Health inspection·July 27, 2023

F 0604 Level of Harm - Minimal harm or potential for actual harm Observation on 07/26/23 at 5:00 P.M. revealed Resident #34 sitting in her broda chair with the tray table across her lap and buckled behind the broda chair while in her room. Interview on 07/27/23 at 2:16 P.M. with the Director or Nursing (DON) confirmed there was no restraint assessment or physician order for for Resident #34. Residents Affected - Few Review of the policy, Use of Restraints, dated December 2007, defined a restraint as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or restricts normal access to one's body. Further review revealed that prior to the placing a resident in a restraint, a pre-restraint assessment was to be performed, a physician order for the restraint usage, consent from the resident and or representative was to be obtained and a plan of care was to be reflective of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 2 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interviews, and review of facility policy, the facility failed to complete an accurate assessment to reflect a resident's current status. This affected one (Resident #82) of one resident reviewed for accuracy of assessments. The facility census was 100. Residents Affected - Few Findings include: Review of the medical record for Resident #82 revealed an admission date of 01/10/23. The resident was admitted with diagnoses including end stage renal disease, type two diabetes mellitus, hypertension, dependence on renal dialysis. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #82 had a Brief Interview Mental Status (BIMS) score of 15 indicating intact cognition. Further review revealed the resident required supervision for walking in his room and corridor. Interview on 07/25/23 at 8:50 A.M. with Resident #82 revealed he was unable to walk since he came to the facility. Interview on 07/26/23 at 8:12 A.M. with Therapy Manager #400 revealed Resident #82 was receiving therapy upon his admission to the facility and was discharged per his choice. The resident did not walk during therapy and utilized a wheelchair for locomotion. Interview on 07/27/23 at 12:36 with MDS Coordinator #272 verified Resident #82' MDS assessment was incorrect in reflecting the residents current status for locomotion. Review of the Resident Assessment Instrument revised 09/2010 revealed the purpose of the assessment was to describe the resident's capability to perform daily life functions and to identify significant impairments in functional capacity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 3 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interviews, and review of facility policy, the facility failed to develop accurate care plans to reflect residents' current status. This affected two (Residents #40 and #34) of three reviewed for care planning. The facility census was 100. Findings include: 1. Review of the medical record for Resident #40 revealed an admission date of 07/14/23. The resident was admitted with diagnoses including end stage renal disease, dependence on dialysis, type two diabetes mellitus, depression, and Rheumatoid Arthritis. The quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #40 had a Brief Interview Mental Status (BIMS) score of 15, indicating intact cognition. The resident was independent with Activities of Daily Living (ADLs). Further review revealed Resident #40 had likely cavity or broken teeth. Additionally, the resident was documented as having pain. Review of the dental note dated 05/05/23 revealed Resident #40 had tooth decay and was referred to an orthodontist for removal. Review of Resident #40's most recent care plan revealed no goals or interventions in place for dental needs or pain. Interview on 07/24/23 at 3:19 P.M. with Resident #40 revealed she needed her teeth repaired and left wrist pain, in which she received pain medication as needed. Interview on 07/27/23 at 9:41 A.M. with MDS coordinator #239 verified dental needs and pain were documented areas of concern on Resident #40's MDS and were not included in the resident's care plan. 2. Review of the medical record revealed Resident #34 was admitted on [DATE]. Diagnoses included convulsions, cerebrovascular disease, myoneural disorder, muscle weakness, dementia, epilepsy, cognitive communication deficit, convulsions, anxiety, and depression. Review of Resident #34's Minimum Data Set (MDS) dated [DATE] revealed a BIMS score of nine, indicating cognitive impairment. Further review revealed the resident required extensive two-person assistance for bed mobility, dressing, personal hygiene, and toileting with incontinence of bowel and bladder. Review of Resident #34's care plan dated 05/21/22 revealed no goals or interventions in place for the use of physical restraints. Observation and interview on 7/24/23 at 11:32 A.M. revealed Resident #34 was observed in her room sitting in a Broda chair with a large plastic tray in front of the resident's lap covering both arm rests. The tray was connected to the Broda chair with a strap that wrapped around to the back of Resident 34's Broda chair and fastened using a plastic buckle clip. Resident #34 stated she was unable to remove the tray, grabbing the tray and shaking the tray with the attempt to move the tray and was unable to remove tray from her lap. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 4 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 07/24/23 at 11:43 A.M. with State Tested Nurse Aide (STNA) #236 revealed Resident #34 was not able to remove the tray attached to her Broda chair herself and proceeded to show the plastic buckle clipped in the back of the Broda chair, with Resident #34 was sitting in the chair. Interview on 07/26/23 at 11:27 A.M. with Licensed Practical Nurse (LPN) #229 revealed Resident #34 used the tray table all the time while up in the Broda chair and was unable to remove the tray herself. Observation on 07/26/23 at 5:00 P.M. revealed Resident #34 sitting in her Broda chair with the tray table across her lap and buckled behind the Broda chair while in her room. Interview on 7/27/23 at 2:16 P.M. with the Director of Nursing (DON) verified Resident #34's care plan did not include the use of physical restraints. Review of the facility's policy, Care Plans- Comprehensive, dated September 2010, revealed an individualized comprehensive care plan is developed for each resident and care plans are revised as information about the resident and the resident's condition change. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 5 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff interview, and review of facility policy, the facility failed to provide a dependent resident with grooming needs. This affected one (Resident #74) of four residents reviewed for activities of daily living. The facility census was 100. Residents Affected - Few Findings include: Review of the medical record revealed, Resident #74 was admitted on [DATE]. Diagnoses included Huntington's chorea, Alzheimer's dementia, Parkinson's disease, adult failure to thrive, aphasia, musculoskeletal impairment, gastrostomy tube, depression, and anxiety. Review of Resident #74's Minimum Data Set (MDS) assessment dated [DATE] revealed her cognitive skills for daily decision making was severely impaired with a Brief Interview for Mental Status (BIMS) score unable to be obtained. Resident #74 required total dependence of two staff for activities of daily living, dressing, toileting, personal hygiene, and bathing. Review of Resident #74's plan of care dated 02/18/23 revealed the resident had an Activities of Daily Living (ADL) self-care performance deficit requiring total dependence on staff for all care needs. Interventions included to check nail length and to trim and clean on bath day and as necessary. Further review of Resident #74's medical record revealed no documentation showing the resident received nail care. Observation on 07/24/23 at 11:25 A.M. revealed Resident #74's fingernails on both hands were long, jagged, and dirty with dark discoloring underneath the nails. Observation on 07/25/23 at 3:57 P.M. revealed Resident #74's fingernails on both hands were long, jagged, and dirty with dark discoloring underneath the nails and red abraded like areas to thumb and first digit on the left hand. Interview 07/25/23 at 3:59 P.M. with State Tested Nurse Aide (STNA) #256 revealed hospice provided Resident #74 with baths. STNA #256 verified Resident #74's nails were long and stated it appeared the nail length caused scratches to Resident #74's thumb and finger. Interview on 07/25/23 at 4:42 P.M. with Licensed Practical Nurse (LPN) #229 at Resident #74's bedside, verified Resident #74's fingernails were long and needed trimmed. LPN #229 verified the abrasions on the resident's hand were caused by nail length. Observation on 07/27/23 at 9:25 A.M. revealed Resident #74's fingernails on both hands were long, jagged, and dirty with dark discoloring underneath the nails and red abraded like areas to thumb and first digit on left hand. Review of the facility policy, Quality of Life- Accommodation of Needs, dated 08/2009, revealed the resident's individual needs and preferences shall be accommodated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 6 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observation, and interview, the facility failed to implement fall interventions to potentially prevent falls. This affected one (Resident #90) of two residents reviewed for falls. The facility census was 100. Findings include: Review of the medical record for Resident #90 revealed an admission date 03/07/23. Diagnoses included traumatic subarachnoid hemorrhage, syncope and collapse, hearing loss bilateral, dementia, dysphagia, Alzheimer's Disease with late onset, and fall. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #90 had severely impaired cognition. The resident required extensive assistance of one person for bed mobility, walk in room, and dressing. The resident required extensive assistance of two persons for transfers. The resident had one fall with no injury since admission, reentry, or prior assessment. Review of the nursing note dated 07/03/23 at 1:30 P.M. revealed Resident #90 was wandering in front of the building in the main common area. The resident slid out of her wheelchair. Resident #90 was unable to describe what happened. Neurological checks were initiated and the resident was assisted into her wheelchair. Maintenance to put anti-roll back devices on the resident's wheelchair for safety. Review of the plan of care dated 07/24/23 revealed Resident #90 had an actual fall with injury related to poor balance and unsteady gait with a goal to resume usual activities without further incident through the review date. Interventions included, anti-roll backs to wheelchair (added 07/07/23), educate resident on proper sitting while in wheelchair, fall mat to side of bed, and wear proper footwear while out of bed. Observation on 07/26/23 at 4:07 P.M. of Resident #90 in the common area revealed the resident did not have an anti-roll back device on her wheelchair. This was verified by Maintenance Staff #218, present at the time. Maintenance Staff #90 stated the resident's wheelchair had an anti-tip device and explained the difference in the modification. Observation on 07/26/23 at 4:51 P.M. Regional Director of Clinical Operations #241 verified Resident #90 did not have an anti-roll back device, as the wheelchair freely rolled backward. Regional Director of Clinical Operations #241 asked the nurse present to monitor the resident one on one until they had the situation figured out. Interview on 07/26/23 at 5:10 P.M. the Director of Nursing (DON) and Regional Director of Clinical Operations #241 reported the resident had been placed in the correct wheelchair. The facility did not provide a policy related to safety devices for resident mobility devices. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 7 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, and facility policy review, the facility failed to properly administer medications via enteral gastrostomy tube. This affected one (Resident #74) of one resident reviewed for medication administration via gastrostomy tube. The facility census was 100. Findings include: Review of the medical record revealed Resident #74 was admitted on [DATE]. Diagnoses included Huntington's chorea, Alzheimer's dementia, Parkinson's disease, adult failure to thrive, aphasia, musculoskeletal impairment, gastrostomy tube, depression, and anxiety. Review of Resident #74's Minimum Data Set (MDS) assessment dated [DATE] revealed her cognitive skills for daily decision making were severely impaired with never or rarely making decisions. Further review revealed the resident required total dependence of two staff for activities of daily living including dressing, toileting, personal hygiene, bathing, with total dependence of one staff for intake of nourishment, and functional limitations of range of motion of upper and lower extremities. Observation on 07/26/23 at 11:27 A.M. revealed Licensed Practical Nurse (LPN) #229 preparing to administer medications to Resident #74's via gastrostomy tube. LPN #229 proceeded to push water mixed with crushed medication through the resident's gastrostomy tube with a syringe. Interview on 07/26/23 at approximately 11:35 A.M. LPN #229 verified during administration of medication to Resident #74, medications were pushed via syringe into the gastrostomy tube, rather than using the gravity method. Review of the facility's policy labeled, Administering Medications through an Enteral Tube, dated March 2015 revealed to attach the syringe without the plunger to the gastrostomy tube, administer medication by gravity flow and flush gastrostomy tubing after medication using gravity flow. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 8 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, and record review, the facility failed to follow fluid restrictions. This affected one (Resident #23) of one resident reviewed for fluid restrictions. The facility census was 100. Residents Affected - Few Findings include: Review of the medical record for Resident #23 revealed an admission date of 08/13/20. Medical diagnoses included End Stage Renal Disease (ESRD), dependence on renal dialysis, diabetes mellitus, and non-compliance with medical regimen or treatment. Review of the physician's orders revealed Resident #23 had an order for a renal diet, with double portions. Additionally, a fluid restriction was ordered for Resident #23 on 06/14/22. The order stated Resident #23 was to be restricted to 1200 milliliters (ml) fluid intake daily. 720 ml total is to be provided by dietary each day, and 480 ml to be provided by nursing daily. The amount provided by nursing was further divided with 360 ml to be provided by nursing staff on the 7:00 A.M. to 7:00 P.M. day shift, and 120 ml to be provided by nursing staff on the 7:00 P.M. to 7:00 A.M. night shift. Observation on 07/26/23 at 12:04 P.M. of Resident #23's lunch tray revealed one cup of coffee, one carton of milk, and one smaller glass of fruit punch. Resident #23 stated he always received the same drinks from the kitchen with meals. The tray slip on Resident #23's tray reflected 8 ounces (equivalent to 240 ml) of coffee, 8 ounces of whole milk, and 4 ounces (equivalent to 120 ml) of sugar free fruit punch. The items listed on the tray ticket matched what appeared on Resident #23's lunch meal tray. Review of Resident #23's dietary tray cards for breakfast, lunch, and dinner on 07/24/23, 07/25/23, and 07/26/23 revealed the resident received 8 oz of coffee, 8 oz of whole milk, and 4 oz of sugar free fruit punch at each meal. Fluid intake provided by dietary at mealtimes totaled 600 ml per meal, and 1800 ml daily. Interview on 07/26/23 at 12:11 P.M. with Dietary Manager (DM) #245 revealed the orders listed in the electronic health record for residents did not transfer over to the dietary department's system used for tray cards. DM #245 stated she had to manually enter all diet orders, supplements, and fluid restrictions manually. Items listed on tray cards are what residents received at mealtimes. DM #245 stated she had no knowledge Resident #23 was on a fluid restriction, and verified the dietary department had no listed fluid restriction for Resident #23, or it would have been listed on the tray card. DM #245 verified Resident #23 received a total of 600 ml of fluid with each meal, and a total of 1800 ml per day from dietary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 9 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 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 0732 Post nurse staffing information every day. Level of Harm - Minimal harm or potential for actual harm Based on review of the daily staffing posting, staff interview, and facility policy review, the facility failed to post current nurse staffing information. This had the potential to affect all residents who reside in the facility. The facility census was 100. Residents Affected - Many Findings include: Observation on 07/24/23 at 4:22 P.M. revealed four daily staff postings for 05/12/23, 05/13/23, 05/14/23, and 05/15/23 posted on the window next to the main entrance of the facility. Observation on 07/25/23 at 8:01 A.M. revealed the daily staff postings for 05/12/23, 05/13/23, 05/14/23, and 05/15/23 remained in place. Interview on 07/25/23 at 10:24 A.M. with the Director of Nursing (DON) verified the facility posted staffing information on the door to the main entrance. The DON verified the staff postings of 05/12/23, 05/13/23, 05/14/23, and 05/15/23 were outdated and needed to be updated. Review of the facility policy titled, Posting Direct Care Daily Staffing Numbers, revised August 2006, revealed the facility will post the number of nursing personnel responsible for providing direct care to residents on a daily basis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 10 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of facility policy, the facility failed to ensure residents were free from significant medication errors. This affected one (Resident #13) of one resident reviewed for significant medication errors. The facility census was 100. Residents Affected - Few Findings include: Review of Resident #13's medical record revealed an admission date of 12/18/20. Diagnoses included paranoid schizophrenia, major depressive disorder, chronic kidney disease stage 3, mild cognitive impairment, alcohol abuse and dysphagia. Review of Resident #13's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was severely cognitively impaired. Review of Resident #13's Plan of Care (POC) dated 06/24/22 revealed Resident #13 utilized psychotropic medications with interventions to administer psychotropic medications as ordered by physician, monitor for side effects and effectiveness every shift. Review of Resident #13's physician orders revealed an order dated 04/14/22 for Haldol Decanoate (psychotropic medication) 100 milligrams (mg)/milliliters (ml), inject 1 ml intramuscularly one time a day every 21 days related to paranoid schizophrenia Review of Resident #13's Medication Administration Record (MAR) for July 2023 revealed the Haldol Decanoate was not documented as administered for the whole month. Interview on 07/27/23 at approximately 2:16 P.M. with the Director of Nursing, (DON) verified Resident #13 did not receive his scheduled dose of Haldol Decanoate on 07/20/23 as scheduled and ordered by the physician. Review of policy titled, Administering Medications, dated December 2012 revealed medications must be administered in accordance with the orders including any required time frame. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 11 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, staff interview, review of manufacturer information for insulin, and review of facility policy, the facility failed to ensure insulin vials were labeled with resident names and staff could decipher opening dates vs expiration dates. This had the potential to affect three (Residents #30, #23, and #22) of three residents who received insulin from the 100 medication cart. The facility census was 100. Findings include: Observation on 07/27/23 at 8:01 A.M. of the 100 medication cart revealed five opened bottles of insulin in the top drawer: Humulin R dated 07/25/23, Novolog dated 07/11/23, Humalog dated 07/10/23 and Lispro dated 07/23/23 did not obtain the resident's name, open date, or expiration date. Lantus dated 07/21/23, expiration 08/21/23 did not obtain the resident's name. Interview on 07/27/23 at approximately 8:01 A.M. with Licensed Practical Nurse (LPN) #229 revealed the inability to determine which bottle of insulin belonged to which resident. LPN #229 further stated the inability to distinguish if the dates labeled on the bottles were opening dates or expirations dates. Review of a facility list provided by the Director of Nursing (DON) revealed three residents (#30, #23, and #22) received insulin from the 100 medication cart. Review of the manufacturers package insert recommendations of Lantus insulin revealed an opened vile of Lantus insulin will expire in 28 days. Review of facility policy titled, Administering Medications, dated December 2012, revealed the expiration/beyond use date on the medication label must be checked prior to administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 12 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 2. Observation on 07/26/23 at 7:56 A.M. of LPN #225 administering medications to Resident #346, revealed LPN #225 attempting to remove a methylprednisolone tablet out of the package. The medication dropped on top of the uncleaned medication cart. LPN #225 picked up the medication, with unwashed hands, and placed it in a medication cup with other pills, and proceeded to continue removal of pills from packages. LPN #225 removed potassium chloride, which dropped on top of the uncleaned medication cart, and with unwashed hands, LPN #225 picked up the medication and placed it in the medication cup containing all morning medications. LPN #225 proceeded to administer the entire cup of pills to Resident #346. Resident #346 swallowed all pills from the cup. Residents Affected - Few Interview on 07/26/23 at 8:04 A.M. with LPN #225 verified two of Resident #346's medications landed on top of the uncleaned cart and were picked up and placed into the container of pills administered to the resident. Review of facility policy titled, Administering Medications, dated December 2012, revealed staff shall follow established facility infection control procedures, handwashing, gloves, antiseptic technique for the administration of medications. Based on observation, staff interview, medical record review, and facility policy review, the facility failed to follow appropriate infection control procedures for a resident with Clostridium difficile (C-diff). This affected one (Resident #298) and had the potential to affect 26 residents who resided on the 100 hall. Additionally, the facility failed to ensure proper infection control procedures were followed during medication administration. This affected one (Resident #346) of five reviewed for medication administration. The facility census was 100. Findings include: 1. Review of the medical record for Resident #398 revealed an admission date of 07/22/23. Medical diagnoses included recurrent Enterocolitis (inflammation of the inner lining of the small and large intestines) due to Clostridium difficile (C-diff, a bacteria that causes diarrhea and inflammation of the colon), intestine transplant status, and arthritis. Resident #398 had a sign on their door to see nurse before entering, contact isolation precautions were in place. Resident #398 resided on the 100-hall. Interview on 07/24/23 at 9:19 A.M. with Licensed Practical Nurse (LPN) #229 revealed Resident #398 was in contact isolation for a C-diff infection. Observation on 07/24/23 at 12:46 P.M. of the lunch tray pass revealed State Tested Nurse Aide (STNA) #255 delivered Resident #398 his lunch tray. Resident #398 asked to be repositioned in the bed. STNA #255 verbally summoned assistance from STNA #254 who was in the hallway nearby. Both staff members retrieved gloves and provided privacy. Upon completion, STNA #254 and STNA #255 removed their gloves. STNA #255 proceeded into the bathroom and washed her hands with soap and water. STNA #254 proceeded to exit the room, without having washed her hands. STNA #254 returned to the area of the tray cart to resume passing trays to residents on the 100-hall. Observation and interview on 07/24/23 at 12:51 P.M. revealed STNA #254 reached for a new meal tray when surveyor intervened. STNA #254 verified she did not wash her hands after exiting Resident #398's room. STNA #254 stated she should have washed her hands with soap and water as Resident #398 has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 13 of 14 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 365843 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kenton Nursing and Rehabilitation Center 117 Jacob Parrott Boulevard Kenton, OH 43326 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 C-diff. STNA #254 proceeded into the utility room to wash hands before returning to tray pass. Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy titled, Infection Control Policy and Procedure, dated 2022, stated handwashing with soap and water should be performed after caring for a resident with known or suspected Clostridium difficile infection. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365843 If continuation sheet Page 14 of 14