Health inspection·March 13, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #39's admission/5-day MDS assessment dated [DATE] revealed Resident #39 was cognitively impaired and received antipsychotic, antianxiety, and antidepressant medications. Review of Resident #39's current physician's orders revealed an order dated 02/05/24 for citalopram hydrobromide oral tablet 10 mg give two tablet by mouth one time a day for depression; an order dated 02/05/24 for lorazepam oral tablet 0.5 mg give one tablet every four hours as needed for anxiety; an order dated 02/05/24 for Risperdal oral tablet 0.5 mg give one tablet by mouth at bedtime due to psychosis; and an order dated 02/18/24 for Ativan oral tablet 0.5 mg by mouth at bedtime for anxiety/agitation. Continued review of Resident #39's plan of care revealed no evidence Resident #39 received antianxiety, antipsychotic, and antidepressant medications. Interview on 03/12/24 at 4:30 P.M. with the DON verified there was no care plan in place for Resident #39's antianxiety, antipsychotic, and antidepressant medications. Based on interview and record review the facility failed to initiate care plans for hospice care and medication monitoring. This affected six residents (#7, #14, #17, #23, #37 and #39) out of 18 residents reviewed for care planning. The facility census was 51. Findings Include: 1. Review of the medical record for Resident #17 revealed an admission date of 05/30/2023. Diagnoses included respiratory failure, chronic kidney disease, Multiple Sclerosis, and localized swelling. Review of Resident #17's admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 was cognitively intact, was dependent for mobility, and received anticoagulant medication. Review of Resident #17's March 2024 physician orders revealed an order dated 06/23/23 for Eliquis (anticoagulant or blood thinning medication) with directions to give 2.5 milligrams (mg) by mouth two times a day for blood clots. Review of Resident #17's care plan dated 12/27/23 revealed no evidence that the resident was receiving anticoagulant medication. Interview on 03/11/24 at 4:34 P.M. the facility's Director of Nursing (DON) confirmed the facility had not developed a care plan for the use of Resident #17's anticoagulant medication. 2. Review of the medical record for Resident #23 revealed an admission date of 09/18/20. Diagnoses included Parkinson's disease, fibromyalgia, atrial fibrillation, and hypertension. Review of Resident #23's quarterly MDS assessment dated [DATE] revealed the resident was moderately impaired, had heart failure, and received anticoagulant medication. Review of Resident #23's March 2024 physician orders revealed an order Eliquis Tablet 2.5 MG with directions to give 0.5 tablet by mouth two times a day for atrial fibrillation. Review of Resident #23's Care Plan dated 01/24/24 revealed no evidence that the resident was receiving anticoagulant medication. Interview on 03/11/24 at 4:34 P.M. the facility's DON confirmed the facility was not monitoring for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 2 of 11 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 03/13/2024 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 0656 side effects related to Resident #23's anticoagulant medication. Level of Harm - Minimal harm or potential for actual harm 3. Review of Resident #14's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including acute chronic respiratory failure, upper respiratory failure, emphysema, chronic obstructive pulmonary disease, anxiety, vertebra fracture, and dysphagia. Residents Affected - Some Review of Resident #14's physician orders dated 01/24/24 revealed admission to hospice services for emphysema. Review of Resident #14's care plan revealed no focus areas, goals, or interventions for the hospice care and services. On 03/12/24 at 12:44 P.M. an interview with MDS Licensed Practical Nurse #265 confirmed Resident #14's care plan did not reflect the new hospice order. No goals or interventions were documented in the plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 3 of 11 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 03/13/2024 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of Resident #7's medical record revealed an admission date of 02/26/22 with diagnoses including Crohn's disease, mild cognitive impairment, venous insufficiency, hypertension, hyperlipidemia, and personal history of other venous thrombosis and embolism. Residents Affected - Some Review of a quarterly MDS assessment dated [DATE] revealed Resident #7 had mild cognitive impairment and received an anticoagulant. Review of Resident #7's March 2024 physician's orders revealed an order dated 02/15/23 for Xarelto oral tablet 20 mg daily for deep vein thrombosis (DVT). There was no order for staff to monitor for side effects of this anticoagulant medication. Continued review of Resident #7s medical record including Medication Administration Records (MARs), Treatment Administration Records (TARs) and the plan of care revealed no evidence of monitoring for side effects related to Resident #7s anticoagulant. Interview on 03/12/24 at 7:55 A.M with Licensed Practical Nurse (LPN) #263 revealed for anticoagulants she would monitor for bruising or bleeding. When asked where documentation was to be done for this monitoring, LPN #263 acknowledged there was not an order on the TAR for staff to document this and was unaware of any other location where this information could be documented. Interview on 03/12/24 at 10:35 A.M. with LPN #266 revealed she would look for cuts and bruises and if a resident was bleeding to get the bleeding under control for a resident receiving an anticoagulant. When asked where monitoring documentation was placed, LPN #266 stated a progress note could be made but there was not a routine location for the monitoring to be signed off, such as on the TAR. Interview on 03/12/24 at 10:44 A.M. with State Tested Nursing Assistant (STNA) #270 revealed they had some skin documentation in the point of care system and but nothing routine to prompt checking for bruising and bleeding. STNA #270 showed the surveyor during the interview the point of care interface which was the same for all residents for skin observation and staff could select scratch, discoloration, red area, skin tear, open area, resident not available, and resident refuse. STNA #270 indicated if there was a bruise they had to report this information to the nurse. Interview on 03/12/24 at 11:00 A.M. with the DON verified there was no monitoring in place for Resident #7's anticoagulant. Review of the facility policy, Anticoagulation-Clinical Protocol, dated November 2018, revealed the staff and physician will monitor for possible complications in individuals who are being anticoagulated and will manage related problems. If an individual on anticoagulation therapy shows signs of excessive bruising, hematuria, hemoptysis, or other evidence of bleeding the nurse will discuss the situation with the physician before giving the next scheduled dose of anticoagulant. Based on interview, record review, and policy review the facility failed to monitor residents using anticoagulant medications. This affected three residents (#7, #17 and #23) out of seven residents reviewed for medications. The facility census was 51. Findings Include: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 4 of 11 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 03/13/2024 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 0757 Level of Harm - Minimal harm or potential for actual harm 1. Review of the medical record for Resident #17 revealed an admission date of 05/30/2023. Diagnoses included respiratory failure, chronic kidney disease, Multiple Sclerosis, and localized swelling. Review of Resident #17's admission Minimum Data Set assessment dated [DATE] revealed the resident was cognitively intact, was dependent for mobility, and received anticoagulant medication. Residents Affected - Some Review of the Resident #17's March 2023 physician orders revealed an order dated 06/23/23 for Eliquis (anticoagulant or blood thinning medication) with directions to give 2.5 milligrams (mg) by mouth two times a day for blood clots. Continued review revealed the facility had no orders in place to monitor the resident for side effects related to her high-risk medication. Continued review of the resident medical record including Point of Care system for state tested nursing aides and the residents care plan revealed the facility did not have any evidence of monitoring for the resident's anticoagulant medication. Interview on 03/11/24 at 4:34 P.M. the facility's Director of Nursing (DON) confirmed the facility was not monitoring for side effects related to Resident #17's anticoagulant medication. 2. Review of the medical record for Resident #23 revealed an admission date of 09/18/20. Diagnoses included Parkinson's disease, fibromyalgia, atrial fibrillation, and hypertension. Review of Resident #23's quarterly MDS assessment dated [DATE] revealed the resident was moderately impaired, had heart failure, and received anticoagulant medication. Review of Resident #23's March 2024 physician orders revealed an order Eliquis Tablet (anticoagulant) 2.5 mg with directions to give 0.5 tablet by mouth two times a day for atrial fibrillation. Continued review revealed the facility had no orders in place to monitor the resident for side effects related to her high-risk medication. Continued review of the resident medical record including Point of Care system for state tested nursing aides and the residents care plan revealed the facility did not have any evidence of monitoring for the resident's anticoagulant medication. Interview on 03/11/24 at 4:34 P.M. the facility's DON confirmed the facility was not monitoring for side effects related to Resident #23's anticoagulant medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 5 of 11 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 03/13/2024 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 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 record review, interview, and facility policy review the facility failed to ensure monitoring for medication effects and potential adverse consequences was completed for residents who were receiving psychotropic medications. This affected two residents (#37 and #39) out of five residents reviewed for unnecessary medications. The facility census was 51 residents. Findings Include: 1. Review of Resident #37's medical record revealed an admission date of 11/20/22 and diagnoses including hyperkalemia, obesity, moderate protein-calorie malnutrition, and cognitive communication deficit. Review of Resident #37's annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #37 had moderate cognitive impairment and received antianxiety and antidepressant medications. Review of Resident #37's current physician's orders revealed an order dated 03/27/23 for mirtazapine tablet 15 milligrams (mg) give one tablet by mouth at bedtime for increase appetite and an order dated 07/19/23 for Vistaril oral capsule 25 mg give one capsule by mouth every dayshift for anxiousness, give one dose 30 minutes before dressing change. There were no orders for staff to monitor for side effects for these medications. Continued review of Resident #37's medical record including Medication Administration Records (MARs), Treatment Administration Records (TARs), and the plan of care revealed no evidence of monitoring for side effects related to her antianxiety and antidepressant medications. Interview on 03/13/24 at 10:12 A.M. with the Director of Nursing (DON) confirmed the lack of medication monitoring relative to Resident #37's antianxiety and antidepressant medications. 2. Review of Resident #39's medical record revealed an admission date of 02/05/24 and diagnoses including Alzheimer's disease, depression, cognitive communication deficit, chronic kidney disease, and hypertension. Review of Resident #39's admission/5-day MDS 3.0 assessment dated [DATE] revealed Resident #39 was cognitively impaired and received antipsychotic, antianxiety, and antidepressant medications. Review of Resident #39's current physician's orders revealed an order dated 02/05/24 for citalopram hydrobromide oral tablet 10 mg give two tablet by mouth one time a day for depression; an order dated 02/05/24 for lorazepam oral tablet 0.5 mg give one tablet every four hours as needed for anxiety; an order dated 02/05/24 for Risperdal oral tablet 0.5 mg give one tablet by mouth at bedtime due to psychosis; and an order dated 02/18/24 for Ativan oral tablet 0.5 mg by mouth at bedtime for anxiety/agitation. There were no orders for staff to monitor for side effects for these medications. Continued review of Resident #39's medical record including MARs, TARs and the plan of care revealed no evidence of monitoring for side effects related to her antianxiety, antipsychotic, and antidepressant medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 6 of 11 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 03/13/2024 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview on 03/12/24 at 4:30 P.M. with the DON confirmed the lack of medication monitoring relative to Resident #39's antianxiety, antipsychotic, and antidepressant medications. Review of the facility policy, Psychotropic Medication Use, dated July 2022, revealed residents receiving psychotropic medications are monitored for adverse consequences including anticholinergics effects, cardiovascular effects, metabolic effects, neurologic effects, and psychosocial effects. Event ID: Facility ID: 365904 If continuation sheet Page 7 of 11 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 03/13/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and policy review the facility failed to ensure foods were labeled, dated, and discarded when expired. This had the potential to affect all 51 residents in the facility. Residents Affected - Many Findings Include: Observation of the main kitchen and resident refrigerators on 03/10/24 starting at 8:59 A.M. with Dietary Manager (DM) #235 revealed the following areas of concern: • In the dry storage area in the main kitchen, there was an expired case of tortillas dated December 2023. • In the juice and supplement cooler in the main kitchen, there were multiple containers of yogurt and juice that were out of date. • On the Division One unit, there were two containers of takeout food without a date or name. • On the Rehab unit, there was takeout with Resident #26's name and a date of 02/22/24. There was also an undated container of takeout with a resident name that was no longer in the facility as of 03/10/24. Interviews with DM #235 verified the out-of-date foods at the time of observation. DM #235 stated resident food was to have a date and resident name and was to be discarded three days after the date listed on the item. DM #235 stated dietary staff would go through the refrigerators once a week to discard out-of-date food but indicated this process was not documented anywhere. Review of an undated policy and procedure manual revealed leftover food should be stored in covered containers or wrapped carefully and securely and clearly labeled and dated before being refrigerated. Leftover food must be used within seven days or discarded as per the 2022 Federal Food Code. All foods should be covered, labeled, and dated. All foods will be checked to assure that foods will be consumed by their use by dates or discarded. Review of the policy, Food Brought in By Family/Visitors, revised March 2022, revealed food brought by family/visitors that is left with the resident to consume later is labeled and stored in a manner that is clearly distinguishable from facility-prepared food. Containers are labeled with the resident's name, the item, and the use by date. Nursing staff will discard perishable foods on or before the use by date. The nursing or food service staff will discard any foods prepared for the resident that show obvious signs of potential foodborne danger (for example past due package dates). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 8 of 11 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 03/13/2024 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and policy reviewed the facility failed to ensure staff wore appropriate Personal Protective Equipment (PPE) into Resident #36's Enhanced Barrier Precautions (EBP) room and completed appropriate hand washing during incontinence care for Resident #36. This affected one resident (#36) out of three residents reviewed for transmission-based precautions. This had the potential to affect all ten residents (#5, #20, #36, #7, #37, #4, #9, #1, #103, and #29) on the 500-hall where Resident #36 resided. The facility census was 51. Residents Affected - Some Findings Include: Review of the medical record for Resident #36 revealed an admission date of 02/05/24. Diagnoses included hydronephrosis with renal and ureteral calculous obstruction, urinary tract infection, and Multiple Sclerosis. Review of Resident #36's admission Minimum Data Set assessment dated [DATE] revealed the resident was cognitively intact, required substantial maximum assistance for toileting. Review of Resident #36 physician order dated 03/10/24 revealed an order for the resident to be on EBP every shift for extended-spectrum beta-lactamases (ESBL) for urinary tract infection (UTI). Observation on 03/12/24 at 1:32 P.M. revealed a sign on Resident #36's door indicating the resident was on EBP with instructions that everyone must clean hands including before entering and when leaving the room. Providers and staff must also wear gloves and a gown for the following high contact resident care activities which include dressing, bathing, transferring, changing linens, providing hygiene, and changing briefs, or assisting with toileting. At this time State Tested Nursing Aide (STNA) #283 and STNA # 271 walked into Resident #36's room without applying a gown. The staff members washed their hands, gathered supplies, and applied gloves. STNA #283 transferred Resident #36 from her recliner chair to her bed using a Hoyer (mechanical) lift. She then repositioned her on the bed. STNA #283 removed the resident's pants and brief, she used a washcloth with water and soap to clean the resident's perineal area, clean water, and a washcloth to rinse the area, and another clean washcloth to dry the area. STNA #283 and STNA #271 positioned the resident on her right side and cleansed her buttocks with soap and water, rinsed with clean water, and then dried her buttocks with a clean washcloth. STNA #283 grabbed a bottle of incontinence cream, squeezed it into her gloved hand and used her hand to apply the cream on the resident's buttocks. She then moved the resident to her back and applied the remaining cream on the resident's perineal area with the same gloved hand. She attached the brief, pulled up the resident's pants and used the remote to transfer the resident back to her recliner before removing her gloves and washing her hands. STNA #283 and STNA #271 completed the incontinence care without donning gowns as indicated on the signage outside of the residents' rooms. Interview on 03/12/24 at 1:45 P.M. STNA #283 revealed she did not complete any hand washing or change her gloves from the start of Resident 36's incontinence care until the resident was seated back in her recliner. She also stated she did not know that she was required to follow the sign on the outside of Resident #36's door because she knew the resident did not have a clotridiodes difficile (C. Diff) infection. Interview on 03/12/24 at 2:15 P.M. the Director of Nursing confirmed Resident #36 is on EBP and all staff who were providing direct care were required to wear a gown and gloves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 9 of 11 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 03/13/2024 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the undated facility policy Hand Washing/Hand hygiene revealed indications for hand hygiene included after contact with blood, body fluids, or contaminated surfaces, before moving from work on a soiled body site to a clean body site on the same resident. Review of the undated Enhanced Barrier Precautions policy revealed EBP is used as an infection prevention and control intervention to reduce the spread of multi-drug residence organism's tor residents. EBP employs targeted gown and glove use during high contact resident care activities when contact precautions do not otherwise apply. Gloves and gowns are applied prior to performing the high contact resident care activities. Examples of high contact resident care activities requiring the use of gown and gloves for EBP include dressing, bathing, transferring, providing hygiene, changing briefs, or assisting with toileting. EBP are indicated for resident infected or colonized with ESBL producing enterobacterales. This deficiency is an example of continued noncompliance from the survey completed on 03/04/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 10 of 11 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 03/13/2024 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on interview, record review, and policy review the facility failed to obtain an ordered culture and sensitivity prior to starting antibiotic therapy for Resident #23. This affected one resident (#23) out of five residents reviewed for antibiotic stewardship. The facility census was 51. Residents Affected - Few Findings Include: Review of the medical record for Resident #23 revealed an admission date of 09/18/20. Diagnoses include Parkinson's disease, fibromyalgia, and hypertension. Review of Resident #23's nursing note dated 12/12/23 at 9:46 A.M. revealed the physician saw the resident on rounds. The resident complained of constipation and abdominal discomfort due to constipation. The physician examined the resident's abdomen and bowel sounds. The resident complained of burning with urination. A urinalysis, lab, and antibiotic were ordered. Review of Resident #23's physician orders revealed an order dated 12/13/23 to straight catheter for urinalysis and culture and sensitive for dysuria and abdominal discomfort. Also noted was an order on 12/13/23 for the resident to start Cefdinir 300 milligrams (mg) (an antibiotic) with directions to take the medication two times a day for infection/dysuria until 12/29/23. Review of Resident #23 Medication Administration Record revealed she received Cefdinir 300 mg from 12/13/23 through 12/29/23. Review of Resident #23 December 2023 lab work revealed the facility did not obtain Resident #23's ordered urinalysis with a culture and sensitivity. Review of the facility Infection Screening Evaluation, dated 12/12/23, revealed the resident did not meet McGeer's criteria for Urinary Tract Infection. Interview on 03/12/24 at 9:40 A.M. the Director of Nursing confirmed the facility missed the order to complete Resident #23's urinalysis with a culture and sensitivity. She stated the facility did not follow correct antibiotic stewardship practices by administering Resident #23 Cefdinir 300 mg twice daily and she did not meet McGeers criteria for a urinary tract infection. Review of the facility policy, Surveillance for infections, revised 09/2017, revealed nursing staff will monitor residents for signs and symptoms that may suggest infection. When an infection or colonization with epidemiologically important organisms is suspected cultures may be sent, if appropriate, to contracted laboratory for identification or confirmation. Cultures will be further screened for sensitive to antimicrobial medications to help determine treatment options. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365904 If continuation sheet Page 11 of 11