Health inspection·December 11, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were no mechanical lift pads including bariatric lift pads available on either long-term care nursing unit or the skilled nursing unit. Further observation revealed Resident #2 did not have a mechanical lift pad on his padded wheelchair or in his room. Observation of the laundry area revealed five bariatric mechanical lift pads were hanging in the laundry area and were wet. STNA #239 stated Resident #2 needed a bariatric mechanical lift pad, and the mechanical lift pads needed to be dry before they could be used. When asked if Resident #2 wanted to get out of bed now would he be able to, STNA #239 stated Resident #2 would not be able to get up at this time and would need to wait for the mechanical lift pads to dry. Interview on 12/11/23 at 1:12 P.M. of Maintenance Supervisor #200 revealed the bariatric mechanical lift pads could be dried at low temperature. Interview on 12/11/23 at 1:52 P.M. of Assistant Director of Nursing (ADON) #240 revealed mechanical lift pads could be placed in the dryer at low temperature but it was preferred to have them air dry because they lasted longer if they were air dried. Review of the facility policy titled Resident Rights and Facility Responsibilities, revised 09/03/20, included references were CMS, 2017, State Operations Manual, F483.10, Resident Rights. Review of the CMS, 2017, State Operations Manual, F483.10 Resident Rights included the resident had a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. This deficiency was an incidental finding discovered during the complaint investigation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 2 of 8 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 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 interview, closed record review, review of the facility policy and review of the Centers for Medicare and Medicaid Services (CMS) guidance the facility failed to ensure Resident #56's eye infection was treated while she resided in the facility. This affected one resident (#56) out of three residents reviewed for infections. The facility census was 55. Residents Affected - Few Findings include: Review of Resident #56's closed medical record revealed an admission date of 10/07/23, and a re-entry date of 10/09/23. Resident #56's diagnoses included Alzheimer's Disease, dementia without behavioral disturbance, and fracture of the left pubis. Resident #56 was discharged from the facility on 11/07/23. Review of Resident #56's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #56 had moderate cognitive impairment. Resident #56 required partial assistance from another person to complete bathing, dressing, using the toilet, eating, and walking from room to room. Resident #56 used a walker. Resident #56 had two unstageable pressure ulcer injuries (full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed) presenting as deep tissue injury (purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue due to pressure and/or shear) present upon admission to the facility. Review of Resident #56's facility Discharge Instructions dated 11/07/23 did not reveal documentation that Resident #56's eyes were red and draining or had a discharge. Review of Resident #56's Hospice Face-to-Face Encounter Report dated 11/07/23 included Resident #56 resided at home with a primary hospice diagnosis of late onset Alzheimer's Disease. Resident #56's son was the primary caregiver. Resident #56 was incontinent of bowel and bladder. Resident #56 had a recent fall with a pelvic fracture, was mostly in bed during rehab, was frailer and now mostly in chair. Resident #56 was wobbly and required the assistance of a rollator. Resident #56 required maximum assistance with activities of daily living (ADL). Resident #56 was discharged today (11/07/23) from the facility and had deconditioning (deteriorating condition), extreme weakness, and required assistance of one person for transfers and ambulation and was unsteady. Resident #56 was alert to self and home; her skin was dry and flaky, her right and left eyes were red, and her left eye was draining. A new order was received for Tobramycin (antibiotic) eye drops, give one drop in both eyes four times a day for seven days. Interview on 12/07/23 at 8:54 A.M. of Resident #56's son revealed the resident was admitted to the facility from the hospital for rehabilitation from a fracture. He stated Resident #56 fell at home, had a fracture, and was hospitalized a week before she was admitted to the facility. He stated Resident #56 was fine when she left the hospital and when he picked Resident #56 from the facility she had bedsores on her feet, her eyes were pussed shut, and she had an infection in both eyes, she smelled bad and when he touched her she was incontinent of urine and the urine just drained off of her into his hands when he touched her. He stated Resident #56 wore incontinence briefs. Interview on 12/07/23 at 11:40 A.M. of Hospice Nurse (HN) #268 revealed Resident #56 did look rough when she arrived home from the facility. HN #268 stated Resident #56's hair was disheveled and did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 3 of 8 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not look like it was brushed for days, her face was oily and had dry skin, she had an odor, wounds to both heels and the wounds were pretty bad looking. HN #268 stated Resident #56 had green drainage coming out of the left eye, and the hospice physician prescribed antibiotic eye drops for her. HN #268 stated Resident #56 was discharged from hospice when she was admitted to the hospital and was readmitted to hospice on 11/07/23. HN #268 stated she had 17 years' experience as a long-term nurse and she could not believe the condition Resident #56 was sent home in. Interview on 12/11/23 at 3:41 P.M. of Licensed Practical Nurse (LPN) #261 revealed she discharged Resident #56 from the facility on 11/07/23 and did not remember if Resident #56's eyes were red and draining or had a discharge from them. Interview on 12/11/23 at 4:14 P.M. of Assistant Director of Nursing (ADON) #240 revealed he was not aware of Resident #56 having an eye condition. ADON #240 stated staff would notify him of any abnormalities concerning residents, and he could follow-up; he did not receive a notification from any staff member regarding Resident #56's eye infection. Review of the facility policy titled Resident Rights and Facility Responsibilities, revised 09/03/20, included references were CMS 2017, State Operations Manual, F483.10, Resident Rights. Review of the CMS, 2017, State Operations Manual, F483.10 Resident Rights included the resident had a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. This deficiency represents non-compliance investigated under Complaint Number OH00148356. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 4 of 8 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 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, interview, closed record review, and review of the facility policy the facility failed to thoroughly document the appearance of Resident #56's bilateral heel deep tissue injuries (DTI). This affected one resident (#56) out of three residents reviewed for pressure ulcer injuries. The facility census was 55. Residents Affected - Few Findings include: Review of Resident #56's closed medical record revealed an admission date of 10/07/23, and a re-entry date of 10/09/23. Resident #56's diagnoses included Alzheimer's Disease, dementia without behavioral disturbance, and fracture of the left pubis. Resident #56 was discharged from the facility on 11/07/23. Review of Resident #56's progress notes dated 10/09/23 through 11/07/23 did not reveal documentation related to the appearance of Resident #56's bilateral heel DTIs (purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue due to pressure and/or shear). Further review revealed the discharge instructions dated 11/07/23 at 5:53 A.M. did not reveal instructions for the care of Resident #56's bilateral heel DTIs. Review of Resident #56's care plan dated 10/10/23 included Resident #56 had the potential for skin breakdown related to diagnosis, mobility status, and incontinence. The goal was Resident #56's skin would remain intact through the next review. Interventions included completing skin assessments per protocol, to elevate heels off the mattress per routine and/or as needed as Resident #56 allowed. Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the left heel which was community acquired and present on admission to the facility. The measurements were 3.0 centimeters (cm) in length by 3.0 cm in width by a depth of unable to be determined, and there was no drainage. There was no description of the wound bed or peri wound (skin surrounding the wound) appearance as the wound bed and peri wound appearance were marked as not applicable. The family and physician were notified, and treatment was to apply Skin-Prep (liquid film-forming skin protectant that prepares damaged skin for tapes and adhesive dressings) BID (twice a day) and as needed and a foam dressing to pad and protect. Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the right heel which was community acquired and present on admission to the facility. The measurements were 0.3 cm in length by 0.3 cm in width by a depth of unable to be determined, and there was no drainage. There was no description of the wound bed or peri wound appearance as the wound bed and peri wound appearance were marked as not applicable. The family and physician were notified, and treatment was to apply Skin-Prep BID and as needed and a foam dressing to pad and protect. Review of Resident #56's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #56 had moderate cognitive impairment. Resident #56 required partial assistance from another person to complete bathing, dressing, using the toilet, eating, and walking from room to room. Resident #56 used a walker. Resident #56 had two unstageable pressure ulcer injuries (full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed) presenting as DTIs present upon admission to the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 5 of 8 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the right heel which was community acquired. The measurements were 3.0 cm in length by 2.0 cm in width 2 cm by a depth of unable to be determined, and there was no drainage. There was no description of the wound bed or peri wound appearance as the wound bed and peri wound appearance were marked as not applicable. The wound status was marked as wound was deteriorating. The family and physician were notified. The treatment was applying Skin-Prep BID and as needed and a foam dressing to pad and protect. There was a new order for PRAFO boots (a device worn on the lower leg and foot designed to assist with the management of pressure related problems to the heel and ankles). Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the left heel which was community acquired. The measurements were 3.0 cm in length by 3.0 cm in width by a depth of unable to be determined, and there was no drainage. There was no description of the wound bed or peri wound appearance as the wound bed and peri wound appearance were marked as not applicable. The wound status was marked as unchanged. The family and physician were notified, and the treatment was to apply Skin-Prep BID and as needed, and a foam dressing to pad and protect. There was a new order for PRAFO boots. Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the right heel which was community acquired. The measurements were 2.0 cm in length by 2.4 cm in width by a depth of 0, and there was no drainage. There was no description of the wound bed or peri wound appearance as the wound bed and peri wound appearance were marked as not applicable. The wound status was improving. The family and physician were notified, and the treatment was to apply Skin-Prep BID and as needed, a foam dressing to pad and protect, and PRAFO boots. Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the left heel which was community acquired. The measurements were 3.0 cm in length by 2.4 cm in width by a depth of 0, and there was no drainage. There was no description of the wound bed or peri wound appearance as the wound bed and peri wound appearance were marked as not applicable. The wound status was marked as improving. The family and physician were notified, and the treatment was to apply Skin-Prep BID and as needed, a foam dressing to pad and protect, and PRAFO boots. Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the right heel which was community acquired and measurements were 2.0 cm in length by 2.2 cm in width by a depth of 0, and there was no drainage. There was no description of the wound bed or peri wound appearance as the wound bed and peri wound appearance were marked as not applicable. The wound status was marked as improving, and family and the physician were notified. The family and physician were notified, and the treatment was to apply Skin-Prep BID and as needed, a foam dressing to pad and protect, and PRAFO boots. Review of Resident #56's Weekly Wound assessment dated [DATE] revealed Resident #56 had a DTI of the left heel which was community acquired. The measurements were 2.8 cm in length by 2.1 cm in width by a depth of 0 and there was no drainage. There was no description of the wound bed appearance or peri wound appearance and both were marked not applicable. The wound status was marked as improving. The family and physician were notified, and the treatment was to apply Skin-Prep BID and as needed, a foam dressing to pad and protect, and PRAFO boots. Review of Resident #56's Discharge Instructions from the facility dated 11/07/23 included for the question asking if wounds were present, the No box was marked. Further review did not reveal instructions for the care of Resident #56's bilateral heel DTIs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 6 of 8 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #56's Hospice Wound Record Report revealed the onset date was 11/07/23, and Resident #56 had bilateral unstageable DTIs to her right and left heels. Further review revealed on 11/09/23 Resident #56's left heel unstageable DTI measured 2.5 cm in length by 3.0 cm in width by a depth of 0, and 26 to 50 percent of the wound had soft black slough and eschar. On 11/09/23 Resident #56's right heel unstageable DTI measured 1.5 cm in length by 2.0 cm width by a depth of 0, and 0 to 25 percent of the tissue was necrotic tissue slough and eschar. Interview on 12/07/23 at 8:54 A.M. Resident #56's son revealed she was admitted to the facility for rehabilitation. He stated Resident #56 had a fall at home, had a fracture, and was hospitalized for about a week for the fracture, then was admitted to the facility for rehabilitation. He stated when he picked Resident #56 up at the facility on 11/07/23, when she was discharged , he was not given instructions on her bilateral bedsores on her feet, and was really upset when he got home and saw how bad the sores on her heels were. He stated in addition to the sores on her feet, her eyes were pussed shut, she smelled very bad and was soaked with urine stating, the urine just ran off Resident #56 into his hands. He stated the facility was supposed to help, not kill Resident #56. Interview on 12/07/23 at 11:40 A.M. of Hospice Nurse (HN) #268 revealed Resident #56 looked rough when she arrived home from the facility. HN #268 stated Resident #56's hair was disheveled and did not look like it was brushed for days, her face was oily and had dry skin, she had an odor, wounds to both heels, and the wounds were pretty bad looking. HN #268 stated Resident #56 had green drainage coming out of the right eye, and the hospice physician prescribed antibiotic eye drops for her. HN #268 stated Resident #56 was discharged from hospice when she was admitted to the hospital and was readmitted to hospice on 11/07/23. HN #268 stated she had 17 years' experience as a long-term nurse, and she could not believe the condition Resident #56 was sent home in. Interview on 12/11/23 at 2:18 P.M. of Assistant Director of Nursing (ADON) #240 revealed the facility did not follow a specific protocol for a low air loss mattress. ADON #240 stated if a resident had a wound that was worsening, he would reach out to the resident's physician to see if a low air loss mattress and PRAFO boots would be beneficial. ADON #240 stated Resident #56's DTIs of her left heel got bigger on 10/16/23, and he notified the Director of Nursing (DON). ADON #240 stated on 10/23/23 both of Resident #56's DTIs worsened, and that was when we received orders for Resident #56's low air loss mattress and PRAFO boots. ADON #240 stated before Resident #56 had orders for a low air loss mattress and PRAFO boots, she had interventions to elevate her heels off the bed as tolerated. ADON #240 stated when he noticed Resident #56's left heel was deteriorating he made sure nurses were aware Resident #56's heels needed to be elevated off the bed. ADON #240 stated when Resident #56's bilateral heels deteriorated he told Medical Director #269 and obtained orders for a low air loss mattress and PRAFO boots. ADON #240 stated Resident #56 did not have orders for a low air loss mattress or PRAFO boots when she was first admitted , because he wanted to see if the treatment for pad and protect the heels was effective. ADON #240 stated Resident #56's bilateral DTIs did not become open wounds, and when she was first admitted the heels were deep red in color with some maroon. ADON #240 indicated on 10/23/23 Resident #56's areas on her heels were larger and the same color as when she was admitted . ADON #240 confirmed he did not document the appearance of Resident #56's bilateral heel DTIs wound bed color or peri wound appearance. ADON #240 stated the wound nurse practitioner (WNP) did not evaluate Resident #56's bilateral heel DTIs because they were not open wounds. ADON #240 stated it was not the practice to consult the WNP until the DTI became an open wound. ADON #240 stated the last time he observed Resident #56's DTIs of her heels was on 11/06/23. Interview on 12/11/23 at 3:31 P.M. of Medical Director #269 revealed it was hard to remember details about residents because she had so many patients. Medical Director #269 stated she always (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 7 of 8 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 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 Level of Harm - Minimal harm or potential for actual harm looked at resident wounds but did not always document the wounds in her notes. Medical Director #269 stated the last time she saw Resident #56 was on 11/01/23, and she had positive pedal pulses. Medical Director #269 stated she did not document the wound bed appearance of Resident #56's bilateral heel DTIs, or the peri wound appearance in her notes, but she remembered the wound beds were reddish in color. Residents Affected - Few Interview on 12/11/23 at 3:41 P.M. of Licensed Practical Nurse (LPN) #261 revealed she discharged Resident #56 from the facility on 11/07/23. LPN #261 stated she did not remember looking at Resident #56's bilateral heel DTI wounds or giving Resident #56's son instructions on the treatment of Resident #56's bilateral heel DTI wounds before Resident #56 was discharged . Observation on 12/11/23 at 4:14 P.M. of pictures sent by Resident #56's son of her bilateral heel wounds with ADON #240 revealed the pictures were taken on 11/07/23 after Resident #56 was discharged from the facility. Observation of Resident #56's first picture of her heel wounds revealed a large circular area on the heel, and the outer perimeter of the circle was dark, black appearing tissue. The inner wound bed had purple, dark purple, and deep red areas noted. The peri wound tissue appeared red in color. Observation of the second picture of her heel wounds revealed a large circular area on the heel, and the wound bed appeared to have pink, light purple, and a couple dark red areas noted. The peri wound tissue was a dark greyish color with some yellow areas noted. ADON #240 confirmed the appearance of Resident #56's heel wounds in both pictures and stated Resident #56's heels did not look like that on 11/06/23, and if they looked like that, he would have consulted the WNP. ADON #240 stated his documentation showed Resident #56's bilateral heel DTIs were getting smaller and improving. ADON #240 stated the outer edge, which was black and looked like eschar, would be debrided by the WNP. ADON #240 stated he did not discharge Resident #56 from the facility, but Resident #56's responsible party was given a printout of orders for the treatment of Resident #56's bilateral heel DTIs. Review of the facility policy titled Pressure Injury Prevention and Treatment Policy, revised 09/18/23, included pressure injuries identified would be assessed initially and at least weekly thereafter, until closed. All assessments would include the following elements including wound bed color and type of tissue and character including evidence of healing for example granulation tissue, maceration as appropriate, and appearance of surrounding tissue. This deficiency represents non-compliance investigated under Complaint Number OH00148356. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365814 If continuation sheet Page 8 of 8