Health inspection·August 11, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, hospital record review, review of data found at www.kidneyfoundation.org, policy review and interviews, the facility failed to prevent an incident of neglect when Resident #51 did not receive hemodialysis treatments as ordered due to a lack of facility provided transportation. This resulted in Immediate Jeopardy and actual harm with risk of death beginning on 07/21/25 when Resident #51, who was dependent on hemodialysis due to end stage renal disease, was not transported to a scheduled dialysis treatment. The resident subsequently missed hemodialysis on 07/23/25 again due to a lack of facility provided/arranged transportation. As a result, Resident #51 developed symptoms of fluid volume overload, shortness of breath, fatigue and weakness. The facility failed to timely identify the resident's condition change and did not transfer the resident to the emergency room (ER) until the evening of 07/23/25 at which time she was diagnosed with hyperkalemia (elevated potassium level of 7.7 (critical)) due to missed hemodialysis treatments and required admission to the intensive care unit (ICU) to receive continuous renal replacement therapy (CRRT) to restore the resident's blood potassium level and prevent imminent deterioration of the resident's condition. This affected one resident (Resident #51) of one resident identified by the facility to receive hemodialysis treatments. The facility census was 52. On 08/04/25 at 4:47 P.M. the Director of Nursing #7, Assistant Director of Nursing #6, Administrator #128 , Regional Director of Operations (RDO) #614, and Regional Director of Clinical Services 615 were notified Immediate Jeopardy began on 07/21/25 when the facility failed to secure transportation for Resident #51 to receive life sustaining hemodialysis treatments required due to the resident's end stage renal disease. Due to the missed appointments, the resident was hospitalized in the intensive care unit requiring continuous renal replacement. The resident was assessed to have hyperkalemia, was hyponatremic and her electrocardiogram revealed cardiac changes, including heart block, due to the changes in condition associated with the missed hemodialysis treatments. The Immediate Jeopardy was removed on 08/04/2025 when the facility implemented the following corrective actions: On 08/04/2025 from 5:07 P.M. until 5:17 P.M. Regional Director of Operations (RDO) #614 Regional Director of Clinical Services #615, Administrator #128, Director of Nursing (DON) #7 and Assistant Director of Nursing (ADON) #6 were educated via Teams call by VP of Clinical Operations #613 and VPO #612 regarding: Abuse and Neglect Policy, Resident examination and assessment, Change in Resident's Condition or Status with Notification, Transportation and interventions, and Charting and Documentation. On 08/04/2025 at 5:20 P.M. all department heads were educated via in-person meeting by RDO #614 and Regional Director of Clinical Services #615 on Abuse and Neglect Policy, Resident examination and assessment, Change in Resident's Condition or Status with Notification, Transportation and interventions, and Charting and Documentation. Department heads educated included Administrator #128, DON #7, Business Office Manager (BOM) #129, ADON #6, admission Coordinator/Marketing #218, Dietary Manager #65, Social Services #106, Minimal Data Set (MDS) Registered Nurse (RN) #2, Regional Director of Clinical Services #615, RDO #614, and Central Supply/Medical Records #5. On 08/04/2025 from 5:30 P.M. until 6:00 P.M. an audit of the facility appointment calendar was completed for all 52 residents for missed appointments due to transportation concerns the week of 07/21/2025 to 07/28/2025 when the facility was without a wheelchair accessible van. Two additional residents were identified as having missed appointments and were clinically assessed for a decline in condition. The audit completed by ADON #6 identified Resident #15 had a chemotherapy appointment scheduled for 07/21/2025 but arranged transportation did not arrive to transport the resident on 7/21/2025. Resident #15's appointment was rescheduled for 07/31/2025 and transportation was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 2 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few provided by the facility. Resident #17 had a non-life sustaining dermatology appointment scheduled for 07/21/2025. Transportation was canceled by Valley Logistics transportation company; the Activity Director was notified on 7/18/2025 when the Activity Director called to confirm transportation arrangements. This appointment and transportation were rescheduled to 08/18/2025, with the facility to transport. On 08/04/2025 from 6:04 P.M. until 6:40 P.M. resident interviews were conducted to identify possible situations of neglect. Thirty-one (31) residents with a Brief Interview for Mental Status (BIMS) score of 13 or higher were interviewed by the BOM. Residents interviewed included Resident #4, # 5, #10, #11, #12, #13, #14, #15, #17, #18, #19, #20, #21, # 22, #23, #26, #28, #29, # 32, #34, #35, #37, #38, #42, #43, #47, # 48, #50, #51, #53, and #55. Questions included, Has staff, a resident or anyone else here neglected you? and Have you seen any resident here being neglected?. On 08/04/2025 from 6:05 P.M. until 6:40 P.M. resident skin assessments were completed for (21) residents with a BIMS score of 12 or lower by facility ADON #6 and DON #7. Residents assessed included Resident #1, #2, #3, #6, # 7, #8, #9, #16, #27, #30, #31, #33, #36, #39, #40, #41, #45, #46, #49 and#54. On 08/04/2025 from 6:40 P.M. until 7:00 P.M. a Quality Assurance Performance Improvement (QAPI) meeting was held meeting held with facility staff members including Administrator #128, Director of Nursing #7, BOM #129, Assistant Director of Nursing #6 , admission Coordinator/Marketing #218, Dietary Manager #65, Social Services #106 (by phone), MDS RN #2, Regional Director of Clinical Services #615, Regional Director Operations #614, Central Supply/Medical Records #5, and Medical Director #606 (by phone). The QAPI agenda consisted of the review of the facility IJ abatement plan, a root cause analysis, staff education topics, and weekly audits to be completed. The root cause was identified as transportation concerns arose, staff did not complete appropriate notifications, assessments, and interventions to ensure Resident #51 had no adverse effects. Education topics include pertinent facility policies, including the policies titled, Abuse and Neglect Policy, Resident examination and assessment, Change in Resident's Condition or Status with Notification, Transportation and interventions, and Charting and Documentation. On 08/04/2025 from 6:59 P.M. until 8:44 P.M. an audit of the facility EHR report titled 72 Hour Report, which included weights and vitals, progress notes, the completion of assessments, etc. for the previous 72 hours, was completed for all 52 residents by MDS RN #2, to confirm appropriate notifications and interventions for residents with a change in condition. On 08/04/2025 from 7:05 P.M. until 7:17 P.M. All Staff Education was completed remotely by RDO #614 via facility communication system on the topics of Abuse/ Neglect, Resident examination and assessment, Change in Resident's Condition or Status with notification, Transportation and interventions, and Charting and Documentation. All 80 staff members were educated, including re-education to facility administration. (Education was provided to 20 licensed practical nurses (LPN) and registered nurses (RN), 34 Certified Nursing Assistants (CNAs), eight dietary staff members, six housekeeping staff members, one laundry staff member, two activity staff members, one central supply/medical records staff member, and eight administrative staff members. The facility communication system allowed facility administration to send information to staff via Short Message Service (SMS), with confirmation of receipt of the message being received by the facility for each staff member. In addition to the remote education, facility staff were to sign an in-service sheet in acknowledgement of receipt of this education, at the arrival of the facility for their next scheduled shift. This was being audited daily by facility Administrator or Designee, until completion. The facility's new hire orientation was updated by the facility Administrator to include the policies outlined in the completed education. On 08/04/2025 from 8:00 P.M. until 8:19 P.M. all appointments scheduled for 07/27/25 through 08/02/25 were audited for missed appointments due to lack of transportation by DON #7. Residents who had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 3 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few appointments included Resident #51, Resident #43, Resident #50, Resident #15. On 08/04/25 from 8:13 P.M. until 8:28 P.M. all appointments scheduled for Sunday 08/03/25 through 08/09/25 were audited to ensure transportation was scheduled. The audit was completed by BOM #129. Residents who have scheduled appointments included Resident #51, Resident #3, Resident #36, Resident #37, Resident #20. Transportation would be completed by the facility or Valley Logistics transportation company for all appointments. On 08/04/25 at 10:39 P.M. Resident #51's care plan was updated to add appropriate steps for any missed dialysis appointments per facility policies by MDS RN #2. Resident #51's care plan would be accessible to nursing staff via facility Electronic Health Record (EHR), including transportation interventions and notification, in accordance with facility policies titled, Transportation, Charting and Documentation, and Change in a Resident's Condition or Status, Resident Examination and Assessment, and a handout titled Education Highlights. The facility implemented a plan for the following audits to be initiated on or by 08/06/2025: o Appointment calendar will be audited for accuracy, completion and transportation five times per week for four weeks and then weekly for four weeks by DON or designee. The facility appointment calendar is managed by Activity Director, including the verification of scheduled appointments and transportation. All transportation is completed by the facility and/or Valley Logistics transportation company. o Interventions for missed appointments would be audited by DON or designee five times per week for four weeks then weekly for four weeks, including documentation in the medical record of interventions and notifications to facility DON and primary care provider team. Facility EHR bulletin board notice posted on 08/04/2025 at 10:46 P.M. by RDO #614 for nurses to notify DON of any missed appointments. o 24/72hr report to be reviewed for resident changes in condition would be audited daily Monday through Friday; Monday to capture Friday through Sunday five times per week for four weeks to ensure proper documentation is included such as assessments, adverse reactions, unusual occurrences, refusals, declines, notifications. Audit to be completed by DON or Designee. o Resident interviews for residents with a BIMS of 13 or higher or head to toe assessments for residents with a BIMS of 12 or lower to assess for concerns of neglect would be completed for three random residents five times per week for four weeks and then three random residents weekly for four weeks by DON or Designee. o Results of all audits would be reviewed weekly, at minimum, by the facility's QAPI committee for the duration of the audits. Although the Immediate Jeopardy was removed on 08/04/2025 the deficiency remains at Severity Level II (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility is still in the process of implementing their corrective action plan and monitoring to ensure on-going compliance. Findings include:Record review revealed Resident #51 was admitted to the facility on [DATE] with diagnoses including respiratory failure, type two diabetes, chronic obstructive respiratory disease, anemia, atherosclerotic heart disease, schizophrenia, borderline personality disorder, hypothyroidism, hypertension, chronic kidney disease, kidney failure and renal (hemo)dialysis dependence. Review of Resident #51's physician orders revealed an order for hemodialysis every Monday, Wednesday, and Friday at an outside dialysis center due to renal failure. Review of Resident #51's care plan dated 04/11/25 revealed the resident needed hemodialysis related to renal failure. Goals included the resident would have immediate intervention should any signs or symptoms of complications from dialysis exist. The care plan reflected the resident received (hemo)dialysis at (name and location of dialysis center) on Monday, Wednesday, and Friday at 10:30 A.M. Interventions included encouraging the resident to go for their scheduled dialysis appointments. Monitor vital signs and notify the medical doctor (MD) of significant abnormalities. Monitor, document, report as needed (PRN) for signs and symptoms of renal insufficiency such as changes in level of consciousness, changes in skin turgor, oral mucosa, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 4 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and changes in heart and lung sounds. Check arteriovenous (AV) fistula (a connection between an artery and vein surgically created to receive dialysis) site thrill (a palpable vibration or tremor felt over an AV fistula that indicates turbulent blood flow)/bruit (an abnormal sound, often described as a swishing or blowing that can be heard with a stethoscope over a blood vessel and indicates turbulent blood flow); palpate/feel to assess for thrill and auscultate for bruit as ordered. Review of Resident #51 quarterly Minimum Data Set (MDS) assessment completed 06/04/25 revealed the resident had a BIMS score of 15 (out of a total score of 15), indicating Resident #51 was cognitively intact. The assessment also reflected the resident received dialysis. Review of Resident #51's dialysis communication binder, taken to and from each dialysis appointment for communication between the facility and the dialysis provider, revealed Resident #51 did not receive dialysis treatments on 07/21/25, or 07/23/25. Resident #51 last attended a dialysis appointment was on 07/18/25 which resulted in Resident #51 going a total of five days without being dialyzed before she was transferred to the hospital (on 07/23/25) for emergent medical intervention/treatment. Further reviews of Resident #51's medical record revealed no documentation, including vital signs, were available on 07/21/25 or 07/23/25 until the resident was transported to the hospital for evaluation (on 07/23/25). Further review revealed no additional nursing progress notes or documentation the resident missed the hemodialysis treatments on this date. There was no documentation the resident's physician or nephrologist were notified of the missed hemodialysis treatments. Review of Resident #51's progress note dated 07/23/25 at 6:49 P.M. authored by Registered Nurse (RN) #120 revealed Resident #51 was feeling very weak and having a change in condition, sending to emergency department for evaluation. An additional note dated 07/23/25 authored by LPN #38 at 10:48 P.M. revealed the resident was admitted to the hospital. Review of Resident #51's emergency room documentation dated 07/23/25 and authored by Doctor of Medicine (MD) #608 revealed Resident #51 presented to the emergency department (ED) on 07/23/25 from a skilled nursing facility (SNF) with shortness of breath. Resident #51 had a past medical history (PMH) of end stage renal disease (ESRD) and missed dialysis on Monday 07/21/25 due to lack of transportation from the SNF. Lab work revealing hyperkalemia, potassium 7.7 milliequivalents per liter (mEq/L) (normal range 3.5-5.0 mEq/L), mixed metabolic and respiratory acidosis (a serious life-threatening situation when the lungs and the body's metabolism are making the blood too acidic at the same time, caused by an increase in carbon dioxide and an excessive amount of acid build up). Electrocardiogram (EKG) showing Intraventricular conduction delay (IVCD) (the electrical signals from the lower heart chambers are moving slower than usual, causing the heart to beat out of sync or rhythm therefore not pumping blood to the body efficiently). Resident #51 was admitted to the ICU to facilitate continuous renal replacement therapy (CRRT). CRRT is a type of dialysis that provides a continuous, 24-hour treatment with acute kidney injury who are too unstable for traditional, intermittent dialysis methods offering life-saving support to critically ill patients. Primary hospital diagnoses for Resident #51 hospital admission from 07/23/25 through 07/25/25 included acute hyperkalemia, encounter for CRRT for end-stage renal disease (ESRD) and admitted to intensive care unit (ICU) for CRRT. Resident #51 required CRRT, transitioning to hemodialysis (HD), hyperkalemia treatment, strict intake and outputs, serial basic metabolic panel (BMP) lab work, and hyponatremia improving with CRRT. Hyponatremia (lab work revealing sodium of 128) was likely due to volume overload with two missed hemodialysis (HD) sessions. EKG on admission with sinus bradycardia (a slower than normal heart rate, less than 60 beats per minute) , second degree atrioventricular (AV) block (a heart rhythm where electrical signals from the upper chambers of the heart are not conducted to the hearts lower chambers causing the heart to miss a beat) , Mobitz type 2 right bundle branch block (the right side of the heart has a delay (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 5 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few in receiving electrical signals causing signals to come late or be completely missed), repeat EKG showing sinus bradycardia with sinus arrhythmia and right bundle branch block, likely metabolic in nature secondary to missed HD and hyperkalemia. Patient was treated with medications without significant improvement and was admitted to ICU for dialysis.Review of Resident #51's hospital record revealed an EKG reading from 07/23/25 authored by Cardiologist #609 that stated Resident #51 had junctional bradycardia with intermittent heart block, widening of the QRS complex, this was a change when compared to prior EKGs Review of Resident #51's hospital record revealed an admission note authored by MD #606 which included Resident #51 was dialysis dependent (for renal failure) and she missed (HD treatments) due to transportation issues. EKG showed junctional bradycardia with intermittent heart block, widening of the QRS complex. Resident #51 showed hyperkalemic changes on her EKG, changes that were not there on the previous. Resident #51 would be admitted to the ICU for dialysis. Review of Resident #51's hospital record revealed a hospital admission note dated 07/23/25 and authored by the emergency department physician Doctor of Osteopathic Medicine (DO) #610, which documented Resident #51 had a high probability of imminent life or limb threatening deterioration due to severe hyperkalemia with EKG changes. Review of Resident #51 hospital record revealed a note dated 07/24/25 and authored by Nephrologist #611 which included Resident #51 was known to their practice due to her dialytic needs. Resident #51 was typically compliant with her treatments for dialysis. Resident #51 missed dialysis on Monday 07/21/25 and Wednesday 07/23/25 due to the nursing facility not having transportation because of issues with their van. Lab work revealed hyperkalemia, acidemia, and cardiac involvement secondary to hyperkalemia. The note included will touch base with our team regarding further management from her facility so these transportation issues are resolved. Review of Resident #51's progress note dated 07/25/25 at 7:42 P.M. and authored by LPN #304 revealed Resident #51 returned from the hospital after admission for continuous dialysis. Interview on 07/30/25 at 10:34 A.M. with offsite Dialysis Registered Nurse (RN) #604 revealed it was not recommended for any patient who required dialysis to miss an appointment for dialysis. Missing even just one appointment could lead to hospitalization and possible death. Someone who may be presenting with adverse reactions from missing dialysis could include confusion and diarrhea; the resident's potassium level could rise causing hyperkalemia; a dangerous excess amount of potassium leading to cardiac changes. Interview on 07/30/25 at 10:59 A.M. with offsite dialysis social worker, Licenses Social Worker (LSW) #603 revealed on Monday 07/21/25 the facility called the dialysis center to cancel Resident #51's dialysis appointment due to transportation issues. LSW #603 also shared the facility canceled dialysis on 07/23/25, without reason. At that time (on 07/23/25) dialysis staff recommended the resident be sent to the ER. Further interview revealed Nephrologist #611 shared, later on 07/23/25, that Resident #51 was in the hospital requiring continuous renal replacement therapy (CRRT). Nephrologist #611 wanted to discharge Resident #51 from the hospital on [DATE] back to the facility; however, the facility advised against this stating they felt it was safer for the resident to remain in the hospital for dialysis. Resident #51 was scheduled for dialysis on 07/25/25 at the offsite dialysis center but remained in the hospital at that time. LSW #603 stated missing a dialysis appointment could lead to toxin build up and fluid overload, some symptoms may include shortness of breath, nausea and vomiting, and swelling. Interview with Via [NAME] Therapeutic Behavior support (TBS) #605 on 07/30/21 at 1:20 P.M. revealed she saw Resident #51 a few days a week. TBS #605 revealed Resident #51 missed a few dialysis appointments and was in the hospital the week of 07/21/25 to 07/25/25. TBS stated she was told Resident #51 missed dialysis due to transportation issues; transportation was down. TBS #605 stated she was told this on Wednesday 07/23/25. TBS #605 stated she went in to see Resident #51on 07/23/25 around 2:30 P.M. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 6 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and Resident #51 said she didn't feel good and that she had thrown up. TBS #605 shared Resident #51 was not her usual self that day. TBS #605 stated she notified the nurse but could not remember which nurse. TBS #605 shared the nurse said they were aware and told her Resident #51 hadn't been feeling well. Interview with Registered Nurse (RN) #11 on 07/30/25 at 2:51 P.M. confirmed Resident #51 did not receive hemodialysis on 07/21/25 and 07/23/25 on her usual appointment days due to the facility not having transportation to get Resident #51 to the dialysis facility. Interview on 07/30/25 at 3:10 P.M. with LPN #60 verified Resident #51 missed two hemodialysis appointments, on Monday 07/21/25 and Wednesday 07/23/25. The LPN revealed Resident #51 missed her dialysis appointments due to not having transportation to the dialysis center and back. LPN #60 stated Resident #51 was ready for dialysis and as time passed and it got closer to when she would usually leave, someone then told them there was no transportation and dialysis was cancelled. LPN #60 stated Resident #51 was eventually transferred to the hospital due to a status change, not feeling well and not acting like her usual self. The nurse stated the resident was in the ICU for a few days due to missing two dialysis appointments. During that time Resident #51 required an ICU admission for CRRT. Interview on 07/30/25 at 3:23 P.M. with Licensed Practical Nurse (LPN) #200 confirmed on 07/21/25 Resident #51 missed her dialysis appointment. LPN #200 stated Resident #51's dialysis appointment was missed due to the facility not having a van to transfer the resident to and from dialysis on 07/21/25. Interview on 07/30/25 at 3:54 P.M. with Anonymous Staff Member (ASM) #484 revealed Resident #51 was not acting herself on Wednesday 07/23/25. The ASM stated Resident #51 had missed two dialysis appointments due to transportation issues and was not acting herself, she would answer appropriately but was acting off. Before Resident #51 was transferred to the hospital, she had vomited. ASM #484 revealed at times when Resident #51 didn't feel good she could be more agitated than usual, maybe a little crabby at times when she was unwell but Resident #51 wasn't even doing this, it was as if the lights were on but no one was there. ASM #484 confirmed Resident #51 was transferred to the emergency room on [DATE] because of her change in status. Interview on 07/30/25 at 4:07 P.M. with Certified Nursing Assistant (CNA) #377 revealed the week of 07/20/25 through 07/26/25 the facility's transportation van was down and out of order. CNA #377 confirmed Resident #51 missed two dialysis appointments due to having no transportation to get there. CNA #377 revealed the days leading up to Resident #51 being transferred to the hospital Resident #51 was not herself, she was acting different than she usually did and even stated several times she was feeling sick. Interview on 07/30/25 at 4:24 P.M. with LPN #61 revealed transportation had been down since last week (week of 07/20/25). LPN #61 revealed residents were missing appointments due to this. LPN #61 stated Resident #51 did not go to dialysis on 07/21/25 due to having no transportation and the resident appeared more tired than usual the days following up to her being admitted to the ICU (on 07/23/25). The LPN was unsure if Resident #51's physician or nephrologist were notified of the resident missing her dialysis appointments. LPN #61 denied any knowledge of anyone trying to set up alternative transportation for Resident #51 for the dialysis on Monday or Wednesday; the transportation vehicle was down so her appointments got canceled. Interview on 07/30/25 at 4:54 P.M. with Resident #51 confirmed she missed dialysis on Monday 07/21/25 because there was no van but stated she could not recall if she missed dialysis on Wednesday 07/23/25 due to her not being able to remember anything from those days. Resident #51 stated she didn't remember if she had dialysis or not, she didn't remember if she was sick, she did not remember if she felt unwell, she couldn't recall anything from those days. Resident #51 shared she missed dialysis on Monday and then she woke up and was in the hospital, in the ICU with a lot of stuff going on around her. Resident #51 stated anything between the two events she didn't recall. Resident #51 stated to her knowledge the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 7 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few dialysis center called the facility to see where she was and that was when the facility told dialysis that she wouldn't be making it to dialysis because the van wasn't working. Resident #51 stated she does not believe her doctor knew she wasn't going to dialysis. Resident #51 stated she knows what goes on, she doesn't forget things, however she stated she could not remember anything after missing dialysis on 07/21/25 until she woke up in the ICU. Interview on 07/30/25 at 6:02 P.M. with ASM #455 revealed Resident #51 missed two dialysis appointments on 07/21/25 and 07/23/25. ASM #455 stated these appointments were missed due to the facility transportation van being out of order. The ASM stated to their knowledge no one attempted to get alternative transportation for Resident #51 to get to her dialysis appointments for either of the two appointments missed. ASM #455 revealed on the days leading up to Resident #51 hospital admission (on 07/23/25) the resident was not right at all, she was acting different, complaints of not feeling well, and even her body color was not what it usually was. ASM #455 revealed something should have been done sooner, transport was down Monday, but the resident still missed Wednesday; and it seemed like her status was worsening and nothing was being done about it. Interview on 07/31/25 at 7:14 A.M. with CNA #74 revealed Resident #51 missed two dialysis appointments on 07/21/25 and 07/23/25. CNA #74 confirmed that these two dialysis appointments were missed due to the facility transportation van being broke down. An interview on 07/31/25 at 7:30 A.M. with CNA #301 revealed on 07/21/25 Resident #51 was up and ready for her dialysis appointment like she was every Monday. Around 9:30 A.M. they were notified that there was no transportation for Resident #51 to go to dialysis. Resident #51 then missed another dialysis appointment on 07/23/25 again due to having no transportation. This resulted in Resident #51 being admitted to the hospital in the intensive care unit requiring continuous dialysis. Interview on 07/31/25 at 7:55 A.M. with CNA #64 confirmed Resident #51 missed two dialysis appointments on Monday 07/21/25 and Wednesday 07/23/25. CNA #64 stated these dialysis appointments were missed due to the facility transportation vehicle not working. CNA #51 confirmed Resident #51 ended up in the intensive care unit requiring continuous dialysis due to missing the two appointments. Interview on 07/31/25 at 8:31 A.M. with CNA #21 confirmed Resident #51 missed dialysis appointments due to not having transportation to get there. CNA #21 revealed awareness of Resident #51 missing dialysis on 07/21/25 and stated she was unsure of how many more days she missed. CNA #21 revealed Resident #51 in the days leading up to her hospitalization after missing dialysis complained of being short of breath, but she was unsure if that was correlated. Interview on 07/31/25 at 12:59 P.M. with facility medical director (MD) #606 revealed the MD was not notified of Resident #51 missing dialysis on 07/21/25 or 07/23/25. MD #606 stated when Resident #51 was admitted to the hospital (on 07/23/25) he was notified she was being admitted , but it wasn't until after that that he was told she had missed two dialysis days. MD #606 revealed missing a dialysis day could result in fluid overload, hyperkalemia, hospitalization, myocardial infarction (MI), and even death. Some symptoms you would experience with fluid overload or hyperkalemia included shortness of breath, cardiac changes, and vomiting. Interview on 07/31/25 at 11:27 A.M. with ASM #450 revealed Resident #51 missed two dialysis appointments, one on 07/21/25 and the other on 07/23/25. The ASM voiced they felt the facility was negligent with Resident #51 missing her dialysis appointments and facility's lack of reaction to Resident #51 decline leading up to her hospitalization. ASM #450 revealed the facility transport van had been down for a while and they (the facility) had ample time to get transportation set up, the facility rented a van to take residents to a wrestling event but didn't attempt to get transportation of any form for Resident #51 to receive medically necessary dialysis. ASM #450 stated in the days leading up to Resident #51's admission to the hospital after missing dialysis she looked pale, she was sleeping a lot and typically she was a very active (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 8 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete person, always awake and utilized her call light often which she hadn't been doing, and hadn't voided. Interview on 08/04/25 at 8:40 A.M. with ASM #451 revealed for about a week (the week of 07/20/25) the facility did not have a transportation van. This resulted in several residents missing appointments. The ASM voiced administration did not attempt to get transportation for the residents, it didn't seem like they cared. Resident #51 missed her dialysis appointments, for two days, she hadn't been to dialysis since 07/18/25 so she hadn't been to dialysis in five days leading up to her discharge to the hospital. The ASM stated administration didn't seem to care. Interview on 08/04/25 at 9:30 A.M. with Dialysis RN #607 confirmed Resident #51 missed her dialysis appointment on 07/21/25 and 07/23/25. RN #607 stated Resident #51 had not been to dialysis for two appointments totaling five days without being dialyzed, and Resident #51 was very compliant with dialysis, she didn't miss. The two days that were missed were due to the facility not having transportation to get Resident #51 to dialysis. RN #607 stated on Monday they asked the facility if the resident could attend dialysis Tuesday 07/22/35 and the facility reported the earliest they could get Resident #51 to dialysis was on Wednesday 07/23/25. RN #607 stated Resident #51's dialysis appointments typically began around 10:30 A.M. On 07/23/25 when it became apparent Resident #51 was not going to make it to her dialysis appointment the dialysis facility called the facility to recommended Resident #51 be transferred to the hospital fairly immediately; however, the resident was not sent until later that evening. Dialysis RN #607 stated it was not safe for someone to miss a dialysis appointment; this could cause fluid overload putting a burden on the resident's heart. Missing dialysis could also cause your potassium to rise causing hyperkalemia and anomalies with heart rhythm all the way up to cardiac arrest. Interview on 08/04/25 at 10:15 A.M. with DON #7 Event ID: Facility ID: 365559 If continuation sheet Page 9 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy review, facility investigation review and interviews the facility failed to thoroughly investigate and report allegations of sexual abuse to the state survey agency. This affected two residents (Resident #7 and #54) of three residents reviewed for abuse. The facility census was 52.Findings Include:1. Record review revealed Resident #7 admitted to the facility on [DATE] with diagnoses of vascular dementia, alcohol use, flaccid bladder, hydronephrosis, major depressive disorder, hypertension, metabolic encephalopathy, and anxiety.Record review of Resident #7 quarterly Minimum Data Set(MDS) dated [DATE] revealed Resident #7 had severe cognitive impairment, exhibited behaviors and could independently walk at least 150 feet.Record review of Resident #7's assessment for behaviors completed 06/13/25 revealed Resident #7 wandered freely without interruption. Additional factors affecting the resident's behaviors included the resident would become frustrated due to problems communicating discomfort or unmet needs.Record review of Resident #7 assessment for elopement revealed Resident #7 is a high elopement risk due to intermittent confusion, poor safety and environment awareness, and wears a wander guard on their left ankle.Review of Resident #7 record revealed a progress note dated 07/09/25 stating resident was ambulating up and down hall two multiple times throughout the day. No behaviors noted at this time. Patient is laying in his bed in his room, eyes closed, arouses easily, call light in reach.Review of Resident #7 record revealed a progress note dated 07/09/25 authored by Assistant Director of Nursing #6 revealed the resident was noted from staff of having increased sexual behaviors. One on one performed and patient redirectable. Psych nurse practitioner (NP)(not identified) in to see patient awaiting recommendations at this time.Review of Resident #7 record revealed a progress note dated 07/09/25 authored by facility Administrator stating administrator and Director of nursing (DON) notified POA of increased sexual behaviors.Review of Resident #7 care plan completed on 07/09/25 revealed the resident has behaviors including increase sexual behaviors. Interventions include, if reasonable, discussing the resident's behavior. Explain/ reinforce why behavior is inappropriate and/pr unacceptable to the resident and praise any indication of the resident's progress/ improvement in behavior.Record review of Resident #7 paper and electronic medical record revealed no documentation of alleged increased sexual behaviors in relation to the medication order, psych consult, and revised care plan due to sexual behaviors. Record review revealed no documentation of Resident #7 POA being notified of increased sexual behaviors or witnessed observations of being sexually inappropriate with Resident #54.Record review revealed Resident #7 order for cimetidine give 400 milligrams (mg) by mouth (PO) three times a day (TID) for decreased sexual behaviors ordered on 07/16/25.Review of Resident #7's visit and progress note from Psychiatric Mental Health Nurse Practitioner (PMHNP) #626 dated 07/22/25 at 11:55 A.M. stating DON #7 reported the previous week that Resident #7 had pulled a female resident into a room and attempted to pull down her pants. He was caught and re-directed. Resident #7 is a poor historian and has speech issues. The DON reported he roams around the facility most of the day. Resident #7 focused on female residents, one particular who is bedbound and has end stage dementia-they have found him several times in her room with his hand under the blanket. He is found in another resident's room sitting close to her bed. Resident #7 is not allowed alone in female (resident) rooms. Resident #7 is continually re-directed. 2. Record review revealed Resident #54 admitted to the facility on [DATE] with diagnoses including femur fracture, anxiety, hyperlipidemia, dementia, depression, anxiety, constipation, and emphysema.Review of Resident #54 Minimum Data Set (MDS) revealed the resident had severe cognitive impairment and was dependent on staff for activities of daily living (ADL) care. Review of the care plan revealed Resident #54 had impaired cognitive function/dementia or Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 10 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few impaired thought process related to dementia. Interventions included supervising and reorient as needed.Review of Resident #54's progress notes revealed a progress note authored by Administrator #1 on 07/09/25 stating the administrator spoke with resident's power of attorney (POA) regarding a room move to the north end of the facility. POA okay with the move.Review of Resident #54's progress notes revealed a progress note authored by social worker 07/09/25 stating the resident was notified about receiving a new room, resident expressed understanding. Administration notified the POA and is okay with move, no concerns at this time. (Please note, there was no documentation regarding any incidents or concerns regarding the need for the resident's room change).Further review of the medical record revealed no evidence of any inappropriate behaviors between Resident #54 and Resident #7.Interview on 07/30/25 at 12:44 P.M. with Psychiatric Mental Health Nurse Practitioner (PMHNP) #616 revealed she was notified by the facility on 07/09/25 of Resident #7 having increased behaviors. PMHNP #616 stated when the facility called to consult her, they didn't go into detail if anything happened, they just stated Resident #7 had increased behaviors and needed seen. PMHNP #616 stated Resident #7 was then seen on 07/22/25, due to waiting for his paperwork to go through to be seen. Interview on 07/30/25 at 3:32 P.M. with Certified Nurses Aide (CNA) #377 revealed there was a situation between Resident #7 and Resident #54 on 07/08/25 where Resident #7 pushed Resident #54 into his room and was found with his pants down. CNA #377 shared that due to this, Resident #54 was moved away from Resident #7, on the north side of the building. CNA #377 stated they were not sure if anything has been done about this situation, they are unsure if the family was notified of the full extent of the situation, and no one had approached them for statement. Interview on 07/31/25 at 7:05 A.M. with CNA #74 revealed Resident #54 was moved to the north end of the building after a situation, they can not recall the exact date, where Resident #7 was caught pushing Resident #54 into his room, and when staff entered his room, his pants were down. Resident #7 still walks to the north side of the building to find Resident #54, every day. Resident #54 is not cognitively intact, and its concerning that he still walks to the north side and finds Resident #54. CNA #74 did not believe Resident #54's family was notified of the situation, because they had to be redirected to the resident's new room when they visited after the incident. They were observed knocking on her old room door and staff had to direct them to her new room. CNA #74 verified they had not provided a statement or asked about the incident. CNA #74 stated the incident was not investigated by the facility.Interview on 07/31/25 at 7:15 A.M. with Licensed Practical Nurse (LPN) #61 revealed there was a shift, they could not recall the exact date, where Resident #7 was trying to hunt down Resident #54. Resident #54 was still on the south side of the building at this time. LPN #61 stated when they had came back to work the next time (after the incident) Resident #54 had been moved to the north side of the building and was told this was due to Resident #7's behaviors. LPN #61 confirmed Resident #7 still walked over to the north side of the building often and the staff re-direct him to go back to the south side.Interview on 07/31/25 at 7:30 A.M. with CNA #301 revealed a few weeks back, they believed the incident took place on 07/08/25 when they were walking down the hallway, pushing Resident #23. CNA #301 noticed Resident #7 hovering around Resident #54. Earlier in the day, Resident #7 had attempted to give Resident #54 coffee, and was patting her back. While walking down the hallway, CNA #301 noticed Resident #7 had pushed Resident #54 into Resident #7's room, then closed the door behind him. CNA #301 stated that immediately they went to the door, knocked and opened the door. CNA #301 observed Resident #7 attempting to pull his pants down and removing the blanket that had been across Resident #54's shoulders. CNA #301 then notified Nurse #39 and CNA #21 of the situation and that assistance was needed. When Nurse #39 and CNA #21 came to the room, CNA #301 proceeded with Resident #23. CNA #301 stated that day on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 11 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 07/08/25, no one asked her to write a statement. Further interview revealed there was a monthly meeting that day so she thought someone would get her statement after the meeting but no one ever did. CNA #301 shared that in these situations, staff notify the nurse and then someone comes to get statements about what happened. CNA #301 stated on 07/09/25 DON #7 called her and asked about the incident and what happened. CNA #301 stated she gave DON a statement of the incident over the phone and told her the same details as stated in this current interview. CNA #301 then showed this writer a cell phone call log with a 37 minute phone call on 07/09/25 with DON #7 at approximately 12:38 P.M. CNA #301 stated they are not sure if family was notified but when they came back to work Resident #54 had been moved to the north side of the building.Interview on 07/31/25 at 7:55 A.M. with CNA #64 revealed Resident #7 was caught being sexually inappropriate with Resident #54. This resulted in Resident #54 being moved to the north side of the facility to be away from Resident #7. Resident #7 still lingered over to the north side to find Resident #54. CNA #64 stated staff were being told to redirect Resident #7 to the south side due to the incident that took place (on 07/08/25).Interview on 07/31/25 at 8:56 A.M. with CNA #21 revealed on 07/08/25 she was at the nurse's station when CNA #301 called for her and Nurse #39 to help in Resident #7's room. CNA #21 stated when she and Nurse #39 approached Resident #7's room, Resident #54 was in their wheelchair by the bathroom door and Resident #7 was attempting to pull the privacy curtain. Resident #7 had been attempting to pull his pants down. Resident #54 was immediately removed from the room. After the incident took place, Resident #54 was re-located to the north side of the building. CNA #21 shared Resident #7 still walked over to the north side of the building all day long, trying to find Resident #54. CNA #21 stated she was not interviewed the next day regarding the incident with Resident #54 and Resident #7. CNA #21 stated she did not believe Resident #54's family was aware of the situation involving Resident #7 because a few days later Resident #54 family came to visit and they went to her old room on the south end of the building.Interview on 07/31/25 at 11:15 A.M. with CNA #102 revealed on 07/08/25 Resident #54 was in the hallway of the south side of the building and Resident #7 came and was lingering around her, touching her hair, her shoulders, and was re-directed and removed from the area. Resident #7 then began to push Resident #54 in her wheelchair into his room, then he closed the door behind him. Staff went in to assess the situation and found Resident #7 with his pants down. Resident #54 was removed from the room. CNA #102 shared there was no documentation or charting that the event took place. ADON #6 was notified about the incident and told staff Resident #54 would be moved to the north side of the building. CNA #102 confirmed Resident #54's family was not notified of the full extent and nature because she was moved to the north side of the building. CNA #102 stated Resident #7 was ordered a medication to decrease his sex drive but in the documentation and charting there was no rationale as to why it was ordered.Interview on 08/04/25 at 8:12 A.M. with CNA #104 revealed there was an incident with Resident #54 and Resident #7 but they were not working when the incident occurred. CNA #104 stated they do know Resident #54 was moved to the north side of the building due to the incident. CNA #104 stated Resident #7 still comes to the north side of the building to look for Resident #54, he is re-directed to the south side. Resident #7 will find Resident #54 and grope her, relentlessly try to find her. Interview on 08/04/25 at 10:15 A.M. with DON #7 revealed Resident #7 had a fixation with Resident #54, which wasn't typical behavior for Resident #7. Resident #7 would push Resident #54's wheelchair around, become protective over her, and brought her suckers. DON #7 stated Resident #54 had no behaviors and stated Resident #54 had advanced dementia. DON #7 confirmed the reason Resident #54 was moved was because of the fixation Resident #7 had with Resident #54 as they originally resided on the same unit. The DON stated she did not initiate an investigation or report the incident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 12 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few because nothing happened.Interview on 08/05/25 at 8:22 A.M. with CNA #216 revealed Resident #7 was found to be in his room with the door closed and his pants down with Resident #54 present. This lead to Resident #54 being moved to the north side of the building. CNA #216 stated this had not stopped Resident #7 from coming to the north side and seeking Resident #54. CNA #216 stated they are told to re-direct Resident #7 and that was it. Interview on 08/05/25 at 12:53 P.M. with Resident #7's POA #617 revealed they were made aware the facility was making changes to Resident #7 medication regimen but were not sure why. POA #617 stated Resident #7 had dementia, and doesn't speak, is lonely and he had a friend who he would push around in her wheelchair and sit beside, but nothing inappropriate happened however the facility moved her to the other side of the building. POA #617 denied being notified of any sort of inappropriate behaviors or incidents between Resident #7 and Resident #54 causing the medication and room change.Interview on 08/05/25 with Resident #54's POA #619 revealed she was notified of Resident #54's room change. POA #619 stated they were told the room change was due to a gentleman being infatuated with Resident #54. POA #619 was told Resident #54 and Resident #7 would hold hands and Resident #7 would give Resident #54 things like coffee or suckers but since legally neither residents were able to give consent, they felt it was safe to move Resident #54. POA #619 denied any other incidents or behaviors being reported to them by the facility regarding Resident #54 or Resident #7.As of 08/05/25, there was no Self-Reported Incident submitted by the facility to the state survey agency.Interview on 08/07/25 at 10:45 A.M. with ADON #6 revealed, when requesting documents regarding the note written by PMHNP #626, she provided a progress note dated 07/22/25 stating Resident #7 was a male residing at the facility long term care. He was being seen today for initial visit for generalized anxiety disorder, major depressive disorder, dementia, and inappropriate sexual behaviors. ADON #6 also provided a hand written note of what residents were seen by PMHNP on 07/22/25 and what new orders were given to those residents. ADON #6 confirmed this was all the facility had regarding documentation from PMHNP #626 and information related to the incident between Resident #7 and Resident #54.Review of facility policy titled Abuse, Neglect, Exploitation, and Misappropriation of resident property dated 10/27/17 revealed it is the facility's policy to investigate all alleged violations involving abuse, neglect, exploitation, mistreatment of a resident, or misappropriation of a resident property, including injuries of unknown source, in accordance with this policy. Facility staff should immediately report all such allegations to the administrator/designee and to the Ohio Department of Health in accordance with the procedures in this policy. Social services if appropriate should be notified of the incident so that it may take appropriate interventions to care for the psychosocial needs of any involved residents. Documentation in the nurses notes should include the results of the residents assessment, notification of the physician and the resident representative. Immediately report to the administrator or designee, and to the Ohio Department of health of alleged violations involving abuse, neglect, exploitation, mistreatment of a resident or misappropriation of a resident property and injuries of unknown source as soon as possible, but in no event later than 24 hours from the time the incident/allegation was made known to the staff member. Mistreatment is defined as inappropriate treatment or exploitation of a resident. Sexual abuse is defined as non-consensual sexual contact of any type with a resident. Prevention and identification include the assessment, care planning, and monitoring of residents with needs and behaviors which might lead to conflict or neglect. Such behaviors include entering other residents' rooms, residents with self injurious behaviors, residents with communication disorders, and those that require heavy nursing care and/or are totally dependent on staff. Ohio Department of health will be notified by using the online enhanced information dissemination and collection system. The facility will submit an online self (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 13 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete reported incident form in accordance with the Ohio Department of health then current instructions. The administrator will notify the resident or the resident representative, as appropriate, when a report has been made to Ohio Department of health. The facility will initiate an investigation of the allegation. The investigation must be completed within five working days. The investigation protocol includes interview with the resident, the accused, and all witnesses. Witnesses will include anyone who witnessed or heard the incident, came in close contact with the resident the day of the incident including other residents and family members, and employees who worked closely with the accused and or alleged victim the day of the incident. If there are no direct witnesses then the interviews may be expanded. Obtain a statement from each witness. Review the resident records. Evidence of the investigation should be documented. Follow up is required with resident to resident abuse, neglect, exploitation, mystery of a resident, or misappropriation of resident property. The facility will refer the matter to the interdisciplinary team to determine the appropriate interventions.This deficiency demonstrates non-compliance investigated under Complaint Number 2567685. Event ID: Facility ID: 365559 If continuation sheet Page 14 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and policy review the facility failed to maintain accurate care plans. This affected one (Resident #51) of nine residents reviewed. The census was 52.Findings include: Record review revealed Resident #51 admitted to the facility on [DATE] with diagnoses including respiratory failure, type two diabetes, (COPD), gastro-esophageal reflux disease (GERD) osteoarthritis, anemia, atherosclerotic heart disease, insomnia, schizophrenia hypercholesterolemia, overactive bladder, borderline personality disorder, hypothyroidism, pyoderma, hypertension, anxiety major depressive disorder, chronic kidney disease, kidney failure, and , renal dialysis dependent. Review of Resident #51 orders revealed an order for hemodialysis every Monday, Wednesday, and Friday for renal failure. Review of Resident #51 minimum data set (MDS) revealed a brief interview for mental status (BIMS) score of 15, indicating Resident #51 was cognitively intact. Review of Resident #51 care plan completed 04/11/25 revealed the resident needed hemodialysis related to renal failure. Goals included the resident will have immediate intervention should any signs or symptoms of complications from dialysis. Interventions include encouraging the resident to go for the scheduled dialysis appointments. The resident receives dialysis at (dialysis center) in St Clairsville on Monday, Wednesday, Friday at 10:30 A.M. Monitor vital signs and notify medical doctor (MD) of significant abnormalities. Monitor, document, report as needed (PRN) for signs and symptoms of renal insufficiency such as changes in level of consciousness, changes in skin turgor, oral mucosa, and changes in heart and lung sounds. Check AV fistula site thrill/bruit; palpate/feel to assess for thrill and auscultate for bruit as ordered. Interview on 07/30/25 at 7:30 A.M. with (name of dialysis center) of St. Clairsville revealed Resident #51 no longer came to their facility for dialysis. (Name of dialysis center) of St. Clairsville revealed Resident #51 used to receive dialysis on their campus but [NAME] for quite some time. Interview on 07/30/25 at 10:34 A.M. with (name of dialysis center) Administrative Assistant of Bridgeport confirmed Resident #51 received dialysis at their location. Interview on 07/30/25 at 4:54 P.M. with Resident #51 confirmed she did not attend dialysis in St. Clairsville, but attended dialysis at (dialysis center) of Bridgeport. Review of Rolling Hills undated policy titled Care Planning- Interdisciplinary Team revealed the facility's care planning [NAME] is responsible for the development of an individualized comprehensive care plan for each resident. The care plan is based on the resident's comprehensive assessment and is developed by Care Planning/ Interdisciplinary Team which includes but is not limited to the following personnel: the resident, attending physician, the registered nurse who has responsibility for the resident, the social service worker, the director of nursing, and others as appropriate or necessary to meet the needs of the resident. This deficiency is an incidental finding discovered during the complaint investigation. Event ID: Facility ID: 365559 If continuation sheet Page 15 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. 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 interview, the facility failed to ensure operations were conducted in a manner that supported and encouraged the highest level of resident care, as staff were prohibited from speaking freely with state agency personnel, which hindered their ability to advocate for residents without fear of retaliation. The facility administration also failed to ensure contracted staff were not asked to alter legal documents contained within resident medical records. This affected one resident (#7) and had the potential to affect all 52 residents residing in the facility.Findings include:During the onsite investigation the following concerns were identified related to administrative oversight in the facility and the ability for staff to openly communicate with state agency survey staff:a. Interview on 07/30/25 at 3:33 P.M. with Anonymous Staff Member (ASM) #707 revealed staff were targeted after surveys if they speak with the state survey agency. The interview revealed there was a fear of retaliation and staff losing their jobs or being treated differently as a result of speaking with state surveyors. Interview on 07/30/25 at 5:45 P.M. with ASM #406 revealed there was a fear of retaliation from management for advocating for residents and speaking with surveyors during survey. ASM #406 revealed staff were told by DON #1 that staff were required to tell management what was discussed with surveyors. Management watched staff speaking with surveyors and following conversations, management would pull staff away from whatever they were doing to interrogate you. Staff were also coached that as soon as the state survey agency walked into the building, they were told what information they could talk about and information they could not give to the surveyors. ASM #406 stated staff fear retaliation from management if they were caught talking to the state survey agency/surveyors.Interview on 07/30/25 at 6:00 P.M. with ASM #407 revealed management does not want staff to speak with the state survey agency when they come in and staff were encouraged not to speak with the surveyor. Staff were told essentially to cover for the facility if there were any issues or concerns. Staff members were coached on topics to steer away from and told if they have to lie, they can. Management sit and watch the cameras and would watch who, and when someone talked with a surveyor. Management staff would then question whoever they see speaking to them questioning what was asked and what information they provided to the state survey agency. ASM #407 revealed management only seemed to watch the cameras when state staff were in the building. This made staff fear retaliation. ASM #407 revealed this was being done by Director of Nursing (DON) #7 and Administrator #1.Interview on 07/30/25 at 6:15 P.M. with ASM #401 revealed there was a fear amongst staff for talking to surveyors initiated by management. ASM #401 stated management had interfered with surveys by coaching staff on what to talk about with surveyors and topics to steer away from, Administrator #1 has told staff to lie about certain topics. ASM #401 stated staff would avoid being seen conversing with surveyors because if they were caught, staff get pulled into the office. ASM #401 stated there was a fear of retaliation, a lot of favoritism was shown by management and staff were targeted after surveys if they were suspected of coming forward with information.Interview on 07/31/25 at 6:00 A.M. with ASM #405 revealed staff were coached by administration during surveys with the state survey agency. Management would pull staff into offices or rooms and staff were told not to volunteer information and if staff didn't want to answer something to come and get management, but don't bring up anything to the surveyors. If staff get caught speaking to a surveyor they were hounded on what was talked about and what information was given. This has been done by DON #7, Administrator #1 and a corporate staff member (unable to recall name) on different occasions. Interview on 07/31/25 at 11:27 A.M. with ASM #501 revealed there was a fear of retaliation from management if staff talked to surveyors and educated/protected the Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 16 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many residents. ASM #501 stated staff were coached to steer away from certain topics, and management somewhat told staff what to say in situations. ASM #501 revealed no staff wanted to talk to state surveyors because if staff were caught talking by management they would get pulled into the office or a private room and asked what was talked about, what was asked, what was said, what the state surveyor said etc Certain employees would be followed around to try to prevent them from speaking to state staff or to overhear their conversations. Further interview revealed this had lead to a decline in resident care because staff were fearful of retaliation negatively affecting the residents.Interview on 07/31/25 at 11:34 A.M. with ASM #502 revealed staff fear retaliation from management. Staff jobs were threatened if management heard staff speaking with state surveyors. ASM stated the staff felt like they became a target. When state staff entered the facility things weren't handled appropriately. ASM #502 revealed if staff brought up a concern, especially resident concerns it seemed like it became hidden and brushed under the rug as if it never happened. Interview on 08/04/25 at 7:03 A.M. with ASM #701 revealed staff were uneasy about speaking with state surveyors due to fear of retaliation from management. ASM #701 stated management had coached staff on what to say to surveyors. Staff were told to keep conversations short, sweet, and vague. Staff were told over and over by management that state is not your friend. If staff were caught speaking with state surveyors there were asked what was talked about and any specific questions the surveyor(s) asked. ASM #701 stated they fear retaliation from management, management was very spiteful and staff might end up losing their job as a result. b. Interview on 08/05/25 at 10:15 A.M. with DON #7 revealed Resident #7 had a fixation with Resident #54, which wasn't typical behavior for Resident #7. Resident #7 would push Resident #54's wheelchair around, become protective over her, and brought her suckers. DON #7 stated Resident #54 had no behaviors and stated she had advanced dementia. DON #7 stated Resident #54 and Resident #7 family's were looped in on the situation. DON #7 confirmed as a result Resident #7 was moved to the other side of the building, to the north end because originally Resident #7 and Resident #54 were on the same hallway. DON #7 stated she did not perform an investigation or report an allegation to the state agency because nothing happened. Interview on 08/07/25 at 10:20 A.M. with Viaquest Mental Health Nurse Practitioner (MHNP) #626 revealed Resident #7 was seen on 07/22/25, there had been a completed psychiatric note since that date, the facility was aware of the note and had access, it was an 11 page document, which included the DON made Viaquest staff aware of sexually inappropriate behaviors displayed by Resident #7 towards a female resident.On 08/07/25 at 10:45 A.M. the surveyor requested documents for Resident #7. A note was provided written by MHNP #626 dated 07/22/25 which included Resident #7 was a [AGE] year old male residing at Rolling Hills LTC. He was being seen today for initial visit for generalized anxiety disorder, major depressive disorder, dementia, and inappropriate sexual behaviors. ADON #7 also provided a hand written note of what residents were seen by MHNP on 07/22/25 and what new orders were given to those residents. ADON #6 confirmed this was all they had regarding notes from MHNP #626 and information regarding the incident between Resident #7 and Resident #54.During an interview on 08/07/25 at 11:15 A.M. Assistant Director of Nursing (ADON) #6 and DON #7 were notified of the state agency surveyor's awareness of an 11 page psych note (requested to be reviewed as part of the survey investigation) written by the MHNP on 07/22/25 for Resident #7.On 08/07/25 at 12:28 P.M. Regional Director of Operations (RDO) #614 provided the psych note for Resident #7 written on 07/22/25 and also provided two witness statements regarding an incident on 07/08/25. Review of the witness statements provided by RDO #614 revealed one statement was not written until 08/05/25 regarding an incident on 07/08/25 and the other was an undated statement written by DON #7 stating she investigated the incident and got statements. On 08/04/25 at 10:15 A.M. interview with DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 17 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete #7 regarding the incident on 07/08/25, revealed she did not gather witness statements regarding the sexually inappropriate incident between Resident #7 and Resident #54 because nothing happened. No documents of investigation were provided to the surveyor for review during the onsite investigation regarding a sexually inappropriate incident between Resident #7 and Resident #54 until 08/07/25 at 12:28 P.M. This information had been repeatedly requested since 07/31/25. Documents were provided after this surveyor confirmed with MHNP that Resident #7 was seen on 07/22/25 and after DON #7 confirmed on 08/04/25 at 10:15 A.M. and ADON #6 confirmed on 08/07/25 at 10:45 A.M. there was no other documentation regarding the incident.Review of an email sent to the state agency surveyor from MHNP #626 on 08/08/25 at 4:33 A.M. revealed the documentation for Resident #7 has been completed but the facility was now attempting to recant the information they were given on this patient. The MHNP has been contacted repeatedly by facility management and asked to change the verbiage and persons involved with Resident #7.This deficiency demonstrates non-compliance investigated under Master Complaint Number 2576098. Event ID: Facility ID: 365559 If continuation sheet Page 18 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and observation, the facility failed to maintain a clean, safe, comfortable and sanitary environment. This had the potential to affect all 52 residents residing in the facility. Findings include: During the onsite complaint survey, the following information was obtained:a. Interview with Certified Nursing Assistant (CNA) #104 on 07/30/25 at 8:51 A.M. revealed there was mold across the whole building. They have recently had several water leaks, on the north side. The water leaks included the washer. CNA #104 stated they were unsure if it was due to a leak, or an overflowing of water but regardless a large amount of water came out onto the floor of the laundry room, and the entire vending machine room carpet was soaked. CNA #104 confirmed the water mark on the carpet of the vending machine room and a strong musty smell. CNA #104 stated there was a musty foul odor throughout the building, however it is the strongest in the vending machine room. CNA #104 stated the AC units of the resident rooms also have a wet/musty smell.b. Interview with CNA #377 on 07/30/25 at 3:32 P.M. revealed there was a strong musty smell in the facility. CNA #377 stated you are also able to smell this odor when in resident rooms. CNA #377 stated they were concerned about the smell, along with things they've seen that could be mold that is affecting the residents and staff.c. Interview on 07/30/25 at 3:10 P.M. with Licensed Practical Nurse #60 revealed there was a foul odor to the building, not a normal odor but almost like a musty wet odor. Nurse #60 stated nothing was being done about this. The Nurse stated there was a concern for residents especially those with chronic respiratory issues.d. Interview on 07/30/25 at 4:24 P.M. with LPN # 61 revealed there is a mold issue in the building, and the facility was aware, but not addressing the issue appropriately. LPN #61 stated they took a water hose and sprayed the AC unit grills after the last inspection. Resident #17 on the south side of the building had mold in it, and a musty odor. LPN #61 stated on the north end of the building a hot water tank leaked into the carpeted crash cart room, behind the nurses station, and that room smells musty and there was a concern mold or something may be growing under the carpet because after the water flooded into the room, it was never cleaned, to their knowledge.e. Observation with Maintenance #600 on 07/30/35 between 4:46 P.M. and 4:50 P.M. confirmed there was an unknown black speckled substance on the air-conditioning unit of room [ROOM NUMBER], the soiled linen room on the north side of the building, in the back right bottom corner there was a moderate amount of a black, unknown substance along the wall and the crash cart room had a strong foul musty odor. Maintenance #600 stated the hot water tank in the room sharing a wall to the crash cart room had leaked. He confirmed the carpet was not pulled up to assess for the cause of the odor or any damage from the water leak.f. Interview on 07/30/25 at 5:45 P.M. with CNA #300 revealed there was a concern with mold in the building. CNA #300 stated it was probably the worst in the vending machine room and if you lifted up weak spots in the carpet of the vending machine room, it is disgusting underneath, CNA #300 stated they were not sure what was under the carpet but it isn't good and along the wall there was a black substance that wasn't always been there. CNA #300 confirmed the vending machine room had a strong musty odor. CNA #300 stated nothing was being done about the root cause of the odors and black substances across the building, but every once in a while management would put out air fresheners or spray air freshener.g. Observation on 07/31/25 at 6:46 A.M. revealed one resident was sitting in the vending machine room. There was a small stand-up portable white air conditioner in the room. There is a strong musty/damp odor to the room.h. Interview on 07/31/25 at 7:00 A.M. with anonymous staff member #459 stated they had a concern about mold within the facility. They stated a lot of people feel sick when they come to work, especially when working a long stretch of days, then when you have a few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 19 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many days off you feel better and the cycle repeats. Anonymous staff member #459 stated if staff were feeling like this, it wasn't good for the residents who are in the facility 24/7. They stated on the north side of the building there was a leak in the laundry room, which shared a wall with the vending machine room, now there are several flies and gnats that swarm in the vending machine room and it had a strong very musty odor. They confirmed this is a common area for residents, visitors, and family to sit in and socialize.i. Interview on 07/31/25 at 7:55 A.M. with CNA #64 revealed the whole building smelled moldy/mildewy. CNA #64 stated that specifically on the north side, in the vending machine area, was the worst. There was a water leak in the laundry room and the water went to the vending machine room, as they share a wall, and the carpet was soaked. Ever since this incident they have had flies and gnats that seem to be getting worse. The crash cart room behind the nurses station on the north side of the building had a smell to it, the same throughout the building a wet musty smell; this had been since a water leak in the hot water room which shares a wall with the crash cart room. The room smelled very musty and its warm so it made it worse. CNA #64 stated several rooms and areas in the building have no ventilation so the leaks, dampness, warmth, and lack of ventilation make the smell horrible and concern for mold growth.j. Interview on 07/31/25 at 8:23 A.M. with CNA #34 revealed there was a previous water issue with some leaks across the building. She stated the carpet held a lot of stuff causing the musty wet odors. CNA #34 stated there are a few rooms along the 400 hall which smell musty. k. Interview on 07/31/25 at 8:56 A.M. with CNA #21 revealed the building was extremely hot and stuffy. There was a sewer smell that came from the south side shower room. CNA #21 stated she assumed there was mold on the north side of the building from where water leaked out of the laundry room and one of the hot water tanks. CNA #21 stated there is a mildew smell in the vending machine room and in the crash cart room behind the nurses station, it was a strong smell.l. Observation on 07/31/25 at 9:26 A.M. of Resident #34 room revealed a foul odor in the bathroom, and an unknown black substance lined along the perimeter of the room. Observation revealed housekeeping had been in to clean the room on 07/31/25. This was confirmed at 9:30 A.M. with CNA #301.m. Observation on 07/31/25 at 10:30 A.M. with Assistant Director of Nursing #6 of Resident #34's bathroom revealed a black unknown substance around the perimeter of the bathroom and there was a musty odor upon entry. Housekeeping had been in to clean the room previously on 07/31/25. The ADON confirmed it is there; this would not be okay in her home. Observation of Resident #34's closet door revealed a ribbon was wrapped around the door and several sewing pin needles were sticking out of the ribbon. This was also verified during the observation.n. Interview with anonymous staff member #450 on 07/31/25 at 11:17 A.M. revealed there was mold all over the building, the north side bathroom is disgusting. The north side public bathroom had a foul odor, constantly, cleaning doesn't help. There was an unknown substance built around the walls and parts of the walls are not in good repair. There was a leak on the south side of the building on the 200 hall, they were told to throw down towels and blankets and eventually a plumber would be called. Anonymous staff member #450 stated there was a musty smell across the building, possibly from all the water leaks/bursts across the north and south side. They stated there was a musty smell coming from the shower rooms and several resident bathrooms had a foul odor. Anonymous staff member #450 stated the vending machine room had a foul smell. There was a leak in the laundry room and leaked into the vending machine room for four days straight, the solution again was to throw towels and blankets over it. The vending machine room was a common area where residents would sit, rest, and socialize with each other.o. Interview on 07/31/25 at 11:35 A.M. with anonymous staff member #483 revealed there was a mold issue thought the building. Several pipes busted and flooded areas around the 200 hall, in the laundry room, and vending machine room and nothing was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 20 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete done about it. Anonymous staff member #483 confirmed there was a musty, damp smell throughout the building and hallways. Nothing was done after the pipes busted in relation to the water filling up the hallway carpeting and walls, and the vending machine room.p. Observation on 07/31/25 at 2:00 P.M. of Resident #32's air conditioning vent revealed an unknown black and white fuzzy substance, speckled along the vent. This was confirmed with CNA #64 at 2:05 P.M.q. Observation on 07/31/25 at 3:05 P.M. with Facility administrator confirmed a moderate amount of a black unknown substance in the vending machine room in the corner behind the 7 up machine. Substance is a black unknown substance behind the 7 up machine in the corner. A green wall paper is seen peeling back revealing a moderate amount of an unknown black speckled substance.r. lnterview on 07/31/25 at 2:45 P.M. with Anonymous staff member #481 revealed the mold was the biggest concern they had. The carpet needed ripped up, there are pipes that had burst and water leaked all over the carpet Anonymous staff member #481 stated the smell was horrible from the carpet due to the water leaking. The worst area was probably the vending machine room after a pipe busted and leaked into the room for a few days. Anonymous staff member #481 was concerned the air ducts in the building were full of mold. She stated there was a smell to them and there would be black speckles along the vents. Anonymous staff member #481 stated the public bathrooms were in bad shape. These bathrooms have water leaking under the sink, and it smells foul all the time. Anonymous staff member #481 revealed they have respiratory issues when they're in the building, then when they have a few days off in a row they feel better. Anonymous staff member #481 stated several staff members have brought up concerns of mold and resident wellbeing in the building but nothing was done about it.s. Interview on 08/04/25 at 12:00 P.M. with Anonymous staff member #453 stated there was a mold issue across the facility. The mold was in the vents, under carpets, and behind wall paper. Anonymous staff member #453 stated in the vending machine room the odor was horrible, the whole building smelled musty and wet. There was a leak from the laundry room leading into the vending machine room and the north hallway, they didn't properly clean the carpet; the solution was throwing towels and blankets over the water until it dried. Anonymous staff member #453 stated lots of staff have been sick and believe the current state of the building is the cause because when they have a few days off they feel fine. Anonymous staff member #453 stated there are residents who are often respiratory sick and they're not checking to see if the mold is a cause at this time.t. Observation on 08/07/25 at 11:40 A.M. revealed a strong, foul smelling sewer- rotten egg- like odor in the south side shower room. This was confirmed with CNA #11 at 11:45 A.M.This deficiency demonstrates non-compliance investigated under Master Complaint Number 2576089 and Complaint Numbers 2567685, 1282969 and 1282968. Event ID: Facility ID: 365559 If continuation sheet Page 21 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, and interviews the facility failed to provide an effective pest management program. This had the potential to affect all 52 residents residing in the facility.Findings include:a. Interview on 07/30/25 at 9:00 A.M. with Certified Nursing Assistant (CNA) #104 confirmed the flies were horrible around the building. There was also an issue with the gnats however the flies were more prevalent. CNA #104 believed the flies and gnats were possibly due to the musty odor and the dampness of the carpeting and air conditioning units. CNA #104 stated the gnats and flies could also be from the lack of having a housekeeper daily. CNA #104 confirmed flies were often found in resident rooms.b. Interview on 07/30/25 with Licensed Practical Nurse (LPN) #61 at 4:40 P.M. revealed the flies in the building were horrible. There was a resident who had them in his room and he required cream on his legs. The flies will swarm around his legs, and you have to ensure the flies do not stick to them. Families have brought in bug spray because it's gotten so bad. LPN #61 stated staff are being told someone is going to come in and spray the building, but nothing is done about it and the amount of flies is becoming worse.c. Interview on 07/31/25 at 7:00 A.M. with anonymous staff member #459 stated on the north side of the building in the vending machine room there are several flies and gnats that swarm in the vending machine room and it has a strong, musty odor. They confirmed this is a common area for residents, visitors and families to sit and socialize.d. Interview on 07/31/25 at 7:35 A.M. with Anonymous staff member #489 revealed there was an issue with gnats and flies in the building and in resident rooms. Anonymous staff member #489 stated there were no screens on the residents' windows. Anonymous staff member #489 stated this may be where the flies and gnats are coming from however, they were unsure of an exact cause.e. Interview on 07/31/25 at 7:55 A.M. with CNA #64 revealed the facility currently had fly and gnat issues that seem to be getting worse and some families have been bringing in bug spray (no families identified).f. Observation during interview on 07/31/25 at 8:23 A.M. with CNA #34 two gnats flew by, confirmed with CNA #34.g. Interview on 07/31/25 at 8:58 A.M. with CNA #21 revealed there were gnats and flies throughout the building, more flies than gnats. CNA #21 stated staff and residents were getting bit so bug spray was brought in by a few people for residents and staff use. h. Observation on 07/31/25 at 9:59 A.M. of the north side nurses station revealed a black container with four unopened mighty shakes and two unopened magic cups were noted at the desk. Three flies were observed swarming around the shakes and cups. This observation was confirmed with CNA #370. Upon observation of the crash cart room at the north side nurses' station, a gnat was flying around this writer's face.i. Observation and interview on 07/31/25 at 2:10 P.M. of Resident #37 revealed she has a pink fly swatter sitting on her bedside table. Resident #37 stated she requested her family bring it in because there are flies everywhere, they swarm around you, land on you and your stuff so she keeps that beside her.j. Interview on 07/31/25 at 2:15 P.M. with Power of Attorney (POA) #620 confirmed there was an issue with flies in the building, and stated its gross. At one time there was four flies flying around her family member's room at one time when they walked in. She is unsure what is causing the problem but its an issue that wasn't getting resolved.k. Interview on 07/31/25 at 2:28 P.M. with POA #625 stated the gnats and flies were all over the place, you were constantly swatting them away from you or your family. They stated they have brought in a fly swatter before.l. Interview on 07/31/25 at 2:45 P.M. with Anonymous staff member #70 confirmed there was a fly issue in the building and it seemed to get worse this past summer.m. Interview on 08/06/25 at 12:06 P.M. with anonymous staff member #102 revealed there was a significant fly problem in the building. Anonymous staff member #102 stated Resident #19 always has so many flies in their room as well as Resident #22 and Resident #36.This deficiency demonstrates non-compliance investigated Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 22 of 23 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 365559 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rolling Hills Rehab and Care Ctr 68222 Commercial Drive Bridgeport, OH 43912 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 0925 under Master Complaint Number 2576098. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365559 If continuation sheet Page 23 of 23