Inspection·June 2, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Employee Handbook revealed the company prohibits employees from taking residents off the premises or from visiting residents outside the scope and course of their employment. Review of the facility policy titled, Abuse Investigation, stated reports of resident abuse, neglect, and injuries of an unknown source shall be promptly and thoroughly investigated by the facility management. The investigations would include interviewing the person(s) involved, any witnesses, and resident's roommate, family, and visitors. The policy also stated employees accused of abuse shall be suspended from duty until the investigation has been completed. The policy continued to state the Administrator will provide a written report of the results of the investigation and appropriate actions taken to the state survey and certification agency within five days of the reported incident. This deficiency represents non-compliance investigated under Complaint Number OH00143068. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365532 If continuation sheet Page 2 of 4 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 365532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Greenville 243 Marion Drive Greenville, OH 45331 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on record review, staff interviews, policy review, and review of the employee handbook, the facility failed to thoroughly investigate an allegation of potential staff to resident sexual abuse. This affected one (#152) out of three residents reviewed for abuse. The facility census was 73. Residents Affected - Few Findings include: Review of the medical record for Resident #152 revealed an admission date of 04/05/21 with medical diagnoses of left above the knee amputation, peripheral vascular disease, hypertension, and depression. The medical record revealed Resident #152 was discharged to the community on 05/19/23. Review of the medical record for Resident #152 revealed an annual Minimum Data Set (MDS) 3.0 assessment, dated 04/11/23, which indicated Resident #152 was cognitively intact and required supervision with bed mobility, transfers, toileting, and was independent with bathing. Review of the medical record for Resident #152 revealed a social service note dated 05/19/23 at 3:59 P.M. which stated the new home address for Resident #152 upon discharge to the community. Interview on 06/02/23 at 9:18 A.M. with Occupational Therapy Assistant (OTA) #175 stated she observed Resident #152 kissing Licensed Practical Nurse (LPN) #41 outside of the facility near the therapy gym windows. OTA #175 stated she couldn't remember the date but stated she informed the Director of Nursing (DON) of her concerns related to a possible inappropriate relationship between Resident #152 and LPN #41. Interview on 06/02/23 at 11:54 A.M. was conducted with Administrator via phone and DON. DON confirmed OTA #175 reported her concerns related to a possible inappropriate relationship between Resident #152 and LPN #41 around 05/17/23 or 05/18/23. DON confirmed Resident #152 was still a resident at the facility at the time the allegation was brought to DON's attention. Administrator stated he, along with employee #21, spoke with LPN #41 the day after the concern was brought to DON's attention and LPN #41 denied the allegation. Administrator confirmed he did not report the allegation to the State agency or thoroughly investigate the allegation of an inappropriate relationship between LPN #41 and Resident #152. Review of the employee personnel file for LPN #41 revealed the nurse signed the acknowledgement of the Employee Handbook and staff Code of Conduct on 11/10/22. Further review of the personnel record for LPN #41 revealed her home address listed was the same home address as Resident #152's discharge address. Review of the Employee Handbook revealed the company prohibits employees from taking residents off the premises or from visiting residents outside the scope and course of their employment. Review of the facility policy titled, Abuse Investigation, stated reports of resident abuse, neglect, and injuries of an unknown source shall be promptly and thoroughly investigated by the facility management. The investigations would include interviewing the person(s) involved, any witnesses, and resident's roommate, family, and visitors. The policy also stated employees accused of abuse shall be suspended from duty until the investigation has been completed. The policy continued to state the Administrator will provide a written report of the results of the investigation and appropriate actions taken to the state survey and certification agency within five days of the reported incident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365532 If continuation sheet Page 3 of 4 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 365532 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ayden Healthcare of Greenville 243 Marion Drive Greenville, OH 45331 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 0610 This deficiency represents non-compliance investigated under Complaint Number OH00143068. 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: 365532 If continuation sheet Page 4 of 4