Inspection·August 2, 2022

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bath often but had never given or offered the resident a shower since he was not scheduled to receive a shower on day shift. STNA #41 reported Resident #44's room used to be in a private room so his roommate was assigned a shower day. STNA #41 further reported the shower schedule was not updated to reflect Resident #44 residing in the room, therefore he had no assigned showers. Interview on 07/27/22 at 11:15 A.M. with Licensed Practical Nurse (LPN) #38 revealed LPN #38 was regularly assigned to Resident #44 and was unaware of the resident ever refusing a shower. LPN #38 reported if a resident refused a shower the nurse on duty was notified. Interview on 07/27/22 at 9:20 A.M. with the Administrator revealed Resident #44 had a care plan for sometimes refusing showers and had been receiving bed baths because of this. Subsequent interview on 07/27/22 at 10:56 A.M. with the Administrator verified there was no evidence Resident #44 had ever refused a shower prior to when the care plan was created during the survey on 07/26/22. Interview on 07/27/22 at 12:27 P.M. with LPN #12 verified all bathing documentation for Resident #44 was included within the medical record and there was no evidence of the resident having received or refused any showers since his admission to the facility on [DATE]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 2 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of resident funds, staff interview, and review of the facility's policy, the facility failed to ensure a resident's funds was returned to the estate within 30 days of the resident's death. This affected one (Resident #256) of three residents reviewed for funds. The facility census was 53. Residents Affected - Few Findings include: Review of Resident #256's medical record revealed she expired in the facility on [DATE]. Review of Resident #256's Resident Fund Management Service authorization and agreement dated [DATE] revealed in th event of Resident #256's death, Resident #256 directs that any funds owed or advanced to Resident #256 by the facility prior to my death were to be paid to the facility with any remaining balance in the resident fund account to become part of my estate. Review of the facility's account statement dated [DATE] revealed Resident #256 had funds in the account totaling $3,829.25. Interview with Human Resource Manager #76 on [DATE] at 3:11 P.M. verified Resident #256's funds remained in the facility's account and the facility failed to return them to the estate or funeral home in a timely manner. Review of the facility's policy titled Resident Personal Funds, dated [DATE], revealed upon discharge, eviction, or death of a resident with a personal fund deposited with the facility, the facility will convey within 30 days the resident's funds and a final account of those funds to the resident, or in the case of death, the individual or probate jurisdiction administering the resident's estate, in accordance with State law. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 3 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure Resident 26's advance directive information was complete. This affected one (Resident #26) of nine residents reviewed for advanced directives. The facility census was 53. Findings include: Review of the medical record revealed Resident #26 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease and depression. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #26 was cognitively intact. Review of the physician's order dated [DATE] revealed Resident #26 had an order for Do Not Resuscitate Comfort Care (DNRCC) code status signifying cardiopulmonary resuscitative (CPR) measures were not to be conducted in case of cardiac or respiratory arrest. Review of Resident #26's paper medical record revealed a Do Not Resuscitate form dated [DATE]. The form indicated Do Not Resuscitate Comfort Care-Arrest (DNRCC-A) or DNRCC should be marked and neither code status was marked. The form was signed by the physician. Interview on [DATE] at 11:15 A.M. with Licensed Practical Nurse (LPN) #38 verified Resident #26's DNR form was incomplete and did not match the physician's order dated [DATE]. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 4 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 ensure bed hold notices were given to residents upon discharge to the hospital. This affected one (Resident #31) of two residents reviewed for hospitalization. The facility census was 53. Findings include: Review of Resident #31's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included type II diabetes mellitus, hepatitis b, chronic obstructive pulmonary disease, and congestive heart failure. Review of the census records for Resident #31 revealed the resident was discharged to a local hospital on [DATE] and returned to the facility on [DATE]. Resident #31 was discharged to the hospital again on 06/09/22 and returned to the facility on [DATE]. Review of both the electronic and hard charts revealed no evidence Resident #31 was given a bed hold notice for the discharges to the hospital on [DATE] and 06/09/22. Interview on 07/27/22 at 12:07 P.M. with the Administrator verified there was no evidence Resident #31 was given a bed hold notice as required on 04/12/22 and 06/09/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 5 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0641 Ensure each resident receives an accurate 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, staff interview, and review of the facility's policy, the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were completed accurately for Residents #25 and #57. This affected two (#25 and #57) of nineteen residents whose MDS assessments were reviewed. The facility census was 53. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #25 revealed an admission date of 09/03/20. Diagnoses included type II diabetes mellitus, depression, anxiety, respiratory failure, and heart failure. Review of Resident #25's physician orders dated 02/10/22 revealed an order for oxygen at four liters per minute via nasal cannula continuously. Review of the Treatment Administration Record (TAR) for July 2022 revealed Resident #25 received oxygen throughout the month per physician order. Review of the quarterly MDS assessment dated [DATE] and the significant change MDS assessment dated [DATE], revealed Resident #25 did not utilize oxygen. Interview on 07/27/22 at 12:27 P.M. with Licensed Practical Nurse (LPN) #12 verified Resident #25's use of oxygen was not accurately reflected on the MDS assessments dated 05/19/22 and 07/22/22. 2. Review of the medical record for Resident #57 revealed an admission date of 04/05/22. Diagnoses included chronic obstructive pulmonary disease, alcohol abuse, and hypertension. Review of the discharge MDS 3.0 assessment for Resident #57, dated 04/25/22, revealed the resident discharged to an acute hospital. Review of the nursing progress notes for April 2022 for Resident #57 revealed the resident discharged home with his daughter-in-law. Interview on 07/27/22 at 2:14 P.M. with Social Service Designee #67 verified Resident #57 was discharged home and the discharge was not accurately reflected on the discharge MDS assessment dated [DATE]. Review of the facility's undated policy titled Conducting an Accurate Resident Assessment revealed the purpose of the policy was to assure all residents received an accurate assessment reflective of the resident's status at the time of the assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 6 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 record review, resident interview, staff interview, and policy review, the facility failed to complete activities of daily living (ADL) for residents who required assistance on staff for assistance with bathing/showering. This affected two (#14 and #24) of three residents reviewed for ADLs. The facility identified 44 residents who required assistance from staff with bathing/showering. The facility census was 53. Residents Affected - Few Findings include: 1. Review of Resident #14's medical record revealed an admission date of 08/29/19. Diagnoses included coronary artery disease, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, cerebral vascular accident, chronic kidney disease, and hemiplegia and hemiparesis of the right side. Review of the quarterly Minimum Data Set assessment dated [DATE] revealed Resident #14 had a high cognitive function. He required a one person physical assist for bathing and personal hygiene. Review of the care plan revealed Resident #14 required total assistance by one staff with bathing, showering, personal hygiene, and oral care. Staff were to use short, simple instructions such as hold your washcloth in your hand, put soap on your washcloth, or wash your face to promote independence. Review of the 100-Hall Shower List revealed Resident #14 was to receive showers on second shift every Monday and Thursday. Review of the shower sheets from 05/01/22 to 06/29/22 revealed Resident #14 received assistance with a shower on 05/02/22, 05/06/22, and on 05/09/22. Resident #14 was documented as asking for a shower and received one on 06/24/22. Shower sheets were rquested for 05/01/22 through 07/28/22 and no further shower sheets were provided during this time frame. Review of the electronic medical records from 06/30/22 to 07/25/22 revealed on 06/30/22 the resident's shower did not occur and was mark non-applicable on 07/07/22, 07/18/22, and on 07/25/22. There was no other documentation Resident #14 received a shower or bath during this time. Review of Resident #14's nurses notes dated 06/15/22 through 07/27/22 revealed no issues pertaining to refusing showers or bathes. Interview with Resident #14 on 07/26/22 at 3:15 P.M. stated he wished to take a shower but staff never assisted him. Resident #14 stated he had to give himself a sponge bath in the sink and stated once staff knew you could care for yourself, they would not offer to assist with showers again. Interview with State Tested Nursing Aide (STNA) #40 on 07/28/22 at 10:05 A.M. stated Resident #14 gave himself sponge bathes and did not require assistance from staff. STNA #40 stated she was unaware if Resident #14 ever requested a shower. 2. Review of Resident #24's medical record revealed an admission date of 05/23/21. Diagnoses included hemiplegia and hemiparesis left side due to a cerebral vascular accidents, chronic kidney disease, and renal dialysis dependence. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 7 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the annual MDS assessment dated [DATE] revealed Resident #24 had a high cognitive function. He required a one-person physical assist for bathing. Review of Resident #24's most recent care plan revealed he had an activity for daily living (ADL) self-care performance deficit related to coronary artery disease, myocardial infarction, cerebral vascular accident with left sided deficit and hemiplegia. Resident #24 required an extensive assistance by one to two staff with bathing/showering as necessary. Resident #24 required extensive assistance by one staff with personal hygiene. Review of the facility's shower schedule revealed Resident #24 was to receive a shower on Sundays and Thursdays on the afternoon shift. Review of Resident #24's shower sheets revealed the resident received assistance with bathing/showers on 07/03/22 and 07/05/22. Shower sheets were requested for 06/01/22 through 07/28/22 and no further shower sheets were provided during this time frame. Interview with Resident #24 on 07/26/22 at 3:52 P.M. revealed because he can wash himself up in the sink the staff do not assist him with showers. Resident #24 would like to have a shower but no one offers one. He would like assistance with bathing/showering twice a week. Interview with STNA #40 on 07/28/22 at 11:52 A.M. stated Resident #24 was self sufficient in bathing and he did not ask to receive a shower. Review of the facility's undated policy titled Resident Showers revealed it was the practice of this facility to assist residents with bathing to maintain proper hygiene, stimulate circulation and help prevent skin issues as per current standards of practice. Residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 8 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Potential for minimal harm Based on record review and staff interview, the facility failed to complete evaluations for two of eight employees reviewed for evaluations. This had the potential to affect all 53 residents residing in the facility. Residents Affected - Many Findings include: Review of the employee personnel record for State Tested Nursing Assistant (STNA) #40 revealed STNA #40 was hired on 04/15/19. The personnel file was silent for completed annual evaluations for 2021 and 2022. Review of the employee personnel record for STNA #75 revealed a hire date of 01/17/05. The personnel file was silent for completed annual evaluations for 2021 or 2022. Interview on 07/28/22 at 4:00 P.M. with the Human Resources #76 confirmed STNAs #40 and #75 had not had annual evaluations completed for 2021 or 2022. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 9 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 observation, staff interview, and review of the facility's policy, the facility failed to ensure the daily posted nursing staff information was updated timely as required. This had the potential to affect all 53 residents residing in the facility. Residents Affected - Many Findings include: Observation of the daily posted nursing staff information on 07/25/22 at 3:35 P.M. revealed the posted information including the facility name, the census, and the total number and actual hours worked by licensed and unlicensed nursing staff for resident care each shift was dated 07/05/22. Observation and interview on 07/25/22 at 3:35 P.M. with Receptionist #36 verified the daily posted nursing staff information was not up to date. Subsequent observation on 07/28/22 at 10:22 A.M. revealed no daily posted staffing information was posted. Interview and observation on 07/28/22 at 10:22 A.M. with Receptionist #36 verified daily posted nursing staff information was not posted. Review of the facility's undated policy titled Nurse Staffing Posting Information, revealed it was the facility's policy to make nurse staffing information readily available in a readable format to residents and visitors at any given time. The policy also stated the facility would post the nurse staffing information at the beginning of each shift. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 10 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 observations, record review, staff interview, and policy review, the facility failed to administer medication as physician ordered resulting in medication errors exceeding five percent. There were five medication errors out of 29 medications opportunities or a medication error rate of 17.24%. This affected two (Residents #48 and #52) of six residents reviewed observed for medication administration. The facility census was 53. Residents Affected - Few Findings include: 1. Review of Resident #48's medical record revealed an admission date of 06/17/19. Diagnoses included schizophrenia, epilepsy, diabetes mellitus, acute kidney failure, and paranoid personality disorder. Review of Resident #48's physician order dated 06/28/22 revealed an order for Risperdal (antipsychotic) one milligram (mg) to be administered by mouth two times a day for schizophrenia. An order dated 06/17/22 for sodium chloride (salt supplement) one gram was to be administered three times a day for muscle contractions. Review of Resident #48's Medication Administration Record (MAR) dated July 2022 revealed the medications were to be administered in the AM. Observation of medication administration on 07/25/22 at 12:04 P.M. with Licensed Practical Nurse #90 revealed Resident #48 was being administered his morning medications. 2. Review of Resident #52's medical record revealed an admission date of 03/18/21. Diagnoses included multiple sclerosis, cauda equina syndrome, vision loss, schizoaffective disorder bipolar type, hemiplegia, and cerebral infarction. Review of Resident #52's physician's order dated 08/22/21 revealed an order for Neurontin (anticonvulsant/nerve pain) was ordered on 03/18/21 for 300 mg to be given three times a day to treat neuropathy. Depakote (anticonvulsant) extended release for 250 mg to be given three times a day to treat schizoaffective bipolar disorder was ordered on 12/20/21. Cymbalta (antidepressant) delayed release particles 60 mg was to be administered in the mornings to treat depression was ordered on 10/13/21. Review of Resident #52's MAR dated July 2022 revealed all medications were to be administered in the A.M. Observation of medication administration on 07/25/22 revealed Resident #52's Neurontin, Depakote, and Cymbalta were not administered until 12:13 P.M. Interview with LPN #90 on 07/25/22 at 12:06 P.M. revealed morning medications were running very late because she had to transfer a resident to the hospital. The nurse verified the medications should have been administered between approximately 8:00 A.M. to 10:00 A.M. Review of the facility's undated policy titled Medication Administration Schedule revealed morning medications were to be administered between 6:00 A.M. and 10:00 A.M. Medication order for three times a day were to be administered at 9:00 A.M., 1:00 P.M. and 5:00 P.M. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 11 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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. Based on staff interview, observation of the medication cart, review of the facility's policy for medication storage, and review of insulin manufacturer instructions, the facility failed to ensure insulin products were marked with open dates. This affected two of the three medication carts observed for drug storage. This affected three residents (Residents #00, #22 and #29). The facility census was 53. Findings include: Observation of the medication cart on 07/28/22 at 10:25 A.M. revealed seven insulin pens with three of the insulin pens without an open date. Three vials of insulin, one insulin vial without an open date. Interview during this observation with Licensed Practical Nurse (LPN) #71 confirmed the insulin products, three insulin pens and one insulin vial were open and in use, but not marked with open dates for Residents #00, #22 and #29. LPN #71 stated an insulin product should be marked with an open date at the time it was initially opened for use and discarded after one month. Review of an undated facility policy titled Medication Storage confirmed medications shall be stored in a manner that ensures maintenance of both the integrity of the medication and the safety of all residents. Review of the manufacturer's guidelines for Humalog insulin, found at www.humalog.com, revealed an open Humalog Kwikpen should be discarded after 28 days. Review of the manufacturer's guidelines for Lantus insulin, found at www.lantus.com, revealed an open Lantus insulin vial or pen should be discarded after 28 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 12 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0838 Level of Harm - Potential for minimal harm Residents Affected - Many Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on record review and staff interview, the facility failed to ensure the assessment used to determine what resources were necessary to care for its residents competently during both day-to-day operations and emergencies was reviewed and updated at least annually. This had the potential to affect all 53 residents residing in the facility. Findings include: Review of the facility assessment tool, dated 08/18/17, revealed the assessment included within the tool was not up-to-date. Review of the assessment also revealed the following: a. The assessment had the incorrect name listed for the Administrator. b. The assessment did not address the facility's use of contract (agency) nursing staff to provide services. Interview on 07/28/22 at 2:42 P.M. with the Administrator verified the facility assessment was not up-to-date. The Administrator reported she was new to the facility and was unsure of the difference between the facility assessment and the emergency preparedness plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 13 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure there was documentation of completion of physician's orders. This affected one (Resident #36) of nineteen residents review accuracy of medical records. The facility census was 53. Findings include: Review of Resident #36's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included acute chronic respiratory failure with hypoxia, tracheostomy, and disorder of the muscle. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #36 had problems with long- and short-term memory, difficulty communicating and was hard to understand. Resident #36 required total assistance with all care, included was oral care, tracheostomy care and suctioning. Review of the physician's order dated 03/28/22 revealed an order for Resident #36's head of bed to elevated at least thirty degrees. Review of Resident #36's treatment administration record for July 2022 revealed no evidence the head of the bed being elevated to at least thirty degrees on 07/05/22, 07/08/22, 07/14/22, 07/19/22, 07/21/22, 07/22/22 and 07/25/22 on the day shift. Review of the physician's order dated 07/01/20 revealed an order for air compressor to be set at twenty-five pounds per square inch (psi), a large volume nebulizer to be set at eighty and concentrator to be set at four liter per minute with oxygen to be infused via mask to tracheostomy every shift. Review of Resident #36's treatment administration record for July 2022 revealed no documentation of the air compressor set at twenty-five pounds per square inch (psi), or the large volume nebulizer set at eighty and the concentrator set at four liters per minute or the administration of oxygen via mask on the day shift on 07/05/22,07/08/22, 07/14/22, 07/19/22, 07/21/22, 07/22/22, and 07/25/22. Interview with Registered Nurse #16 on 07/26/22 at 4:15 P.M. verified there was no documentation the head of the bed for Resident #36 being elevated to at least thirty degrees and further verified there was no evidence Resident #36 received oxygen as ordered on 07/05/22, 07/08/22, 07/14/22, 07/19/22, 07/21/22, 07/22/22, and 07/25/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 14 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 Based on observation, staff interview and review of the facility's policy, the facility failed to ensure proper infection control practices and procedures were in place when administering medications to residents. This affected three (Residents #37, #49 and #50) of 29 residents observed for medication administration. The facility census was 53. Residents Affected - Few Findings include: Observations on 07/28/22 from 10:28 A.M. to 10:52 A.M. of medication administration completed by Licensed Practical Nurse (LPN) #71 revealed the following: • At 10:28 A.M. medications for Resident #49 were removed from pill cards by LPN #71. LPN #71 did not remove the pill cards from the drawer in the medication cart. LPN #71 pushed each pill from each of the pill cards with the right hand and caught each pill between the bare first finger and bare thumb of the left hand then placed each pill into the medication cup sitting on top of the medication cart. LPN #71 then walked with medication cup of pills into Resident #49's room, administered the medications to Resident #49 and walked back to the medication cart, unlocked the medication cart, and proceeded to remove the medications for Resident #50. Hand hygiene was not completed. • At 10:40 A.M. the medications for Resident #50 were removed from pill cards by LPN #71. LPN #71 did not remove the pill cards from the drawer in the medication cart. LPN #71 pushed each pill from each of the pill cards with the right hand and caught each pill between the bare first finger and bare thumb of the left hand then placed each pill into the medication cup sitting on top of the medication cart. LPN #71 then walked with medication cup of pills into Resident #50's room, administered the medications to Resident #50 and walked back to the medication cart, unlocked the medication cart, and proceeded to remove the medications for Resident #37. Hand hygiene was not completed. • At 10:46 A.M., the medications for Resident #37 were removed from pill cards by LPN #71. LPN #71 did not remove the pill cards from the drawer in the medication cart. LPN #71 pushed each pill from each of the pill cards with the right hand and caught each pill between the bare first finger and bare thumb of the left hand then placed each pill into the medication cup sitting on top of the medication cart. LPN #71 then walked with medication cup of pills to Resident #37 who was sitting in the hallway outside the dining room, administered the medications to Resident #37 and walked back to the medication cart, unlocked the medication cart. Hand hygiene was not completed. Interview with LPN #71 on 07/28/22 at 10:52 A.M. verified pill cards were not removed from the medication cart and the pills for Residents #37, #49 and #50 were touched by LPN #71's bare hands. LPN #71 also confirmed hand hygiene had not been completed between administering medications to each of the three residents. Review of the undated facility policy titled Medication Administration stated hand hygiene is to be completed before and after administering medication to each resident and further stated medications (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 15 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 are taken from the source, and medications are not to be touched with bare hands. 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: 365488 If continuation sheet Page 16 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0888 Ensure staff are vaccinated for COVID-19 Level of Harm - Potential for minimal harm Based on the unprecedented global pandemic that resulted in the Presidential declaration of a State of National Emergency dated 03/13/20, review of Centers for Medicare and Medicaid Services (CMS) memorandum QSO-22-09-ALL, record review, review of an employee COVID-19 vaccination matrix, staff interview, and review of the facility's COVID-19 vaccination policy, the facility failed to implement the facility's COVID-19 vaccination policy and grant exemptions for the staff qualifying for an exemption. The vaccination rate for the facility was calculated at 100%. The facility census was 53. Residents Affected - Many Findings include: Review of the employee COVID-19 vaccination matrix revealed 73 total staff, 61 of the staff had received the COVID-19 vaccination and 12 staff had a requested an accommodation for an exemption. Three of the twelve staff who requested an accommodation for exemption had incomplete accommodation requests. Review of Licensed Practical Nurse (LPN) #12's personnel file revealed LPN #12 declined the COVID-19 vaccination and submitted an accommodation request on 01/26/22. The accommodation request remained silent and had not indicated if the accommodation was either accepted or rejected. The attestation statement for staff with a vaccination exemption remained silent for LPN #12 and the Administrator or Human Resource's signatures. Review of LPN #17's personnel file revealed LPN #17 declined the COVID-19 vaccination and submitted an accommodation request on 09/10/21. The accommodation request remained silent and had not indicated if the accommodation was either accepted or rejected. The signature of the Administrator or Human Resources remained absent on the attestation statement for staff with a vaccination exemption. Review of Registered Nurse (RN) #39's personnel file revealed RN #39 declined the COVID-19 vaccination and submitted an accommodation request on 05/20/22. The accommodation request remained silent and had not indicated if the accommodation was either accepted or rejected. The attestation statement for staff with a vaccination exemption was signed by RN #39 but was not dated. The signature of the Administrator or Human Resources remained absent on the attestation statement for staff with a vaccination exemption. Interview on 07/28/22 at 4:00 P.M. with the Human Resources Manager #76 verified LPN #12, LPN #17, and RN #39's requests for accommodation per the COVID-19 vaccination mandate had not been completed per the facility policy. Review of the Centers for Medicare & Medicaid Services (CMS) memorandum, QSO-22-09-ALL regarding COVID-19 health care staff vaccination, dated 04/05/22, revealed facilities must have a process by which staff may request exemption from COVID-19 vaccination based on an applicable Federal law. This process should clearly identify how an exemption is requested, and to whom the request must be made. Additionally, facilities must have a process for collecting and evaluating such requests, including the tracking and secure documentation of information provided by those staff who have requested exemption, the facility's determination of the request, and any accomodation that are granted. Review of the facility's policy titled COVID-19 Vaccination Mandate policy dated 02/2022 stated any eligible staff that declined to be vaccinated against COVID-19 must sign the COVID-19 attestation form and provide the exemption paperwork to Human Resources or to the facility Administrator to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 17 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 0888 Level of Harm - Potential for minimal harm request an exemption. The policy further stated the Administrator or Human Resources will review the accommodation submitted and either accept or deny the request and inform the employee of the determination. A copy of the determination remained in the employee's personnel file. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 18 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 - Some 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 observations, resident and staff interview, and policy review, the facility failed to maintain a homelike and clean environment for residents. This affected 20 resident rooms (#103, #109, #110, #111, #114, #115, #116, #117, #118, #119, #121, #122, #123, #125, #126, #127, #208, #210, #216, and #221) of 51 resident rooms. The facility census was 53. Findings included: 1. Observations on 07/25/22 at 10:41 A.M. of room [ROOM NUMBER] revealed the resident's bathroom door had an approximate three-inch round hole, the walls were scuffed and missing paint, and the floor strip between the bathroom and main area was missing. Observation on 07/25/22 at 11:10 A.M. of room [ROOM NUMBER] revealed the walls were scuffed with black marks along the floor and half-way up the wall. There were towels laying on top of the sheets on the resident's bed and the towels were stained with a dark brown oval area approximately 12 inches by five inches. The wall to the left of the bathroom had vinyl trim which was dirty and coming loose from the wall. All four walls were scuffed and in need of fresh paint. Observation on 07/25/22 at 11:13 A.M. of room [ROOM NUMBER] revealed the resident had a soft chair and behind the chair, there was a large piece of drywall missing. Observation of the bathroom revealed the drainpipe under the sink was leaking and there was a black, plastic garbage can under the sink which was catching dirty water. The garbage can was three-fourths full of dirty water. Observation on 07/25/22 at 11:24 A.M. of room [ROOM NUMBER] revealed the walls were found to be scuffed with black marks approximately one foot above the floor level and halfway up the wall on all four walls. The vinyl trim at the floor was found to be dirty and loose from the wall at near the bathroom door and on the window wall. Observation on 07/25/22 at 11:44 A.M. of room [ROOM NUMBER] revealed four floor tiles were missing beside the resident's bed. The vinyl trim on the wall along the floor was dirty, scuffed, and coming loose from the wall in many places around the room. Observation and interview with Maintenance Director #82 on 07/27/22 at 11:15 A.M. verified Resident #16, #13, #33, #30, #21, and #22's room needed repaired. Maintenance Director #82 stated due to low census the facility had no assistant maintenance and he could not get the work completed. Facility tour with Maintenance Director #82 on 07/27/22 at 11:15 A.M. verified rooms 103, 109, 110, 111, 112, 114, and 208 needed repaired. The Maintenance Director stated due to low census the facility had no assistant maintenance and he could not get the work completed. 2. Observations of resident's rooms on 07/25/22 between 9:22 A.M. and 10:44 A.M. and on 07/26/22 between 8:50 A.M. and 9:01 A.M. revealed the following: 2a. room [ROOM NUMBER] had large food crumbles located under a tray table, unknown debris on the floor near the foot of the bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 19 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 - Some 2b. room [ROOM NUMBER] had food and debris located under a tray table, and a used alcohol pad near the doorway. 2c. room [ROOM NUMBER] had three shreds of paper located under the bed, a red wrapper on the floor near the foot of the bed, a disposable plastic lid near the doorway of the room, and debris located under a blue chair located in the room. Observation and interview on 07/26/22 at 4:10 P.M. of room [ROOM NUMBER] revealed the debris had been swept up. A resident residing in the room reported housekeeping had not been in to clean the room on 07/25/22 or on 07/26/22 so the resident went ahead and swept their own room on 07/26/22. Interview on 07/26/22 at 4:18 P.M. with the Administrator revealed the facility shared dietary and housekeeping staff. 3. A tour of the facility was conducted with Housekeeper #78 on 07/26/22 at 4:30 P.M. Housekeeper #78 verified the following observations of the resident's rooms concerns: 3a. room [ROOM NUMBER] had dirt built up on and around the trim leading into the room. There was wallpaper peeling on the lower left wall leading into the room. 3b. room [ROOM NUMBER] still had some crumbles of food located under the tray table. There was also chipped paint on the trim located around the doorway of the room. 3c. room [ROOM NUMBER] had an excessive amount of dirt built up on and around the trim leading into the room. A rectangular patch located directly inside the doorway was missing out of the floor and was patched with three smaller rectangular strips creating an uneven surface and there was no tile/flooring in the upper left corner of the patched rectangle. 3d. room [ROOM NUMBER] had a brown substance splattered along the left wall of the room, where the television was hanging, where greater than 78 droplets were counted. There was also chipped paint on the trim located around the doorway of the room. 3e. room [ROOM NUMBER], #117, #118, #122, #123, and #125 also had an excessive amount of dirt built up on and around the doorway leading into each room. 3f. room [ROOM NUMBER], #118, #119, #123, and #127 had chipped paint located on the trim around the doorway leading into each room. 4. Observation and interview on 07/27/22 at 11:11 A.M. revealed a protective strip located several inches above the ground across the front of the nurse station located on the 100-hall was not secured and screws were seen loosely coming out of the wall. Dirt ran across the protective strip and along the trim located directly between the protective strip and the floor. Licensed Practical Nurse (LPN) #38 verified the loose and visibly dirty protective strip. 5. Observation on 07/25/22 at 9:34 A.M. of room [ROOM NUMBER] revealed eight visible deep scratches of various width and length in the wall above the resident's bed and table. Interview with the resident in room [ROOM NUMBER] at the time of the observation revealed the deep scratches of various width and length had been present when the resident admitted to the facility on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 20 of 21 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Toledo 4420 South Avenue Toledo, OH 43615 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 [DATE]. Level of Harm - Minimal harm or potential for actual harm 6. Observation on 07/25/22 at 9:55 A.M. of room [ROOM NUMBER] revealed a broken closet door. The brown wooden folding closet door was pulled open in the middle of the closet with the right-side roller off the metal track at the top of the folding door. Residents Affected - Some Interview with Maintenance Director #82 on 07/27/22 at 11:15 A.M. verified the brown wooden folding closet door was broken and off the track and further verified the closet door could not be opened and closed and the resident in room [ROOM NUMBER] had personal items in the closet. 7. Observation on 07/26/22 at 11:10 A.M. of room [ROOM NUMBER] revealed an orange crayon wrapper under the head of the resident's bed and a broken, crumbled orange crayon, ground into the floor under the resident's bed near the bottom right wheel. An additional observation on 07/27/22 at 7:22 A.M. revealed the orange crayon wrapper and the crumbled orange crayon remained under the bed. Interview with Maintenance Director #82 on 07/27/22 at 11:20 A.M. verified the orange crayon wrapper and the crumbled orange crayon was ground into the floor under the bed of the resident in room [ROOM NUMBER]. Review of the facility's policy titled Routine Cleaning and Disinfection dated November 2017 revealed it was the policy of this facility to ensure the provision of routine cleaning and disinfection to provide a safe, sanitary environment and to prevent the development and transmission of infections to the extent possible. Review of the facility's policy titled Resident Environmental Quality, dated November 2017, revealed the facility shall preventive maintenance schedules for the maintenance of the building and equipment, should be followed to maintain a safe environment. All facility personnel are responsible for reporting broken, defective malfunctioning equipment or furnishings immediately upon identification of the issue. Functional furniture appropriate to the resident's needs, and private closet space in the resident's bedroom with clothes rack and shelves accessible to the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 21 of 21