Health inspection·October 7, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not receive isosorbide due to medication no being available. d) From 08/09/25 through 08/11/25, the MAR was blank for oxycodone five mg, which indicated no medications were administered. Review of a progress note for Resident #75 dated 08/12/25 at 9:59 A.M., revealed the resident presented with an altered mental status (AMS) along with abnormal vital signs. The resident's pulse fluctuated between 29 and 40 beats per minute (normal 60-80), blood pressure was 130 over 97 milliliters of mercury (mmHg), oxygen saturation was 95 percent (%), and her body temperature was 97.9 Fahrenheit (F). Resident #75 was diaphoretic, complained of numbness in her right arm and hand along with three episodes of emesis. The resident was transferred to the hospital via squad. Review of the Prescription Order Status (a printed form by the facility showing the medications ordered and delivered) for Resident #75 on 10/07/25 at 2:00 P.M., revealed the resident had the following medications delivered to the facility: On 07/08/25, a quantity of 14 diltiazem 180 ER, a quantity of 14 sotalol 80 mg and a quantity of nine oxycodone five mg were delivered to the facility. On 07/14/25, a quantity of 28 oxycodone five mg were delivered. On 07/29/25, a quantity of 14 isosorbide 30 mg ER were delivered. On 08/04/25 a quantity of 14 sotalol were delivered. On 08/06/25, a quantity of 14 Diltiazem 180 mg ER were delivered and on 08/12/25, a quantity of 14 isosorbide tablets were delivered on 08/12/25. Review of a Controlled Drug Receipt/Record (Narcotic sheet) for Resident #75 75 on 10/07/25 at 2:10 P.M., revealed the facility received 28 oxycodone five mg tablets on 07/14/25. The resident was administered oxycodone on a regular basis from 07/16/25 through 08/08/25 when the card was empty. There were no additional oxycodone five mg received for Resident #75 after 08/08/25. Interview on 10/07/25 at 3:44 P.M. with the Director of Nursing (DON) confirmed the facility received 14 Diltiazem 180 mg for Resident #75 on 07/08/25, and 14 more 08/06/25. The DON verified Resident #75 was ordered to receive diltiazem 180 mg daily from 07/08/25 through 08/12/25. The DON verified the resident's MAR indicated the resident received diltiazem 180 mg from 07/22/25 through 08/06/25, despite the facility not having the medications in the facility and stated she could not explain the discrepancy. The DON also verified Resident #75 did not receive diltiazem 180 mg on 08/07/25, 08/10/25, and 08/11/25 due to the MAR indicating the medication was not available. The DON also verified the facility received 14 sotalol 80 mg for Resident #75 on 07/08/25 and 14 more on 08/04/25. The DON verified Resident #75 was ordered to receive sotalol 80 mg one half tablet twice daily from 07/08/25 through 08/12/25. The DON stated the 14 sotalol 80 mg received on 07/08/25 would have finished on 07/23/25. The DON verified the resident's MAR indicated the resident received sotalol 80 one half tablet twice daily from 07/24/25 through 08/04/25, despite the facility not having the sotalol in the facility and stated she could not explain the discrepancy. The DON also verified the facility received 14 isosorbide 30mg for Resident #75 on 07/29/25 and 14 more on 08/12/25. The DON verified Resident #75 was ordered to receive isosorbide ER 30 mg daily from 07/19/25 through 08/12/25. The DON verified the resident's MAR indicated the resident received isosorbide 30 mg from 07/19/25 through 07/29/25, despite the facility not having the medications in the facility and stated she could not explain the discrepancy. The DON also verified the facility received eight oxycodone five mg for Resident #75 on 07/08/25 and 28 more on 07/14/25. The DON verified Resident #75 received oxycodone regularly from 07/09/25 through 08/08/25 The DON verified the oxycodone five mg was not available for resident from 08/09/25 through 08/12/25. The DON stated a nurse requested a refill on 08/11/25 at 12:26 P.M. and the order was never filled. The DON stated she checked the facility's emergency supply box (e-box) list, and it did not reveal any indications of the nursing staff removing diltiazem, isosorbide mononitrate, sotalol, or oxycodone for Resident #75. The DON verified there was no documented evidence that the physician was notified of Resident #75 medication discrepancies. The DON stated it was the expectation for the nursing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365974 If continuation sheet Page 2 of 7 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 365974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete staff to contact the physician for any missed medications.Interview on 10/07/25 at 10:49 A.M. with PCP #500 stated he was never notified of the medication discrepancies for Resident #75. PCP #500 stated he was concerned about the medication discrepancies because Resident #75 was discharged to the hospital on [DATE] for heart related issues. Interview on 10/07/25 at 11:31 A.M. with Licensed Practical Nurse (LPN) #181 who stated she does not notify the physician if a resident missed medications. LPN #181 stated she would only notify the physician if the medication was an important medication but could not give an example of what an important medication was.Review of a text message exchange between Primary Care Physician (PCP) #500 and 100-200 hall nurse on 10/07/25 at 10:40 A.M. revealed the 100-200 hall nurse sent a text message to PCP #500 on 08/11/25 at 12:26 P.M. and reported Resident #75 needed a new script for PRN Oxycodone. At 4:09 P.M. the 100-200 hall nurse sent a text message to PCP #500 and noted Resident #75 had several episodes of diarrhea and wanted to give the resident Imodium. PCP #500 responded with an order for Imodium four mg three times a day prn. The message did not include anything about the oxycodone refill. Review of the facility policy titled Notification of Change dated 09/14/23 confirmed notifications of changes will be completed and documented. An immediate notification of the resident's physician will be completed for a need to alter treatments. Event ID: Facility ID: 365974 If continuation sheet Page 3 of 7 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 365974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068 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 medical record review, the facility staff interview, and facility policy review the facility failed to provide resident with showers. This affected one (#75) out of the three residents reviewed for showers. The facility census was 61.Findings include:Review of the medical record for Resident #75 revealed she was admitted to the facility on [DATE]. Resident #75 was discharged to the hospital on [DATE] and never returned. Diagnoses included anxiety disorder, hypo-osmolality and hyponatremia, major depressive disorder, diabetes mellitus (DM), atrial fibrillation, hypercholesterolemia, peripheral vascular disease, gastro-esophageal reflux disease, and hypothyroidism. Review of the July 2025 shower/bathing sheets for Resident #75, revealed the resident was documented as only receiving a shower on 07/14/25 and 07/24/25. Resident #75 had no documented showers for August 2025. Review of the Minimum Data Set (MDS) assessment for Resident #75, dated 08/12/25, revealed her cognitive status was not assessed and the resident was dependent on staff for personal hygiene and bathing/showers. Interview with the Director of Nursing (DON) on 10/07/25 at 3:44 P.M. who stated the residents were assigned two shower/bathing days a week and more if needed or requested. The DON verified Resident #75 only received a shower on 07/14/25 and 07/24/25, and there was no documented evidence Resident #75 received any showers/bathing in August 2025. Review of the facility policy titled Bathing dated 02/04/24 revealed the purpose of the bathing policy was to ensure residents receive bathing and given choices if desired. Further review of the policy revealed the residents were scheduled for bathing two times per week.This deficiency represents non-compliance investigated under Complaint Number 2625070. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365974 If continuation sheet Page 4 of 7 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 365974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068 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 medical record review, observation, staff interview, physician interview, review of pharmacy delivery sheets, review of Controlled Drug Receipt/Records, and review of the facility policy, the facility failed to ensure residents were free of significant medication errors. This affected one (#75) of the three residents reviewed for medications. The census was 57. Findings include: Review of the medical record for Resident #75 revealed the resident was admitted to the facility on [DATE], discharged on 08/12/25 and never returned. Diagnoses included dementia, anxiety disorder, hypo-osmolality and hyponatremia, major depressive disorder, diabetes mellitus (DM), atrial fibrillation, hypercholesterolemia, peripheral vascular disease, gastro-esophageal reflux disease, and hypothyroidism. Review of the Minimum Data Set (MDS) assessment for Resident #75, dated 08/12/25, revealed the resident was cognitively impaired and was dependent on staff for medication administration.Review of physician orders for Resident #75 dated 07/08/25 and discontinued on 08/12/25, revealed the resident was ordered Diltiazem (used to treat high blood pressure and heart rhythm disorders) extended release (ER) 180 milligrams (mg) daily in the morning, Sotalol (used to treat abnormal heart rhythms) 80 mg one half tablet (40 mg) twice daily and oxycodone (narcotic pain reliever) five mg every six hours as needed (PRN) for pain. Physician orders dated 07/19/25 and discontinued on 08/12/25, revealed the resident was ordered to receive isosorbide mononitrate (vasodilator used to treat heart conditions) ER 30 mg every morning. Physician orders dated 07/26/25 and discontinued on 08/02/25, revealed the resident was ordered metformin 500 mg daily. Review of the progress notes for Resident #75 from 07/22/25 through 08/11/25, revealed no documentation of the physician being notified of the medication discrepancies. Review of the July 2025 medication administration record (MAR) for Resident #75 revealed the following: a) From 07/22/25 through 07/31/25, it was documented that the resident received diltiazem 180 mg daily, except for 07/28/25 (blank entry). b) From 07/24/25 through 07/31/25, it was documented that the resident received sotalol 80 mg twice daily, except for the morning dose of 07/28/25 (blank entry). c) From 07/19/25 through 07/29/25, it was documented the resident received isosorbide 30 mg daily, except for 07/28/25 (blank entry). d) On 07/26/25, 07/27/25, 07/28/25 (blank entry) and 07/29/25, the resident did not receive metformin 500 mg due to the medication being unavailable/new order. e) On the morning of 07/28/25, Lasix (anti-diuretic) 40 mg, Eliquis (anti-coagulant), Lantus (insulin) 20 units, cholecalciferol (vitamin D-3) (supplement), and lidocaine patch (pain reliever) were blank which indicated the resident was not administered the medications. There was also no documented blood sugar check (accuchecks) completed on 07/28/25 in the morning. Review of the August 2025 MAR for Resident #75 revealed the following: a) From 08/01/25 through 08/06/25, it was documented that the resident received diltiazem 180 mg daily. The MAR indicated the resident did not receive diltiazem 180 mg on 08/07/25, 08/10/25 (blank entry), 08/11/25 and 08/12/25, due to the medication not being available. b) From 08/01/25 through 08/04/25, it was documented that the resident received sotalol 80 mg twice daily. c) On 08/03/25 and 08/12/24, the MAR indicated the resident did not receive isosorbide due to medication no being available. d) from 08/09/25 through 08/11/25, the MAR was blank for oxycodone five mg, which indicated no medications were administered. Review of a progress note for Resident #75 dated 08/12/25 at 9:59 A.M., revealed the resident presented with an altered mental status (AMS) along with abnormal vital signs. The resident's pulse fluctuated between 29 and 40 beats per minute (normal 60-80), blood pressure was 130 over 97 milliliters of mercury (mmHg), oxygen saturation was 95 percent (%), and her body temperature was 97.9 Fahrenheit (F). Resident #75 was diaphoretic, complained of numbness in her right arm and hand along with three episodes of emesis. The resident was transferred to the hospital via Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365974 If continuation sheet Page 5 of 7 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 365974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few squad. Review of the Prescription Order Status (a printed form by the facility showing the medications ordered and delivered) for Resident #75 on 10/07/25 at 2:00 P.M., revealed the resident had the following medications delivered to the facility: On 07/08/25, a quantity of 14 diltiazem 180 ER, a quantity of 14 sotalol 80 mg and a quantity of nine oxycodone five mg were delivered to the facility. On 07/14/25, a quantity of 28 oxycodone five mg were delivered. On 07/29/25, a quantity of 14 isosorbide 30 mg ER were delivered. On 08/04/25 a quantity of 14 sotalol were delivered. On 08/06/25, a quantity of 14 Diltiazem 180 mg ER were delivered and on 08/12/25, a quantity of 14 isosorbide tablets were delivered on 08/12/25. Review of a Controlled Drug Receipt/Record (Narcotic sheet) for Resident #75 75 on 10/07/25 at 2:10 P.M., revealed the facility received 28 oxycodone five mg tablets on 07/14/25. The resident was administered oxycodone on a regular basis from 07/16/25 through 08/08/25 when the card was empty. There were no additional oxycodone five mg received for Resident #75 after 08/08/25. Interview on 10/07/25 at 3:44 P.M. with the Director of Nursing (DON) confirmed the facility received 14 Diltiazem 180 mg for Resident #75 on 07/08/25, and 14 more 08/06/25. The DON verified Resident #75 was ordered to receive diltiazem 180 mg daily from 07/08/25 through 08/12/25. The DON verified the resident's MAR indicated the resident received diltiazem 180 mg from 07/22/25 through 08/06/25, despite the facility not having the medications in the facility and stated she could not explain the discrepancy. The DON also verified Resident #75 did not receive diltiazem 180 mg on 08/07/25, 08/10/25, and 08/11/25 due to the MAR indicating the medication was not available. The DON also verified the facility received 14 sotalol 80 mg for Resident #75 on 07/08/25 and 14 more on 08/04/25. The DON verified Resident #75 was ordered to receive sotalol 80 mg one half tablet twice daily from 07/08/25 through 08/12/25. The DON stated the 14 sotalol 80 mg received on 07/08/25 would have finished on 07/23/25. The DON verified the resident's MAR indicated the resident received sotalol 80 one half tablet twice daily from 07/24/25 through 08/04/25, despite the facility not having the sotalol in the facility and stated she could not explain the discrepancy. The DON also verified the facility received 14 isosorbide 30mg for Resident #75 on 07/29/25 and 14 more on 08/12/25. The DON verified Resident #75 was ordered to receive isosorbide ER 30 mg daily from 07/19/25 through 08/12/25. The DON verified the resident's MAR indicated the resident received isosorbide 30 mg from 07/19/25 through 07/29/25, despite the facility not having the medications in the facility and stated she could not explain the discrepancy. The DON also verified the facility received eight oxycodone five mg for Resident #75 on 07/08/25 and 28 more on 07/14/25. The DON verified Resident #75 received oxycodone regularly from 07/09/25 through 08/08/25 The DON verified the oxycodone five mg was not available for resident from 08/09/25 through 08/12/25. The DON stated a nurse requested a refill on 08/11/25 at 12:26 P.M. and the order was never filled. The DON stated she checked the facility's emergency supply box (e-box) list, and it did not reveal any indications of the nursing staff removing diltiazem, isosorbide mononitrate, sotalol, or oxycodone for Resident #75. Interview on 10/07/25 at 10:49 A.M. with PCP #500 stated he was never notified of the medication discrepancies for Resident #75. PCP #500 stated he was concerned about the medication discrepancies because Resident #75 was discharged to the hospital on [DATE] for heart related issues. Review of a text message exchange between Primary Care Physician (PCP) #500 and 100-200 hall nurse on 10/07/25 at 10:40 A.M. revealed the 100-200 hall nurse sent a text message to PCP #500 on 08/11/25 at 12:26 P.M. and reported Resident #75 needed a new script for PRN Oxycodone. At 4:09 P.M. the 100-200 hall nurse sent a text message to PCP #500 and noted Resident #75 had several episodes of diarrhea and wanted to give the resident Imodium. PCP #500 responded with an order for Imodium four mg three times a day prn. The message did not include anything about the oxycodone refill. Review of the undated facility policy titled Medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365974 If continuation sheet Page 6 of 7 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 365974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Quaker Heights 514 West High Street Waynesville, OH 45068 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 Level of Harm - Minimal harm or potential for actual harm Administration, revealed all medications would be administered in an organized, accurate and safe manner, accordance with manufacturers specifications, and good nursing principles and practices. If a regularly scheduled medication was withheld, refused or given at other than the scheduled time, the nurse shall document in the MAR and enter an explanatory note in the record. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365974 If continuation sheet Page 7 of 7