Health inspection·March 4, 2024

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, review of facility policy and interviews, the facility did not ensure the Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property policy was implemented to ensure timely reporting of alleged resident mistreatment to the Administrator, timely reporting of the allegation to the Ohio Department of Health (ODH) and thorough investigation of the incident. This affected three residents (Resident #23, #32 and #41) of eleven residents reviewed for abuse. The facility census was 51. Residents Affected - Few Findings include: 1. Record review was conducted for Resident #41 who was admitted to the facility on [DATE] with diagnoses including muscle weakness, cognitive communication deficit, heart failure and diabetes mellitus type two. Review of the Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #41 had intact cognition, no behaviors, required extensive assistance by two staff for bed mobility and transfers, extensive assistance by one staff for toileting and set up help only for eating. Review of the plan of care, dated initiated 05/25/23, revealed no findings related to abuse. 2. Record review was conducted for Resident #23 who was admitted to the facility on [DATE] with diagnoses including need for assistance with personal care, major depressive disorder and generalized muscle weakness. Review of the MDS 3.0 assessment dated [DATE] revealed Resident #23 had impaired cognition, no behaviors, required extensive assistance of one staff for bed mobility and toileting, one person physical assist for eating and extensive assistance of two staff for transfers. Review of the plan of care, date initiated 07/18/19, revealed no findings related to abuse. 3. Record review was conducted for Resident #32 who was admitted to the facility on [DATE] with diagnosis including multiple sclerosis and quadriplegia. Review of the MDS 3.0 assessment dated [DATE] revealed intact cognition, no behaviors, and total dependence on staff for all activities of daily living. Review of the plan of care, date initiated 04/10/18, revealed no findings related to abuse. Review of an email communication sent to the Administrator, dated 11/09/23, timed 11:36 A.M. and authored by the Director of Nursing (DON) revealed on 11/03/23 in the evening, the DON (who at the time of the email was working in the position of Unit Manager and not yet the DON) was asked by STNA #159 to speak to Resident #41 and Resident #32 because Resident #41 and #32 needed to tell her something. Resident #41 told the DON State Tested Nursing Assistant (STNA) #208 was a bully, mean and would tell her things like you break my back and STNA #208 was rude and mean when she spoke to Resident #41. Resident #41 was hesitant to speak to the DON about this because she was afraid it would get back to the person that she told on, and it would get worse. The DON asked if STNA #208 physically harmed her, and Resident #41 stated no it's the way she talks to me, and I wish I didn't have to have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 2 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few any help when she is here. The DON then went to Resident #32's room and stated it was the same conversation regarding STNA #208 being rude and talking mean to her. The DON told Resident #32 she would be talking to someone about her concerns. Interview was conducted on 02/22/24 at 11:05 A.M. with the DON who verified on 11/03/23 she identified staff to resident treatment concerns involving care provided to Residents #41 and #32 from STNA #208 and thought she had sent the Administrator an email about it. The DON explained she was having problems with the email, so it did not actually get sent to the Administrator until 11/09/23 which she did not realize until questioned by the Administrator on 11/09/23. The DON was unable to recall if she notified Administratror by phone or what. Interview was conducted on 02/22/24 at 10:34 A.M. with the Administrator who revealed she did not recall getting a call from the DON regarding concerns of staff to resident mistreatment reported by Resident #41 and Resident #32 to the DON on 11/03/23. The Administrator verified she was not notified until 11/09/23. The Administrator indicated it was not until 11/16/23 that an allegation of abuse was made by the daughter of Resident #23 via email which involved STNA #208. The Administrator began an investigation into the allegation but did not report it as a self-reported incident to the Ohio Department of Health. The Administrator was unable to give a reason as to why no self-reported incident (SRI) was initiated. The Administrator stated after interviewing Resident #41 and #32 she terminated employment of STNA #208 on 11/16/24 via telephone due to numerous complaints of STNA #208 being rude, mean, cursing and yelling when residents ask for help. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, date revised 10/2022, stated facility staff should immediately report all such allegations of inappropriate treatment of a resident to the Administrator and to the Ohio Department of Health (ODH) in accordance with the procedures in the policy. The Administrator or designee shall notify ODH as soon as possible but no later than 24 hours from the time the incident/allegation was made known by the staff member. This deficiency represents non-compliance identified during the investigation of Complaint Number OH00151177. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 3 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of facility policy and interviews, the facility did not ensure an allegation of resident mistreatment was immediately reported to the Administrator and was timely reported to the Ohio Department of Health (ODH). This affected one resident (Resident #23) of eleven residents reviewed for abuse. The facility census was 51. Findings include: Record review was conducted for Resident #23 who was admitted to the facility on [DATE] with diagnoses including need for assistance with personal care, major depressive disorder and generalized muscle weakness. Review of the MDS 3.0 assessment dated [DATE] revealed Resident #23 had impaired cognition, no behaviors, required extensive assistance of one staff for bed mobility and toileting, one person physical assist for eating and extensive assistance of two staff for transfers. Review of the plan of care, date initiated 07/18/19, revealed no findings related to abuse. Review of a typed letter from the family member of Resident #23, dated 11/16/23, and addressed to the facility Administrator, the Director of Social Services, and the DON, revealed an allegation of staff to resident abuse involving State Tested Nursing Assistant (STNA) #208. The letter stated STNA #208 was neglectful and verbally and emotionally abusive to Resident #23. The letter stated STNA #208 would yell statements at the resident such as you're bothering me, what do you want and when Resident #23 requested help toileting, STNA #208 would say you don't need help, you can go by yourself. Review of the facility document titled Record of Warning or Disciplinary Action, dated 11/16/23, revealed STNA #208 was terminated from her employment at the facility on 11/16/23 via telephone for unsatisfactory job performance. The explanation was numerous complaints of STNA #208 being rude, mean, cursing, yelling at residents who ask for help. Interview was conducted on 02/22/24 at 2:32 P.M. with the family member of Resident #23 who indicated she did not want Resident #23 to know anything about the letter sent to the facility about STNA #208. The family member also did not want the surveyor to interview Resident #23 so no verification from the resident on whether she felt STNA #208 had been abusive to her was obtained. Interview was conducted on 02/22/24 at 10:34 A.M. with the Administrator who revealed it was not until 11/16/23 that an allegation of abuse was made by the daughter of Resident #23 via email which involved STNA #208. The Administrator began an investigation into the allegation, verified resident mistreatment occurred by STNA #208, but did not report it as a self-reported incident to the Ohio Department of Health. The Administrator was unable to give a reason as to why no self-reported incident (SRI) was initiated. The Administrator stated after obtaining resident interviews as part of her investigation, she decided to terminate employment of STNA #208 on 11/16/24 via telephone due to numerous complaints of STNA #208 being rude, mean, cursing and yelling when residents ask for help. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property, date revised 10/2022, stated facility staff should immediately report all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 4 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete such allegations of inappropriate treatment of a resident to the Administrator and to the Ohio Department of Health (ODH) in accordance with the procedures in the policy. The Administrator or designee shall notify ODH as soon as possible but no later than 24 hours from the time the incident/allegation was made known by the staff member. This deficiency represents non-compliance identified during the investigation of Complaint Number OH00151177. Event ID: Facility ID: 365904 If continuation sheet Page 5 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 record reviews and interviews, the facility failed to ensure timely initiation of wound treatment orders and thorough admission skin assessments for Resident #7, #8, #10, and #13 and failed to ensure a weekly wound assessment was completed for Resident #1 who had existing wounds. This affected five residents ( Resident #1, #7, #8, #10 and #13) of 15 residents reviewed for wounds. The facility census was 51. Residents Affected - Some Finding included: 1. Review of the medical record revealed Resident #7 was admitted to the facility on [DATE]. Diagnoses included bacterial pneumonia, acute respiratory failure, urinary tract infection, cognitive communication deficit, polyneuropathy, anxiety disorder, major depressive disorder, chronic obstructive pulmonary disease, atherosclerotic heart disease, chronic constructive pericarditis, hypertension, cervicalgia and dorsalgia. Resident #7 was sent out to the hospital on [DATE]. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #7 had intact cognition. Review of the admission Nursing Evaluation V2 document, dated 01/25/24, revealed Resident #7 was admitted to the facility with a Stage two pressure wound to the coccyx. There was no description of the wound or the surrounding tissue and no measurement was obtained of the Stage two wound. A right hip abrasion was also noted on this evaluation. Review of the Skin/Wound note dated 01/26/24 at 12:25 P.M. revealed the nurse attempted to perform a head-to-toe assessment. Resident #7 was eating and visiting with her family so she requested to defer at that time. It was noted follow up would be with the Wound Nurse Practitioner (NP) to assess the wounds for Resident #7. Review of the wound care evaluation by the wound physician, dated 01/29/24, revealed Resident #7 had an unstageable (full-thickness pressure injury with the base obscured by slough or eschar) pressure wound to her coccyx from admission measuring 1.8 centimeters (cm) by 1.4 cm by undetermined (UTD) depth. The wound had 10 percent slough covering the wound base. She had a Stage two pressure wound to the right lateral ankle which was present on admission. It was a shallow open area which measured 0.5 cm by 1.1 cm by 0.1 cm depth. The wound bed was composed of pink moist tissue. She had a stage two pressure area to the left elbow. It was a shallow open area which measured 0.8 cm by 1.1 cm by 0.1 cm depth. The wound bed was composed of pink moist tissue. Subsequent evaluations were completed on 02/05/24, and on 02/12/24 the evaluation indicated the wounds were improving/healing. Review of the physician's orders revealed no wound treatment orders were obtained until 01/29/24 for the left elbow, right ankle, and coccyx wounds for Resident #7. Review of the January 2024 Treatment Administration Record (TARS) revealed there was no documentation of treatments being done to the coccyx until 01/31/24 or the left elbow and right ankle until 02/01/34. On 02/21/24 at 12:37 P.M. an interview with the Director of Nursing (DON) verified there was not a thorough skin assessment completed on admission and there were no treatment orders obtained until 01/29/24 for Resident #7. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 6 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 - Some 2. Review of the medical record revealed Resident #1 was admitted to the facility on [DATE]. Diagnoses included respiratory failure, non-Hodgkin's lymphoma, cognitive communication deficit, muscle weakness, moderate protein-calorie malnutrition, COVID-19, chronic kidney disease, aortic valve stenosis, and atrial fibrillation. Review of the Skin/Wound progress note dated 01/05/24 revealed Resident #1 had an unstageable pressure injury noted to the thoracic spine which measured 1.2 cm by 1.3 cm by UTD. The wound bed had a 40 percent adherent yellow slough canopy which obscured the wound bed. Review of wound nurse documentation dated 01/08/24 revealed she had assessed Resident #1 however she did not do an assessment of the thoracic spine pressure area at this visit. Further review of the medical record revealed there was no wound assessment documented for 10 days from 01/05/24 to 01/15/24 for the wound on the thoracic spine. Review of the wound nurse documentation dated 01/15/24 revealed Resident #1 had an unstageable pressure injury to the thoracic spine measuring 1.1 cm in length by 1.3 cm in width by UTD. The wound bed was covered in five percent slough. On 02/20/24 at 2:50 P.M. an interview with the DON verified there was no documentation of a wound assessment for 10 days from 01/05/24 to 01/15/24 for Resident #1. She stated the wound nurse NP had visited on 01/08/24 but had not documented on her thoracic spine wound. 3. Review of the medical record revealed Resident #8 was admitted to the facility on [DATE]. Diagnoses included sepsis, urinary tract infection, extended spectrum beta lactamase resistant, meningitis, atrial fibrillation, restless leg syndrome, hypertension, and pulmonary emboli. Review of the physician's orders revealed Resident #8 had treatment orders for skin preparation to the right buttock, cover with calcium alginate and cover with a foam dressing every day and apply zinc oxide to the left buttock every shift dated 01/19/24. Review of the physician's orders revealed Resident #8 had an order for zinc oxide to the left gluteal fold dated 01/20/24. Further review of the medical record revealed Resident#8 was sent out to the hospital on [DATE] and readmitted [DATE]. Review of the admission assessment dated [DATE] revealed Resident #8 had no skin issues. Review of the January 2024 MARS and Treatment Administration Records (TARS) revealed there was no documentation of a skin treatment for Resident #8. Review of the admission MDS 3.0 assessment dated [DATE] revealed Resident #8 had moderately impaired cognition. Review of the wound nurse documentation dated 02/05/24 revealed Resident #8 had an unstageable pressure area to the right buttock which was present on admission. The wound measured 2.0 cm by 2.9 cm by UTD with 15 percent slough. The left buttock area was healed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 7 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 On 02/20/24 at 11:50 A.M. an interview with Family Member #500 revealed Resident #8 has had a pressure ulcer to his bottom since he was in the hospital and was admitted to the facility with them. She stated she was not really sure when they started treatment to his bottom at the facility. An interview with Resident #8 at this time revealed he was admitted with the sore to his bottom but he does not remember if they were doing a treatment to his bottom or not but they were almost healed now. Residents Affected - Some On 02/22/24 at 11:05 A.M. an interview with the DON revealed she could not find any documentation of a pressure ulcer to the right or left buttocks of Resident #8 or a treatment in place until 01/29/24 if he did have them on admission. She verified there was not a thorough skin assessment completed on 01/26/24. 4. Review of the medical record revealed Resident #10 was admitted to the facility on [DATE]. Diagnoses of sepsis, urinary tract infection, influenza, acute respiratory failure, cerebral infarction, and multiple sclerosis. He was discharged to the hospital on [DATE] and readmitted on [DATE]. Review of the admission assessment dated [DATE] revealed Resident #10 was admitted to the facility with areas of skin impairment to the right buttock, left buttock, and right ankle with no measurements. Review of the February 2024 TARS revealed no treatments for Resident #10 until 02/06/24. Review of the wound notes dated 02/05/24 revealed Resident #10 had an unstageable wound to the left buttock which was present upon admission. The wound measured 11.6 cm by 8.4 cm by UTD and had 15 percent slough with a DTI noted at the wound base. It had moderate drainage. He had a DTI to the right buttock with no measurement and this wound was healed now. He had an unstageable wound to the left ischium which measured 1.4 cm by 1.9 cm by undetermined depth. It had moderate amount of drainage. He had a DTI to the right ankle which was present upon admission which measured 0.9 cm by 1.4 cm by UTD depth. Review of the physician's orders revealed no treatment to the right buttock, left buttock, and right ankle from admission on [DATE] to 02/06/24. On 02/06/24 he was ordered skin preparation to the peri-wound, apply medical grade honey pack loosely with calcium alginate and cover with a foam dressing to the left buttock and left ischium at bedtime, apply skin preparation to the peri-wound, paint eschar with betadine and leave open to air to the right ankle at bedtime, and apply zinc oxide to the right buttock at bedtime. Review of the admission MDS dated [DATE] revealed Resident#10 had intact cognition. On 02/20/24 at 1:00 P.M. an interview with Resident #10 revealed he had admitted with a sore bottom. He stated he knows it was a couple days before they started doing any treatments to it but he does not remember how many. He stated it was healing now. He stated he was not having any real pain. On 02/22/24 at 2:25 P.M. an interview with the DON verified Resident #10 was admitted with pressure areas on 02/02/24 however no treatment orders were obtained until 02/05/24 when the Wound NP visited. She also verified there was not a thorough assessment completed on admission to reflect wound measurements. She stated the charge nurse could call the physician and receive orders for wound treatments so they did not have to wait for the Wound NP to visit. 5. Review of the medial record revealed Resident #13 was admitted to the facility on [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 8 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 Diagnoses included diabetes, cardiac defibrillator, cardiomyopathy, history of falling, atrial fibrillation, moderate protein-calorie malnutrition, chronic kidney disease, hypertension, anemia, and melanoma of the skin. There was no MDS information submitted at this time to review. Residents Affected - Some Review of the admission assessment dated [DATE] revealed Resident #13 had a partial thickness loss of dermis presenting as a shallow open ulcer with a red, pink center wound bed on the coccyx. The wound nurse was aware of his skin issues. There were no measurements. Review of the physician's orders revealed no treatment orders were obtained until 02/14/24 for application of Silva gel and cover with bordered gauze daily to the left lateral ankle, apply skin prep and offload heel when in bed daily to the right heel deep tissue injury. Review of the February TARS revealed no documentation of treatments being done for Resident#13 until 02//14/24. On 02/22/24 at 3:24 P.M. an interview with the DON verified there was not a thorough admission skin assessment completed on Resident#13 and there were not orders for wound treatments until 02/14/24. Review of the facility policy Prevention of Pressure Injuries, dated April 2020, indicated residents should be assessed on admission (within eight hours) for any exisiting risk for pressure injury. Repeat the risk assessment weekly and with any change of condition. Conduct a comprehensive skin assessment upon (or soon after) admission, and skin should be inspected daily with personal care and when performing activities of daily living. Evaluate, report and document changes in skin. This deficiency represents non-compliance identified during the investigation of Complaint Number OH00151177. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 9 of 10 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 365904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Saint Joseph Care Center 2308 Reno Drive NE Louisville, OH 44641 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 Based on review of the infection control logs, review of facility policy and interviews with staff, the facility failed to maintain proper surveillance of all infections in the facility. This had the potential to affect all 51 residents in the facility. Residents Affected - Many Findings include: Review of the infection control log from 11/20/23 to 02/20/24 revealed no documentation of infections from 01/01/24 to 02/20/24. On 02/20/24 at 11:51 A.M. an interview with the Administrator revealed they facility did not have any surveillance of infections documented for January and February 2024 due to the infection control nurse, who just quit her job at the facility the prior week, had not been doing them. On 02/26/24 at 12:27 P.M. an interview with Registered Nurse # 210 revealed she had been the facility's infection control nurse, however, she was never trained to do the infection control log so she never created them for January and February 2024. She stated she had asked several times to be shown how to do the logs but was never shown how to do them. Review of the facility policy titled, Surveillance for Infection, dated 09/17, revealed the infection preventionist would conduct ongoing surveillance for healthcare-associated infections and other epidemiologically significant infections that have substantial impact on potential resident outcome and that may require transmission-based precautions and other preventative interventions. This deficiency represents non-compliance identified during the investigation of Complaint Number OH00151177. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 10 of 10