Inspection·February 9, 2024

F 0609 the power cord. I have them right now here in my room. Level of Harm - Minimal harm or potential for actual harm Interview on 02/07/24 at 10:40 A.M. with State Tested Nursing Assistant (STNA) #40 revealed Resident #86 was without the use of the charger for his electric wheelchair prior to him being discharged . STNA #40 stated, They took the charger to his electric wheelchair away from him and wouldn't give it back to him until he left the facility. I guess he had to borrow someone else's charger until he left the facility. Residents Affected - Few Interview on 02/07/24 at 10:58 A.M. with the Administrator confirmed Resident #86 did use a manual wheelchair at one time prior to being discharged from the facility. The administrator stated, Resident #86 did have the charger to his wheelchair when we transported him to the hotel. Interview on 02/07/24 at 11:10 A.M. with the Director of Nursing (DON) revealed she was not aware of any time Resident #86 was without the charger to his electric wheelchair. The DON also shared the only time the outlets would be covered is on the memory unit for a resident's safety. Interview on 02/07/24 at 11:22 A.M, with the Environmental Director #166 revealed the only time the outlets would be covered would be on the memory unit for the safety of a resident. The electric wheelchairs are usually placed in the hallway to charge them when the resident isn't using the chair. Interview on 02/07/24 at 12:38 P.M. with Resident #26 revealed the use of an electric wheelchair for mobility. Resident #26 stated, I do use an electric wheelchair, it's the one over there (Resident #26 pointed out into the hallway to where an electric wheelchair was located). There's no room in here, so they charge it out there I the hallway. I did let a guy use my charger and power cord a couple times. I guess his wasn't working or something like that. Interview on 02/07/24 at 12:48 P.M. with Resident #44 revealed the use of an electric wheelchair for mobility. Resident #44 stated, I do use an electric wheelchair to get around here. It's the one parked out there in corner of the hallway. I did let a man use my charger just recently. I guessed it worked; I didn't get to talk with him after he used it. He kind of had a situation and now he's not here anymore. Interview on 02/07/24 at 12:50 P.M. with Licensed Practical Nurse (LPN) #126 stated, The other administrator took the charger to his electric wheelchair and put it her car. They tried to make him use a manual wheelchair. The wheelchair did not fit him, and his feet would drag on the ground. He borrowed another resident's charger to charge his chair. When they got wind of that, they covered the outlets in his room, but then I heard the maintenance man came back and uncovered one of the outlets because he didn't agree with what he did. They did give him the charger back when he was leaving the facility the day he discharged . The LPN shared the charger was missing a few days before the resident discharged . Interview on 02/07/24 at 12:19 P.M. with the Regional Director of Operations (RDO) #2 revealed she was the acting administrator from approximately 11/27/23 until 01/02/24. Resident #86 was given a manual wheelchair to use due to threats towards staff of harming them with the electric wheelchair. RDO #2 stated, at no point was his charger removed or the outlets covered in his room. Interview on 02/07/24 at 12:44 P.M. with the Administrator verified the allegation of Resident #86's wheelchair charger being removed met the facility's abuse policy definition of misappropriation. The Administrator also verified a self-reported incident was not submitted as required. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 2 of 13 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 02/09/2024 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the January 2024 Missing Items Log revealed no report of the resident's wheelchair charger missing. Review of the facility's 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's property in accordance with this policy. Facility staff should immediately report all such allegations to the Administrator/designee and the the State Agency in accordance with the procedures in this policy. Misappropriation is defined as the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent. When possible, the State Agency will be notified using the online Enhanced Information Dissemination and Collection (EIDC) system. The facility will submit an online Self-Reported Incident in accordance with the State Agency's then-current instructions. This deficiency represents non-compliance investigated under Master Complaint Number OH00150746 and Complaint Number OH00150534. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 3 of 13 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 02/09/2024 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 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, interview, and facility policy review the facility failed to investigate an allegation of misappropriation. This affected one resident (#86) of five residents reviewed for misappropriation. The facility census was 84. Residents Affected - Few Findings Include: Review of the closed record for Resident #86 revealed an admission date of 10/09/22 and discharge date [DATE]. Diagnoses included paraplegia, chronic obstructive pulmonary disease (COPD), intermittent explosive disorder, cocaine abuse, opioid abuse, cannabis abuse, and depression. Review of a quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #86 had intact cognition with a Brief Interview of Mental Status (BIMS) score of 15 (no impairment). The assessment revealed Resident #86 had behaviors towards staff, was frequently incontinent of urine and bowel, used a wheelchair for self-propelling, nursing care for a diabetic skin impairment and required limited assist from staff for activities of daily living (ADL) including transfers and incontinence care, with care needs fluctuating daily. Review of a care plan dated 10/10/22 revealed Resident #86 had an activities of daily living (ADL) self-care performance deficit related to abnormalities of gait and mobility, and paraplegia requiring assistance from staff for transfers and toileting. Resident #86 used an electric wheelchair for mobility. Review of the progress notes/medical record from 01/20/24 through 01/31/24 revealed no documentation of the resident threatening to harm the staff with his electric wheelchair Review of the facility's self-reported incident history revealed there were no current incidents completed for misappropriation. Interview on 02/07/24 at 10:22 A.M. with Resident #86 revealed he had left the facility last week (01/31/24). Resident #86 stated, A couple days before I left the facility, that other administrator took my wheelchair charger and the power cord. I was not able to charge my wheelchair afterwards. I then asked a couple other people that had electric wheelchairs if I could borrow their chargers to use on my wheelchair. One of the power cords worked for my wheelchair, so I used it to charge up my chair. Once they found out I was using someone else's charger they had the maintenance man come in and cover my outlets. Later that night he came back and removed the covers. I was told I would not get my charger back until I left the facility for good. When I left, they gave me back the charger and the power cord. I have them right now here in my room. Interview on 02/07/24 at 10:40 A.M. with State Tested Nursing Assistant (STNA) #40 revealed Resident #86 was without the use of the charger for his electric wheelchair prior to him being discharged . STNA #40 stated, They took the charger to his electric wheelchair away from him and wouldn't give it back to him until he left the facility. I guess he had to borrow someone else's charger until he left the facility. Interview on 02/07/24 at 10:58 A.M. with the Administrator confirmed Resident #86 did use a manual wheelchair at one time prior to being discharged from the facility. The administrator stated, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 4 of 13 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 02/09/2024 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 0610 Resident #86 did have the charger to his wheelchair when we transported him to the hotel. Level of Harm - Minimal harm or potential for actual harm Interview on 02/07/24 at 11:10 A.M. with the Director of Nursing (DON) revealed she was not aware of any time Resident #86 was without the charger to his electric wheelchair. The DON also shared the only time the outlets would be covered is on the memory unit for a resident's safety. Residents Affected - Few Interview on 02/07/24 at 11:22 A.M., with the Environmental Director #166 revealed the only time the outlets would be covered would be on the memory unit for the safety of a resident. The electric wheelchairs are usually placed in the hallway to charge them when the resident isn't using the chair. Interview on 02/07/24 at 12:38 P.M. with Resident #26 revealed the use of an electric wheelchair for mobility. Resident #26 stated, I do use an electric wheelchair, it's the one over there (Resident #26 pointed out into the hallway to where an electric wheelchair was located). There's no room in here, so they charge it out there I the hallway. I did let a guy use my charger and power cord a couple times. I guess his wasn't working or something like that. Interview on 02/07/24 at 12:48 P.M. with Resident #44 revealed the use of an electric wheelchair for mobility. Resident #44 stated, I do use an electric wheelchair to get around here. It's the one parked out there in corner of the hallway. I did let a man use my charger just recently. I guessed it worked; I didn't get to talk with him after he used it. He kind of had a situation and now he's not here anymore. Interview on 02/07/24 at 12:50 P.M. with Licensed Practical Nurse (LPN) #126 stated, The other administrator took the charger to his electric wheelchair and put it her car. They tried to make him use a manual wheelchair. The wheelchair did not fit him, and his feet would drag on the ground. He borrowed another resident's charger to charge his chair. When they got wind of that, they covered the outlets in his room, but then I heard the maintenance man came back and uncovered one of the outlets because he didn't agree with what he did. They did give him the charger back when he was leaving the facility the day he discharged . The LPN shared the charger was missing a few days before the resident discharged . Interview on 02/07/24 at 12:19 P.M. with the Regional Director of Operations (RDO) #2 revealed she was the acting administrator from approximately 11/27/23 until 01/02/24. Resident #86 was given a manual wheelchair to use due to threats towards staff of harming them with the electric wheelchair. RDO #2 stated, at no point was his charger removed or the outlets covered in his room. Interview on 02/07/24 at 12:44 P.M. with the Administrator verified the allegation of Resident #86's wheelchair charger being removed met the facility's abuse policy definition of misappropriation. The Administrator confirmed there was no investigation completed regarding the resident's alleged missing motorized wheelchair charger despite the allegation meeting the facility definition of misappropriation. Review of the facility's 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's property in accordance with this policy. Facility staff should immediately report all such allegations to the Administrator/designee and the the State Agency in accordance with the procedures in this policy. Misappropriation is defined as the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a resident's belongings or money without the resident's consent. When (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 5 of 13 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 02/09/2024 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few possible, the State Agency will be notified using the online Enhanced Information Dissemination and Collection (EIDC) system. The facility will submit an online Self-Reported Incident in accordance with the State Agency's then-current instructions. Once the Administrator and State Agency are notified, an investigation of the allegation violation will be conducted. The investigation must be completed within five working days, unless there are special circumstances causing the investigation to continue beyond five working days. This deficiency represents non-compliance investigated under Master Complaint Number OH00150746 and Complaint Number OH00150534. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 6 of 13 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 02/09/2024 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 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, policy review, and interview, the facility failed to provide and document sufficient preparation, coordination and orientation for Resident #86 to ensure the resident had a safe and orderly transfer/discharge from the facility to an appropriate location that could meet his total care needs. This affected one resident (#86) of three residents reviewed for discharge. The facility census was 84. Residents Affected - Few Findings Include: Review of the closed medical record for Resident #86 revealed an admission date of 10/09/22 and a discharge date [DATE]. Resident #86 had diagnoses including paraplegia, chronic obstructive pulmonary disease (COPD), intermittent explosive disorder, cocaine abuse, opioid abuse, cannabis abuse, and depression. Review of a care plan dated 10/10/22 revealed Resident #86 was at risk for skin breakdown related to fragile skin, incontinence, and venous ulcer to lower legs and feet. A care plan dated 10/10/22 revealed Resident #86 had an activities of daily living (ADL) self-care performance deficit related to abnormalities of gait and mobility, and paraplegia requiring assistance from staff for transfers and toileting. Resident #86 used an electric wheelchair for mobility. A care plan dated 10/19/22 revealed Resident #86's discharge plan including a planned appropriate discharge and needs met. Resident #86 was dis-enrolled from the home choice program. A care plan dated 05/26/23 revealed Resident #86 displayed incontinence requiring management and assistance from staff. Review of physician orders dated 11/22/23 revealed treatment to left foot skin impairment. Cleanse with normal saline, pat dry, pack wound with Silver Alginate, cover with dry dressing. Change/apply treatment daily and as needed. Further review revealed a physician order dated 04/29/23 to apply house barrier cream with each episode of incontinence. Review of a progress note dated 11/21/23 at 6:56 P.M. revealed Resident #86 had been issued a 30-day discharge notice due to a substantial history of continual outbursts, lack of following facility recommendations, smoking in (his) room, bringing in marijuana to the facility, refusing to return smoking paraphernalia, refusal of care, refusal for continuing psychological services, and physical and verbal threats towards the facility staff. Resident #86 stated he wanted to discharge from the facility and preferred to stay in the Columbus area. Social services were notified of the need to send the referral to facilities in the area and to follow up with the Home Choice program to see the progress of Resident #86's application. Resident #86 refused to sign the 30-day notice. Resident #86 was notified of receiving a certified copy of the 30-day notice. A certified copy was also sent to the Long-Term Care Ombudsman. Review of Discharge Appeal Hearing verdict dated 12/27/23 revealed Resident #86 requested to appeal the 30-day discharge notice which the facility had issued on 11/21/23. The hearing officer ruled for Resident #86 to be discharged to the skilled nursing facility in the Cincinnati area forthwith. Review of a quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #86 had intact cognition with a Brief Interview of Mental Status (BIMS) score of 15 (no impairment). The assessment revealed Resident #86 had behaviors towards staff, was frequently incontinent of urine and bowel, used an electric wheelchair for self-propelling, nursing care for a diabetic skin impairment and required limited assist from staff for activities of daily living (ADL) including transfers and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 7 of 13 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 02/09/2024 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 0624 incontinence care, with care needs fluctuating daily. Level of Harm - Minimal harm or potential for actual harm Review of the physician progress note dated 01/24/24 at 2:02 P.M. authored by Physician #322 revealed medical necessity for visit was for discharge discussion. Resident #86 refused the remainder of the physical examination. Physician recommendations included Resident #86 may discharge from the facility with the remainder of (his) medications. There was no indication the physician was aware of where Resident #86 was being discharged at the time the progress note was written. Residents Affected - Few Review of a progress note dated 01/24/24 at 2:38 P.M. and authored by the Administrator, outlined several days and situations with interaction of Resident #86 and the Administrator. On 01/19/24 Resident #86 had been notified a skilled nursing facility in Cleveland had accepted resident for admission, with transportation to the new facility on Monday 01/22/24. Resident #86 became agitated and verbally aggressive towards the Administrator. Resident #86 refused to transfer to this new facility. Further review revealed Resident #86 was willing to leave the facility and wanted to be discharged to a local homeless shelter. The Administrator explained the shelter could not meet Resident #86's level of care and they would not accept Resident #86. Resident #86 requested the facility find an apartment to be discharged to. The Administrator explained there would be the same issue of Resident #86's level of care and the apartment groups would not accept Resident #86. When asked by the Administrator concerning discharging to a family member's home, Resident #86 stated, He would have a place to go on Monday (01/22/24). On Monday 01/22/24, Resident #86 met with the Administrator and stated he had no place to go. Resident #86 was informed by the Administrator the police would be notified. The police advised the Administrator to get an emergency eviction notice and they would assist in removing Resident #86 from the facility. Record review revealed on 01/30/24 a Resident Release Against Medical Advice (AMA) discharge form was signed by Resident #86, AD #176 and Witness #600. The AMA form did not identify the risks of leaving AMA or the reason the resident wanted to leave AMA. The form indicated the resident released the facility, administration and staff, and physician from responsibility for the consequences of this action. The only place the form contained the resident's name was a signature dated 01/30/24. Review of progress note dated 01/31/24 at 11:33 A.M. authored by Social Services #184 revealed Resident #86 was discharged from the facility against medical advice (AMA). The note indicated all additional resources were provided via discharge instruction form. No further progress notes were available concerning Resident #86's discharge from the facility on 01/31/24. An interview on 02/05/24 at 2:26 P.M. with the Administrator and the Director of Nursing (DON) revealed Resident #86 had been discharged AMA from the facility on 01/31/24. Upon Resident #86 request to leave, the facility financially secured a hotel room for 30 days for the resident. The facility provided Resident #86 with the remaining medications including Tylenol and the muscle relaxant Flexeril, wound care supplies, and incontinence supplies including a box of adult briefs. The facility transported Resident #86 to a nearby extended stay hotel via the facility bus. An interview on 02/06/24 at 9:24 A.M. with Admissions Director (AD) #176 revealed, following issuance of the 30-day discharge notice to Resident #86, the facility sent out referrals to 22 skilled nursing facilities (SNF) in the Columbus area and 11 skilled nursing facilities (SNF) outside of the Columbus area including one in Cincinnati and one in Cleveland which had accepted Resident #86. Admissions Director #176 stated, The facilities declined placement due to behaviors and one facility was not in network for his insurance. The AD confirmed there were no progress notes or other documents reflecting when the referrals were sent to the facilities or the reply from those facilities. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 8 of 13 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 02/09/2024 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 0624 On 02/06/24, the facility provided a list containing the facilities where Resident #86's referral packet had been sent by AD #176. Level of Harm - Minimal harm or potential for actual harm - Residents Affected - Few Facility #22 located in Columbus, OH Facility #1 located in Columbus, OH Facility #23 located in Columbus, OH Facility #2 located in Columbus, OH Facility #24 located in Columbus, OH Facility #3 located in Columbus, OH Facility #25 located in Columbus, OH Facility #4 located in Columbus, OH Facility #26 located in Columbus, OH Facility #5 located in Columbus, OH Facility #27 located in Columbus, OH (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 9 of 13 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 02/09/2024 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 0624 Facility #6 located in Columbus, OH Level of Harm - Minimal harm or potential for actual harm Facility #28 located in Columbus, OH Residents Affected - Few Facility #7 located in Columbus, OH Facility #29 located in Columbus, OH Facility #8 located in Columbus, OH Facility #30 located in Columbus, OH Facility #9 located in Columbus, OH Facility #31 located in Columbus, OH Facility #10 located in Columbus, OH Facility #12 located in Xenia, OH Facility #18 located in Xenia, OH Facility #13 located in [NAME], OH Facility #15 located in Cincinnati, OH (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 10 of 13 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 02/09/2024 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 0624 - Level of Harm - Minimal harm or potential for actual harm Facility #11 located in Portsmouth, OH - Residents Affected - Few Facility #17 located in Cleveland, OH Facility #19 located in [NAME], OH Facility #21 located in Peninsula, OH Facility #14 located in Cleveland, OH Facility #22 located in Cleveland, OH Facility #16 located in Cleveland, OH Facility #33 located in Cincinnati, OH Facility #34 located in Cleveland, OH Interview on 02/06/24 at 10:12 A.M. with Facility #22's admissions director (AD) #1 revealed no referral for Resident #86 was received from the facility. Interview on 02/06/24 at 10:15 A.M. with Facility #23's AD #3 revealed Resident #86's referral packet had been received. Resident #86 was declined admission due to Facility #23 did not have a contract with Resident #86's insurance. Interview on 02/06/24 at 10:30 A.M. with Facility #6's AD #9 revealed Facility #6 did not receive a referral packet for Resident #86 from the facility. Interview on 02/06/24 at 2:10 P.M. with Facility #10's AD #14 revealed Facility #10 did not receive a referral packet for Resident #86 from the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 11 of 13 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 02/09/2024 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 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 02/06/24 at 3:00 P.M. with Facility #30's AD #11 revealed Resident #86's referral packet had been received. Resident #86 was declined for admission to Facility #30 due to behaviors reviewed in the referral packet. Interview on 02/06/24 at 3:05 P.M. with Facility #13's AD #17 revealed Facility #13 did not receive a referral packet for Resident #86 from the facility. Interview on 02/06/24 at 3:15 P.M. with Facility #14's AD #19 revealed Facility #14 did not receive a referral packet for Resident #86 from the facility. Interview on 02/06/24 at 3:25 P.M. with Facility #16's AD #20 revealed Facility #16 received a referral packet from the facility for Resident #86. Facility #16 declined admission for Resident #86. AD #16 did not give a reason for the declined admission. Interview on 02/07/24 at 1:00 P.M. with Facility #12's AD #15 revealed Facility #12 did not receive a referral packet for Resident #86 from the facility. Interview on 02/07/24 at 1:10 P.M. with Facility #18's AD #16 revealed Facility #18 did not receive a referral packet for Resident #86 from the facility. Interview on 02/07/24 at 2:00 P.M. with Facility #25's AD #5 revealed Facility #25 did not receive a referral packet for Resident #86 from the facility. AD #5 stated, If we did we would have accepted the admission. Interview on 02/07/24 at 2:10 P.M. with Facility #24's AD #4 revealed Facility #24 did not receive a referral packet for Resident #86 from the facility. Interview on 02/07/24 at 2:18 P.M. with Facility #4's AD #6 revealed Facility #4 did not receive a referral packet for Resident #86 from the facility. Interview on 02/07/24 at 2:50 P.M. with Facility #7's AD #10 revealed Facility #7 did not receive a referral packet for Resident #86 from the facility. Interview on 02/07/24 at 3:09 P.M. with Facility #9's AD # 12 revealed Facility #9 did not receive a referral packet for Resident #86 from the facility. Interview on 02/07/24 at 3:13 P.M. with Facility #31's AD #13 revealed Facility #31 did not receive a referral packet from the facility. Interview on 02/07/24 at 4:00 P.M. with Facility #19's AD #18 revealed Facility #19 did not receive a referral packet from the facility. Interviews were attempted on 02/06/24 from 10:28 A.M. to 10:41 A.M. with Facilities #1, #3, and #22 with no return phone calls received by 02/09/24 at 12:00 P.M. The facility was unable to provide evidence of Resident #86's referral packet being sent to these facilities. Interviews were attempted on 02/07/24 from 1:45 P.M. to 4:03 P.M. with Facilities #2, #26, #5, #27, #28, #29, #15, #11, #17, #21, and #22 with no return phone calls received by 02/09/24 at 12:00 P.M. The facility was unable to provide evidence of Resident #86's referral packet being sent to these (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 12 of 13 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 02/09/2024 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 0624 facilities. Level of Harm - Minimal harm or potential for actual harm Interview on 02/07/24 at 3:08 P.M. was attempted with Facility #8. The facility failed to provide which health campus and location the referral packet for Resident #86 was sent for review by Facility #8. Residents Affected - Few Interview on 02/06/24 at 9:13 A.M. with AD #176 confirmed Resident #86 had been accepted for admission at Facility #33 and at Facility #34. However, Resident #86 had refused to transfer to either facility due to those facilities being outside of the Columbus area. Interview on 02/06/24 at 9:43 A.M. with Long-Term Care Ombudsman #500 revealed her interaction with Resident #86 began on 12/06/23 following the receipt of the certified 30-day notice dated 11/21/23. Ombudsman #500 met with Resident #86 and then requested an appeal hearing for the 30-day discharge notice. At the time of the meeting, the facility did not have an acting social service designee due to turn over of administration staff. During the discharge hearing, Resident #86 was in attendance, but became angry and left the hearing. After the results of the hearing were received, Ombudsman #500 requested a list of all the facilities Resident #86's referral packet had been sent to from the facility. During follow up phone calls to random facilities on the list, the ombudsman confirmed none of the facilities which she had contacted received Resident #86's referral packet form the facility. Ombudsman #500 attempted to contact the Director of Nursing (DON) and the Social Services Designee (SSD) at the facility for confirmation and proof of sending the referral packet, however, there was no communication from either facility staff member. On 01/31/24, Resident #86 contacted Ombudsman #500 to notify her of his discharge from the facility to In Town Suites (an extended stay hotel). Interview on 02/07/24 at 10:22 A.M. with Resident #86 revealed he had left the facility last week (01/31/24). Resident #86 stated, The Administrator and the Social Worker brought me to this hotel. They had given me some supplies and my medications. I do need help with my dressing changes on my foot and with getting cleaned up. There are a couple of friends I made there that come over to help me, and my brother is here. They had wanted me to go to Cleveland and some place in Cincinnati and I said No because I wanted to stay here near my people. They say I left against medical advice, but I didn't know what I was signing when I left there. The resident confimed he was still at the extended stay hotel. Review of the facility's policy titled, Transfer or Discharge Notice dated 12/2016 revealed, in determining the transfer location for a resident, the decision to transfer to a particular location would be determined by the needs, choices and best interests of that resident. This deficiency represents non-compliance investigated under Master Complaint Number OH00150746 and Complaint Number OH00150534. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365572 If continuation sheet Page 13 of 13