Health inspection·August 20, 2025

F 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (MDS) assessment dated [DATE] revealed Resident #24 was cognitively intact with a BIMS of 15. Review of fund authorization form dated 06/27/24 revealed Resident #24 opened an personal fund account at the facility. Review of facility withdrawal receipts and store receipts from 01/01/25 to 06/10/25 for Resident #24 found:On 02/24/25 a withdrawal of $50.00 was documented for clothing and personal items by Social Services #210, no receipts were provided and the facility had no documentation of where the money/change went.On 03/03/25 a withdrawal of $60.00 was documented for Walmart by Social Services #210, a receipt was provided dated 03/11/25 for $26.50. The facility had no documentation of where the money/change went after the purchase. On 05/08/25 a withdrawal of $30.00 was documented for Walmart by Social Services #210, a receipt was provided dated 05/09/25 for $17.04. The facility had no documentation of where the money/change went after the purchase. On 06/04/25 a withdrawal of $10.00 was documented for the beautician by Social Services #210, no receipts were provided and the facility had no documentation of where the money/change went. 4. Review of the medical record for Resident #06 revealed an admission date of 03/29/24. Diagnoses included heart failure, unspecified dementia, malnutrition, and muscle weakness.Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #06 was cognitively impaired with a BIMS of two. Review of fund authorization form with and eligible date revealed Resident #06 opened an personal fund account at the facility. Review of facility withdrawal receipts and store receipts from 01/01/25 to 06/10/25 for Resident #06 found: On 03/03/25 a withdrawal of $150.00 was documented for clothing and personal items by Social Services #210, no receipts were provided and the facility had no documentation of where the money/change went.On 04/29/25 a withdrawal of $20.00 was documented for clothing and personal items by Social Services #210, no receipts were provided and the facility had no documentation of where the money/change went. On 05/07/25 a withdrawal of $100.00 was documented for clothing and personal items by Social Services #210, no receipts were provided and the facility had no documentation of where the money/change went.On 05/15/25 a withdrawal of $30.00 was documented for clothing and personal items by Social Services #210, no receipts were provided and the facility had no documentation of where the money/change went. Interview on 08/14/25 at 11:03 A.M. with [NAME] Police Officer #500 revealed the criminal investigation had concluded and revealed facility had significant issues with book keeping and facility had very little oversite regarding resident funds. Interview on 08/14/25 at 1:35 P.M. with Resident #24 found facility had informed her of potential missing money a few months ago and reported money had been returned. She did not remember if she was asked to sign a blank receipt for staff, but revealed she had never really looked. I just trusted them. Interview on 08/18/25 at 10:20 A.M. with Director of Nursing (DON), Administrator, Business Office Manager (BOM) #55 and Regional Account Manager (RAM) #205 confirmed facility had investigated the allegation of misappropriation. They confirmed Social Services (SS) #210 had taken resident money to go shopping, but confirmed a large amount of withdrawals had no evidence of receipts showing proof of purchases and several purchases that had receipts had no documented evidence of money or change being returned to the resident or returned to the fund account. BOM confirmed facility did not have a process of requiring receipts after staff completing shopping with resident's money. Interview on 08/18/25 at 3:00 P.M. with Administrator and Regional Account Manager #205 confirmed Social Services (SS) #210 took resident money to her home for an unknown amount of time but per her statement in the investigation, they confirmed she had resident money in her possession for several months. They confirmed staff regularly shop for residents and they did not have a standard procedure for staff taking resident money, how long they could keep the money before returning it, or returning the resident's change. They acknowledged facility had no checks and balances and no one making sure staff followed any guidelines when taking residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366038 If continuation sheet Page 2 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0568 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete money out of the building. They also confirmed staff reported concerns of SS #210 asking activity aides to sign blank facility receipts for resident fund withdrawals and when questioned by staff, SS #210 reported she would fill in an amount later once an amount was known. Interview on 08/18/25 at 3:25 P.M. with Activity Aide (AA) #70 confirmed Social Service (SS) #210 had asked her to have residents sign a blank receipt to take out resident funds. She questioned it and SS #210 stated she would fill in an amount later. AA #70 reported she just had residents sign the ones with amounts, and put the receipt book back with the blank receipts left unsigned. Review of the facility policy titled, Deposit of Resident Funds, dated 04/2017 revealed resident personal funds shall be held and managed by the facility and shall be safeguarded. Funds over $50 shall be deposited in an interest bearing account. Facility did not provide any evidence of written policy or procedure regarding staff shopping for residents and signing out resident money to staff. This deficiency represents non-compliance investigated under Complaint Number 1342630 and 2580694. Event ID: Facility ID: 366038 If continuation sheet Page 3 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, review of resident fund account documentation, review of self reported incident investigation, staff interviews, and policy review, facility failed to ensure residents were free from the potential of misappropriation. This affected three Residents (#7 #42 and #46) of three reviewed for misappropriation. Facility census was 41. Findings include 1.Review of the medical record for Resident # 42 revealed an admission date of 02/21/21 and discharge date of 08/06/25. Diagnoses included displaced fracture of the right leg, chronic obstructive pulmonary disease (COPD), muscle weakness, and unspecified dementia without behaviors. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #42 was cognitively impaired with a brief interview of mental status (BIMS) score of five. Review of facility Self Reported Incident (SRI) #261495 investigation dated 06/10/25 to 06/13/25 revealed Social Services (SS) #210 had asked an Activity Aide (AA) #185 to have a resident sign a blank receipt for resident funds. When questioned, SS #210 informed AA #185 she would fill in the amount later. AA #185 had concerns of mishandling of funds and reported an allegation of misappropriation to management who began an SRI investigation. The investigation found when the facility was taking money out of the resident accounts to shop for the resident, staff were not consistently providing a receipt to account for the disposition of the funds removed and did not keep documentation whether the change was returned and if so how (cash back to the resident, or returned to the fund account). Review of a staff statement from SRI #261495 investigation from Social Services (SS) #210 revealed she was asked if she had any additional money or receipts due to money being unaccounted for during the SRI investigation audit. SS #210 reported she had $500.00 in her car for several months for Resident #42. At the time of this interview statement, SS #210 had been suspended since 06/10/25 for an allegation of mishandling funds. 2. Review of the medical record for Resident #46 revealed an admission date of 07/20/20 to 06/23/25. Diagnoses included kidney failure, muscle weakness, heart failure, vascular dementia and edema. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #46 was cognitively impaired with a BIMS of seven. Review of a staff statement from SRI #261495 investigation from Social Services (SS) #210 revealed she was asked if she had any additional money or receipts due to money being unaccounted for during the SRI investigation audit. SS reported she had $92.41 in her car for Resident #46. At the time of this interview statement, SS #210 had been suspended since 06/10/25 for an allegation of mishandling funds. Review of Resident fund account from 06/01/25 to 08/14/25 revealed no evidence the $92.41 was returned to resident fund account for Resident #46. Interview on 08/18/25 at 2:35 P.M. with Regional Nurse #200, Regional Account Manager (RAM) #205 and Administrator confirmed Resident #46 did not have the cash money found in Social Service #210's personal vehicle return to his personal fund account. 3. Review of the medical record for Resident #07 revealed an admission date of 09/27/16. Diagnoses included dysphagia, intellectual disabilities, contracture of upper extremities, and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #07 was cognitively impaired with a BIMS of six. Review of a staff statement from SRI #261495 investigation from Social Services (SS) #210 revealed she was asked if she had any additional money or receipts due to money being unaccounted for during the SRI investigation audit. SS reported she had $30.00 in her car for Resident #7. At the time of this interview statement, SS #210 had been suspended since 06/10/25 for an allegation of mishandling funds. Interview on 08/18/25 at 10:20 A.M. with Director of Nursing (DON), Administrator and Business office Manager (BOM) #55 and Regional Account Manager (RAM) #205 confirmed facility had investigated the allegation of misappropriation. They confirmed Social Serivces (SS) #210 was suspended pending investigation. They confirmed Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366038 If continuation sheet Page 4 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete SS had taken resident fund money home with her. Interview on 08/18/25 at 3:00 with Administrator and Regional Account Manager #205 confirmed Social Services (SS) #210 took resident money to her home. They confirmed staff regularly shop for residents and they did not have a standard procedure for staff taking resident money and how long they could keep the money before returning it, or returning the resident's change. They acknowledged SS #210's statement included a report she had $500.00 for Resident #42 for several months in her personal vehicle. They acknowledged the risk of theft with no checks and balances and no one making sure staff followed any guidelines when taking residents money out of the building. Review of facility policy titled, Abuse Neglect, Exploitation and Misappropriation Prevention Program, dated 04/2021 revealed Residents had the right to be free from misappropriation. Facility shall protect residents from misappropriations by anyone including facility staff. Facility shall develop and implement policies and protocols to prevent and identify misappropriation. This deficiency represents non-compliance investigated under Complaint Number 1342630 and 2580694. Event ID: Facility ID: 366038 If continuation sheet Page 5 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, self-reported incident (SRI) review, review of the facility investigation, resident interview, staff interview, and policy review, the facility failed to ensure a thorough investigation was completed for Resident #51 who had an allegation of abuse and for Residents #7, #42, and #46 who were involved with an allegation of misappropriation. This affected four residents (#7, #42, #46, and #51) out of four reviewed for abuse, neglect, and misappropriation. The facility identified 19 residents (#2, #3, #6, #7, #8, #15, #19, #21, #24, #25, #26, #29, #37, #42, #43, #44, #45, #46, #47) who were potentially affected by the accounting practices related to the misappropriation SRI #261495 and one resident (#51) identified in the abuse SRI #262018. The facility census was 41.Findings Include: 1. Review of the medical record for Resident #51 revealed an admission date of 03/18/25 and a discharge date of 07/25/25. Diagnoses included chronic pulmonary disease, fracture of the left femur, and bipolar disorder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #51 was cognitively intact.Review of Self Reported Incident (SRI) #262018 revealed Resident #51 reported Registered Nurse (RN) #72 had pushed him. No suspected perpetrator was listed on the intake and no witnesses were listed on the intake. RN #72 was interviewed and named two witnesses who observed the entirety of the interaction, one was an aide and the other was a hospice nurse. No statements were provided from those two staff members stating their observations of the incident.Interview on 08/14/25 at 4:00 P.M. with the Administrator confirmed the suspected perpetrator was not reported appropriately for tracking purposes to the Health Department for SRI #262018. The Administrator also confirmed two witnesses were mentioned in the suspected perpetrators statement, noting those two people were at the nurses station and saw the whole event. The Administrator confirmed those staff were not listed in the report intake either and neither witness had a signed statement of what they observed during the incident in question.2. Review of facility Self Reported Incident (SRI) #261495 investigation dated 06/10/25 to 06/13/25 revealed Social Services (SS) #210 had asked an Activity Aide (AA) #185 to have a resident sign a blank receipt for resident funds. When questioned, SS #210 informed AA #185 she would fill in the amount later. AA #185 had concerns of mishandling of funds and reported an allegation of misappropriation to management who began an SRI investigation. The facility also identified Activity Aide (AA) #185 as the staff who reported the allegation. The investigation found when the facility was taking money out of the resident accounts to shop for the residents, staff were not consistently providing a receipt to account for the disposition of the funds removed and did not keep documentation whether the change was returned and if so, how (cash back to the resident or returned to the fund account). Further review of the investigation revealed Resident #42 was the only resident assigned as a victim through the system (which tracks perpetrators, victims and witnesses), though 19 total residents were included in the investigation (#2, #3, #6, #7, #8, #15, #19, #21, #24, #25, #26, #29, #37, #42, #43, #44, #45, #46, and #47). The investigation stated the residents/responsible parties were immediately advised they would be refunded for any transactions in question. The investigation revealed Activity Aide (AA) #70 was not listed on the SRI intake as a witness and no other witnesses were listed. Staff statements were unclear due to having several statements from the same staff on the same day including AA #70 having three interviews that provided slightly different information, including one statement naming Registered Nurse #95 as a witness. No interviews were included for Activity Aide #185 or Registered Nurse #95, who were named as additional potential witnesses. Staff statements were also written by facility management as an interview without providing interview questions of what was asked. It was unknown if additional information was known by staff, but not specifically asked about. Social Services #210 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366038 If continuation sheet Page 6 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some also had documented two interviews/statements on 06/10/25 that varied in information.Review of the facility investigation revealed audits for 2025. The audits revealed 12 residents (#2, #3, #6, #7, #19, #21, #24, #26, #42, #44, #45, and #46) had withdrawals without receipts. The reimbursement report for 2025 stated a total $3,223.55 was refunded to 11 residents (#2, #3, #6, #19, #21, #24, #26, #42, #44, #45, and #46). It did not include any evidence of Resident #7 being reimbursed the unaccounted for withdrawal from 05/15/25 and 06/04/25 equaling a total of $40.00. Additionally, the accounting for Resident #46 revealed the resident was not reimbursed the accurate amount and was shorted $96.38.Interview on 08/14/25 at 1:35 P.M. with Resident #24 found the facility had informed her of potential missing money a few months ago and reported the money had been returned. She did not remember if she was asked to sign a blank receipt for staff, but revealed she had never really looked and she stated, I just trusted them.Interview on 08/18/25 at 10:20 A.M. with Director of Nursing (DON), Administrator, Business Office Manager (BOM) #55 and Regional Account Manager (RAM) #205 confirmed the facility had investigated the allegation of misappropriation. They stated Social Services (SS) #210 had taken resident money to go shopping, but confirmed a large amount of withdrawals had no evidence of receipts showing proof of purchases, and several purchases that had receipts had no documented evidence of money or change being returned to the resident or returned to the residents fund account. BOM #55 confirmed the facility did not have a process of requiring receipts after staff completed shopping with resident's money. They also confirmed SS #210 had taken a portion of the money home and returned it upon staffs request during the investigation.Interview on 08/18/25 at 2:35 P.M. with Regional Nurse (RN) #200, Regional Account Manager (RAM) #205, and the Administrator confirmed staff statements were completed by interviews without the questions provided on the statement. They also confirmed several statements were in the file from the same staff member that were slightly different. They confirmed not all residents or witnesses were included in the Self Reported Incident Reporting and also not all were included in the listing of refunded residents, as Resident #7 was missing. They further confirmed Resident #46 was not reimbursed the accurate amount and was shorted $96.38. Resident #46 was reimbursed during the survey.Interview on 08/18/25 at 3:00 P.M. with Administrator and Regional Account Manager #205 confirmed Social Services (SS) #210 took resident money to shop for residents on a regular basis. They reported she should have provided receipts for all transactions and provided change back to the residents or to the fund account. The Administrator confirmed the facility did not have a standard procedure for staff taking resident money, how long they could keep the money before returning it, or returning the resident's change. They acknowledged facility had no checks and balances and no one making sure staff followed any guidelines when taking residents money out of the building. The Administrator confirmed all interviews conducted were included in the file.Interview on 08/18/25 at 3:25 P.M. with Activity Aide (AA) #70 confirmed Social Service (SS) #210 had asked her to have residents sign a blank receipt to take out resident funds. She questioned it and SS #210 stated she would fill in an amount later. AA #70 reported she just had residents sign the ones with amounts, and put the receipt book back with the blank receipts left unsigned. AA #70 reported she did not report the incident initially, but another Activity Aide #185 was the first to report the incident to the management team.Review of facility policy titled, Abuse Neglect, Exploitation and Misappropriation Prevention Program, dated 04/2021 revealed residents had the right to be free from misappropriation. The policy stated the facility shall investigate all allegations of abuse.Review of facility policy titled, Abuse Neglect, Exploitation and Misappropriation Prevention Program, dated 09/2022 revealed the facility shall report allegations of misappropriation to the State licensing agency and the verbal/written notices shall include the resident(s) names and names of all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366038 If continuation sheet Page 7 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0610 Level of Harm - Minimal harm or potential for actual harm persons involved in the alleged incident. Upon receiving allegations, the Administrator was responsible for determining what actions were needed for resident protection.This deficiency represents non-compliance investigated under Complaint Number 1342630 and Complaint Number 2580694. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366038 If continuation sheet Page 8 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure a safe discharge plan was implemented. This affected one resident (#48) of three reviewed for discharge planning. The facility census was 41. Findings Include: Review of the medical record for Resident #48 revealed an admission date of 02/19/25 and a discharge date of 05/22/25. Diagnoses included pulmonary disease, respiratory failure, embolism of thoracic aorta, cerebral infarct, bipolar disorder, schizophreniform disorder, skin picking disorder and neuropathy.Review of the plan of care dated 03/05/25 revealed Resident #48 would possibly require discharge planning with interventions to provide information on community resources and utilize resources (for example: home health care) and participate in therapy.Review of the communication in the insurance portal with [NAME] on 05/14/25 revealed Resident #48 had seven benefit days remaining before benefits ran out. The message instructed facility to begin discharge planning.Review of the physical therapy notes dated 05/20/25 revealed Resident #48 required 50 percent (%) verbal instruction for transfer training with 75% physical assistance of two staff due to compromised balance, coordination and safety awareness. The resident transferred to the wheelchair with pivot transfer with two person moderate assistance. When using the slide board Resident #48 required minimum assistance of two staff. Resident #48 continued to need stabilization of lower extremities to keep feet from lifting off the floor during sit to stand transfers.Review of the occupational therapy note dated 05/20/25 revealed Resident #48 had transfer training of stand pivot transfers from the wheelchair to the mat table with maximum assistance of one to moderate assistance of two staff. Resident #48 had increased anxiety with fear of falling requiring increased time to allow the resident to rest.Review of the physical therapy notes dated 05/21/25 revealed Resident #48 and her son were educated on bilateral upper and lower extremity exercises. Skilled interventions focused on transfer training to increase functional task performance. The resident's son was educated on wheelchair mat transfers and the resident's son completed a return demonstration. He stated he felt confident with these transfers at home.Review of the occupational therapy note dated 05/21/25 revealed Resident #48 was educated on compensatory strategies for activities of daily living (ADLs) including wearing a gown for ease, elastic shoe laces to improve the ability to slide shoes on, they discussed recommendations for toileting, encouraged bed level verses one person assistance (with son having to stand and manage clothing items and bed/rails), performed basin bath due to second story shower, and easy open containers and light meals if her family was out for short periods of time. Resident #48 stated her son was taking a leave of absence from work to be a full time caregiver and provide meals and ADL care. Resident #48's family also planned to hire a part-time caregiver in addition to the recommended home healthcare for therapy and nursing.Review of the physical therapy Discharge summary dated [DATE] revealed Resident #48 had requested to return home. It stated the resident had only met one of six goals and required maximum assistance of one to two people for functional transfers and minimum to moderate assistance with the use of a bed rail for bed mobility.Review of the occupational therapy Discharge summary dated [DATE] revealed Resident #48 exhausted her benefits days and declined treatment (private pay). It stated Resident #48 had only met one of seven goals and required substantial maximum assistance for toileting and partial to moderate assistance for activities of daily living.Review of the progress notes dated 05/21/25 from the Director of Nursing revealed Resident #48 was scheduled to discharge home 05/22/25 with referrals to home health services for physical therapy, occupational therapy, nursing and state tested nursing aides (STNA). Resident #48 and her son were aware. The note dated 05/22/25 from Licensed Practical Nurse (LPN) #58 revealed the nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366038 If continuation sheet Page 9 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366038 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenfield Skilled Nursing and Rehabilitation 238 South Washington Street Greenfield, OH 45123 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete signed discharge paperwork with Resident #48's son (Power of Attorney (POA)). Resident #48 discharged with her POA. The note dated 05/22/25 from Social Services #210 revealed Resident #48 was discharging home with her son and home health and appointments were set up.Review of Resident #48's discharge Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) of 06 indicating impaired cognition. It stated Resident #48 required set up assistance for eating, substantial maximum assistance for oral hygiene, shower/bathing, upper body dressing, personal hygiene, rolling, sitting up in bed and sitting at the edge of the bed and she was dependent upon staff with toileting assistance, lower body dressing, placing footwear, mobility from sit to stand, chair to bed transfers, toilet transfers, and shower transfers. Car transfers and walking 10 feet were not attempted due to medical or safety concerns.Review of the discharge summary/discharge plan of care dated 05/22/25 revealed Resident #48 was discharged due to meeting therapy goals. It also stated Resident #48 was set up with home healthcare for aide services as well as physical and occupational therapy services and named Ross County Home Health as the provider.Interview on 08/14/25 at 1:15 P.M. with Therapy Director (TD) #60 revealed Resident #48 was cut from therapy and had requested to discharge home with her family at that time instead of paying privately. TD #60 revealed Resident #48's family was reluctant about taking her home and she felt the resident had pressured her family to take her home at discharge.Interview on 08/14/25 at 4:00 P.M. with Administrator revealed Resident #48's insurance informed the facility on 05/14/25 that her days were about to be exhausted and she had seven days left, with the last covered day being 05/21/25. She confirmed the note mentioned the facility was to provide discharge planning.Interview on 08/18/25 at 11:56 A.M. with Home Health Agency: Ross County Home Health revealed they denied the referral for Resident #48 and stated they were out of network with her insurance. They stated they received the referral on 05/22/25 and informed Social Services staff on 05/22/25 they were out of network. They revealed they did not hear back and followed up with a second email informing the facility they were out of network on 06/01/25, and again did not receive any response or confirmation back. They confirmed they had never met with Resident #48 or initiated services.Interview on 08/18/25 at 12:25 P.M. with Director of Nursing (DON) revealed she had an expectation of a safe discharge plan and the previous social services staff should have confirmed acceptance of a home health agency. The DON confirmed the discharge summary did not give an accurate reason for discharge as it stated the resident met therapy goals. She also acknowledged the agency listed did not begin any services and confirmed the facility sent Resident #48 home without the needed and recommended services, which was not a safe discharge plan.Interview on 08/18/25 at 1:55 P.M. with Regional Nurse (RN) #200 confirmed the facility had no evidence of Resident #48 having an accepted home health agency at the time of discharge. RN #200 confirmed the facility only had evidence that two referrals were sent on 05/22/25 and none were sent prior to the day of discharge. RN #200 confirmed the facility had no evidence of prior discharge planning and no evidence a discharge care conference was held. RN #200 confirmed she received an email in June 2025 about referrals for Resident #48 and stated it was not our job to ensure the resident had services arranged prior to discharge to ensure a safe discharge plan.Interview on 08/18/25 at 1:55 P.M. with Regional Nurse (RN) #200 and Regional Account Manager (RAM) #205 reported the facility had discussions with Resident #48 and her family regarding difficulties with the insurance and acknowledged the facility had no evidence of the discussions and no documentation of difficulties with discharge planning.This deficiency represents non-compliance investigated under Complaint Number 2581704. Event ID: Facility ID: 366038 If continuation sheet Page 10 of 10