Inspection·October 20, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few injuries were noted at that time. The progress note dated 10/13/25 at 12:14 P.M. revealed Resident #7 complained of left hip pain following another transfer. An X-ray was ordered for her left knee, hip, and elbow. The X-Ray results dated 10/14/25 revealed Resident #7's left elbow, knee, and hip had no acute osseous findings, and the left hip is in alignment with mild osteoarthritis of the left hip with no fracture or dislocation seen. Interviews conducted on 10/16/25 at 11:18 A.M. with Resident #7 revealed she could not recall the name of the CNA who transferred her in July but stated the CNA performed the transfer alone. Resident #7 stated the aide squeezed too tight, and she immediately felt pain, telling the CNA, I think you broke my rib. Resident #7 stated she informed the nurse of her pain, but she could not recall the nurse's name. She stated she was crying in pain, and the transfer that caused the rib fracture occurred the same day she reported the injury. At 12:20 P.M., Resident #7 stated for the transfer in July, only one CNA performed the transfer. She reported that a mechanical lift (Hoyer lift) had not been used for some time but could not recall when it was last used. Resident #7 also stated only one CNA performed the transfer on 10/13/25 and she had to be lowered to the ground. An interview conducted on 10/16/25 at 1:10 P.M. with LPN #466 identified CNA #353 reported having to lower Resident #7 to the floor due to the wheelchair not being locked. LPN #466 stated she believed CNA #353 was working alone during the transfer, but this was never confirmed. An interview conducted on 10/16/25 at 1:45 P.M. with Director of Nursing (DON) revealed CNA #353 involved in the October transfer was verbally educated on ensuring wheelchair brakes were locked prior to transfer. The DON stated there was no documentation of written education or retraining for the aide following either incident. An interview conducted on 10/16/25 at 2:12 P.M. with the Administrator confirmed that the facility's investigation determined the resident sustained a rib fracture during a transfer. The Administrator stated the facility was unable to identify the staff member who performed the transfer in July. An interview conducted on 10/16/25 at 3:15 P.M. with the DON revealed that when discussing the July X-ray findings with the physician, the physician was informed of a prior report of rib pain related to an incident before admission in which the resident's spouse reportedly squeezed her ribs. The DON stated the physician advised that the July fracture might be related to that incident. A follow-up interview conducted on 10/16/25 at 3:20 P.M. with Nurse Practitioner (NP) #701 revealed she was unaware of the July or October incident and had not reviewed the findings of the physician's assessment, but her name was on the X-ray orders as the ordered provider for both the July and October X-Rays. An interview was conducted on 10/16/25 at 3:30 P.M. with Radiologist #700 from MobileX. Radiologist #700 stated Resident #7's left tenth rib fracture was definitely a new injury. Radiologist #700 explained that, when determining the acuity of a fracture, he looks for specific radiologic indicators such as visible lines or fluffy areas, which suggest whether a fracture is healing or has already healed. Radiologist #700 reported he observed some early signs of healing on the July X-ray but clarified that it remained consistent with an acute fracture rather than an old or chronic one. Radiologist #700 further explained that if the fracture had been older, the X-ray would show greater density or whitening in the area from callus formation, and in some cases, older fractures may even show edges that rub against one another as they heal. He stated that comparison of the 07/11/25 X-ray with previous images from May 2025 confirmed the July fracture was not healed and appeared acute. Radiologist #700 emphasized that, based on his comparison, the July X-ray did not demonstrate the characteristics of an older fracture and confirmed that the injury was definitely not older than eight weeks. In his medical opinion, the findings were consistent with a new injury that had occurred ranging from the day of the transfer to within a few weeks prior to the 07/11/25 X-ray. Review of the facility policy titled Activities of Daily Living (ADL), Supporting dated 2001 revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365618 If continuation sheet Page 2 of 4 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 365618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Presidential Post-Acute 524 James Way Marion, OH 43302 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 0689 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the following key points regarding assistance with ADLs: Residents unable to carry out daily living activities independently will receive necessary services. Residents will be provided with care, treatment, and services to ensure their ADLs do not diminish unless unavoidable due to clinical conditions, with a decline only justified by a resident's medical record or functional decline. Appropriate care and services are provided with resident consent and in accordance with the plan of care, covering hygiene, mobility, elimination, dining, and communication, with efforts to prevent or minimize functional decline through pain management and depression treatment.This deficiency represents non-compliance investigated under Complaint Number OH00165095 (1373756). Event ID: Facility ID: 365618 If continuation sheet Page 3 of 4 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 365618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Presidential Post-Acute 524 James Way Marion, OH 43302 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, review of Centers for Disease Control and Prevention (CDC) guidance, and facility policy review, the facility failed to implement enhanced barrier precautions (EBP) as physician ordered during wound care for Resident #67. This affected one (#67) of three residents reviewed for wounds. The facility identified 13 residents who had EBP in place. The facility census was 91. Findings include:Review of Resident #67's medical record revealed she was admitted to the facility on [DATE]. Diagnoses included congestive heart failure, chronic kidney disease, diabetes mellitus, and morbid obesity. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE], revealed Resident #67 had impaired cognition and required assistance from staff with transfers, bed mobility, and bathing. Residents Affected - Few Review of Resident #67's care plan dated 05/07/24 revealed a care plan focus of EBP. Resident #67 required EBP during high-contact resident care activities due to the presence of wounds. Interventions included to utilize personal protective equipment (PPE) (gown and gloves, face-shield as indicated) during high contact resident care activities (e.g. Brief changes, toileting assistance, device care and wound care). Review of Resident #67's physicians orders dated 10/01/25 revealed orders to assist for EBP during high contact resident care every shift and a wound care treatment order to the sacrum/right buttocks every shift. Observation of wound care on 10/16/25 at 9:45 A.M. revealed Nurse #494 and Wound Nurse #474 provided wound care to Resident #67's sacrum/right buttocks and they did not wear gowns during the wound care. Interview on 10/16/25 at 10:05 A.M. with Wound Nurse #474 confirmed Resident #67 was on EBP for the wounds and confirmed Nurse #494 and Wound Nurse #474 did not wear a gown during wound care. Wound Nurse #474 confirmed a gown should have been worn by the nurse during wound care. Review of the facility's EBP policy dated March 2024 revealed EBP involves the use of gowns and gloves during high-contact resident care activities, in addition to standard precaution and staff should don appropriate PPE before engaging in high-contact resident care activities. Review of the CDC guidance titled Implementation of PPE Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) found at https://www.cdc.gov/long-term-care-facilities/hcp/prevent-mdro/PPE.html and dated 04/02/24 revealed MDRO transmission is common in skilled nursing facilities, contributing to substantial resident morbidity and mortality and increased healthcare costs. EBP is an infection control intervention designed to reduce transmission of resistant organisms that employs targeted gown and glove use during high contact resident care activities. EBP may be indicated for residents with any of the following: wounds or indwelling medical devices, regardless of MDRO colonization status. This deficiency represents non-compliance investigated under Complaint Number OH00166290 (1373764). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365618 If continuation sheet Page 4 of 4