Inspection·January 12, 2023

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 01/10/23 at 10:10 A.M. with Licensed Practical Nurse (LPN) #697 confirmed Resident #23's hard chart had a signed DNR-CC order and his electronic record revealed physician orders for DNR-CCA. LPN #697 stated the Social Worker took care of the residents' code status. Interview on 01/10/23 at 2:22 P.M. with Licensed Social Worker (LSW) #611 revealed Resident #23's advance directive should be DNR-CC, and the physician order dated 11/10/22 for DNR-CCA was not correct. Review of the undated facility policy titled Advanced Directives included the facility staff would document in the clinical record whether or not the resident had executed an advance directive. The physician would write an appropriate order for the resident relating to their advance directive. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 2 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, policy review and review facility Self-Reported Incidents (SRIs), the facility failed to implement its policy to thoroughly investigate one incident of neglect and one incident of resident to resident abuse. This affected three residents (#50, #116 and #283) out of nine reviewed for abuse. The facility census was 126. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #50 revealed an admission date of 06/04/20 with diagnoses including diabetes, pancreatitis, obesity, and kidney failure. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #50 had intact cognition. He required extensive assistance of two staff for bed mobility, toilet use and transfers, extensive assistance of one staff for hygiene, and was totally dependent on two staff for dressing. 2. Review of the medical record for Resident #116 revealed an admission date of 10/20/22 with diagnoses including dementia and heart disease. Review of the comprehensive MDS 3.0 assessment dated [DATE] revealed Resident #116 had intact cognition. He required supervision of one staff for bed mobility, transfers, and hygiene, extensive assistance of one staff for toilet use, and limited assistance of one staff for dressing. 3. Review of the medical record for Resident #283 revealed and admission date of 11/18/22 and a discharge date of 12/04/22. Diagnoses included acute respiratory failure, diabetes, sleep apnea, and arthritis. Review of the comprehensive MDS 3.0 assessment dated [DATE] revealed Resident #283 had moderately impaired cognition. She required extensive assistance of two staff for bed mobility and transfers and extensive assistance of one staff for dressing and hygiene. Review of the facility self-reported incident (SRI) dated 12/30/22 revealed Resident's #50 and #116 got into a physical altercation in the dining room after dinner. The investigation revealed assessments were completed for both residents and both residents were to be placed on 15-minute checks for the next 72 hours. Upon review of the investigative file, there was no evidence Resident #116 was checked on every 15 minutes, all witnesses were interviewed, other residents were assessed, or education was provided. Review of the facility SRI dated 12/09/22 revealed Resident #283's family had various concerns regarding her care. The investigation revealed staff was educated on neglect but revealed no evidence other residents or families were interviewed about their care. Interview on 01/12/23 at 2:06 P.M. with the Administrator confirmed was no evidence Resident #116 was checked on every 15 minutes, all witnesses were interviewed, other residents were assessed, or education was provided for the SRI involving Residents #50 and #116, and there were no interviews or assessments of other residents for the SRI involving Resident #283. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 3 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0607 Review of the facility policy for abuse, dated August 2019, revealed all investigations would be thorough. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 4 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, policy review and review facility Self-Reported Incidents (SRIs), the facility failed to thoroughly investigate one incident of neglect and one incident of resident to resident abuse. This affected three residents (#50, #116 and #283) out of nine reviewed for abuse. The facility census was 126. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #50 revealed an admission date of 06/04/20 with diagnoses including diabetes, pancreatitis, obesity, and kidney failure. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #50 had intact cognition. He required extensive assistance of two staff for bed mobility, toilet use and transfers, extensive assistance of one staff for hygiene, and was totally dependent on two staff for dressing. 2. Review of the medical record for Resident #116 revealed an admission date of 10/20/22 with diagnoses including dementia and heart disease. Review of the comprehensive MDS 3.0 assessment dated [DATE] revealed Resident #116 had intact cognition. He required supervision of one staff for bed mobility, transfers, and hygiene, extensive assistance of one staff for toilet use, and limited assistance of one staff for dressing. 3. Review of the medical record for Resident #283 revealed and admission date of 11/18/22 and a discharge date of 12/04/22. Diagnoses included acute respiratory failure, diabetes, sleep apnea, and arthritis. Review of the comprehensive MDS 3.0 assessment dated [DATE] revealed Resident #283 had moderately impaired cognition. She required extensive assistance of two staff for bed mobility and transfers and extensive assistance of one staff for dressing and hygiene. Review of the facility self-reported incident (SRI) dated 12/30/22 revealed Resident's #50 and #116 got into a physical altercation in the dining room after dinner. The investigation revealed assessments were completed for both residents and both residents were to be placed on 15-minute checks for the next 72 hours. Upon review of the investigative file, there was no evidence Resident #116 was checked on every 15 minutes, all witnesses were interviewed, other residents were assessed, or education was provided. Review of the facility SRI dated 12/09/22 revealed Resident #283's family had various concerns regarding her care. The investigation revealed staff was educated on neglect but revealed no evidence other residents or families were interviewed about their care. Interview on 01/12/23 at 2:06 P.M. with the Administrator confirmed was no evidence Resident #116 was checked on every 15 minutes, all witnesses were interviewed, other residents were assessed, or education was provided for the SRI involving Residents #50 and #116, and there were no interviews or assessments of other residents for the SRI involving Resident #283. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 5 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0610 Review of the facility policy for abuse, dated August 2019, revealed all investigations would be thorough. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 6 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. Based on record review, interview, and facility policy review the facility failed to ensure a safe and complete discharge for Resident #123. This affected one resident (#123) of three reviewed for discharge. The facility census was 126. Findings include: Review of the medical record for Resident #123 revealed an admission date of 11/03/22 and a discharge date of 11/10/22. Diagnoses included a fracture of the left shoulder and gastro esophageal reflux disease (GERD). Review of a progress note dated 11/08/22 revealed Resident #123 told the facility she would not be returning to the facility after the appointment she had scheduled for the following day. The social worker was notified. Review of the medical record revealed no evidence of a physician's order for discharge, the resident received a discharge summary, or follow-up instructions. Interview on 01/12/23 at 9:48 A.M. with Social Services Designee (SSD) #622 confirmed there was no physician's order for discharge or discharge follow-up for Resident #123 once they were informed she would not be returning. Review of the undated facility policy titled Admission, discharge and transfer revealed all discharges would be safe and orderly regardless of where the resident discharged to, and all discharges would be documented in the medical record including a physician's order and notification to the resident. This deficiency represents non-compliance investigated under Complaint Number OH00139045. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 7 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and facility policy review the facility failed to ensure Resident #125 was given all his medications upon discharge. This affected one resident (#125) of three residents reviewed for discharge. The facility census was 126. Residents Affected - Few Findings include: Review of the medical record for Resident #125 revealed an admission date of 09/20/22 and a discharge date of 10/05/22. Diagnoses included diabetes, hyperglycemia, chronic kidney disease, hypercholesterolemia, and atrial fibrillation. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #125 had moderately impaired cognition. Review of the physician's orders for October 2022 revealed Resident #125 was taking Vitamin D3 (supplement), Lasix (diuretic) 20 milligrams (mg), Acetaminophen (pain reliever) 650 mg, Ferrous Sulfate (iron supplement) 325 mg, Apixaban (anticoagulant) 2.5 mg, Pravastatin (medication to treat high cholesterol) 80 mg, Potassium Chloride extended release (ER) (supplement) 20 milliequivalents (mEq), Ipratropium-Albuterol solution (bronchodilator) 0.5-2.5 mg, Aspirin 81 (blood thinner) mg and Insulin Glargine solution 100 units. Review of the Discharge summary dated [DATE] revealed Resident #125 was given a two-week supply of Apixaban 2.5 mg, Pravastatin 80 mg, and Potassium Chloride ER 20 mEq. There was no evidence the resident received the rest of his prescribed medication or prescriptions to fill the medication upon discharge. Interview on 01/12/23 at 8:59 A.M. with the Director of Nursing (DON) revealed the nurses were to review the medications prior to a resident being discharged to ensure accuracy. She confirmed there was no evidence Resident #125 was sent home with all his prescribed medications or prescriptions to fill the medication upon discharge. Review of the undated facility policy titled Admission, discharge and transfer revealed all aspects of the resident's discharge would be documented in the medical record. This deficiency represents non-compliance investigated under Complaint Number OH00139045. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 8 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure Resident #275 received physician ordered catheter care. This affected one resident (#275) out of one resident reviewed for catheter care. The facility census was 126. Findings include: Review of Resident #275's medical record revealed an admission date of 12/30/22. Diagnoses included hypotension, kidney failure, obstructive reflex uropathy, and benign prostatic hyperplasia (BPH) with lower tract symptoms. Continued review of the medical record revealed the resident was admitted with a Foley catheter (a flexible tube that passes through the urethra and into the bladder to drain urine), but there was no documented evidence the resident was receiving Foley catheter care. Review of Resident #275's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had intact cognition. Review of Resident #275's January 2023 Physician orders revealed an order for Foley catheter care per policy twice daily and as needed. Review of Resident #275's care plan dated 12/30/22 revealed it did not indicate that the resident had a Foley catheter. Observation on 01/10/23 at 1:29 P.M. revealed Resent #275 resting in bed. Attached to his bed frame was a Foley catheter bag draining clear liquid. Interview on 01/10/23 at 4:45 PM the Director of Nursing (DON) confirmed that although the facility has an order for Foley catheter care for Resident #275, the order did not get transcribed to the treatment record. She confirmed that there was no documented evidence of Foley catheter care being completed for the resident. She stated it was her expectation for catheter care to be completed twice daily and as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 9 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy the facility failed to ensure Resident #427 was administered oxygen per physician orders. This affected one resident (#427) out of three residents reviewed for oxygen administration. The facility census was 126. Residents Affected - Few Findings include: Review of Resident #427's medical record revealed an admission date of 08/28/15 with diagnoses including congestive heart failure, acute respiratory failure with hypoxia, and atrial fibrillation. Review of Resident #427's physician orders dated 10/13/22 revealed an order to discontinue oxygen at one to six liters per minute via nasal cannula to maintain oxygen saturation levels above 92 percent. Further review of Resident #427's physician orders from 10/13/22 through 01/04/23 did not reveal orders for oxygen administration. Review of Resident #427's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #427 was cognitively intact and did not use oxygen. Review of Resident #427's care plan dated 12/30/22 included Resident #427 had an alteration in health maintenance related to acute respiratory failure with hypoxia and other diagnoses. Resident #427's needs would be met, and she would function at optimal level within limitations imposed by the disease process. Interventions included to administer oxygen as ordered and as needed to relieve shortness of breath. Review of Resident #427's physician orders dated 01/05/23 revealed may use oxygen to keep saturation levels above 92 percent. There were no parameters documented for administration of oxygen liters per minute. Review of Resident #427's electronic medical record dated 12/29/22 through 01/10/23 did not reveal documentation of oxygen saturation levels. Review of Resident #427's Medication Administration Record (MAR) and Treatment Administration Record (TAR) from 01/01/23 through 01/10/23 did not reveal documentation of oxygen saturation levels. Review of Resident #427's progress notes on 01/05/23 at 10:47 A.M. included Resident #427 had a moist non-productive cough and oxygen was administered at two liters per minute via nasal cannula. Resident #427's temperature was 97.6 Fahrenheit and lungs were clear. Resident #427 remained in bed and refused to get up to the chair. Resident #427's appetite was fair. There was no documentation of Resident #427's oxygen saturation levels. Further review of Resident #427's progress notes from 12/29/22 through 01/09/23 revealed no documentation Resident #427 had a cough. Observation on 01/09/23 at 2:05 P.M. revealed Resident # 427 lying in bed with oxygen being administered at two liters per minute via nasal cannula. Resident #427 stated she used oxygen about a year ago after a hospitalization but had not needed it in a while. Resident #427 indicated she was having respiratory issues in the last few days and felt like she needed oxygen again. Resident #427 stated she asked an unidentified nurse to give her oxygen and the nurse replied, sure you can wear it again, it won't hurt. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 10 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 01/10/23 at 3:25 P.M. with Registered Nurse (RN) #609 revealed she was on vacation and when she returned to work on 01/05/23 she observed Resident #427 had a non-productive cough, was otherwise asymptomatic, and had oxygen at two liters per minute via nasal canula. RN #609 indicated she did not know what nurse initiated Resident #427's oxygen. RN #609 checked Resident #427's medical record and did not find an order for oxygen administration. RN #609 stated the unknown nurse who initiated the oxygen did not obtain a physician order. RN #609 stated it was not out of the norm for residents to have coughs and colds at this time of year and she did not test Resident #427 for COVID-19 on 01/05/23. RN #609 indicated she tried to titrate Resident #427 off the oxygen, but her saturations kept dropping and she was not able to discontinue the oxygen. RN #609 stated she obtained an order to administer oxygen to keep Resident #427's oxygen saturation levels above 92 percent and confirmed there were no parameters for oxygen administration. RN #609 indicated Resident #427 did not remember the nurse who initiated the oxygen. Observation on 01/10/23 at 3:53 P.M. of Resident #427 revealed she was lying on her back in bed, sleeping, and wearing oxygen at two liters per minute via nasal cannula. Interview on 01/12/23 at 3:00 P.M. with the Director of Nursing (DON) revealed she asked Resident #427 if she remembered who gave her the oxygen and Resident #427 stated it was a blond-haired nurse. Resident #427 stated the nurse gave her the oxygen because she asked for it and thought the oxygen would make her feel better. Resident #427 did not know the nurse's name. The DON stated having a cough was not unusual for Resident #427. Review of the undated facility policy titled Oxygen Therapy included a physician must order oxygen therapy. Once verified a credentialed Respiratory Care Practitioner (RRT or CRT) or other licensed, credentialed personnel, with documented equivalent ability and training, would perform the tasks of initiating and monitoring of oxygen delivery systems. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 11 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy the facility failed to ensure Resident #115's psychotropic medication was administered as ordered. In addition, the facility failed to ensure Resident #124 had a diagnosis for a prescribed antipsychotic medication. This affected two residents (#115 and #124) of five residents reviewed for unnecessary psychotropic medications. The facility census was 126. Findings include: 1. Review of Resident #115's medical record revealed an admission date of 10/09/22 with diagnoses including fracture of the neck of the left femur, end stage renal disease, and dementia. Review of Resident #115's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #115 was cognitively intact and required extensive assistance of two staff members for bed mobility and transfers and required the assistance of one staff member for toilet use. Review of Resident #115's physician orders dated 10/21/22 revealed an order for Risperidone tablet (antipsychotic) 0.5 milligrams (mg), give 0.5 mg at bedtime for delirium. Review of Resident #115's psychiatric evaluation dated 10/21/22 included Resident #115 had a history of dementia, end stage renal disease, and went to dialysis three times a week. Current medications included Risperidone and Sertraline (Selective Serotonin Reuptake Inhibitor (SSRI) used to treat depression). According to staff, Resident #115 was verbally aggressive towards staff, using profanity, was demanding, refused medications, but currently the nurse reported no aggressive behavior, stating, Resident #115 was just grouchy. During the evaluation, Resident #115 was irritable and sarcastic at times. The recommendation was to increase Sertraline to 50 mg every morning and decrease Risperidone to 0.25 mg every at bedtime. Review of Resident #115's Medication Administration Record (MAR) from 10/21/22 through 01/12/23 revealed risperidone 0.5 mg was given at bedtime daily. Observation on 01/11/23 at 8:55 A.M. revealed Resident #115 sitting in a wheelchair in his room, his head was down, and he appeared to be taking a nap. Resident #115 raised his head when a knock sounded on the door. Resident #115 stated he was waiting to go to dialysis. Resident #115 indicated he didn't leave until after 10:00 A.M. but didn't want to lay down because he started to think sad thoughts when he was in bed. Resident #115 was pleasant and answered questions appropriately. Interview on 01/12/23 at 12:38 P.M. with the Director of Nursing (DON) revealed she spoke to an unidentified nurse and stated the nurse thought Nurse Practitioner (NP) #800 said she would talk to Resident #115 and might not decrease the Risperidone. The DON stated she spoke to NP #800 and was told the Risperidone should have been decreased to 0.25 mg back in October 2022, and Resident #115 should have been receiving Risperidone 0.25 mg and not 0.5 mg. 2. Review of the medical record for Resident #124 revealed an admission date of 11/16/22 and a discharge date of 11/21/22. Diagnoses included acute kidney failure, muscle weakness, anemia, and human (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 12 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0758 immunodeficiency virus (HIV). Level of Harm - Minimal harm or potential for actual harm Review of the comprehensive MDS 3.0 assessment dated [DATE] revealed Resident #124 had moderately impaired cognition. Residents Affected - Few Review of the physician's orders for November 2022 revealed an order for Prochlorperazine (antipsychotic) 10 mg every morning. Interview on 01/12/23 at 9:32 A.M. with the Director or Nursing (DON) revealed the medication was supposed to be used for nausea and vomiting due to the resident's diagnosis of HIV but was entered incorrectly and being used as an antipsychotic, which the resident did not have a diagnosis for. Review of the undated facility policy titled Psychotropic Drug Use revealed the facility would ensure psychotropic drugs were used for the correct reason, and with the appropriate diagnosis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 13 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to maintain a medication error rate of less than five (5) percent (%). The medication error rate was calculated to be 8% and included two medication errors of 25 medication administration opportunities. This affected two residents (#46 and #31) of five residents observed during medication administration. The facility census was 126. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #46 revealed an admission date of 01/08/15. Diagnoses included schizoaffective disorder, anxiety disorder, and major depressive disorder. Review of Resident #46's January 2023 physician's orders revealed Resident #46 had an order to receive Deplin 15-90.314 milligram (mg) capsule by mouth in the morning for hormone replacement. Observation on 01/11/23 at 7:40 A.M. of Registered Nurse (RN) #620 passing medications to Resident #46 revealed, RN #620 was unable to administer Resident #46's Deplin 15-90.314 mg. Interview on 01/11/23 at 8:07 A.M. RN #620 confirmed that the facility has not reordered Resident #46's Deplin 15-90.314 mg making it unavailable. She stated that she will reorder it today. 2. Review of the medical record for Resident #31 revealed an admission date of 01/07/22. Diagnoses included hypertension, dysphasia, and acute kidney failure. Review of Resident #31's January 2023 physician's orders revealed an order for Flonase (corticosteroid) 50 micrograms (mcg) two sprays in each nostril daily. Observation on 01/11/23 at 7:50 A.M. of RN #620 revealed, while administering Resident #31's Flonase 50 mcg, she only administered one spray in each nostril. Interview on 01/11/23 at 8:07 A.M. RN #620 confirmed that she only administered one spray of Resident #31's Flonase in each nostril. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 14 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0886 Perform COVID19 testing on residents and staff. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy the facility failed to ensure Resident #427 with symptoms of COVID-19 was tested timely. This affected one resident (#427) out of three residents reviewed for oxygen administration. The facility census was 126. Residents Affected - Few Findings include: Review of Resident #427's medical record revealed an admission date of 08/28/15 with diagnoses including congestive heart failure, acute respiratory failure with hypoxia, and atrial fibrillation. Review of Resident #427's physician orders dated 10/13/22 revealed an order to discontinue oxygen at one to six liters per minute via nasal cannula to maintain oxygen saturation levels above 92 percent. Further review of Resident #427's physician orders from 10/13/22 through 01/04/23 did not reveal orders for oxygen administration. Review of Resident #427's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #427 was cognitively intact and did not use oxygen. Review of Resident #427's care plan dated 12/30/22 included Resident #427 had an alteration in health maintenance related to acute respiratory failure with hypoxia and other diagnoses. Resident #427's needs would be met, and she would function at optimal level within limitations imposed by the disease process. Interventions included to administer oxygen as ordered and as needed to relieve shortness of breath. Review of Resident #427's physician orders dated 01/05/23 revealed an order stating may use oxygen to keep saturation levels above 92 percent. There were no parameters documented for administration of oxygen liters per minute. Review of Resident #427's electronic medical record dated 12/29/22 through 01/10/23 did not reveal documentation of oxygen saturation levels. Review of Resident #427's Medication Administration Record (MAR) and Treatment Administration Record (TAR) from 01/01/23 through 01/10/23 did not reveal documentation of oxygen saturation levels. Review of the facility Long Term Care Respiratory Surveillance Line List dated 01/06/23 revealed State Tested Nursing Assistant (STNA) #680 tested positive for COVID-19. On 01/05/23 STNA #680's primary floor assignment was the nursing unit Resident #427 resided on. STNA #680 experienced a cough, chills, and body aches. Review of Resident #427's progress notes on 01/05/23 at 10:47 A.M. included Resident #427 had a moist non-productive cough and oxygen was administered at two liters per minute via nasal cannula. Resident #427's temperature was 97.6 Fahrenheit and lungs were clear. Resident #427 remained in bed and refused to get up to the chair. Resident #427's appetite was fair. There was no documentation of Resident #427's oxygen saturation levels. Further review of Resident #427's progress notes from 12/29/22 through 01/09/23 did not reveal documentation stating Resident #427 had a cough. Observation on 01/09/23 at 2:05 P.M. revealed Resident # 427 lying in bed with oxygen being (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 15 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0886 Level of Harm - Minimal harm or potential for actual harm administered at two liters per minute via nasal cannula. Resident #427 stated she used oxygen about a year ago after a hospitalization but had not needed it in a while. Resident #427 indicated she was having respiratory issues in the last few days and felt like she needed oxygen again. Resident #427 stated she asked an unidentified nurse to give her oxygen and the nurse replied, sure you can wear it again, it won't hurt. Residents Affected - Few Review of Resident #427's progress notes dated 01/09/23 at 2:17 P.M. revealed COVID-19 testing was completed per CDC (Center for Disease Prevention and Control) guidelines with positive results. Isolation precautions in place. Interview on 01/10/23 at 2:17 P.M. with the Director of Nursing (DON) revealed residents were tested on ce a week for COVID-19 during an outbreak and twice a week if they were unvaccinated. The DON indicated if a resident had symptoms the nurse would obtain an order from the nurse practitioner or physician to test for COVID-19 and additional orders if needed. The information would be documented in the resident's progress notes. Interview on 01/10/23 at 2:31 P.M. with Assistant Director of Nursing/Licensed Practical Nurse/Infection Preventionist (ADON/LPN/IP) #718 revealed residents were tested on ce a week for COVID-19 while the facility was in outbreak. ADON/LPN/IP #718 stated if a resident had symptoms on other days they were tested for COVID-19 regardless, and usually complained of a cough or congestion, might have a low grade temperature, and residents with upper respiratory symptoms were tested. Interview on 01/10/23 at 3:25 P.M. with Registered Nurse (RN) #609 revealed she was on vacation and when she returned to work on 01/05/23 she observed Resident #427 had a non-productive cough, was otherwise asymptomatic and had a nasal cannula with oxygen being administered at two liters per minute. RN #609 indicated she did not know what nurse initiated Resident #427's oxygen administration. RN #609 checked Resident #427's medical record and did not find an order for oxygen administration. RN #609 stated the unknown nurse who initiated the oxygen did not obtain a physician order. RN #609 stated it was not out of the norm for residents to have coughs and colds at this time of year and she did not test Resident #427 for COVID-19 on 01/05/23. RN #609 indicated she tried to titrate Resident #427 off the oxygen, but her saturations kept dropping and she was not able to discontinue the oxygen. RN #609 stated she obtained an order to administer oxygen to keep Resident #427's oxygen saturation levels above 92 percent, and confirmed there were no parameters for oxygen administration. RN #609 indicated Resident #427 did not remember the nurse who initiated the oxygen. Observation on 01/10/23 at 3:53 P.M. of Resident #427 revealed she was lying on her back in bed, sleeping, and wearing oxygen at two liters per minute via nasal cannula. Interview on 01/11/23 at 10:19 A.M. with ADON/LPN/IP #718 confirmed Resident #427 was not tested on [DATE] for COVID-19 when she had a moist, non-productive cough. ADON/LPN/IP #718 stated the physician saw Resident #427 on 01/05/23 and she was feeling fine (there was no documentation of this in Resident #427's medical record and the facility could not provide documentation this occurred). ADON/LPN/IP #718 indicated if the facility was in outbreak and a staff member tested positive for COVID-19, contact tracing would identify where the staff member last worked and if any residents were showing signs and symptoms of COVID-19. ADON/LPN/IP #718 confirmed an unidentified nurse put Resident #427 on oxygen, did not document why, chart oxygen saturation levels, or get a physician order for oxygen. Interview on 01/12/23 at 3:00 P.M. with the Director of Nursing (DON) revealed she asked Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 16 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0886 Level of Harm - Minimal harm or potential for actual harm #427 if she remembered who gave her the oxygen, and Resident #427 stated it was a blond-haired nurse. Resident #427 stated the nurse gave her the oxygen because she asked for it, and she thought the oxygen would make her feel better. Resident #427 did not know the nurse's name. The DON stated having a cough was not unusual for Resident #427. The DON stated she did not feel Resident #427 needed to be tested on [DATE] because she had been tested on [DATE] and had negative results. Residents Affected - Few Review of the facility policy titled COVID-19 Testing of Staff and Residents, revised 03/2022, included the facility would conduct COVID-19 testing in accordance with the standards of practice as followed: residents who were symptomatic should be tested and placed on transmission-based precautions in accordance with CDC guidelines while awaiting results. The facility would take appropriate actions based on results. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 17 of 18 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 365823 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Center at the Ridge 3379 Main Street Mineral Ridge, OH 44440 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure Resident #1 and Resident #119's call lights were within reach. This affected two residents (#1 and #119) of three residents reviewed for call lights. The facility census was 126. Residents Affected - Few Findings include: 1. Review of Resident #1's medical record revealed an admission date of 02/15/18. Diagnoses included frontal lobe and executive function deficit, impulsiveness, and impulse control disorder. Review of Resident #1's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had impaired cognition and needed extensive assistance for bed mobility and transfers. Observation on 01/10/23 at 9:06 A.M. revealed Resident #1 lying in bed with his call light device located out of his reach under his bed. The resident was yelling out for staff requesting more food. Observation on 01/10/23 at 4:30 P.M. Resident #1 was observed again lying in his bed. His call light remained in the same position under his bed. Interview on 01/10/23 at 4:35 P.M. Licensed Practical Nurse (LPN) #697 confirmed Resident #1's call light device was placed out of his reach. 2. Review of Resident #119's record revealed an admission date of 11/04/22. Diagnoses included intellectual disabilities, pervasive developmental disorder, and muscle weakness. Review of Resident #119's admission MDS 3.0 assessment dated [DATE] revealed the resident had impaired cogitation and needed extensive assistance for bed mobility and transfers. Observation on 01/11/23 at 8:21 A.M. revealed LPN #621 administer medication to Resident #119. At this time, it was noted that Resident #119's call light device was located out of his reach on the floor. The nurse left room without placing the call light within his reach. Observation on 01/11/23 at 11:17 A.M. of Resident #119 revealed he was lying in his bed with his call light device in the same place on the floor out of his reach. Interview on 01/11/23 at 11:17 A.M. Registered Nurse (RN) #620 confirmed Resident #119's call light device was on the floor out of his reach. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365823 If continuation sheet Page 18 of 18