Health inspection·March 13, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of a the facility water management plan, staff interview, review of the Centers for Disease Control and Prevention (CDC) website, and policy review, the facility failed to implement a complete water management program to prevent the growth of Legionella bacteria and failed to wear gloves during administration of an injected medication. This had the potential to affect all 34 residents residing in the facility. The census was 34. Residents Affected - Many Findings include: 1. Review of the facility the facility's water management plan lacked any information about how the facility would intervene when control measures were not met and possible contamination with Legionella bacteria was suspected or address ongoing monitoring of the plan's effectiveness. Interview with the Administrator on 03/13/25 at 10:07 A.M. verified the facility's water management plan did not address how the facility would intervene if control measures were not met, what interventions the facility would implement if contamination of Legionella bacteria was suspected, or how the facility would monitor the plan's effectiveness on an ongoing basis. Review of the undated policy titled, Legionella Surveillance and Detection, revealed the facility was committed to the prevention, detection, and control of water-borne contaminants, including Legionella. Review of the CDC website at, https://www.cdc.gov/control-legionella/php/wmp/index.html, under the title, Overview of Water Management Programs, dated 03/15/24, revealed water management programs identify hazardous conditions and take steps to minimize the growth and transmission of Legionella and other waterborne pathogens in building water systems. Developing and maintaining a water management program was a multi-step process that required continuous review. Such programs are now an industry standard for many buildings in the United States. Further review of the website under the subsection titled, Key Elements, revealed there were seven key elements of a Legionella water management program which included to establish a water management program team, describe the building water systems using text and flow diagrams Burden of Waterborne Disease, identify areas where Legionella could grow and spread, decide where control measures should be applied and how to monitor them, establish ways to intervene when control limits are not met, make sure the program was running as designed (verification) and was effective (validation), and document and communicate all the activities. 2. Review of the medical record for Resident #31 revealed an admission date of 09/04/24 with a diagnosis of diabetes mellitus. Review of the current physician orders as of March 2025 for Resident #31 revealed he was prescribed Admelog Solostar insulin 36 units subcutaneously (SQ). Observation on 03/12/25 at 8:39 A.M. of Licensed Practical Nurse (LPN) #360 during medication administration revealed LPN #360 administered Admelog insulin SQ to Resident #31 without applying gloves prior to the administration of the insulin. Interview on 03/12/25 at 8:46 A.M. with LPN #360 verified she did not put on gloves prior to administration of the insulin to Resident #31. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 2 of 3 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 366081 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Care Center 1406 Oak Harbor Rd Fremont, OH 43420 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled, Administering Medications, revised 12/02, revealed staff shall follow established infection control procedures (such as handwashing, antiseptic technique, gloves, and isolation precautions) for the administration of medications, as applicable. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 3 of 3