Inspection·May 4, 2023

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to ensure communication interventions were provided and available for use to increase communication abilities of one (#10) resident reviewed for impaired hearing and communication interventions. Facility census 31. Residents Affected - Few Findings include: Review of the medical record revealed Resident #10 admitted to the facility on [DATE]. Diagnosis included severe dementia, neuromuscular urinary bladder dysfunction, hypertension, anemia, pulmonary fibrosis, pain, hydrocephalus, bilateral conductive hearing loss, major depression, and epilepsy. Review of the Minimum Data Set assessment, dated 03/21/23, assessed Resident #10 with severe cognitive impairment, moderate difficulty with hearing, no hearing aid or appliance used, clear speech, sometimes understood and understands, dependent on staff for the completion of activities of daily living, and utilizes a wheelchair for mobility. Review of the care plan dated 11/09/17 revealed supports and services to address the resident's hearing impairment included: wears hearing aid when family visits. On 03/21/23 the plan of care was revised and interventions included the following; Adjust tonal quality and speak distinctly. If resident refuses to wear hearing aid, explore reason for refusal. Allow resident to utilize amplifiers when unable to hear TV adequately. Provide quiet, non-hurried environment, free of background noises and distractions. Speak into resident's left ear. Face the resident when speaking to the resident. Repeat phrases as needed. Rephrase if necessary. Allow resident to lip read if appropriate. Provide with materials for written communication as needed and as appropriate. Review of the speech therapy (ST) treatment encounter notes on 04/27/23, Resident #10 was seen for skilled ST to address cognitive-linguistic skills. Speech Language Pathologist (SLP) utilized amplifier with headphones this date to maximize functional communication. SLP informed staff of need for multiple adjustments. Resident able to identify family members from pictures, limited ability to recall family members not in pictures, exhibiting decreased long term memory. SLP educated resident for option of use of memory book and visual aids to maximize expression and recall. On 04/28/23 ST encounter notes document Resident #10 was seen for skilled ST to address cognitive-linguistic skills. Resident pleasant and cooperative for session. SLP educated resident, nursing and state tested nurse aides (STNAs) for use of white board to maximize functional communication with resident due to severe hearing loss and staff reports of negative behaviors. With moderate to maximum cues, resident able to read and respond to questions with use of white board. According to ST encounter notes on 05/01/23 and 05/02/23 the resident received ST to address functional communication and cognitive-linguistic skills. Resident was receptive to use of amplifier with headphones to improve communication due to hearing loss. Observation on 05/01/23 at 10:01 A.M. noted Resident #10 seated in a wheelchair in the dining room. Attempts to acknowledge the resident using verbal interactions resulted in the resident unable to converse. At 12:10 P.M. Resident #10 was in the dining room with staff speaking loudly toward resident related to meal choice. At 4:45 P.M. the resident was observed in his room. Registered Nurse (RN) #428 was in the residents room, speaking loudly related to urinary catheter. The speech volume was heard from common area outside the room. No white board was observed in use. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 2 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 05/02/23 at 9:06 A.M. with Licensed Practical Nurse (LPN) #498 following interactions with Resident #10, revealed therapy was looking into the use of a white board for communication. LPN #498 stated Resident #10 reads lips very well. However, staff must wear mask during interaction with the residents. Observation on 05/03/23 at 10:22 A.M. revealed Resident #10 in his room with ST #500 working with head-set hearing device and wearing a disposable surgical mask. ST #500 was observed speaking into the device at a common speech level and unable to be heard from the corridor. Resident #10 was interacting and responding to discussion at the same speech level effectively. ST #500 stated the resident had used the hearing device in the past but was unable to indicated the time frame. ST #500 stated she had been working with the resident since an evaluation on 04/27/23, at which time she left a white board for Resident #10 to use for communication. ST #500 revealed she was unable to locate the white board and had instructed the staff working at the time on it's use to address communication. Interview on 05/03/23 at 10:30 A.M., LPN #498 verified she was unaware the white board was to be used for communication and confirmed the white board was not available inside the residents room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 3 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to ensure monitoring and interventions were implemented to promote the management of lower extremity edema. This affected one resident (#25) reviewed for bilateral lower extremity edema. Facility census 31. Residents Affected - Few Findings include; Review of the medical record revealed Resident #25 admitted to the facility on [DATE]. Diagnoses included left femur fracture, anemia, spondylolithesis, osteoporosis, type II diabetes mellitus, hypertension, scoliosis, and unstageable pressure ulcer to left heel. Review of the Minimum Data Set assessment, dated 04/04/23, revealed Resident #25 was assessed with severely impaired cognition, clear speech and the ability to understand and be understood, no rejection of care behavior, dependent on staff for the provision of activities of daily living, requires extensive assistance of one staff for bed mobility and transfer. Review of nursing progress notes dated 03/14/23 at 1:37 P.M. noted Resident #25 admitted to the facility with no edema present. Review of the wound specialist, Certified Nurse Practitioner (CNP) #2's, skin evaluation on 03/22/23 Resident #25 was assessed with left and right lower extremity grade two (2) plus (+) edema. On 04/04/23, 04/19/23, and 05/02/23 CNP #2 assessed the resident with grade 2+ edema to the left lower extremity. No documentation contained in the medical record revealed interventions to address the residents lower extremity edema. Observation on 05/01/23 10:53 A.M. noted Resident #25 seated in a chair with bilateral feet on the floor with ankle socks constricting both ankles. Edema was observed to the bilateral ankles. 05/02/23 at 8:32 A.M. the resident was seated in the chair with feet on the floor wearing tight/constricting ankle socks to the bilateral feet. Observation on 05/02/23 at 2:05 P.M. found Resident #25 seated in the chair with bilateral feet on the floor wearing constricting ankle socks and edema present to the bilateral lower extremities. Observation on 05/03/23 at 8:39 A.M. with Licensed Practical Nurse (LPN) #498 revealed Resident #25 with feet on the floor and ankle socks constricting the bilateral lower extremities. LPN #498 assessed the resident's right lower extremity with 2+ edema and left lower extremity with 3+ edema. LPN #498 confirmed no specific interventions had been implemented to address the resident's lower extremity edema. Interview on 05/03/23 at 8:45 A.M., the Director of Nursing (DON) confirmed Resident #25's record contained no documentation regarding any monitoring of the resident's edema, or implementation of any interventions to reduce the presence of the edema. Observation on 05/03/23 at 10:21 A.M. revealed Resident #25 was seated in a recliner with feet on the floor and ankle socks in place with an indentation into the skin at the tops of the socks. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 4 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 Based on observation, medical record review, staff interview, and review of facility policy, the facility failed to ensure interventions were maintained to promote intact skin integrity. This affected one (#13 ) of five residents reviewed for skin breakdown prevention interventions. The facility identified 28 residents with preventative treatment for skin breakdown. The facility census was 31. Residents Affected - Few Findings include: Review of Resident #13's medical record revealed an admission date of 06/01/22 and a readmission date of 02/06/23. Diagnoses included heart failure, atherosclerotic heart disease, hypertension, neuromuscular dysfunction of bladder, cerebral infarction, edema, history of falling and depression. Review of a significant change in condition Minimum Data Set (MDS) assessment, dated 02/13/23, revealed Resident #13 was cognitively intact, required extensive assistance with bed mobility, transfers, toilet use, and personal hygiene. In addition, Resident #13 was at risk of developing pressure ulcers and had no current pressure ulcers. Resident #13 had a pressure reducing device for his chair and bed. Review of the plan of care, reviewed 01/23/23, revealed Resident #13 was at risk for skin breakdown related to decreased mobility and low endurance. Interventions included use pressure reduction mattress when resident is in bed. Review of a Skin Risk Assessment with Braden Scale dated 02/06/23 revealed Resident #13 was at moderate risk for developing pressure sores. Review of a physician order, dated 02/06/23, revealed Resident #13 was ordered a specialty low air loss alternating air pressure (LAL AAP) mattress and bariatric bed. Interview on 05/01/23 at 10:13 A.M. of Resident #13 revealed his mattress sagged behind his back. Resident #13 stated he had previously told a nurse about it but nothing had been done. Observation and interview on 05/02/23 at 11:48 A.M. of Resident #13's mattress, with Unit Manager (UM) #505 confirmed Resident #13 had an LALAAP mattress due to pressure sore risk and the resident's mattress sagged in the area approximate to the resident's back. LPN #505 confirmed the facility did not routinely monitor the functioning of air mattresses and Resident #13 did not have an order for his air mattress to be monitored for functionality. LPN #505 stated she was uncertain what was wrong with the air mattress and would have to call the durable medical supplier. Interview on 05/04/23 at 11:57 A.M. of the Director of Nursing (DON) confirmed Resident #13's air mattress settings were not correct, resulting in the sagging mattress. The DON verified the facility did not monitor the function of the air mattress and the staff had not been trained on monitoring air mattresses. Additionally, the DON verified Resident #13 had a history of skin breakdown. Review of facility policy titled Prevention, Detection and Treatment of Pressure Ulcers, revised 09/13/22, revealed based upon the assessment and the resident's clinical condition, choices, and identified needs, basic and routine care should include interventions to redistribute pressure and provide appropriate pressure redistributing support surfaces. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 5 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 observation, medical record review, staff interview, and review of facility policy, the facility failed to ensure fall prevention interventions were provided in accordance with physician orders and per care plan. This affected two (#17 and #23) of two residents reviewed for the prevention of accidents. The facility census 31. Findings include: 1. Review of the medical record revealed Resident #23 admitted to the facility on [DATE]. Diagnoses included fracture to left femur, unspecified fall, calculus of kidney, muscle weakness, hypothyroidism, atrial fibrillation, edema, depression, urinary tract infection, and neuromuscular dysfunction of bladder. Review of the Minimum Data Set assessment, dated 03/21/23, revealed Resident #23 was assessed with intact cognition, was dependent on staff for the completion of activities of daily living including two or more staff for bed mobility and transfer According to a fall risk assessment completed on 03/14/23 Resident #23 was scored at high risk of sustaining falls. The assessment also indicated the resident required assistance or supervision for mobility, transfer, or ambulation. Review of physician orders dated 03/29/23 revealed an order or the use of two person assist while transferring using the stand-up ([NAME] steady) lift as recommended by therapy. Review of the care plan dated 07/16/22 addressed Resident #23's history of falling related to unsteady gait, weakness, debility and deconditioning, impaired cognition, and incontinence. Interventions included the following; initiated 03/29/23 stand-up lift ([NAME] Steady) for all transfers and bed cane on left side of bed to aid resident when participating in turning and repositioning in bed, shifting of position. Initiated 07/16/22 encourage resident to assume a standing position slowly. Provide toileting assistance every two hours and as needed. Observe frequently and place in supervised area when out of bed. Give resident verbal reminders not to ambulate/transfer without assistance. Place resident in a fall prevention program. Observation on 05/02/23 at 8:35 A.M. noted State Tested Nurse Aide (STNA) #464 obtained the stand-up lift and assist Resident #23 to the standing position. Resident #23 was observed to require maximum physical assistance from STNA #464 to reach the standing position. STNA #464 propelled the resident in the lift into the bathroom and proceeded to place the resident to the toilet. While Resident #23 was placed to the toilet the resident was physically assisted to the standing position a second time to remove an adult brief, due to dropping to the seat with the lack of standing stability. STNA #464 stood Resident #23 with physical support to the standing position into the stand-up lift and proceeded to transfer the resident to a wheelchair. Interview with STNA #464 on 05/02/23 at 8:55 A.M. revealed the STNA was unaware Resident #23 required two staff when providing transfer while using the stand-up lift. Interiew on 05/02/23 at 8:59 A.M., Licensed Practical Nurse (LPN) #498 verified Resident #23 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 6 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 required two staff to assist the resident with transfer while using the stand-up lift. Level of Harm - Minimal harm or potential for actual harm Interview with the Director of Nursing on 05/02/23 at 9:20 A.M. confirmed Resident #23 required two staff to assist the resident with transfer while using the stand-up lift. Residents Affected - Few 2. Review of Resident #17's medical record revealed an admission date of 10/04/21 and a readmission date of 03/30/23. Diagnoses included dementia, delusional disorder, hallucinations, hypotension, Parkinson's disease, cognitive communication disorder, difficulty in walking, repeated falls, hypertension, benign prostatic hyperplasia, delusional disorder, depression, and anxiety. Review of the significant change in condition Minimum Data Set assessment, dated 04/06/23, revealed Resident #17 was cognitively intact. In addition, Resident #17 had repeated falls and did not utilize a chair alarm. Review of the plan of care initiated 10/22/21, revealed Resident #17 had a history of falling related to unsteady gait, psychotropic drug use, Parkinson's disease, and decreased mobility. Interventions included alarming velcro seatbelt: activate when resident was in the wheelchair to alert staff to potential unsafe self-transfers unassisted, as tolerated by the resident. Additional review of a plan of care problem area initiated 12/28/22 revealed Resident #17 would refuse to keep alarming seatbelt on while in the wheelchair at times when the resident was restless, agitated and had poor safety judgement. Interventions included explain to the resident the need for the seatbelt - to alert staff to potential unsafe transfer and respond when alarming. Review of current physician orders revealed no orders for an alarming seatbelt. Review of a Fall Risk Assessment, dated 04/04/23, revealed Resident #17 was at high risk for falls. Observation on 05/02/23 at 10:52 A.M. revealed Licensed Practical Nurse (LPN) #499 and State Tested Nurse Aide (STNA) #458 looking at a disconnected chair alarm hanging on the back of Resident #17's wheelchair. Interview of LPN #499 and STNA #458 verified Resident #17 had a chair alarm on his wheelchair that was not on. Both staff stated they were unaware Resident #17 had a chair alarm and were uncertain if it even worked. Interview on 05/02/23 at 11:24 A.M. of Unit Manager (UM) #505 revealed Resident #17 had a chair alarm but the resident was able to remove it himself and typically did not keep it in place. UM #505 stated there should have been a physician's order for the use of the chair alarm, and staff should document any resident refusals to utilize the fall intervention. UM #505 verified there was no order in place for the use of the chair alarm and no monitoring was being completed to check the functionality of the alarm or Resident #17's refusals to utilize the intervention. Interview on 05/03/23 at 10:36 A.M. of LPN #403 revealed Resident #17 had 222 falls last year and fall interventions ebb and flow based on what the resident was willing to do. LPN #403 stated Resident #17 still had the chair alarm on his wheelchair but the resident refused to use it. LPN #403 stated she was unsure if the alarm even had batteries. LPN #403 stated Resident #17's family purchased the chair alarm and the resident was able to remove it himself, so it was not considered a restraint. While Resident #17 refused to use the chair alarm, LPN #403 stated it was an intervention the facility was keeping at this time. LPN #403 verified there was no physician order for the use of the alarm and stated the resident had gone out to the hospital and it must not have been reactivated upon his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 7 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 FORM CMS-2567 (02/99) Previous Versions Obsolete readmission. In addition, LPN #403 verified staff were not monitoring the functionality of the chair alarm. LPN #403 stated as Resident #17's disease process progressed, the chair alarm may be something the facility could utilize to prevent falls. Review of facility policy titled Fall Prevention and Management, revised 09/13/22, revealed interventions will be put into place based upon risk factors. Event ID: Facility ID: 365996 If continuation sheet Page 8 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview, and review of facility perineal care policy, the facility failed to ensure a resident received timely and proper incontinence. This affected one (#23) resident reviewed for incontinence care. The facility identified 26 incontinent residents. Facility census 31. Findings include; Review of the medical record revealed Resident #23 admitted to the facility on [DATE]. Diagnoses included fracture to left femur, calculus of kidney, hypothyroidism, atrial fibrillation, edema, depression, urinary tract infection, and neuromuscular dysfunction of bladder. Review of the Minimum Data Set assessment ,dated 03/21/23, Resident #23 had intact cognition, required the total dependence of staff for the completion of toileting, was incontinent of bowel and bladder, and had a urinary tract infection. Review of the nursing plan of care dated 07/16/23 revealed a plan of care to address Resident #23's functional urinary incontinence related to difficulty recognizing the urge and communicating the need to eliminate. Interventions included the following; Check for incontinent episodes at least every two hours. Provide incontinence care after each incontinent episode. On 03/14/23 a plan of care was implemented to address Resident #23's potential for painful urination, hematuria, incomplete bladder emptying related to history of urinary tract infection (UTI), kidney stone and neurogenic bladder. Interventions included the following; Administer antibiotics. Evaluate/record/report effectiveness/adverse side effects. Monitor lab work and vital signs every day. Report any presence of fever. Keep perineal area clean and dry. Report signs of UTI (acute confusion, urgency, frequency, bladder spasms, nocturia, burning, pain, difficulty urinating, low back/flank pain, malaise, nausea/vomiting, chills, fever, foul odor, concentrated urine, blood in urine). Review of physician orders dated 03/14/23 revealed orders for Resident #23 to receive antibiotic therapy for the treatment of a urinary tract infection and concluded on 03/27/23. On 04/12/23 the physician ordered the administration of an antibiotic cephalexin 250 milligrams (mg) once daily as a prophylactic due to reoccurring urinary tract infections. On 04/26/23 the resident was ordered the antibiotic Cipro 500 mg twice daily for UTI for 10 days. Review of laboratory urine culture results, dated 04/07/23 and 04/25/23, noted the resident to be diagnosed with a urinary tract infection discovering greater than 100,000 colony forming units/milliliter (CFU/MI) of Citrobacter freundii complex organism non-viable for susceptibility. Interview on 05/02/23 at 8:30 A.M., Licensed Practical Nurse (LPN) #498 revealed Resident #23 was currently receiving antibiotic therapy due to being diagnosed with a urinary tract infection. Observation on 05/02/23 at 8:35 A.M. noted Stated Tested Nurse Aide (STNA) #464 to enter Resident #23's room. Interview with STNA #464 at the time revealed the interaction with Resident #23 was her first contact with the resident for the day and she had assumed care of the resident at 6:00 A.M. The resident was last checked for incontinence the previous shift at an undetermined time. STNA #464 proceeded to assist the resident to the bathroom and removed a moderately urine soiled adult brief. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 9 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few STNA #464 assisted the resident with cleaning her face back and upper extremities. STNA #262 then stood the resident using the stand-up lift and wiped the residents anal area and buttocks. At no time did STNA #464 cleanse the residents perineum. STNA #464 applied a clean adult brief and dressed the resident. The resident was then transferred from the bathroom to the resident room and placed in a wheelchair. Interview on 05/02/23 at 8:55 A.M., STNA #464 verified Resident #23 was incontinent of urine per the adult brief and did not receive perineal care when she took the resident into the bathroom. Review of the facility policy titled Perineal Care, revised May 20, 2022, revealed perineal care includes care of the external genitalia and anal area that should occur during the daily bath and if the patient is incontinent of urine or stool. The procedure promotes cleanliness and prevents infection. Interview with the Director of Nursing on 05/02/23 at 9:20 A.M. verified Resident #23 develops frequent urinary tract infections and is dependent on staff for incontinence checks every two hours with the completion of perineal care following incontinence episodes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 10 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, observation, resident and staff interview, and review of facility policy, the facility failed to follow physician orders to provide a meal for one (#8) of one resident reviewed nutrition. The facility census was 31. Residents Affected - Few Findings include: Review of Resident #8's medical record revealed an admission date of 02/22/23 and a readmission date of 04/06/23. Diagnoses included cognitive communication deficit, dysphagia, hypertension, paroxysmal atrial fibrillation, depression, dementia, malignant neoplasm of prostate, ileostomy status, gastrostomy status, and hypoxemia. Review of the Minimum Data Set (MDS) assessment, dated 04/13/23, revealed Resident #8 was moderately cognitively impaired and required extensive assistance with eating. In addition, Resident #8 had no significant weight loss, had a feeding tube, was on a mechanically altered diet, and received 25% or less of total calories through feeding tube. Review of a plan of care initiated 02/24/23 revealed Resident #8 required enteral nutrition and hydration, was now consuming meals in the dining room with supervision. Interventions included follow physician's orders for tube feeding and water bolus supplementation. Additional review revealed Resident #8's ability to help with self-care deteriorated secondary to generalized weakness. Interventions included assistance for Activities of Daily Living (ADL) care and encourage resident participation. Lastly, Resident #8 had malnutrition related to increased nutrient needs due to illness, difficulty chewing and swallowing, decreased appetite, and unable to safely chew and swallow certain foods. Interventions included provide bolus feed as ordered, only given if resident consumed less than 50% at meals. Review of physician orders revealed Resident #8 was on a pureed texture diet with honey thick liquids and no straws. In addition, Resident #8 received a bolus tube feed of 240 cubic centimeters (cc) of nutritional formula after each meal if resident consumed less than 50% of meal. Observation on 05/01/23 at 12:10 P.M. revealed Resident #8 seated by himself at a table in the dining room. Resident #8 was served two four ounce containers of yogurt and an eight ounce glass of apple juice. Resident #8 consumed both yogurts and drank approximately half of the juice. Resident #8 was not served a lunch meal. Continued observation on 05/01/23 at 12:28 P.M. revealed State Tested Nurse Aide (STNA) #493 entered the dining room and ask STNA #431 if Resident #8 had been served a meal. STNA #431 stated Resident #8 only ate yogurt and he was done with lunch. STNA #431 and STNA #493 assisted Resident #8 with standing and began assisting the resident out of the dining room. Licensed Practical Nurse (LPN) #498 approached Resident #8, STNA #431, and STNA #493 and inquired about the percentage of lunch Resident #8 had eaten. STNA #431 stated the resident had eaten all of his lunch. This surveyor intervened and inquired whether Resident #8 should have been served the lunch meal. STNA #431 stated Resident #8 only ate yogurt, was on a pureed diet, and did not have a meal ticket. STNA #431 verified Resident #8 was not served a lunch meal. LPN #498 asked Resident #8 if he was hungry and the resident stated Yes. STNA #431 and STNA #493 returned Resident #8 to the dining room and proceeded to serve the resident a full lunch meal, which consisted of grilled chicken, sweet potatoes, applesauce, and mashed potatoes. Further observation revealed Resident #8 ate 100% of his chicken and applesauce and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 11 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 0692 approximately 25% of his mashed potatoes. Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled Feeding, Long-Term Care, revised 11/28/22, revealed staff should confirm that the correct meal tray was delivered to the correct resident. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 12 of 13 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 365996 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ohio Living Swan Creek 1650 Swan Creek Lane Toledo, OH 43614 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and staff interview, the facility failed to ensure the shower was maintained in a clean and sanitary manner. This affected all residents except two (#2 and #12) residents identified by they facility as not using the shower room. The facility census was 31. Findings include: Observation on 05/01/23 at 11:05 A.M. of the shared resident shower room revealed a black substance on the caulk on the floor near the entrance to the shower and a brown and black substance in both back corners and along the walls, near the floor of the shower. Observation on 05/02/23 at 7:34 A.M. of the shared resident shower room revealed the substance remained on the floor and walls of the shower. Coinciding interview with State Tested Nurse Aide (STNA) #575 verified the substance in the shower, stating she believed it was mildew. STNA #575 stated aides were responsible to clean the area after each shower and housekeeping was responsible for doing a thorough cleaning each day. Further observation on 05/02/23 at 2:33 P.M. of the shower room revealed the substance remained on the floor and around the walls of the shower. Interview on 05/02/23 at 2:33 P.M. wtih Licensed Practical Nurse (LPN) #498 confirmed all residents, except for Residents #2 and #12, utilized the shared shower room. Interview 05/03/23 at 7:23 A.M., Housekeeper (HK) #535 verified the shared resident shower had mildew on the caulk on the floor and along the walls and corners. HK #535 stated the shower was cleaned regularly but they had not found a cleaning product that had effectively removed the mildew from the caulk. Additionally, HK #535 stated they were not able to utilize bleach products due to the potential to aggravate breathing issues of some of the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 13 of 13