Inspection·July 13, 2023

F 0606 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 07/06/23 at 2:45 P.M. interview with the Administrator revealed about two months ago he had heard some scuttlebutt that DE #203 had possibly been a sexual offender. In response to the scuttlebutt the Administrator checked the Ohio Attorney General's website and said he found no findings when running DE #203's name so did not pursue the matter any further. The Administrator stated he had no verifying evidence he had run the check, but stated if he had verified DE #203 was a tier three sexual offender, he would have fired him immediately. The surveyor requested confirmation of background checks being completed for DE #203 and all dietary staff. The Administrator then indicated he received confirmation DE #203 had been convicted and was a tier three Child Victim Offender. The Administrator then indicated this was the first knowledge he had of DE #203's prior convictions and stated he had not been alerted by the dietary contract company, as they were the entity responsible for doing the background checks for their individual employees, including DE #203. Interview on 07/07/23 at 11:55 A.M. with Director of Operation of Ohio (DOO) #300, who was a director for the dietary contract company, revealed both DOO #300 and DE #203 told the Administrator they had paperwork from the county Sheriff's office saying it was OK for DE #203 to be employed in the dietary department and he had confirmed after talking to the Sheriff's Department it was no concern DE #203 was working in a nursing facility kitchen. However, DOO #300 stated he could not confirm if there had been a complete background check done on DE #203 because DE #203 was hired on 10/05/22, he had only taken over the DOO position about two and a half months ago and the previous DOO (DOO #400) had taken the employee files upon leaving. DOO #300 stated he would try to get DE #203's file from the Corporate Office in New Jersey. An interview was conducted on 07/10/23 at 11:53 A.M. with Lieutenant (LT) #700 who stated she was the Lieutenant for Ashtabula County with responsibility for approving or disproving employment placement for persons with charges of sexual offenses. LT #700 explained she had approved DE #203 for employment in the kitchen at the facility because his conviction was 20 years ago, and the type of sexual offence did not exclude him from employment at the facility working in the kitchen because he would just stay in the kitchen. LT #700 said kitchen jobs were one of the few placements she could employment find for sex offenders. LT #700 verified DE #203 was a tier three child sex offender. LT #700 did not verbalize understanding nor acknowledge the facility admitted residents under the age of 18 when the surveyor asked if she was aware adolescents were part of the demographic at the facility or of the employee's interaction with facility residents outside the kitchen based on the job duties of the employee's position. Interview on 07/11/23 at approximately 11:00 A.M. with the Director of Human Resources and Payroll (DHRP) #104 revealed she did the background checks for facility staff, but had not been responsible for the background checks for the contracted staff working in the dietary department. DHRP ##104 said she was not aware DE #203 was a tier three registered sex offender until 07/06/23 or 07/07/23 when she was informed by the Administrator. DHRP #104 stated DOO #300 and DE #203 told the Administrator they had paperwork from the county Sheriff's office saying it was OK for DE #203 to be employed in the dietary department. DHRP # 104 explained that having the tier three child sex offender in the facility was concerning to her because the facility admitted residents under the age of 18 and this would exclude him from employment in a nursing home. Interviews were conducted on 07/11/23 from 11:15 A.M. to 11:25 A.M. with Licensed Practical Nurse (LPN) #147, State Tested Nursing Assistant (STNA) #126, and STNA#150. During the interviews, each staff member informed the surveyor it was the dietary aides' responsibility to bring the tray carts from the kitchen to the resident units for those residents eating on the units instead of in the dining room, so dietary aides (including DE #203) did come out of the kitchen into the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365441 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 365441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Pointe Rehabilitation and Nursing Center 22 Parrish Road Conneaut, OH 44030 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 0606 population. Level of Harm - Minimal harm or potential for actual harm On 07/11/23 from 11:22 A.M. to 11:49 A.M. observations of the main dining room, general facility environment, the kitchen environment, and the lunch dining room service in the facility revealed the kitchen was connected to the resident's dining room via a door and the dietary aide from the kitchen was observed bringing a beverage cart into the dining room while multiple residents sat waiting to be served. The kitchen was adjacent to the therapy gym and common area for resident activities. Residents Affected - Many Interview on 07/11/23 at approximately 12:30 P.M. with Dietary Manager (DM) #200 revealed she became aware of DE #203's conviction as a sex offender about two months ago and did bring it to the attention of the former boss of the kitchen (Director of Operations of Ohio #400). DM #200 added DE #203 had been dating a nurse aide at the facility and they had gotten into an argument and the nurse aide told staff in the facility DE #203 was a sex offender. DM #200 verified DE #203 worked as both a cook and dietary aide and the dietary aide position did require DE #203 to be outside of the kitchen and around the facility to deliver tray carts, snacks and hydration to residents. Interview on 07/11/23 at 4:30 P.M. with the Administrator verified DE #203 was not appropriate for employment in the facility due his disqualifying offense and indicated prior Dietary Manager (DM) #900 had been responsible for completing the background checks for DE #203. The Administrator explained it would have been the responsibility of the contract company and DM #900 to run background checks on the dietary employees to ensure they did not have any disqualifying convictions for employment in the facility. Interview on 07/11/23 at approximately 5:55 P.M. with the Administrator verified the facility accepted and admitted residents under the age of 18 with the youngest accepted age being [AGE] years old. Review of the facility policy titled Abuse Prevention Program, revised August 2006, revealed the facility would not knowingly employ any individual who had been convicted of abusing, neglecting or mistreating individuals. This deficiency represents non-compliance identified during the investigation of Complaint Number OH00144289. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365441 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 365441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Pointe Rehabilitation and Nursing Center 22 Parrish Road Conneaut, OH 44030 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on record review, review of facility policy and interviews, the facility failed to ensure Dietary Manager (DM) #200, Dietary Employee (DE) #203, DE #204 and DE #205 were properly screened according to abuse prevention policy and procedures. The facility also failed to implement the policy to avoid hiring DE #203 having a disqualifying criminal conviction. This had the potential to affect all 61 residents living in the facility. Residents Affected - Many Findings included: Review of the personnel records for Dietary Employee (DE) #203 revealed a hire date of 10/05/22. Review of the dietary staffing schedules for May 2023 through July 2023 revealed DE #203 worked as a dietary aide on the A.M. and P.M. shifts as well as working as a Cook. Review of the online Attorney Generals Sexual Offenders for Ohio database search by the surveyor revealed DE #203 was a Tier Three Sexual Offender. Review of the facilities Bureau of Criminal Identification and Investigation (BCI) log revealed DE #203's name did not show up on the log nor did three additional dietary employees including the current Dietary Manager (DM) #200, DE #204 and DE #205, as well as for DE #203. Review of additional personnel records for DM #200 revealed a date of hire (DOH) of 02/16/23. DOH for DE #205 was 08/07/22 and DOH for DE #204 was 05/30/23. Interview was conducted on 07/11/23 at approximately 11:00 A.M. with the Director of Human Resources and Payroll (DHRP) #104 who revealed she did the background checks for facility staff, but had not been responsible for the background checks for the contracted staff working in the dietary department and that was why DE #203, DE #204, DE #205 and DM #200 were not showing on the BCI log. On 7/10/23 at 12:49 P.M. an interview with the Administrator revealed he had discovered the dietary contract company had not done background checks on all the employees contracted to work in the dietary department at the facility. After reviewing the files, the Administrator determined he did not have criminal background BCI checks on three additional employees including Dietary Manager #200 with a hire date 02/16/23, Dietary Employee #205, hire date 08/07/22, and Dietary Employee #204 with a hire date 05/30/23. The Administrator stated he sent them out immediately to have the BCI background check done. The Administrator also stated he had immediately checked the three employees against the Nurse Aide Registry and Ohio Attorney Generals Sexual Offenders Registry and found no concerns. The Administrator informed the surveyor DE #203 was terminated from employment at the facility upon discovery of his sex offender registry status. Review of the facility's Human Resources (HR) Checklist for Onboarding stated a background and physical must be done before the start date of the employee. Review of the facility policy titled Abuse Prevention Program, dated 08/2006, stated it was the policy of the facility to conduct employee background checks of all employees. Review of the facility policy titled Preventing Resident Abuse, dated 12/2013, stated it was the policy of the facility to conduct background investigations to avoid hiring persons who have been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365441 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 365441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Pointe Rehabilitation and Nursing Center 22 Parrish Road Conneaut, OH 44030 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 0607 Level of Harm - Minimal harm or potential for actual harm found guilty (by a court of law) of abusing, neglecting, or mistreating individuals or those who have had a finding of such action entered into the state nurse aide registry or state sex offender registry. This deficiency represents non-compliance identified during the investigation of Complaint Number OH00144289. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365441 If continuation sheet Page 5 of 5