Health inspection·May 31, 2022

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, staff interview, and review of facility policy, the facility failed to properly store an oxygen E cylinder. This had the potential to affect 79 residents residing in the health center. The facility census was 100. Findings Include: Observation of the main entrance during survey entry on 05/23/22 at 8:30 A.M. revealed there were six oxygen E cylinders in a holder, one oxygen E cylinder free standing and six small oxygen cylinders in a holder. The free standing oxygen E cylinder had a regulator on the tank, indicating the tank was 1/2 full. Interview on 05/23/22 at 10:46 A.M. Secretary #108 verified there was an E cylinder not in a holder in the main entry way. Secretary #108 stated she was not sure why the tanks were sitting in the entry, but verified the tanks in holders had been in the same spot since February 2022, when she started working for the facility. Secretary #108 stated she was not sure how long the free standing tank had been in the entry area. Secretary #108 verified the main entry, where the oxygen cylinder was free standing, was the entry where all staff entered and exited the facility. The secretary verified the E cylinder was 1/2 full. Review of facility policy titled, Oxygen Administration and Handling, revised 10/10/20 revealed dated 04/15/03 revised 10/10/2020 revealed if E cylinder tanks were in use, the tank must always be kept in the cylinder stand/cart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365416 If continuation sheet Page 2 of 6 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 365416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Westminster-Thurber 717 Neil Avenue Columbus, OH 43215 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility staff interview, and review of facility policy, the facility failed to monitor a resident's blood pressure and heart rate with the administration of blood pressure medication, as ordered. This affected one (#23) of five residents reviewed for medications with parameters. The facility census was 100. Findings include: Review of Resident #23's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including Parkinson's, heart failure, hypertension, diabetes, hyperlipidemia, and dementia. Review of the most recent quarterly Minimum Data Set (MDS) assessment revealed the resident had mild cognitive impairment and no behaviors. The resident required extensive assistance for activities of daily living. Review of physician orders revealed an order dated 12/21/21 for Carvedilol (anti-hypertensive) 6.25 milligrams (mg) by mouth, twice daily for congestive heart failure, hold for systolic blood pressure less than 110 and heart rate less than 55. Review of Resident #23's Medication Administration Record (MAR) for May 2022 revealed the resident was administered the Carvedilol twice daily. There was no documentation showing Resident #23's blood pressure or heart rate were taken prior to administration. Further review of the medical record revealed no evidence Resident #23's heart rate or blood pressure were monitored prior to administering the Carvedilol as ordered. Interview on 05/24/22 at 4:29 P.M. Licensed Practical Nurse (LPN) #109 verified Resident #23's Carvedilol order had parameters in place and the resident's blood pressure and heart rate should have been monitored prior to administering the medication. LPN #109 reported the pharmacy typically added a space on the MAR where staff could document vital signs at the time of medication administration. LPN #109 further verified Resident #23's MAR did not obtain the added space and there were no vital signs documented prior to administering the Carvedilol. Review of facility policy titled, Medication Administration General Guidelines, revised January 2021 revealed any vital signs would be obtained and recorded prior to medication administration as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365416 If continuation sheet Page 3 of 6 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 365416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Westminster-Thurber 717 Neil Avenue Columbus, OH 43215 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to monitor behavioral symptoms for a resident who recieved psychotropic medication. This affected one (#23) of five residents reviewed for unnecessary medications. The facility census was 100. Findings Include: Review of Resident #23's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including Parkinson's, heart failure, hypertension, diabetes, hyperlipidemia, and dementia. Review of the most recent quarterly Minimum Data Set (MDS) assessment revealed the resident had mild cognitive impairment. The resident had no behaviors, hallucinations, or delusions during the review period. Review of physician orders revealed an ordered dated 12/21/21 for Seroquel (anti-psychotic) 12.5 milligrams (mg) daily for hallucinations related to Parkinson's. Further review of Resident #23's medical record revealed no evidence the resident's behaviors/hallucinations were monitored. Interview on 05/24/22 at 4:29 P.M. Licensed Practical Nurse (LPN) #109 reported staff were to document resident behaviors in the progress notes. There were no other documents used to record behaviors. LPN #109 stated resident behaviors were documented at the time of behavior. If a resident was on a high risk medication, staff monitored the resident for behavirors and side effects of the medication. Interview on 05/25/22 at 8:35 A.M. the Director of Nursing (DON) verified staff documented resident behaviors in progress notes. Interview on 05/26/22 at 7:40 A.M. the DON verified Resident #23 did not have routine behavior monitoring documented. The DON stated the phyisican and pharmacy staff monitor the use of anti-psychotic medications. The facility did not have a policy regarding routine behavior monitoring. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365416 If continuation sheet Page 4 of 6 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 365416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Westminster-Thurber 717 Neil Avenue Columbus, OH 43215 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and review of facility policy, the facility failed to ensure a resident received medications as ordered. This affected one (#46) of five residents reviewed for receiving medications as ordered. The facility census was 100. Residents Affected - Few Findings Include: Medical record review for Resident # 46 revealed the resident admitted to the facility on [DATE], with diagnosis including end stage renal disease, hypertension, monoclonal gammopathy, dependent on dialysis and cirrhosis. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had mild cognitive impairment with no behaviors noted. The resident required limited assistance with activities of daily living (ADLs). Resident #56 had end stage renal disease and was dependent on dialysis. Review of Resident #46's physician orders revealed the resident had orders for Dialysis on Tuesdays, Thursdays, and Saturdays at 8:00 A.M. Review of physician order dated 04/07/22 revealed an order for Sevelamer carbonate (medication used to control high blood levels of phosphorus in people with chronic kidney disease who are on dialysis) 800 milligrams (mg) three times per day at 8:00 A.M., 12:00 P.M., and 4:00 P.M. Review of Medication Administration Record (MAR) for May 2022 revealed Resident #46 did not receive the Sevelamer carbonate at 12:00 P.M. on dates: 05/05/22, 05/07/22, 05/12/22, 05/13/22, 05/17/22, 05/19/22, 05/21/22, and 05/24/22 and did not receive the Sevelamer carbonate at 4:00 P.M. on 05/13/22. It was documented the resident was unavailable for administration. The resident missed nine doses total. Review of monthly calendar for May 2022, revealed missed doses of Sevelamer carbonate were on days Resident #46 was scheduled to be at dialysis, minus the missed dose on 05/13/22. Review of progress notes for May 2022 revealed no documentation stating why the medications were missed or the physician being notified of missed medication. Additionally, there was no evidence staff had a discussion with the physician about changing administration times to prevent the resident from missing medications while he was at dialysis. Interview on 05/25/22 at 12:18 P.M. Unit Manager Registered Nurse (RN) #106 verified Resident #46 returned to the facility from dialysis around 1:30 P.M. RN #106 verified the missed medications and reported she was unaware of the missed doses and would look into it. RN #106 further reported the physician should have been notified of the missing medication. No additional information was provided by RN #106. Review of facility policy titled, Medication Administration General Guidelines, revised January 2021, revealed if a dose of regularly scheduled medication is withheld, refused, or given at other than the scheduled time (for example, the resident is not in the nursing care center at scheduled dose time, or a starter dose of antibiotic is needed), the space provided on the front of the MAR for that dosage administration is initialed and circled. An explanatory note is entered on the reverse side (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365416 If continuation sheet Page 5 of 6 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 365416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Westminster-Thurber 717 Neil Avenue Columbus, OH 43215 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 of the record provided for as needed documentation. 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: 365416 If continuation sheet Page 6 of 6