Inspection·April 27, 2023

F 0584 This deficiency represents non-compliance investigated under Complaint Number OH00140015. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/27/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of hospital records, review of a 911 Incident Detail Report, guardian interview, and staff interview, the facility failed to follow the healthcare provider's orders to transport a resident to the hospital when a resident experienced a change in condition. This resulted in Actual Harm when Resident #03's healthcare provider's orders to transport the resident to the hospital when experiencing a low oxygen (O2) saturation level were not immediately followed, delaying transport of the resident to the hospital for several hours, which delayed medical interventions to improve the resident's respiratory status, including mechanical ventilation. This affected one (#03) of three residents reviewed for change in condition. The facility census was 54. Residents Affected - Few Findings include: Review of Resident #03's medical record revealed an admission date of 09/28/16 with a readmission date of 04/24/23. Diagnoses included metabolic encephalopathy, chronic obstructive pulmonary disease (COPD), morbid obesity, anxiety disorder, major depressive disorder, schizophrenia, hypertension, dysphagia, diabetes, and acute and chronic respiratory failure. Review of the quarterly Minimum Data Set (MDS) assessment, dated 03/15/23, revealed Resident #03 was cognitively intact. Review of a plan of care focus area, revised on 07/23/19, revealed Resident #03 had an alteration in respiratory function related to COPD. Interventions included administer medication as ordered. Review of a nursing progress note dated 04/19/23 at 4:29 P.M., revealed the Director of Nursing (DON) was called into Resident #03's room by the nurse on duty due to the resident's O2 saturation being in the 70s. The DON applied a non-rebreather mask with oxygen at 15 liters (L) per minute while another nurse call Certified Nurse Practitioner (CNP) #400 to provide an update on Resident #03's condition. With the non-breather mask in place Resident #03's O2 saturation was 88 percent (%). CNP #400 gave orders for an immediate (STAT) chest x-ray, prednisone 40 milligrams (mg) now and daily for five days, breathing treatment every six hours and send Resident #03 to the emergency department (ED) for further evaluation if O2 saturation was not maintained at 88% or higher. Resident #03's guardian was contacted and updated on the resident's condition with a request to be updated throughout the remainder of the day. Review of physician orders dated 04/19/23 revealed orders for a STAT chest x-ray one time for shortness of breath, prednisone oral tablet 20 mg two tablets by mouth one time for shortness of breath, ipratropium-albuterol solution one applicator inhale orally every six hours for shortness of breath, vitals every three hours for 24 hours for monitoring, and send to the hospital for O2 less than 88%. Review of a nursing progress note dated 04/19/23 at 5:54 P.M. revealed Resident #03 tested negative for COVID-19. Resident #03 was currently sitting up in bed with O2 saturation at 87%. There is no evidence the physician or CNP was notified of the O2 saturation less than 88%. Review of the Medication Administration Record (MAR) dated April 2023 revealed on 04/19/23 at 6:00 P.M., Resident #03 was administered ipratropium-albuterol solution one applicator (breathing treatment) and the resident's O2 saturation was 85%. There is no evidence the physician or CNP was notified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/27/2023 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 0684 of the O2 saturation less than 88%. Level of Harm - Actual harm Review of a nursing progress note dated 04/19/23 at 7:47 P.M. revealed Resident #03's O2 saturation was rechecked and was at 82%. Per CNP order Resident #03 was sent to the ED. Residents Affected - Few Review of a hospital History and Physical,dated 04/19/23,revealed Resident #03 was hypoxic (inadequate oxygenation) with O2 saturations in the 70s at the nursing home and was not normally on O2. Upon presentation to the ED the resident had O2 saturations in the 70's. Her O2 was increased to 8 L with failure to improve significantly. Respiratory therapy identified the resident was absent of breath sounds on the left. Resident #03 was intubated shortly after arrival to the ED and sedated. The chest x-ray revealed opacity and volume loss to the left lung. The electrocardiogram (EKG) revealed sinus tachycardia. Further review of the exam revealed lung sounds were absent on the left and rhonchi (gurgling and bubbling) on the right. Diagnoses included acute hypoxic and hypercapnic respiratory failure and white out of the left lung, suspect secondary to a large mucous plug. Review of the record revealed Resident #03 was readmitted to the facility on [DATE] with a physician order for O2 2 L continuous. Review of a 911 Incident Detail Report revealed the facility called 911 to transport Resident #03 on 04/19/23 at 7:19 P.M. Interview on 04/27/23 at 10:18 A.M. with Resident #03's guardian revealed she had been contacted on 04/19/23 regarding the resident having low O2 saturation levels. The guardian was informed CNP #400 had given orders and Resident #03 was being monitored. Later that evening another family member went to visit the resident. During the visit the guardian was on the phone with the family member. The family member requested Resident #03's O2 saturation be checked. The nurse stated it had been checked an hour ago and it was fine. At the insistence of the guardian and family member, the guardian stated the nurse did check it and it was 82%. The guardian stated the nurse did not believe Resident #03 needed to be sent to the ED and the resident was sent only at her insistence. The guardian stated soon after her arrival to the ED Resident #03 was intubated and placed on a ventilator because her O2 saturation was so low and she was unable to breathe adequately. Interview on 04/27/23 at 10:57 A.M. with Licensed Practical Nurse (LPN) #142 confirmed she was the nurse working with Resident #03 on 04/19/23. LPN #142 stated the resident had seemed fine and stated as much throughout the day. LPN #142 stated around 4:00 P.M. Resident #03's color was funny and her eyes were watery and red, which prompted LPN #142 to check the resident's vitals. LPN #142 stated Resident #03's O2 saturation was in the 70s. LPN #142 requested assistance from the DON and a non-breather mask was applied to the resident and oxygen was administered at 15 L. CNP #400 was contacted and gave orders for a breathing treatment, a STAT chest x-ray, and prednisone. LPN #142 stated she believed Resident #03 was stable. Around 7:00 P.M., a family member came to the facility to visit Resident #03 and requested LPN #142 check the resident's O2 saturation. LPN #142 stated she believed it was around 86%. At that time, the family member was on the phone with the resident's guardian and the guardian insisted Resident #03 be sent to the hospital. LPN #142 stated they were still waiting for the mobile x-ray company to come to do the STAT chest x-ray but the guardian did not want to wait for that to occur and insisted Resident #03 be sent to the hospital. LPN #142 stated she did not believe Resident #03 needed to be sent to the hospital at that time and her condition probably could have been managed in the facility. Interview on 04/27/23 at 12:40 P.M. with the DON confirmed on 04/19/23 LPN #142 called her to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 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 365488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/27/2023 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 0684 Level of Harm - Actual harm Residents Affected - Few Resident #03's room due to the resident experiencing a low O2 saturation. The DON confirmed she applied a non-breather mask and O2 at 15 L, which raised the resident's O2 saturation to 88%. In the meantime the Assistant Director of Nursing (ADON) contacted CNP #400 for orders. The DON stated she left the facility for the day a little after 5:00 P.M. and Resident #03 appeared stable at that time. At approximately 7:15 P.M., the DON called the facility to check on the resident's condition and was told Resident #03 was being sent out to the ED. The DON verified the O2 saturation documented in Resident #03's medical record on 04/19/23 were 87% at 5:54 PM. and 85% at 6:00 P.M These O2 saturation levels would have required Resident #03 be sent to the ED based on orders given by CNP #400 at approximately 4:29 P.M. Interview on 04/27/23 at 1:02 P.M. with CNP #400 confirmed she was contacted on 04/19/23 related to Resident #03's O2 saturation being low. CNP #400 verified she would have expected Resident #03 to have been sent to the ED sooner than she was if her O2 saturation was not maintained above 88%. In addition, CNP #400 stated Resident #03 had whiteout lung and would have needed to be placed on a ventilator. This deficiency represents non-compliance investigated under Master Complaint Number OH00142244. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365488 If continuation sheet Page 5 of 5