Inspection·October 27, 2022

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to provide written notification of reasons for transfers to the hospital. This affected one (Resident #59) of three residents reviewed for hospitalization. Findings include: On 10/24/22 at 11:48 A.M., during interview Resident #59 reported she had been in and out of the hospital multiple times, usually related to respiratory issues. Resident #59 stated for a while she was being hospitalized every month. Review of Resident #59's medical record revealed diagnoses including acute and respiratory failure, chronic congestive heart failure, chronic obstructive pulmonary disease, type two diabetes mellitus, iron deficiency anemia and stage three chronic kidney disease. Review of progress notes revealed Resident #59 was sent to the hospital by the facility and admitted [DATE] to 01/14/22, 04/27/22 to 05/02/22, 06/01/22 to 06/08/22, and 07/08/22 to 07/12/22. Resident #59 was also sent to the hospital per her request on 06/17/22. No transfer notices were able to be located. On 10/26/22 at 9:42 A.M., Lead Receptionist #105 stated no transfer notices had been provided because she was unaware it was required. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 2 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of bed hold notices, and interview, the facility failed to provide required bed hold notices in a timely manner. This affected one (Resident #59) of three residents reviewed for hospitalization. Findings include: Review of Resident #59's medical record revealed diagnoses including acute and respiratory failure, chronic congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), type two diabetes mellitus, iron deficiency anemia and stage three chronic kidney disease. A nursing note dated [DATE] at 9:00 A.M. indicated Resident #59 was sent to the emergency room due to abnormal laboratory values, abnormal lung sounds, increased edema, tremors, change in mental status and thrombocytopenia (abnormally low level of platelets). A nursing note dated [DATE] at 3:26 A.M. revealed Resident #59 returned to the facility on [DATE] at 9:00 P.M. Review of a Notification of Bed Hold Days form revealed Resident #59 left the faciity on [DATE] to [DATE] and as of that date had 30 remaining days available in the calendar year in which the facility would hold Resident #59's bed. Resident #59 signed the notification on [DATE]. A nursing note dated [DATE] at 4:01 P.M. indicated a staff member from the cardiovascular center notified the facility Resident #59 was being admitted to the hospital but was unable to provide a diagnosis. A nursing note dated [DATE] at 10:38 A.M. indicated the hospital was contacted for an update and reported Resident #59 had been admitted with CHF. A nursing note dated [DATE] at 7:00 P.M. indicated Resident #59 returned to the facility. Review of a Notification of Bed Hold Days form revealed Resident #59 left the faciity on [DATE] to [DATE] and as of that date had 23 remaining days available in the calendar year in which the facility would hold Resident #59's bed. Resident #59 signed the notification on [DATE]. A certified mail receipt copied with the notice indicated the date of delivery of the notice was [DATE]. Nursing notes on [DATE] between 6:03 P.M. and 6:42 P.M. indicated Resident #59 had a low oxygen saturation level (even after an oxygen concentrator was changed) and deterioration in condition. An order was received to send Resident #59 to the hospital and the emergency squad arrived at 6:42 P.M. A nursing note on [DATE] at 12:54 P.M. indicated the hospital reported Resident #59 had been admitted to the intensive care unit for respiratory failure, pneumonia and CHF. Resident #59 returned to the facility on [DATE]. Review of bed hold notifications revealed no notification for the days away from the facility between [DATE] to [DATE]. A Hospitalization observation form dated [DATE] indicated Resident #59 was transferred to the hospital at 6:04 P.M. for shortness of breath with an oxygen saturation level of 74% on four liters of oxygen. Resident #59 returned to the facility [DATE]. Review of a Notification of Bed Hold Days form revealed Resident #59 left the faciity on [DATE] and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 3 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few of that date had 11 remaining days in which the facility would hold the bed. A certified mail receipt had a hand written notation of [DATE] in the postmark area. A hospital observation form dated [DATE] indicated Resident #59 was transferred to the hospital at 6:15 A.M. due to shortness of breath, increased respiratory rate of 26, use of accessory muscles for breathing and a low oxygen saturation of 76% on four liters. A nursing note dated [DATE] at 10:25 A.M., the emergency department nurse reported Resident #59 was given a breathing treatment and intravenous diuretics. Diagnoses of CHF and COPD were provided. Resident #59 returned to the facility on [DATE] at 11:43 A.M. and continued to complain of shortness of breath and using accessory muscles. An order was received to increase breathing treatments to every four hours. A nursing note on [DATE] at 6:00 P.M. indicated Resident #59 complained of shortness of breath and chest tightness and requested she be returned to the hospital. A nursing note dated [DATE] at 6:28 A.M. indicated Resident #59 was admitted to the hospital with diagnoses of CHF and COPD. Resident #59 was readmitted to the facility on [DATE]. Review of a Notification of Bed Hold Days form revealed Resident #59 left the faciity on [DATE] and of that date had three remaining days in which the facility would hold the bed. A certified mail receipt had a date stamp of [DATE] and was addressed to Resident #59 at the facility's address. A nursing note dated [DATE] at 7:08 A.M. indicated Resident #59 was short of breath and had an oxygen saturation level of 85%. Resident #59 was transferred to the hospital and admitted for pleural effusion and fluid retention. Resident #59 returned to the facility [DATE]. Review of a Notification of Bed Hold Days form revealed Resident #59 left the faciity on [DATE] and had no remaining bed hold days available for the calendar year. The notice was unsigned and a certified mail receipt copied with the notice had no date stamp but was sent to Resident #59 at the facility's address. A nursing note dated [DATE] at 5:09 P.M. indicated Resident #59 was direct admitted to the hospital from the cardiology office for exacerbation of CHF. Resident #59 returned to the facility on [DATE] at 9:00 P.M. Review of a Notification of Bed Hold Days form revealed Resident #59 left the faciity on [DATE] and had no remaining bed hold days available for the calendar year. The notice was unsigned and a certified mail receipt copied with the notice had no date stamp but was sent to Resident #59 at the facility's address. On [DATE] at 9:42 A.M., during interview, Lead Receptionist #105 stated she was responsible for providing bed hold notices. Lead Receptionist #105 verified the bed hold notices were provided after Resident #105 returned from the hospital and not at the time of transfer so Resident #59 would be more informed of the number of days her bed would be held. Lead Receptionist #105 verified even those sent via certified mail were sent to the facility's address and would not be received until after Resident #59 returned from the hospital. Lead Receptionist #105 stated when she was not working there was nobody else assigned to provide the notifications. On [DATE] at 2:25 P.M., Lead Receptionist #105 verified she had not sent a bed hold notice for the hospitalization from [DATE] to [DATE], stating that one slipped by her. Lead Receptionist #105 was unable to explain how residents were notified when their bed hold days expired when in the hospital if not notified before. Lead Receptionist #105 was unable to state how the facility determined if a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 4 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0625 resident wanted to hold the bed or if they were charged after the bed hold coverage ended. The Administrator who was in the room did not know either. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 5 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview, the facility failed to ensure comprehensive assessments were completed a minimum of annually. This affected one (Resident #36) of 21 residents reviewed for assessments. The census was 79. Findings include: Review of Resident #36's medical record revealed diagnoses including dementia, chronic pain syndrome, depression, insomnia, schizoaffective disorder, arthritis, anxiety disorder, and irritable bowel syndrome. Resident #36 was admitted to the facility 07/17/20. Only one comprehensive assessment dated [DATE] was completed. On 10/27/22 at 2:54 P.M., during interview Registered Nurse (RN) #112 stated the last comprehensive assessment done for Resident #36 prior to 09/21/22 was during a previous admission on [DATE]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 6 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of therapy notes, observations, and interviews the facility failed to ensure the resident had a plan of care for contracture and failed to ensure the resident performed independent range of motion (ROM) exercises to prevent decline and maintain function of the contractures. This affected one (Resident #55) of two residents reviewed for position/mobility. Findings included: Record review revealed Resident #55 was admitted to the facility on [DATE] with diagnoses including contracture of right lower leg and right upper arm, osteomyelitis, diabetes, cognitive communication deficit, muscle weakness, need for assistance with personal care, hemiplegia and hemiparesis, lack of coordination, anxiety, schizophrenia, right foot pain, dementia with behavioral disturbance, restlessness and agitation, disorientation, depression with severe psychotic symptoms, and psychotic disorder with delusions. There was no evidence of a right-hand contracture diagnosis. Review of Resident #55's restorative task dated 09/25/22 to 10/25/22 revealed no documentation was entered. Observation and interview on 10/24/22 at 11:30 A.M., of Resident #55 revealed the resident's right hand was contracted. The resident was not able to open her fingers to a neutral position. The resident reported her right shoulder was contracted as well due to a stroke she had years ago. The resident reported she was not receiving range of motion exercises or had splints. Observation on 10/25/22 at 4:35 P.M., of Resident #55 with the Director of Nursing (DON) revealed the resident was not able to extend fingers. The DON was able to physically extend the pinky and thumb to a neutral position; however, the other three fingers were not able to be extended to a neutral position. The resident reported she was not receiving therapy or ROM exercises. The resident was not able to move right shoulder as well. Review of Resident #55's current plan of care and minimum data set (MDS) dated [DATE] with the DON revealed no evidence the plan of care for leg, arm, shoulder, or hand contractures and the MDS indicated the resident had limited ROM on one side of the upper and lower extremity and had not received restorative therapy. The resident had required more assistance with eating and walking in the room compared to the prior quarterly MDS dated [DATE]. Review of therapy notes dated 04/05/22 revealed the resident had right hand contracture and orthosis would benefit the resident. The resident was agitated and stated her hand isn't usually contracted and she doesn't want an orthosis. Educated on risk for skin breakdown, however patient is disinterested. Patient instructed in self ROM exercises with RUE including stretching of the fingers/wrist requiring verbal/visual cues for proper techniques. Physical Therapy (PT) educated on the importance of self ROM/stretching to prevent contractures with fingers unable to be opened all the way and resident stating they just have some tension today. Discharge planning indicated to refer to nursing for restorative. Review of Resident #55's occupational therapy (OT) notes dated 06/16/22 revealed the resident was referred to evaluate and treat weight bearing status to right lower extremity. The resident declines (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 7 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0688 Level of Harm - Minimal harm or potential for actual harm assessment of passive range of motion and declines orthosis for right hand. The evaluation was to provide the resident with a bedside commode for over toilet to increase ease of toilet transfers. Review of Resident #55's physical therapy notes dated 06/30/22 revealed the resident was discharged with a home exercise program. Residents Affected - Few Interview on 10/26/22 at 10:06 A.M., with the DON revealed there was no plan of care for the resident contractures. The DON wasn't sure if the resident was on restorative and would have to check due to there was no documentation under the restorative task. Interview on 10/26/22 at 10:11 A.M., with Corporate Nurse (CN) #410 confirmed there was no care plan or restorative program for Resident #55 for her contractors. CN #410 confirmed the OT and PT discharge for restorative indicated to refer to nursing. Nursing updated the plan of care today to include contractures but did not update the interventions to include activities/exercise the resident was to perform to prevent declines or maintain function. Interview on 10/26/22 at 11:15 A.M., with Resident #55 with the DON revealed the resident had a hard time focusing and was switching conversation. The surveyor had to ask the resident several times about ROM. At first, she reported her ROM exercise was just pulling her arm up. She could not recall how frequently or number of repetitions. Then when asked again she said she was to pick up her legs, then she was asked again she said she was to kick her feet and bend ankles. Then the surveyor asked about her hands, and she said probably should stretch her fingers. Then the surveyor asked how many times should you do that, and she said 20 times and then asked how many times a week and she said every week. The surveyor asked if she meant every day and she responded yes. The resident reported she was not doing ROM every day and then started to talk about the keys in her apartment and then went back to saying it's been on her mind to do. Interview on 10/26/22 at 12:00 P.M., with Certified Occupation Therapy Assistant (COTA) #126 reported she had last seen the resident in April 2022 and was asked to write a statement today that reflected the resident's cognition level in April. The COTA reported she didn't think the resident needed nursing restorative at that time because the resident could perform restorative independently. The COTA reviewed the therapy notes and confirmed she could not provide evidence of what the resident's independent program entailed. The COTA then reported she was not the one that wrote the discharge plan so she could not answer what the resident discharge plans were. Interview on 10/26/22 at 12:42 P.M., with State Tested Nursing Aide (STNA) #150 confirmed Resident #55 was not a restorative program and does her own care, dressing, etc. that she was aware of. There was not a restorative aide and floor staff were responsible for providing restorative care. Most of the residents refuse restorative on the North Hall. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 8 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure urinary output levels were monitored per orders. This affected one (Resident #65) of one resident reviewed for hydration. Findings included: Record review revealed Resident #65 was admitted to the facility on [DATE] with diagnoses including neuromuscular dysfunction of bladder, diabetes, and chronic kidney disease. Review of Resident #65's current orders dated 10/2022 revealed indwelling catheter to straight drain and to record urinary foley output every shift (three times a day). The resident's orders indicated the resident was at risk for fluid imbalance. Review of Resident #65's medication and treatment administration records dated 10/2022 revealed no evidence of urinary output level. Further review of the records revealed the resident received intravenous (IV) fluids on 10/22/22, 10/24/22 and 10/25/22. Review of Resident #65's foley urinary output levels in the vital report dated 10/01/22 to 10/27/22 revealed the resident's urinary output level amounts were only recorded 24 shifts out of the 81 shifts. Further review of Resident #65's urinary output levels on the dates she received IV fluids revealed on 10/22/22 there was only one urinary output that was documented on afternoon shift of 550 milliliters (ml), on 10/24/22 there was no documentation of urinary output, and 10/25/22 the only documented urinary output amount was on afternoon shift of 600 ml. Interview on 10/27/22 at 12:12 P.M. with the Director of Nursing (DON) verified the only documentation of the urinary output levels was documented in the vitals report. The DON verified there were several missing amounts of urinary output level. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 9 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview the facility failed to ensure intravenous (IV) fluids were administered per orders. This affected one (Resident #65) of one resident reviewed for hydration. Residents Affected - Few Findings included: Record review revealed Resident #65 was admitted to the facility on [DATE] with diagnoses including hallucination, schizoaffective disorder, diabetes, and chronic kidney disease. 1. Review of Resident #65's orders dated 10/21/22 revealed to administer Sodium Chloride 0.9% parenteral solution one liter intravenous. There were special instruction to administer one-liter normal saline, run at 75 cubic centimeters (cc) an hour. Review of Resident #65's medication and treatment administration records dated 10/2022 revealed the resident received intravenous (IV) fluids on 10/22/22. There was no evidence of the amount of IV fluids administered. Review of Resident #65's nursing progress notes dated 10/21/22 to 10/27/22 with the Director of Nursing (DON) and Corporate Nurse (CN) #410 on 10/27/22 at 12:45 P.M., revealed on 10/21/22 at 10:42 P.M., the Nurse Practitioner (NP) ordered IV Normal Saline (NS) at 75cc/hr. for one liter. On 10/22/22 at 1:06 A.M. an IV was started at 75cc an hour. On 10/22/22 at 7:03 P.M. (18 hours later) the NP was notified the IV would not flush and new orders were received to pull the IV. The DON and CN #410 verified the one liter should have been completely infused in 13 hours and 19 minutes. There was no documented evidence of the amount of IV fluid administered. Interview on 10/27/22 at 3:10 P.M., interview with Licensed Practical Nurse (LPN) #189 and the DON revealed on 10/22/22 only 800 cc of the 1000 cc had infused over the 18 hours and the entire 1000 cc should have infused in a little over 13 hours, however they were using a control a flow (dial flowed) instead of IV pump. The DON reported the LPN should have monitored the IV closer to ensure the fluid was infused within the time frame ordered. 2. Review of Resident #65's orders dated 10/23/22 revealed to administer Sodium Chloride 0.9% parenteral solution one liter intravenous. There were special instruction to administer one-liter normal saline, run at 75 cubic centimeters (cc) an hour. Observation on 10/25/22 at 7:27 A.M., of Resident #65 with the Director of Nursing (DON) revealed the resident was receiving 0.9% of Sodium Chloride via an IV pumping running at 75 cc/hr. The DON reported she would have to investigate the order and see why there was not a stop date and the reason the resident was receiving IV fluids. Review of Resident #65's progress note revealed on 10/23/22 at 12:09 P.M., a second NP was notified the resident remained confused and hallucinating. The NP ordered a midline catheter to be placed and one dose of Rocephin (antibiotics) Intra-muscular (IM), then six days of IV Rocephin. There was no evidence to administer or re-initiate IV fluids. On 10/24/22 at 8:38 A.M. the midline was placed, and IV fluids were started. Interview on 10/25/22 at 4:35 P.M., with the DON revealed the resident was started on IV fluids for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 10 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0694 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dehydration as evidence of an elevated blood urea nitrogen (BUN). The DON confirmed the IV fluids were only ordered for one liter to be administered. She had called the Medical Director for clarification of the IV orders, and he reported that the extra fluids did not harm the resident and to complete the current bag of fluids and discontinue them. Interview on 10/27/22 at 12:45 P.M. and 2:21 P.M., with the DON revealed the facility just interviewed the nurse that was working on 10/22/22 and 10/23/22 and she had reported the NP on 10/23/22 ordered fluid to be re-initiated, however the nurse did not clarify the orders. The fluids were not started until 10/24/22 at 8:28 A.M. even though the midline catheter was ordered on 10/23/22 at 12:09 P.M. (20 hours after originally ordered), due to the facility was waiting for an outside agency to place the midline catheter instead of sending the resident to the hospital to have the midline catheter placed. Interview on 10/27/22 at 3:10 P.M., with Licensed Practical Nurse (LPN) #189 and the DON revealed she did not clarify the order with the NP. The NP just told her to re-initiate the IV fluids. The new order written on 10/23/22 was written for one liter and should have been completed in a little over 13 hours (9:57 P.M.). The LPN reported she had written a telephone order today to reflect the order that was given to re-initiate IV fluids. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 11 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, and policy review, the facility failed to provide evidence of ongoing communication with the dialysis provider regarding dialysis care and services. This affected one (Resident #64) of one resident reviewed for dialysis care. The facility identified one resident receiving dialysis services. Residents Affected - Few Findings include: Review of Resident #64's medical record revealed an admission date of 05/06/22 with diagnoses including chronic renal disease with hemodialysis, chronic obstructive pulmonary disease, malignant lung neoplasm, pneumonia, and muscle weakness. Review of Resident #64's Care Plan, dated 05/19/22, revealed resident will receive renal dialysis without complications in coordination with the dialysis center. Review of physician orders, dated October 2022, revealed hemodialysis to be provided three times weekly at the dialysis provider. Further review of the medical record and the dialysis binder revealed no communication documentation with the dialysis provider. During interview on 10/27/22 at 10:10 A.M., Registered Nurse (RN) #204 confirmed there was no evidence of communication with the dialysis provider located in Resident #64's medical record or located in a separate dialysis binder. RN #204 stated she is unsure where dialysis communication between the facility and the dialysis provider is kept. During interview on 10/27/22 at 10:20 A.M., the Director of Nursing (DON) confirmed no evidence of dialysis communication between the facility and the dialysis provider for Resident #64. Review of the facility's policy, Dialysis Policy, dated November 2017, revealed it is the facility's policy that all residents utilizing dialysis receive comprehensive interdisciplinary monitoring to ensure residents safety and support of dialysis services. The facility will document in the resident's medical record and/plan of care updates or changes with the resident's renal dialysis. The dialysis center will send reports from resident dialysis treatments to the facility after each visit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 12 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staffing document review, review of resident council notes, observation, and interviews the facility failed to ensure adequate staffing levels to meet the resident's needs. This affected Residents #2, #31, #55, #59, #65 and had the potential to affect all residents residing in the facility. The facility census was 79. Findings included: 1. Interview on 10/24/22 at 11:29 A.M., with Resident #59 revealed sometimes there was only one staff member per hall. The resident reported she had to wait long periods of time for them to get help especially on night shift and evening shift varied due to she required a hoyer lift (mechanical lift). Resident #59 reported that on Saturday it took four hours to get help to be placed on a bedpan on day shift and two hours on afternoon shift. The resident reported she was usually continent, but was incontinent twice Saturday because she had to wait so long, and it became painful. Interview on 10/24/22 at 11:37 A.M. with Resident #55 revealed there was not enough staff to meet her needs. Resident #55 reported it takes an hour for staff to answer her call light especially on afternoon and nights. Interview on 10/24/22 at 1:44 P.M., with Resident #31 revealed there was not enough staff to meet her needs timely. The resident reported she was bedfast and was not able to sit up long periods and she must wait 45 minutes to 90 minutes for staff to assist her back to bed. Resident #31 revealed the staff have too much to do. Interview on 10/25/22 at 7:58 A.M. with Resident #2 revealed there was not enough staff on night shift to meet his needs. There is usually one aide on night shift, and they are not able to get him up early like he likes. Resident #2 reported that today night shift didn't get him up even though there was two of them because one of the aides was an agency aide and the one was a regular staff member, but they did not work together. Each one started at the opposite ends of the hall and worked down to the middle. Resident #2 stated that he requires a sit to stand lift for transfers and it takes two staff members to use the lift. When there is only one aide scheduled to work, he usually doesn't get out of bed until day shift arrives. He likes to get up around 4:30 to 5:00 A.M. and day shift doesn't get there until 6:00 A.M. and by the time they get report and get to him it's usually 7:00 A.M. or after. Observation on 10/26/22 at 5:35 A.M. revealed Licensed Practical Nurse (LPN) #130 answered the door when the surveyor had to call the facility to be let in due to no one answered the doorbell and the front door was locked. LPN #130 reported she was responsible for North Hall and there was another Agency Registered Nurse (ARN) #400 that was responsible for the other three units. There were four aides, one for each unit. Three were State Tested Nurses Aide's (STNA's) (#190, #183, #141) and one Certified Nursing Assisting (CNA) #144. CNA #144 was on North Hall. STNA #190 was on South (secured unit), STNA #183 was on Spirit (secured unit) and STNA #141 was on Novartis. LPN #130 reported they had a call off last night and apparently the call off was not replaced. Review of the daily staffing post dated 10/25/22 revealed the census was 80 and there were six STNA's and two LPN's for 10:00 P.M. to 6:00 A.M. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 13 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 Anonymous interviews on 10/26/22 from 5:35 A.M. to 2:00 P.M., revealed: Level of Harm - Minimal harm or potential for actual harm Anonymous Staff Member #401 reported there were residents who like to get up on night shift but because of staffing shortages the resident's have to wait for day shift to arrive to get up. Night shift will have them dressed and ready to get up usually. Residents Affected - Some Anonymous Staff Member #402 revealed there was not enough staff on night shift. If there were residents with behaviors on the secure unit one staff member was not enough to provide care to the other residents there had to be one on one with the resident with behaviors. The nurse for the unit has to float between three units and is busy with her own work. Staff are required to get so many residents up in the morning and they are not provided all the morning care for example teeth brushed and hair combed. They are basically given a quick bed bath, dressed, and put in chair. There was not enough staff on nights to assist residents up that require two assist, hoyer lifts, or sit to stands upon their request as well. Anonymous Staff Member #403 revealed there was not enough staff on night shift to meet the residents needs. If there was a resident with behaviors, you cannot provide one on one care for that resident plus take care of the other residents on the unit by yourself. The staff member reported she can't do transfers if the resident requires a hoyer lift, sit to stand, or two assist. The Agency staff are not knowledgeable about the transfer equipment. There was one resident on North that was not appropriate for a sit to stand, and she refuses to help staff transfer him. The facility doesn't have a restorative program. Anonymous Staff Member #407 revealed staffing was short everywhere. On nights there was only one aide for each unit and the nurses on South were responsible for three units. The nurses try to help but if there was an event the staff are not able to meet the residents needs with just one staff member. Anonymous Staff Member #404 reported there was not enough staff on Midnight shift to meet the needs of the residents. The night before last there was only one staff member for both secure units (South and Spirit). The staff member reported it is difficult to encourage COVID positive residents to stay in their room while trying to provide care to the other residents on the secure units. Showers are not getting done and residents are not getting up that require a hoyer or sit to stand lift because they require two staff members. There are residents on North that like to get up on Midnight shift and they are not able to assist them up upon their request because they required two staff members to get up. There is a list of residents that nightshift staff are required to get up before dayshift starts and staff has got in trouble for not having those residents up and ready. You must fight to get staff from other units to help because they are busy and have their own residents to provide care for. The nurses try to help but they are busy as well. Sometime the facility was short staffed because of call offs, but sometimes they just don't have enough staff scheduled. It was also hard to turn and reposition residents by yourself. Sometimes they have hospitality aids work on night shift, but they can't provide direct care and that's what they need help with. Anonymous Staff Member #405 revealed North Hall was very stressful. There are two residents that like to get up early, but she can't get them up because she can't use the sit to stand or hoyer lift by herself. Both residents were still in bed this morning. This had happened a few times this week that night shift was not able to get residents up upon their request. Resident #2 was one of the residents that likes to get up early and was still in bed this morning, but he was dressed and ready. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 14 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 Anonymous Staff Member #406 revealed staff are unable to provide sufficient supervision to prevent falls on the secure units due to once one resident starts screaming and yelling it gets the others going especially on afternoon shift. There was one resident that needed one on one supervision for months and the facility was not able to provide one on one supervision so staff had to do the best they could sharing the responsibility of trying to keep an eye on her. She would get into altercations with other residents and take other residents' items. The family was spending a lot of time at the facility to help with the resident. This resident has since had COVID and medication changes and does not have the same problems she was having. Often there is no nurse on the dementia units at night. The nurse must share halls. Interviews and observation on 10/26/22 at 6:08 A.M., with Resident #2 revealed the resident was dressed but still in bed. The resident confirmed there was only one aide working the North Hall last night and she could not get him up this morning and he must wait for dayshift to arrive. The resident reported he usually like to get out of bed around 4:30 A.M. to 5:00 A.M., every day. The Resident reported this happens frequently due to there not being enough staff on midnight shift. Interview on 10/26/22 at 6:49 A.M., 8:47 A.M., and 10:42 A.M., with the Administrator revealed the daily posting was inaccurate and there were 78 residents not 80, three STNA's one CNA, one LPN and one RN. The Administrator reported that one staff member was on the schedule in error and one staff member was supposed to work 2:00 P.M. to 6:00 A.M. but did not stay for the second shift (10:00 P.M. to 6:00 A.M.). Interview on 10/26/22 at 12:42 P.M. with LPN #197 and STNA #150 confirmed Resident #2 requests to get up around 4:30 A. M to 5:00 A.M. every morning and he was still in bed when day shift arrived today. Interview on 10/27/22 at 3:10 P.M., with LPN #189 and the Director of Nursing (DON) revealed on 10/23/22 and 10/24/22 LPN #189 did not enter orders or document all medication administration on Resident #65 due to it was a busy day and she was trying to help the aides and make phone calls to the providers and was not able to perform her job duties and enter orders and document. Record review revealed Resident #2 was admitted to the facility on [DATE] with diagnoses including multiple sclerosis, chronic fatigue, and drop foot. Review of Resident #2's quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident required extensive assistance of two or more for bed mobility, transfers, dressing, toilet use, and personal hygiene. He was total dependent for bathing. 2. Review of Resident Council Minutes dated 10/14/22 revealed afternoon and midnight shifts need more help. The solution was staffing levels presented to resident council. The president of Resident Council (Resident #2) reported on 10/20/22 that staffing had greatly improved recently and hoped it stays that way. Only three residents had attended the meeting. Interview on 10/25/22 at 2:23 P.M., with Resident #2 revealed he felt like he had to sign the resident council form, he did say staffing had improved because hospitality aides could get water, etc., however they can't assist with hands on care such as assisting residents to bed. He had gone to the Administrator the next day after he signed the form and voiced concerns about only having one STNA on night shift. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 15 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 observation, interview, review of temperature logs, and policy review the facility failed to ensure medications were stored wth proper temperature controls. This had the potential to affect all residents residing in the facility. Findings included: 1. Observation on 10/24/22 at 10:02 A.M., with Licensed Practical Nurse (LPN) #197 revealed the medication refrigerator was 26 degrees Fahrenheit. There were insulins (Levemir (1), Trulicity (3), Lantus (18), Humalog (2), acetaminophen suppository (22), Latanoprost eye drops (1), and one vial of tuberculosis that was stored in the refrigerator door. Observation on 10/25/22 at 7:16 A.M., of the North and Novartis medication refrigerators with the Director of Nursing (DON) revealed the North refrigerator was 32 degrees Fahrenheit and the Novartis was 28-degree Fahrenheit. The DON reported the refrigerated temperatures should be 35 to 41 degrees Fahrenheit according to the refrigerator temperature logs. The Novartis refrigerator contained acetaminophen and bisacodyl suppository, Latanoprost eye drops, insulins (Humalog, Lantus, Basgalar, Trulicity, Novolog, Levemir, Humulin, Novolin), flu vaccine, Promethegan, and Pantoprazole. The North refrigerator had Levemir, tuberculosis, Bravada, pneumovax 23, bisacodyl, Humalog, Lantus, Trulicity, Promethegan, and Novolog. Interview on 10/25/22 at 12:37 P.M., with the Maintenance Director reported he was still having trouble regulating the temperatures on the South and Novartis refrigerators. He was able to get the North refrigerator regulated. 2. Review of the South medication refrigerator temperature log dated 06/2022 to 10/2022 revealed in June there was 24 days the temperature was not checked twice daily and three days it was not checked at all. In July there was nine days the temperature wasn't checked twice daily. In August there was seven days the temperature wasn't checked twice daily, 11 days the temperature wasn't checked at all, and two times the temperatures were below 30 degrees Fahrenheit. In September there was 20 days the temperature wasn't checked twice daily, eight days the temperature wasn't checked at all, and six times the temperature was under 35 degrees Fahrenheit. In October there was thirteen days the temperature wasn't checked twice daily, four days the temperature wasn't checked at all, and 20 days the temperature was below 35 degrees Fahrenheit. The log indicated if the temperature was above 41 degrees to contact the Dietary Manager or Maintenance. It did not indicate what to do if temperatures were below 34 degrees. Review of the Novartis refrigerator temperature log dated 08/2022 to 10/2022 revealed in August there was 17 days the temperature wasn't checked twice daily and six days it wasn't checked at all. In September there was 26 days the temperature wasn't checked twice daily. Review of the North refrigerator temperature log dated 08/2002 to 10/2022 revealed 19 days the temperature wasn't checked twice daily, four days there wasn't any temperature taken, and four days the temperature was under 35 degrees. In September there was 18 days the temperature wasn't checked twice daily, two days the temperature wasn't checked at all, and five times the temperature was below 35 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 16 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 degrees. In October there were 11 times the temperature wasn't checked twice daily. Level of Harm - Minimal harm or potential for actual harm Interview on 10/24/22 at 4:00 P.M., with the DON revealed the medication refrigerators temperatures should be checked twice daily per the facility's policy and recommendations. Residents Affected - Many Review of the facility's temperature list for each medication that were observed in South medication refrigerator on 10/24/22 revealed all the medications should have been stored in temperatures ranging form 36 degrees to 46 degrees Fahrenheit. Review of the Medication Storage in the Facility policy and procedure (dated May 2020) revealed all medications are maintained within the temperature ranges noted in the USP and by the Centers for Disease Control (CDC). Refrigerated 36 degrees Fahrenheit to 46 degrees Fahrenheit with a thermometer to allow temperature monitoring. Medications requiring refrigeration are kept in a refrigerator at temperatures between 36 degrees Fahrenheit to 46 degrees Fahrenheit with a thermometer to allow temperature monitoring. The facility should maintain a temperature log in the storage area to record temperature at least once daily. The facility should check the refrigerator or freezer in which vaccines are stored, at least two times a day per the CDC guidelines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 17 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview the facility failed to ensure stat laboratory tests were performed timely. This affected one (Resident #65) of two residents reviewed for infection. Residents Affected - Few Findings included: Record review revealed Resident #65 was admitted to the facility on [DATE] with diagnoses including hallucination, schizoaffective disorder, diabetes, and chronic kidney disease. Review of Resident #65's progress notes dated 10/20/22 to 10/23/22 revealed on 10/20/22 at 8:30 P.M. agency was there to collect stat labs for urinalysis and culture and blood cultures. On 10/21/22 at 10:42 P.M., stat labs (Basic Metabolic Panel (BMP) and Complete Blood Count (CBC) were reviewed with Nurse Practitioner (NP) and new orders received to start IV with normal saline to run at 75 cc/hr., Rocephin one gram time one dose, and obtain vital signs every shift. Review of Resident #65's order dated 10/20/22 revealed one order that indicated BMP and CBC and then in parenthesis was typed blood culture times two and UA to be completed STAT-immediately for change in mental status. Further review of Resident #65's orders revealed on 10/23/22 one order for a STAT urine with culture and sensitivity and a separate order for blood cultures times two for altered mental status. Review of Resident #65's laboratory results dated [DATE] revealed a basic metabolic panel and complete blood count results were received and urine was extra. The resident's BUN was 49, which was down from 09/13/22 when it was 61. The sodium and white blood count levels were within normal limits. Further review of Resident #65's laboratory results revealed no evidence the stat urine or blood cultures were obtained on 10/20/22. Review of Resident #65's laboratory results dated [DATE] revealed the resident had urine test completed on 10/23/22, 07/06/21, and 07/03/21. There was no evidence a urine was result on 10/20/22. Further review revealed the blood cultures were obtained on 10/23/22. Review of Resident #65's NP note dated 10/25/22 revealed the resident was a poor historian due to cognitive/psychiatric impairment. The resident had a urine sample obtained on 10/23/22 that had no bacteria growth and blood cultures had no growth after one day. There was no evidence the resident had blood cultures or urine test dated on 10/20/22. Interview on 10/27/22 at 12:45 P.M. and 2:55 P.M., with the Director of Nursing (DON) confirmed the stat labs were not obtained on 10/20/22 and the NP was notified on 10/23/22 and recorded the test. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 18 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm Based on medical record review and interview, the facility failed to provide timely extraction of teeth for one (Resident #59) of two residents reviewed for dental status. Residents Affected - Few Findings include: On 10/24/22 at 11:37 A.M., Resident #59 stated the dentist had visited and received approval for her to have her last two teeth pulled but there had been a lack of follow through. Review of Resident #59's medical record revealed diagnoses including congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes mellitus. A report from the dentist dated 09/30/21 indicated a plan for extraction of teeth #6 and #11. A consent for dental surgery was signed by Resident #59 and dated 10/04/21. A nursing note dated 10/22/21 at 8:08 A.M. indicated the consent for dental surgery was forwarded to the dental provider. Notes from a dental visit dated 04/12/22 indicated Resident #59 continued to need to have teeth #6 and #11 extracted to make dentures. A progress note dated 07/26/22 at 2:13 P.M. indicated the nurse contacted a dental clinic to request orders and information from an appointment on 07/25/22 be provided to the facility. No other documentation was located. On 10/26/22 at 9:12 A.M., Licensed Social Worker (LSW) #110 reported Resident #59's teeth could be extracted at the facility. LSW #110 stated Resident #59's physician gave physical clearance for the extraction of the teeth on 04/21/22. LSW #110 stated the dental company had visited 08/02/22 and 10/11/22 but she did not yet have a date for the next visit. LSW #110 was unable to provide rationale for it being more than a year since the extractions were recommended and Resident #59 had signed the consent form but the teeth not yet being pulled. On 10/26/22 at 1:54 P.M., Dental Operations Director #225 from the dental provider confirmed Resident #59 had a dental appointment 09/30/21 in which extraction of teeth #6 and #11 were discussed. Dental Operations Director #225 stated as of 04/12/22 during the next visit, the dental company did not have physician clearance. In order for a resident to have teeth extracted the dental company needed both the signed consent of the resident or responsible party and physician clearance. Dental Operations Director #225 stated the dental company's treatment plan indicated they were awaiting paper work so Resident #59 was not provided services to extract her teeth. After looking up information outside the treatment plan, Dental Operations Director #225 verified Resident #59 had received physician clearance 04/21/22 and they had a copy of the resident consent signed 10/04/21. The reason Resident #59 would not have been seen when the dentist visited 08/02/22 and 10/11/22 was because their treatment plan indicated they were still awaiting the necessary paperwork (physician clearance and consent). Dental Operations Director #225 stated Resident #59 would be added to the list for the dentist to see on his planned visit 12/01/22. However, since it had been greater than one year since Resident #59 signed the consent form it was outdated and a new one would need signed. Dental Operations Director #225 verified payment was not an issue as Resident #59 received Medicaid. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 19 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of menus, and interview, the facility failed to ensure the appropriate amount of food was served in accordance with menus. This had the potential to affect 72 (Residents #1, #2, #3, #4, #5, #6, #7, #8, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24, #25, #27, #28, #29, #30, #31, #32, #33, #34, #35, #37, #38, #39, #40, #41, #42, #44, #45, #46, #47, #48, #49, #51, #52, #53, #54, #55, #56, #57, #58, #59, #60, #61, #62, #63, #64, #65, #66, #67, #68, #69, #70, #71, #72, #73, #127, #277, #329, #330, #331) of 79 residents who had orders for regular or mechanical soft texture. The census was 79. Findings include: Review of the menu and spreadsheet for lunch on 10/26/22 revealed items to be served included eight ounces of broccoli chicken [NAME] for all diets except small portion orders (four ounces) and puree (2/3 cup). On 10/26/22 observation of tray line between 12:05 P.M. and 12:11 P.M. revealed staff had four ounce scoops in the broccoli chicken [NAME] (both regular texture and mechanical soft texture). [NAME] #191 verified the scoop sizes. At 12:11 P.M., after seven trays were prepared and placed on the cart marked North hall, [NAME] #191 verified she was serving four ounces of the broccoli chicken [NAME]. [NAME] #191 stated she was supposed to use a #8 scoop (four ounces), not eight ounces. [NAME] #191 continued to prepare additional trays serving four ounces of broccoli chicken [NAME]. On 10/26/22 at 12:15 P.M., Dietary Manager (DM) #174 verified the menu indicated eight ounces of the broccoli chicken [NAME] were to be served and she informed [NAME] #191 who continued to prepare trays but started serving 8 ounces. On 10/26/22 at 12:23 P.M. the first cart left the kitchen without any additional broccoli chicken [NAME] being added to the trays that had already been prepared with the incorrect portion sizes. This was verified by the dietary manager at that time. On 10/27/22 at 8:33 A.M. DM #174 identified first seven residents who received four ounces of broccoli chicken [NAME] on 10/26/22 as Residents #15, #31, #37, #54, #58, #59, and #69. The facility identified an additional 65 residents who received regular or mechanical soft textures (Residents #1, #2, #3, #4, #5, #6, #7, #8, #11, #12, #13, #14, #16, #17, #18, #19, #20, #21, #22, #23, #24, #25, #27, #28, #29, #30, #32, #33, #34, #35, #38, #39, #40, #41, #42, #44, #45, #46, #47, #48, #49, #51, #52, #53, #55, #56, #57, #60, #61, #62, #63, #64, #65, #66, #67, #68, #70, #71, #72, #73, #127, #277, #329, #330, and #331). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 20 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 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 - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure new orders were written, medication documented on the medication administration records, and ensure nurses did not sign the Nurse Practitioner name on new orders. This affected one (Resident #65) of two residents reviewed for infections. Findings included: Record review revealed Resident #65 was admitted to the facility on [DATE] with diagnoses including diabetes, chronic kidney disease, anemia, and neuromuscular dysfunction of the bladder. Review of Resident #65's progress notes dated 10/23/22 revealed new orders were received for Rocephin (antibiotic) intramuscular (IM) times one dose, then intravenously for six days. Review of Resident #65's medication administration records (MAR) and orders revealed no evidence the Rocephin IM order was written or administered. Interview on 10/27/22 at 12:45 A.M., with the Director of Nursing (DON) and Corporate Nurse (CN) #410 verified there was no evidence the Rocephin IM order received on 10/23/22 was written or documented it was administered on the MAR. Interview on 10/27/22 at 3:10 P.M., with Licensed Practical Nurse (LPN) #189 and DON confirmed the order for the Rocephin IM was not written or documented on the MAR. The LPN reported she did administer the Rocephin IM on 10/23/22. The LPN and DON reported the facility had the LPN write the new telephone order today and had her document the administration of the Rocephin IM on a paper MAR. Review of the orders revealed the nurse had signed the Nurse Practitioners (NP) name in the area where the NP was to sign. The DON and LPN confirmed the signature wasn't the NP and the DON told the LPN she should write per verbal order and not sign the NP in the signature box where the NP was to sign. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 21 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview the facility failed to ensure ordered antibiotics met criteria prior to administration. This affected one (Resident #65) of two residents reviewed for infection. Residents Affected - Few Findings included: Record review revealed Resident #65 was admitted to the facility on [DATE] with diagnoses including hallucination, schizoaffective disorder, diabetes, and chronic kidney disease. Review of Resident #65's progress notes dated 10/20/22 to 10/25/22 revealed on 10/20/22 at 8:30 P.M. agency was there to collect stat labs for urinalysis (UA) and culture and blood cultures. On 10/21/22 at 10:42 P.M., stat labs (Basic Metabolic Panel (BMP) and Complete Blood Count (CBC) were reviewed with Nurse Practitioner (NP) and new orders received to start IV with normal saline to run at 75 cc/hr., Rocephin one gram time one dose, and obtain vital signs every shift. There was no evidence the UA or blood cultures were obtained per orders. On 10/23/22 at 2:16 P.M., a different NP ordered Rocephin IM times one, then IV for six days. Review of Resident #65's laboratory results dated [DATE] revealed a basic metabolic panel and complete blood count results were received urine was extra. The resident's BUN was 49, which was down from 09/13/22 when it was 61. The sodium and white blood count levels were within normal limits. Further review of Resident #65's laboratory results revealed no evidence a urine culture or blood cultures were obtained on 10/20/22. Review of Resident #65's laboratory results dated [DATE] revealed urine were collected on 10/23/22, 07/06/21, and 07/03/21. There was no evidence a urine was resulted on 10/20/22. Further review revealed on 10/26/22 the blood and urine culture had no growth. The resident's white blood cells were within normal limits. Review of Resident #65's medication administration record revealed the resident received one dose of Rocephin on 10/21/22. There was no evidence the Resident received the second dose of Rocephin IM on 10/23/22. Review of Resident #65's NP note dated 10/25/22 revealed the resident was a poor historian due to cognitive/psychiatric impairment. The resident had urine culture obtained on 10/23/22 that had no bacteria growth and blood cultures had no growth after one day. There was no evidence the resident had blood cultures or urine on 10/20/22. Further review revealed the resident had received one dose of Rocephin IM time one. The resident received IV fluids for hypotension. She had no evidence of sepsis type changes. Review of Resident #65's events revealed no evidence the McGeer's criteria was completed for the resident to ensure she met criteria for antibiotic treatments. Review of the infection control log dated 10/2022 revealed no evidence Resident #65 was listed on the infection control log. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 22 of 23 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 365402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Alliance Ctr for Rehab & NC Inc 11750 Klinger Avenue NE Alliance, OH 44601 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0881 Level of Harm - Minimal harm or potential for actual harm Interview on 10/24/22 at 2:21 P.M. and 2:55 P.M., interview with the Director of Nursing (DON) verified the McGeer's criteria form wasn't completed for the resident, and she didn't meet criteria for treatment. The DON reported she had interviewed the nurse (Licensed Practical Nurse (LPN) #189) that provided care to the resident on 10/23/22 and she reported she had administered the Rocephin IM on 10/23/22, however she did not write the order for the Rocephin IM or document she had administered the Rocephin. Residents Affected - Few Interview on 10/27/22 at 3:10 P.M., with LPN #189 confirmed she did not write an order or document the Rocephin IM she had administered on 10/23/22. The facility had her write an order today (10/27/22) and document the administration on a paper medication administration record as well today. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365402 If continuation sheet Page 23 of 23