Health inspection·December 23, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete notified of the x-ray results of the right ankle.Review of the nurse's notes, physician orders, and medication administration record (MAR) for 10/06/25 revealed no documentation the resident had received the intravenous fluids per physician orders. There was also no documentation the physician was notified the intravenous fluids had not been administered. Interview on 12/03/25 at 9:07 A.M., Unit Manager Licensed Practical Nurse (UMLPN) #102 verified there was no documentation Resident #05's representative had been notified of the x-ray results for the right ankle. UMLPN #102 verified there was no documentation the IV had been administered per physician orders. Further interview with UMLPN #102 revealed she was unable to obtain IV access. UMLPN #102 verified there was no documentation of the unsuccessful attempt to initiate the IV and no documentation the physician was notified.Review of the policy Change in a Resident' Condition or Status, revised 02/2021, revealed the facility would promptly notify the attending physician of a need to alter the resident's medical treatment. This deficiency represents non-compliance investigated under Complaint Number 2677336. Event ID: Facility ID: 365535 If continuation sheet Page 2 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record, resident interview, staff interview, and policy review. The facility failed to ensure surgical wound care was completed per physician orders. This affected one resident (#43) of three residents reviewed for wound care. The facility identified five residents with surgical wounds. The facility census was 83. Review of the medical record for Resident #43 revealed an admission date of 09/10/25 and a readmission date of 10/23/25. Diagnoses included pneumonia, anxiety, and surgical aftercare following surgery of the digestive system.Review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. Review of the physician orders dated 11/18/25 revealed the resident had a surgical wound to the right upper quadrant mid abdomen. The orders were to cleanse the wound with wound cleanser, pat dry, apply skin prep to the skin surrounding the wound, apply the antibacterial dressing and foam, change three times per week on Tuesdays, Thursdays, and Saturdays, and as needed. Review of the nurses' notes from 11/21/25 through 11/25/25 revealed no documentation the resident had refused wound care. Review of the Treatment Administration Record (TAR) dated 11/01/25 through 11/25/25 revealed the wound care treatment to the abdomen had been documented as completed on 11/22/25. Interview on 11/25/25 at 1:25 P.M., Resident #43 revealed the facility had not completed the wound care to her surgical wound since the previous week. Resident #43 revealed she had asked the nurse to change the dressing on Saturday 11/22/25 but the nurse never returned to complete the dressing change. Resident #43 also revealed she had to request every week for dressing for her PICC (Peripherally Inserted Central Catheter) line to be changed or it would not have gotten done.Observation on 11/25/25 at 1:25 P.M. of Resident #43's abdominal wound dressing revealed the dressing was dated 11/20/25. Interview on 11/25/25 at 1:36 P.M., the Assistant Director of Nursing (ADON) #114 verified the wound dressing was dated 11/20/25 and the wound treatment had not been completed on 11/22/25 as documented. ADON #114 revealed she would find someone to change the wound dressing. Review of the facility policy Wound Care, revised 10/2010, revealed wound care would be provided per physician orders and the dated and time the wound care was given would be documented in the medical record. This deficiency represents non-compliance investigated under Complaint Number 2677336. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 3 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, review of wound care provider documentation, review of hospital documentation, staff interview, family interview, nurse practitioner interview, review of the National Pressure Injury Advisory Panel 2025 guidelines, and review of facility policies, the facility failed to provide a timely assessment, ongoing monitoring, and interventions to prevent the development of a pressure ulcer for Resident #05, who was known to have arterial and venous insufficiency, and who was identified at risk for pressure ulcers. This resulted in Immediate Jeopardy and serious physical harm, injuries, and/or negative health outcome on 09/07/25 when Resident #05 was found with an unstageable pressure ulcer to the right malleolus (ankle) underneath an ankle monitoring device. The unstageable pressure ulcer was not accurately assessed, and no interventions were initiated. On 09/08/25 the wound was assessed as an unstageable pressure ulcer and an intervention for wound treatment was to elevate the extremity. There were no interventions documented regarding the frequency of monitoring Resident #05's skin under the ankle monitor and no documentation that the ankle monitor had been removed. There was no documentation of an investigation regarding Resident 05's unstageable pressure ulcer to determine causative factors of the wound development or need to change pressure reduction interventions. Furthermore, Resident #05's nutritional status was not reassessed with the change in condition. Resident #05's wound began deteriorating on 09/25/25 with signs of infection. Wound Nurse Practitioner (WNP) #700 ordered offloading heel boots, a wound culture, and a vascular consult. There was no documentation of the offloading heel boots being implemented. The resident's wound culture was not obtained until 10/06/25. On 10/05/25 the resident began experiencing a decline in condition and laboratory testing was ordered. The laboratory was unable to obtain vascular access, and the resident refused a second attempt. On 10/06/25 the resident was ordered intravenous fluids which were not administered. Additionally, the vascular consult was not obtained prior to the resident discharging per family request to the hospital on [DATE]. On 10/06/25, Resident #05 was admitted to the hospital and diagnosed with a wound infection, septic arthritis of the right ankle, osteomyelitis of the fibula due to Staphylococcus aureus, and was hypoglycemic with an extremely low blood sugar of 26 milligrams per deciliter (mg/dL) and required 15 grams of oral glucose. Resident #05 also required intravenous antibiotics, wound debridement, and negative pressure wound therapy (wound vac). Resident #05 was diagnosed with moderate to severe stenosis of the right lower extremity and an above the right knee amputation was performed on 10/17/25. This affected one (#05) of four residents reviewed for pressure ulcers. The facility identified 10 residents with pressure ulcers. The facility census was 83.On 12/03/25 at 4:31 P.M., the Administrator, the Director of Nursing (DON), and the Assistant Director of Nursing (ADON) #114 were notified that the Immediate Jeopardy began on 09/07/25 at approximately 10:30 A.M. when Resident #05 was found with an unstageable pressure ulcer to the right ankle from an ankle monitoring device with no documented interventions regarding the skin monitoring under the ankle monitor and no documentation the ankle monitor had been removed. Also, there was no documentation in the medical record of an immediate wound assessment and no investigation of the causative factors of the wound development or the need to change pressure reduction interventions. Furthermore, Resident #05's nutritional status was not reassessed with the change in condition. Resident #05's wound began deteriorating on 09/25/25 with signs of infection. WNP #700 ordered offloading heel boots, a wound culture, and a vascular consult. There was no documentation in the medical record that the offloading heel boot intervention was implemented, and the resident's wound culture was not obtained until 10/06/25. On 10/05/25 the resident began experiencing a decline in condition and laboratory testing was ordered. Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 4 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few The laboratory was unable to obtain vascular access, and the resident refused a second attempt. On 10/06/25 the resident was ordered intravenous fluids which were not administered, and the provider was not notified of the intravenous fluids not being administered. Additionally, the vascular consult was not obtained prior to the resident discharging, per family request, to the hospital on [DATE]. On 10/06/25 the resident was admitted to the hospital and diagnosed with a wound infection, septic arthritis of the right ankle, osteomyelitis of the fibula due to Staphylococcus aureus and was hypoglycemic with an extremely low blood sugar of 26 milligrams per deciliter (mg/dL) requiring 15 grams of oral glucose. The resident required intravenous antibiotics, wound debridement, and negative pressure wound therapy (wound vac). Resident #05 was diagnosed with moderate to severe stenosis of the right lower extremity and an above the right knee amputation was performed on 10/17/25.The Immediate Jeopardy was removed on 12/05/25 after the facility implemented the following corrective actions:- On 12/03/25, the Administrator immediately notified Physician #600, the Interim Medical Director.- On 12/03/25, Unit Manager Licensed Practical Nurse (UMLPN) #108 conducted a thorough assessment on Resident #05 with no adverse effects noted.- On 12/03/25, the following immediate actions were implemented for Resident #05: - Registered Dietitian (RD) #100 completed a nutritional reassessment for Resident #05. RD #100 reviewed and updated the nutritional interventions by adding an additional nutritional supplement with all meals. - The DON and UMLPN #108 reviewed Resident #05's wound care regimen to ensure the regimen was updated per current physician orders. - The UMLPN #108 reviewed and evaluated Resident #05's medical devices (heel boot) for proper fit and skin protection measures. - The DON implemented for Resident #05 an enhanced turning and repositioning schedule with documentation every two hours. - The DON and ADON #114 reviewed Resident #05's pressure redistribution surfaces as indicated by the current risk assessment. - The DON reviewed Resident #05's current skin care plan. - The ADON #114 reviewed the Certified Nursing Assistant's charting documentation tasks to ensure accuracy.- On 12/03/25, the DON/designee conducted audits for all residents to identify those at risk for pressure ulcer development, with particular focus on residents with ankle monitoring devices or other medical devices in contact with skin. Each identified at risk resident received immediate reassessment of current interventions and implementation of enhanced monitoring protocols. The DON identified one current resident (#51) with an ankle monitoring device and implemented skin monitoring checks each shift. - On 12/03/25, the DON/designee identified 33 residents (#62, #29, #74, #79, #41, #77, #52, #85, #86, #26, #31, #05, #56, #18, #60, #11, #35, #02, #10, #53, #25, #72, #14, #13, #83, #64, #67, #27, #32, #80, #75, #57, #19) with medical devices. The DON/designee implemented enhanced orders for skin monitoring each shift. - On 12/03/25, the DON/designee identified 10 residents (#29, #56, #17, #54, #05, #30, #14, #52, #46, #60) with existing pressure ulcers or a history of pressure ulcers and implemented enhanced skin monitoring orders for nurses to complete visual skin checks on shower/bath day along with a daily comprehensive skin evaluation.- On 12/03/25, the DON/designee identified 14 residents (#05, #07, #12, #13, #14, #15, #16, #20, #22, #25, #31, #52, #55, #75) with vascular insufficiency or other circulatory conditions and implemented enhanced monitoring orders for nurses to complete visual skin checks on shower/bed bath day.- On 12/03/25, the DON/designee identified 34 residents (#01, #05, #12, #13, #14, #16, #17, #18, #19, #21, #22, #25, #28, #30, #32, #36, #38, #39, #41, #46, #49, #50, #52, #55, #56, #57, #61, #63, #67, #69, #70, #74, #77, #80) at moderate to high risk of skin breakdown and implemented enhanced monitoring orders for nurses to complete visual skin checks on shower/bed bath day.- On 12/03/25, the DON, the Administrator, and ADON #114 conducted a root cause analysis identifying contributing factors including: - People: Insufficient knowledge of ankle monitoring skin monitoring protocols - Process: Lack of standardized skin inspection (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 5 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few procedures for medical devices - Environment: Insufficient communication systems for reporting skin changes - Methods: Absence of structured investigation process for new pressure ulcers- On 12/03/25, the DON/designee started education will all nurses and certified nursing assistants on pressure ulcer prevention, medical device skin safety to ensure the skin under a device is monitored, skin and wound assessment and documentation training with emphasis on timely reporting. Nurses were also re-educated on implementation of physician orders. Education to be completed by 12/05/25.- On 12/03/25, the Administrator and ADON #114 reeducated RD #100 on the position job description and the importance of reassessing residents with skin integrity changes.- On 12/03/25, the DON/designee implemented enhanced monitoring orders for nurses to complete visual skin checks on all residents on their shower/bed bath day. All new admissions will be evaluated to determine if they qualify for this classification. - On 12/03/25, the DON/designee implemented a standardized pressure ulcer investigation form and process. - On 12/03/25, the DON/designee implemented weekly wound care rounds with wound team participation.- On 12/03/25, the Administrator and the Quality Assurance Team (MD #600, UMLPN #102, UMLPN #108, ADON #114) reviewed policies on medical devices with skin integrity, lab procedures and policies, and clinical documentation.- On 12/03/25, the Administrator and Medical Director (MD) #600 implemented new best practices on A Guide to Device Skin Inspection, effective 12/04/25.- On 12/03/25, the DON reviewed the new admission checklist. The DON updated the checklist to include obtaining physician orders for skin monitoring for new admissions with medical devices. The new admission checklist was implemented and put into effect on 12/05/25. - On 12/04/25, the Administrator notified MD #602 of Immediate Jeopardy. - On 12/04/25, UMLPN #108 conducted a thorough skin assessment on Resident #51 with no adverse effects noted. - On 12/04/25, the Administrator reeducated UMLPN #102 on job duties, manager role, chart review, wound care, accurate order entry, complete investigation, and follow through on all job duties.- On 12/04/25 at 1:30 P.M., the facility held an ad hoc Quality Assurance and Performance Improvement (QAPI) meeting with the Administrator, Infection Preventionist/ADON #114, UMLPN #108, UMLPN #102, and Medical Director (MD) #600. - On 12/04/25, the Administrator and MD #600 reviewed policies for laboratory procedures, and policies for clinical documentation. The reviewed policies were acceptable with no changes needed.- On 12/04/25, RD #100 reviewed all residents with skin integrity changes for nutritional intervention needs. - On 12/04/25, the Administrator/designee educated all staff on new best practices A Guide to Device Skin Inspection. Education was completed on 12/08/25. - On 12/04/25, the Administrator/Designee educated all nurses on laboratory communication and documentation. Education was completed on 12/08/25. - On 12/04/25, the DON/designee conducted a review of all residents with medical devices for skin integrity documentation. Ongoing monitoring will occur daily for five days, then five residents weekly for four weeks, then two residents monthly for two months with a completion date of 03/2026.- On 12/04/25, Unit Managers/designee performed an audit of physician order implementation timeframes on all residents with new orders or order changes. Audits will continue daily for five days, then audit five residents weekly for four weeks, then audit two residents monthly for two months with a completion dated 03/2026.- Starting 12/08/25, the DON/designee will audit random resident medical records to ensure pressure ulcer prevention interventions and skin assessments are in place as ordered. Audits by the DON/designee will continue with five random resident medical records per week for one month, then two random resident records per week for two months with a completion date on 03/31/26.Starting 12/08/25, the DON/designee will conduct weekly audits on wound dressing changes to ensure timely treatments on five random residents for four weeks, then for five random residents monthly for two months with a completion date of 03/31/26. - Beginning 12/2025, all systemic changes would be reviewed monthly for three months by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 6 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the Quality Assurance (QA) Team. The DON/designee would report monitoring plan results to the QAPI committee monthly. The QAPI committee would monitor on an ongoing basis until sustained compliance was achieved with quarterly reviews to assess effectiveness and make necessary adjustment to the monitoring plan frequency on demonstrated compliance rates. - Interviews conducted on 12/08/25 from 7:53 A.M. through 8:05 A.M. with Licensed Practical Nurse (LPN) #116, LPN #122, LPN #103, Certified Nursing Assistant (CNA) #202 and CNA #204 revealed the staff had received education on monitoring skin each shift for residents with medical devices. The staff also received education on laboratory communication and procedures, clinical documentation, pressure ulcer prevention, completing wound assessments and wound treatments per physician orders. - On 12/08/25, review of staff education revealed 41 of 43 nurses had received education on laboratory policies and procedures. Interview with the Administrator at the time of the review revealed staff who were not educated would not be scheduled to work until the education was completed. - On 12/08/25, review of staff education revealed 77 of 83 nurses and nursing assistants had completed education on pressure ulcer prevention, medical device skin safety, skin and wound assessments, implementation of physician orders, reporting, and clinical documentation. Interview with the Administrator at the time of the review revealed staff who were not yet educated would not be scheduled until the education had been completed. Although the Immediate Jeopardy was removed on 12/05/25, the facility remained out of compliance at a Severity Level 2 (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility was in the process of implementing their corrective action plan and monitoring to ensure ongoing compliance.Review of the medical record for Resident #05 revealed an admission date of 06/14/23. Diagnoses included chronic obstructive pulmonary disease, type two diabetes mellitus, Alzheimer's disease, dementia, hypertension, repeated falls, anemia, peripheral vascular disease. Updated diagnoses dated 10/21/25 included orthopedic aftercare following surgical amputation, methicillin susceptible staphylococcus aureus infection, occlusion and stenosis of carotid artery, and unstageable pressure ulcer of sacral region, acquired absence of right leg above knee, and protein calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #05 had severe cognitive impairment. The resident had no unhealed pressure ulcers but was at risk for developing pressure ulcers/injuries. Resident #05 used a wheelchair and could not ambulate, required the substantial/maximal assistance of staff for toileting, bathing, bed mobility, and transfers. Review of the plan of care initiated 06/16/23 revealed the resident had a potential for an alteration in skin integrity related to immobility, multiple sclerosis, incontinence, and a history of left hip arthroplasty. Interventions included keeping linens clean, dry, wrinkle free, and free of foreign matter, offload heels as tolerated, a pressure reduction mattress to the bed, turn and reposition as needed, and use pillows/pad to support/position as appropriate. Further review of the care plan revealed the resident had impaired cognitive function, wandered, and was an elopement risk due to impaired safety awareness. Interventions included an ankle monitor to the left leg. Staff were to document wandering behaviors and were to check the function of the ankle monitor daily and the placement every shift. The care plan had no interventions to monitor the skin under the ankle monitor. On 09/08/25 the plan of care was revised as the resident had an unstageable pressure ulcer to the right malleolus and was at risk for further breakdown and/or slow healing, and delayed healing due to decreased mobility. Interventions included administering treatments per physician orders, a pressure relieving device for heels, enhanced barrier precautions during high-contact resident care activities, and wound consults as indicated. The resident was also at risk for hyperglycemic/hypoglycemic reactions, abnormal lab values, and diabetic ulcers related to diabetes mellitus and peripheral vascular disease. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 7 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Interventions included for staff to monitor and report signs and symptoms of hypoglycemia/hyperglycemia and administer medication per physician orders. Further review of the care plan revealed there was no care plan in place for edema or any interventions for the use of compression stockings. Review of Resident #05's physician orders revealed an order dated 01/25/24 for a dietary consult/evaluation as needed. A physician order dated 02/23/24 revealed staff were to check the ankle monitoring device function daily and the placement of ankle monitoring device to the left ankle every shift. Review of a physician order dated 02/23/24 revealed a second order to check placement of the ankle monitoring device each shift and to check function daily. The second order did not specify the location of the ankle monitoring device and did not include anything about monitoring the resident's skin under the ankle monitoring device. Both physician orders for the ankle monitoring device were discontinued on 10/08/25. Review of a physician order dated 05/13/24 revealed an order for blood sugar monitoring daily in the morning. Review of a physician order dated 06/24/24 revealed Resident #05 was ordered knee high compression stockings, staff were to apply in the morning and then remove at bedtime for lower extremity edema, as tolerated. The order for the compression stockings was discontinued on 10/08/25. Review of a quarterly nutritional risk review assessment dated [DATE] at 2:49 P.M. revealed Resident #05 had intact skin, fed self at meals with set up provided, and had variable meal intakes between 51 percent to 75 percent of most meals. The resident was on a controlled carbohydrate regular texture diet with thin liquids, received a nutritional supplement once daily at breakfast and consumed 100 percent of all supplements served. Further review of the nutrition assessments and progress notes revealed no further nutritional assessments were completed until 10/26/25.Review of a shower/bed bath sheet dated 09/03/25 revealed Resident #05 had no apparent skin issues. Review of a shower/bed bath sheet dated 09/07/25 revealed the resident had an open area on the right ankle. Review of an incident report dated 09/07/25 at 10:30 A.M., revealed while the resident was getting a bed bath, support staff noticed Resident #05 had a wound/pressure ulcer on the right ankle. The wound was noted as closed with dry flaky skin covering the wound. The wound was assessed, cleansed, and bandaged. The right foot was then elevated on a pillow. The resident was noted to be wearing an ankle monitor (electronic wander-prevention bracelet) to the right leg. Further review of the progress notes and skin evaluations for 09/07/25 revealed no documentation of a wound assessment or of wound measurements. Review of the physician orders and Treatment Administration Record (TAR) revealed no wound care orders were initiated or administered. Further review of the medical record revealed no notifications of the wound were made to the family or physician. Review of a skin and wound evaluation dated 09/08/25 at 10:42 A.M. revealed Resident #05 had a new in-house acquired unstageable pressure ulcer on the right malleolus found on 09/07/25. The wound measured 2.4 centimeters (cm) in length, 2.1 cm in width, with an undeterminable depth due to a wound bed with 90 percent slough and 10 percent granulation tissue. No odor was noted. The wound had attached edges with serous exudate with amount noted as none. The surrounding wound tissue was intact, dry/flaky, and normal in color and temperature. There was no edema. The wound was noted as healable. An antimicrobial dressing with a foam secondary dressing were noted. The wound was to be cleansed, and honey gel applied to the wound bed and covered with a dry dressing. Wound dressing changes were to be completed daily. The resident was to follow up with the wound nurse practitioner. The physician and family were notified. There was no documentation of notification to the dietitian.A physician order dated 09/08/25 revealed the resident was ordered enhanced barrier precautions for high contact resident care, including wound care. Further review of the physician orders dated 09/08/25 revealed an order to cleanse the unstageable pressure wound with wound cleanser, pat dry, apply honey gel to the wound base and cover with dry dressing, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 8 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few change daily and as needed every evening shift. The order was discontinued on 09/11/25. Review of a nurses note dated 09/08/25 at 12:20 P.M. revealed the interdisciplinary team (IDT) met and reviewed the new pressure ulcer documentation. The nursing assistant was bathing resident when an area of dry skin fell off from the right malleolus revealing a dark moist center. The nurse was alerted, examined the resident's wound, placed a dressing on the wound and elevated the resident's foot on a pillow. The physician was notified with new treatment orders obtained. The resident's family was notified. A new intervention was added to apply a heel boot. The resident would be seen by the wound provider on the next visit. Review of a physician progress note dated 09/08/25 at 4:08 P.M., revealed Resident #05 had a new pressure ulcer to the right ankle but the wound was not examined by the physician. The physician assistant noted the resident would follow up with in-house wound care. Review of a wound provider initial visit progress report dated 09/11/25 revealed Resident #05 had an acute pressure ulceration of the right malleolus. The provider noted previous treatments had included off-loading and elevation. The goal was to facilitate complete closure of the resident's acute wound. Due to numerous comorbidities, the aim was also to prevent the progression of the wound, prevent infection, as well as prevent hospitalization. The wound was noted as unstageable due to slough/eschar. The wound measured 2.1 cm in length by 1.9 cm in width, and depth was indeterminable. The wound had 100 percent necrotic tissue with moderate serosanguineous exudate. The wound was noted as small and full thickness with well-defined wound edges. Other related factors were noted as the resident's age, hypertension, nutrition status, and limited mobility. Wound debridement was completed. The practitioner ordered to cleanse the wound with wound cleanser, pat dry with gauze, apply skin prep to the peri-wound (skin surrounding the wound), apply medical grade honey to the wound bed only, then cover with calcium alginate (cut to size) and then apply a dry dressing three times per week and as needed if loose or soiled. The provider noted an offloading heel boot was recommended, along with turning and repositioning. Review of a wound provider progress report dated 09/18/25 revealed the wound was unchanged with 100 percent necrotic tissue. The wound measured 2.3 cm in length, 2.6 cm in width, with an undetermined depth with light serosanguineous drainage. Wound debridement was completed. The wound provider made no changes to the wound treatment orders and continued to recommend an offloading heel boot. Review of a wound provider progress report dated 09/25/25 revealed the resident's wound was deteriorating. The wound measured 3.5 cm in length and 3.0 cm in width with an undetermined depth. The wound was 100 percent necrotic tissue with moderate serosanguineous drainage. The wound provider ordered a wound culture and a vascular consultation. The wound provider continued to recommend heel boots. New physician wound care orders included to cleanse wound with Dakins solution, rinse with wound cleanser, and pat dry with gauze, apply skin prep to the peri-wound, Santyl (nickel thick, applied to wound from edge to edge), cover with silver alginate (cut to size) and apply dry dressing three times per week and as needed if loose or soiled.Review of a nurse progress note dated 09/26/25 at 12:10 P.M. revealed Resident #05's family was notified of an order for a vascular consult. The family agreed and would call back with dates available to attend the appointment. Review of a nurse's progress note dated 09/30/25 at 3:00 P.M. revealed the resident's family provided dates of availability for the vascular appointment. The vascular provider's office was contacted, and a message was left. A call was placed to the laboratory to check on the wound culture results. The laboratory noted the testing could not be completed as the specimen was not labeled. The nurse practitioner was notified with a new order for a new specimen to be obtained and sent out as soon as possible. Review of a physician order dated 09/30/25 revealed an order for a vascular consult for the right ankle wound and increased pain in the right leg. Review of a wound provider progress report dated 10/02/25 revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 9 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #05's wound continued to deteriorate. The wound measured 5.3 cm in length, 6.5 cm in width, with an undeterminable depth. The wound was 100 percent necrotic tissue with moderate serosanguineous drainage. The wound was debrided. The provider noted awaiting wound culture results and the date of the vascular appointment. The provider noted the resident continued to keep the right leg pulled up and in a lateral position. The provider continued to recommend off-loading heel boots. No changes were made to the wound treatment orders. Review of a nurse's note dated 10/05/25 at 2:16 P.M. revealed the resident had a decrease in appetite and fluids were encouraged during rounding. Resident #05 had muscle tremors on the left side along with an elevated heart rate of 122 beats per minute (normal heart rate 60 to 80 beats per minute). The on-call physician was notified, and new orders were received for an electrocardiogram (EKG), a right ankle x-ray, and laboratory testing including a complete blood count, a complete metabolic panel, an erythrocyte sedimentation rate, C-Reactive protein, and lactate. Review of a radiology report dated 10/05/25 and electronically signed at 7:11 P.M. revealed an x-ray of Resident #05's right ankle was completed due to ankle pain. The radiology report noted the study quality was limited by inappropriate technique which reduced sensitivity for subtle fracture, malalignment, and small joint effusion. Further review of the findings revealed no acute fracture or dislocation, no focal soft tissue swelling, no soft tissue gas, or foreign body identified.Review of a nurse's note dated 10/05/25 at 10:27 P.M. revealed the x-ray and EKG results were reviewed with the on-call physician with no new orders received. Staff continued to encourage fluids and the resident had no distress at this time. Review of a nurse's note dated 10/06/25 at 5:55 A.M. revealed the laboratory staff were unable to draw labs on the first poke and the resident refused the second poke. The lab stated they would redraw tomorrow. Review of a nurse practitioner progress note dated 10/06/25 at 7:00 A.M. revealed Resident #05 had a right ankle wound, pain, tachycardia, and poor intake. The resident was seen as a follow up related to staff reports of a continued decline, poor appetite, tachycardia, an ankle wound, and pain. A wound culture was resent to the laboratory. Heart rate continues at 113 beats per minute today. The resident was noted with an order for metoprolol twice a day, but the medication was withheld due to low blood pressures. The resident refused repeat laboratory orders so far. The nurse practitioner noted that depending on the conversation with the family about the resident's poor appetite and ankle status, may order fluids via hypodermoclysis (subcutaneous or under the skin). Review of a nurse's note dated 10/06/25 at 10:27 A.M. revealed a call was placed to the vascular provider who then requested a fax of the resident's information. An attempt was made twice to fax the requested information, and a message was left to obtain a different fax number. There was no documentation of any attempts to contact the vascular provider between 10/01/25 and 10/05/25. Review of a nurse's note dated 10/06/25 at 12:00 P.M. revealed the resident's family was updated on the orders for the EKG and the x-ray. The family was notified that the resident had refused labs this morning. The resident's family was informed that the nurse practitioner was most likely going to order intravenous fluids. The family was also updated about the pending vascular consult and notified the nurse had made several attempts to get the appointment scheduled. Review of a nurse's note dated 10/06/25 at 1:10 P.M. revealed the vascular provider had provided another fax number and the referral information was faxed again. The nurse practitioner gave a verbal order to start intravenous therapy 0.9 percent normal saline at 50 milliliters (ml) per hour. The resident agreed to the treatment. Review of a physician order dated 10/06/25 revealed an order for a protein supplement, 30 milliliters by mouth twice daily to aid in wound healing. Review of a late entry nurse's note incorrectly dated for 10/07/25 at 7:30 P.M. revealed the resident was sent to the emergency room and the family was updated. Review of a laboratory report dated 10/10/25 revealed Resident #05's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 10 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete wound culture was collected on 10/06/25 at 1:00 A.M. and received at the lab at 7:08 A.M. The results were verified on 10/10/25 at 8:44 A.M. with the residents' wound testing positive for methicillin-resistant staphylococcus aureus (MRSA).Review of the progress notes and TAR dated 08/01/25 through 10/05/25 revealed no documentation the resident had refused her compression stockings or of the physician being notified of compression stocking refusals. Review of the TAR dated 09/01/25 through 10/06/25 revealed the nurses had documented completing checks for the left ankle monitor placement and function every shift except during the dayshift on 09/14/25 and 09/18/25. The nurses also documented the completion of checks for ankle monitor placement each shift and function daily except during the dayshift on 09/14/25 and 09/18/25. The TAR did not list the location of the ankle monitor. Further review of the TAR revealed no documentation of the intervention for the heel boots being implemented or completed. Wound treatments for the right malleolus were completed per physician orders. Review of the nurse's notes, physician orders, and Medication Administration Record (MAR) for 10/06/25 revealed no documentation the resident had received the intravenous fluids per physician order. There was also no documentation the physician was notified the intravenous fluids had not been administered. Additional review of the MAR revealed the resident was not administered the protein supplement prior to discharge to the hospital on [DATE].Review of hospital documentation dated 10/06/25 through 10/18/25 revealed Resident #05 arrived at the emergency department on 10/06/25 at 8:16 P.M. with hypoglycemia, with an extremely low blood sugar of 26 milligrams[TRUNCATED] Event ID: Facility ID: 365535 If continuation sheet Page 11 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record, review of bowel records, staff interview, and policy review, the facility failed to ensure bowel movements were accurately documented and failed to ensure the bowel protocol was followed when a resident was without a bowel movement for greater than three days. Additionally, the facility failed to timely complete a bowel assessment for a resident with a known history of constipation who had no documented bowel movements for six days. This affected one (#74) of three residents reviewed for bowel and bladder. The facility census was 83. Review of the medical record for Resident #74 revealed an admission date of 02/17/22. Diagnoses included chronic respiratory failure, chronic obstructive pulmonary disease, type two diabetes mellitus, chronic kidney disease, and osteoarthritis. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had intact cognition. The resident was always incontinent of bowel and frequently incontinent of bladder. The resident was dependent on staff for all activities of daily living. Review of the care plan revealed the resident was at risk for constipation due to decreased mobility, and frequent pain medication use. Interventions included administering medications per physician orders, monitoring for medication side effect and reporting changes and complications of constipation. Review of the physician orders for Resident #74 revealed an order dated 05/06/25 for Dulcolax suppository ten milligrams daily, an order dated 10/11/25 for Linzess, 72 micrograms daily for chronic constipation, and an order for Metamucil, two capsules daily for chronic constipation. Further review of the physician orders revealed orders dated 06/11/25 for sennoside-docusate tablet 8.6-50 mg tablet three times per day, and orders dated 06/11/25 for Miralax 17 grams four times a day for constipation, and an order dated 05/05/25 for a mineral oil enema as needed up to twice weekly for constipation.Review of the Medication Administration Record (MAR) dated 11/01/25 through 11/20/25 revealed the scheduled routine bowel medications had been administered per physician orders. the resident refused the Dulcolax suppository ten times, refused the sennoside-docusate four times, and refused the Miralax 46 times. The as needed mineral oil enema was never administered. Review of the bowel task documentation completed by the Certified Nursing Assistants dated 11/15/25 through 11/20/25 revealed the resident had no bowel movements from 11/15/25 through 11/20/25. Review of the progress notes dated 11/15/25 through 11/20/25 revealed there was no documentation the physician was notified of the resident not having a bowel movement. There was no documentation the resident was assessed for bowel sounds prior to 11/20/25. There was no documentation the resident was provided with additional interventions or medications to assist with bowel movements. There was no documentation the resident had been educated regarding refusals of bowel medications. Review of a nurse's note dated 11/20/25 at 11:49 A.M. revealed the resident had a declinein condition with increased pain in his bottom, drooling, and greenish phlegm. The nurse practitioner was notified.Review of a nurses note dated 11/20/25 at 1:13 P.M. revealed the resident was evaluated by the nurse practitioner with new orders for STAT labs. The resident was agreeable with the treatment plan. The resident's representative called 911 and the resident was sent to the hospital. Review of the bowel alert report dated 11/15/25 through 11/20/25 revealed Resident #74 had triggered an alert for no bowel movement on 11/16/25, 11/17/25, 11/18/25, 11/19/25, and 11/20/25. Review of the hospital documentation dated 11/20/25 through 11/25/25, provided by the facility, revealed no documentation the resident had a bowel blockage. The resident was admitted to the hospital with diagnoses including acute respiratory failure and pneumonia.Interview on 11/25/25 at 11:52 A.M., Licensed Practical Nurse (LPN) #103 revealed the facility tracked resident bowel movements. LPN #103 revealed a resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 12 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few would be added the no bowel movement list after three days. LPN #103 revealed Resident #74 had received a lot of bowel medications. LPN #103 revealed if a resident had not had a bowel movement in three days then the nurse practitioner would be notified. LPN #103 revealed Resident #74 has had several x-rays in the past to check for blockages. Interview on 11/25/25 at 12:00 P.M., LPN #122 revealed Resident #74 was not feeling well and the nurse practitioner had ordered some laboratory testing which the resident was agreeable with. LPN #122 revealed she had went to lunch and when she returned another nurse had stated the resident was not looking good. LPN #122 revealed she had went to notify the nurse practitioner but the resident's family member had requested the resident be sent to the hospital. LPN #122 revealed there was no time to assess the resident as the nurse practitioner was already in the room and then emergency medical services had arrived. LPN #122 revealed the unit managers provided a bowel list each morning and the nurse practitioner was notified if the resident had no bowel movement in three days. LPN #122 revealed she was not aware if the resident was on the no bowel movement list prior to discharging to the hospital. Further interview on 11/25/25 at 1:53 P.M. LPN #122 revealed she now recalled a nursing assistant had informed her on 11/18/25 that the resident had diarrhea but LPN #122 had not asked the aide the amount or consistency. LPN #122 was aware it was possible to have diarrhea with a bowel blockage. LPN #122 verified she had not assessed the resident, had not listened for bowel sounds, and had not reviewed the bowel movement charting. LPN #122 further revealed Assistant Director of Nursing (ADON) #114 had asked her today when the resident's last bowel movement was because there was no record of it. LPN #122 revealed she made a late entry progress note in the medical record today. Interview on 11/25/25 at 1:44 P.M., Unit Manager Licensed Practical Nurse (UMLPN) #102 revealed a dashboard in the electronic medical records provided an alert for resident's with no bowel movements after 72 hours. UMLPN #102 revealed after 72 hours the physician should be notified. UMLPN #102 had reviewed the resident's bowel charting and nurse's notes. UMLPN #102 then verified there was no documentation Resident #74 had a bowel movement from 11/15/25 through 11/20/25 and no documentation the physician had been notified. UMLPN #102 could not recall if the resident had alerted for no bowel movements. UMLPN #102 was asked to provide documentation of the no bowel movement report. UMLPN #102 revealed she was not sure if that could be provided but would look into it. Interview on 11/25/25 at 2:33 P.M., Nurse Practitioner (NP) #109 revealed Resident #74 had a history of constipation and diarrhea. NP #109 revealed staff normally notified her if a resident had not had a bowel movement in three or four days. NP #109 revealed staff may have told her in passing of Resident #74 not having a bowel movement and she had just not made a documented note of it. NP #109 revealed the resident was non-compliant with his many bowel medications and saw a gastrointestinal (GI) physician. NP #109 revealed Resident #74 complained more about diarrhea then constipation. NP #109 revealed the resident was not feeling well on 11/20/25 and she had ordered labs for the resident. NP #109 revealed the resident wanted to remain in the facility, but the resident's representative wanted the resident sent out and called emergency medical services. NP #109 revealed she had assessed the resident prior to transport to the hospital. NP #109 also revealed she had assessed the resident's bowel sounds which were present in all four quadrants. Interview on 12/01/25 at 11:06 A.M., LPN #116 revealed the nursing assistants charted the resident's bowel movements and the unit manager would provide a daily list of residents without a bowel movement for three days. LPN #116 revealed after three days the physician would be notified for new orders but the nurses could use the facility's standing orders in the binder. Review of the facility policy Bowel Management Protocol, dated 02/15/25, revealed the facility would ensure residents were free from complications secondary to constipation. This would be accomplished through adequate assessment, tracking, and treatment as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 13 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated. A normal bowel pattern was once daily up to once every three days. Further review of the policy revealed to provide medications per physician orders, encourage activity as allowed and tolerated, and encourage fluid intake as allowed and tolerated. Prune juice may be given daily. The Certified Nursing Assistants would document each shift the number the number of bowel movements and size of bowel movements on the resident flow record. The nurse would medication as ordered by the physician or obtain a physician's order for residents on the bowel care list including a suppository, milk of magnesia or lactulose. The nurse would follow up on those residents on the bowel care list for results and documentation should include size and consistency of the bowel movement. Event ID: Facility ID: 365535 If continuation sheet Page 14 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 observation, review of the medical record, staff interview, resident interview, family interview, and policy review revealed the facility failed to ensure medical documentation was complete and accurate. This affected two (#5, #51) of three residents reviewed for clinical documentation and had the potential to affect all residents. The facility census was 83. 1. Review of the medical record for Resident #05 revealed an admission date of 06/14/23. Diagnoses included chronic obstructive pulmonary disease, type two diabetes mellitus, Alzheimer's disease with late onset, dementia, hypertension, repeated falls, anemia, peripheral vascular disease, orthopedic aftercare following surgical amputation, Methicillin susceptible staphylococcus aureus infection, occlusion and stenosis of carotid artery, and unstageable pressure ulcer of sacral region, acquired absence of right leg above knee, and protein calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #05 had severe cognitive impairment. The resident required the substantial/maximal assistance of staff for toileting, bathing, bed mobility, and transfers. Review of the plan of care initiated 06/16/23 revealed the resident had impaired cognitive function, wandered, and was an elopement risk due to impaired safety awareness. Interventions included an ankle monitor to the left leg. Staff were to document wandering behavior and were to check function of ankle monitor daily and placement every shift. Further review of the care plan revealed there was no care plan in place for edema or interventions for compression stockings. Review of a physician order dated 02/23/24 revealed to check the ankle monitoring device function daily and placement of ankle monitoring device to the left ankle every shift. Review of a physician order dated 02/23/24 revealed a second order to check placement of the ankle monitoring device each shift and check function daily with no specified location of the device. The orders for the ankle monitoring device were discontinued on 10/08/25. Review of a physician order dated 06/24/24 revealed the resident was ordered knee high compression stockings, staff were to apply in the morning and then remove at bedtime for lower extremity edema, as tolerated. The order for the compression stockings was discontinued on 10/08/25.Review of an incident report dated 09/07/25 at 10:30 A.M. revealed the resident was found with a wound to the right ankle. Further review of the incident report revealed the resident's ankle monitor was on the right leg. Review of the progress notes and Treatment Administration Record (TAR) dated 08/01/25 through 10/05/25 revealed no documentation the resident had refused the compression stockings. Staff documented daily the compression stockings were applied in the morning and removed at bedtime. Further review of the TAR revealed staff were documenting the ankle monitor to the left leg was checked for placement and function every shift. There was no documentation the ankle monitor had been moved to the right leg. Review of a late entry nurse's note dated 10/07/25 at 7:30 P.M. revealed the resident was transported to the hospital. Review of the hospital documentation dated 10/06/25 revealed the resident was admitted to the hospital on [DATE] around 8:16 P.M. Interview on 12/01/25 at 2:30 P.M., Unit Manager Licensed Practical Nurse (UMLPN) #102 revealed Resident #05 no longer wore an ankle monitor. UMLPN #102 revealed the resident used to wear an ankle monitor on the right leg. UMLPN #102 reviewed the resident's medical record and verified the resident had two separate physician orders for documenting function and placement of the ankle monitor. The first order noted no location of the ankle monitor, and the second order noted the ankle monitor on the left ankle. UMLPN #102 verified staff had documented completing both orders. UMLPN #102 revealed staff should have checked both ankles and then clarified the order and the correct location of the ankle monitor. Further interview on 12/01/25 at 3:52 P.M., UMLPN #102 revealed she could not say with 100 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 15 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 percent certainty if Resident #05's ankle monitor was on the right leg. Additional interview with UMLPN #102 revealed the nurse's note dated 10/07/25 stating the resident was admitted to the hospital had been documented on the incorrect date on 10/07/25. UMLPN #102 verified the resident was transferred to the hospital on [DATE].Interview on 12/01/25 at 4:52 P.M., LPN #116 revealed being notified on 09/07/25 by Certified Nursing Assistant (CNA) #130 of a wound found on Resident #05's right ankle. LPN #116 revealed a risk assessment had been completed noting the ankle monitor was on the right ankle. LPN #116 revealed moving the ankle monitor up higher on the resident's right leg. LPN #116 revealed he was only aware of the ankle monitor being in place on the right ankle. LPN #116 revealed he was unaware there were two separate physician orders for monitoring placement and function of the ankle monitor with one noting the left ankle and the other with no specified location.Interview on 12/02/25 at 8:07 A.M., Certified Nursing Assistant (CNA) #130 revealed Resident #05 had a wound to the right ankle and the resident's ankle monitor would rest in the area of the wound. CNA #130 revealed Resident #05 was supposed to wear compression stockings but would refuse to wear them most of the time saying, they hurt her legs. CNA #130 revealed she tried to make sure the ankle monitor was over the resident's socks or compression stockings.Interview on 12/03/25 at 8:14 A.M., with Resident #05's Family Member (FM) #98 revealed the resident had the ankle monitor device on her right ankle for over a year with nothing underneath of it. FM #98 revealed the device was plastic and rubbed and irritated the resident's skin. FM #98 revealed she had asked staff to remove the ankle monitor. FM #98 revealed the Administrator stated, we cannot remove it. FM #98 revealed when the resident got the sore on her right ankle she had asked the staff again to remove the ankle monitor as the staff had to lift of the ankle bracelet to attend to the sore. FM #98 revealed one day she visited the resident and staff had moved the ankle monitor to the left ankle. FM #98 revealed she had never seen the resident wearing compression stockings and was unaware the resident had required compression stockings. FM #98 revealed the resident wore non-skid socks.Interview on 12/03/25 at 8:56 A.M., LPN #119 revealed Resident #05 had sometimes refused compression stockings. LPN #119 believed Resident #05's ankle monitor had been on the right ankle but was not 100 percent certain.Interview on 12/08/25 at 8:09 A.M., the DON verified Resident #05 had not liked wearing the compression stockings and would refuse. Interview on 12/08/25 at 10:33 A.M., the Administrator revealed the facility had no documentation the resident had been refusing her compression stockings. The Administrator revealed staff had been educated on documenting resident refusals and the accuracy of their documentation.2. Review of the medical record for Resident #51 revealed an admission date of 06/21/22. Diagnoses included dementia, type two diabetes mellitus, chronic obstructive pulmonary disease, and heart failure. Review of the quarterly Minimum Data Set (MDS) assessment completed 09/16/25 revealed the resident had moderate cognitive impairment. The resident was independent for bed mobility. The resident was at risk for pressure ulcers.Review of the care plan initiated 11/13/24 revealed the resident wandered aimlessly and was an elopement risk related to impaired safety awareness. Interventions included for placement of an ankle monitoring device to the right ankle. Staff were to check placement every shift and monitor functioning status per facility protocol. Review of the physician orders dated 11/13/24 revealed for staff to check placement and function for the ankle monitor every shift to the right ankle. Review of the Treatment Administration Record (TAR) from 11/01/25 through 11/30/25 revealed staff had documented completing ankle monitoring checks for placement and function every shift except on day shift on 11/08/25, 11/12/25, 11/13/25, and 11/18/25. Licensed Practical Nurse (LPN) #140 had documented the ankle monitoring function and placement checks were completed during the day shift on 11/07/25, 11/11/25, 11/16/25, 11/17/25, 11/21/25, 11/28/25, 11/29/25, and 11/30/25.Observation and concurrent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 16 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 FORM CMS-2567 (02/99) Previous Versions Obsolete interview on 12/02/25 at 9:03 A.M., LPN #140 revealed Resident #51 was the only current resident with an ankle monitor. LPN #140 revealed she would check and make sure the ankle monitor was not too tight. LPN #140 revealed Resident #51's ankle monitor would alarm if the resident's family took the resident out of the unit. LPN #140 revealed she had worked in the facility for about a year. LPN #140 revealed she was unaware of any device used to check the function of an ankle monitor. LPN #140 looked for a device to check function at the nurse's station and found the device in a bottom drawer. LPN #140 verified she had been documenting she had checked the function and placement of the resident's ankle monitor when in fact she had not known how. LPN #140 could not get the device monitor to turn on. LPN #140 then consulted with UMLPN #108 who then opened the battery compartment on the device revealing no batteries were present. UMLPN #108 then left the unit to find batteries. Further observation revealed UMLPN #108 replaced the battery and instructed LPN #140 on how to use the device monitor to check the function of the ankle monitor. LPN #140 then checked Resident #51's ankle monitoring sensor for function and placement. Review of the facility policy Charting and Documentation, revised 07/2017 revealed all services provided to the resident, progress toward care plan goals, and changes in condition shall be documented in the resident's medical record. Documentation in the medical record would be objective, complete, and accurate. Event ID: Facility ID: 365535 If continuation sheet Page 17 of 18 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 365535 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Three Meadows Post Acute 10540 Fremont Pike Rd Perrysburg, OH 43551 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record, staff interview, and policy review, the facility failed to ensure enhanced barrier precautions were maintained during wound care. This affected one (#05) of four residents reviewed for wound care. The facility identified 29 residents with enhanced barrier precautions. The facility census was 83. Review of the medical record for Resident #05 revealed an admission date of 06/14/23. Diagnoses included chronic obstructive pulmonary disease, type two diabetes mellitus, Alzheimer's disease with late onset, dementia, hypertension, repeated falls, anemia, peripheral vascular disease, orthopedic aftercare following surgical amputation, Methicillin susceptible staphylococcus aureus infection, occlusion and stenosis of carotid artery, and unstageable pressure ulcer of sacral region, acquired absence of right leg above knee, and protein calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #05 had severe cognitive impairment. The resident was at risk for developing pressure ulcers/injuries. The resident used a wheelchair and could not ambulate. The resident required the substantial/maximal assistance of staff for toileting, bathing, bed mobility, and transfers. Review of a physician order dated 10/21/25 revealed the resident was ordered enhanced barrier precautions for high contact resident care including wound care.Review of a nurse ' s note dated 10/21/25 at 2:00 P.M. revealed Resident #05 had returned from the hospital on [DATE] and a second skin check was completed. The resident had an above the knee amputation of the right leg with the incision well approximated with 16 sutures. The resident had an unstageable pressure ulcer to the coccyx, and unstageable pressure ulcer to the left heel, a deep tissue injury of the left lateral foot and left malleolus. Observation on 11/25/25 at 2:00 P.M. of Resident #05 revealed a sign outside the resident ' s door indicating the resident required enhanced barrier precautions (gown and gloves) when providing high contact care. Licensed Practical Nurse (LPN) #103 and the Unit Manager Licensed Practical Nurse (UMLPN) #102 provided wound care treatment for the resident ' s unstageable sacral wound per physician orders. LPN #103 and UMLPN #102 had not donned a gown prior to providing wound care for the resident. The uniform tops of both LPN #103 and UMLPN #102 touched the resident while turning and repositioning the resident during wound care. Interview on 11/25/25 at 2:16 P.M., LPN #103 and UMLPN #102 verified the resident required enhanced barrier precautions during wound care. LPN #103 and UMLPN #102 verified they had not worn gowns while providing wound care for the resident. Review of the facility policy Enhanced Barrier Precautions, revised 03/2024, revealed enhanced barrier precautions (EBPs) were utilized to reduce the transmission of multidrug-resistant organisms (MDROs) to residents. EBPs employ targeted gown and glove use in addition to standard precautions during high contact resident care activities including wound care. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365535 If continuation sheet Page 18 of 18