Inspection·July 1, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview and record review, the facility failed to place a call light button in a location where Resident #16 was able to utilize the call light. This affected one resident (#16) out of seven residents reviewed for call light placement. The facility census was 74. Residents Affected - Few Findings include: Record review revealed Resident #16 was admitted to the facility on [DATE] with diagnoses included multiple sclerosis (MS), pressure ulcer of sacral region stage four, type two diabetes mellitus, need for assistance with personal care, need for assistance with personal care, osteoarthritis, and other reduced mobility. Review of a care plan dated 02/25/25 revealed Resident #16 required the use of a soft touch call light. The care plan referenced Resident #16 needed his call light positioned near his head so he could turn it on when in bed. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was cognitive intact. Resident #16 was noted to have impairment on both sides on both his upper and lower extremities, and was dependent on staff for eating, toileting, showering, dressing, hygiene, rolling left to right and transfers. Observation on 06/29/25 at 1:56 P.M. revealed Resident #16 was seated upright in bed with head bent over to the right in what appeared to be an awkward position. Resident #16's call light was on right side of bed and appeared out of reach. Interview on 06/29/25 at 1:56 P.M. with Resident #16 confirmed he was uncomfortable. Resident #16 confirmed he was unable to reposition himself and was unable to reach his call light. Resident #16 stated in order to use his call light he would need the call light to be placed on his stomach near his left hand. Observation on 06/30/25 from 10:38 A.M. to 11:50 A.M. revealed Resident #16 was lying in bed and his call light was dangling down off of the right side of the bed, almost touching the floor. Interview on 06/30/25 at 11:29 A.M. with Resident #16 confirmed he would not be able to press the call light if it were by his head. He said he needed it on his stomach near his left hand. Interview and observation on 06/30/25 at 11:50 A.M. with Certified Nursing Assistant (CNA) #151 confirmed Resident #16's call light was dangling down to the floor and he would not be able to reach it in that location. CNA #151 confirmed she would normally put the call light on the table and relocated the call light to the bedside table. When asked if Resident #16 would be able to reach the call light on the table, she hesitated and asked the resident who confirmed he needed the call light placed on his stomach in order to reach it. Observation and interview on 06/30/25 at 1:58 PM Resident #16 was sitting up in bed and had the call light button positioned under his right elbow. Resident #16 said he didn't know where the call light button was because he couldn't see it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 2 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview on 06/30/25 at 2:25 PM with MDS Licensed Practical Nurse (LPN) #175 confirmed she had just updated the care plan that day for Resident #16 to say the call light should be near head or on stomach. She said that his abilities were variable and acknowledged that at the present time he was not able to press call light button with his head. She said that when she met with him earlier that day he told her he needed it on his stomach. She confirmed Resident #16 would not be able to reach call light button on the table or dangling to the floor. Event ID: Facility ID: 365421 If continuation sheet Page 3 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide nail care for one resident (#32) out of four residents reviewed for activities of daily living (ADLs). The facility census was 74. Residents Affected - Few Findings include: Review of the medical record for Resident #32 revealed an admission date of 05/17/16. Medical diagnoses include dementia, cerebral infarction, hypertensive heart disease, chronic kidney disease, chronic pain, major depressive disorder, deaf and non-speaking, and dysphagia. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 4 indicating severely impaired cognition. Resident #32 was noted to have impaired range of motion, required supervision for eating, and was dependent on staff for self-care and mobility. Review of the care plan dated 06/05/25 revealed a goal that Resident #32's ADL needs will be met through the next review date with listed interventions which included assisting the resident with shaving and nail care. Review of Resident #32's shower sheets for the month of June 2025 revealed his fingernails were clipped each shower day except for 06/09/25. The last shower sheet for June 2025 revealed Resident #32's nails were clipped on 06/26/25. Observation on 06/30/25 at 2:44 P.M. of Resident 32 revealed the resident was noted to have long, thick nails on his right, contracted hand. Interview on 06/30/25 at 2:22 P.M. with Licensed Practical Nurse (LPN) #177 revealed residents are to be offered nail trims on their scheduled shower or bathing days. Observation on 07/01/25 at 11:21 A.M. of Resident #32 with LPN #188 revealed Resident #32's fingernails on the right hand remained unchanged from the prior observation. Resident #32's fingernails appeared jagged and long, approximately one half inch in length. LPN #188 stated Resident #32's fingernails were too long and should be cut with each shower day. Interview on 07/01/25 at 11:57 A.M. with the Director of Nursing (DON) confirmed the facility did not have a policy for nail care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 4 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, review of facility policy, and review of the National Pressure Injury Advisory Panel recommendations, the facility failed to ensure interventions to prevent the development or decline of pressure ulcers were in place. This affected two residents (#16 and #228) out of three residents reviewed for pressure ulcers during the annual survey. The facility census was 74. Residents Affected - Few Findings include: 1. Record review for Resident #228 revealed the resident was admitted to the facility on [DATE] and had diagnoses which included hemiplegia and hemiparesis, protein-calorie malnutrition, and altered mental status. Review of the care plan, dated 06/17/25, revealed Resident #228 was at risk for alteration in skin integrity. Interventions included pressure reduction boots as tolerated. Review of the physician order dated 06/26/25 revealed an order for prevalon boots (pressure reduction boots to offload pressure from a resident's heels) every shift. Observation on 06/29/25 at 11:24 A.M. revealed Resident #228 was lying in bed with bare feet lying flat against the mattress. No prevalon boots were present on the resident's feet or in the room. Observation on 06/30/25 at 8:14 A.M. revealed Resident #228 was lying in bed and again did not have prevalon boots in place on his feet. Interview on 06/30/25 at 8:14 A.M. with Nurse Manager #405 at the time of the observation confirmed Resident #228 did not have prevalon boots on his feet or present in his room. 2. Record review revealed Resident #16 was admitted to the facility on [DATE] with diagnoses including multiple sclerosis (MS), pressure ulcer of sacral region stage four, type two diabetes mellitus, need for assistance with personal care, osteoarthritis, and other reduced mobility. Review of the care plan dated 01/14/25 revealed Resident #16 had alteration in skin integrity as evidenced by pressure ulcer present to his coccyx. Listed interventions included to administer treatments per physician order, staff to provide assistance with activities of daily living (ADLs) and repositioning as needed, and to encourage and assist the resident to turn and reposition as needed. An additional care plan focus dated 02/05/25 noted non-compliance and noted that Resident #16 had declined pressure reduction boots and was non-compliant with constrictive shoes. There were no other examples of noncompliance noted. Review of the Braden Scale for Predicting Pressure Sore Risk dated 05/14/25 revealed a score of 12 on a scale of 6 (high risk) to 23 (no risk), which indicated Resident #16 to be at high risk for skin breakdown. Review of the physician order dated 01/21/25 for staff to encourage/assist to turn and reposition as tolerated every shift. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was cognitive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 5 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few intact. Resident #16 was noted to have impairment on both sides on both his upper and lower extremities, and was dependent for eating, toileting, showering, dressing, hygiene, rolling left to right, and transfers. Resident #16 was noted to have one stage 4 pressure ulcer that was not present upon admission to the facility. Review of the care plan dated 06/20/25 revealed Resident #16 was at risk for alteration in skin integrity related to MS, weakness, and impaired dexterity. Listed interventions included for staff to provide assistance with ADLs and positioning as needed and to encourage and assist resident to turn and reposition as needed. Observation on 06/29/25 at 1:56 P.M. Resident #16 was sitting up in bed with head at awkward position. The call light was on right side of bed in a place where he was not able to press it to ask to be repositioned. Interview on 06/29/25 at 1:56 P.M. Resident #16 confirmed he is unable to reposition himself. Resident #16 reported staff are supposed to reposition him every shift. Resident #16 reported sometimes the staff does not reposition him and that whether he gets repositioned would depends on which staff was working. Review of Progress Notes for Resident #16 for May 2025 and June 2025 revealed no documentation of Resident #16 refusing to be repositioned or turned. Interview on 06/30/25 at 2:25 P.M. with MDS Licensed Practical Nurse (LPN) #175 confirmed resident did not have care plan entry indicated he declined to be repositioned. Interview on 06/30/25 at 2:28 P.M. with the Administrator confirmed the facility did not have any documentation or care plan evidence of Resident #16 declining to be repositioned, as it had not been a problem with him. The Administrator noted staff only documents refusals if there are ongoing issues. Review of Wound Care Report from 06/23/25 revealed Resident #16 had a stage 4 pressure ulcer on his coccyx acquired in-house with full-thickness depth exposure, a wound size of 1.5 x 0.8 x 2.5 cm with 100% granulation and heavy seroanguinous exudate. The report noted that the wound had increased in size from the previous visit and was slightly expanded and deeper. The report said that the contributing factors included that the resident was poorly compliant with offloading, had overall poor medical condition, and incontinence. Interview on 06/30/25 at 2:50 P.M. with Wound Certified Nurse Practitioner (Wound CNP) #210 clarified that when she said Resident #16 was poorly compliant with offloading (removing pressure on coccyx) in her 06/23/25 report, she did not mean that Resident #16 was refusing to be turned, but rather he is unable to turn himself due to his medical condition. In regard to how frequently Resident #16 should be turned/repositioned, she said she would defer to the facility policy. She confirmed professional standards of care would normally expect a resident with a pressure ulcer to their coccyx to be repositioned/turned every two to three hours and that once every eight hours would not be enough. Review of the facility policy Skin Assessment revised 03/15/24 revealed risk factors impacting the development, treatment and/or healing of pressure injuries, including underlying medical conditions, intrinsic/extrinsic risk factors and causal factors are evaluated and provide the basis for defining approaches for the prevention and management of pressure injuries in accordance with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 6 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0686 resident's needs, goals and professional standards of practice. Level of Harm - Minimal harm or potential for actual harm Review of the National Pressure Injury Advisory Panel Quick Reference Guide recommendations dated February 2025 noted it is good practice to reposition individuals at risk of pressure injuries regardless of the type of pressure redistribution full body support surface being used. The frequency recommended is dependent on whether the individual is able to reposition themselves. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 7 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 observation, interview, and record review, the facility failed to ensure care and services to prevent the worsening of contractures were provided. This affected one resident (#23) out of four residents reviewed for limited range of motion. The facility census was 74. Findings include: Review of the medical record for Resident #23 revealed an admission date of 01/05/12. Medical diagnoses include myocardial infarction, contracture right hand, major depressive disorder, hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, legal blindness, deaf nonspeaking, and adult failure to thrive. Resident #23 utilized an American Sign Language (ASL) interpreter and utilized tactile signing for communication. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #23 had a severe cognitive impairment and the Brief Interview for Mental Status (BIMS) score was unable to be completed. Resident #23 required supervision or touch assistance with self-care and mobility and utilized a manual wheelchair. The assessment further noted Resident #23's hearing and vision were highly impaired, and she had no speech. Resident #23 was noted to have received physical therapy services beginning on 03/26/25 and concluding on 04/23/25. Review of the care plan dated 05/30/25 for Resident #23 revealed the care plan did include any mention of the resident having a right hand contracture, nor did it include any goals or interventions addressing any type of contracture. Review of physician orders dated 06/11/25 did not include orders to address Resident #23's right hand contracture and included no current orders for occupational or physical therapy. Observation on 06/29/25 at 3:23 P.M. revealed Resident #23 had a contracted right hand with limited movement resting down at her side. Resident #23 did not have any type of splint or positioning device or equipment in use to her contracted extremity. There was no splint, hand roll, or any other type of device present at Resident #23's bedside. Interview on 06/30/25 at 11:35 A.M. with Director of Rehab Services (DRS) #101 revealed she was unsure if Resident #23 had a hand splint or adaptive device for her right hand contracture. DRS #101 stated that Resident #23 was evaluated for occupational therapy services on 06/30/25. DRS #101 confirmed there had been no care plan goals or interventions added to Resident #23's care plan regarding the contracture. Interview and observation on 06/30/25 at 4:54 P.M. with Resident #23, utilizing Interpreter #209, revealed the resident could not extend her contracted right fingers. Resident #23 could extend her pointer finger using left hand, but no other fingers were able to be manually extended by Resident #23. Interview on 07/01/25 at 11:27 A.M. with the Director of Nursing (DON) revealed no knowledge of Resident #23's contracture care and confirmed the facility had no policy regarding range of motion and/or care of contractures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 8 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 Interview on 07/01/25 at 2:46 P.M with Licensed Practical Nurse (LPN) #188 confirmed no splint or range of motion exercises were a part of Resident #23's routine care. 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: 365421 If continuation sheet Page 9 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure tube feeding solution was administered at the rate ordered by the physician and failed to ensure placement and residual were verified prior to using Resident #228's gastrostomy tube. This affected one resident (#228) out of one resident reviewed for gastrostomy tubes. The facility census was 74. Findings include: 1. Record review for Resident #228 revealed the resident was admitted to the facility on [DATE] and had diagnoses which included hemiplegia and hemiparesis, protein-calorie malnutrition, altered mental status, and encounter for gastrostomy tube. Review of the care plan, revised 06/27/25, revealed the resident had an alteration in nutrition and hydration. The resident was to have nothing by mouth and received 100 percent of calories through tube feeding. a. Review of the physicians order, dated 06/26/25, revealed the resident was to be administered Isosource 1.5 (a tube feeding formula) at a rate of 65 milliliters (ml) per hour by gastrostomy tube. Observation on 06/29/25 at 11:24 A.M. revealed Resident #228 was lying in bed with with Isosource 1.5 being administered at a rate of 60 ml per hour by gastrostomy tube. Observation on 06/29/25 at 12:43 P.M. revealed Resident #228 was lying in bed. Isosource 1.5 continued to be administered at a rate of 60 ml per hour by gastrostomy tube. Observation on 06/30/25 at 8:14 A.M. revealed Resident #228 was lying in bed. Isosource 1.5 continued to be administered at a rate of 60 ml per hour by gastrostomy tube. Interview on 06/30/25 at 8:14 A.M. with Nurse Manager #405 at the time of the observation confirmed Resident #228 was being administered Isosource 1.5 at a rate of 60 ml by gastrostomy tube and confirmed the physicians order was for 65 ml per hour of Isosource 1.5 to be administered. b. Review of Resident #228's clinical physician orders, dated 06/30/25, revealed the resident had orders for Keppra Oral Solution (an anticonvulsant) 100 milligrams (mg)/ml, give 5 ml via gastrostomy tube twice daily, Senna (laxative) 8.6 mg tablet, give one tablet via gastrostomy tube twice daily, Lisinopril (an antihypertensive) 20 mg tablet, give one tablet via gastrostomy tube once daily, Clopidogrel bisulfate (an antiplatelet) 75 mg tablet, give one tablet via gastrostomy tube once daily, famotidine 20 mg tablet, give one tablet via gastrostomy tube once daily, Baclofen (a skeletal muscle relaxant) 10 mg tablet, give one tablet via gastrostomy tube twice daily, aspirin 81 mg tablet, give one tablet via gastrostomy tube once daily and Amlodipine (an antihypertensive) 10 mg tablet, give one tablet via gastrostomy tube once daily. Resident #228's physician orders did not include orders for checking gastrostomy tube placement or residual (the amount of liquid or food remaining in the stomach after a period of enteral feeding). Observation on 06/29/2025 at 11:10 A.M. revealed Registered Nurse (RN) #192 prepared all scheduled medications for Resident #228. RN #192 proceeded to crush all oral medications together and placed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 10 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the combined crushed tablets into a second cup. RN #192 was then observed adding approximately 60 cc's of water to the cup of combined tablets. Observations on 06/29/25 at 11:25 A.M. revealed RN #192 proceeded to administer Resident #228's crushed and combined medications via gastrostomy tube. RN #192 did not check Resident #228's gastrostomy tube for proper placement or check the tube feed residual prior to administering the crushed and combined medications. Interview on 06/29/25 at 11:37 A.M. with RN #192 following the observation confirmed that he should have checked Resident #228's gastrostomy tube for proper placement and residual prior to administering the medications. Review of the facility policy titled Enteral Tube Feeding dated 06/11/24, revealed it is the practice of the facility to provide enteral nutrition as prescribed and in accordance with current clinical standards of practice. The policy noted nurses should verify provider's prescription and check expiration date on formula, and confirm the placement of the feeding tube. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 11 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observations and interviews, the facility failed to ensure daily staffing information was posted for residents and visitors to view. This had the potential to affect all residents residing in the facility. The facility census was 74. Residents Affected - Many Findings include: Observation on 06/29/25 at 9:20 A.M. revealed no daily staffing information was posted in the facility for residents and visitors to view. Observation and interview with the Administrator on 06/29/25 at 9:22 A.M. confirmed there was the previous day's schedule in the plastic holder located at the entrance desk of the facility. The Administrator confirmed it was the staffing schedule for 06/28/25 and the schedule for the current day 06/29/25 should have been in the plastic holder on display. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 12 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observation, and staff interview, the facility failed to ensure the medication error rate did not exceed five percent (%). The facility had seven errors out of 37 opportunities for a medication error rate of 18.9%. This affected one resident (#228) of four residents reviewed for medication administration. The facility census was 74. Residents Affected - Few Findings include: Review of Resident #228's medical record revealed an admission date of 06/14/22 with diagnoses that included gastrostomy status, hypertension, cerebral infarction affecting the right dominant side, convulsions, dysphagia and peripheral vascular disease. Review of Resident #228's clinical physician orders, dated 06/26/25, revealed the resident had orders for Keppra Oral Solution (an anticonvulsant) 100 milligrams (mg) per milliliter (ml), give 5 ml via gastrostomy tube twice daily, Senna (laxative) 8.6 mg tablet, give one tablet via gastrostomy tube twice daily, Lisinopril (an antihypertensive) 20 mg tablet, give one tablet via gastrostomy tube once daily, Clopidogrel bisulfate (an antiplatelet) 75 mg tablet, give one tablet via gastrostomy tube once daily, famotidine 20 mg tablet, give one tablet via gastrostomy tube once daily, Baclofen (a skeletal muscle relaxant) 10 mg tablet, give one tablet via gastrostomy tube twice daily, aspirin 81 mg tablet, give one tablet via gastrostomy tube once daily and Amlodipine (an antihypertensive) 10 mg tablet, give one tablet via gastrostomy tube once daily. Resident #228's physician orders included an order to crush medications that are crushable as needed. There was no physician order to combine or cocktail medications together during administration. Observation on 06/29/2025 at 11:10 A.M. revealed Registered Nurse (RN) #192 began to gather all scheduled medication for Resident #228. RN #192 poured Keppra 5 ml (liquid) into a small medicine cup before proceeding to crush the oral medications in tablet form; Lisinopril 20 mg, Aspirin 81 mg, Famotidine 20 mg, Clopidogrel 75 mg, Baclofen 10 mg, Senna 8.6 mg, and Amlodipine 10 mg. The medications were crushed and combined together in a small drinking cup. RN #192 was then observed adding approximately 60 ml of water to the cup of combined tablets to dilute and mix the crushed medications. Observations on 06/29/25 at 11:25 A.M. revealed RN #192 proceeded to administer the crushed and combined tablets mixed with water to Resident #228 via his gastrostomy tube. Interview on 06/29/25 at 11:38 A.M. with RN #192 confirmed that he crushed and combined Resident #228's seven oral medications prior to administering them altogether to Resident #228 via gastrostomy tube. Review of a nursing journal article titled Administering medications through a gastrostomy tube dated December 2022, located at https://journals.lww.com/nursing/citation/2002/12000/administering_medication_through_a_gastrostomy.14.aspx, revealed that nurses should not mix medications with tube feeding formula or another medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 13 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, and facility policy review, the facility failed to ensure appropriate transmission based precautions (TBP) were maintained for Residents #28 and #14. This had the potential to affect all 17 residents residing on the 100 hall. Additionally, the facility failed to ensure acceptable infection control practices were maintained while administering medications to Resident #36. This affected one resident (#36) of four residents reviewed for medication administration. The facility census was 74. Residents Affected - Some Findings include: 1. Review of the medical record for Resident #28 revealed an admission date of 08/29/22, with diagnoses including extended spectrum beta-lactamase (ESBL) resistance and a non-pressure chronic ulcer of the left lower leg. Review of the Minimum Data Set (MDS) quarterly assessment dated [DATE] recorded a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. Review of Resident #28's physician orders revealed an order dated 05/20/25 for active contact isolation precautions for ESBL (an enzyme produced by certain bacteria that make them resistant to many commonly used antibiotics) colonization in a wound. Observation on 06/30/25 at 12:16 P.M. revealed a staff member applied a gown prior to entering Resident #28's room. The staff member was not observed to apply gloves and proceeded to enter the room. A moment later, the staff member was observed exiting the Resident #28's room, who was in contact precautions, proceeded to retrieve gloves, and then re-entered Resident #28's room. Interview on 06/30/25 at 12:21 P.M. with Director of Nursing (DON) confirmed the unnamed staff member entered Resident #28's room, exited while still wearing personal protective equipment (PPE) to retrieve gloves, and then re-entered the room. The DON additionally confirmed the orders for Resident #28's contact precautions were active. 2. Review of the medical record for Resident #14 revealed an admission date of 08/01/18, with diagnoses including chronic obstructive pulmonary disease (COPD), chronic kidney disease, dementia with behavioral disturbance, and conjunctivitis. Review of the MDS quarterly assessment dated [DATE] revealed Resident #14 had a BIMS score of 7, indicating severely impaired cognition. Review of Resident #14's physician orders dated 06/19/25 revealed an order for contact isolation precautions for conjunctivitis every shift for 13 days, from 06/19/25 through 07/02/25. Observation on 06/30/25 at 12:20 P.M. revealed the DON entered Resident #14's room without any PPE to deliver a meal tray. Interview on 06/30/25 at 12:21 P.M. with the DON confirmed he stepped into Resident #14's room without putting on PPE prior to entering. The DON additionally confirmed the contact precaution orders for Resident #14 were active. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 14 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the facility policy titled Infection Control Policy/Procedure: Antibiotic Stewardship Program, revised April 2025, revealed the facility shall implement protocols to reduce adverse events associated with infection transmission, and that all staff shall adhere to protocols for the appropriate use of PPE. The policy emphasized the use of infection prevention strategies, including isolation precautions and staff compliance with PPE requirements, to reduce transmission risks. Section 4 of the policy stated that nursing staff are responsible for evaluating residents and following protocols, and Section 7 emphasized that the elements of the infection prevention program are to be implemented and reviewed regularly to ensure effectiveness. 3. Review of Resident # 36's medical record revealed that she was admitted on [DATE] with diagnoses that included COPD, cerebral infarction with left hemiplegia, type two diabetes mellitus, chronic pain, epilepsy, fibromyalgia, depression, and hypertension. Review of Resident #36's MDS Quarterly assessment dated [DATE] revealed the resident had a BIMS score of 15 indicating intact cognition. Observation on 06/29/25 at 9:18 A.M. of the medication administration pass with Registered Nurse (RN) #192 revealed that he did not wash or sanitize his hands prior to preparing medications for Resident #36. RN #192 then removed three pharmacy packages for Resident #36 that had medication descriptions on the front and individually packed medication tablets inside of them. He opened the three pharmacy packages and placed the individually packed medication tablets on his nursing cart. He used his right first finger to guide each pill into the medication cup. RN #192 then placed the three empty pharmacy packages into the trash can that was attached to his nursing cart. RN #192 then explained that Resident #36 sometimes liked to know which medications she was receiving, and he took the three packages out of the trash can and entered Resident #36's room where he placed the packages which had previously been in the trash on Resident #36's bedside table. Resident #36 held each of the packages to read her medications as RN #192 explained each one. Interview on 06/29/25 at 9:35 A.M. with RN #192 confirmed that he did not wash or sanitize his hands prior to or after administering medications, and confirmed that he used his ungloved finger to touch each medications when preparing Resident #36's medications. RN #192 additionally confirmed that he placed the pharmacy packages that had been in the trash on Resident #36's bedside table. Review of the facility policy labeled Medication Administration, dated 06/21/27, revealed that the nurse should cleanse hands as appropriate and never touch any medications with fingers when preparing medications for administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 15 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 record review, staff interview, and facility policy review, the facility failed to ensure antibiotics were not administered unnecessarily for two residents (#17 and #26) out of three residents reviewed for urinary tract infections. The facility census was 74. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #26 revealed an admission date of 01/22/21 and diagnoses including Parkinson's disease with dyskinesia, recurrent urinary tract infections (UTIs), chronic kidney disease, urinary retention, obstructive uropathy, and neurogenic bladder. Review of the Minimum Data Set (MDS) 3.0 annual assessment dated [DATE] revealed Resident #26 had a Brief Interview for Mental Status (BIMS) score of 14, indicating intact cognition. The assessment also noted Resident #26 had an indwelling catheter, frequent incontinence, impaired mobility, and was dependent for many activities of daily living. Review of the physician orders for Resident #26 revealed an order dated 12/10/24 for Cephalexin (an antibiotic) 500 milligram (mg) three times daily for seven days to treat a UTI and an order dated 12/11/24 for phenazopyridine (a medication used to relieve pain, burning and discomfort commonly caused by a UTI) 200 mg, give one tablet by mouth after meals for two days for UTI. Review of the Medication Administration Record (MAR) dated December 2024 for Resident #26 confirmed both medications, Cephalexin and phenazopyridine, were administered for the full length of treatment as ordered. Review of a progress note dated 12/10/24 at 11:29 A.M. revealed Resident #26 was noted to have pain throughout the shift in her stomach and perineal area. Her urinary catheter was in place and patent. Resident #26's urine was noted to be a light brown color. The physician was notified and was in to assess the resident. Resident #26 requested to go to the emergency room. Resident #26 was transported to a local emergency room at approximately 10:45 A.M. and the resident's family was notified. A subsequent note dated 12/10/24 timed 5:56 P.M. revealed Resident #26 had returned from the hospital at approximately 5:45 P.M. Resident #26 was diagnosed with a UTI and new antibiotic orders were noted. Review of Resident #26's hospital record dated 12/10/24 revealed a urine culture had been collected at a local emergency room on [DATE], with the final report dated 12/13/24. The final report noted multiple organisms grew in the sample, and results suggested improper specimen collection or delay in delivery. If clinical condition warrants, laboratory suggests repeat specimen. The report further listed care coordination notes by a hospital provider dated 12/13/24 which stated Given symptoms of UTI and history of foley (indwelling urinary) catheterization, highly recommend repeat specimen collection. Continue taking antibiotic that has already been prescribed in the meantime. Further review of Resident #26's record revealed there was no evidence that laboratory testing, including a culture and sensitivity, was completed at the facility upon the resident's return to the facility to determine if the antibiotic prescribed was appropriate for treatment of the urinary tract infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 16 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 Residents Affected - Few An interview conducted on 06/30/25 at 8:48 A.M. with Nurse Practitioner (NP) #200 confirmed that no repeat culture and sensitivity was obtained for Resident #26 in December 2024. NP #200 stated the antibiotic was prescribed for broad-spectrum coverage and was based on hospital discharge documentation without confirmation of effectiveness through laboratory results. An interview conducted on 06/30/25 at 12:07 P.M. with Regional Clinical Manager #205 confirmed that a culture and sensitivity was not completed after Resident #26 returned from the hospital in December 2024. She explained that when a resident returns from the hospital on an antibiotic, cultures may not provide accurate results due to active medication in the resident's system. However, she acknowledged that a follow-up culture and sensitivity should be obtained after the antibiotic course is completed, and confirmed this was not done. 2. Review of the medical record revealed Resident #17 was admitted to the facility on [DATE] with medical diagnoses included non-traumatic brain dysfunction, hypertension, hyperlipidemia, and Alzheimer's disease. Review of the MDS 3.0 quarterly assessment dated [DATE] revealed Resident #17 had a BIMS score of 07, indicating severely impaired cognition. The assessment documented the resident used a walker for ambulation, was independent for toileting hygiene, and was recorded to be always continent of bowel and bladder. Review of Resident #17's laboratory report dated 06/13/25 revealed there was no valid specimen received. There were no additional laboratory results identified in Resident #17's record to reflect a urinalysis and/or a urine culture and sensitivity was completed prior to initiating antibiotic therapy or to confirm that Resident #17 had a urinary tract infection and that the ordered antibiotic was appropriate to treat the resident's suspected urinary tract infection. Review of a progress note dated 06/14/25 at 1:45 P.M. indicated that the laboratory had notified staff that the urine specimen for Resident #17 needed to be resent. The note documented that the nurse was aware and attempting to recollect, and the Nurse Practitioner (NP) #200 was also notified. However, subsequent review of Resident #17's progress notes revealed no additional documentation was found indicating a new sample was collected for a urinalysis or that a culture and sensitivity was performed. Review of the physician orders for Resident #17 revealed an order dated 06/14/25 for Ciprofloxacin (an antibiotic) for a suspected urinary tract infection (UTI). The order called for Ciprofloxacin 500 mg, give one tablet by mouth two times a day for a suspected UTI for 7 days from 06/14/25 through 06/21/25. Review of the Medication Administration Record (MAR) for June 2025 confirmed Resident #17's Ciprofloxacin antibiotic was administered for the full course of the ordered seven-day treatment. An interview conducted on 06/30/25 at 8:00 A.M. with the Director of Nursing (DON) revealed Resident #17 did not have an additional urine culture completed as Resident #17 had stopped having symptoms after the initial specimen was deemed invalid. An interview conducted on 06/30/25 at 11:03 A.M. with NP #200 confirmed that no culture and sensitivity was obtained. NP #200 stated that Ciprofloxacin was prescribed for Resident #17 for broad-spectrum coverage. NP #200 acknowledged that although Ciprofloxacin was later continued for treatment of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 17 of 18 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 365421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Inniswood Health and Rehabilitation 1150 Colony Drive Westerville, OH 43081 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 cellulitis, the indication on the order remained listed as treatment for a UTI. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled, Infection Control Policy/Procedure: Antibiotic Stewardship Program revised April 2025, revealed diagnostic testing shall be in accordance with the provider's order. Prescriptions for antibiotics shall specify the dose, duration, and indication for use. Reassessment of empiric antibiotics is conducted for appropriateness and necessity, factoring in results of diagnostic tests, laboratory reports, and/or changes in the clinical status of the resident. Antibiotic orders shall be reviewed for appropriateness, including those obtained from consulting, specialty, or emergency providers. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365421 If continuation sheet Page 18 of 18