Inspection·July 22, 2025

F 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the facility implemented the following corrective actions: On 07/07/25 at 4:39 P.M., an ad hoc meeting was held with the interdisciplinary team (IDT) staff members and Physician #150 to discuss the incident in May 2025 involving Resident #50, the plan for removing the Immediate Jeopardy, the plan of correction (POC), education, quality assurance and performance improvement (QAPI) components to correction, and necessary audits. The meeting was organized and led by the Administrator and the DON. On 07/07/25 at 5:00 P.M., an investigation was initiated regarding the incident in May 2025 involving Resident #50 and the clinical actions taken. The investigation was completed by the Administrator and the DON and determined an agency nurse (Licensed Practical Nurse [LPN] #139) did not notify the physician for a change in condition. On 07/07/25 at 5:55 P.M., the DON/designee reviewed all nursing schedules to determine where the possible breakdown occurred as part of the investigation. It was determined an agency nurse, LPN #139, was the nurse in charge of Resident #50 when the resident experienced a change in condition on 05/10/25. The staffing agency was notified by the DON that a do not return (DNR) notice was issued to LPN #139 for not notifying the physician for Resident #50's change in condition. On 07/07/25 at 6:04 P.M., the Medical Director (MD) was notified by the DON of the incident regarding Resident #50 and was made aware of the potential deficient practice. On 07/07/25, the DON and Registered Nurse (RN) #130 provided education to all clinical nursing staff and all members of the IDT regarding notification of change in condition, physician notification, and hydrating residents. The training was completed for all staff in person, via telephone and text messages, through electronic applications (OnShift), and staffing tool with all staff requiring return acknowledgement of the education. All education was completed by 07/07/25. On 07/07/25, the DON/designee completed a full house audit for all residents to review dietary orders and residents with liquid diet orders to ensure all orders were appropriate. No revisions were needed, and no concerns were identified. All audits were completed on 07/07/25. On 07/07/25, the DON/designee assessed all residents for signs and symptoms of dehydration and changes in condition. Any concerns were addressed immediately, and notification was given to the provider. All assessments were completed on 07/07/25. On 07/07/25, the DON/designee reviewed all resident medical records to review for any missed medications in the preceding weeks. Notification of any resident that missed medications was promptly provided to the physician. All reviews were completed on 07/07/25. On 07/07/25, the DON began education for agency staff through creating an agency binder. The binder will ensure agency staff are informed of the facility policies, and the schedule will be updated to indicate agency staff need to review the binder contents, including the policies related to dehydration, change in condition, and notification of change. A sign-in/in-service sheet was implemented to audit each agency staff completing the in-service. The agency binder will be monitored daily by the DON to ensure all agency staff have signed the acknowledgement of reviewing the binder contents when they are working in the facility. On 07/07/25, the facility implemented daily audits to review residents for change in condition and notification of any changes to be discussed through the facility morning clinical meetings. The audit information will be collected by the Administrator or the DON/designee during clinical rounds, nursing huddles, chart review, observation, and during clinical IDT meetings every 24 hours. The clinical morning meetings are a daily meeting held Monday through Friday. On 07/07/25, a QAPI performance improvement project (PIP) was implemented to review and interpret all audit findings. All findings will be discussed at the weekly ad hoc quality assurance and assessment (QAA) meeting for a minimum of four weeks to ensure compliance is maintained. The project will be completed by the Administrator, the DON/designee, and IDT members including RDO #01, Maintenance Director #401, Therapy Director #105, RN #131, Physician #150, RN #130, Scheduler #129, Business Office Manager #402, Activities Director #403, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 2 of 8 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 07/22/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Dietary Manager #405, and Housekeeper #410. On 07/07/25, two (#41 and #49) additional residents were reviewed for care and services provided, change in condition, and physician notifications with no concerns identified. On 07/08/25, the DON completed an audit of the agency binder and determined all agency staff working completed and signed the education provided by the facility. On 07/09/25, the DON completed an audit of one (#29) resident to review for hydration status concerns with no issues identified. On 07/09/25, the DON completed an audit of one (#32) resident to review for changes in condition with verification of a notification made to the physician.Although the Immediate Jeopardy was removed on 07/09/25, the facility remained out of compliance at Severity Level 2 (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility is still in the process of implementing their corrective action plan and monitoring to ensure on-going compliance. Findings include:Review of Resident #50's medical record revealed an admission date of 03/25/25. Diagnoses included bipolar disease with severe manic psychotic features, paranoid schizophrenia, suicidal ideation, diabetes mellitus, and moderate intellectual disabilities. Review of Resident #50's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a moderately intact cognition. The resident was assessed with no behaviors, was independent with eating, and had no swallowing issues.Review of Resident #50's physician advanced directive order dated 03/25/25 revealed the resident was a full code (full life-saving measures in the event of cardiac or respiratory arrest).Review of Resident #50's care plan dated 03/26/25 revealed she was a full code with an intervention to adhere to the desired code status. Review of Resident #50's care plan dated 03/28/25 revealed the resident had a nutritional problem or potential nutritional problem related to bipolar and brief psychotic disorder. Interventions included to monitor, document, and report as needed any signs of dysphasia (difficulty swallowing) including pocketing, choking, coughing, drooling, holding food in the mouth, several attempts at swallowing, refusing to eat, and appearing concerned during meals.Review of Resident #50's most recent nutrition assessment dated [DATE] revealed the resident was alert and verbal, independent for feeding herself, and on a regular diet.Review of Resident #50's ER documentation dated 05/06/25 revealed the resident was sent to the ER for altered mental status, hyperglycemia (elevated blood glucose levels), and dehydration. The resident was diagnosed with mild dehydration and hyperglycemia and was treated with intravenous (IV) fluids and returned to the facility with no new orders.Review of Resident #50's Certified Nurse Practitioner (CNP) #135 progress note dated 05/06/25 revealed the resident was seen to follow-up and to reassess. It was reported that the resident was not participating in therapy and had an increase in overall physical weakness and lack of orientation. A neurological assessment was completed, and the resident was found to be unable to perform certain tasks. Resident #50 took two bites of food at lunch, and it took her 15 minutes to swallow. Due to this condition, the resident was sent to the local hospital. A head computed tomography (CT), urinalysis, and chest x-ray were completed and found to be negative. Laboratory values showed mild dehydration, and IV fluids were administered as well as insulin for a blood sugar of 400 milligrams per deciliter (mg/dL). Nursing was to continue with neurological checks with their assessments, obtain daily vital signs, and to continue with weights. Nursing was also informed to call the on-call provider for any changes in Resident #50's condition.Review of Speech Therapist (ST) #138's evaluation and treatment plan for Resident #50 dated 05/08/25 revealed a swallow study was completed that day. Due to physical impairments and associated functional deficits, Resident #50 was at risk for aspiration (inhalation of a substance [like food, liquid, or other foreign material] into the airway and lungs, instead of being swallowed into the esophagus) and further decline in function. It was recommended the resident begin a pureed consistency diet with thin liquids by cup. The resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 3 of 8 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 07/22/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few must sit in an upright position during meals and upright posture for more than 30 minutes after meals.Review of Resident #50's intake documentation dated 05/08/25 at 10:50 A.M. (late entry) and on 05/08/25 at 5:34 P.M. revealed the resident refused food and drink for each meal and an alternate meal option was offered.Review of Resident #50's intake documentation dated 05/09/25 at 8:50 A.M., 3:03 P.M. (late entry), and 5:25 P.M., revealed the resident ate between zero (0) percent (%) and 25% of each of the three meals and the resident drank 120 milliliters (mL) for breakfast and 20 mL at both lunch and supper meals. The section for offering the resident an alternate meal option was documented as Not Applicable for all three meals on 05/09/25. Review of Resident #50's intake documentation dated 05/10/25 at 9:54 A.M. and 4:01 P.M. (late entry) revealed the resident refused food and drink at both meals and an alternate meal option was offered. Review of an intake documented 05/10/25 at 5:41 P.M. revealed Resident #50 ate between 76% and 100% of the meal and drank 240 mL of fluids with the meal. Review of a physician order dated 05/10/25 revealed Resident #50 was ordered a regular diet with pureed texture and nectar thickened consistency fluids.Review of Resident #50's May 2025 medication administration record (MAR) revealed on 05/10/25 at 10:00 P.M., the resident's blood glucose level was 202 mg/dL, and she was treated with four (4) units of rapid acting insulin. Further review of the May 2025 MAR revealed on 05/10/25 the resident did not receive the cholesterol-lowering medication rosuvastatin calcium, the antidepressant medications trazodone and sertraline (Zoloft), the antipsychotic Risperdal, nor the mood stabilizer lithium carbonate as ordered due to swallowing difficulties.Review of Resident #50's nursing progress notes dated 05/10/25 revealed the resident was unable to take her evening medication due to swallowing difficulties. Further review of a nursing progress note dated 05/10/25 at 10:45 P.M. revealed the resident was lying in bed with her eyes closed. The resident was alert with confusion, and her medications were held due to increased swallowing difficulty. Resident #50's lungs were clear to auscultation and bowel sounds were present in all four (abdominal quadrants). Further review of Resident #50's medical record dated 05/09/25 and 05/10/25 revealed the record was absent regarding notification to a physician or CNP regarding the resident's change of condition now having swallowing difficulties and refusing to eat. There were no documented observations of Resident #50 in the medical record until 05/11/25. Review of Resident #50's nursing progress notes on 05/11/25 at 7:12 A.M. revealed LPN #136 was called to Resident #50's room by a certified nurse aide (CNA) who stated the resident was unresponsive. The resident appeared to be lethargic and was responding slowly to verbal stimuli. The resident's blood pressure was 85/68 milligrams of mercury (mmHg), and pulse was 46 beats per minute. Resident #50 was transferred to the local hospital via stretcher with EMS at 5:59 A.M.Review of Resident #50's situation, background, appearance, and review (SBAR) communication form completed by the DON and dated 05/11/25 revealed the resident had an altered mental status which stayed the same and the condition had not happened before. The resident's blood pressure was 110/62 mmHg, pulse was 96 beats per minute with an apical heart rate of 80 beats per minute, respirations were 18 breaths per minute, temperature was 97.9 degrees Fahrenheit (F), and the most recent weight was 144 pounds on 05/05/25. Resident #50 had an altered level of consciousness, needed more assistance with activities of daily living, and had difficulty swallowing. The resident was unresponsive and was sent to the ER.Review of the EMS run report dated 05/11/25 revealed the unit received a call regarding Resident #50 at 5:38:54 A.M. for a diabetic problem related to Resident #50 and was dispatched at 5:39:49 A.M. Upon arrival to the facility at 5:45:09 A.M., Resident #50 was lying supine (flat on the back facing upward) in bed. At 5:48 A.M., an assessment was completed of Resident #50 by EMS staff, and the resident was noted to be unresponsive to all stimuli. The resident's eyes were dry, and her lips were dry and cracking. Dried vomit was noted on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 4 of 8 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 07/22/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #50's mouth and it was also agape (wide open). The resident's respirations were noted to be shallow and rapid with accessory muscles used. At 5:49 A.M., Resident #50 was unresponsive, and her pulse was 110 beats per minute, respirations were 27 breaths per minute, oxygen saturation was 65% on room air, blood glucose was 393 mg/dL, and EMS was not able to obtain a blood pressure. At 5:51 A.M., Resident #50's blood pressure was 40/26 mmHg, and the heart rate was 107 beats per minute. EMS staff continued to obtain Resident #50's vital signs through 6:09 A.M. and noted the resident's oxygen saturation rate improved with supplemental oxygen, respiration and heart rate were lowered, the resident's blood pressure improved to 75/45 mmHg, and the resident's temperature was obtained at 6:00 A.M. and found to be 103.7 degrees F. Resident #50 remained unresponsive throughout the entire time EMS was providing services. The facility staff stated her blood sugar was high and she was not really responding. The staff stated Resident #50 had been like this for the last two (2) days. The staff reported the resident was transferred to the ER on [DATE] and returned to the facility because everything was fine. The facility staff stated Resident #50 was not given her daily medications because she would not swallow. The staff could not tell the EMS staff how long Resident #50 had been unresponsive or the last time she was well. EMS staff transported Resident #50 to the hospital at 6:08:24 A.M. and arrived at the hospital at 6:20:00 A.M. Review of Resident #50's ER report dated 05/11/25 revealed the resident came from the nursing home facility with concerns of altered mental status. Per EMS, the resident was unresponsive for two days with gradually worsening mental status. Upon EMS arrival, Resident #50's oxygen level was saturated at 55% on room air. The resident initially responded to the supplemental oxygen but then lost respiratory effort shortly upon entering the ambulance, and they transported her with bag-valve-mask (BVM) ventilation. Upon arrival at the hospital, Resident #50 was unresponsive and was being ventilated with BVM. Resident #50 was chronically ill appearing, jaundiced (unnaturally yellowed skin complexion) and pale, and unresponsive. The resident was also noted with poor dentition, vomitous, and dried mucous membranes. Resident #50's pupils were three (3) millimeters (mm) in diameter and non-reactive bilaterally. The resident exhibited bradycardia (slow heartbeat) and bradypnea (abnormally slow breathing). The resident was noted to have an intraosseous (IO) device (a needle inserted into the bone marrow cavity to deliver fluids, medications, or blood products) in the left shin. Resident #50 arrived at the hospital with worsening altered mental status to the point of unresponsiveness starting 2 days ago. The resident arrived at the ER with poor respiratory effort requiring BVM ventilation. The resident was initially bradycardic in the 20s (heart beats per minute) on the monitor and quickly decompensated to asystole (no heartbeat). Cardiopulmonary resuscitation was in progress with medications and defibrillation per advanced cardiac life support (ACLS) protocol. The resident was intubated with a central line placed. Resident #50 received 36 minutes of critical care including medications and one shock without success and the resident was pronounced dead at 6:48 A.M. on 05/11/25. Further review of the hospital notes revealed on 05/11/25 at 7:08 A.M. the coroner's office was briefed on the case, and it was determined Resident #50's death would be a Coroner's case. Review of the County Coroner's office investigator's report dated 05/11/25 revealed Resident #50 expired in the local ER. The ER staff were unable to start intravenous (IV) access in the resident's left or right antecubital (the inner side of the elbow) due to dehydration. Resident #50's sclera (the white outer coating of the eye) in both eyes was dry, and her lips and mouth were dry. Review of the County Coroner's office Report of Death, with an investigation date of 05/11/25 and a submission date of 06/04/25, revealed EMS was summoned to the facility on [DATE] at 5:45 A.M. for an unresponsive female resident (#50). The EMS began their assessment at 5:49 A.M. and the resident was transferred to the local hospital and arrived at 6:20 A.M. Resident #50 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 5 of 8 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 07/22/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few observed unresponsive by staff at the nursing home in the early morning hours of 05/11/25. The CNP ordered her to be transferred to the local hospital. The EMS found the resident to be breathing but unconscious on arrival. They also suspected septic shock. On transport to the local hospital, the resident went into cardiac arrest. The resident was pronounced dead at 6:48 A.M. on 05/11/25. Resident #50 had sores on her lips, her tongue and her mouth were very dry, and her sclera was dry. The resident's dentition and dental hygiene were poor. There was some smeared blood on the right anterior thigh from the insertion of a femoral vein IV. Interview by the County Coroner with the DON at the nursing home facility revealed, on 05/05/25, Resident #50 was sent to the local hospital, and she had a chest x-ray, CT scan, and laboratory draws, and returned to the nursing home without new orders. Further review revealed the facility nurses interviewed, which included the DON, revealed Resident #50's condition failed to improve. The DON stated Resident #50's blood glucose had risen to over 400 mg/dL at one point. The facility staff stated Resident #50's blood glucose levels were difficult to control even with new orders given by the CNP. It was reported the resident's food intake was below average. After consultation with the County Coroner and the ER physician, there was probable cause to believe that the acute care of Resident #50 may have been delayed, allowing a decline in her condition.Review of an email from a local County Coroner's office to County Coroner Investigator (CCI) #01, dated 07/01/25, revealed Resident #50 was obtunded (a dulled or reduced level of alertness or unconsciousness) for several days prior to her terminal admission to the hospital, which was consistent with acute pneumonia. Postmortem concentrations of sertraline (metabolite desmethylsertraline) are both elevated. Further the metabolite was much higher than would be expected relative to the concentration of the parent compound. The reason for that discrepancy (underlying metabolic problem, or abnormal metabolism because of her dehydration slash malnutrition state) was unknown. Additionally, interpretation was complicated because the medical records are unclear as to how long the medications (specifically sertraline) had been held prior to Resident #50's demise. It does appear her terminal events are related both to malnutrition/dehydration and perhaps also toxicity of sertraline, with her underlying developmental delay as an overarching problem. But the extent to which each of those factors contribute, and which factor(s) initiated the lethal sequences unknown. As such, the cause and manner of death are best classified as undetermined.Interview with CNA #122 on 07/02/25 at 6:55 A.M. revealed she did not take care of Resident #50 on 05/11/25, but she was working with other residents that night (05/10/25) when Resident #50's assigned CNA informed her the resident was barely breathing. CNA #122 stated the nurse aides reported this to the nurse, and she was aware Resident #50 had been declining for a couple days and was having trouble swallowing.Interview with CCI #01 on 07/02/25 at 9:16 A.M. revealed Resident #50's preliminary Coroner's report and result of death could not be determined. CCI #01 stated there was an elevated level of sertraline which may have been due to dehydration.Telephone interview with Physician #150 on 07/02/25 at 9:54 A.M. revealed Resident #50 was sent to the hospital several days prior to her death for dehydration and hyperglycemia but was sent back to the facility. Physician #150 stated he did not send her to the hospital on [DATE] and the facility had failed to inform him of her further decline between 05/09/25 and 05/11/25.Interview on 07/02/25 at 3:00 P.M. with local EMS Chief #222, EMS Lieutenant #224, and EMS Paramedic #225 revealed they were on scene when EMS was dispatched to the facility for Resident #50 in the early morning of 05/11/25. EMS Paramedic #225 stated the EMS staff were informed by the facility floor nurse that Resident #50's blood sugar was off and elevated, and she was not responding. The emergency responders asked how long the resident had been in that condition, and the facility staff were unable to answer. When the rescue team entered Resident #50's room her mouth was agape, and she was wearing a brief (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 6 of 8 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 07/22/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few which appeared to be old, but it was dry. The staff gave them a packet of papers for the hospital. The lead nurse informed the paramedics Resident #50 had been unable to swallow for a couple of days and no medications had been administered. Vital signs were decreasing at the scene, so the paramedics began providing bagging (providing artificial breaths) the resident due to her being unresponsive and being unable to find a blood pressure or radial pulse. The paramedics began an IO infusion due to the resident being severely dehydrated, they were unable to access a vein. The paramedics reported Resident #50's mouth and tongue were very dry. EMS Lieutenant #224 stated Resident #50's eyes were so dry they were gel-like. EMS Lieutenant #224 continued that Resident #50 had labored respirations and had very little vascularity. Soon after EMS arrived at the local hospital from the facility Resident #50 died. EMS Chief #222 stated after receiving the report from his crew he immediately contacted Adult Protective Services to report the resident's condition.Telephone interview with LPN #136 on 07/07/25 at 9:37 A.M. revealed she worked on 05/10/25 at 11:00 P.M. and relieved an agency nurse that had worked from 7:00 P.M. to 11:00 P.M. LPN #136 stated the agency nurse cared for Resident #50 the previous four hours. LPN #136 revealed, during the nursing report, she was told Resident #50 had been declining for two days and was found to be moderately dehydrated and had an elevated blood sugar at the hospital on [DATE]. LPN #136 continued that at approximately 5:00 A.M. on 05/11/25, two CNAs informed her Resident #50 was unresponsive. LPN #136 stated she immediately went to the resident's room but could not obtain vital signs, then contacted the nurse manager who informed her to contact the DON. LPN #136 called for EMS, who quickly arrived, and transported the resident to the hospital. LPN #136 stated she had no idea the resident was unable to swallow and was not administered medications on the prior shift and stated she received a poor report from the agency nurse.Telephone interview with CNP #134 on 07/07/25 at 1:46 P.M. revealed she ordered sliding scale insulin for Resident #50 on 05/08/25 due to elevated blood sugars, and that was the last time she examined the resident prior to her death. CNP #134 stated, on 05/11/25 at approximately 6:00 A.M., she received a telephone call from LPN #136. The LPN was extremely upset and stated Resident #50 was sent to the hospital due to her being unresponsive. CNP #134 stated LPN 136 told her she was given a poor report from the off-going nurse on the previous shift about Resident #50 and had no idea the resident was declining so quickly. Further interview with CNP #134 revealed none of the facility staff informed her that Resident #50 was unable to swallow or having swallowing difficulties in the days before her death. Interview with the DON on 07/07/25 at 2:35 P.M. revealed the facility failed to keep track of Resident #50's intake and output because there was no physician order to do so even after returning from the hospital diagnosed with dehydration on 05/08/25. The DON subsequently provided intake records for Resident #50 but no output records. Review of the facility policy titled, Resident Hydration and Prevention of Dehydration, revised October 2017, revealed the facility will strive to provide adequate hydration and to prevent and treat dehydration. The dietitian will assess all residents for hydration as part of the comprehensive assessment, at least quarterly, and more often as necessary per resident need. Nurses will assess for signs and symptoms of dehydration during daily care. If potential inadequate intake and/or signs and symptoms of dehydration are observed, intake and output monitor will be initiated and incorporated into the care plan. Activities of Daily Living (ADLs) status, diagnosis, individual preference, habits, and cognitive and medical status will be considered in all interventions. The physician will be notified.Review of the facility policy titled, Change in a Residents Condition or Status, revised February 2021, revealed the facility promptly notifies the resident, his or her attending physician, and the residents' representative of changes in the resident's medical/mental condition and/or status. The nurse will notify the resident's attending physician or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 7 of 8 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 07/22/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety physician on call when there has been a significant change in the resident's physical/emotional/mental condition. A significant change of condition is a major decline or improvement in the resident's status that will not normally resolve itself without intervention by staff or implementing standard disease related clinical interventions.This deficiency represents non-compliance investigated under Master Complaint Number OH00166094 (iQIES Complaint Number 1356449). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366081 If continuation sheet Page 8 of 8