Health inspection·December 4, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview and facility policy review, the facility failed to notify the resident and the resident's primary care physician of a medication error. This affected one resident (#50) of three residents reviewed for medication errors. The facility census was 53.Findings Include:Review of the medical record for Resident #50 revealed an initial admission date of 08/27/25 with the diagnoses including but not limited to diabetes mellitus (DM), chronic obstructive pulmonary disease, asthma, hypertension, chronic kidney disease, polyneuropathy, intervertebral disc degeneration, lumbar region, severe morbid obesity, osteoarthritis and obstructive sleep apnea. Review of the plan of care dated 08/27/25 revealed the resident experienced acute and chronic pain or discomfort due to osteoarthritis, neuropathies, wounds, left below the knee amputation, DM, morbid obesity and degenerative disc disease. Interventions included administer medications as ordered, assess for non-verbal indicators of pain, assess pain every shift and as indicated and notify physician if resident experiences unmanageable or intolerable pain. Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had no cognitive deficit. The assessment indicated the resident utilized scheduled, as needed and non-pharmacological interventions for pain relief. Review of the resident's monthly physician orders for November 2025 identified orders dated 10/30/25 for Oxycodone extended release (ER) 10 milligrams (mg) by mouth every 12 hours for moderate to severe pain and Oxycodone 5 mg by mouth every 12 hours as needed for the pain scale of five to 10. Review of the resident's November 2025 Medication Administration Record (MAR) revealed on 11/04/25 at 8:30 A.M., the nurse initialed the resident was administered Oxycodone 10 mg by mouth as physician ordered. Further review revealed the nurse had not documented the resident received the as needed dose of Oxycodone 5 mg by mouth on 11/04/25 at 8:30 A.M. Review of the resident's controlled drug receipt/record disposition form for the resident's Oxycodone 5 mg by mouth revealed the resident received Oxycodone 5 mg by mouth on 11/05/25 at 7:30 P.M., 11/14/25 at 8:00 A.M., 11/15/25 at 8:00 A.M. and 8:50 P.M. Further review revealed no evidence that the Oxycodone 5 mg by mouth was administered as the as needed dosage. Review of the incident report dated 11/14/25 at 7:34 P.M. revealed during the shift change narcotic sheet counts on 11/14/25 it was discovered the nurse administered Oxycodone 5 mg by mouth instead of the Oxycodone 10 mg by mouth as physician ordered at 8:30 A.M. Review of the medical record revealed no documented evidence the resident or the resident's physician was notified of the medication error of the resident received the wrong dose of medication Oxycodone on the listed dates and the resident should have received Oxycodone 10 mg by mouth. On 11/20/25 at 3:00 P.M., interview with the Regional Nurse #510 verified the facility had no documented evidence the resident or the resident's physician was notified of the medication error. Review of the facility policy titled, Change in a Resident's Condition or Status, last revised in 02/21 revealed the facility would promptly notifies the resident, his or her attending physician and the resident representative of changes in the resident's medical/mental condition and/or status. This deficiency represents incidental finding of non-compliance investigated under Master Complaint Number 2673793. Event ID: Facility ID: 365780 If continuation sheet Page 2 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed record review, review of fall investigations, review of Quality Assurance (QA) documentation, Mayo Clinic Diabetic Ketoacidosis information review, review of hospital notes, and interviews, the facility failed to comprehensively assess and timely identify an acute change in Resident #22's condition resulting in hospitalization and failed to ensure effective and necessary care and treatment was provided to manage the resident's diabetes mellitus. This affected one resident (#22) of four residents reviewed for change in condition. The facility census was 53. Actual harm occurred beginning on 11/02/25 when Resident #22 was noted at multiple times on this date to have a blood sugar that read hi (a hi reading is reached when the blood sugar result is too high for the glucometer to read, often greater than 600 milligrams per deciliter (mg/dL)) on the glucometer without effective and/or adequate monitoring and treatment. On 11/03/25 Resident #22 did not receive her diabetic medication (blood sugar lowering medications), insulin glargine (a long acting human insulin use to manage blood glucose levels in individuals with type 1 and type 2 diabetes) or Novolog insulin (a rapid acting insulin used to manage blood sugar levels in individuals with type 1 and type 2 diabetes) at (if needed based on blood sugar results) at 9:00 A.M. as scheduled. Resident #22 was later found (on this date) in her room unresponsive on the floor with a hi blood sugar glucometer reading. Resident #22 was transferred to the hospital and admitted to the intensive care unit (ICU) for treatment of diabetic ketoacidosis (a life-threatening medical emergency that occurs when the body, lacking sufficient insulin, breaks down fat for energy, creating high levels of ketones that make the blood acidic) and sepsis (a life-threatening medical emergency where the body's response to an infection triggers a chain reaction that causes tissue damage and organ dysfunction). Findings include:Review of Resident #22's closed medical record revealed Resident #22 was admitted to the facility on [DATE] with diagnoses including type I diabetes with diabetic neuropathy, muscle weakness, and difficulty in walking. Review of a care plan dated 09/10/25 revealed Resident #22 required hyperglycemic medication related to diabetes. Goals included Resident #22 would exhibit a therapeutic effect related to the use of medication, would not have signs or symptoms of hyperglycemia, and would not have side effects related to the medication. Interventions included to administer medications per orders, vital signs as indicated, pharmacy review as indicated, finger sticks as ordered and report abnormal findings to physician, labs as orders and report abnormal results to physician, observe for signs and symptoms of hyperglycemia (flushed skin, dry skin, drowsiness, nausea, vomiting, abdominal pain, increased respiration) and report to physician, observe for signs and symptoms of hypoglycemia (dizziness, lethargy, diaphoresis, headache, irritability, confusion, restlessness, shallow respirations) and notify physician, observe for symptoms of lactic acidosis and immediately report to physician (feeling tired or weak, muscle pain, trouble breathing, abdominal pain, feeling cold, cold or blue hands and feet, dizziness or light headedness, slow or irregular heartbeat, persistent nausea and/or vomiting, shortness of breath and an enlarged or tender liver or weight loss). Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 had mildly impaired cognition, refused care one to three days, and required (staff) supervision or touching assistance for transfers and bed mobility. Review of an order dated 09/18/25 revealed Resident #22 had an order to receive insulin glargine subcutaneous solution pen-injector 100 units/milliliters (ml) 15 units subcutaneously one time a day at 9:00 A.M. for diabetes. Review of an order dated 10/21/25 revealed Resident #22 was to receive Novolog injection solution 100 unit/ml as per sliding scale (depending on fingerstick blood sugar results) four times a day with blood sugar checks scheduled to be obtained at 9:00 A.M., 12:00 P.M., 5:00 P.M., and 9:00 P.M. If Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 3 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm Residents Affected - Few the resident's blood sugar was 150-200 (mg/dL) give 4 units, if 201-250 give 6 units, if 251-300 give 10 units, if 301-350 give 15 units, if 351-400 give 18 units, if 401-450 give 22 units subcutaneously four times a day for diabetes with instructions to call physician if blood sugar was greater than 450 or less than 75. Review of a progress note dated 10/21/25 by Certified Nurse Practitioner (CNP) #515 revealed Resident #22 had been having intermittent hypoglycemia despite an elevated glycated hemoglobin (A1c), but was not experiencing hyperglycemia with blood sugar ranging from 350-528. The progress note revealed hyperglycemia was improved with additional Novolog. Review of a nursing note dated 11/02/25 at 1:57 P.M. authored by Registered Nurse (RN) #156 revealed Resident #22's blood sugar showed hi on two devices. The on-call company (of medical providers) was called, and orders were received to give 26 units of Novolog and call back in two hours. The 26 units of Novolog insulin was documented as given. Review of a nursing note dated 11/02/25 at 3:14 P.M. authored by RN #156 revealed Resident #22's blood sugar was 477 (hyperglycemic), the on-call physician was called again and per their request 26 units (of Novolog insulin) was given with instructions to call back in two hours. Review of a nursing note dated 11/02/25 at 4:10 P.M. authored by RN #156 revealed Resident #22 had a fall in the morning while attempting to stand up to get a cup for ice. Resident #22 stated she stood up, then slid to the floor but did not hit her head. Resident #22 had a skin tear on her right elbow which was cleaned with wound cleanser and covered with a bordered gauze. (Note- this is a late entry note for a fall that had occurred 11/02/25 earlier in the day in the dining room). Record review and review of a facility fall investigation revealed no evidence a root cause analysis was completed or evidence the facility considered the resident's fall to be associated with her elevated blood sugar levels that had been identified on this date. Review of a nursing note dated 11/02/25 at 4:52 P.M. authored by RN #156 revealed Resident #22's blood sugar showed hi on two devices. The on-call company (of medical providers) was called, and orders were received to give 26 units of Novolog insulin and call back in two hours. The 26 units of Novolog insulin were documented as given. Review of a nursing note dated 11/02/25 at 4:57 P.M. authored by RN #156 revealed Resident #22's blood sugar was 477 mg/dL, the on-call physician was called again and per their request 26 units were given with instructions to call back in two hours. Review of a nursing note dated 11/02/25 at 6:08 P.M. authored by RN #156 revealed Resident #22's blood sugar was 347 mg/dL. The note included information was passed to the night shift nurse. Review of the MAR for this date, revealed when the resident's blood sugar was 347 mg/dL, the resident should have received 15 units of Novolog insulin. However, there was no evidence the resident received the 15 units of Novolog insulin at this time. The MAR identified a 9 which indicates to look at the nursing note; however the corresponding nursing note did not provide evidence the Novolog insulin was administered and/or a reason why it was not. Record review revealed no evidence the resident ' s blood sugar was re-checked or monitored between 11/02/25 at 9:33 P.M. and 11/03/25 at 11:50 A.M. Review of the Medication Administration Record (MAR) dated 11/03/25 revealed no documented evidence Resident #22 received her 9:00 A.M. physician ordered glargine insulin or blood sugar check for the possible administration of Novolog insulin per sliding scale coverage. Review of the medication administration record (MAR) dated 11/03/25 at 4:30 A.M. revealed Resident #22 received Med Pass (dietary supplement) and consumed 100%. Review of task documentation for 11/03/25 at 8:20 A.M. by Certified Nurse Aide (CNA) #175 revealed Resident #22 ate 26-50% of her breakfast on this date. Review of a nursing note dated 11/03/25 at 12:34 P.M. authored by LPN #183 revealed she had gone to check Resident #22's blood sugar but was unable to find her in her room, Resident #22's wheelchair was in her room, LPN #183 asked an aide if they knew where Resident #22 was, but they did not know. Additional people were asked where Resident #22 was, but they did not know. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 4 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm Residents Affected - Few Shower rooms, bathrooms and other public areas were searched. An aide found Resident #22 in her room on the floor between her bed and window laying on the left side of her face. Resident #22 was lying in her own vomit. The aide assisted Resident #22 back into bed. LPN #183 checked Resident #22's blood sugar which read hi and the nurse practitioner was notified and stated to complete a full skin sweep and to get vitals. At this time the resident's blood pressure was documented to be low at 88/40 manually and the resident's pulse was 121 beats per minute (bpm). Resident #22's oxygen saturation would not read but after applying two liters of oxygen it read 83%. Skin check revealed left side of resident's face was puffy. Nurse practitioner was notified and gave orders to send Resident #22 to the hospital. Resident #22's son was notified. There was no additional information in the nursing progress note as to when the resident had last been seen prior to this time. A corresponding fall investigation dated 11/03/25 at 11:50 A.M. and authored by LPN #183 revealed at approximately 11:50 A.M. nursing staff went to Resident #22's room to perform routine blood glucose monitoring in preparation for the lunch meal. When arriving to the room, staff noted Resident #22 was not in her bed or wheelchair as expected. The nurse immediately began to look for the resident and asked several staff members if they had seen Resident #22 or knew her whereabouts. Staff did not know, and the Administrator reported to Resident #22's room to check and found her lying on her left side on the floor between her bed and the window, an area which was not visible from the doorway or hallway. Resident #22 was found with emesis present on the floor near her face though the emesis was not obstructing her airway; the resident was assessed to be breathing without difficulty. Staff immediately ensured Resident #22's safety and initiated assessments. When LPN #183 returned to the room moments later, staff had already assisted the resident back into her bed with appropriate assistance. Resident #22 was alert and responsive, able to communicate, and stated she was not sure what she was trying to do when she ended up on the floor. The investigation revealed Resident #22's level of consciousness was deviated from her normal baseline. Vitals signs were obtained and revealed significant abnormalities from the resident's baseline. Blood pressure was 88/40 (mg/Hg- normal reading 120/80) which was significantly lower than baseline, heartrate was elevated to 121 bpm, and notably Resident #22's pulse was irregular which represented a new finding that had not been previously documented. Respiratory rate was 16 breaths per minute, temperature was 98 (degree Fahrenheit), and oxygen saturation was critically low at 83% on 2 liters per minute (lpm) of supplemental oxygen in place at the time she was found on the floor, likely falling off when the fall occurred. Blood glucose was obtained and read hi indicating hyperglycemia. The investigation revealed given the abnormal vital signs, the new irregular heart rhythm, the severe hyperglycemia, and the resident's complex medical history including type I diabetes mellitus, the licensed medical provider was immediately notified and ordered Resident #22 to be sent to the emergency department. The investigation included the resident had multiple risk factors including type I diabetes with history of unstable blood glucose levels, gastrointestinal symptoms including nausea and vomiting in the days preceding the fall, and the resident's unwitnessed activity without seeking staff assistance via call light. Review of a nursing note dated 11/03/25 at 12:26 P.M. authored by LPN #139 revealed Resident #22 was transferred to the emergency department (ED). Review of a hospital note dated 11/03/25 at 12:44 P.M. revealed Resident #22 presented to the ED due to altered mental status and a fall at her nursing facility. Resident #22 was not oriented to time, place, or person and stated she had pain throughout her body. Report was Resident #22 was missing for two hours in the facility and was found beside her bed. The emergency medical services (EMS) staff reported Resident #22's blood sugar was greater than their detectable range on the way to the ED. At 12:51 P.M., Resident #22's vital signs included temperature of 98.2 F, heartrate of 114 bpm, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 5 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm Residents Affected - Few respirations of 28, blood pressure 86/71 (hypotensive), and oxygen level of 91. Resident #22 had an elevated white blood cell count at 17.7, a low but stable hemoglobin at 10.8, venous blood gases (VBG) were acidotic at 7.26 and her glucose was over 1000. Resident #22's chemistry panel showed a low sodium of 125, potassium of 5.8, creatinine elevated to 1.55, glucose was 1039, lactic acid was 4.5, and beta hydroxybutyrate of 6.07 which confirmed a diagnosis of diabetic ketoacidosis (DKA). Resident #22 was placed on DKA protocol, she received one liter of fluid prior to the right femoral CVC being placed and would not receive a second liter because she met the criteria for severe sepsis and already received 2000 ml at this time. Resident #22 was empirically treated with cefepime (antibiotic) and vancomycin (antibiotic) for severe sepsis/septic shock. Resident #22 needed to be admitted to the ICU. Admitting diagnoses included DKA, high anion gap metabolic acidosis, an acute urinary tract infection, a non-ST elevated myocardial infarction (NSTEMI) with troponin levels up to 2630, and sepsis. Review of a nursing note dated 11/03/25 at 9:57 P.M. authored by LPN #136 revealed she called the hospital for an update on Resident #22 who was admitted to the intensive care unit (ICU) for diabetic ketoacidosis and low blood pressure. The Director of Nursing (DON) was notified. The resident did not return to the facility following hospitalization. Review of an undated statement from Medical Director (MD) #129 revealed DKA is a progressive condition that typically develops over several hours to days and results from a combination of factors including inadequate insulin, increased insulin resistance, decreased oral intake, gastrointestinal illness, and other physiological stressors.Interview on 11/12/25 at 2:17 P.M. with Resident #22's family revealed Resident #22's blood sugar had been above 1000 and her blood pressure had bottomed out on 11/03/25 which was what led to hospitalization. The family member revealed when they were informed of Resident #22's fall, they were told staff would monitor her, but they requested resident be sent out to the emergency room instead. The family member stated Resident #22's son had been at the facility (on 11/03/25) at about 9:00 A.M. and they received a call at about 11:40 A.M. asking if they were aware of where Resident #22 was. Resident's family stated they were frustrated because she (Resident #22) needed assistance to get out of bed and staff just walked right by without checking the floor to see if she fell. Resident #22's family revealed on 11/02/25, Resident #22 had been nauseous with vomiting which was reported to a nurse (unspecified what nurse) and again on 11/03/25 the nurse (unspecified what nurse) was told the resident was sick at about 9:30 A.M. when her son left. Interview on 11/12/25 at 2:40 P.M. with LPN #183 revealed on 11/03/25, a nurse had called off leaving two nurses for three hallways. LPN #183 stated she was on the 200 hall and LPN #174 had the 300 hall, while the 400 hall (Resident #22 resided on the 400 hall) did not have a nurse. LPN #183 stated a nightshift nurse, LPN #151, was supposed to stay and pass morning medications for the 400 hall until the facility was able to find coverage for a dayshift nurse. LPN #183 stated she wasn't sure if LPN #151 passed any medication and if so, it was only a couple. LPN #183 stated another nurse was coming to the facility at noon at cover the 400 hall. LPN #183 stated she had heard during her shift Resident #22 was not feeling well but could not recall where she heard the information. LPN #174 finished her halls medication pass first and moved on to the 400 hall for medications and had asked an aide, Certified Nurse Aide (CNA) #175, to start checking resident vital signs. LPN #183 stated she finished her medication pass on 200 hall and sometime after 11:00 A.M., she went to tell LPN #174 a resident on the 300 hall was requesting her. At approximately 11:30 A.M., LPN #183 stated she went to check Resident #22's blood sugar before the lunch meal but she was not able to locate the resident in her room. Resident #22's wheelchair was in her room, but she was not in bed, in the bathroom, or the common areas. LPN #183 stated she had entered the room to about the center of the room but was not able to see the floor next to the window from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 6 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm Residents Affected - Few that standpoint. LPN #183 stated someone else went to Resident #22's room and found her on the floor next to the window, in her vomit. LPN #183 stated she asked CNA #175 when vitals for Resident #22 were checked and CNA #175 stated she went to the resident's room at about 10:00 A.M. but she was unable to find her. LPN #183 stated Resident #22's son had been in to visit and left at about 9:30 A.M., and multiple nurse managers were out of the facility for personal reasons so there was not much help. LPN #183 stated once she arrived back to Resident #22's room to check on her, the aide had already put her in bed, she had vomit on her, her face was puffy, and she didn't look good. LPN #183 stated she checked Resident #22's vitals, which were awful, her blood sugar read hi which means greater than 600, her pulse was 121 beats per minute, oxygen would not read, and blood pressure was 88/40. LPN #183 stated there were no visible injuries to Resident #22, but she had troubles with her blood sugars for a while due to being a type I brittle diabetic. Interview on 11/17/25 at 2:10 P.M. with Regional Director of Clinical Services (RDCS) #188 confirmed on 11/03/25 Resident #22 did not receive her scheduled dose of 15 units of insulin glargine or the Novolog per sliding scale (ordered with blood sugar checks) within the appropriate timeframe scheduled for the medications due to LPN #151 leaving prior to medication administration without informing nursing management so they could replace her on the hall. RDCS #188 believed Resident #22 was last checked on at about 9:30 A.M., after her son left and had been seen in bed while staff were walking down the hall afterwards, but they were not able to hammer down a time when she came out of bed. RDCS #188 revealed an aide was supposed to check vitals but when she was not able to locate resident, did not report her missing from her room but indicated the aide did continue to look for the resident on her own. RDCS #188 confirmed Resident #22 had experienced harm as a result of this incident due to having high blood sugar and not receiving blood glucose monitoring or scheduled doses of insulin as ordered on 11/03/25, leading to subsequent hospitalization and treatment for DKA and sepsis. Interview on 12/04/25 at 7:18 A.M. with LPN #151 revealed she worked the night shift of 11/02/25 and did not identify any concerns with Resident #22. LPN #151 stated she later found out Resident #22 had been vomiting and nauseous on 11/02/25 during the previous shift but stated that had not been reported to her during shift change report. LPN #151 stated she did stay over the morning of 11/03/25 to wait for someone to count the cart with her but was not on the floor or caring for residents when Resident #22 had a visitor, had vomited, or had fallen out of bed. Interview on 12/04/25 at 8:00 A.M. with RN #156 revealed on 11/02/25, she worked Resident #22's hallway which was not typically where she works. RN #156 stated in the morning when checked Resident #22's blood sugar was in the 300s but in the afternoon, the glucometer read hi. RN #156 stated she was unsure of what hi meant so she asked another nurse who told her to call the doctor. RN #156 was not able to recall the amount of insulin the on-call provider ordered, but stated she administered it and called back in two hours per their instructions. When she re-checked Resident #22's blood sugar, it was still hi so the on-call provider told her to administer another dose of insulin and check again in two hours. RN #156 stated she followed instructions and when she last checked her blood sugar, it was fine and she passed it on to nightshift. RN #156 stated Resident #22 had been shaky during observations but stated she was ok and that happened often. RN #156 stated she was unsure of Resident #22's baseline but was concerned her sugars had been running above 400 all day. RN #156 stated when she would call the provider, she would mention she previously called and was given the same instructions and asked if they wanted her to proceed with the same order again, and they responded yes. RN #156 stated she was concerned there was not much intervention for the Resident #22. RN #156 stated Resident #22 was a brittle diabetic. RN #156 could not recall a fall, nausea, or vomiting during her shift. During the interview, when asked about the nursing progress note (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 7 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm Residents Affected - Few entries dated 11/02/25 at 3:14 P.M. and 4:57 P.M. (which were identical in content but at different times), RN #156 stated she did enter the documentation for Resident #22's blood sugars as duplicates but indicated she only had blood sugar concerns twice during her shift. RN #156 stated she was concerned because Resident #22 had a fall the following morning and was admitted to the ICU and was still there last week. Interview on 12/04/25 at 11:01 A.M. with the Director of Nursing (DON) revealed she was not present on 11/03/25 when Resident #22 missed scheduled insulin and was found to be in DKA. The DON stated Resident #22 was a type I diabetic and had a history of high and low blood sugars, saw an endocrinologist, and had had multiple medication adjustments made. The DON also indicated Resident #22 was non-compliant with her prescribed diet. The DON also revealed Resident #22 had previously been seen / treated in the emergency room for weakness and altered mental status in relation to her blood sugars. During the interview, the DON confirmed Resident #22's blood sugar being hi for two days beginning on 11/02/25 and continuing to 11/03/25 was a change in her baseline condition as well as the resident having confusion and nausea/vomiting. The DON stated since she personally knew the resident's history, she would have checked the resident's blood sugars more frequently throughout the night. The DON also indicated she had a history of working in critical care and as an RN had more critical care knowledge than an LPN might. Interview on 12/04/25 at 11:53 A.M. with CNA #194 revealed she was assigned to Resident #22's unit on 11/03/25. CNA #194 stated Resident #22's son had visited the morning of 11/03/25 and reported to the nurse, LPN #151, that the resident had been complaining of an upset stomach but LPN #151 threw a fit and was angry because she was not supposed to be at the facility since her shift was finished. CNA #194 stated she checked on Resident #22 and checked her vitals and her temperature was 99.8 which was reported to LPN #151 who didn't address concerns. CNA #194 stated she then went to LPN #174 and informed her of the situation and LPN #174 checked on Resident #22. CNA #194 stated she was giving showers, so CNA #175 was rounding for her and supposed to check resident vital signs. However, CNA #175 could not find Resident #22 and did not inform anyone until the nurse went to check blood sugars. CNA #194 stated after about two and a half hours of CNA #175 not locating Resident #22, she went to her room and saw her on the floor, her face was swollen and discolored, her oxygen tubing was tight on her face and around her neck. CNA #194 stated she picked Resident #22 up on instinct and began to clean her. She had yelled for a nurse and the Administrator entered the room and observed the situation. CNA #194 stated she instructed CNA #175 to get washcloths so a bed bath could be complete, and LPN #183 entered the room and appeared to be panicked. CNA #194 stated she could not recall additional details other than giving a bed bath, talking to the resident, and the ambulance coming. CNA #194 stated Resident #22 was out of it while they were talking. CNA #194 stated a couple weeks leading up to 11/03/25, Resident #22 was vomiting a lot and her sugar kept dropping, even as low as 32. Interview on 12/04/25 at 12:01 P.M. with Resident #22's son revealed he was visiting the facility on 11/03/25 and left at approximately 9:30 A.M. The son revealed he reported he told the nurse at the nurses' station Resident #22 had an upset stomach. He could not recall which nurse he spoke to or what she looked like. Information included on the Mayo Clinic website revealed signs and symptoms of DKA include being very thirsty, urinating often, feeling a need to throw up and throwing up, having belly pain, being weak or tired, being short of breath, having fruity-scented breath, and being confused. It's important to get care right away and if not treated, DKA can lead to death. Review of a policy titled Change in Condition dated 2001 revealed a significant change in condition is a major decline or improvement in resident status that will not normally resolve itself, impacts more than one area of resident health status, requires interdisciplinary review, and is ultimately based on the judgement of clinical staff and the guidelines (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 8 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Actual harm outlined in the resident assessment instrument. This deficiency represents non-compliance investigated under Complaint Number 2664625.This deficiency is evidence of continued non-compliance from the survey completed 09/15/25. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 9 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, review of staff schedules, review of the facility assessment, and policy review, the facility failed to maintain safe staffing levels to prevent harm to residents. This affected one (#22) of three residents reviewed and had the potential to affect 19 additional residents residing on the 400 unit. The facility census was 53. Findings include:Review of Resident #22's closed medical record revealed Resident #22 was admitted to the facility on [DATE] with diagnoses including type I diabetes with diabetic neuropathy, muscle weakness, and difficulty in walking. Review of a care plan dated 09/10/25 revealed Resident #22 required hyperglycemic medication related to diabetes. Goals included Resident #22 would exhibit a therapeutic effect related to the use of medication, would not have signs or symptoms of hyperglycemia, and would not have side effects related to the medication. Interventions included to administer medications per orders, vital signs as indicated, pharmacy review as indicated, finger sticks as ordered and report abnormal findings to physician, labs as orders and report abnormal results to physician, observe for signs and symptoms of hyperglycemia (flushed skin, dry skin, drowsiness, nausea, vomiting, abdominal pain, increased respiration) and report to physician, observe for signs and symptoms of hypoglycemia (dizziness, lethargy, diaphoresis, headache, irritability, confusion, restlessness, shallow respirations) and notify physician, observe for symptoms of lactic acidosis and immediately report to physician (feeling tired or weak, muscle pain, trouble breathing, abdominal pain, feeling cold, cold or blue hands and feet, dizziness or light headedness, slow or irregular heartbeat, persistent nausea and/or vomiting, shortness of breath and an enlarged or tender liver or weight loss). Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 had mildly impaired cognition, refused care one to three days, and required (staff) supervision or touching assistance for transfers and bed mobility. Review of an order dated 09/18/25 revealed Resident #22 had an order to receive insulin glargine subcutaneous solution pen-injector 100 units/milliliters (ml) 15 units subcutaneously one time a day at 9:00 A.M. for diabetes. Review of an order dated 10/21/25 revealed Resident #22 was to receive Novolog injection solution 100 unit/ml as per sliding scale (depending on fingerstick blood sugar results) four times a day at 9 A.M., 12 P.M., 5 P.M., and 9 P.M. If the resident's blood sugar was 150-200 (mg/dL) give 4 units, if 201-250 give 6 units, if 251-300 give 10 units, if 301-350 give 15 units, if 351-400 give 18 units, if 401-450 give 22 units subcutaneously four times a day for diabetes with instructions to call physician if blood sugar was greater than 450 or less than 75. Review of a progress note dated 10/21/25 by Certified Nurse Practitioner (CNP) #515 revealed Resident #22 had been having intermittent hypoglycemia despite an elevated glycated hemoglobin (A1c), but was not experiencing hyperglycemia with blood sugar ranging from 350-528. Hyperglycemia was improved with additional Novolog. Review of a nursing note dated 11/02/25 at 1:57 P.M. authored by Registered Nurse (RN) #156 revealed Resident #22's blood sugar showed hi on two devices. The on-call company (of medical providers) was called, and orders were received to give 26 units of Novolog and call back in two hours. The 26 units of Novolog insulin was documented as given. Review of a nursing note dated 11/02/25 at 3:14 P.M. authored by RN #156 revealed Resident #22's blood sugar was 477 (hyperglycemic), the on-call physician was called again and per their request 26 units (of Novolog insulin) was given with instructions to call back in two hours. Review of a nursing note dated 11/02/25 at 4:10 P.M. authored by RN #156 revealed Resident #22 had a fall in the morning while attempting to stand up to get a cup for ice. Resident #22 stated she stood up, then slid to the floor but did not hit her head. Resident #22 had a skin tear on her right elbow which was cleaned with wound cleanser and covered with a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 10 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bordered gauze. (Note- this is a late entry note for a fall that had occurred 11/02/25 earlier in the day in the dining room). Record review and review of a facility fall investigation revealed no evidence a root cause analysis was completed or evidence the facility considered the resident's fall to be associated with her elevated blood sugar levels that had been identified on this date. Review of a nursing note dated 11/02/25 at 4:52 P.M. authored by RN #156 revealed Resident #22's blood sugar showed hi on two devices. The on-call company (of medical providers) was called, and orders were received to give 26 units of Novolog insulin and call back in two hours. The 26 units of Novolog insulin were documented as given. Review of a nursing note dated 11/02/25 at 4:57 P.M. authored by RN #156 revealed Resident #22's blood sugar was 477 mg/dL, the on-call physician was called again and per their request 26 units were given with instructions to call back in two hours. Review of a nursing note dated 11/02/25 at 6:08 P.M. authored by RN #156 revealed Resident #22's blood sugar was 347 mg/dL. The note included information was passed to the night shift nurse. Review of the MAR for this date, revealed a 347 mg/dL blood sugar should have received 15 units of Novolog insulin. However, there was no evidence the resident received the 15 units of Novolog insulin at this time. The MAR identified a 9 which indicates to look at the nursing note; however the corresponding nursing note did not provide evidence the Novolog insulin was administered and/or a reason why it was not. Record review revealed no evidence the resident's blood sugar was re-checked or monitored between 11/02/25 at 6:08 P.M. and 11/03/25 at 11:50 A.M./12:34 P.M. Review of the Medication Administration Record (MAR) dated 11/03/25 revealed no documented evidence Resident #22 received her 9:00 A.M. physician ordered glargine insulin or blood sugar check for the possible administration of Novolog insulin per sliding scale coverage. Review of the medication administration record (MAR) dated 11/03/25 at 4:30 A.M. revealed Resident #22 received Med Pass (dietary supplement) and consumed 100%. Review of task documentation for 11/03/25 at 8:20 A.M. by Certified Nurse Aide (CNA) #175 revealed Resident #22 ate 26-50% of her breakfast. Review of a nursing note dated 11/03/25 at 12:34 P.M. authored by LPN #183 revealed she had gone to check Resident #22's blood sugar but was unable to find her in her room, Resident #22's wheelchair was in her room, LPN #183 asked an aide if they knew where Resident #22 was, but they did not know. Additional people were asked where Resident #22 was, but they did not know. Shower rooms, bathrooms and other public areas were searched. An aide found Resident #22 in her room on the floor between her bed and window laying on the left side of her face. Resident #22 was lying in her own vomit. The aide assisted Resident #22 back into bed. LPN #183 checked Resident #22's blood sugar which read hi and the nurse practitioner was notified and stated to complete a full skin sweep and to get vitals. At this time the resident's blood pressure was documented to be low at 88/40 manually and the resident's pulse was 121 beats per minute (bpm). Resident #22's oxygen saturation would not read but after applying two liters of oxygen it read 83%. Skin check revealed left side of resident's face was puffy. Nurse practitioner was notified and gave orders to send Resident #22 to the hospital. Resident #22's son was notified. There was no additional information in the nursing progress note as to when the resident had last been seen prior to this time. A corresponding fall investigation dated 11/03/25 at 11:50 A.M. and authored by LPN #183 revealed at approximately 11:50 A.M. nursing staff went to Resident #22's room to perform routine blood glucose monitoring in preparation for the lunch meal. When arriving to the room, staff noted Resident #22 was not in her bed or wheelchair as expected. The nurse immediately began to look for the resident and asked several staff members if they had seen Resident #22 or knew her whereabouts. Staff did not know, and the Administrator reported to Resident #22's room to check and found her lying on her left side on the floor between her bed and the window, an area which was not visible from the doorway or hallway. Resident #22 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 11 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few found with emesis present on the floor near her face though the emesis was not obstructing her airway; the resident was assessed to be breathing without difficulty. Staff immediately ensured Resident #22's safety and initiated assessments. When LPN #183 returned to the room moments later, staff had already assisted the resident back into her bed with appropriate assistance. Resident #22 was alert and responsive, able to communicate, and stated she was not sure what she was trying to do when she ended up on the floor. The investigation revealed Resident #22's level of consciousness was deviated from her normal baseline. Vitals signs were obtained and revealed significant abnormalities from the resident's baseline. Blood pressure was 88/40 (mg/Hg- normal reading 120/80) which was significantly lower than baseline, heartrate was elevated to 121 bpm, and notably Resident #22's pulse was irregular which represented a new finding that had not been previously documented. Respiratory rate was 16 breaths per minute, temperature was 98 (degree Fahrenheit), and oxygen saturation was critically low at 83% on 2 liters per minute (lpm) of supplemental oxygen in place at the time she was found on the floor, likely falling off when the fall occurred. Blood glucose was obtained and read hi indicating hyperglycemia. The investigation revealed given the abnormal vital signs, the new irregular heart rhythm, the severe hyperglycemia, and the resident's complex medical history including type I diabetes mellitus, the licensed medical provider was immediately notified and ordered Resident #22 to be sent to the emergency department. The investigation included the resident had multiple risk factors including type I diabetes with history of unstable blood glucose levels, gastrointestinal symptoms including nausea and vomiting in the days preceding the fall, and the resident's unwitnessed activity without seeking staff assistance via call light. Review of a nursing note dated 11/03/25 at 12:26 P.M. authored by LPN #139 revealed Resident #22 was transferred to the emergency department (ED). Review of a hospital note dated 11/03/25 at 12:44 P.M. revealed Resident #22 presented to the ED due to altered mental status and a fall at her nursing facility. Resident #22 was not oriented to time, place, or person and stated she had pain throughout her body. Report was Resident #22 was missing for two hours in the facility and was found beside her bed. The emergency medical services (EMS) staff reported Resident #22's blood sugar was greater than their detectable range on the way to the ED. Resident #22 needed to be admitted to the ICU. Admitting diagnoses included DKA, high anion gap metabolic acidosis, an acute urinary tract infection, a non-ST elevated myocardial infarction (NSTEMI) with troponin levels up to 2630, and sepsis. Review of a nursing note dated 11/03/25 at 9:57 P.M. authored by LPN #136 revealed she called the hospital for an update on Resident #22 who was admitted to the intensive care unit (ICU) for diabetic ketoacidosis and low blood pressure. The Director of Nursing (DON) was notified. The resident did not return to the facility following hospitalization. Review of a staffing schedule dated 11/03/25 revealed three nurses- LPN #183, LPN #174, and LPN #141- were scheduled to work from 7:00 A.M. to 7:30 P.M. LPN #141 had been crossed out, and the schedule was updated to reflect LPN #151 would work from 7:00 A.M. to 10:00 A.M. and LPN #139 would work 12:00 P.M. to 5:00 P.M. Review of a facility assessment dated [DATE] revealed the facility would be able to care for patients with metabolic disorders, including diabetes, thyroid disorders, hyponatremia, hyperkalemia, hyperlipidemia, obesity and morbid obesity. Further review revealed the staffing plan was to have one full-time DON, one unit manager, one RN treatment nurse, and at a minimum two to three LPNs and/or RNs covering the floors each shift. Direct care staff should include three LPNs and/or RNs on dayshift, and RN treatment nurse on dayshift, 2.33 to three LPNs on nightshift, five to six CNAs on dayshift, and three CNAs on nightshift. As census or center needs change, staffing levels are adjusted accordingly. Interview on 11/13/25 at 2:40 P.M. with LPN #183 revealed on 11/03/25, she and LPN #174 were scheduled to work and a third unnamed nurse had called off. LPN #183 stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 12 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nightshift nurse, LPN #151, was supposed to stay and pass morning medications until nurse coverage was found. LPN #183 stated LPN #151 did not want to stay and pass medications and ultimately passed one medication and left early. Interview on 12/04/25 at 7:18 A.M. with LPN #151 revealed on 11/03/25 she did not agree to stay over and was not asked to stay over. LPN #151 stated she was waiting for her relief who was on the schedule but was not supposed to be scheduled. LPN #151 stated she completed her shift, called the DON at 7:15 A.M. because she was on-call and never heard back from her. LPN #151 stated she felt the morning of 11/03/25 was a fluke and it was the first time the new Administrator had to deal with staffing concerns. The Administrator and Activity Director were aware there were only two nurses and LPN #151 was waiting for relief. LPN #151 stated she did not have a way to contact the nurse who supposed to be scheduled for a shift because there was not a list of contact information available so when Human Resources came in she told them about the concern. LPN #151 stated one nurse manager was off sick, one was off for bereavement, and one was off for scheduled paid time off. LPN #151 stated she does not ever stay over to complete morning medication pass because she is not familiar with the medications to be passed in the morning. LPN #151 stated she filled out a report sheet and was upset because she had missed an appointment and she was exhausted and did not feel safe to pass medications. LPN #151 stated she informed the Administrator it was not safe for her to pass pills. Interview on 12/04/25 at 8:55 A.M. with the Administrator revealed on 11/03/25 when he arrived for work, only two dayshift nurses had come in. The Administrator stated LPN #151, nightshift nurse, was waiting for someone to come in and was asked to stay over and pass medications but she had a problem with that. The Administrator stated he asked her again to pass medications and she had a whatever attitude about it, but she stayed and he assumed that meant she would pass medications. The Administrator confirmed LPN #151 never stated she was willing or capable of staying to pass morning medications. The Administrator stated LPN #151 could have passed the cart to the new nurse unit manager, but confirmed it was her third day at the facility and she had not completed training. The Administrator stated LPN #151 could have given the cart to one of the other dayshift nurse because based on census, it would have been acceptable to have two nurses work 11/03/25. The Administrator reported LPN #151 did report to human resources she was going to leave, and the message was not passed on to nursing staff. The Administrator stated he felt the excuse of being tired was weak because he has seen LPN #151 stay over to talk with staff after her shift. When asked if talking and safely passing medications to residents required the same level of alertness, Administrator stated, no, but passing medications and driving does and she drove home. Interview on 12/04/25 at 11:01 A.M. with the DON revealed on 11/03/25 she was contacted by LPN #151 because relief did not show up. The DON stated she told LPN #151 she was sick, but would contact the scheduler. Interview on 12/04/25 at 11:53 A.M. with CNA #194 revealed on 11/03/25, she could recall a nightshift nurse, LPN #151, was waiting for relief to come in but there was a delay in shift change. CNA #194 stated she witnessed Resident #22's family approach LPN #151 and state the resident was feeling ill and LPN #151 was angry, threw a fit, and tossed the keys on the cart and stated, I don't have keys to the cart anymore, what do you want me to do about?Review of an employee handbook document titled Employee Conduct dated 11/12/24 revealed staff are expected to be at work ready to perform job duties on time each day. Absenteeism or tardiness is disruptive of operations and creates a burden for co-workers. Absenteeism or tardiness can result in disciplinary action up to and including termination. If late or absent from work for any reason, a supervisor must be personally notified as far in advance as possible so proper arrangements can be made to handle workload. Some situations may arise in which prior notice cannot be given and in those circumstances, notify the supervisor as quickly as possible. Leaving a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 13 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete voicemail, message, or sending an email does not qualify as personally contacting your supervisor. If you are required to leave work early, you must personally contact your supervisor and obtain permission. Leaving work early without authorization is strictly prohibited. Review of a policy titled Staffing Policy dated 2001 revealed the facility maintains adequate staffing on each shift to ensure residents' needs and services are met. Licensed registered nursing and licensed nursing staff are available to provide and monitor the delivery of resident care services. The facility ensures licensed nursing staff remain available beyond their scheduled shift as necessary to maintain adequate coverage in the event of call-offs or no-shows, thereby supporting continuity of resident care. Certified nursing assistants are available on each shift to provide the care and services needed by each resident as outlined in the resident's comprehensive care plan. Other support services are staffed to meet resident needs. This deficiency represents non-compliance investigated under Complaint Number 2673793.This deficiency is evidence of continued non-compliance from the survey completed 09/15/25. Event ID: Facility ID: 365780 If continuation sheet Page 14 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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, facility incident report review, interview and facility policy review, the facility failed to ensure residents were free from unnecessary medication. This affected two residents (#54 and #87) of five residents reviewed for medication administration errors. The facility census was 53. Findings include:1. Review of the medical record for Resident #54 revealed an initial admission date of 10/18/25 with the diagnoses including but not limited to cerebral infarction, encounter for palliative care, aphasia, contusion of scalp, chronic obstructive pulmonary disease, protein calorie malnutrition, age related physical debility, hydronephrosis, dysphagia, pressure induced deep tissue damage to right heel, disorders of lungs and anxiety disorder. Review of the plan of care dated 10/20/25 revealed the resident required the use of anti-anxiety medication (Lorazepam) related to diagnosis of anxiety disorder. Interventions included administer antianxiety medications as ordered by the physician. Review of the resident's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a moderate cognitive deficit. The assessment indicated the resident was taking antianxiety medications. Review of the resident's monthly physician orders for November 2025 identified orders dated 11/11/25 Lorazepam 0.25 milligrams (mg) by mouth twice daily for anxiety, give half of 0.5 mg tablet to equal the 0.25 mg ordered dose, and Lorazepam 0.5 mg by mouth every four hours as needed for anxiety/restlessness. Review of the progress note dated 10/26/25 at 7:38 P.M. revealed a medication error was observed during medication pass of Lorazepam 0.25 milligrams (mg) twice daily as the resident was being administered the Lorazepam 0.5 mg instead of the Lorazepam 0.25 mg. Review of the facility's incident report dated 10/26/25 at 7:00 P.M. revealed during medication pass it was discovered by the nurse that the staff nurses were signing off the resident was receiving Lorazepam 0.5 mg twice daily, however the resident's order was for Lorazepam 0.25 mg twice daily. The resident's Lorazepam 0.5 mg was to be used as needed only. On 10/27/25 the nurse was provided with verbal education about the five rights of medication administration and notifying pharmacy for label clarification as needed. Review of the resident's controlled drug receipt/record disposition form for the resident's Lorazepam 0.5 mg by mouth from 11/08/25 through 11/20/25 revealed the resident was administered Lorazepam 0.5 mg instead of Lorazepam 0.25 mg on 11/11/25 at 8:25 P.M., 11/12/25 at 8:17 A.M. and 8:34 P.M., 11/13/25 at 8:11 A.M. and 8:31 P.M., 11/14/25 at 7:02 P.M., 11/15/25 at 8:07 A.M. and 9:18 P.M., 11/16/25 at 8:09 A.M. and 8:26 P.M., 11/17/25 at 8:05 A.M., 11/18/25 at 7:56 A.M. and 7:56 P.M., 11/19/25 at 8:55 A.M. and 8:16 P.M. and 11/20/25 at 9:02 A.M. Further review revealed no evidence that the Lorazepam 0.5 mg by mouth was administered for the as needed dosage. On 11/20/25 at 3:55 P.M., interview with the Regional Nurse #510 verified the resident received the wrong dose of Lorazepam on the listed dates and verified the resident should have received Lorazepam 0.25 mg by mouth. 2. Review of the medical record for Resident #87 revealed an initial admission date of 04/19/23 with the latest readmission of 04/04/24 with diagnoses including but not limited to chronic obstructive pulmonary disease, cirrhosis of liver, alcoholic cirrhosis of liver with ascites, esophageal varices, with bleeding, scoliosis, pain in right shoulder, rotator cuff tear or rupture, depression and systemic inflammatory response syndrome. Review of the plan of care dated 06/20/23 revealed the resident had pain/discomfort related to arthritis, right shoulder pain and left should rotator cuff tear. Interventions included administer pain medications per physician orders. Assess for pain, monitor and report non-verbal signs of pain and orthopedic appointments as ordered. Review of the resident's quarterly MDS assessment dated [DATE] revealed the resident had no cognitive deficit. The assessment indicated the resident utilized scheduled, as needed, and non-pharmacological interventions for pain relief. The assessment Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365780 If continuation sheet Page 15 of 16 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 365780 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marietta Heights Post Acute 5001 State Route 60 Marietta, OH 45750 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated the resident had frequent pain at a level of seven out of 10 with zero being no pain and 10 being the worst pain possible. Review of the resident's monthly physician orders for November 2025 identified orders dated 06/02/25 for Oxycodone 5 mg by mouth every six hours for pain; and Hydromorphone 2 mg by mouth every four hours as needed for pain at the level of six to10. Review of the facility incident report dated 11/02/25 at 7:30 P.M. revealed during the narcotic shift count it was discovered the resident was administered an extra dose of Oxycodone 5 mg by mouth. Review of the resident's controlled drug receipt/record disposition form for the resident's Oxycodone 5 mg by mouth revealed on 11/02/25 the resident was administered an extra dose of Oxycodone 5 mg by mouth at 10:39 A.M. with a physician's order.Review of the resident's medical record revealed no evidence a physician ordered for Resident #87 to receive an extra dose of Oxycodone 5 mg.Review of the resident's November MAR revealed no documentation the resident was administered an extra dose of Oxycodone 5 mg by mouth on 11/02/25. Review of the medical record revealed no documentation of the medication error occurred.On 11/20/25 at 3:55 P.M., interview with Regional Nurse #510 verified on 11/02/25 Resident #87 received an extra dose of Oxycodone 5 mg by mouth without a physician's order to administer. Review of the facility policy titled, Administering Medications, last revised 04/19 revealed medications are administered in a safe and timely manner and as prescribed. Medications are administered in accordance with prescriber orders, including any required timeframes. The individual administering the medication checks the label three times to verify the right resident, right medication, right dosage, right time and right method of administration before giving the medication.This deficiency represents non-compliance investigated under Complaint Number 2639947.This deficiency is evidence of continued non-compliance from the survey completed 09/15/25. Event ID: Facility ID: 365780 If continuation sheet Page 16 of 16