to give one tablet in the evening for dementia with behaviors . The start dates for the medication were [DATE] and [DATE]. Resident #59 and the resident's Power of Attorney (POA) were made aware. There was no indication the resident's hospice provider was notified of the medication changes. Residents Affected - Few Review of the care plan dated [DATE] revealed Resident #59 had a terminal prognosis related to hospice services for Parkinson's Disease with declines in condition expected. Interventions included Capital City Hospice, all care must be preauthorized: all new medications-call before contacting contracted company, all new treatments-medical equipment, labs, diagnostic tests, x-rays, transport from the facility, condition change, hospice will call the resident's physician unless other arrangements are made with hospice staff. The interventions were resolved on [DATE]. On [DATE], interventions included Transitions Hospice was initiated. Additional intervention included coordinate all care with hospice and work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical and social needs are met (dated [DATE]). Review of the Encounter Summary-Progress Note completed by the facility's Certified Nurse Practitioner (CNP), CNP #150, dated [DATE] at 1:47 P.M. revealed Resident #59 was seen for an acute visit due to behaviors including restlessness, impulsivity, yelling out during the day and night, and difficulty with redirecting the resident. CNP #150 planned to increase Seroquel to 100 mg daily at bedtime and add Trazodone 25 mg daily at bedtime to address dementia with psychotic disturbances. The resident's instructions included the same and to continue to follow with hospice. There was no indication the hospice provider was notified of the medication changes. Review of Plan of Care Conference, dated [DATE] (nine days after medication changes), revealed Resident #59's POA/spouse, the resident's daughter and son-in-law, Hospice Executive Director ([NAME]) #105, Licensed Social Worker (LSW) #112, and the Director of Nursing (DON) attended the care conference. Nursing Services noted the current plan of care, behaviors, falls, and interventions were reviewed. Nursing agreed with the current plan and medication education was provided. Resident #59's family reported medication tweaks and environmental adjustments were still occurring. The care conference did not indicate what medications were reviewed or what medications the resident's family were educated on. Interview on [DATE] at 1:08 P.M. via telephone with CNP #103 revealed she was the on-call CNP for Resident #59's hospice provider. CNP #103 stated the facility's CNP (CNP #150) increased Resident #59's Seroquel shortly after the resident was admitted and thinks CNP #150 also adjusted or added some other medication as well that she was not notified of until she attended a care conference via telephone to discuss Resident #59 on [DATE] and reviewed Resident #59's medications. CNP #103 recommended Resident #59's antipsychotic medication be reduced again at that time. CNP #150 stated she did not attend a care conference on [DATE] for Resident #59. Interview on [DATE] at 10:21 A.M. via telephone with [NAME] #105 revealed the facility's CNP (CNP #150) adjusted Resident #59's medications, including Seroquel, without notifying the hospice provider/hospice CNP (CNP #103). [NAME] #105 stated CNP #103 became aware of the medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365399 If continuation sheet Page 6 of 7 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 365399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westerwood Rehabilitation 5757 Ponderosa Drive Columbus, OH 43231 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few adjustments/changes on [DATE] when CNP #103 attended a care conference via telephone to discuss Resident #59 and she reviewed the resident's medications. CNP #103 requested to have the medications reduced again at the time of the care conference. [NAME] #105 denied medications were discussed during the care conference held on [DATE]. Interview on [DATE] at 11:12 A.M. with the DON confirmed there were some communication issues between the facility and the hospice provider for Resident #59. The DON stated the facility conducted two care conferences for Resident #59 during her stay at the facility. The DON stated one was completed in November and the other was completed in [DATE]. The DON stated a hospice representative attended both care conferences and the resident's medications would have been reviewed at each care conference. The DON confirmed there was no documentation the hospice provider was notified of any medication changes for Resident #59 prior to [DATE] (nine days later). Interview on [DATE] at 2:10 P.M. with Licensed Social Worker (LSW) #112 confirmed a care conference was completed on [DATE] for Resident #59 (nine days after the medication changes). LSW #112 stated she was not able to remember exactly what was discussed during the care conference but the resident's medications would have been reviewed as that was standard procedure for all care conferences. LSW #112 confirmed [NAME] #105 attended the care conference on [DATE] via telephone but CNP #103 did not attend. LSW #112 stated there was a family meeting held on [DATE] per the family's request as well but she was not able to attend that meeting and was not aware what occurred during that meeting. Review of the facility policy, Hospice Program, undated, revealed the policy stated, The hospice agency retains overall professional management responsibility for directing the implementation of the plan of care related to the terminal illness and related conditions. All hospice services are provided under contractual arrangement. Complete details outlining the responsibilities of the facility and the hospice agency are contained in this agreement. Review of the hospice contract, dated [DATE], revealed the contract stated, 3.3 Notification Agreement. The facility will immediately notify the hospice about the following: significant change in the patient's physical, mental, social, or emotional status. Clinical complications that suggest a need to alter the plan of care. This deficiency revealed non-compliance during the investigation of Complaint Number OH00149558. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365399 If continuation sheet Page 7 of 7