Health inspection·April 25, 2022

F 0582 mobility, transfers, dressing, eating, toileting, and personal hygiene. Level of Harm - Minimal harm or potential for actual harm Review of Resident #62's Notice of Medicare Non Coverage (NOMNC) dated 03/24/22 revealed Resident #62 discharged from Medicare Part A services on 03/24/22. Resident #62 signed the NOMNC on 03/22/22. Residents Affected - Few Review of Resident #62's chart revealed Resident #62 did receive a Skilled Nursing Facility Advance Beneficiary Notice of Non Coverage (SNF ABN) notice to inform the resident of the potential liability for a non-covered stay. Interview with Social Services Director #12 on 04/21/22 at 1:17 P.M. verified Resident #62 was discharged from Medicare Part A services on 03/24/22 and Resident #62 was not provided a SNF ABN to inform the resident of the potential liability for a non-covered stay. Social Services Director #12 verified Resident #62 remained in the facility after being discharged from Medicare Part A skilled services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 2 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 record review and staff interview, the facility failed to provide a bed hold notice to a resident within 24 hours of transferring to the hospital. This affected one (#03) resident out of five residents reviewed for hospitalizations. The facility census was 61. Findings include: Review of Resident #03's medical record revealed Resident #03 admitted to the facility on [DATE] with diagnoses including encephalopathy, poisoning by hydantoin derivatives accidental unintentional subsequent encounter, major depressive disorder, hypo-osmolality and hyponatremia, unspecified dementia without behavioral disturbance, acute kidney failure, sepsis, coronavirus (COVID-19), pain in left hip, osteoarthritis of hip, abnormal posture, cognitive communication deficit, hypertension, and pain. Review of Resident #03's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be severely cognitively impaired. Resident #03 required extensive assistance with bed mobility, transfers, dressing, toileting, eating and personal hygiene. Resident #03 also had adequate vision with corrective lenses. Review of Resident #03's progress note dated 10/02/21 revealed Resident #03 was gagging and making a coughing sound. Resident #03's eyes were rolling back in his head. The nurse practitioner was called, and a new order was put in place to send the resident to the emergency department. Review of Resident #03's census sheet revealed Resident #03 readmitted to the facility from the hospital on [DATE]. Review of Resident #03's bed hold notice dated 10/08/21 verified Resident #03 discharged to the hospital on [DATE]. The bed hold notice also stated Resident #03 readmitted to the facility on [DATE] and he used four bed hold days. Interview with the Administrator on 04/20/22 at 12:36 P.M. verified Resident #03 transferred to the hospital on [DATE] and was not provided a bed hold notice until 10/08/21. Review of the facility's undated bed hold and leave of absence notifications policy, revealed residents should be provided notice prior to transfer to the hospital. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 3 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to complete and transmit resident discharge Minimum Data Set (MDS) assessments. This affected two residents (#01 and #02) out of 16 residents reviewed for assessments. The facility census was 61. Residents Affected - Few Findings include: 1. Review of Resident #01's medical record revealed Resident #01 admitted to the facility on [DATE] with diagnoses including fracture of unspecified part of neck of left femurs, other ascites, gastrointestinal hemorrhage, hepatic failure, obesity, acute posthemorrhagic anemia, localized edema, other pancytopenia, unspecified cirrhosis of liver and thrombocytopenia. Resident #01 discharged from the facility on 11/20/21. Review of Resident #01's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and required extensive assistance with bed mobility, transfers, and toileting. Resident #01 required limited assistance with dressing, eating, and personal hygiene. Review of Resident #01's progress note dated 11/20/21 revealed Resident #01 discharged from the facility on 11/20/21. Review of Resident #01's medical record revealed Resident #01 did not have a completed or transmitted discharge MDS assessment. Interview on 04/20/22 at 8:57 A.M. with Licensed Practical Nurse (LPN) #26 verified Resident #01's discharge MDS assessment was not completed. 2. Review of Resident #02's medical record revealed Resident #02 admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy, other lack of coordination, unspecified convulsions, alcohol dependence, acute kidney failure, gout, essential hypertension, and anxiety disorder. Resident #02 discharged from the facility on 12/27/21. Review of Resident #02's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be moderately cognitively impaired and required extensive assistance with bed mobility, transfers, dressing, toileting, and personal hygiene. Resident #02 required limited assistance with eating. Review of Resident #02's progress note dated 12/27/21 revealed Resident #02 discharged home with her daughter. Review of Resident #02's medical record revealed Resident #02 did not have a completed or transmitted discharge Minimum Data Set (MDS) assessment. Interview on 04/20/22 at 8:57 A.M. with LPN #26 verified Resident #02's discharge MDS assessment was not completed. Review of the facility's resident assessment instrument policy dated November 2021 revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 4 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 0640 facility would complete and transmit MDS assessments within federal and state guidelines. 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: 365427 If continuation sheet Page 5 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and observations the facility failed to ensure a resident's diagnoses and treatment needs were identified in the care plan. This affected one Resident (#65) of three residents reviewed for care plans. The facility census was 61. Findings include: Medical record review for Resident #65 revealed an admission of 10/22/22 with a diagnosis osteoporosis. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] for Resident #65 revealed the assessment was silent for diagnosis of osteoporosis. Review of the plan of care dated 10/21/22 for Resident #65 revealed the plan of care was silent for osteoporosis. Review of active physician order for Resident #65 dated 11/02/22 revealed an order for Prolia (osteoporosis treatment) 60 milligrams/milliliter (mg/ml) to be administered every six months sub cutaneous by outside physician office. Review of physician progress note dated 11/02/22 at 8:04 A.M. revealed a routine visit and verification Resident #65 had osteoporosis with treatment of Prolia every six months. Observation on 04/19/22 at 11:35 A.M. of Resident #65 revealed a well-groomed alert and oriented resident sitting in her wheelchair in her room without signs and symptoms of distress or discomfort. Interview on 04/19/22 at 11:38 A.M. Resident #65 verified she had osteoporosis and received treatment, but she did not remember when her last treatment dose of medication was. Interview on 04/20/22 at 11:01 A.M. the MDS Licensed Practical Nurse (LPN) #26 verified osteoporosis was not included in Resident #65's plan of care. LPN #26 verified osteoporosis and treatment should have been included in Resident #65's plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 6 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, and staff interview the facility failed to ensure residents care plans were updated to reflect current health status. This affected two residents (#30 and #65) of three reviewed for care plans. The facility census was 61. Findings included: 1. Medical record for Resident #30 revealed an admission date of 06/30/2015 with diagnoses including stroke, schizoaffective disorder, arthropathy, altered mental status, type II diabetes, sleeplessness, and anxiety. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #30 had intact cognition. Resident #30 required supervision for bed mobility, transfers, eating and limited assist with toileting. Resident was coded with diagnoses including anxiety, depression, bipolar disorder, psychotic disorder, and schizophrenia. Resident #30 was receiving antipsychotic, antianxiety, and antidepressant medications during the assessment period. Review of the care plan for Resident #30 dated 06/22/16 with revisions on 05/09/17 and 01/07/21 revealed, Resident #30 received psychotropic medication for schizoaffective disorder. Interventions included, administer medication as ordered, monitor for side effects to the medication and provide notifications per facility protocol, follow up as ordered, educate caregivers about risks, benefits and the side effects and/or toxic symptoms of Seroquel and Wellbutrin, monitor and re-evaluate quarterly for continued need for this medication and initiate medication reduction if appropriate. Review of discontinued physician's orders for Resident #30 revealed an order for Seroquel 50 milligrams (mg) one tablet two times a day was discontinued on 02/04/16 and an order for Wellbutrin extended release 300 mg one time a day that was discontinued on 11/17/2015. Interview on 04/19/22 at 3:20 P.M. Resident #30 stated she did not remember taking Seroquel or wellbutrin. Interview on 04/21/22 at 1:14 P.M. the Assistant Director of Nursing (ADON) verified the care plan contained Seroquel and Wellbutrin and should not have. 2. Medical record review for Resident #65 revealed an admission date of 10/22/22 with diagnoses including sepsis and cellulitis. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #65 revealed intact cognition. Resident #65 required extensive assistance for bed mobility, transfer, and toileting. Resident #65 required supervision for eating. Resident #65 was coded as receiving an application of non surgical dressings. Resident #65 received antidepressant, anticoagulant and antibiotic medications daily during the assessment period. Review of care plan dated 10/22/21 for Resident #65 revealed the resident was at potential risk for infection, fluid overload related to intravenous antibiotic via left upper extremity midline peripheral inserted central catheter (PICC). Interventions included, change PICC line dressing weekly and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 7 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few as needed, change PICC line tubing every 24 hours, flush PICC after antibiotic with 10 cubic centimeter (cc) with normal saline followed by 5 milliliters (ml) of heparin, flush PICC per facility policy, and flush PICC prior to antibiotic administration with five ml of normal saline using a 10 cc syringe. Review of physician's orders for Resident #65 revealed an order dated 11/13/22 to remove pressure dressing to left upper extremity after forty-eight hours post PICC removal. Interview on 04/20/22 on 11:01 A.M. with the MDS Licensed Practical Nurse (LPN) #25 verified the PICC was discontinued and should have been taken off the plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 8 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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, staff interview, observations, and review of facility policy, the facility failed to monitor for adverse side effects for psychotropic medications. This affected two resident (#30 and #65) reviewed for monitoring for adverse side effects for psychotropic medications. The facility census was 61. Findings include: 1. Medical record for Resident #30 revealed an admission date of 06/30/15 with diagnoses including stroke, schizoaffective disorder, arthropathy, altered mental status, type II diabetes, sleeplessness, and anxiety. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #30 had intact cognition. Resident #30 required supervision for bed mobility, transfers, eating and limited assistance with toileting. Resident #30 was coded with diagnoses including anxiety, depression, bipolar disorder, psychotic disorder, and schizophrenia. Resident #30 was receiving antipsychotic, antianxiety and antidepressant medications during the assessment period. Review of the care plan for Resident #30 initiated on 05/09/17 with revisions, revealed the resident used antianxiety medications related to anxiety disorder. Interventions included educate the resident/family/caregivers about risks, benefits and the side effects and/or toxic symptoms of (anti-anxiety medication drugs being given), give anti-anxiety medications ordered by physician, and monitor/document side effects and effectiveness. Further review of the care plan revealed the resident received psychotropic medication related to schizoaffective disorder. Interventions included administer medication as ordered and monitor for adverse side effects to the medication and provide notifications per facility protocol. Review of physician orders for Resident #30 revealed an order dated 04/18/22 for Trazodone 200 milligrams (mg) one tablet daily for sleeplessness, an order for Haloperidon tablet 5 mg give one tablet daily at bedtime dated 04/14/22, an order for Zoloft 50 mg, give one table by mouth daily for major depressive disorder dated 04/12/22 and an order for Ativan 0.5 mg give one table by mouth two times a day for anxiety. Review of discontinued physician order for Resident #30 revealed an order for Zoloft 25 mg give one tablet one time a day for schizoaffective disorder dated 02/08/22 and discontinued on 04/12/22, an order for Haloperidol 5mg give one tablet daily for schizoaffective disorder dated 02/08/22 and discontinued on 04/12/22, an order for Trazodone 150 mg give one tablet daily by mouth at night for sleeplessness and an order for Zoloft 25 mg give one tablet daily for schizoaffective disorder dated 02/08/22 and discontinued on 04/12/22. Review of Resident #30's Medication Administration Record (MAR) from 01/01/22 to 04/21/22 revealed the MARs were silent for monitoring for adverse side effects of psychotropic medications. Review of Resident #30's Treatment Administration Record (TAR) from 01/01/22 to 04/21/22 revealed the TARs were silent for monitoring for adverse side effects of psychotropic medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 9 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 Review of progress notes for Resident #30 from 01/01/22 to 04/21/22 revealed progress notes were silent for for monitoring for adverse side effects of psychotropic medications. Observation on 04/19/22 at 3:19 P.M. of Resident #30 revealed the resident was resting in bed, awakened easily with verbal stimulation. Resident was well groomed and in appropriate clothing. Residents Affected - Few Interview on 04/21/22 at 10:25 A.M. Licensed Practical Nurse (LPN) #25 verified the facility was not monitoring for specific side effects related to psychotropic medications. LPN #25 stated she was unaware of any monitoring tools used by the facility. Interview on 04/21/22 at 1:07 P.M. with Assistant Director of Nursing (ADON) #25 verified the facility is not monitoring for adverse side effects and they should have. Further stated the last monitoring of adverse side effects was documented in 2018. 2. Review of the medical record for Resident #26 revealed an admission date of 01/20/20 with diagnoses including schizoaffective disorder bipolar type, cerebral infarction, COVID-19, personality disorder, depression, involuntary movements, type II diabetes and insomnia. Review of quarterly Minimum Data Assessment (MDS) assessment dated [DATE] revealed Resident #26 had intact cognition. Resident #26 displayed behaviors including physical symptoms directed at others, verbal behaviors directed at others, other behavioral symptoms not directed towards others, and rejected care. Resident #26 required extensive assistance for bed mobility, transfers, eating, and toileting. Review of the care plan for Resident #26 revealed the resident had potential for or alteration in psychosocial well being and or moods behaviors related to schizoaffective disorder, thoughts of being better off dead, self harm, wandering, depression and anxiety. Interventions included administer medication as ordered and monitor and document for side effects and effectiveness, behavioral consults as needed, monitor and record mood to determine if problems seem to be related to external causes. Further review of the care plan revealed the need to monitor for altered behavior patterns, disruptive interactions, disruptive verbally, resistive to care, violence/anger related to manipulative behavior, history of suicidal ideation's, attention seeking behaviors, feeling depressed, placing self on floor from wheelchair and/or bed. Interventions included administer prescribed medications, observe for side effects and monitor for effectiveness, and allow resident to pace where he or she can be observed. Review of the active physician orders for Resident #26 revealed an order for Lithium level every three months, dated 4/4/22, an order for Lithium Carbonate ER Tablet Extended Release 450 mg, give 1 tablet by mouth one time a day for schizoaffective disorder dated 04/04/22, Seroquel tablet 200 mg give one tablet by mouth at bedtime for schizophrenia dated 03/21/22, Seroquel tablet, give 150 mg by mouth two times a day for schizophrenia dated 03/21/22, Cogentin Solution 1 mg/ml inject 1 mg intramuscularly every 12 hours as needed for extrapyramidal signs and symptoms dated 03/11/22, and Remeron tablet (antidepressant), give 15 mg by mouth at bedtime for schizo affective disorder dated 03/11/22. Review of progress notes for Resident #26 from 01/01/22 through 04/21/22 revealed progress notes were silent for monitoring for adverse side effects. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 10 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 Review of Resident #26's Medication Administration Record (MAR) from 01/01/22 to 04/21/22 revealed the MARs were silent for monitoring for adverse side effects of psychotrophic medications. Review of Resident #26's Treatment Administration Record (TAR) from 01/01/22 to 04/21/22 revealed the TARs were silent for monitoring for adverse side effects of psychotropic medications. Residents Affected - Few Interview on 04/21/22 at 10:25 A.M. Licensed Practical Nurse (LPN) #25 verified the facility was not monitoring for specific side effects related to psychotropic medications. LPN #25 stated she was unaware of any monitoring tools used by the facility. Interview on 04/21/22 at 1:07 P.M. with Assistant Director of Nursing (ADON) #25 verified the facility is not monitoring for adverse side effects and they should have. Further stated the last monitoring of adverse side effects was documented in 2018. Review of facility policy titled, Psychotropic Medications, undated, revealed residents would be monitored for adverse side effects. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 11 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 - Few 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, staff interview, and review of facility policy, the facility failed to ensure medication was stored appropriately. This affected one resident (#43) out of four residents reviewed for medication storage. The facility census was 61. Finding include: Review of medical record for Resident #43 revealed an admission date of 02/19/22. Diagnosis included atrial fibrillation, chronic obstructive pulmonary disease, sleep disorders, and bipolar disorder. Review of record of Resident #43's Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 15, indicating the resident was cognitively intact. Resident #43 required extensive assistance with bed mobility, transfers, toileting, bathing, dressing, and personal hygiene. Resident #43 used a walker and wheelchair for ambulation. Review of plan of care dated 04/05/22 revealed Resident #43 was at risk for altered respiratory status related to chronic obstructive pulmonary disease, respiratory failure, pulmonary embolism, anxiety, and sleep apnea. Interventions included administer oxygen as per physician's order, allow frequent rest periods with activities of daily living, assist with activity of daily livings, monitor for signs and symptoms of difficulty of breathing, monitor oxygen saturation, and offer and administer pain medication as physician orders. Review of physician order for Resident #43 dated 02/20/22 revealed an order for Dulera Aerosol inhaler treatment for two times a day for chronic obstructive pulmonary disease. Further review of physician orders for Resident #43 revealed no orders for Resident #43 to store medications in her room. Interview on 04/20/22 at 8:50 A.M. Licensed Practical Nurse (LPN) #39 stated Resident #43's Dulera Aerosol inhaler was not in the medication cart. LPN #39 stated it had always been in the medication cart. Interview on 04/20/22 at 9:00 A.M. Resident #43 stated on 04/19/22, the nurse left Resident #43's Dulera Aerosol inhaler in her room after morning medication administration. Resident #43 stated the nurse was supposed to come back to her room. Resident #43 stated nurses typically do not leave the inhaler in her room. Observation on 04/20/22 at 9:05 A.M. with LPN #39 present, revealed Resident #43's Dulera Aerosol inhaler was on her bed side table. LPN #39 verified Resident #43's Duelera Aersol inhaler was on Resident #43's bed side table and not in the medication cart. Interview on 04/21/22 at 11:25 A.M. the Director of Nursing (DON) verified there were no residents who requested to store medications in their rooms. The DON further explained if a resident wanted to store medications in their room, a self-medication administration assessment would be completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 12 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 There were no current residents who self-administered medications. Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled, Storage of Medication Policy dated 02/02/21 revealed the nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. Drugs shall be stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems. Each resident's medications shall be assigned to an individual cubicle, drawer, or other holding area to prevent the possibility of mixing medication of several residents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 13 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview, and review of facility policy, the facility failed to ensure supplies used in the kitchen were clean. This had the potential to affect 60 residents who received food from the kitchen and utilized kitchen dishes. The facility census was 62. Findings include: Tour of the kitchen on 04/19/22 at 8:20 A.M. revealed an orange industrial floor fan was observed to have a brown like substance build up located on the inside blades and the exterior grill face of the fan. The fan was on and blowing air directly onto clean dishes. On 04/19/22 at 8:25 A.M. interview with Dietary Manager #25 revealed the fan was on daily because the kitchen got extremely hot while washing the dishes. Additionally, Dietary Manager #25 verified the brown build up on the fan and verified the fan was turned on and blowing air directly onto clean dishes. Review of the policy, Sanitation dated January 2022, all equipment in the kitchen shall be kept clean and maintained in good repair. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 14 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 medical record review, observations, staff interview, review of facility policy, and review of Centers for Disease Prevention and Control (CDC) guidance, the facility failed to ensure staff utilized proper Personal Protective Equipment (PPE) when interacting with a resident (Resident #367) on droplet isolation. This affected one resident (#367) out of four residents reviewed for infection control and had the potential to affect eight additional residents (#16, #39, #58, #62, #167, #168, #169, and #171) being cared for by the same staff members. The facility census was 61. Residents Affected - Some Findings Included: Medical record review for Resident #367 revealed an admission date of 04/20/22. Diagnosis included dementia with Lewy bodies and gastrointestinal hemorrhage. Review of Minimum Data Set (MDS) assessment dated [DATE] for Resident #367, revealed the assessment was not completed in its entirety and a Brief Interview of Mental Status (BIMS) score (cognition level) was not established. Review of physician order dated 04/20/22 for Resident #367, revealed the resident was on COVID-19 isolation, including contact and droplet precautions. Full PPE including an N95 mask was required. All services were to be provided in Resident #367's room every day and night shift for 10 days. Further review of Resident #367's medical record revealed an immunization for tetanus only. There was no evidence the resident received any COVID-19 vaccines. Observation on 04/21/22 at 1:10 P.M. revealed State Tested Nurse Aide (STNA) #68 assisting Resident #367 out of the restroom and proceeded to provide care. STNA #68 was observed wearing a gown, gloves, and surgical mask while interacting with Resident #367. STNA #68 was not wearing an N95 mask. Interview on 04/21/22 at 1:15 P.M. STNA #68 verified she was wearing a surgical mask when interacting with Resident #367 and she did not wear an N95 mask. STNA #68 reported she only had to wear the surgical mask. Interview on 04/21/22 at 1:18 P.M. with Licensed Practical Nurse (LPN) #67 revealed she was only wearing a surgical mask for the newly admitted Resident #367 per facility protocol. LPN #67 verified Resident #367 was in quarantine for being a new admission. Interview on 04/21/22 at 1:25 P.M. the Director of Nursing (DON) stated new admits would be quarantined if the resident did not have COVID-19 vaccination or partial vaccination. All employees whether vaccinated or not, were required to wear all required PPE in quarantined resident's room. Interview on 04/21/22 at 2:00 P.M. the Assistant Director of Nursing (ADON) reported new admits would be on droplet precautions if the resident did not have COVID-19 vaccination or partial vaccination. The ADON verified regardless of vaccination status, staff were to wear PPE, including an N95 mask when interacting with residents on droplet precautions. Surgical masks were not to be used. Interview on 04/21/22 at 2:45 P.M. the Administrator verified eight residents (#16, #39, #58, #62, #167, #168, #169, and #171) resided on the same hallway as Resident #367 and were cared for by STNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 15 of 16 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 365427 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loveland Health Care Center 501 North Second Street Loveland, OH 45140 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 #68 and LPN #67. Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled, Covid-19 Policy and Procedure, revised 02/2022, revealed new admission and readmission residents who leave the facility for 24 hours or more would be quarantined. Residents not up to date on COVID-19 vaccinations, who were new admissions or readmissions or who had been out of the facility for 24 hours or greater: would be placed in a quarantine for 10 days or seven days if asymptomatic and negative test result. New admissions or readmissions would be tested immediately upon admission or return and would be retested in five to seven days. New admissions and residents who had been out of the facility for 24 hours or more required quarantine only when they were not up to date with COVID-19 vaccinations. However, residents who were up to date still required testing as outlined above. Health care providers caring for residents in quarantine should use full personal PPE, including a gown, gloves, eye protection, and N95 or higher-level respirator. Residents Affected - Some Review of CDC Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes updated 02/02/22 revealed in general, all residents who were not up to date with all recommended COVID-19 vaccine doses and were new admissions and readmissions should be placed in quarantine, even if they have a negative test upon admission. Facilities located in counties with low community transmission might elect to use a risk-based approach for determining which of these residents require quarantine upon admission. Decisions should be based on whether the resident had close contact with someone with SARS-CoV-2 infection while outside the facility and if there was consistent adherence to infection prevention practices in healthcare settings, during transportation, or in the community prior to admission. Guidance addressing duration and recommended PPE when caring for residents in quarantine was described in Section: Manage Residents who had Close Contact with Someone with SARS-CoV-2 Infection: Health Care Personnel (HCP) should utilize full PPE, including an N95 mask, when caring for residents who had close contact with someone with SARS-CoV-2 and were not up to date with vaccination. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 16 of 16