Inspection·September 7, 2023

F 0623 Level of Harm - Minimal harm or potential for actual harm Review of the census documentation revealed Resident #101 was hospitalized from [DATE] and returned to the facility on [DATE]. Review of Ombudsman notification documentation, dated July 2023, revealed Resident #58, Resident #60, and Resident #101 were not included on the transfer/discharge notification. Residents Affected - Few Interview on 09/07/23 at 2:11 P.M., with Social Services #200 verified hospitalization records did not pull in the report and Resident #58, Resident #60, and Resident #101 were not included in the notification of transfers and discharges to the Ombudsman's office. This deficiency represents non-compliance investigated under Complaint Number OH00145743. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 2 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. Based on review of the medical record review, staff interview, and review of policy, the facility failed to ensure the comprehensive care plan included discharge planning. This affected two (#8 and #9) of three former residents reviewed for discharge care plans. The facility census was 78. Findings include: 1. Review of Resident #8's closed medical record revealed an admission date of 04/26/23 and discharged on 08/23/23. Diagnoses for Resident #8 included pulmonary hypertension, type two diabetes mellitus with hyperglycemia, hypoxemia, heart disease, essential (primary) hypertension, hypothyroidism, and hyperlipidemia. Review of the Minimum Data Set (MDS) assessment, dated 08/23/23, revealed a discharge assessment was completed. Review of the care plan, initiated on 05/02/23 and closed on 09/05/23, revealed Resident #8's care plan did not include a discharge goal. 2. Review of Resident #9's closed medical record revealed an admission date of 03/07/23 and discharged on 08/24/23. Diagnoses for Resident #9 included muscle wasting and atrophy, interstitial pulmonary disease, ulcerative proctitis without complications, end stage renal disease, type two diabetes mellitus, acquired absence of left leg below knee, essential hypertension, polyneuropathy, hyperparathyroidism, and hyperkalemia. Review of the MDS assessment, dated 08/24/23, revealed a discharge assessment was completed. Review of the care plan, initiated on 03/12/23, revealed Resident #9's care plan did not include a discharge goal. Interview on 09/06/23 at 10:40 A.M., with the Director of Nursing (DON) verified Resident #8 and Resident #9's care plans did not include a discharge goal. Review of the policy titled, Plan of Care Overview, with review date of 05/01/22, revealed the facility will provide resident centered care and person-centered care planning including goals to potentially return to a community setting. This deficiency represents non-compliance investigated under Complaint Number OH00145743. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 3 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, review of the medical record, and review of policy, the facility failed to ensure the functioning of wandering devices to prevent elopement was monitored. This affected two (#30 and #31) of two residents reviewed for wandering devices. Additionally, the facility failed to ensure hot water temperatures did not exceed 120 degrees Fahrenheit (F). This affected two (#11 and #115) of seven residents reviewed for hot water temperatures. The facility census was 78. Findings include: 1. Review of Resident #30's medical record revealed an admission date of 06/27/17, with a diagnosis of dementia. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #30 had impaired cognition. Review of a physician order dated 11/17/22 revealed Resident #30 required staff to check the function of his wandering device on day and night shifts. Review of the Treatment Administration Record (TAR) for the evening shift on 09/02/23 revealed Licensed Practical Nurse (LPN) #252 checked the function on Resident #30's wandering device. Interview on 09/05/23 at 9:28 A.M., with LPN #252 revealed she had residents on her hall with a wandering device but could not identify them at that time. Follow-up interview and observation on 09/05/23 at 2:31 P.M., with LPN #252 revealed she checked the placement of Resident #30's wandering device on his left ankle. Further interview at that time with LPN #252 revealed she performed no additional tasks other than verifying placement when monitoring residents with a wandering device. LPN #252 revealed the functioning of the device was checked by maintenance or the on-call manager. LPN #252 confirmed she documented on Resident #30's TAR on 09/02/23 that she checked the functioning of his wandering device. LPN #252 stated the maintenance person and the on-call manager do not have access to the orders, she had to complete for Resident #30, so she documented the task was completed. Interview on 09/05/23 at approximately 3:25 P.M., with Unit Manager (UM) #201 informed the surveyor, LPN #252 was knowledgeable about when and how to check the functionality of wandering devices on residents' ankles at bedside and LPN #252 misunderstood the surveyor's question. UM #201 further stated maintenance, or the on-call manager checked the functioning of the doors in response to the wandering device, but nurses were responsible for checking the functionality of the wandering device on each resident's ankle. Interview on 09/05/23 at approximately 3:27 P.M., with LPN #252 revealed the functionality of the wandering device on each resident's ankle was checked by the maintenance. 2. Review of the medical record for Resident #31 revealed an admission date of 04/29/14, with diagnoses of type 2 diabetes mellitus and Alzheimer's disease. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 4 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Review of the quarterly MDS assessment dated [DATE] revealed Resident #31 had impaired cognition and did not exhibit any wandering behavior. Review of the physician orders for Resident #31 revealed no order to check the functionality of his wandering device. Residents Affected - Some Interview on 09/06/23 at 2:44 P.M., with the Director of Nursing confirmed Resident #31 had no order to check the functionality of his wandering device. Review of the undated policy titled Wander Bracelet revealed wander bracelets would be checked for proper functioning daily using the function tester and documented on the TAR. 3. Observation and interview on 09/05/23 at approximately 3:50 P.M. with Maintenance Technician #273 confirmed the bathroom sink temperature was 128 degrees Fahrenheit in the bathroom shared by Resident #11 and Resident #115. Interview on 09/07/23 at approximately 1:30 P.M., with the Administrator confirmed water temperatures in the facility should be no higher than 120 degrees Fahrenheit. This deficiency represents non-compliance investigated under Complaint Number OH00145743. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 5 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 observation, staff interview, medication insert review, and policy review, the facility failed to ensure medications were administered timely and per manufacturer recommendations. This affected two residents (#17 and #40) of three residents observed for medication administration. The facility census was 78. Findings included: 1. Review of Resident #40's medical record revealed an admission date of 06/29/20, with diagnoses including asthma, spina bifida, and seasonal allergies. Review of Resident #40's quarterly Minimum Data Set (MDS), dated [DATE], revealed he had an intact cognition and required one person supervision for eating. Review of Resident #40's most recent care plan revealed he had an alteration in respiratory status related to asthma. Interventions were to administer medications per medical provider's orders and observe for side effects and effectiveness. Review of Resident #40's medical record revealed a physician's order dated 06/28/23 for Advair Diskus (steroid and bronchodilator) 250-50 micrograms aerosol powder, breath activated. Administer one puff inhalation orally two times a day for shortness of breath and wheezing due to asthma. Observation on 09/06/23 at 7:36 A.M. revealed Licensed Practical Nurse (LPN) #253 handed the Advair Inhaler to Resident #40 in which he completed one inhalation. The nurse then took the inhaler and placed it back into the medication cart drawer. Interview on 09/06/23 at 7:43 A.M., with LPN #253 verified Resident #40 failed to be given proper direction to swish and rinse after administering the Advair Inhaler because the nurse felt it was not required. Review of the packet insert revealed Advair Diskus should be administered as one inhalation twice daily by the orally inhaled route only. After inhalation, the patient should rinse his/her mouth with water without swallowing to help reduce the risk of oropharyngeal candidiasis. Review of the policy titled Medication Administration, with review date of 05/29/19, revealed to rinse mouth after administering an inhaler containing steroids. 2. Review of Resident #17's medical record revealed an admission date of 01/12/23, with diagnoses including osteoarthritis, convulsions, acute cystitis, and Menier's disease Review of Resident #17's quarterly MDS dated [DATE] revealed the resident was cognitively intact. She was independent but required some supervision for activities of daily living. Review of Resident #17's most recent care plan revealed the resident had complaints of acute and chronic pain due to osteoarthritis. Interventions were to provide medication per physician orders, monitor for side effects, and evaluation effectiveness. The resident also suffered from chronic urinary tract infections. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 6 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 Review of Resident #17's medical record revealed a physician's order dated 01/18/23 to apply Voltaren External Gel (pain reliever) 1% externally to both knees topically every six hours for pain. Review of Resident #17's Medication Administration Record (MAR) dated July 2023 revealed the resident failed to be administered the Voltaren Gel on 07/17/23 and 07/22/23 at 6:00 A.M. Residents Affected - Few Review of Resident #17's MAR dated August 2023 revealed the resident failed to receive the gel on 08/04/23, 08/18/23, 08/23/23, 08/26/23, 08/27/23, 08/28/23, and 08/29/23 at 6:00 A.M. per orders. In addition, she failed to receive the medication on 08/23/23 and 08/29/23 at midnight. Review of Resident #17's MAR dated September 2023 revealed the resident failed to receive the Voltaren Gel on 09/01/23 and 09/02/23 at 6:00 A.M. and on 09/05/23 at midnight. Review of Resident #17's medical record revealed a physician's order dated 09/02/23 for Ciprofloxacin HCI (antibiotic) oral tablet 250 milligram to be administered by mouth twice daily to treat a urinary tract infection for three days. Review of Resident #17's September 2023 MAR revealed the resident was failed to be administered the Ciprofloxin on 09/04/23 at 6:00 A.M. The resident was to receive six doses total. Interview on 09/07/23 at 11:42 A.M., with the Director of Nursing (DON) stated the Voltaren was sometimes held for Resident #17 if she was sleeping, but the reason for the missed times failed to be documented. The DON also verified the Ciprofloxin was not administered timely and there was no documentation as to the reason. Review of the policy titled Medication Administration, with review date of 05/29/19, revealed medications would be administered within the time frame of one hour before and up to one hour after time ordered. Medications that are refused or withheld or not given will be documented. This was an incidental finding discovered during the complaint investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 7 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, the facility failed to ensure residents received assistive devices with meals. This affected one (#11) of three residents reviewed for assistive devices. The facility census was 78. Residents Affected - Few Findings include: Review of the medical record for Resident #11 revealed an admission date of 05/31/13 with diagnoses of depression, insomnia, and paranoid schizophrenia. Review of the quarterly minimum data set (MDS) assessment dated [DATE] revealed Resident #11 had impaired cognition and required limited assistance of one person for eating. Review of a physician order dated 04/06/23 revealed Resident #11 required a spouted cup with meals. Review of Resident #11's current care plan updated 07/29/23 revealed he had a nutritional problem due to receiving a mechanically altered diet. Interventions included a divided plate and spouted cup at every meal. Review of the meal ticket for Resident #11 for the noon meal on 09/05/23 revealed he should receive a spouted cup and divided plate with meals. Observation and interview on 09/05/23 at 12:45 P.M., with Licensed Practical Nurse (LPN) #269 confirmed Resident #11 received his meal on a regular plate and did not receive a divided plate as was specified on his meal ticket. This deficiency represents non-compliance investigated under Complaint Number OH00145743. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 8 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, staff interviews, review of facility identified diet list, review of the facility temperature logs, and review of the facility policies, the facility failed to ensure refrigerator and freezer temperatures were monitored daily. This had the potential to affect all residents in the facility except 10 residents (#38, #57, #58, #59, #61, #62, #68, #69, #86, and #102) identified to receive no food from the kitchen. Additionally, the facility failed to ensure staff followed proper hand hygiene when serving meals to residents in the dining room. This affected 13 residents (#11, #13, #14, #17, #22, #23, #25, #27, #30, #31, #46, #51, and #53) in the dining room who received cheese ravioli. The facility census was 78. Findings include: 1. Observation on 09/05/23 at 10:05 A.M., revealed the August 2023 temperature logs were incomplete from 08/24/23 through 08/31/23 for the milk refrigerator, the reach-in refrigerator, and walk-in refrigerator and the walk-in freezer. Interview on 09/05/23 at 10:05 A.M., with the Dietary Manager #286 confirmed the temperature logs were incomplete. Review of the policy Food Storage: Cold Foods, revised March 2018, revealed a written record of daily temperatures will be recorded. 2. Observations beginning on 09/06/23 at 12:15 P.M., revealed Director of Social Services (DSS) #200 plating food for the noon meal. DSS #200 was wearing plastic gloves when she picked up a plate, a meal ticket, touched the utensil to stir sauce, then picked up three cheese ravioli by hand, placed them on the plate, used the utensil to scoop and pour sauce over the ravioli, picked up a slice of garlic bread with her gloved hand and placed it on the plate, then picked up a pre-portioned salad and placed the plate and salad on top of the serving line for the dietary aide to retrieve and place on the resident's tray. Continued observation revealed DSS #200 did not wash her hands or change her gloves and proceeded to plate resident meals while touching non-food items, including serving utensils, meal tickets, and pre-portioned salad while also picking up each cheese ravioli and garlic bread with her gloved hands for residents in the dining room. Interview on 09/06/23 at 12:25 P.M., with DSS #200 confirmed she touched ready-to-eat foods with the same gloves as she touched several other non-food items. DSS #200 stated she used her gloves to pick up the ravioli because she did not want to damage the shell by using a utensil. Further observation revealed no attempt to re-serve the dining room residents who received plates with cheese ravioli. Interview on 09/06/23 at approximately 4:00 P.M., with District Manager for Dietary Services #289, confirmed DSS #200 practiced unsafe food handling by touching non-food items between touching ready-to-eat items without washing her hands and changing her gloves. Review of facility identified diet list revealed 10 residents (#38, #57, #58, #59, #61, #62, #68, #69, #86, and #102) who do not receive meals from the kitchen. The facility identified 13 residents (#11, #13, #14, #17, #22, #23, #25, #27, #30, #31, #46, #51, and #53) in the dining room who received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 9 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 0812 cheese ravioli. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00145743. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 10 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure staff accurately documented completed tasks in the medical record. This affected one (#30) of 14 records reviewed. The facility census was 78. Findings include: Review of Resident #30's medical record revealed an admission date of 06/27/17, with a diagnosis of dementia. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #30 had impaired cognition. Review of a physician order dated 11/17/22 revealed Resident #30 required staff to check the function of his wandering device on day and night shifts. Review of the Treatment Administration Record (TAR) for the evening shift on 09/02/23 revealed Licensed Practical Nurse (LPN) #252 checked the function on Resident #30's wandering device. Interview on 09/05/23 at 9:28 A.M., with LPN #252 revealed she had residents on her hall with a wandering device but could not identify them at that time. Follow-up interview and observation on 09/05/23 at 2:31 P.M., with LPN #252 revealed she checked the placement of Resident #30's wandering device on his left ankle. Further interview at that time with LPN #252 revealed she performed no additional tasks other than verifying placement when monitoring residents with a wandering device. LPN #252 revealed the functioning of the device was checked by maintenance or the on-call manager. LPN #252 confirmed she documented on Resident #30's TAR on 09/02/23 that she checked the functioning of his wandering device. LPN #252 stated the maintenance person and the on-call manager do not have access to the orders, she had to complete for Resident #30, so she documented the task was completed. Interview on 09/05/23 at approximately 3:25 P.M., with Unit Manager (UM) #201 informed the surveyor, LPN #252 was knowledgeable about when and how to check the functionality of wandering devices on residents' ankles at bedside and LPN #252 misunderstood the surveyor's question. UM #201 further stated maintenance, or the on-call manager checked the functioning of the doors in response to the wandering device, but nurses were responsible for checking the functionality of the wandering device on each resident's ankle. Interview on 09/05/23 at approximately 3:27 P.M., with LPN #252 revealed the functionality of the wandering device on each resident's ankle was checked by the maintenance. This deficiency represents non-compliance investigated under Complaint Number OH00145743. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 11 of 12 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 365704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Healthcare Center 955 Garden Lake Pkwy Toledo, OH 43614 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, staff interview, and policy review, revealed facility staff failed to follow the infection control protocol when caring for residents. This affected one (#86) of one residents observed in isolation. The facility census was 78. Residents Affected - Few Findings included: Review of Resident #86's medical record revealed an admission date of 09/06/23, with diagnoses including: colon cancer, liver cancer, prostate cancer, and lung cancer. The resident had a history of multi-drug resistant organism (MDRO). Review of Resident #86's medical record revealed a physician's order dated 09/05/23 for enhanced barrier precautions related to a history of MDRO when dressing, bathing, showering, transferring, personal hygiene, changing linens, toileting, and peri care. Providing care to resident with a history of colonized multi-drug resistant organism; klebsiella pneumoniae. Observation on 09/06/23 at 3:41 P.M., Resident #86's room door was closed with a sign posted which revealed the resident was on enhanced barrier precautions and any staff coming in contact with the resident was required to wear personal protective equipment (PPE). Hanging on the door was a receptacle which contained gowns, gloves, and masks. On entering the room Physical Therapist #256 was observed providing therapy to Resident #86. The therapist was viewed raising and lowering the residents legs up and down off of his bed without the benefit of personal protective equipment including gloves. Interview on 09/06/23 at 3:45 P.M., with Physical Therapist #256 and Infection Control Preventionist #217 verified the therapist failed to wear proper PPE as required. Review of the policy titled PPE General Statement, with review date of 02/25/22, revealed employees are required to use PPE when indicated to reduce exposure risks. This incidental finding was found during the complaint survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365704 If continuation sheet Page 12 of 12