Inspection·July 29, 2025

F 0567 Level of Harm - Minimal harm or potential for actual harm Fund dated 06/01/16 revealed the facility would comply with all Federal and State laws and regulation regarding the handling of resident's funds and personal needs allowance accounts. This deficiency represents non-compliance investigated under Complaint Number OH00166292 (1284491). Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 2 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 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 closed medical record review, review of hospital records, review of Medscape medical reference information, policy review, and interviews, the facility failed to protect Resident #64's right to be free from neglect. This resulted in Immediate Jeopardy and Actual Harm with subsequent death beginning on [DATE] when the facility failed to provide timely and appropriate goods and services to meet Resident #64's total care and medical needs and failed to ensure the resident received timely and necessary care and treatment to prevent serious illness and death. On [DATE] Resident #64 returned from the hospital with orders for Lasix (diuretic) 20 milligrams (mg) daily and basic metabolic profile (BMP) laboratory test to be completed on [DATE]. The orders for Lasix and the BMP were not initiated or completed per the hospital discharge orders. On [DATE], Resident #64 was ordered additional laboratory testing, including thyroid stimulating hormone (TSH), Vitamins B1, B6, and B12, plasma, folate, and Vitamin D and D3 levels that were not completed. Resident #64 was hospitalized from [DATE] to [DATE] for hypoglycemia, hyperkalemia with EKG changes, hyponatremia, and encephalopathy. On [DATE], the resident was ordered Lasix 80 mg upon discharge from the hospital that was not implemented. On [DATE], the resident was ordered to have laboratory testing including a complete blood count (CBC) and BMP completed STAT (immediately) to determine if the resident's Lasix was appropriate to continue. On [DATE], a one-time order for Lasix 40 mg and Potassium 20 milliequivalents (meq) was ordered and not administered. The STAT CBC and BMP lab results ordered on [DATE] and completed on [DATE] were not reported timely to the provider, resulting in the resident being hospitalized from [DATE] to [DATE] with edema requiring a Bumex (diuretic) continuous intravenous infusion. Additionally, upon re-admission on [DATE], Resident #64 was ordered Lactulose 15 mg/milliliter (ml), 45 ml four times daily. On [DATE], Resident #64 reported to the telehealth Nurse Practitioner (NP) that she had been on Lactulose and would like to restart it again to treat her cirrhosis. The telehealth NP inadvertently ordered a duplicate dose of Lactulose 30 ml, and the resident started the dosage on [DATE]. Resident #64 received duplicate doses of Lactulose, 45 ml and 30 ml doses, from [DATE] until [DATE] (with the exception of [DATE] and [DATE] when the medication was not administered). On [DATE], the resident's progress notes referenced the resident had left calf pain and was ordered an unspecified scan, which was not completed. Resident #64 continued to decline, could not stand, and requested to go the emergency room (ER) on [DATE]. However, Resident #64 was not transferred to the ER, nor was the nurse practitioner (NP) notified. On [DATE], Resident #64 again requested to go to the ER because she could not stand, which was abnormal for her. In the ER, the resident was diagnosed with hyperkalemia (elevated potassium level), acute kidney injury, and encephalopathy (a condition that affects brain function or structure and can lead to changes in mental state, behavior, or cognitive abilities). The resident subsequently went into acute respiratory arrest (in the ER) and expired in the hospital on [DATE]. This affected one resident (#64) of three residents reviewed for abuse and neglect. The facility census was 63. On [DATE] at 2:07 P.M., the Administrator, Interim Director of Nursing (IDON) #600, Assistant Director of Nursing/Registered Nurse (ADON/RN) #179, and Regional Nurse #601 were notified Immediate Jeopardy began on [DATE] when the facility failed to provide timely and appropriate goods and services to meet Resident #64's total care and medical needs and failed to ensure the resident received timely and necessary care and treatment to prevent serious illness and death. The Immediate Jeopardy was removed on [DATE] when the facility implemented the following corrective actions: On [DATE] at 3:00 P.M., Regional Director of Clinical Services #601 educated the Interim Director of Nursing #600 and Director of Nursing #179, LPN #135 and LPN #107 on the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 3 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 Abuse Neglect and Misappropriation, Residents Rights, Laboratory and Radiologic Services Reporting, Medication Administration, and Notification of Change in Condition policies, with emphasis on residents receiving the care and treatment needed to prevent serious illness and/or death, including medications needed to treat serious medical issues, providing ordered lab work and diagnostic tests that could identify medical issues, identifying serious changes and decline in a resident's condition. On [DATE] all new admissions (Resident #18, #28, #33, #43, #59 and #66) from [DATE] to current were audited and reviewed from 3:00 P.M. to 6:00 P.M., by Licensed Practical Nurse (LPN) #135 and LPN #107 to ensure all new admission orders were identified and implemented at time of admission. On [DATE], all 63 residents from [DATE] to current, were audited and reviewed from 3:00 P.M. to 8:00 P.M., by LPN #135 and LPN #107, to ensure all lab work was completed as ordered. Eight residents (Resident #4, #27, #28, #43, #50, #52, #59, #66) labs were re-scheduled due to the orders were not entered into lab portable. The physician was notified. On [DATE], all 63 residents from [DATE] to current were audited and reviewed from 3:00 P.M. to 3:30 P.M., by Registered Nurse (RN) #179, to ensure all lab results were identified and reported to the provider. On [DATE], all 63 residents from [DATE] to current were audited and reviewed from 3:00 P.M. to 3:30 P.M. by RN #179, for duplicated orders including lactulose orders awaiting clarification. On [DATE], all 63 residents from [DATE] to current were audited and reviewed from 3:00 P.M. to 3:30 P.M. by RN R#179, to ensure all diagnostic testing orders were identified and reported to the provider. One resident's (Resident #1) diagnostic tests were re-scheduled, and physician notified. On [DATE], all residents with a Brief Interview for Mental Status (BIMS) score of 13 or higher, total of 35 residents (Resident #3, #4, #8, #9, #10, #11, #12, #15, #17, #18, #20, #22, #28, #29, #32, #33, #35, #36, #41, #42, #43, #44, #45, #46, #47, #50, #51, #54, #55, #57, #58, #60, #61, #62, and #63) were interviewed by Social Service Designee (SSD) #116 and Director of Admissions #120, from 6:00 P.M. to 8:00 P.M., to ensure the residents were receiving goods and services as ordered such as medications, labs, and diagnostics. Three residents (Resident #3, #17, and #50), with concerns noted were addressed and MD notified. On [DATE], all 28 residents (Resident #1, #2, #5, #7, #13, #14, #16, #21, #23, #24, #25, #26, #27, #30, #31, #34, #37, #38, #39, #40, #48, #49, #52, #53, #56, #59, #64, and #66) with a BIMS less than 13 were assessed from 5:00 P.M. to 8:00 P.M. by LPN #135 and LPN #107 for potential neglect as a result of needed goods and services not being provided. Assessment included head to toe to assess for change of condition. Beginning on [DATE] the facility implemented a plan that upon hire, any new RN or LPN would receive education by the Assistant Director of Nursing/designee on Policies titled Abuse Neglect and Misappropriation, Residents Rights, Laboratory and Radiologic Services Reporting, Medication Administration, and Notification of Change in Condition, and verifying and confirming telehealth orders in a timely manner with emphasis on residents receiving the care and treatment needed to prevent serious illness and/or death, including medications needed to treat serious medical issues, providing ordered lab work and diagnostic tests that could identify medical issues, identifying serious changes and decline in a resident's condition. On [DATE] between 4:00 P.M and 10:00 P.M DON #600 and RN #179 educated all licensed nurses, (10 RNs and 9 LPNs) on the Abuse Neglect and Misappropriation, Residents Rights, Laboratory and Radiologic Services Reporting, Medication Administration, and Notification of Change in Condition policies, and verifying and confirming telehealth orders in a timely manner with emphasis on residents receiving the care and treatment needed to prevent serious illness and/or death, including medications needed to treat serious medical issues, providing ordered lab work and diagnostic tests that could identify medical issues, identifying serious changes and decline in a resident's condition. On [DATE] at 6:00 P.M, the Administrator presented the Quality Assessment and Performance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 4 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 Improvement (QAPI) Team with investigation and all findings for discussion and review. Discussion included abatement plan from incident regarding Resident #64, ensuring residents were receiving the care and treatment needed to prevent serious illness and/or death, including medications needed to treat serious medical issues, providing ordered lab work and diagnostic tests that could identify medical issues, identifying serious changes and decline in a resident's condition. Staff in attendance included the Administrator, Interim DON #600, LPN #107, Medical Records Director #188, SSD #116, LPN #135, Human Resource Director #155 and Regional Director of Clinical Operations #601. Via phone included the Medical Director #700, Regional Director of Operations (RDO) #701, Diversional Director of Clinical Operations (DDCO) #203, [NAME] President (VP) #702. A root cause analysis was performed on [DATE] by the interdisciplinary team with oversight by the Administrator. In review of the facilities non-compliance at Data Tag F600 current policies and procedures, documentation and staff interview, the root-cause analysis determined a need for improved clinical education and comprehensive oversight by clinical managers. Beginning on [DATE], the Administrator and DON or designee would conduct an audit on 3-5 residents/week for four weeks, and randomly thereafter to ensure residents were receiving the care and treatment needed to prevent serious illness and/or death, including medications needed to treat serious medical issues, providing ordered lab work and diagnostic tests that could identify medical issues, identifying serious changes and decline in a resident's condition, to prevent the same actions, situations, and/or practices from occurring in the future and to ensure on-going compliance. The audit would include reviewing new orders in the daily clinical meeting to ensure labs and diagnostics have been scheduled, results have been received, medications have been administered, and MD follow-up was complete. Three residents would be interviewed a week to identify if there were concerns. All findings of concern would be immediately addressed and reported to the QAPI committee for further review and prompt response and resolution. Although the Immediate Jeopardy was removed on [DATE], the deficiency remained at Severity Level 2 (no actual harm with the 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 included:Review of the closed medical record for Resident #64 revealed the resident was admitted to the facility on [DATE] with diagnoses including chronic kidney disease, cirrhosis, asthma, encephalopathy, bipolar, epilepsy, anxiety, falls, hypertension, depression, sleep disorder, post-traumatic stress disorder, hyperlipidemia, type 2 diabetes, left leg deep vein thrombosis, peripheral artery disease, and anemia. Review of Resident #64's plan of care initiated [DATE] revealed the resident used anti-anxiety medications and was encouraged to voice feelings, discuss coping skills, provide a calm environment, and limit over-stimulation. A care plan focus initiated [DATE] revealed Resident #64 was at nutritional risk due to acute renal failure, depression, diabetes, bipolar, morbid obesity, hypertension, fatty liver cirrhosis, diuretic therapy, large weight fluctuations related to fluid shifts from advanced disease process, and the resident doesn't want a therapeutic diet. The interventions included establishing a baseline weight, notify the medical provider and resident representative of unplanned weight changes, obtain labs per medical provider orders, obtain weekly weights if unplanned loss was identified, and provided diet as ordered. A care plan focus initiated [DATE] revealed Resident #64 had renal failure with interventions including to administer medication per orders and to observe for side effects and effectiveness. Report abnormal findings to medical provider. Observe for signs and symptoms of complication of renal disease (decrease urine output, increased BUN/creatine, edema, dyspnea, elevated blood pressure and heart rate, decreased peripheral pulses, fatigue, weight gain, confusion, and distended jugular veins). Notify medical provider, resident/resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 5 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 representation of abnormal findings. Obtain and monitor labs/diagnostic studies, as ordered. Report abnormal findings to medical provider. Obtain weight as ordered and report abnormal fluctuations to medical provider. Provide diuretics as ordered. A care plan focus initiated [DATE] revealed Resident #64's activity of daily living (ADL) listed Resident #64 as independent with toileting and toileting hygiene. A care plan focus dated [DATE] revealed Resident #64's was at risk for altered bowel elimination related to medication side effects. Interventions included to administer medication per medical provider's order, monitor bowel movements, monitor medication for side effects of constipation. Keep medical provider, resident/resident representative of any problems. A care plan focus initiated [DATE] revealed Resident #64's had cirrhosis of the liver. Listed interventions included administering medication as ordered, providing emergency care for excessive bleeding, observing for signs and symptoms of liver disease (malaise, fatigue, anorexia, weight loss, edema, bleeding, constipation, diarrhea, ascites, confusion, and jaundice). Notify the medical provider of abnormal findings. Obtain and monitor labs/diagnostic studies as ordered. Obtain weight as ordered. A care plan focus initiated [DATE] revealed Resident #64 utilized anti-platelet medication. Interventions included providing medication as ordered and obtaining labs per orders. A care plan focus initiated [DATE] revealed Resident #64 occasionally had urinary incontinence related to urgency but was continent of bowel. The resident tended to wait too long to summon assistance and was noted to rush to the bathroom. Resident #64 was noted to toilet herself independently but was alert and able to ask for assistance if needed. A care plan focus initiated [DATE] revealed Resident #64 had behaviors related to bipolar disorder (verbal/physical outburst and delusions). Interventions included ensuring the resident felt safe and was able to express feelings and encouragement from family. Review of Resident #64's quarterly Minimum Data Set, dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 15, indicating the resident had intact cognition. The resident's height was 65 inches, and she weighed 343 pounds. The assessment revealed the resident had delusions, but no behaviors towards others or rejection of care. The resident was always continent of urine and bowel and only required supervision of touching assistance with toileting. The resident's active diagnoses included renal failure, diabetes mellitus, hyperlipidemia, epilepsy, anxiety disorder, depression, asthma, cirrhosis of liver, stage 3 chronic kidney disease, and sleep disorder. The resident had no condition or chronic disease that may result in life expectancy of less than six months. The assessment revealed the resident wanted to talk to someone regarding returning to the community. Review of the resident's medical record revealed beginning on [DATE] the facility failed to provide timely and appropriate goods and services to meet Resident #64's total care and medical needs resulting in resident neglect. The facility failed to ensure comprehensive and individualized systems were in place to prevent resident neglect and to ensure Resident #64 received timely and necessary care and treatment to prevent serious illness and death. The following concerns were identified: a. Review of Resident #64's hospital records revealed the resident was hospitalized from [DATE] to [DATE] with diagnoses including acute kidney injury, hyperkalemia, volume overload/edema, hypertension, and anemia. Resident #64 was discharged from the hospital with new orders to increase Lactulose to 45 ml four times daily and to continue Lasix 40 mg twice daily. Review of Resident #64's progress note authored by NP #803 and dated [DATE] revealed the residents' blood pressure was low, her speech was slurred, and she was slow to respond. The resident has a history of encephalopathy with elevated ammonia levels and acute kidney injury. The note stated to send Resident #64 to the emergency room for evaluation and STAT labs. Review of Resident #64's hospital record dated [DATE] to [DATE] revealed the resident was transferred to the emergency room for altered mental status. The resident was diagnosed with acute kidney injury. The resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 6 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 discharge instructions included to decrease Lasix to 20 mg daily and listed an order for a BMP laboratory test to be completed on [DATE]. Review of Resident #64's medical record revealed no evidence a medication reconciliation was reviewed with a provider following the resident's re-admission on [DATE]. Review of Resident #64's Medication Administration Record (MAR) and orders dated 05/2025 revealed the Lasix 40 mg twice daily was discontinued. However, the new order for Lasix 20 mg was not initiated upon the resident's return from the hospital on [DATE]. Review of Resident #64's medical record revealed no evidence a BMP was completed on [DATE] as ordered. Review of Resident #64's weights revealed no evidence the resident was weighed on re-admission on [DATE]. On [DATE], the resident weighed 315 pounds and on [DATE], the resident weighed 340 pounds (reflecting a 25-pound weight gain in a seven-day period). Review of Resident #64's progress note dated [DATE] authored by RN #103 revealed Resident #64 had orders for laboratory testing including thyroid-stimulating hormone (TSH), Vitamin B1, B6, and B12, plasma, folate, and Vitamin D2 and D3. Review of Resident #64's medical record revealed no evidence the laboratory testing order on [DATE] for TSH, Vitamin B1, B6, and B12, plasma, folate, and Vitamin D2 and D3 was done. Review of Resident #64's progress note dated [DATE] authored by LPN #163 revealed the resident was on her way to an appointment with the liver doctor and she got very lethargic and felt like she was about to black out. The residents' blood sugar was 57 (hypoglycemic) and she was transferred to the emergency room. The aide that accompanied the resident reported the hospital was discussing admitting the resident. Review of Resident #64's hospital records dated [DATE] to [DATE] revealed the resident was admitted for hypotension, hypoglycemia, and altered mental status and was found to have acute kidney injury, hyperkalemia, and acute anemia and was transferred to interventive care unit (ICU) due to hypotension. The resident was also managed for acute on chronic anemia, acute encephalopathy, cirrhosis, sub-occlusive deep vein thrombosis, and lactic acidosis. The resident was re-admitted to the facility on [DATE]. Interview on [DATE] at 3:14 P.M., with the Administrator, IDON #600, and Corporate Nurse #601 confirmed the hospital records dated [DATE] indicated to decrease Lasix to 20 mg daily, however the order was not implemented. IDON #600 and Corporate Nurse #601 confirmed there was no documented evidence that the re-admission orders were reconciled with the resident's physician. IDON #600 confirmed the resident was re-admitted to the hospital on [DATE] and noted the resident had a 25-pound weight gain. During the interview the Administrator, IDON #600, and Corporate Nurse #601 confirmed there was no evidence the TSH, Vitamin B1, B6, and B12, plasma, folate, and Vitamin D2 and D3 laboratory testing was completed on [DATE] as ordered. Interview on [DATE] at 9:06 A.M., with Corporate Nurse #802 confirmed Resident #64 did not have a BMP on [DATE] per the hospital orders on [DATE]. b. Review of Resident #64's re-admission weight dated [DATE] revealed the resident weighed 391.8 pounds. Review of Resident #64's re-admission orders dated [DATE] revealed the resident was ordered Lasix 80 mg daily until appropriately diuresed and in one week ([DATE]) follow up with (laboratory testing) iron panel, TIBC, ferritin, CBC, and BMP. Review of Resident #64's MAR and orders revealed no evidence the Lasix 80 mg was implemented per the hospital discharge orders dated [DATE]. Review of Resident #64 progress note dated [DATE] at 1:36 P.M. authored by LPN #107 revealed it was reported to the nurse manger Resident #64 had increased edema in her abdomen and pelvis. A call was placed to the facility NP who consulted with the physician. New orders were obtained for a STAT CBC and BMP laboratory test, and a one-time dose of Lasix 80 mg was ordered. Review of Resident #64 laboratory results dated [DATE] revealed Resident #64's CBC and BMP were collected on [DATE] at 12:26 P.M., received at 2:22 P.M., and resulted at 2:28 P.M. The residents' glucose, BUN, and creatine were high and red blood cells, hemoglobin and hematocrit were noted to be low. Review of Resident #64's NP #905 note dated [DATE] revealed the resident was seen for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 7 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 edema. The resident had requested Lasix. The nurse reported the facility had not received the laboratory testing that was completed on [DATE] due to it being sent to the hospital. The nurse would call the hospital to try to get renal function test to determine if routine Lasix was ordered. A one-time order of Lasix 40 mg and Potassium 20 meq was ordered until renal function could be evaluated. The note included to please call back with any changes in conditions. Further review of Resident #64's 05/2025 MAR revealed no documented evidence the one-time order for Lasix 40 mg or Potassium 20 meq was administered per the NP's order on [DATE]. Review of Resident #64's progress note dated [DATE] authored by LPN #178 revealed the nurse attempted to call the hospital, however an automated system indicated laboratory requests were only available Monday through Friday and if there was a holiday, you could not get results until the following day. Review of Resident #64's progress note dated [DATE] authored by LPN #163 revealed laboratory results were received. The resident potassium was 4.9, BUN was 38, and Creatinine was 2.4. There was no documented evidence that the provider was notified of laboratory results. Review of Resident #64's weight dated [DATE] revealed the resident weighed 407.2 pounds (reflecting a 15.4-pound weight gain from the [DATE] weight of 391.8 pounds). Review of Resident #64's progress note dated [DATE] authored by RN #902 revealed Resident #64 was requesting a water pill due to her feet swelling up. Upon checking orders, the resident was not on any Lasix. The resident insisted she wanted it back. The provider called and said she could only give a stat order as she was waiting for the resident's labs. Resident #64 stated the labs were already drawn. The note included the provider couldn't trace her recent labs and said they had to wait for the results to determine if the resident could continue to take the Lasix. STAT order for a one-time dose of Lasix 40 mg and Potassium 40 mEq were placed and administered. Resident #64 later complained of shortness of breath, but her oxygen saturation levels were withing normal limits. Review of Resident #64's progress note dated [DATE] authored by LPN #178 revealed during skin assessment the resident was noted to have plus three pitting edema (a moderate amount of swelling where an indentation remains on the skin after pressure is applied for a short period of time) in her bilateral lower extremities. The resident was swollen from her abdomen to her toes. Resident #64's abdomen was tight, bumpy and dimpled like an orange peel. The physician was previously notified, and new orders were received. Review of Resident #64's progress note dated [DATE] at 1:30 P.M. authored by RN #158 revealed the resident complained of not feeling well. On examination, the resident had a distended abdomen that was pitting to the touch, with clear fluid oozing from the left side. The resident had edema of both lower extremities that were pitting to the touch. The resident complained of pain with touch to both the abdomen and lower extremities. The note referred to a new order to transfer the resident to the hospital. Review of Resident #64's hospital record dated [DATE] to [DATE] revealed the resident was seen for swelling and weight gain. The resident was profoundly edematous and was symptomatic with shortness of breath from volume (fluid) overload. The records indicated Resident #64 likely required a trial of aggressive diuresis. The resident reported gaining over 100 pounds over the past few weeks. The resident had increased peripheral edema as well as shortness of breath associated with weight gain. Due to these symptoms, she was brought to the emergency department for evaluation. Laboratory studies in the emergency department revealed the resident had an acute kidney injury with her creatine (a waste product indicative of kidney health, with elevated levels indicating kidney issues) elevated at 3.73. The last known creatine was on [DATE] and it was 2.40. Resident #64's potassium was elevated at 5.6 (normal level 3.5 to 5.0 (when levels get too high it can cause problems such as muscle weakness, irregular heartbeat, and can become life-threatening). The notes indicated Resident #64 also had anemia, with a hemoglobin level of 7.9 (normal values between 10.5 to 12.5). A chest x-ray was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 8 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 completed with findings of vascular congestion. The resident was admitted to the intensive care unit (ICU) for further evaluation and management. Nephrology (kidney specialist) was consulted due to renal failure and hyperkalemia. Resident #64 was started on a Bumex (diuretic) continuous intravenous infusion. Review of Resident #64's hospital record dated [DATE] to [DATE] revealed Resident #64 was ordered 45 ml of Lactulose four times daily and Bumex 2 mg daily. Interview on [DATE] at 3:14 P.M., with the Administrator, IDON #600, and Corporate Nurse #601 confirmed there was no documented evidence the provider was notified of the STAT laboratory results that were collected and resulted on [DATE]. There was no documented evidence on the MAR the Lasix 40 milligram (mg) and Potassium 20 milliequivalent (meq) were administered on [DATE] per NP #905 progress note dated [DATE]. Corporate Nurse #601 confirmed the resident was hospitalized from [DATE] to [DATE]. Interview on [DATE] at 9:06 A.M., with Corporate Nurse #802 confirmed the resident's Lasix 80 mg was not implemented per the discharge orders dated [DATE]. c. Review of Resident #64 bowel history records dated 05/2025 revealed the resident was hospitalized on [DATE] and returned on [DATE] and had one large soft bowel movement (BM) on night shift. On [DATE] one large loose BM, on [DATE] no BM, [DATE] one medium loose BM, no BM on [DATE], on [DATE] one medium formed BM on day shift and one large loose BM on nights. On [DATE] and [DATE], one medium soft BM on nights, [DATE] and [DATE] large soft BM on nights, and [DATE] one medium formed BM on days. The resident was hospitalized from [DATE] to [DATE]. On [DATE], the resident had one medium formed BM on nights, [DATE] one large form BM on days, [DATE] one large loose BM on nights. The resident was hospitalized on [DATE] to [DATE]. Review of Resident #64's re-admission orders dated [DATE] revealed an order for Lactulose 10 grams (gm) per 15 ml, give 45 ml four times day. Review of NP #200's telehealth note dated [DATE], which was not part of the medical record, revealed NP #200 completed a telehealth visit on [DATE] for monthly rounds. Resident #64 reported she was previously on Lactulose and would like to restart back on Lactulose for history of cirrhosis. The resident denied nausea, vomiting, abdominal pain, constipation, and diarrhea. The resident was having regular bowel movements without bleeding. The plan was to restart the Lactulose and obtain laboratory testing to check ammonia, prealbumin, CBC, and BMP. There was an addendum added after the surveyor noted concerns with the Lactulose order on [DATE]. The addendum was dated [DATE] at 11:37 A.M., indicating that Lactulose had been previously increased due to lack of stools and a listed goal was for the resident to have two to three stools a day. Review of Resident #64's MAR dated 06/2025 revealed from [DATE] to [DATE], the resident received 45 ml of Lactose four times daily. From [DATE] to [DATE], the resident received 30 ml of Lactose four times a day except for the 10:00 P.M. doses on [DATE] and [DATE] which were not given as the nurse questioned the duplicate orders and noted she was awaiting clarification. Review of Resident #64's progress note dated [DATE] authored by RN #902 revealed the resident's blood glucose was 91. The resident reported her stomach felt full and she had not been able to eat well for two days. Review of Resident #64's bowel record dated 06/2025 revealed the resident did not have a bowel movement (BM) on [DATE], one large, formed BM on [DATE] and [DATE] and one medium BM on [DATE]. Interview on [DATE] at 10:00 A.M., with LPN #135 revealed she had reached out to NP #200 to send his telehealth visit note as it was not contained in Resident #64's medical record. Interview on [DATE] at 3:14 P.M., with the Administrator, IDON #600, and Corporate Nurse #601 reported the NP visits were all telehealth visits, and the NPs were available 24/7 to verify/clarify all orders. They indicated they were not sure why the Lactulose order was not clarified on [DATE]. Interview on [DATE] at 11:50 A.M., via telephone with Corporate Nurse #601 confirmed NP #200 had increased the dose (of Lactulose) on [DATE], however his progress note was not in the medical record. The resident's ammonia level on [DATE] was 45 (normal range 9-33) and the prior ammonia level (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 9 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 dated [DATE] was 114 in the hospital. A telephone interview on [DATE] at 12:05 P.M., with NP #200 revealed he did a telehealth visit on [DATE] which was not in the medical record due to a glitch in the system. NP #200 reported he added an order for an additional 30 ml of Lactulose due to Resident #64 not having two to three bowel movements a day, which was the goal. Resident #64 had just been re-admitted on [DATE] after being hospitalized from [DATE] to [DATE]. NP #200 could not recall how many bowel movements the resident was having prior to increasing the dose. NP #200 reported he did not consult with the resident's physician or specialist because he felt 75 ml was safe dose for a short period of time. The NP confirmed he did not put a stop date on the new order because he stated he knew Resident #64 would be seen again in a week for a follow-up. Interview on [DATE] at 12:30 P.M., via email with the Administrator confirmed NP #200 had added a late addendum, dated [DATE], to his progress note from [DATE] to include the Lactulose was increased due to Resident #64's lack of stools and the goal was two to three stools daily. Interview on [DATE] at 7:03 A.M., with Certified Nursing Aide (CNA) #113 reported Resident #64 toileted herself and reported the resident had three BM's daily. The CNA reported she had provided care to the resident the last few weeks before she had expired and she had intermittent confusion. Interview on [DATE] at 9:25 A.M., with CNA #190 revealed Resident #64 usually toileted herself, however the last few weeks she started [TRUNCATED] Event ID: Facility ID: 365629 If continuation sheet Page 10 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of self-reported incidents (SRI), interviews, and policy review, the facility failed to prevent misappropriation of Resident #48's narcotic pain patches. This affected one resident (#48) of three residents reviewed for controlled medications. The facility census was 63. Findings include: Medical record review revealed Resident #48 was admitted to the facility on [DATE] with diagnoses including hospice services, chronic obstructive pulmonary disease, type two diabetes, absence of eye and above right knee, anxiety, peripheral vascular disease, aphasia, bursitis of right elbow, and heart disease. Review of Resident #48's orders dated 03/31/25 to present revealed Fentanyl (an opioid analgesic) 50 microgram (mcg) patch. Instructions stated to apply one patch topically to the resident's upper torso every 72 hours routinely for pain. Review of Resident #48's admission assessment completed 03/31/25 revealed the resident was not capable of verbalizing pain. The resident was noted to have displayed non-verbal indicators of pain. The resident was receiving scheduled pain medication. Review of Resident #48's aphasia plan of care dated 03/31/25 and revised 06/17/25 revealed the resident had a communication problem. Listed interventions included to observe and document for physical and non-verbal indicators of discomfort or distress and to follow-up as needed. Review of Resident #48's chronic pain plan of care dated 04/01/25 revealed to observe the resident for pain every shift and follow physician orders for complaints of pain. Review of Resident #48's Minimum Data Set (MDS) admission assessment dated [DATE] revealed the resident's was rarely/never understood. The resident had non-verbal sounds and facial expressions as indicators of pain or possible pain. The resident was noted to have indicators of pain or possible pain daily. Review of Resident #48's controlled drug record dated 04/2025 revealed on 03/31/25, five Fentanyl 50 mcg patches were delivered. The first patch was recorded as administered on 04/01/25 and the second patch on 04/04/25 as scheduled. There was a missed dose on 04/07/25, and the third dose was administered on 04/10/25. The fourth dose was administered on 04/13/25, and the fifth dose did not have a date or time it was administered. Two additional Fentanyl 50 mcg patches were sent by the pharmacy on 04/11/25. The first patch was administered 04/16/25, there was missed dose on 04/19/25, and the second patch was administered on 04/22/25.Review of Resident #48's medication administration records dated 04/2025 revealed a Fentanyl 50 mcg patch was to be applied to the resident's upper torso every 72 hours routinely for pain. The patch was signed out on the controlled drug record on 04/13/25 and 04/16/25. There was no documented evidence that an additional patch was administered between 04/13/25 to 04/16/25 to account for the fifth patch that was sent on 03/31/25.Review of Resident #48's pain assessment dated [DATE] revealed the resident received scheduled pain medication and was unable to express acceptable pain level and/or tolerance. Interview on 07/08/25 at 12:22 P.M. with Registered Nurse (RN) #158 revealed there had been several instances where Resident #48's Fentanyl patch was not in-place. He could not recall dates, but the first time he didn't think anything about it. The second time he started to wonder. The third time another nurse reported to him Resident #48's Fentanyl patch was missing, and he knew it was in-place because he was the one that administered the patch. The fourth time he spoke to the previous Director of Nursing (DON) regarding his concerns that someone was removing patches from Resident #48, however she had theories of what could have happened, but did not do anything. Then, on 06/03/25, RN #158 reported he started his own investigation and tried to rule out the hospice aide. On 06/03/25, he noticed there was not a patch in place where it was documented it was placed, however there was an old patch on her lower back that was outdated (not three days prior but could not recall exact date). RN #158 reported he waited until the hospice aide gave the resident a shower and left. The outdated Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 11 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few patch was still on the resident's lower back. He asked another nurse to witness him applying the new patch and when he went back two hours later to give the resident oral medication, the patch was missing. He asked the nurse to come back to verify the patch was missing. The facility searched for the room and resident and the patch could not be found. They told the unit manger which told the Administrator. RN#158 reported he never thought it would come up missing in two hours and he even put a transparent patch over the pain patch to ensure it was secure. Interview on 07/08/25 at 4:00 P.M., with Regional Nurse #203 confirmed the fourth patch was signed out on the 04/13/25 and the next patch would have due on 04/16/25. Regional Nurse #203 confirmed there was documented evidence on the narcotic control sheet the date and time the fifth patch was administered, however an additional two patches were sent on 04/11/25 and staff had signed out one patch on 04/16/25 leaving patch five on the previous control sheet unaccounted for.Review of SRI #261202 dated 06/04/25 revealed nursing staff reported to administration a missing fentanyl patch that was previously placed on Resident #48 approximately one and one-half hours before noticing it was missing. Licensed Practical Nurse (LPN) did not witness any staff, resident, or visitor enter the resident's room after placing the fentanyl patch. Nursing administration immediately searched the resident's room and facility for the missing fentanyl patch. The fentanyl patch was not found. An effort was made to communicate with resident in effort to gain knowledge of missing patch. Resident #48 seemed to understand and was willing to answer questions, though some confusion was observed. Initially, Resident #48 confirmed that she had taken the patch off herself but seemed to lose communication when asked of the current location of the patch. When questioned a second time, Resident #48 communicated that a white female staff member had taken the patch off of her. All female staff members present were not identified by the resident as the staff member in question. All staff, including staff that had already clocked out for their shift, were recalled to the building and statements were collected for all staff members pertaining to this investigation with no findings. The County Sheriff's office was notified. Officers arrived and also interviewed all staff with no findings as a result. One female housekeeping aide that had returned after being recalled was potentially identified as the suspected staff member who removed the patch by Resident #48 nodding her head. The female staff member was immediately suspended pending the outcome of the investigation. The female staff member submitted herself immediately for drug screening on her own accord. The results of the drug testing showed no positive result for illicit drugs. The following day, the staff member reported to her immediate supervisor that she would be resigning effective that day. Staff statements and interviews conducted by facility administration and the local sheriff's department resulted in no conclusive evidence as to who removed the fentanyl patch. Like residents were identified and audited with no concerns identified. A facility-wide narcotic audit was completed with no findings. Residents were interviewed regarding pain and/or assessed with no adverse findings. Resident #48's fentanyl patch was replaced by the facility at the facility's expense, and the resident's physician and responsible party was notified. All staff were re-educated on the facility's policy for abuse, neglect and misappropriation reporting out of an abundance of caution. Resident #48 had no adverse outcome as a result of the incident. The SRI concluded by referencing that the evidence was inconclusive. Review of the facility's policy and procedure titled Fentanyl Transdermal Patch undated revealed the regulation requires the facility have a system to account for controlled medications' receipt and disposition in sufficient detail to enable an accurate reconciliation. Fentanyl transdermal patches present a unique situation given the multiple boxed warnings, and the substantial amount of fentanyl remaining in the patch after removal, creating a potential for abuse, misuse, diversion, or accidental exposure. Remove the previous patch and dispose of immediately (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 12 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete prior to adding the next patch. If no patch is located, provide a complete body scan and search clothing, bed linens and surrounding area if the patch had fallen off. Validate there is no patch on skin prior to applying the next patch. Document that no patch was located to be removed and verify with a second nurse. Notify the DON and/or Nursing management for follow-up. Recheck security of the patch and see that it actually sticks. The nurse will dispose of the patch in the presence of a second nurse. The nurse will stick the sticky sides of the patch together and place them in the drug disposal system. Both nurses will sign on the controlled substances proof of use sheet or the current use narcotic sign out sheet stating destruction, date, time, and method of destruction. Example S. [NAME], Licensed Practical Nurse (LPN) [NAME] Registered Nurse (RN) 03/02/17 Flushed 10:07 A.M. to denote destruction. Review of the facility's policy and procedure titled Medication Controlled Drugs and Security undated revealed narcotics would be kept under double lock and would be counted by the on-coming and off-going nurse at the end of each shift and before the keys are passed to the next shift. A record is retained for all drugs destroyed by licensed personnel and by individual state guidelines. Drug diversion would be treated as misappropriation of resident property and the board of nursing would be notified as appropriate for known drug diversions or suspected drug diversion after careful review and evidence collection. Controlled drugs as well as the controlled drug count sheets and cards, are counted every shift change by the nurse reporting on duty with the nurse reporting off duty. In the event a discrepancy is found, check the resident's medication sheets and chart to see if a narcotic had been administered and not recorded. Check previous recordings on the control sheet for mistakes in arithmetic. If the cause of the discrepancy cannot be located and/or the count does not balance, report the matter to the supervisor for immediate investigation. Nurses, or qualified medication aide may not leave the unit until the directed to do so by the immediate supervisor. The incident would be investigated and reported the Administration leadership. Review of the facility's policy and procedure titled Abuse, Neglect, and Misappropriation undated revealed an injury of unknown origin must meet both of the following conditions: the source of the injury was not observed by any person and could not be explained by the resident and the injury was suspicious because of the extent and location of the injury, number of injuries observed at one particular point in time, or the incidence of injuries over time. Misappropriation of resident property was defined as the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent. It was the facility's policy to prevent the abuse, mistreatment, or neglect of residents or the misappropriation of their property. In the event an allegation was made, the facility would take measures to protect residents from harm during an investigation. Accurate and timely reporting of incidents, both alleged and substantiated, will be sent to officials in accordance with the state law. If the alleged violation is verified, appropriate corrective action would be taken by the facility. This deficiency represents non-compliance investigated under Complaint Number OH00166292 (1284491). Event ID: Facility ID: 365629 If continuation sheet Page 13 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 medical record review, observation, interview, and facility policy review, the facility failed to timely investigate an injury of unknown origin. This affected one resident (#31) of three residents reviewed for abuse. The facility census was 63. Findings include:Medical record review revealed Resident #31 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, dementia with other behavioral disturbance, conversion disorder with seizures or convulsions, anxiety, depression, paranoid schizophrenia, and nontraumatic intracerebral hemorrhage. Review of Resident #31's skin assessment dated [DATE] revealed the resident had skin tear on the left elbow measuring 2.0 centimeter (cm) in length by one cm in width by 0.1 cm depth. The diagnoses was fragile skin. Review of Resident #31's order dated 07/02/25 revealed to cleanse the left elbow with normal saline, pat dry, apply xeroform (a non-adherent gauze dressing) and cover with silicone boarder foam dressing. Instructions included to change the dressing daily and as needed, every day shift, for impaired skin integrity.Further review of Resident #31's record revealed no evidence how the resident sustained the skin tear or documentation regarding the bruise to the left lower arm. Observation on 07/08/25 at 10:50 A.M. of Resident #31 revealed the resident was sitting in common area in a wheelchair. The resident had a dressing intact, and a bruise noted to his left lower arm.Interview and observation of Resident #31 on 07/09/25 at 2:38 PM with Regional Nurse #202 and Administrator revealed the resident had a dark purple bruise on his left lower arm, scratches on the upper arm, scabs noted above the dressing on the left lower arm, and slight edema to the left arm. Regional Nurse #202 confirmed the facility did not conduct an investigation to determine how the resident sustained the skin tear, nor was there documentation regarding the bruise on the left lower arm. The Administrator reported the facility had started an self-reported incident (SRI) that day (07/09/25).Review of the facility's policy titled Abuse Neglect, and Misappropriation undated revealed an injury should be classified as an injury of unknown origin when both of the following conditions are met: the source of the injury was not observed by any person and the source of injury could not be explained by the resident and the injury was suspicious. The accurate and timely identification of any event which would place a resident at risk is a primary concern of the facility. The following procedure will assist the staff in the identification of incident and direct them to appropriate steps and interventions. Each occurrence of resident incident, bruise, abrasion, or injury of unknown source, or report of alleged abuse, neglect, or misappropriation of funds would be identified and reported to the supervisor and investigated timely. This deficiency represents non-compliance investigated under Complaint Number OH00166698 (1284492). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 14 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interviews, the facility failed to ensure that adequate care and treatment was provided for a resident with left arm edema and failed to ensure bruising was assessed and documented. This affected one resident (#31) of three residents reviewed for change in condition. The facility census was 63. Findings include:Medical record review revealed Resident #31 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, dementia with other behavioral disturbance, conversion disorder with seizures or convulsions, anxiety, depression, paranoid schizophrenia, and nontraumatic intracerebral hemorrhage. Review of Resident #31's progress notes dated 07/04/25 to 07/06/25 revealed no evidence the resident had left arm edema. Review of Resident #31 progress note dated 07/07/25 at 12:35 P.M., revealed the resident had a telehealth visit completed for concern of a swollen left arm. Nurse Practitioner (NP) #200 ordered a doppler (a non-invasive ultrasound used to assess the health of blood vessels) of the left arm. Further review of Resident #31's record revealed no documented evidence an assessment of the left arm edema was completed. Review of Resident #31's record revealed no evidence of the telehealth visit that was completed on 07/07/25 by NP #200.Review of Resident #31's orders dated 07/07/25 revealed no evidence a doppler of the left arm had been ordered. Review of Resident #31's telehealth visit completed by NP #201 dated 07/08/25 (actual time of visit was not noted) revealed the nurse reported the resident's left arm was swollen. The nurse stated it was not like that when she last cared for the resident a few days prior. The note stated Resident #31 did not seem to be in pain when at rest and when the arm was not being disturbed. Resident refused to straighten the left arm, even with the nurse trying on video. The resident was swatting her away. The resident had scrapes on the left arm that the nurse stated were from hitting his arms on things like the wheelchair. The note referenced there had been no recent significant trauma or falls. Resident #31's left upper arm did appear slightly swollen with mild pitting edema. A full evaluation could not be done due to the resident not being cooperative at the time of the exam. The note stated the left arm had no erythema (redness) observed on areas that could be observed via video in the current position. The plan was to apply ice and cold compress to the left upper arm for 30 minutes at a time, every three hours as tolerated by Resident #31 and to elevate the left upper extremity on pillows or rolled towels while in bed. The note stated to continue with orders by the previous provider (doppler examination). The note stated to report any results received to the provider for review upon receipt. The note concluded by instructing staff to monitor Resident #31 and report any acute changes in condition or declines noted to the providers promptly. Review of Resident #31's July 2025 physician orders revealed no evidence of any orders for ice and/or cold compresses for 30 minutes at a time every three hours as tolerated. Additionally, there was no evidence of an order to elevate Resident #31's left upper extremities on pillows or rolled towels while in bed as referenced in NP #201's note. Further review of Resident #31's physician orders revealed two orders were entered on 07/08/25 at 12:21 A.M. and 3:55 P.M. for a doppler of the left arm to rule out deep vein thrombosis (DVT) for new onset edema of left upper extremity for two days. Observation on 07/08/25 at 10:50 A.M., of Resident #31 revealed the resident was sitting in common area in a wheelchair. The resident had a dressing intact to his left lower arm and a dark purple bruise was noted on left lower arm measuring 5 centimeters (cm) by 4 cm. Review of Resident #31's progress notes dated 07/08/25 at 4:07 P.M. revealed the resident's left arm was still swollen. The resident had no complaints of pain or discomfort. A venous doppler was ordered to rule out DVT and labs were ordered for the following morning. Review of Resident #31's plan of care revealed no evidence a plan of care, or any Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 15 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete interventions such as ice or elevation, had been implemented to address Resident #31'sleft upper extremity edema. Review of Resident #31's medical record on 07/09/25 revealed no evidence the doppler had been performed. Additionally, there was no evidence the dark purple bruise on the resident's left lower arm had been assessed. Interview and observation of Resident #31 on 07/09/25 at 2:38 PM with Regional Nurse #202 and the Administrator revealed the resident had a dark purple bruise on left lower arm, scratches on the upper arm and scabs noted above the dressing on the left lower arm, and slight edema noted to the left arm. The resident was lying in bed, and the resident's arm was not elevated. There was no evidence any ice or cold compress had been recently applied. Interview on 07/10/25 at 8:56 AM with Regional Nurse #202 confirmed the doppler should have been done within 24 hours of the original order on 07/07/25 at 12:35 P.M. The Regional Nurse confirmed the progress note indicated NP #200 had ordered the doppler on 07/07/25 at 12:35 P.M., however the order was not entered. Regional Nurse #202 confirmed NP #201 re-evaluated the Resident on 07/08/25 and ordered ice and elevation which was not implemented or ordered. The Regional Nurse confirmed there was no documentation of the dark purple bruise on the left arm as well. Interview on 07/14/25 at 11:58 A.M., with LPN #135 confirmed NP #200's note was not contained in Resident #31's electronic medical record. The LPN reported the note from NP #200 did not transfer into the system. The LPN provided the surveyor a copy of the note. The note was dated 07/07/25 at 10:44 A.M. and revealed the resident had complaining of left arm edema which began 2-3 days prior. The resident denied pain and any wounds or trauma. Resident #31 reported the left arm had some mild redness but denied any fevers or chills. The resident had plus-two (pitting) edema to the left upper extremity. The plan was to check a venous duplex (a type of doppler examination that uses real-time imaging in addition to ultrasound) of the left arm, check complete blood count and basic metabolic panel laboratory levels. If the duplex was positive (indicating an abnormal finding), the provider noted they may consider prescribing Resident #31 an anticoagulant. This deficiency represents non-compliance investigated under Complaint Number OH00166292 (1284491) and is a recite to the complaint survey completed 06/02/25. Event ID: Facility ID: 365629 If continuation sheet Page 16 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview, and policy review the facility failed to ensure residents received effective pain management. This affected three residents (#48, #61, and #65) of three residents reviewed that received pain patches. Findings include:1. Medical record review revealed Resident #48 was admitted to the facility on [DATE] with diagnoses including hospice services, chronic obstructive pulmonary disease, type two diabetes, absence of eye and above right knee, anxiety, peripheral vascular disease, aphasia, bursitis of right elbow, and heart disease. Review of Resident #48's admission assessment completed [DATE] revealed the resident was not capable of verbalizing pain. The resident was displaying non-verbal indicators of pain. The resident was receiving scheduled pain medication. Review of Resident #48's aphasia plan of care dated [DATE] and revised [DATE] revealed the resident had a communication problem. Interventions included observing/document for physical/nonverbal indicators of discomfort or distress and follow-up as needed. Review of Resident #48's chronic pain plan of care dated [DATE] revealed to observe pain every shift and follow physician orders for complaints of pain. Review of Resident #48's admission minimum data set (MDS) dated [DATE] revealed the resident's cognition was rarely/never understood. The resident had non-verbal sounds and facial expression as indicators of pain or possible pain. The resident had indicators of pain or possible pain daily. Review of Resident #48's pain assessment dated [DATE] revealed the resident received scheduled pain medication and was unable to express acceptable pain level and or tolerance. Review of Resident #48's orders dated [DATE] to present revealed Fentanyl (narcotic medication) 50 microgram (mcg) patch. Apply one patch topically to upper torso every 72 hours for pain. Review of Resident #48's Fentanyl 50 mcg control drug record dated [DATE] to [DATE] revealed no evidence a pain patch was administered on [DATE] and [DATE]. Interview on [DATE] at 4:00 P.M., with Regional Nurse #203 confirmed Resident #48's Fentanyl patch was not administered on [DATE] and [DATE] per physician orders and therefore would not have provided effective pain control for the resident.Interview on [DATE] at 9:43 A.M., with Registered Nurse (RN) #108 revealed Resident #48 had communication impairment and if she likes you she will nod when questioned. The resident had general chronic pain all over. The resident was receiving hospice services and the resident's hospice provider ordered the resident's pain medication on a schedule to ensure adequate pain control. 2. Record review revealed Resident #61 was admitted to the facility on [DATE] with diagnoses including dorsalgia, chronic pain, epilepsy, peripheral autonomic neuropathy, and hyperlipidemia. Review of Resident #61's chronic pain plan of care dated [DATE] revealed to provide medications per orders.Review of Resident #61's current orders revealed Buprenorphine (pain medication that works to block pain signals between the brain and the rest of the body) 10 mcg patch, one patch transdermal every seven days for pain (order written by pain center medical provider).Review of Resident #61's MAR dated [DATE] revealed the resident was not administered Buprenorphine pain patch on [DATE] or [DATE] due to medication was not available. The last dose was administered on [DATE] and resumed on [DATE]. Review of Resident #61's progress note dated [DATE] revealed resident requested as needed pain medication around 10:00 A.M. The nurse explained to the resident that it was an hour too early. The resident became irritated and started yelling that it was bullshit because it was only helping for four hours and they only let him have them every six hours and he had not slept for seven days because he was in pain. He states that they don't want to do anything about it and that they gave him a patch and nobody even changes it, that it has been over ten days since it was changed. The nurse reported she would look into it. The resident continued to curse at the nurse. The resident reported he would believe it all when he saw it because he had heard this all before. The nurse asked Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 17 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the resident to stop cursing and he reported he had enough and was tired of being the one in pain and no one doing anything about it. After checking into the residents' orders, this nurse tried to explain to the resident that the patch was due to be changed on [DATE] but it was not available. The nurse reported the facility called the pain clinic and was waiting on them to call back. Review of Resident #61's progress notes dated [DATE] to [DATE] revealed the facility did not attempt to notify the pain clinic the resident was out of Buprenorphine until [DATE]. The office was closed on [DATE]. The next attempt to contact the pain clinic was [DATE]. The office was closed. A third attempt was made on [DATE] and facility staff left a voice message. Review of Resident #61's Buprenorphine 10 mcg patch control drug record sheet revealed no evidence the resident received a pain patch on [DATE] or [DATE]. Further review revealed pharmacy had sent four additional patches on [DATE], however staff never administered the medication until [DATE]. Interview on [DATE] at 3:14 P.M., with Administrator, Intermit Director of Nursing (IDON) #600, and Corporate Nurse #601 confirmed Resident #61 did not receive Buprenorphine pain patch [DATE] and [DATE] and there was no documented evidence the pain clinic was notified until [DATE] the resident was out of Buprenorphine. Corporate Nurse #601 confirmed the facility attempted to call the pain clinic on [DATE] and [DATE]. The facility received the pain patch on [DATE], however it was not administered to the resident until [DATE]. 3. Closed medical record review revealed Resident #65 was admitted to the facility on [DATE] and expired on [DATE] and had been receiving hospice services. The resident's diagnoses included rheumatoid arthritis and diabetes. Review of Resident #65's orders dated 03/2025 to 06/2025 revealed the resident was ordered Fentanyl (narcotic medication) 75 mcg patch, apply two patches topically to upper torso every 72 hours for pain.Review of Resident #65's control drug record dated [DATE] revealed the resident had only received one 75 mcg Fentanyl patch (order was for two). Further review of the control drug records revealed no evidence of a control sheet for the Fentanyl patch that was administered on [DATE], [DATE], [DATE], [DATE], and [DATE]. Interview on [DATE] at 3:14 P.M., with Administrator, Interim Director of Nursing (IDON) #600, and Corporate Nurse #601 confirmed there was no evidence Resident #65 had received two Fentanyl patches on [DATE] and the facility was not able to find a control sheet for the Fentanyl patches that were administered on [DATE], [DATE], [DATE], [DATE], and [DATE]. Review of the facility's policy and procedure titled Medication Administration (undated) revealed to administer medication only as prescribed by the provider. Observe the five rights (resident, time, medication, dose and route) in giving each medication. Full attention should be given during preparation of medication. Medication will be charted when given. Narcotics will be signed out when given. Rotate transdermal patches and note location on the Medication Administration Record (MAR). Remove old patch and dispose of it properly. Narcotic patches require a second nurse to validate removal and disposal. Documentation of medication will be current for medication administration. Documentation of medication will follow accepted standard of nursing practice. Review of the facility's policy and procedure titled Pain Management and Assessment (undated) revealed staff would ensure that residents receive the treatment and care in accordance with professional standards of practice, the comprehensive care plan, and the residents' choices related to pain management. There is no objective test that can measure pain. The clinician must accept the resident's report of pain. This deficiency represents non-compliance investigated under Complaint Number OH00166292 (1284491). Event ID: Facility ID: 365629 If continuation sheet Page 18 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview, and policy review the facility failed to ensure narcotic medication (pain patches) were properly disposed of. This affected two residents (#48 and #65) of three residents reviewed that received narcotic pain patches. The facility census was 63.Findings include:1. Medical record review revealed Resident #48 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, type two diabetes, absence of eye and above right knee, anxiety, peripheral vascular disease, aphasia, bursitis of right elbow, and heart disease. Review of Resident #48's orders dated [DATE] to [DATE] revealed Fentanyl (narcotic medication) 50 microgram (mcg) patch. Apply one patch topically to upper torso every 72 hours for pain. Review of Resident #48's Fentanyl 50 mcg control drug record dated [DATE] to [DATE] revealed on [DATE], [DATE], [DATE], unknown date (no date documented), [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] (times two), [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE] there was no documented evidence the used Fentanyl patches was destroyed by two nurses. Interview on [DATE] at 4:00 P.M., with Regional Nurse #203 confirmed Resident #48's Fentanyl patch destruction was not witnessed by two staff nurses on [DATE], [DATE], [DATE], unknown date (no date documented), [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] (times two), [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE]. Interview on [DATE] at 9:48 A.M., with Licensed Practical Nurse (LPN) #189 confirmed she had removed Resident #48's Fentanyl patch and did not have a second nurse witness the destruction of the patch. The LPN reported she had placed the old patches in the sharp's container. 2. Closed medical record review revealed Resident #65 was admitted to the facility on [DATE] and expired on [DATE] and had received hospice services. The resident's diagnoses included rheumatoid arthritis and diabetes. Review of Resident #65's orders dated 03/2025 to 06/2025 revealed the resident was ordered Fentanyl 75 mcg patch apply two patches topically to upper torso every 72 hours for pain.Review of Resident #65's control drug record dated [DATE] to [DATE] revealed on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE] there was no documented evidence the used Fentanyl patch was destroyed by two nurses. Further review of the control drug records revealed no evidence of a control sheet for the Fentanyl patch that was administered or destroyed on [DATE], [DATE], [DATE], [DATE], and [DATE]. Interview on [DATE] at 3:14 P.M., with Administrator, Interim Director of Nursing (IDON) #600, and Corporate Nurse #601 confirmed there was no documented evidence the Fentanyl patch was destroyed by two nurses on [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], and [DATE] per the facility's policy. Corporate Nurse #601 confirmed the facility was not able to find a control sheet for the Fentanyl patches that were administered on [DATE], [DATE], [DATE], [DATE], and [DATE]. The Administrator confirmed he had submitted a self-reported incident (SRI) on [DATE] for Resident #48 pain patch that missing and the facility had reviewed Resident #48 and #65's medical records, however the discrepancies identified by the surveyor with the Fentanyl patches were not discovered during the facility's investigation completed on [DATE]. Resident #65 was Resident #48's roommate, and they were the only residents receiving Fentanyl patch medication during the investigation. Review of the facility's policy and procedure titled Fentanyl Transdermal Patch (undated) revealed the regulation required the facility have a system to account for controlled medications' receipt and disposition in sufficient detail to enable an accurate reconciliation. Fentanyl transdermal patches present a unique situation given the multiple boxed warnings, and the substantial amount of Fentanyl remaining in the patch after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 19 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete removal, creating a potential for abuse, misuse, diversion, or accidental exposure. Remove the previous patch and dispose of immediately prior to adding the next patch. If no patch is located, provide a complete body scan and search clothing, bed linens and surrounding area if the patch has fallen off. Validate there is no patch on skin prior to applying the next patch. Document that no patch was located to be removed and verify with a second nurse. Notify the DON and/or Nursing management for follow-up. Re-check security of the patch and see that it actually sticks. The nurse will dispose of the patch in the presence of a second nurse. The nurse will stick the sticky sides of the patch together and place them in the drug disposal system. Both nurses will sign on the controlled substances proof of use sheet or the current use narcotic sign out sheet stating destruction, date, time, and method of destruction. Review of the facility's policy and procedure titled Medication Controlled Drugs and Security (undated) revealed narcotics were to be kept under double lock and would be counted by the on-coming and off-going nurse at the end of each shift and before the keys are passed to the next shift. A record is retained for all drugs destroyed by licensed personnel and by individual state guidelines. Drug diversion would be treated as misappropriation of resident property and the board of nursing would be notified as appropriate for known drug diversions or suspected drug diversion after careful review and evidence collection. Controlled drugs as well as the controlled drug count sheets and cards, are counted every shift change by the nurse reporting on duty with the nurse reporting off duty. In the event a discrepancy is found, check the resident's medication sheets and chart to see if a narcotic had been administered and not recorded. Check previous recordings on the control sheet for mistakes in arithmetic. If the cause of the discrepancy cannot be located and/or the count does not balance, report the matter to the supervisor for immediate investigation. Nurses, or qualified medication aide may not leave the unit until the directed to do so by the immediate supervisor. The incident would be investigated and reported to the Administration leadership. This deficiency represents non-compliance investigated under Complaint Number OH00166292 (1284491). Event ID: Facility ID: 365629 If continuation sheet Page 20 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 review of pest invoices, review of concerns submitted to the state survey agency complaint intake unit, interviews, observation, and review of facility policy revealed the facility failed to ensure an effective pest control program was maintained. This had the potential to affect all 63 residents residing in the facility. Findings include:1 a. Review of concerns submitted to the state survey agency complaint intake unit dated 06/13/25 and 07/10/25 revealed a concern with cockroaches in the kitchen. Review of the pest control invoice dated 06/10/25 revealed the building was inspected for services including all interior areas for possible pest entry ways and activity. All glue boards were replaced as needed. Open area of concern was noted in the kitchen. The wall covering was loose/peeling. Wall tile was cracked and there were gaps between baseboards and wall. These areas need repaired or replaced to help prevent pest entry and harbor sites. The kitchen door seal was not rodent proof. The seal needed repaired. There were German Cockroaches noted to be found on the devices. Concerns were discussed with Licensed Practical Nurse (LPN) #108. Review of the pest invoice dated 06/23/25 revealed there were still open concerns with the wall covering and door seal in the kitchen. Findings were discussed with the previous Maintenance Director (MD) #204.Observation on 07/08/25 at 7:34 A.M. of the kitchen with Dietary Manger (DM) #300 revealed there was several sticky bug traps with numerous bugs observed in the boxes. There were additional closed red boxes that contained pests but could not be observed. Dietary Manager (DM) #300 reported the facility had a few oriental roaches which come up through the drains, but they were mostly German roaches that come from the wooded area behind the building. The DM #300 and staff reported they had not seen any live roaches, but there had been some found in the traps. The DM #300 confirmed the back door seal was missing from the bottom door and the light from outside was coming through the bottom of the door. The DM #300 confirmed the observed findings and reported the pest control company had voiced concerns that the pests were coming from the back door. There were several broken floor tiles noted in front of the door. The DM #300 confirmed the seal had been missing for some time. The DM #300 reported the facility did not have a Maintenance Director (MD) at this time. Observation on 07/08/25 at 10:52 A.M. of the kitchen with the Administrator and DM #300 confirmed the areas of concern listed on the pest control invoices on 06/10/25 and 06/23/25 had not been repaired. The Administrator and DM #300 confirmed the tiles in the dishwasher area were pulled away from the wall, the back door seal on the bottom was missing, and the tile on the floor and wall near the back door were broken and tile was pulling away from the wall. Interview on 07/09/25 at 11:45 A.M., with the previous Director of Nursing (DON) confirmed staff had voiced concerns regarding roaches in the last monthly meeting, however she had never seen any live roaches. b. Interview on 07/08/25 at 1:22 P.M., with an Ombudsman representative via phone revealed she had received a call from a medical provider that was visiting Resident #20 and had noticed gnats in Resident #20's room. The resident had voiced concerns, and the medical provider was concerned due to the resident had a colostomy bag and was not able to get out of bed on his own. Observation on 07/09/25 at 8:19 A.M., of Resident #20's room revealed there were 12 gnats observed in the resident room. The gnats were observed on the resident pillow, bedside table, and wall by bed. The resident reported that the gnats had been a problem for the last two weeks and he was happy to see the surveyor so hopefully the surveyor could do something about it. Observation and interview on 07/09/25 at 8:21 A.M., with Housekeeper Manager (HM) #413 confirmed there was 12 gnats in Resident #20's room. The HM #413 reported she would have staff clean the room immediately. Interview on 07/10/25 at 7:07 A.M., with Certified Nurse Aide (CNA) #186 confirmed there were issues with gnats and roaches. CNA #186 reported Resident #20's room was really bad with gnats and the roaches were mostly in the Residents Affected - Many (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365629 If continuation sheet Page 21 of 22 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 365629 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dixon Healthcare Center 135 Reichart Avenue Wintersville, OH 43953 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete kitchen area. Interview on 07/10/25 at 7:16 A.M., with CNA #113 confirmed there was issues with gnats and roaches in the building currently. The roaches were worse in the kitchen area. Interview and observation on 07/10/25 at 7:28 AM with Resident #20 revealed there were still gnats in his room, but he reported it was better than yesterday. There was one gnat observed flying near the resident's face. Review of the facility's policy and procedure titled Pest Control dated 09/15/21 revealed the pest control company would establish a regimented time each month for spraying and to eliminate pests in the center. If a problem should develop, the Environmental Service Director will contact the pest control company for an additional visit. The pest control company would report any problems or changes to the Environmental Service Director. This deficiency represents non-compliance investigated under Complaint Number OH00166698 (1284492) and OH00166292 (1284491). Event ID: Facility ID: 365629 If continuation sheet Page 22 of 22