Health inspection·December 19, 2018

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide written notification of a transfer to the hospital to the resident, family, and Ombudsman. This affected two (#58 and #62) of three residents reviewed at for hospitalization during the annual survey. The facility census was 59. Findings include: 1. Review of the medical record revealed Resident #58 was admitted to the facility on [DATE]. Diagnoses included chronic combined systolic (congestive) and diastolic (congestive) heart failure, chronic kidney disease stage 3, acute respiratory failure with hypoxia, diabetes mellitus type II, atrial fibrillation, acute kidney failure and schizoaffective disorder. Review of Resident #58's medical record revealed he had severe cognitive impairment. Review of the progress note dated 11/08/18 revealed the nurse was contacted by the wound clinic nurse concerning Resident #58 being sent to local hospital from the wound clinic to have toe amputated. There was no evidence of written notification to Resident #58, the family, or the Ombudsman concerning the resident being transferred to the hospital. 2. Review of the medical record revealed Resident #62 was admitted to the facility on [DATE]. Diagnoses included diverticulitis of intestine, left lower quadrant pain, hypertension, atherosclerotic heart disease of native coronary artery with angina pectoris. Review of the medical record for Resident #62 revealed she had intact cognition. Review of the progress note dated 10/22/18 revealed Resident #62 was experiencing a possible change of condition. The progress note revealed the resident was having acute abdominal pain and bloody drainage from a surgical site and was transferred to the local hospital for treatment. There was no evidence of written notification to Resident #58, the family, or the Ombudsman concerning the resident being transferred to the hospital. Interview on 12/18/18 at 2:45 P.M., Director of Social Services #14 confirmed the facility had not sent out a written notification to Resident #58 and Resident #62, their families or the Ombudsman concerning the residents being transferred to the hospital. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 2 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to provide notification of bed hold and facility return policy to the resident and family upon transfer to the hospital. This affected two (#58 and #62) of three residents reviewed at for hospitalization during the annual survey. The facility census was 59. Findings include: 1. Review of the medical record revealed Resident #58 was admitted to the facility on [DATE]. Diagnoses included chronic combined systolic (congestive) and diastolic (congestive) heart failure, chronic kidney disease stage 3, acute respiratory failure with hypoxia, diabetes mellitus type II, atrial fibrillation, acute kidney failure and schizoaffective disorder. Review of Resident #58's medical record revealed he had severe cognitive impairment. Review of the progress note dated 11/08/18 revealed the nurse was contacted by the wound clinic nurse concerning Resident #58 being sent to local hospital from the wound clinic to have toe amputated. There was no evidence of written notification to Resident #58, the family, or the Ombudsman concerning the resident being transferred to the hospital. There was no evidence the resident or family were notified of the facility's bed hold notice and return policy when the resident was transferred to the hospital. 2. Review of the medical record revealed Resident #62 was admitted to the facility on [DATE]. Diagnoses included diverticulitis of intestine, left lower quadrant pain, hypertension, atherosclerotic heart disease of native coronary artery with angina pectoris. Review of the medical record for Resident #62 revealed she had intact cognition. Review of the progress note dated 10/22/18 revealed Resident #62 was experiencing a possible change of condition. The progress note revealed the resident was having acute abdominal pain and bloody drainage from a surgical site and was transferred to the local hospital for treatment. There was no evidence of written notification to Resident #58, the family, or the Ombudsman concerning the resident being transferred to the hospital. There was no evidence the resident or family were notified of the facility's bed hold notice and return policy when the resident was transferred to the hospital. Interview on 12/18/18 at 2:45 P.M., Director of Social Services #14 confirmed the facility had not send out a bed hold notice and return policy to Resident #58 and Resident #62 or their families when the residents were transferred to the hospital. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 3 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0638 Assure that each resident’s assessment is updated at least once every 3 months. Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interview, the facility failed to ensure a quarterly Minimum Data Set (MDS) assessment was completed timely for four (#2, #4, #5, and #8) out 18 residents reviewed for MDS assessments during the annual survey. The facility census was 59. Residents Affected - Some Findings include: 1. Review of medical record for Resident #2 revealed an admission date of 06/14/18. Diagnosis included anxiety disorder, gastrointestinal hemorrhage, major depression, insomnia, anemia, diabetes type two, hypertension, muscle weakness, shortness of breath, above the knee left leg amputee, heart failure, and dysphagia. Review of Resident #2's admission MDS assessment documented an assessment reference date (ARD) of 06/23/18 and a completion date of 06/27/18. Review of Resident #2's next quarterly MDS assessment had an ARD dated of 12/14/18 and was documented as still in progress. Interview on 12/17/18 at 3:15 A.M., MDS Manager #1 verified Resident #2 did not have a quarterly MDS assessment completed between after his admission MDS assessment. 2. Review of medical record for Resident #4 revealed an admission dated of 08/10/16. Diagnoses included dementia with behavioral disturbances, muscle weakness, hypertrophied, heart disease and mood disorder. Review of Resident #4's quarterly MDS assessment with an ARD of 11/13/18 revealed the assessment was not completed until 12/18/18. 3. Review of medical record for Resident #5 revealed an admission dated of 05/18/18. Diagnoses included dementia with behavioral disturbances, muscle weakness, hypertrophied, psychosis, major depression, anxiety disorder, schizoaffective, deep vein thrombosis, cerebral infarct, hypertension, and insomnia. Review of Resident #5's quarterly MDS assessment with an ARD of 11/14/18 revealed the assessment was not completed until 12/18/18. 4. Review of medical record for Resident #8 revealed an admission date of 04/13/17. Diagnoses included multiple contractures, facial weakness, allergy, delusional disorder, metabolic encephalopathy, muscle weakness, toxic mega colon, insomnia, hypotension, hematemesis, and major depressive disorder. Review of Resident #8's quarterly MDS assessment with an ARD of 10/30/18 revealed assessment was not completed until 12/16/18. Interview on 12/17/18 at 3:15 A.M., MDS Manager #1 verified the quarterly MDS assessments for Resident #4, #5, and #8 were not completed within 14 days of the ARD. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 4 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0641 Ensure each resident receives an accurate assessment. 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 and staff interview, it was determined the facility failed to accurately code Minimum Data Set (MDS) assessments for two (#5 and #45) out of 18 residents reviewed for MDS assessments during the annul survey. The facility census was 59. Residents Affected - Few Findings include: 1. Review of medical record for Resident #5 revealed an admission dated of 05/18/18. Diagnoses included dementia with behavioral disturbances, psychosis, muscle weakness, major depression, anxiety disorder, schizoaffective, deep vein thrombosis, cerebral infarct, hypertension, and insomnia. Review of physician progress noted dated 08/03/18 documented Resident #5 psychosis was controlled and to continue her use of the antipsychotic medication, Seroquel. Review of a MDS assessment identified as an admission assessment, dated 08/05/18, did not indicate Resident #5 had a diagnosis of psychosis. Interview on 12/18/18 at 1:12 P.M., MDS Manager #1 verified Resident #5's diagnosis of psychosis was not coded accurately on the MDS assessment dated [DATE]. 2. Review of medical record for Resident #45 revealed an admission date of 08/10/15. Diagnosis included cerebral palsy, allergies, anxiety disorder, major depression, hyperlipidemia, dysphagia, hypokalemia, abnormal posture and and venous insufficiency. Review of the Preadmission Screening and Resident Review (PASARR) assessment, dated 08/10/05, documented Resident #45 had indication of intellectual disability. Review of the MDS assessment identified as an admission assessment, dated 09/05/18, lacked any assessment/documentation under section A 1550 of the resident being assessed as having indication of mental retardation or a related condition. Interview on 12/18/18 at 1:12 P.M., MDS Manager #1 verified the MDS was not code accurately to reflect the resident as having mental retardation or other condition as required. He stated her cerebral palsy diagnosis for her developmental disability should have been coded under section A 1550. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 5 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, facility policy review, observation and staff interview the facility failed to ensure one cognitively impaired resident was assessed and care-planned for severely impaired vision. This affected one Resident #59 out of one reviewed for impaired vision. The facility census was 59. Findings include: Review of the medical record revealed Resident #59 was admitted on [DATE] with a diagnosis of cerebral infarction, anemia, hypothyroidism, mood affective disorder, muscle weakness, repeated falls, encephalopathy, abnormal coagulation, other disorders of bilirubin metabolism, nontraumatic hematoma of soft tissue, pain in unspecified ankle and joints of unspecified foot, abnormalities of gait and mobility, hypertension, constipation, melena, old myocardial infarction, personal history of other venous thrombosis, presence of coronary angioplasty implant and graft, atherosclerotic heart disease of native coronary artery without angina pectoris, hyperlipidemia, acute post hemorrhagic anemia, and gastrointestinal hemorrhage. Review of Medicare 30-day quarterly MDS dated [DATE], revealed Resident #59 had severe cognitive deficits, and required extensive assistance with one person for bed mobility, transfers and toileting; frequently incontinent of bowel and bladder. The MDS revealed Resident #59 vision is highly impaired with corrective lenses. Reviewed care plan dated 11/15/18 revealed no care plan for impaired vision. Observations on 12/16/18 at 11:16 A.M. Resident #59 was in bed, awaken in hospital gown. No television on. In bed with no glasses. Two pair of glasses lying next to him on the night stand. Observations on 12/16/18 3:45 P.M., revealed Resident #59 sitting up in wheelchair fully dressed. Resident #59 had no glasses on his face. Glasses were lying next to him on the night stand. Observations on 12/17/18 at 11:55 A.M., revealed Resident #59 sitting on bed eating lunch. Resident #59 did not have any glasses on face. Glasses lying on night stand. Observations on 12/19/18 at 9:42 A.M., revealed Resident #59 walking to therapy with walker without his eye glasses. Glasses lying on night stand. Observations on 12/19/18 at 12:21 P.M., revealed Resident #59 pressed call light to go to the bathroom. Stated Tested Nursing Assistant (STNA) #70 took resident to the bathroom without any glasses on his face Interviewed on 12/19/18 at 11:00 A.M. revealed Licensed Practical Nurse (LPN) #61 confirmed Resident #59 was taking eye drops for an eye condition. Interviewed on 12/19/18 at 11:40 A.M., revealed Certified Occupational Therapy Assistant(COTA) #69 reported of walking resident from room to therapy without his glasses on face. Resident and COTA #69 walked 140 feet to and from therapy. COTA #69 reported of being aware of Resident #59's vision impairment and reports of seeing shadows. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 6 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 12/19/18 at 11:45 A.M., revealed State Tested Nursing Assistant (STNA) #70 reported Resident #59 could barely see out of right eye and is totally blind in the left eye. STNA #70 stated that the resident reported to her that he has reading glasses, but he cannot see out of them. STNA #70 denies of reporting the conversation to the nurse, DON or Administrator. Interview on 12/19/18 at 1:48 P.M. with the Director of Nursing (DON) verified Resident #59 vision is highly impaired. DON reported when Resident #59 was admitted he had a large magnifying glass about the size of a lap top but asked his Power of Attorney (POA) to take it home. DON verified Resident #59 was not care planned for impaired vision. Based on medical record review, staff interview, and review of facility policy, the facility failed to develop complete comprehensive care plans for two (#28 and #59) out 18 residents reviewed for care plans during the annual survey. The facility census was 59. Findings include: 1. Review of medical record for Resident #28 revealed an admission date of 01/17/15. Diagnoses included acute respiratory failure, sepsis, unspecified convulsions, mixed hyperlipidemia, hypertension, anxiety disorder, schizophrenia, major depression and paralytic syndrome. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/20/18, documented Resident #28 as having severe functional range of motion impairments to both sides of his upper extremities. Review of the current comprehensive care plan revealed Resident #28 did not have a care plan in place for his left hand contracture to ensure appropriate care and monitoring was in place. Observation on 12/16/18 at 11:59 A.M. revealed Resident #28's left hand was contracted with no splint in place. Interview on 12/19/18 at 12:55 P.M., MDS Manager #1 verified there was no care plan in place for Resident #28's left hand contracture. Review of the facility policy titled Care Plan, Comprehensive, dated August 2014, documented the care plan will be individualized by identifying resident problems, unique characteristics, strengths and and individual needs. 2. Review of the medical record revealed Resident #59 was admitted on [DATE]. Diagnoses included cerebral infarction, anemia, hypothyroidism, mood affective disorder, muscle weakness, repeated falls, encephalopathy, abnormalities of gait and mobility, hypertension, melena, personal history of other venous thrombosis, presence of coronary angioplasty implant and graft, and atherosclerotic heart disease of native coronary artery without angina pectoris. Review of the quarterly MDS assessment, dated 12/04/18, revealed Resident #59 had severe cognitive deficits, had highly impaired vision, and wore corrective lenses. Reviewed care plan dated 11/15/18 revealed plan in place to address Resident #59's impaired vision. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 7 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0656 Interview on 12/19/18 at 11:45 A.M., State Tested Nursing Assistant (STNA) #70 reported Resident #59 Level of Harm - Minimal harm or potential for actual harm could barely see out of right eye and was totally blind in the left eye. STNA #70 stated the resident reported to her he has reading glasses, but he cannot see out of them. Residents Affected - Few Interview on 12/19/18 at 1:48 P.M., the Director of Nursing (DON) verified Resident #59 had no care plan for impaired vision. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 8 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and staff interview, the facility failed to provide assistance for the application of glasses for a visually impaired resident. This affected one (#59) of one resident sampled for quality of life. The facility census was 59. Residents Affected - Few Findings include: Review of the medical record revealed Resident #59 was admitted on [DATE]. Diagnoses included cerebral infarction, hypothyroidism, mood affective disorder, muscle weakness, repeated falls, encephalopathy, nontraumatic hematoma of soft tissue, hypertension, melena, myocardial infarction, presence of coronary angioplasty implant and graft, atherosclerotic heart disease of native coronary artery without angina pectoris, hyperlipidemia, acute post hemorrhagic anemia, and gastrointestinal hemorrhage. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/04/18, revealed Resident #59 had severe cognitive deficits. The MDS revealed Resident #59's vision was highly impaired with corrective lenses. The resident required extensive assistance with one person for bed mobility, transfers and toileting and was frequently incontinent of bowel and bladder Observations on 12/16/18 at 11:16 A.M. Resident #59 in a hospital gown lying in bed, awake, with no glasses. Two pair of glasses were lying on the night stand next to Resident #59. Observations on 12/16/18 at 3:45 P.M., revealed Resident #59 sitting up in wheelchair fully dressed. Resident #59 had no glasses on his face. Glasses were lying next to him on the night stand. Observations on 12/17/18 at 11:55 A.M., revealed Resident #59 sitting on bed eating lunch. Resident #59 did not have any glasses on his face. There were glasses lying on night stand. Observations on 12/19/18 at 9:42 A.M., revealed Resident #59 walking to therapy using his walker without his eye glasses in use. The glasses were observed lying on his night stand. Interviewed on 12/19/18 at 11:00 A.M., Licensed Practical Nurse (LPN) #61 confirmed Resident #59 had vision impairment. Interviewed on 12/19/18 at 11:40 A.M., Certified Occupational Therapy Assistant COTA) #69 verified walking Resident #59 from his room to therapy without his glasses on. COTA #69 reported of being aware of Resident #59's vision impairment and reports of seeing shadows. COTA #69 verified she worked with Resident #59 on grooming, hygiene, fine motor control, dressing, toileting and bathing and strengthening goals without his glasses on his face. Interview on 12/19/18 at 11:45 A.M., State Tested Nursing Assistant (STNA) #70 reported Resident #59 could barely see out of right eye and was totally blind in the left eye. STNA #70 stated the resident reported he has reading glasses, but he cannot see out of them. Interview on 12/19/18 at 1:48 P.M., the Director of Nursing (DON) verified Resident #59's vision was highly impaired. DON reported she was unaware Resident #59 was not wearing his eyeglasses due vision being impaired. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 9 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and staff interview, the facility failed to accurately assess and provide activities of interest for one (#59) out two residents reviewed. The facility census was 59. Residents Affected - Few Findings include: Review of the medical record revealed Resident #59 was admitted on [DATE]. Diagnoses included cerebral infarction, hypothyroidism, mood affective disorder, muscle weakness, repeated falls, encephalopathy, nontraumatic hematoma of soft tissue, hypertension, melena, myocardial infarction, presence of coronary angioplasty implant and graft, atherosclerotic heart disease of native coronary artery without angina pectoris, hyperlipidemia, acute post hemorrhagic anemia, and gastrointestinal hemorrhage. Review of the quarterly Minimum Data Set (MDS) assessment, dated 12/04/18, revealed Resident #59 had severe cognitive deficits. The MDS revealed Resident #59's vision was highly impaired with corrective lenses. Reviewed activity initial assessment dated on 11/10/18 revealed Resident #59's interests were television shows that consist of news and family. Resident #59 also enjoys reading newspapers. Observations on 12/16/18 at 11:16 A.M., revealed Resident #59 in a hospital gown lying in bed, awake. There was a television is in room but it was turned off. There was no newspaper in the room. Observations on 12/16/18 at 3:45 P.M., revealed Resident #59 was sitting up in the wheelchair. The television was turned off and no newspaper was in the room. Observations on 12/18/18 at 11:26 A.M., revealed Resident #59 lying in bed with no television and no newspaper in the room. Resident #59 was not sleeping. Observations on 12/17/18 11:55 A.M., revealed Resident #59 eating lunch sitting in bed. No glasses were on his face, no television was on, and no newspaper in room. Interview on 12/18/18 11:31 A.M., License Practical Nurse (LPN) #39 stated Resident #59 was confused and a fall risk. LPN #39 states Resident #59 preferred to stay in bed and must be closely watched. Interview on 12/19/18 at 10:44 A.M., Manager Activities (MA) #11 reported the activity assessment was completed on 11/10/18 and Resident #59 enjoyed reading newspapers and watching TV news channels. MA #11 verified no television was on and no newspaper was in the room. MA#11 was unaware that Resident #59 was not watching television and denied staff informing her any reasons why Resident #59 was unable to watch television. Interview on 12/19/18 at 11:00 A.M., LPN #61 reported Resident #59 does not like watching television due to not watching much of it at home. Observations on 12/19/18 at 11:30 A.M., revealed Resident #59 sitting in wheelchair with no television on and no newspaper in the room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 10 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview on 12/19/18 at 11:45 A.M., State Tested Nursing Assistant #70 reported the resident refuses activities and had impaired vision. STNA #70 reported Resident #70 does not like to watch television. STNA #70 denied seeing activities staff visiting with resident. Interview on 12/19/18 at 2:37 P.M., the Director of Nursing revealed Resident #59 had become more confused when the television was on in his room. Event ID: Facility ID: 365743 If continuation sheet Page 11 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 record review, observation, and interview, the facility failed to follow physician orders for treatment of nonpressure skin impairment for one (#24) of one resident reviewed for skin. The facility census was 59. Residents Affected - Few Findings include: Review of the medical record revealed Resident #24 was admitted [DATE]. Diagnoses included dyspnea, pneumonia, neuromuscular dysfunction of bladder, bipolar disorder, embolism and thrombosis of unspecified vein, atherosclerotic heart disease, lymphedema, low back pain, type 2 diabetes mellitus, rheumatoid arthritis, anxiety disorders, insomnia, rash and other nonspecific skin, idiopathic peripheral autonomic neuropathy, schizophrenia major depressive disorder, schizoaffective disorder bipolar type, chronic obstructive pulmonary disease, and anxiety disorder. Review of the annual Minimum Data Set (MDS) assessment, dated 10/12/18, documented the resident had intact cognition for decisions. The resident required extensive assistance with one-person physical assist for bed mobility, transfers, and toilet use. Review of the plan of care dated 08/09/18 revealed the resident had potential for impaired skin integrity related to impaired mobility and incontinence. Interventions included administer medications as ordered and observe skin integrity during care. Review of the physician orders from 10/24/18 to 11/21/18 identified orders for weekly skin inspection every Wednesday during night shift. Orders included apply the antifungal cream ketoconazole and the psoriasis medication Calcipotriene cream to the groin and breasts every shift for rash and apply non-adherent pads under bilateral breast every shift due to a rash. Review of the Treatment Administration Record (TAR) for November 2018 and December 2018 revealed the weekly skin inspections had not been completed on 11/21/18, 11/28/18, 12/19/18, and 12/26/18. Review of the TAR for November 2018 and December 2018 revealed the ketoconazole and Calcipotriene cream was to be administered in the morning and evening. These were not completed on 11/25/18 either shift, 11/28/18 on the evening shift, 12/04/18 and 12/09/18 either shift, and 12/13/18 on the evening shift. Review of the TAR for November 2018 and December 2018 revealed the non-adherent pads under bilateral breast was not completed on 11/21/18, 11/25/18, 11/28/18, 12/04/18, 12/09/18, and 12/13/18. Interview on 12/16/18 at 12:40 P.M., Resident #24 reported the nurses were not providing the treatments as ordered from the doctor for her skin condition on her breast and groin areas. Interview on 12/18/18 at 11:39 A.M., Licensed Practical Nurse (LPN) #39 verified no refusals pertaining towards skin conditions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 12 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based medical record review, observation, and staff interview, the facility failed to ensure a therapy recommended splint was obtained and implemented for a hand contracture for one (#28) out of one resident reviewed for limited range of motion (ROM). The facility identified four resident currently with limited ROM and contractures. The facility census was 59. Findings include: Review of medical record for Resident #28 revealed an admission date of 01/17/15. Diagnoses included acute respiratory failure, sepsis, unspecified convulsions, mixed hyperlipidemia, hypertension, anxiety disorder, schizophrenia, major depression and paralytic syndrome following a non traumatic interceder encourage affecting unspecified side. Review of occupational therapy progress note and Discharge summary dated [DATE] documented Resident #28's goal was met. The resident was able to tolerate left upper extremity resting hand splint for two hours. Further review documented the resident discharge plan and instructions included an upper extremity orthodic. Review of physician orders from 05/17/17 through 12/18/19 lacked any documentation of a upper extremity orthodic being ordered for implementation as recommended by by an occupational therapy. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/20/18, documented Resident #28 as having severe functional range of motion impairments to both sides of his upper extremities. Review of the current comprehensive care plan revealed Resident #28 did not have a care plan in place for his left hand contracture to ensure appropriate care and monitoring was in place. Observation on 12/16/18 at 11:59 A.M. revealed Resident #28's left hand was contracted with no splint in place. Interview on 12/19/18 at 08:31 A.M., Certified Occupational Therapy Assistant (COTA) #62 verified Resident #28 did have a contracture to his left hand and there was no ordered splint device in place for his left hand. Interview on 12/19/18 04:45 at P.M., the Director of Nursing (DON) stated usually therapy will recommend a splint order it and notify nursing about recommendations. She verified therapy was in charge of ordering devices for residents. The previous therapy company made the recommendation for Resident #28's splint and there were a lot of problems with the company providing devices. She verified Resident #28 did not have splint device in place for his left hand contracture. She stated she was never aware the Resident was suppose to have a device in place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 13 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 record review and staff interview, the facility failed to ensure the pharmacy provided antibiotics for timely administration for one (#24) of five residents reviewed for unnecessary medications. The facility census was 59. Finding include: Review of Resident # 24's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included pneumonia, hypercholesterolemia, bipolar disorder, chronic embolism and thrombosis, metabolic encephalopathy, major depressive disorder, obesity, psoriasis, hypertension, insomnia, hyperlipidemia, schizophrenia, osteoarthritis, anxiety disorder, chronic obstructive pulmonary disease and cellulitis. Review of the quarterly Minimum Data Set assessment, dated 10/12/18, indicated the resident had mild or no cognitive impairment and required extensive assistance with bed mobility, transfers and toileting. Review of the physician orders dated 12/12/18 revealed an order for the antibiotic doxycycline 200 milligrams (mg) twice per day for cellulitis. Review of a progress note dated 12/12/18 at 2:14 P.M. documented the wound physician ordered the resident to be placed on an antibiotic for cellulitis. The note indicated Resident #24 was to start doxycycline 200 milligrams twice per day. Review of the Medication Administration Record (MAR) for December 2018 revealed the doxycycline was ordered on 12/12/18 and was to start on 12/13/18 at 5:00 P.M. The MAR revealed the antibiotic was not administered until 12/14/18 at 9:00 A.M. Interview on 12/19/18 at 11:46 A.M., Licensed Practical Nurse (LPN) #61 stated the wound doctor assessed the resident on 12/12/18 and wanted to started her on an antibiotic for cellulitis, but due to the resident's multiple drug allergies the physician wanted the primary care physician to determine if the doxycline was safe to give the resident. LPN #61 stated she contacted the physician who agreed with the doxycycline. LPN #61 stated the medication was not to be started until 12/13/18 because the facility could not get it delivered that evening and it was not in the emergency drug box. LPN #61 further stated she did not give the 12/13/18 5:00 P.M. dose because the medication had not been received yet from the facility. LPN #61 verified the resident did not get the medication until 12/14/18 because the pharmacy did not provide make it available for the facility until 12/14/18. Interview on 12/19/18 at 4:45 P.M., the Director of Nursing stated normally medications arrive from the pharmacy within three to four hours and verified Resident # 24 did not received her antibiotic timely. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 14 of 15 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 365743 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wright Rehabilitation and Healthcare Center 829 Yellow Springs - Fairfield Rd Fairborn, OH 45324 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, staff interview, and review of a housekeeping manual, the facility failed to ensure the environment was maintained in a clean, sanitary, and comfortable manner for three (#11, #12, and #24) out of three residents reviewed for environment. The facility census was 59. Finding include: 1. Observation on 12/17/18 at 2:44 P.M. of Resident #11's mattress revealed multiple areas soiled with an unknown substance. Interview on 12/17/18 at 2:45 P.M., Housekeeper #9 verified Resident #11's mattress was soiled with multiple areas of an unknown substance visible. She verified she was not sure when Resident #11's mattress was cleaned. She revealed the mattresses are usually just cleaned when housekeeping staff are asked to and she was unaware of any cleaning schedule for the mattresses. 2. Observation on 12/17/18 at 2:47 P.M. revealed Resident #12's privacy curtain was heavily soiled with a black substance. The black substance was noted to be approximately two feet from the bottom all the way around the privacy curtain. Interview on 12/17/18 at 2:49 P.M., Housekeeper #9 verified Resident #12's privacy curtain was heavily soiled. She further described it as being gross. She then revealed she was not aware how often the privacy curtains are changed and stated she has never changed one herself. 3. Observation on 12/17/18 at 3:25 P.M., Resident #24's room was noted to have multiple areas of missing paint to the bathroom door. The bedroom wall paper was peeling and missing in three areas. The ceiling had three areas where the textured finish was missing and part of the ceiling was hanging down. The bathroom wall was marred in multiple areas. Interview on 12/17/18 at 3:26 P.M., Director of Environmental Services #59 verified Resident 24's room was noted to have multiple areas of missing paint to her bathroom door, the wall paper was peeling and missing in three areas, and the ceiling was missing the finish. He also verified Resident #24's bathroom wall was marred in multiple areas. He stated he knew about the disrepair but could only do so much at a time. Review of the undated Introduction to the Housekeeping Manual revealed the focus of the manual was to provide a clean, safe, and beautiful environment for the residents. This deficiency substantiates Complaint Number OH00101640. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365743 If continuation sheet Page 15 of 15