Inspection·August 27, 2025

F 0684 Level of Harm - Actual harm Residents Affected - Few right hip pain and requested a Lidocaine patch to his right hip. Hospice NP #202 declined ordering an x-ray at this time and a new order was placed for 4% Lidocaine topical patch to the right hip for five days.Review of the facility progress note dated 06/01/25 at 9:56 P.M. revealed Resident #30 received a new order for Lidocaine patch 4% to be applied to right hip x 5 days d/t (due to) fall. Resident #30's POA (power of attorney) aware.Review of the hospice visit note dated 06/02/25 revealed Resident #30 continued to report right hip pain.Review of the facility progress note dated 06/02/25 at 1:45 P.M. revealed Resident #30 stated he could not stand up. Review of the facility progress note dated 06/03/25 at 12:59 P.M. revealed Resident #30 complained of pain on his right side where he fell. Review of the hospice visit note dated 06/05/25 revealed Resident #30 was lying in bed with his right leg bent and when asked to straighten his leg, he tried but was unable to straighten it. The hospice nurse contacted NP #202, and an x-ray was ordered of Resident #30's right hip. Review of the facility progress note dated 06/05/25 at 9:15 P.M. revealed Resident #30 received a new order for an x-ray of the right hip/pelvis and lower spine. Review of the facility progress note dated 06/09/25 at 9:00 A.M. revealed the facility called the external imaging provider regarding the x-ray that was ordered on 06/05/25 and they stated Resident #30 was combative and refused the x-ray. Review of the facility progress note dated 06/09/25 at 9:01 A.M. revealed a STAT (urgent or rushed) x-ray was ordered for Resident #30. Review of the hospice visit note dated 06/09/25 revealed Resident #30 continued to have complaints of right hip pain.Review of the hospice progress notes dated 06/09/25 revealed the x-ray results dated 06/09/25 for Resident #30 revealed he had a mild displaced comminuted intertrochanteric fracture of right hip with varus angulation. Resident #30 wished to go to the hospital to see if they could fix it. Review of the hospital records for Resident #30 revealed he was admitted to the hospital on [DATE] with a diagnosis of acute comminuted intertrochanteric fracture of the proximal right femur with a plan to have surgery to repair the broken hip.Review of electronic mail (e-mail) communication on 06/18/25 at 11:02 A.M. between Unit Manager #131 and an external imaging provider, revealed an order had been received for an x-ray for Resident #30's right hip on 06/05/25, but the resident refused. Further review of the e-mail communication revealed the x-ray technician states she reported Resident #30's refusal to an unidentified staff member on 06/05/25 at 4:38 P.M. Interview on 08/26/25 at 10:49 A.M. with Resident #30's family member revealed Resident #30 had an unwitnessed fall on 05/31/25 and did not have an x-ray performed until 06/09/25). She stated after the x-ray was obtained, Resident #30 wanted to be transferred to a hospital to see about having his broken hip repaired.Interview on 08/27/25 at 7:06 A.M. with Unit Manager #131 revealed Resident #30 fell on [DATE] and imaging was not completed until 06/09/25. Unit Manager #131 stated an initial imaging order was placed on 06/05/25 but was not completed due to resident refusal. Unit Manager #131 stated the delay in care was due to waiting on orders from the hospice provider. Interview on 08/27/25 at 8:55 A.M. with Unit Manager #131 revealed if the facility does not get answers regarding resident care from the hospice provider, the facility should seek directions from the facility provider regarding resident care. She stated the floor nurse communicates with hospice nurses and providers, but the Unit Manager will assist in following up and following through with resident care issues that are relayed to her from a floor nurse. She stated if the Unit Manager does not receive follow-up from hospice, the issue should be escalated to the Director of Nursing (DON) to determine what the next steps would be. Interview on 08/27/25 at 1:13 P.M. with Licensed Practical Nurse (LPN) #111 revealed she was the hospice nurse who initially assessed Resident #30 after his fall, but she works for the facility now. She stated when she initially saw Resident #30 after his fall, he was complaining of pain in his right hip, but there was no swelling, bruising, or redness noted upon her initial (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 2 of 6 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 08/27/2025 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 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete assessment. Interview on 08/27/25 at 2:24 P.M. with hospice NP #202 revealed the hospice nurse initially assessed Resident #30 and reported to her Resident #30 did not have reproducible pain and she could not assess a difference in the lengths of his legs. Review of the policy titled, Change of Condition: Observing, Recording and Reporting, dated 08/07/24, revealed the facility will record and report any change in condition to the nurse in charge and attending physician so proper treatment will be implemented. This deficiency represents non-compliance investigated under Complaint Numbers 2566353 and 1358032. Event ID: Facility ID: 365996 If continuation sheet Page 3 of 6 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 08/27/2025 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of medical records, family interview, staff interview, rand review of policy, the facility failed to provide interventions to prevent the development of a pressure ulcer. This affected one (#31) of three residents reviewed for pressure ulcers. The facility census was 28.Findings include: Review of the medical record for the Resident #31 revealed an admission date of 05/13/25 with diagnoses including aftercare following joint replacement surgery, unilateral primary osteoarthritis-left hip, unspecified fall, generalized muscle weakness, need for assistance with personal care, cognitive communication deficit, dementia, hypotension, pain due to internal orthopedic prosthetic devices, other specified personal risk factors, presence of left artificial hip joint, stage three chronic kidney disease, colostomy, malignant neoplasm, unspecified vitamin deficiency, anxiety, other specified depressive episodes, overactive bladder, and personal history of irradiation. The resident was discharged on 06/15/25.Review of Resident #31's physician order dated 05/13/25 revealed skin/oral check every week, to be completed every Tuesday between 6:00 A.M. through 2:00 P.M. Review of the medical record revealed weekly skin checks were completed for Resident #31 as ordered.Review of the admission Minimum Data Set (MDS) Assessment, dated 05/18/25, revealed a Brief Interview of Mental Status (BIMS) Score of 07, indicating Resident #31 had severely impaired cognition. Review of the MDS Assessment revealed Resident #31 required substantial to maximal assistance with all functional abilities.Review of Resident #31's care plan, dated 05/19/25 revealed Resident #31 is at risk for pressure ulcers due to moisture/mobility with a goal of intact skin without evidence of redness, irritation, maceration, or open areas and an intervention of elevating heels off bed or use heel protectors. Review of Resident #31's physician order dated 05/28/25 through 06/15/25 revealed an order to offload bilateral heels and apply skin prep to heels daily between 10:00 P.M. through 6:00 A.M. Review of the medical record revealed this order was completed for Resident #31 as ordered. Review of the skin assessments for Resident #31 dated 05/13/25, 05/19/25, 05/26/25, 06/03/25, and 06/10/25 revealed the resident's Braden risk assessment score for skin breakdown was 15-18, indicating Resident #31 was at risk for skin breakdown. Review of the weekly skin assessments dated 05/19/25, 05/26/25, 06/03/25, and 06/10/25, as well as his admission skin assessment, dated 05/13/25, revealed no areas of skin breakdown or pressure sores noted.Review of the skin assessment dated [DATE] for Resident #31 revealed the writer was notified by therapy that resident has a pressure sore on his left heel. The writer assessed and noted a deep tissue injury (DTI) on the resident's left heel. The writer cleaned the resident's heel with normal saline, patted dry and applied Hydrocolloid dressing to resident's heel. Resident #31 did moan during treatment and scheduled Oxycodone 5/325 milligrams was given and effective. The DTI pressure sore on his left heel measured 6.2 centimeters (cm) by five cm. Review of Resident #31's physician orders dated 06/14/25 revealed to offload heels bilaterally every shift, pressure relief boots to be worn while in bed and sitting in the recliner every shift, and wound care to clean left heel with NS (normal saline), pat dry, and cover with Hydrocolloid dressing every M, W, F, and PRN (Monday, Wednesday, Friday, and as needed).Interview on 08/27/25 at 7:06 A.M. with Unit Manager #131 verified Resident #31 developed a sore on his left heel that he was not admitted with. She stated that the cause of the sore on his left heel was due to his heels not being offloaded properly.Interview on 08/27/25 at 7:56 A.M. with Resident #31's family member revealed the facility called her on 06/14/25 and told her that Resident #31 had a pressure sore on the bottom of his heel.Interview on 08/27/25 at 2:34 P.M. with Unit Manager #113 and Division Manager of Quality and Compliance (DMQC) #203 revealed the offloading of Resident #31's heels was not started on admission, it was not started until 05/28/25. DMQC #203 and Unit Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365996 If continuation sheet Page 4 of 6 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 08/27/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Manager #113 stated there was nothing brought up for there to be a need to have an order to offload heels on admission. They stated that on 05/28/25 Resident #31 was changed from a Hoyer Lift (a mechanical device designed to assist caregivers in safely transferring individuals with limited mobility) to a [NAME] Steady (a sit to stand manual lift aid) and they feel the offloading of heels order was place at this time in response to this change. Unit Manager #113 and QDMC #203 verified Resident #31's pressure ulcer that was documented on 06/14/25 was facility acquired. Interview on 09/04/25 at 2:30 P.M. with the Administrator verified there was a physician order placed on 05/28/25 to offload Resident #31's heels and there was not an order to offload Resident #31's prior to 05/28/25. He also verified that there was a care plan in place that was dated 05/19/25 to offload Resident #31's heels. He stated that the MDS nurse is relatively new to her role and put the care plan in preventatively on 05/19/25. He stated that the facility has educated her that when a preventative care plan is put in place, there needs to be a physician order that is written so that the preventative measures are enacted by the treatment team. He further stated there is no documented evidence of the offloading of the heels from 05/19/25 to 06/14/25, until after the pressure sore was discovered. Review of the facility policy titled, Prevention, Detection, and Treatment of Pressure Ulcers, dated 07/25/25, revealed a pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, because of pressure in combination with shear and/or friction. A suspected deep tissue injury is purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue and /or shear; the area may be preceded by tissue that is painful, firm, boggy, warmer or cooler as compared to adjacent tissue. This deficiency represents non-compliance investigated under Complaint Number 2566353. Event ID: Facility ID: 365996 If continuation sheet Page 5 of 6 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 08/27/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete 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, and staff interview, the facility failed to ensure interventions were implemented timely to address incontinence. This affected one (#11) of four residents reviewed for timely care and treatment in a facility census of 29. Findings include:Review of the medical record revealed Resident #11 admitted to the facility on [DATE] with the diagnoses including, left humerus fracture, history of fall, rhabdomyolysis, muscle weakness, unspecified kidney injury, urinary tract infection, cerebral infarction, aphasia, coronary artery disease, atrial fibrillation, and congestive heart failure. Review of the most current Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #11 was assessed with severe cognitive impairment, was dependent on staff for the provision of activities of daily living (ADLs), and was incontinent of bowel and bladder.Review of a nursing plan of care dated 07/16/25 revealed a focus area to address Resident #11's bladder incontinence related to requiring assistance with toileting, transfers, and hygiene. Interventions included to provide staff assistance for toileting task, apply a moisture barrier to the skin, and provide incontinence care after each incontinent episode. Observation on 09/23/25 at 10:44 A.M. with Licensed Practical Nurse (LPN) Unit Manager (UM) # 300 discovered Resident #11 in bed. LPN UM #300 removed Resident #11 top sheet and noted Resident #11 to be heavily soiled with urine and a moderate amount of stool. A pervasive urinary odor was also detected. Interview with LPN UM #300 at the time of the observation confirmed the odor and Resident #11's urinary and bowel incontinence soaking through an adult brief and a Chux (a disposable and absorbent incontinence underpad) pad, and onto the resident's bed linen. LPN UM #300 stated the resident would require a complete bed change and bed bath. LPN UM #300 verified Resident #11 appeared to have been left incontinent for an extensive time. On 09/23/25 at 10:48 A.M. interview with Certified Nurse Aide (CNA) #200 stated Resident #11 was last checked for incontinence at 7:30 A.M. and at that time Resident #11 refused to get out of bed. CNA #200 stated she did not inform the assigned nurse (LPN #301) of the resident's refusal. CNA #200 went on to verify Resident #11 had not been checked for incontinence or re-approached for care since 7:30 A.M. CNA #200 verified Resident #11 was heavily soiled with urine and stool. On 09/23/25 at 10:54 A.M. interview with LPN #301 revealed the nurse was unaware Resident #11 would not allow CNA #200 to check or change her for incontinence since 7:30 A.M.Review of the facility incontinence briefs and pad handling, long-term care guideline, reviewed 11/18/24, revealed to help prevent pressure injuries, nursing staff members should minimize folds and wrinkles when applying incontinence product, regularly check for wetness, change product frequently, and inspect the residents skin when changing the product. Nursing staff should promptly report any changes in the residents skin integrity. Staff should explain the procedure to the resident and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation. Include the importance of checking the briefs or pad frequently (at least every two hours) and changing it when it is soiled to prevent skin breakdown. Event ID: Facility ID: 365996 If continuation sheet Page 6 of 6