Inspection·May 14, 2021

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview 05/05/21 12:21 P.M. with Resident #4 revealed the staff never cover her up and provide privacy when they push her down the hallway to the the shower room. She indicated her bottom was always exposed. Review of the facility policy, Resident Rights, dated 08/11/17 revealed it was the facility policy to provide resident centered care that meets the psychosocial, physical, and emotional needs and concerns of the residents. The purpose of the policy was to guide employees in the general principles of dignity and respect of caring for residents, including the right to refuse treatment and care and the rights and safety of other residents, staff, and visitors. Care for resident would be provided in a safe respectful manner that includes care in a private setting. Review of the facility policy, Personal Bathing and Shower, dated 04/25/18 revealed prior to bringing resident to shower room or undressing in room, gather equipment, provide for covering for comfort and dignity such as towel and/or bath blankets. 2. Review of the medical record revealed Resident #6 was admitted to the facility on [DATE] with the diagnoses of chronic respiratory failure, traumatic brain injury, altered mental status, COVID-19, contractures of the right elbow, left elbow, right hand, left hand, neuromuscular dysfunction of the bladder, hypertension, gastrostomy, and tracheotomy. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #6 had severely impaired cognition and required total assistance for all ADLs. Observation on 05/05/21 at 11:20 P.M. revealed Registered Nurse (RN) #31 preformed a dressing change on Resident #6. RN #31 never spoke to the resident or explained anything she was doing to the resident, she took his blanket completely off of him, she rolled him over, took off his Profo boots and socks without explaining anything she was doing to him. She took his incontinence undergarment off and cleaned up his bowel movement without explaining anything she was doing to him. Interview on 05/05/21 at 11:45 A.M. with RN #31 verified she had not explained anything to Resident #6. She indicated she had said hello to him when she went into the room but had not explained step by step what she was doing during his treatment change or during incontinent care. Review of the facility policy, Resident Rights, dated 08/11/17 revealed it was the facility policy to provide resident centered care that meets the psychosocial, physical, and emotional needs and concerns of the residents. The purpose of the policy was to guide employees in the general principles of dignity and respect of caring for residents, including the right to refuse treatment and care and the rights and safety of other residents, staff and visitors. Care for resident would be provided in a safe respectful manner that includes care in a private setting. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 2 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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** 9. Resident #84 was admitted to the facility on [DATE] with diagnosis that included chronic obstructive pulmonary disease, muscle weakness, heart failure, type II diabetes, major depression and needs assistance with personal care. The annual comprehensive assessment dated [DATE] indicated the resident had mild cognitive impairment and required extensive assistance with personal hygiene. Residents Affected - Some Observation of the resident's nails on 05/03/21 at 11:08 AM revealed the resident had a black substance beneath his nails. The surveyor asked if staff provided nail care when he was being bathed, and he stated no. Resident #84 was unable to clean his own nails. On 05/05/21 at 11:08 A.M. the DON and another surveyor observed Resident #84's finger nails. Interview with the DON at this time verified the resident had long dirty fingernails. This deficiency substantiates Complaint Number OH00122064. Based on observations, resident interviews, and staff interviews, the facility failed to ensure nail care and mouth care was provided to the residents. This affected nine (Residents #6, #26, #38, #41, #55, #71, #84, #88 and #93) of 11 reviewed for activities of daily living. The facility census was 96 residents. Findings include: 1. Review of the medical record revealed Resident #88 was admitted to the facility on [DATE] with the diagnoses of chronic kidneys disease, dementia, hypertension, anxiety, major depression, and insomnia. Review of the quarterly MDS dated [DATE] revealed Resident #88 had severely impaired cognition and extensive assistance of one for personal hygiene. Review of the plan of care dated revealed Resident #88 had an ADL self care performance deficit related to weakness. Interventions included the resident required extensive assistance of one staff member for toilet use, transfer, repositioning, bathing personal hygiene, and oral care. Observations on 05/03/21 at 11:22 A.M., 05/04/21 at 9:35 A.M., and 05/05/21 at 9:26 A.M. revealed Resident #88 had long, dirty fingernails. On 05/05/21 at 11:07 A.M. interview and observation with the DON verified Resident #88 had long dirty fingernails. Interview on 05/05/21 at 2:00 P.M. with the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 3 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. Residents Affected - Some 2. Review of the medical record revealed Resident #38 was admitted to the facility on [DATE] with the diagnoses of dementia with behavioral disturbance, psychotic disorder with delusion, polyosteoarthrutis, mood affective disorder, major depressive disorder, anxiety disorder, Alzheimer's disease, and schizoaffective disorder. Review of the quarterly MDS date 03/09/21 revealed Resident #38 had severely impaired cognition and required total assistance with all ADLs. Review of the plan of care dated 04/09/14 revealed Resident #38 had an ADL self-care performance deficit related to decreased mobility and decreased cognition. Interventions included the resident required extensive assistance of one staff member for personal hygiene. Observation on 05/03/21 at 10:10 A.M. and on 05/05/21 at 9:29 A.M. revealed Resident #38 had long, dirty fingernails. On 05/05/21 at 11:08 A.M. observation and interview with the DON verified Resident #38 had long, dirty fingernails which were curled into her contracted hands. Interview on 05/05/21 at 2:00 P.M. with the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. 3. Review of the medical record revealed Resident #26 was admitted to the facility on [DATE] with the diagnoses of sarcopenia, macular degeneration, dementia, hearing loss, legally blind, COVID-19, major depression, repeated falls, and need for assistance with personal care. Review of the annual MDS 3.0 assessment dated [DATE] revealed Resident #26 had moderately impaired cognition and required extensive assistance with personal hygiene. Review of the plan of care dated 02/24/21 revealed Resident #26 had an ADL self-care performance deficit and required assistance with ADL cognitive deficit and sarcopenia. Interventions included to observe and anticipate resident's needs, place the call light within reach, therapy evaluations and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 4 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 Level of Harm - Minimal harm or potential for actual harm treatment as per medical orders, required extensive one staff assistance with bed mobility, hygiene, bathing, transfers, dressing, and toileting. Observation on 05/03/21 at 10:00 A.M. and on 05/04/21 at 9:33 A.M. revealed Resident #26 had long, jagged, dirty fingernails. Residents Affected - Some On 05/05/21 at 11:10 A.M. observation and interview with the DON verified Resident #26 had long, dirty and jagged fingernails. Interview on 05/05/21 at 2:00 P.M. the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. 4. Review of the medical record revealed Resident #41 was admitted to the facility with the diagnoses of intracranial injury, amebic brain injury, hypertension, major depressive disorder, anemia, constipation, intracranial abscess, and granuloma. Review of the annual MDS assessment dated [DATE] revealed the resident had severely impaired cognition and required total assistance with ADLs. Review of the plan of care dated 03/16/21 revealed Resident #41 had an ADL self-care performance deficit and required assistance with ADL cognitive deficit. Interventions include the resident required extensive assistance with hygiene Observation on 05/03/21 at 9:58 A.M., 05/04/21 at 9:39 A.M., and on 05/05/21 at 9:26 A.M. revealed Resident #41 had long dirty fingernails. On 05/05/21 at 11:11 A.M. observation and interview with the DON verified Resident #41 had long dirty fingernails. Interview on 05/05/21 at 2:00 P.M. the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 5 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. Residents Affected - Some 5. Review of the medical record revealed Resident #55 was admitted to the facility on [DATE] with the diagnoses of traumatic brain injury, anoxic brain damage, altered mental status, chronic obstructive pulmonary disease, epilepsy, COVID-19, major depression, anxiety disorder, chronic pain, migraine, asthma, and pulmonary embolism. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #55 had severely impaired cognition and required extensive assistance of one for personal hygiene. Review of the plan of care dated 05/03/21 revealed Resident #55 had an ADL self care performance deficit related to impaired balance, limited mobility, contractures and combative with care at times. Interventions included the resident required extensive assistance of one staff member for personal hygiene. Observations on 05/03/21 at 9:54 A.M. and on 05/05/21 at 9:26 A.M. revealed Resident #55 had long dirty fingernails. On 05/05/21 at 11:12 A.M. observation of the resident and interview with the DON verified Resident #55 had long dirty fingernails and a beard. Interview on 05/05/21 at 2:00 P.M. the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. 6. Review of the medical record revealed Resident #6 was admitted to the facility on [DATE] with the diagnoses of chronic respiratory failure, traumatic brain injury, altered mental status, COVID-19, contractures of the right elbow, left elbow, right hand, left hand, neuromuscular dysfunction of the bladder, hypertension, gastrostomy, and tracheotomy. Review of the quarterly Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed Resident #6 had severely impaired cognition and required total assistance for all ADLs. Review of the plan of care dated 08/20/19 revealed Resident #6 had an Activity of Daily Living (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 6 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 Level of Harm - Minimal harm or potential for actual harm (ADL) self-care and performance deficit related to traumatic brain injury. Interventions included the resident required total assistance of staff member for personal hygiene. Observation on 05/03/21 at 9:32 A.M., 11:45 A.M., and 3:30 P.M. revealed Resident #6 had long dirty fingernails. Residents Affected - Some On 05/05/21 at 11:13 A.M. observation of the resident and interview with the Director of Nursing (DON) verified Resident #6 had long dirty fingernails. Interview on 05/05/21 at 2:00 P.M. with the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. 7. Review of the medical record revealed Resident #93 was admitted to the facility on [DATE] with the diagnoses of Alzheimer's disease, sacral pressure ulcer, left heel pressure ulcer, iron deficiency anemia, nutritional deficiency, dementia, disorder of the kidneys and ureters, left hand contracture, neuromusculaer dysfunction of the bladder, adult failure to thrive, COVID-19, hypertension, osteoarthritis, colostomy, and insomnia. Review of the quarterly MDS dated [DATE] revealed Resident #93 had severely impaired cognition, and required total assistance with bed mobility, transfers, toilet use and personal hygiene. She had an ostomy and an indwelling catheter. Review of the plan of care dated 05/03/21 revealed Resident #93 had an ADL self-care performance deficit related to activity intolerance, wounds, and contracture. Interventions included the resident required extensive assistance of two staff members for personal hygiene. Observations on 05/03/21 at 9:25 A.M. and 11:15 A.M., and on 05/04/21 at 8:44 A.M., revealed Resident #93 had a left hand contracture with long dirty fingernails. Her nails were leaving an imprint on the palm of her hand but had not broken the skin. Observation on 05/05/21 at 11:20 A.M. with the DON revealed Resident #93 had long dirty fingernails. Interview at this time with DON verified Resident #93 had long, dirty fingernails. Interview on 05/05/21 at 2:00 P.M. the DON revealed nails were to be trimmed and cleaned on shower days. Review of the facility policy Routine Resident Care, dated 05/29/19 revealed it was the policy of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 7 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the facility to promote resident centered care by attending to the physical, emotional, social and spiritual needs and honor resident lifestyle preferences while in care of this facility. Licensed staff would include the following services based upon their scope of practice; assisting and teaching activities of daily living. Review of the facility policy Nail and Hair Hygiene Services, dated 05/30/19 revealed the facility would provide routine care for the residents for hygienic purposes and for the psychosocial well-being of the resident including but not limited to routine nail hygiene, care for ingrown or damaged nails would be provided on an individual care bases. These services were provided by the facility as part of regular grooming care. 8. Medical record review revealed that Resident #71 was admitted on [DATE] with diagnoses including chronic obstructive pulmonary disease, type two diabetes mellitus, and dysphagia. Review of Resident #71's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident required extensive assistance with one-person physical assistance for personal hygiene. Interview on 05/04/21 at 9:53 A.M. with Resident #71 revealed that facility staff do not provide him any mouth care, and that he does not have a toothbrush or toothpaste. Observation on 05/05/21 at 8:56 A.M. with State Tested Nursing Assistant (STNA) #71 revealed that the resident did not have a toothbrush, mouth wash, or any supplies to complete mouth care. Interview on 05/05/21 at 8:56 A.M. with State Tested Nursing Assistant (STNA) #81 revealed that she is responsible for Resident #71's morning care including mouth care, and that he has not been receiving mouth care. Review of the facility policy Oral Hygiene revised 04/25/18 revealed Mouth care and oral hygiene is part of the daily care of the resident. Oral hygiene may include brushing and rinsing of natural teeth, but may also involve cleaning oral devices including but not limited to dentures, partial plates, bridges or other dental appliances. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 8 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 review of the medical record, resident interview and staff interview the facility failed to provide scheduled showers for Resident #43. This affected one resident (Resident #43) of one reviewed for choices. The facility census was 96 residents. Residents Affected - Few Findings include: Review of the medical record revealed Resident #43 was admitted to the facility on [DATE] with the diagnoses of chronic obstructive pulmonary disease, chronic pain, diabetes, major depressive disorder, insomnia, muscle weakness, schizoaffective disorder, anxiety disorder, hypertension, cerebral infraction, and age related physical debility. Review of the quarterly Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #43 had intact cognition and required physical help with bathing. Review of the Activities of Daily Living computer tracking forms from 04/10/21 to present revealed Resident #43 received a shower on 04/22/21. Review of the Point Click Care shower task tracking from 04/11/21 to 05/11/21 revealed Resident #43 had received a shower on 04/22/21 with no other documentation of any other showers being given or refused. Interview on 05/04/21 at 9:45 A.M. Resident #43 indicated she has not had a shower in awhile. Interview on 05/11/21 at 12:28 P.M. Resident #43 stated she had received her shower on Monday 05/10/21 however, she did not receive one last Thursday, she indicated it was the first shower she has had in two months. She indicated she had refused her shower one time because there was poop on the bath chair and she told the nursing assistant she would have to clean it up first before she would sit in it. She indicated she use to get her showers all the time when another nursing assistant worked in the facility but she had quit. She indicated she has not been getting them on schedule since then. Interview on 05/11/21 at 12:46 P.M. the Director of Nursing indicated the nursing assistants were supposed to document in point of care when they give a resident a shower but with all the agency staff working it was hard to track them down if they forget to chart on someone. She verified there was no documentation Resident #43 had received her scheduled showers. Review of the facility policy, Personal Bathing and Shower dated 04/25/18 revealed the facility would provide resident centered care that meets the psychosocial, physical and emotional needs and concerns of the residents. Safety was a primary concerns for the resident staff and visitors. Residents have the right to choose their schedules, consistent with their interest, assessments, and care plans including choice for personal hygiene. This includes, but not limited to, choice about the schedule and type of activities for bathing that may include a shower, a bed-bath or tub bath, or combination and on different days. The facility would not develop a schedule for care, such as waking or bathing, for staff convenience and without the input of the resident/representative. This deficiency substantiates Complaint Numbers OH00122064 and OH00111582. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 9 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on Observation, review of the medical record and staff interview the facility failed to complete a dressing change as ordered for Resident #38. This affected one resident (Resident #38) of seven residents reviewed for pressure ulcers. Residents Affected - Few Findings include: Review of the medical record revealed Resident #38 was admitted to the facility on [DATE] with the diagnoses of dementia with behavioral disturbance, psychotic disorder with delusion, polyosteoarthrutis, mood affective disorder, major depressive disorder, anxiety disorder, Alzheimer's disease, infectious and parasitic disease, schizoaffective disorder, hypertension and anemia. Review of the May 2021 physician's orders revealed Resident #38 had an order for bilateral first metatarsal head, left second toe, left great toe, left heel to cleanse with normal saline, apply Venelex ointment to discoloration and dorsal foot and toe Bilateral open areas apply medihoney gel with calcium alginate with calcium alginate rope between the toes, pad and protect bilateral feet and heels with abdominal dressings, secure with Kerlix every Monday, Wednesday and Friday and as needed. Observations on 05/03/21 at 10:10 A.M., 3:35 P.M., and 4:00 P.M. (after the Director of Nursing verified) revealed Resident #38 had both her feet wrapped in Kerlix and both were dated 4/28/21. Interview on 05/03/21 at 11:00 A.M. the Director of Nursing verified the bilateral dressings to Resident #38's feet were dated 04/28/21 and had not been done on Friday 04/30/21 as ordered. They had not been changed for five days. Review of the facility policy, Wound Care, dated 05/30/19 revealed residents admitted with or developed skin integrity issues would receive treatment as indicated based on location, stage and drainage. This deficiency substantiates Complaint Number OH00110980. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 10 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 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. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, therapy discharge notes, and policy review the facility failed to ensure Resident #76 received restorative services necessary to maintain dexterity in his right hand. Actual harm occurred when Resident #76 was admitted back into the facility from the hospital, and the facility did not reorder the resident's splint or initiate restorative services as recommended by occupational therapy, resulting in a decline in the resident's ability to open his right hand. This affected one (Resident #76) resident of four reviewed for limited range of motion. The facility census was 96 residents. Findings include: Medical record review revealed that Resident #76 was admitted on [DATE] with diagnoses including, chronic kidney disease stage 2, need for assistance with personal care, and a right hand contracture. Review of Resident #71's quarterly Minimum Data Set (MDS) 3.0 dated 04/06/21 revealed the resident received extensive assistance with one person assist for dressing and a noted impairment on one side. Interview on 05/05/21 at 11:23 A.M. with Resident #76 revealed that he was in therapy and had a splint for his right hand. He further revealed that the facility no longer has him in therapy, he is not receiving range of motion, and can no longer open his fingers enough to get his splint on his right hand since stopping therapy. Review of Resident #76's Occupational Therapy Discharge Summary revealed that on 09/24/20 the resident's right hand was tight and his current splint is unable to fit due to splint not being worn constantly. Patient has increased pain at seven out of ten with shoulder, forearm, wrist, and fingers. At the time of discharge from occupational therapy on 10/07/20 the note revealed the resident's right hand was contracted and the patient had an appropriate splint to prevent further tightness. It further revealed the patient had been tolerating splint for eight hours and will resume wearing as a night splint, and to reestablish restorative nursing program for range of motion and splint monitoring. Review of Resident #76's Restorative Care Program dated 10/07/20 that is given to the facility by occupational therapy revealed the facility should provide daily range of motion with right upper extremity, and apply right hand splint as a night splint with skin checks between application. Review of the Resident # 76's physician orders from 10/2020 through 5/03/21 revealed that on 10/07/20 the resident was discharged from occupational therapy. On 10/26/20 the resident order for a right hand splint to be worn as a night splint up to eight hours as tolerated with skin check before and after application every morning and at bedtime, monitor for redness and report any concerns to therapy or the doctor. An order for restorative range of motion was not noted. Interview on 05/05/21 at 1:10 P.M. with Registered Nurse (RN) #30 revealed that she is the restorative nurse and thought Resident #76 had a splint order, but upon review realizes not that he does not. She further revealed that Resident #76 was not receiving restorative services and has not since (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 11 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 - Actual harm Residents Affected - Few his discharge from occupational therapy in October 2020. She also revealed that the floor State Tested Nursing Assistants (STNA) run the restorative programs. RN #30 revealed that she will have therapy reassess the resident. Interview on 05/05/21 at 1:21 P.M. with Therapy Manager #85 revealed Resident #76 was discharged from occupational therapy in 10/2020, and at this time he was tolerating a hand splint for eight hours a day. He further revealed that upon his discharge the therapy department also made a restorative referral. Interview on 05/05/21 at 1:31 P.M. with Licensed Practical Nurse (LPN ) #25 with revealed that Resident #76 does not have orders to wear a splint, and was not receiving any type of restorative services. Interview on 05/05/21 at 01:34 P.M. with STNA #50 revealed that she was not aware that Resident #76 had a hand splint, and that she does not provide any restorative services to Resident #76 including range of motion. Review of Resident #76's nursing notes from 10/2020 through 11/2020 revealed that Resident #76 was admitted to the hospital from [DATE] through 11/17/20. Interview on 05/05/21 at 1:59 P.M. with the Director of Nursing confirmed that when Resident #76 returned from the hospital on [DATE] the facility did not reorder his splint. She further confirmed that his splint and restorative range of motion should have been ordered when he returned from the hospital. Interview on 05/10/21 at 2:00 P.M. with Therapy Manager #85 confirmed that Resident #76 has less dexterity in his right hand at this time compared to 10/2021 when he was discharged from occupational therapy. He further revealed that Resident #76 now requires occupation therapy services again. Review of the facility's policy, Restorative Program (dated 07/26/18), revealed that the facility offers treatment options that may include active and passive range of motion. This deficiency substantiates Complaint Number OH00114070. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 12 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and policy review, the facility failed to ensure consistent catheter care was provided for one resident. This affected one (Resident #34) of nine residents who received catheter care at the facility. The facility cenus was 96 residents. Findings include: Medical record review revealed Resident #34 was admitted to the facility on [DATE] with diagnoses that included cauda equnia syndrome, muscle weakness, and hydronephrosis with ureteropelvic junction obstruction. Review of Resident #34's quarterly Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed she required total dependence with one-person physical assist for toileting and extensive assistance with two plus physical assistance for personal hygiene. Review of Resident #34 care plan dated 03/26/21 revealed that the resident has an indwelling urinary catheter with a goal that the resident will show no signs or symptoms of a urinary tract infection through review the date. Review of Resident #34's May 2021 physician orders revealed that she does not have any orders regarding her catheter care. Interview on 05/03/21 at 3:33 P.M. Resident #34 revealed that she always seems to have a urinary tract infection, and she does not receive frequent catheter care. Observation on 05/05/21 at 11:25 A.M. of Resident #34's catheter care with State Tested Nursing Assistant (STNA) #54 revealed the STNA gathered supplies, washed hands, applied gloves, and then checked the residents tubbing for kinks. She then dipped a clean washcloth into the basin of water and cleaned the tubbing to the catheter from top to bottom. After cleaning the catheter tubbing, she changed her gloves but did not wash her hands. STNA #34 then dipped a new washcloth into the basin of water applied perineal wash to the washcloth and cleaned the resident's perineal area. After cleaning the resident's perineal area with her same gloves, she repositioned the resident, touched the resident's sheets, and replaced the perineal wash. STNA #34 then removed her gloves and pulled the bedside table into the hall before washing her hands. Interview on 05/05/21 at 11:34 A.M. with STNA #20 verified that catheter care was not done correctly according to infection control practices. Review of facility's catheter care documentation from 04/05/21-05/04/21 revealed catheter care was not provided on 04/09/21, 04/11/21, 04/12/21, 04/13/21, 04/14/21, 04/17/21, 04/19/21, 04/20/21, 04/21/21, 04/27/21, 04/28/21, 04/29/21, and 05/01/21. Review of the facility infection control logs revealed that the Resident #34 was treated five times for a urinary tract infection from November 2020 through March 2021. The dates included 11/26/20, 12/18/21, 01/05/21, 02/10/21, and 03/13/21. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 13 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview on 05/11/21 at 10:34 A.M. with the Director of Nursing confirmed that according to documentation Resident #34 was not receiving catheter care twice as day as indicated in the facility's policy. She further revealed that Resident #34 does not have any physician orders regarding her catheter care, when to change her catheter, or how often to provide catheter care. Review of the facility policy Catheter Care, dated 05/01/17, revealed that the facility staff should perform catheter care at least twice daily on residents that have indwelling catheters, for as long as the catheter is in place. Event ID: Facility ID: 365771 If continuation sheet Page 14 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record, and staff interviews, the facility failed to ensure the dression on the peripherally inserted central catheter (PICC), which was used for intravenous medications was changed as ordered. This affected one (Resident #79) of three residents reviewed for PICC dressing changes. Residents Affected - Few Findings include: Review of the medical record revealed Resident #79 was admitted to the facility on [DATE] with the diagnoses of cord compression, spinal stenosis, spondylosis, hypertension, neuromuscular dysfunction of the bladder, anemia, osteomyelitis, asthma, and atherosclerotic heart disease. Review of the admission Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #79 had moderately impaired cognition and required extensive assistance for all activities of daily living. The resident had not received intravenous medications. Review of a physician's order dated 04/27/21 revealed the PICC line dressing for Resident #79 was to be changed every week on Sunday. Observation on 05/10/21 at 1:40 P.M. revealed the PICC dressing for Resident #79 was dated 05/02. An interview at this time with Registered Nurse #30 verified the date on the PICC dressing for Resident #79 and indicated the dressing was ordered to be changed every seven days. This deficiency substantiates Complaint Number OH00110980. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 15 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the medical record revealed Resident #93 was admitted to the facility on [DATE] with the diagnoses of Alzheimer's disease, sacral pressure ulcer, left heel pressure ulcer, iron deficiency anemia, nutritional deficiency, dementia, disorder of the kidneys and ureters, left hand contracture, neuromuscular dysfunction of the bladder, adult failure to thrive, COVID-19, hypertension, osteoarthritis, colostomy, and insomnia. Residents Affected - Many Review of the quarterly Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #93 had severely impaired cognition, required total assistance with bed mobility, transfers, toilet use, and personal hygiene. The resident had two stage four pressure ulcers with one present upon admission, an ostomy, and an indwelling catheter. Review of the physician's order dated 04/09/21 revealed Resident #93 had and order for a wound vacuum to her sacrum at 125 millimeters of mercury (mmHg) continuous, cleanse the sacral wound with wound cleanser, rinse with normal saline, apply Adaptic over the exposed bone with black wound vacuum foam every Monday, Wednesday, Friday and as needed. Observation on 05/05/21 at 10:30 A.M. revealed Registered Nurse (RN) #31 and Physician #86 changed the wound vacuum dressing for Resident #93. RN #31 removed the old dressing from the resident's bilateral heels; she washed her hands and put on gloves. She rolled the resident over to remove wound vacuum dressing, washed her hands and put on new gloves. She placed a clean bath towel directly on the resident's bed and placed her dressing supplies onto the towel. She cleaned the sacral wound, washed her hands and put on gloves. RN #31 had then took scissors directly out of her pants pocket, did not clean them and proceeded to cut the transparent wound film and black sponge for the wound vacuum with the scissors. She placed the black sponge inside the resident's sacral wound. RN #31 proceeded to discard all opened packages of wound vacuum supplies which were laying on the bath towel; she washed her hands and the replaced gloves. RN #31 placed all dressing supplies for the resident's heels on the bath towel on the bed where all the discarded dressing supplies were laying and proceeded to change Resident #93 heel dressings. Interview on 05/05/21 at 11:45 A.M. with RN #31 revealed the bath towel was her clean field but she verified the bed was not able to be cleaned and was not an appropriate clean field to set up on. She indicated she had cleansed her scissors prior to placing them in her pocket but verified she did not clean them after she took them out of her pocket prior to cutting the wound vacuum dressing and sponge. Review of the facility policy Wound Care, dated 05/30/19, revealed residents admitted with or developed skin integrity issues would receive treatment as indicated based on location, stage and drainage. Based on observation, interview, record review, and policy review, the facility failed to ensure proper infection control practices were implemented during catheter care for Resident #34; failed to properly transport soiled linens in the hallway; and failed to follow proper infection control practice for a dressing change for Resident #93. This affected two (Residents #34 and #93) residents and had the potential to affect all 96 facility residents. Findings include: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 16 of 17 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 365771 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/14/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copley Health Center 155 Heritage Woods Drive Copley, OH 44321 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 1. Medical record review for Resident #34 revealed she was admitted to the facility on [DATE] with diagnoses that included, cauda equnia syndrome, muscle weakness, and hydronephrosis with ureteropelvic junction obstruction. Review of Resident #34's quarterly Minimum Data Set 3.0 (MDS) assessment dated [DATE] revealed she required total dependence with one-person physical assist for toileting and extensive assistance with two plus physical assistance for personal hygiene. Observation on 05/05/21 at 11:25 A.M. of Resident #34's catheter care with State Tested Nursing Assistant (STNA) #54 revealed the STNA gathered supplies, washed hands, applied gloves, and then checked the residents tubbing for kinks. She then dipped a clean washcloth into the basin of water and cleaned the tubbing to the catheter from top to bottom. After cleaning the catheter tubbing, she changed her gloves but did not wash her hands. STNA #34 then dipped a new washcloth into the basin of water applied perineal wash to the washcloth and cleaned the resident's perineal area. After cleaning the resident's perineal area with her same gloves, she repositioned the resident, touched the resident's sheets, and replaced the perineal wash. STNA #34 then removed her gloves and pulled the bedside table into the hall before washing her hands. Interview on 05/05/21 at 11:34 A.M. with STNA #20 verified that catheter care was not done correctly according to infection control practices. Review of the facility policy Catheter Care, dated 05/01/17, revealed that the facility staff should perform perineal care prior to catheter care. Review of the facility policy Standard Precautions, dated 04/01/17, revealed that hand hygiene should be performed when hands move from a contaminated body site to a clean body site during patient care. 2. Observation on 05/10/21 at 10:05 A.M. revealed STNA #73 transporting a bag of soiled linens down the hall. The bag was touching the facility floor as she walked down the hall and past the nurse's station. A wet streak was noted on the floor as she transported the bag down the hall. She then opened the soiled linen closet and disposed of of the bag. Interview on 05/10/21 at 10:10 A.M. STNA #73 confirmed the bag she was transporting down the hall was full of solid linens. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365771 If continuation sheet Page 17 of 17