Health inspection·August 26, 2024

F 0880 b) All residents with chronic wounds, indwelling medical devices (I.e., central line, urinary Level of Harm - Minimal harm or potential for actual harm catheter, feeding tube, trach) regardless of MDRO colonization status. Place sign on resident's room door. (Optional: Placement of signage may be better located in the Residents Affected - Few resident room near the resident's bed especially for shared rooms - choose location that most appropriate to make staff and visitors aware of precautions.)* Gown and gloves will be placed immediately outside of the resident room (Optional: Supplies may be placed in an area inside of the room.) Gown and gloves use will be used, in addition to standard precautions, in the following activities: a) Dressing b) Bathing/showering c) Transferring d) Providing hygiene e) Changing linens f) Changing briefs or assisting with toileting g) Device care or use (central line, urinary catheter, feeding tube, tracheostomy) h) Wound care/any skin opening requiring a dressing. Review of the Quality, Safety and Oversight (QSO) 24-08-NH dated 03/20/24 revealed EBP are indicated for residents with any of the following: · Infection or colonization with a CDC-targeted MDRO when Contact Precautions do not otherwise apply; · Wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO. Wounds generally include chronic wounds, not shorter-lasting wounds, such as skin breaks or skin tears covered with an adhesive bandage (e.g., Band-Aid®) or similar dressing. Examples of chronic wounds include, but are not limited to, pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous stasis ulcers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 2 of 5 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 08/26/2024 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 This deficiency represents non-compliance investigated under Complaint Number OH0015287. 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 3 of 5 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 08/26/2024 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview and policy review the facility failed to ensure a homelike environment was provided for the residents. This affected three (#13, #32 and #75) of three residents reviewed for environment. The facility also failed to ensure a room was cleaned on a regular basis. This affected one (#75) of one reviewed for cleansing of the room. The census was 74. Findings included: Observation of Resident #13's room on 08/20/24 at 9:18 A.M. revealed cobwebs in the window sills and thick black substance, scuff marks on the walls, and holes where pictures used to hang, and holes with nails sticking out of the wall. The bathroom floor was sticky, and room walls have black marks on them. The curtains in the room on the windows were dusty and wrinkled. On the inside bathroom door there is a substance that ran down the door that had dried. Observation of Resident #32's room on 08/20/24 at 9:50 A.M. revealed throughout the room there were holes in the walls with nails sticking out of the walls. The walls had black marks on them. The bathroom had a dusty vent in the ceiling, black marks on the walls, floors were stained and the door going into the bathroom looked like it had some kind of substance running down both sides that had dried. Observation of Resident #75's room on 08/20/24 at 11:02 A.M. revealed there were black marks on the walls throughout the room. In the bathroom it was dirty by the handrails, and coming into the room there was molding coming off the wall. A tour and interview of the above mentioned rooms with Housekeeping Supervisor on 08/20/24 at 2:30 P.M. confirmed all of these areas needed to be cleaned. 2. Medical record review for Resident #75 revealed an admission date of 07/09/24. Medical diagnoses included fracture to the right femur. She was discharged on 07/23/24. Review of the admission Minimum Data Set (MDS) dated [DATE] revealed Resident #75 was cognitively intact. Her functional status was setup or clean-up assistance for eating, dependent for toileting, bed mobility was independent, and transfers were partial/ moderate assistance. She was frequently incontinent for bladder and occasionally incontinent for bowel. She didn't have any pressure ulcers on this assessment. Review of the daily housekeeping documents revealed there was an empty space for cleaning on 07/10/24, 07/11/24, 07/14/24, 07/16/24, 07/19/24, 07/22/24, and 07/23/24 for Resident #75. Further review of the document revealed on 07/17/24, 07/21/24, and 07/25/24 it was blank for a check mark as being cleaned. Interview with Housekeeping Aide (HSKG) #151 on 08/26/24 at 11:25 A.M. revealed on the days she didn't clean FSR's room she did work. She stated there wasn't enough staff in the facility and she had to clean other halls. She stated she was off on 07/17/24, 07/21/24, and 07/25/24 and the room didn't get cleaned on those days either. She stated the rooms were to be cleaned everyday. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 4 of 5 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 08/26/2024 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 0921 Level of Harm - Minimal harm or potential for actual harm Review of the policy entitled Environmental Services undated revealed housekeeping will keep resident areas clean and will be assigned specific areas of the facility to ensure that all areas are cleaned. Cleaning of resident rooms, bathrooms, and all public areas will be maintained on a routine basis. This deficiency represents non-compliance investigated under Complaint Number OH00156287. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365427 If continuation sheet Page 5 of 5