Inspection·September 5, 2023

F 0677 totally dependent on two staff for bed mobility, transfers, toilet use, and bathing. Level of Harm - Minimal harm or potential for actual harm Review of bathing documentation for Resident #6 revealed he was scheduled to be bathed on Tuesdays and Fridays. There was no documented evidence of Resident #6 being bathed on 08/01/23 and 08/22/23. Review of Skin Sweep form revealed Resident #6 received a bed bath on 08/04/23, 08/08/23, 08/11/23, 08/15/23, refused on 08/18/23, and received a bed bath on 08/24/23 and 08/29/23. Residents Affected - Few Interview on 08/30/23 at 11:02 A.M. Resident #6 revealed he was not getting bathed and had been given only three showers in seven weeks. Resident #6 stated he would like to have more showers. Interviews on 08/30/23 and 08/31/23 with Resident #3, #4, and the family of Resident #40 revealed bathing was not being done as scheduled and residents were not provided showers very often. On 09/05/23 at 11:30 A.M. the Regional Director of Operations revealed Resident #6 was not able to sit in a wheelchair for a shower, but therapy had worked with him, and he had resumed taking showers. On 09/05/23 at 2:59 P.M. the Regional Director of Operations verified there was no further documented evidence of showers or bed baths for Resident #6. 3. Review of the medical record revealed Resident #86 was admitted on [DATE] with diagnoses including hemiplegia and hemiparesis, aphasia, polyneuropathy, cerebral infarction, contracture, type two diabetes mellitus, and dementia. Review of the quarterly MDS assessment dated [DATE] revealed Resident #86 had severe cognitive impairment and required extensive assistance of two staff for bed mobility and total dependence of two staff for transfers and bathing. Review of the bathing documentation for Resident #86 revealed she was scheduled to be bathed on Wednesdays and Fridays. There was no documented evidence of Resident #86 being bathed on 08/02/23, 08/11/23, and 08/16/23. Interviews on 08/30/23 and 08/31/23 with Residents #3, #4, and the family of Resident #40 revealed bathing was not being done as scheduled and residents were not provided showers very often. On 09/05/23 at 2:59 P.M. the Regional Director of Operations verified there was no further documented evidence of showers or bed baths for Resident #86. This deficiency represents non-compliance investigated under Master Complaint Number OH00145680 and Complaint Number OH00145591. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 2 of 8 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 365572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastland Rehabilitation and Nursing Center 2425 Kimberly Parkway East Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of the facility Perineal Care policy and procedure and family and staff interview, the facility failed to implement adequate skin risk interventions, including timely incontinence care and treatment for Resident #34, who was cognitively impaired, at risk for pressure ulcer development and dependent on staff for turning and repositioning, to prevent the development of a pressure ulcer to the resident's coccyx. Residents Affected - Few Actual harm occurred on 08/13/23 at 7:04 A.M. when a reddened area was noted to Resident #34's coccyx area without evidence of effective preventative measures being in place or additional interventions implemented at that time. On 08/14/23 at 10:13 P.M. the Wound Certified Nurse Practitioner (CNP) assessed Resident #34 to have a Stage III (full-thickness loss of skin, in which adipose (fat) is visible in the ulcer. Slough and/or eschar may be visible) pressure ulcer to the coccyx. However, treatment orders were not implemented until 08/16/23 when an order was received for the application of Desitin 40-percent (provides a protective barrier with maximum-level of zinc oxide) to be applied every shift. This affected one resident (#34) of three residents reviewed for pressure ulcers. The facility census was 86. Findings include: Review of the medical record revealed Resident #34 was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included encephalopathy, dysphagia, subarachnoid hemorrhage, history of transient ischemic attack, and dementia. Review of the plan of care dated 07/11/22 revealed Resident #34 was at risk for skin breakdown. Interventions included to encourage and assist Resident #34 to turn and reposition as tolerated, keep skin clean, dry, and odor free, and staff to apply barrier cream after each incontinent episode. An additional plan of care dated 07/11/22 revealed Resident #34 had activities of daily living self-care performance deficit. Interventions included to apply moisture barrier to buttocks, noted the resident required extensive assistance of two (staff) for bed mobility, and included an intervention for the resident to be checked for incontinence every two hours. A plan of care dated 07/27/22 revealed Resident #34 had incontinence of bowel and bladder. Interventions included to apply moisture barrier to buttocks, document when incontinent, and use pads/briefs to manage incontinence. A plan of care dated 11/17/22 revealed Resident #34 had the potential for changes in mood/behaviors and refused care, medications, and treatments at times. Interventions included to administer medications as ordered and behavioral health consult as needed. Review of the Braden Scale for Predicting Pressure Sore Risk assessment, dated 04/21/23 revealed Resident #34 was at risk for the development of pressure sores. A physician's order dated 07/13/23 revealed Resident #34 was to have house barrier cream applied with each incontinence episode. The resident also had orders to encourage to turn and reposition every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 3 of 8 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 365572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastland Rehabilitation and Nursing Center 2425 Kimberly Parkway East Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 two hours as tolerated, encourage to float heels as tolerated, and pressure reducing mattress to bed. Level of Harm - Actual harm Review of incontinence documentation from 08/02/23 to 08/30/23 revealed incontinence care was documented as only being provided once a day on 08/03/23, 08/06/23, 08/08/23, 08/10/23, 08/18/23, 08/25/23, 08/26/23, and 08/28/23. The other days in August 2023, staff documented the provision of incontinence care for the shift as opposed to with each episode of incontinence. Residents Affected - Few In addition, review of the administration records revealed no evidence staff documented turning and repositioning every two hours for the resident. A weekly skin assessment dated [DATE] revealed Resident #34 had no reddened areas, rash, bruises, blisters, dry/flaky skin, or open lesions, cuts, lacerations, skin tears, wounds, or open ulcers at this time. A general progress note dated 08/13/23 at 7:04 A.M. revealed Resident #34 screamed all night and fights staff during patient care. The note documented it was hard to turn Resident #34 every two hours. A reddish area was noted to Resident #34's sacral area. The note documented the nurse cleansed the area with normal saline and notified the director of nursing, physician, and family. However, there was no other assessment/description of the area to Resident #34's coccyx noted in the medical record on 08/13/23 and no evidence any new interventions were considered/implemented in regard to staff having difficulty with turning the resident or fighting with staff during care. A wound care note by the Wound CNP dated 08/14/23 at 10:13 P.M. revealed Resident #34 had a Stage III pressure ulcer to coccyx that measured 1.3 centimeters (cm) long by 1.5 cm wide with a depth of 0.1 cm. There was a shallow open area with granulation tissue and a scant amount of serous (thin, watery, clear) drainage. The peri wound appeared to be macerated (resulting from when skin is in contact with moisture for too long). The note indiciated the area was to be cleansed with soap and water and Desitin 40-percent was to be applied with the wound left open to air. The note revealed the area was to be offloaded regularly and Resident #34's brief was to be left off at night. A physician order dated 08/14/23 at 2:46 P.M. revealed Resident #34 was ordered an air mattress (following the development of the pressure ulcer) and moisture barrier cream (already ordered prior to the development) to coccyx area with each incontinence episode. A physician order dated 08/16/23 at 6:33 A.M. (two days after the pressure ulcer was assessed by the wound CNP) revealed an order was received for Resident #34's coccyx area to be cleansed with soap and water and Desitin 40-percent to be applied every shift. Review of the treatment administration record (TAR) revealed the first new treatment following the identification of the ulcer on 08/13/23 was Desitin 40-percent, documented as being applied on 08/16/23 on day shift and night shift. Further review of the TAR revealed the treatment was not completed on day shift on 08/17/23. The TAR reflected on the evening shift on 08/17/23 a treatment of Zinc Oxide was applied, until Desitin 40-percent was received. A wound care note by Wound CNP dated 08/22/23 revealed Resident #34 was a long-term resident that was nonverbal with dementia lying in bed yelling. Resident #34 began yelling when the provider entered the room. After much encouragement, Resident #34 was able to be redirected so her bottom could be assessed. Resident #34 had a Stage III pressure ulcer to the coccyx that measured 1.4 cm length by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 4 of 8 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 365572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastland Rehabilitation and Nursing Center 2425 Kimberly Parkway East Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 1.6 cm width with 0.1 cm depth. The wound base had 100-percent granulation tissue and the peri wound area appeared macerated. Zinc Oxide cream was to be applied every shift and as needed. Level of Harm - Actual harm Residents Affected - Few A wound care note by Wound CNP dated 08/29/23 revealed Resident #34 was confused, obese, and incontinent. Resident #34 had a Stage III pressure wound to the coccyx that measured 1.2 cm length by 1.4 cm width with 0.1 cm depth. The wound base had 100-percent granulation tissue. The peri wound area appeared macerated and Zinc Oxide cream was to be applied every shift and as needed. Interview on 08/31/23 at 2:49 P.M. with Mobile Director of Nursing (DON) #500 revealed Resident #34 was found with a probable Stage I (no-blanchable redness of a localized area usually over a bony prominence) pressure ulcer on 08/13/23 that deteriorated to a Stage III pressure ulcer on 08/14/23. Interview on 08/31/23 at 3:47 P.M. with Assistant Director of Nursing (ADON) #248 revealed Resident #34 had a small open area that was staged as a Stage III pressure ulcer by the Wound CNP on 08/14/23. Interview on 08/31/23 at 4:10 P.M. with a family member of Resident #34 revealed concerns related to the resident's skin breakdown. The family member revealed the the facility had called her and said Resident #34 had an area to her bottom, but it was not open. The family member stated Resident #34 always had an incontinence brief on and she was unable to tell if Resident #34 was soiled. The family member stated there was a turn schedule hanging in Resident #34's room, so she did not understand how Resident #34 developed a pressure ulcer to her bottom. The family member stated she felt an air mattress should have been put in place prior to Resident #34 developing a pressure ulcer because Resident #34 did not want to get out of bed very often. Interview on 08/31/23 at 4:34 P.M. with Licensed Practical Nurse (LPN) #209 revealed Resident #34 would fight with staff at times and would yell out as soon as someone entered her room. At the time of the interview, observation wtih LPN #209 verified a turning schedule was posted on the wall next to Resident #34's bed with 4:00 PM showing Resident #34 should be on left side. LPN #209 verified Resident #34 was observed lying on her back at that time. LPN #209 also verified the turn schedule showed Resident #34 was to be turned every two hours from side to side and not onto her back. Interview on 08/31/23 at 4:40 P.M. with State Tested Nursing Assistant (STNA) #268 revealed it required two staff to turn Resident #34 because Resident #34 would fight the staff. STNA #268 stated Resident #34 did not get out of bed and staff were required to turn the resident every two hours. Interview on 08/31/23 at 4:46 P.M. with STNA #256 revealed the turning chart hanging in Resident #34's room was old and was for the previous resident. STNA #256 stated a clear cream was to be applied by STNA staff to Resident #34's buttocks and coccyx because Resident #34 had an area to her bottom before. On 09/05/23 at 11:30 A.M. interview with the Regional Director of Operations (RDO) revealed Desitin cream was purchased by central supply on 8/16/23 due to the facility not having any Desitin. The formulary (list of medications that may be prescribed) revealed Zinc Oxide would replace Desitin, so Desitin was discontinued and Zinc Oxide was ordered. The RDO revealed the Wound CNP's recommendation for Resident #34 not to wear a brief at night was placed inside Resident #34's closet and communicated to the STNA's during report. The Regional Director of Operations verified Resident #34 had been in the same room since admission on [DATE]. The Regional Director of Operations also verified STNA staff were responsible for charting incontinence care every shift. The RDO revealed if the STNA staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 5 of 8 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 365572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastland Rehabilitation and Nursing Center 2425 Kimberly Parkway East Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0686 Level of Harm - Actual harm Residents Affected - Few did not chart every shift, they were called to come back to work and complete the documentation or follow up with discipline process. There had been a turnover in staff and some of the staff did not follow instructions. The resident continued to be treated for the Stage III pressure ulcer at the time of the survey. On 09/05/23 at 2:30 P.M. the Regional Director of Operations revealed Desitin had been stopped after being applied twice, not because of formulary, but because there was not enough Desitin to cover the treatments for the upcoming days. The order to apply Desitin was discontinued and a new order was given to apply Zinc Oxide until Desitin became available. Review of Perineal Care Policy and Procedure revised October 2010 revealed the resident's care plan should be reviewed to assess for any special needs of resident. The following information should be recorded in the resident's medical record: the date and time the perineal care was provided and any discharge odor, bleeding, skin care problems or irritation, and complaints of pain or discomfort. This deficiency represents non-compliance investigated under Master Complaint Number OH00145680. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 6 of 8 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 365572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastland Rehabilitation and Nursing Center 2425 Kimberly Parkway East Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interviews, and policy review the facility failed to provide appropriate incontinence care for Resident #50. This affected one resident (#50) out of three residents reviewed for incontinence. The facility census was 86. Findings include: Review of the medical record revealed Resident #50 was admitted on [DATE] with diagnoses including heart failure, type two diabetes mellitus, legal blindness, and polyneuropathy. Review of the care plan dated 05/26/23 revealed Resident #50 was incontinent of bowel and bladder. Interventions included to check for incontinence, clean and dry skin if wet or soiled, document when incontinent, and use pads/briefs to manage incontinence. The care plan dated 06/30/23 revealed Resident #50 had activities of daily living self-care performance deficit. Interventions included checking for incontinence every two hours and as needed, clean and dry skin if wet or soiled, and use pad/briefs to manage incontinence. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #50 was cognitively intact. Resident #50 required extensive assistance of two staff for bed mobility, total dependence of two staff for transfers, and extensive assistance of two staff for toilet use. Resident #50 was always incontinent of bowel and bladder. Review of the urinary continence documentation from 08/02/23 to 08/30/23 revealed incontinence care was provided to Resident #50 once on 08/03/12, 08/07/23, 08/09/23, 08/11/23, 08/18/23, 08/21/23, 08/22/23, 08/24/23, 08/28/23, and 08/29/23. Observation of incontinence care for Resident #50 on 08/30/23 at 2:57 P.M. with Mobile Director of Nursing (DON) #500 and State Tested Nursing Assistant (STNA)/ Social Service Director (SSD) #300 revealed Resident #50 had two (one blue and one white) incontinence briefs on and fastened. Resident #50 also had an incontinence pad lying over his penis inside of the two briefs. The incontinence pad was saturated. Resident #50 stated he had not had incontinence care since 5:00 A.M. but staff did check on him. STNA/SSD #300 stated they had been an STNA for many years but was not assigned to provide care for Resident #50 and did not know who had placed two incontinence briefs on Resident #50. STNA/SSD #300 stated Resident #50 had a penile implant that did not allow Resident #50's penis to lay down and Resident #50 requested an additional brief to be laid on top of the brief that was fastened to help with constant urinary leakage. Interview on 08/30/23 at 3:14 P.M. STNA #253 revealed they were assigned to provide care for Resident #50. STNA #253 stated they provided incontinence care for Resident #50 around lunchtime but did not put two briefs on Resident #50. STNA #253 stated someone from another unit may have provided incontinence care for Resident #50 and put two briefs on him without her knowledge. A general progress note dated 8/30/23 at 4:01 P.M. revealed Resident #50 was interviewed by facility staff. Resident #50 stated he would prefer to have eight incontinence briefs on at a time to make him feel more secure due to his penis implant. Resident #50 was told the facility staff were unable to provide eight briefs but could do two or three incontinence briefs at one time. Resident #50 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 7 of 8 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 365572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastland Rehabilitation and Nursing Center 2425 Kimberly Parkway East Columbus, OH 43232 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 stated the day shift STNA checked him multiple times, but he told the STNA he did not need changed. Level of Harm - Minimal harm or potential for actual harm Interview on 08/31/23 at 4:05 P.M. the Regional Director of Operations verified Resident #50 had not been educated about the risks of wearing multiple briefs and not having incontinence care provided every two hours and as needed. The Regional Director of Operations verified the facility did not usually allow residents to have two briefs put on and verified there was no documented evidence of Resident #50 requesting multiple briefs or a care plan about penile implant and constant urinary leakage. The Regional Director of Operations also verified they interviewed STNA #253. STNA #253 stated they had lied about changing Resident #50 around lunchtime and had not provided any incontinence care to Resident #50 during day shift. On 09/05/23 at 11:30 A.M. the Regional Director of Operations also verified STNA's were responsible for charting incontinence care every shift. If the STNA's do not chart every shift, they were called to come back to work and complete the documentation or follow up with discipline process. There had been a turnover in staff and some of the staff did not follow instructions. Residents Affected - Few Review of the Perineal Care Policy and Procedure, revised October 2010, revealed the resident's care plan should be reviewed to assess for any special needs of resident. The following information should be recorded in the resident's medical record: the date and time the perineal care was provided and any discharge odor, bleeding, skin care problems or irritation, and complaints of pain or discomfort. If a resident refused, the reason why and the intervention taken should be recorded in the resident's medical record. This deficiency represents non-compliance investigated under Master Complaint Number OH00145680 and Complaint Number OH00145591. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 8 of 8