Inspection·August 8, 2019

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview and facility policy review, the facility failed to provide the bed hold policy to Resident #64 and Resident #79. This affected two (#64 and #79) of two residents reviewed for hospital discharges. The facility census was 90. Findings include: 1. Review of the medical record for Resident #64 revealed an admission dated of 11/29/17. Review of the progress notes revealed on 06/15/19 at 4:30 P.M. Resident #64 was sent to the emergency room (ER) for evaluation and treatment of shortness of breath. On 06/16/19 at 2:28 A.M., Resident #64 was admitted to the hospital. Further review of the medical record revealed it was silent for the bed-hold policy being provided to the resident or her representative. 2. Review of the medical record revealed Resident #79 was admitted to the facility on [DATE]. Diagnosis included Alzheimer's disease, major depressive disorder, dementia without behavioral disturbance, essential hypertension, muscle weakness, insomnia, and anxiety disorder. On 05/12/19, Resident #79 was sent to ER for evaluation for seizures and was hospitalized for two days. She returned to the facility on [DATE]. Further review of the medical record revealed it was silent for the bed-hold policy being provided to the resident or her representative. Interview with Business Office Manager (BOM) #210 on 08/07/19 at 12:13 P.M. verified there was no bed-hold policy given to Resident #64 or Resident #79. BOM #210 verified it should have been provided. Review of the facility policy titled Bed Hold Notification, revised 09/19/18, revealed residents and their responsible party have a right to be notified verbally and in writing on the reserve bed payment policy per the state plan when someone goes out to the hospital or on a therapeutic leave. Before a nursing facility transfers a resident to a hospital or the resident goes on a therapeutic leave, the facility must provide written information to the resident or resident representative that specifies the duration of the state bed hold policy during which the resident is permitted to return and resume residence in the facility; the reserve bed payment policy; the policy regarding bed hold periods permitting a resident to return. The facility must provide the the resident and the resident's representative written notice which specifies the duration of the bed hold policy in writing. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 2 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interviews and policy review, the facility failed to ensure a resident received assistance with showers as scheduled. This affected one (#42) of one residents reviewed for showers. The facility census was 90. Residents Affected - Few Findings include Medical record review revealed Resident #42 admitted to the facility on [DATE]. Diagnoses included dementia with behavioral disturbances, anxiety, cerebral infarction, aphasia, difficulty walking and urinary incontinence. Review of the quarterly Minimum Data Set (MDS) assessment, dated 06/17/19, revealed Resident #42 had severe cognitive impairment. Resident #42 was dependent on staff for bathing and personal hygiene. Review of the shower list revealed Resident #42 was scheduled for showers on Mondays and Thursdays on second shift. Review of the Resident Bathing Chart from 07/09/19 through 08/07/19 revealed Resident #42 had received no showers. Review of the nurse's notes from 07/09/19 through 08/07/19 revealed no documentation Resident #42 had refused his showers. Interview on 08/08/19 at 8:54 A.M., the Administrator verified there was no documentation Resident #42 had received a shower from 07/09/19 through 08/07/19. The Administrator further revealed the resident was combative during care. Interview on 08/08/19 at 12:13 P.M. with Registered Nurse (RN) #300 revealed the nurses were responsible to ensure showers were completed. RN #300 revealed nurses should also document when a resident refused a shower. Review of the Guidelines for Bathing Preferences, last revised 05/11/16, revealed bathing would occur at least twice a week unless resident preference stated otherwise. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 3 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 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 record review, observation, resident interview, and staff interview the facility failed to monitor an open wound on the resident's right shin. This affected one (Resident #90) of six residents reviewed for skin conditions. The facility failed to ensure a bowel management program was initiated a resident. This affected one (Resident #85) of one resident reviewed for bowel management. The facility census was 90. Residents Affected - Few Findings include: 1. Record review for Resident #90 revealed the resident was admitted to the facility on [DATE]. Diagnoses included aftercare post surgery, severe sepsis, cellulitis of lower limbs, end stage renal disease, diabetes type two, neuropathy and heart failure. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 07/05/19, revealed the resident has intact cognition and was being treated for unhealed wounds. Review of the physician orders, dated 07/11/19, revealed Resident #90 was to have tubigrips socks applied to bilateral lower leg, monitor shins and report if not improving. Review of the progress notes, from 07/11/19 to 08/08/19, revealed on 07/11/19 the nurse documented there were open areas on the resident's bilateral shins. Per the note, the nurse applied a dressing and notified the physician. Review of Resident #90's care plans, dated 07/14/19, revealed a focus for skin integrity. Interventions for the focus included skin assessments weekly, treatments as ordered and minimize skin moisture. Further review of the care plan revealed no documentation regarding the resident's wounds on the right shin. Further review of Resident #90's record revealed no documentation of the monitoring of the resident's bilateral shins. No documentation of improvement or physician notification of the status of the skin condition was noted in the resident's chart. Observation and interview on 08/06/19 at 8:02 A.M. with Resident #90 revealed the resident had 'issues' with his lower legs and the nurses were treating his wounds daily. Per Resident #90, he had an open area on his right shin and the nurses were changing the dressing daily. Resident #90 stated he had scratched the area open himself and asked for it to be covered. Resident #90 denied any pain with the right shin wound. Interview on 08/08/19 at 9:52 A.M. with Registered Nurse (RN) #333 revealed the resident did have a dressing on his right shin. Per RN #333, she did not change the dressing so she was unsure of what type of skin condition the dressing was covering. Per RN #333, the resident did have a history of scratching his skin causing open areas on his legs. Observation and interview on 08/08/19 at 11:50 A.M. with Corporate RN #300 and the Director of Nursing (DON) revealed the resident's right shin there was one small band-aid, and a five centimeter (cm.) by five cm. foam dressing dated 08/07/19 on the skin above the resident's ankle. The Corporate RN #300 removed the band-aid to reveal dry skin but no open areas on the right shin. When the nurse removed foam dressing, there was a open area on the shin with minimal red drainage. The Corporate RN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 4 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 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 - Minimal harm or potential for actual harm #300 measured the wound to be two cm. by 2.2 cm. with no depth. The wound edges were approximated and there was minimal drainage noted on the old dressing. The Corporate RN #300 cleaned the wound and applied another foam dressing to the wound. The DON and Corporate RN #300 verified there was no documentation or measuring of the open wound on the resident's right shin or any physician orders for the foam dressing to be changed. Residents Affected - Few 2. Review of the medical record revealed Resident #85 was admitted to the facility on [DATE]. Diagnoses included dementia with behavioral disturbance, major depressive disorder, hypertensive heart disease without heart failure, type I diabetes mellitus with hyperglycemia and anxiety disorder. Review of the State Tested Nursing Assistant (STNA) tracking of bowel movements for the last 30 days revealed Resident #85 went from 07/13/19 to 07/20/19 (eight days) without a bowel movement. Review of Resident #85's bowel and bladder detailed entry report revealed the resident did not have a bowel movement from 07/13/19 to 07/20/19. Review of Resident #85's July 2019 Medications Administration Report (MAR) revealed no evidence that a bowel protocol was initiated. Interview on 08/08/19 at 2:13 P.M. with LPN #250 verified Resident #85's bowel movement tracking sheet demonstrated Resident #85 did not have a bowel movement from 07/13/19 to 07/20/19. LPN #250 verified the facility bowel protocol should have been initiated. Interview on 08/08/19 at 2:21 P.M. with RN #320 verified bowel protocol was not initiated for Resident #85 until 07/20/19. Review of the policy, Bowel Protocol Guidelines, dated 11/09/17, revealed the ineffective bowel pattern event should be initiated for any resident not having a bowel movement within 72 hours. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 5 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 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 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure the resident was seen by the physician for the initial visit in the facility. This affected one (Resident #50) of three resident reviewed for physician visits. The facility census was 90. Residents Affected - Few Findings include: Record review of Resident #50's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses for Resident #50 include urinary tract infections, chronic kidney disease, depression, fracture of the left radius, and dementia with Lewy bodies. Review of the comprehensive Minimum Data Set (MDS) assessment, dated 06/29/19, revealed the resident had impaired cognition. Further review of Resident #50's medical record from 06/22/19 through 08/06/19 revealed there was no physician assessment or progress notes in the resident's record for the initial or subsequent visits. Interview on 08/07/19 at 5:15 P.M. with MDS Registered Nurse (RN) #320 revealed the only documentation for the initial visit from the physician was a faxed assessment completed and dated 07/05/19 by the physician's Certified Nurse Practioner (CNP). Review of the faxed document revealed the CNP signed the note and the physician signed next to the CNP's signature on the document. No date was noted on the physician's signature. MDS RN #320 revealed the resident will continue to be seen by her private physician and stated there was no way to determine if the physician or the CNP did the assessment. MDS RN #320 nurse verified the CNP had completed the note and the physician had signed the note. MDS RN #320 stated there was no physician progress note except that of the CNP note's for the resident's initial assessment after admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 6 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, staff interview and policy review, the facility failed to ensure proper disposal of medications. This had the potential to affect six (#12, #19, #50, #62, #83 and #84) of seven residents near the medication cart who were independently mobile with impaired cognition. The facility census was 90. Findings include: Observation on 08/06/19 at 8:13 A.M. during medication administration revealed Licensed Practical Nurse (LPN) #220 cut a tablet of Depakote (anticonvulsant medication) in half. LPN #220 placed half of the Depakote tablet in an uncovered waste container attached to the medication cart. The medication cart was located next to the dining room in the memory care unit. There were seven residents sitting in the dining room. Observation on 08/06/19 at 8:23 A.M. revealed LPN #220 continued to prepare medications for Resident #76 including one tablet of atenolol 100 milligrams (mg.) (blood pressure medication), one tablet of carbamazepine 200 mg. (anticonvulsant), one half tablet of Depakote 125 mg., one tablet of Hydrochlorothiazide 25 mg. (diuretic), one tablet of Losartan 100 mg. (an antihypertensive), one tablet of memantine 10 mg., one tablet of potassium 20 milliequivalents (MEQ), and one tablet of Amlodipine 10 mg. (blood pressure medication). Further observation revealed Resident #76 refused the medications. LPN #220 then threw the additional eight medications in the same uncovered trash container. Interview on 08/06/19 at 8:25 A.M. with LPN #220 revealed she normally disposed of unused medications in the trash container unless the medication was a narcotic. LPN #220 verified the medications in the trash container could potentially be accessed by the residents. LPN #220 was unaware of the facility policy for medication disposal. LPN #220 then stated she should have placed the pills in the sharps container or flushed them down the toilet. Review of the facility's list of residents who were sitting in the dining room and were independently mobile and had impaired cognition revealed Resident #12, #19, #50, #62, #83 and #84 were in the dining room on 08/06/19 at 8:23 A.M. Review of the policy Guidelines for Disposal of Non-Controlled Drugs, last revised 08/01/16, revealed non-controlled medications requiring disposal should be placed in the sharps container or mixed in kitty litter, coffee grounds or approved medication disposal kits to ensure they are not obtainable to other residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 7 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, staff interview and policy review, the facility failed to ensure a medication cart was locked. This had the potential to affect seven (#29, #41, #49, #67, #71, #81 and #89) of 31 residents the facility identified as independently mobile with impaired cognition residing in the three hallways near the medication cart. The facility census was 90. Findings include Observation on 08/08/19 beginning at 7:48 A.M. of the hallway revealed a medication cart was left unlocked and unattended. Interview on 08/08/19 at 7:55 A.M. with the Administrator was notified and provided verification the medication cart was left unlocked and unattended in the hallway. Interview on 08/08/19 at 2:57 P.M. the Administrator revealed there were seven residents (#29, #41, #49, #67, #71, #81 and #89) who were independently mobile with cognitive impairment residing in the three hallways near the unlocked medication cart. Review of the facility policy Medication Storage In The Facility, last revised 01/2017, revealed medication carts should be locked when not attended by persons with authorized access. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 8 of 9 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 365541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage The 2820 Greenacre Dr Findlay, OH 45840 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview and facility policy review, the facility failed to maintain infection control in the laundry room. This affected 90 of 90 residents residing in the facility who used the facility laundry. Residents Affected - Many Findings include: 1. Observation on 08/08/19 at 7:06 A.M. conducted in the facility laundry room revealed Environmental Services Assistant (ES) #200 was sorting laundry from a large laundry bin. The bin contained resident's soiled personal items. Laundry Aide (LA) #200 was wearing gloves but no gown or other personal protective equipment. Her brown polo shirt was continually draping across the dirty laundry bin and in contact with it as she leaned over the bin to remove soiled clothes for sorting. Interview at the time of the observation with LA #200 stated she was sorting the residents' soiled personal items to be washed. LA #200 verified she was not wearing a gown and stated she does not usually wear a gown. LA #200 pointed out that there was a plastic apron hanging on the wall near the entry door and stated she would wear it if things were really dirty. LA #200 verified the shirt was contacting the dirty laundry bin and that the bin was not clean because it contained dirty laundry. 2. Observation on 08/08/19 at 8:35 A.M. revealed State Tested Nursing Assistant (STNA) #180 pushed a shower chair down the hallway containing visibly soiled sheets to a room labeled dirty linen. The soiled sheets were not in a bag. Interview on 08/08/19 at 8:36 A.M. with STNA #180 verified the soiled linens should have been bagged before transport to the dirty linen room. Review of the facility policy titled Guidelines for Handling Linen, revised 05/11/16, revealed the purpose was to provide clean, fresh linen to each resident and to prevent contamination of clean linen. All dirty linen should be handled as if it was contaminated by following Standard Precautions. Place soiled linens in a plastic bag if it is wet or soiled with feces. Discard soiled linen is soiled linen containers. Maintain distance between soiled linens and clean linens. Review of the facility policy titled Standard Precautions Guidelines, revised 05/11/16, revealed the purpose of the policy was to prevent the transmission of infectious organisms. Standard precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. Standard precautions include hand hygiene, the proper use of gloves, gowns and masks (or other personal protective equipment [PPE]) resident placement and the care of the environment, textiles and laundry. Equipment or items in the resident's environment likely to have been contaminated with infectious fluids or other potentially infectious matter must be handled in a manner so as to prevent transmission of infectious agents. It is important for staff to use appropriate PPE as a barrier to exposure to any body fluids. As appropriate, gloves and other PPE such as gowns and masks are to be used as necessary to control the spread of infections. Standard precautions are also intended to protect residents by ensuring the staff do not carry infectious agents to residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365541 If continuation sheet Page 9 of 9