Health inspection·February 15, 2024

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the medical record revealed no documented evidence the resident had six stage I pressure ulcers. Observation on 02/12/24 at 1:06 P.M. of State Tested Nursing Assistant (STNA) #170 provide incontinence care for Resident #80 revealed the resident entered the room and gained permission to provide care. The STNA set-up the required supplies, washed her hands and donned gloves. The STNA cleansed the resident from font to back using a different section of a soapy washcloth. The STNA rinsed in the same manner and pat dry. The STNA turned the resident onto her right side and cleansed the resident's anal area and buttocks in the same manner. The resident had scattered light pink areas to the resident's labia and buttocks. STNA #170 revealed the resident had a topical yeast infection and the scattered pink areas was residual. The STNA revealed the resident had not had any pressure ulcers since being admitted to the facility. On 02/12/24 at 3:46 P.M., interview with the Director of Nursing (DON) revealed she completed the second skin sweep on the Resident #80 and she had no pressure. 2. Review of the medical record for Resident #79 revealed an initial admission date of 10/05/23 with the diagnoses including anoxic brain damage, respiratory failure, disorder of the autoimmune nervous system, nondisplaced posterior arch fracture of first cervical vertebra, fracture of shaft of right fibula, fracture of shaft of left tibia, gastrostomy and tracheostomy. Review of the resident's weekly wound observation dated 10/10/23 revealed the wound documented was blank for wound number one. Review of the resident's progress notes from 10/10/23 to 10/12/23 revealed no documented evidence of what type of wound the resident developed, location or assessment of the wound. Review of the resident's comprehensive MDS assessment dated [DATE] revealed the resident was rarely/never understood and had a severe cognitive deficit. The resident was dependent on staff for activities of daily living. The assessment indicated the resident was frequently incontinent of bladder and always incontinent of bowel. The resident was assessed as being at high risk for skin breakdown and had no unhealed pressure ulcers/injury. The facility implemented the interventions pressure reducing device for chair/bed, turning/repositioning program, nutrition or hydration intervention to manage skin problems, application of nonsurgical dressing and application of ointments/medications other than to feet. Review of the plan of care dated 10/12/23 revealed the resident had a pressure ulcer related to immobility. Interventions included administer medications as ordered, administer treatments as ordered, assess/record/monitor wound healing, measure length, width and depth where possible, assess and document the status of wound perimeter, wound bed and healing progress, report improvements and declines to the physician, monitor dressing to ensure it is intact and adhering, report lose dressing to treatment nurse, monitor nutritional status, served diet as ordered, monitor intake and record. Review of the nutrition progress note dated 10/12/23 at 4:14 P.M. revealed the Registered Dietician (RD) was updated on skin review during Interdisciplinary Team (IDT) meeting on this date. The resident enteral nutrition remains sufficient to meet wound healing needs as was calculated into enteral nutritional needs on admission. No changes were recommended at that time. Review of the weekly wound observations revealed no weekly skin assessment for the wound for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 2 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 0641 10/17/24 for wound number one. Level of Harm - Minimal harm or potential for actual harm Review of the weekly wound observation dated 10/24/23 revealed the assessment was blank for wound number one. Residents Affected - Few Review of the resident's discontinued physician orders identified an order dated 10/06/23 to cleanse the stage II pressure ulcer (Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough or bruising. May also present as an intact or open/ ruptured blister.) to the posterior left upper thigh with normal saline (NS) and leave open to air daily and 10/12/23 cleanse the stage II pressure ulcer to the posterior left upper thigh with NS, pack with saline moisten gauze and cover with a dry clean dressing daily at bedtime for pressure injury. On 02/13/23 at 3:31 P.M., interview with the Unit Manager (UM) #160 verified the resident was admitted to the facility with a stage II pressure ulcer to the left posterior upper thigh. UM #160 revealed she opened the weekly wound observation dated 10/10/23. The UM verified the resident had no documented assessment of the stage II pressure ulcer to the posterior left upper thigh. The UM revealed the stage II pressure ulcer to the left posterior upper thigh was healed on 10/24/23. This was an incidental finding discovered during investigation for Complaint Number OH00150351 and OH00150080. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 3 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interview and facility policy review, the facility failed to develop a comprehensive plan of care for residents in the area of skin and eating. This affected two (Resident #33 and #73) of four sampled residents. The facility census was 83. Findings Include: 1. Review of the medical record for Resident #33 revealed an initial admission date of 09/21/23 with the latest readmission of 12/21/23 with the diagnoses including alcohol abuse, falls, cerebrovascular accident with left sided hemiplegia, generalized muscle weakness, difficulty in walking, gastro-esophageal reflux disease, hypertension, unsteadiness on feet, muscle wasting and atrophy, hyperlipidemia, cognitive communication deficit, dysphagia and benign prostatic hyperplasia (BPH). Review of the nursing admit/readmit care plan dated 09/21/23 revealed the resident was admitted to the facility with no skin issues. Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had no cognitive deficit. The assessment indicated the resident had one venous stasis ulcer. Review of the medical record revealed no plan of care addressing the resident's venous stasis ulcer to his legs. Review of the medical record revealed no documented evidence the resident had any venous stasis ulcer to his legs. Review of the photographs dated 12/17/23 at 5:30 P.M., revealed the resident's leg was noted to have five various sized open pink wounds to his lower shin. The resident also had two blackish yellow scabbed areas to the left lower shin. One scab was located above the open pink wounds and one was located to the inner side of the leg. The resident also had thee various sized open pink wound to the back of the leg. The resident's lower leg was dry and flaky. Review of the progress note dated 12/17/23 at 7:12 P.M., authored by Licensed Practical Nurse (LPN) #180 revealed at 5:30 P.M. the family notified the nurse about the wounds and swelling to the resident's left lower leg and the family requested the resident be sent to the local emergency room (ER). The physician was notified and order to send him per family request. Review of the progress note dated 12/17/23 at 7:44 P.M., authored by Registered Nurse (RN) #102 revealed the granddaughter came to the facility and notified the nurse regarding the resident's open blister. The resident developed a fluid filled blister and it opened up. The nurse spoke with granddaughter regarding wound care coming into facility weekly, however daughter and granddaughter wanted the resident sent to the local ER. The physician was notified and the resident was transported to the local hospital at 7:00 P.M. On 02/13/24 at 2:00 P.M., interview with the Director of Nursing (DON) verified the resident had no plan of care addressing the resident's venous stasis ulcer. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 4 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2. Review of the medical record for Resident #73 revealed an initial admission date of 07/21/23 with the latest readmission of 09/22/23 with the diagnoses including encephalopathy, human immunodeficiency virus (HIV), decreased white blood cell count, generalized muscle weakness, cognitive communication deficit, dysphagia, asthma and muscle wasting and atrophy. Review of the resident's quarterly MDS assessment dated [DATE] revealed the resident had a severe cognitive deficit. Review of the monthly physician orders for February 2024 identified orders dated 12/28/23 regular pureed diet with special instructions for one on one supervision/assistance from caregivers/staff. Review of the resident's plan of care revealed no care plan addressing the resident's eating assistance and special instructions for supervision. Review of the progess note dated 01/20/24 at 1:38 P.M. revealed the family was informed State Tested Nursing Assistant (STNA) #170 fed the resident a gummie candy despite the fact the resident's physician ordered diet was regular pureed. On 02/07/24 at 9:03 A.M., interview with the DON verified the resident had no plan of care addressing the resident's special instructions for eating. Review of the facility policy titled, Comprehensive Person Centered Care Plan, dated 12/16 revealed the Interdisciplinary Team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. This deficiency represents non compliance investigated under Complaint Number OH00150589 and OH00150080. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 5 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews, the facility failed to identify, assess, monitor and implement interventions for Resident #33 who had multiple stasis ulcers. This affected one (Resident #33) of three residents reviewed for wounds. The facility census was 83. Residents Affected - Few Findings Include: Review of the medical record for Resident #33 revealed an initial admission date of 09/21/23 with the latest readmission of 12/21/23 with the diagnoses including alcohol abuse, falls, cerebrovascular accident with left sided hemiplegia, generalized muscle weakness, difficulty in walking, gastro-esophageal reflux disease, hypertension, unsteadiness on feet, muscle wasting and atrophy, hyperlipidemia, cognitive communication deficit, dysphagia and benign prostatic hyperplasia (BPH). Review of the nursing admit/readmit no care plan dated 09/21/23 revealed the resident was admitted to the facility with no skin issues. Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had no cognitive deficit. The assessment indicated the resident had one venous stasis ulcer. Review of the medical record revealed no plan of care addressing the resident's venous stasis ulcer to his legs. Review of the medical record revealed no documented evidence the resident had any venous stasis ulcer to his legs. Review of the photographs dated 12/17/23 at 5:30 P.M., the resident's leg was noted to have five various sized open pink wounds to his lower shin. The resident also had two blackish yellow scabbed areas to the left lower shin. One scab was located above the open pink wounds and one was located to the inner side of the leg. The resident also had thee various sized open pink wound to the back of the leg. The resident's lower leg was dry and flaky. Review of the progress note dated 12/17/23 at 7:12 P.M., authored by Licensed Practical Nurse (LPN) #180 revealed at 5:30 P.M. the family notified the nurse about the wounds and swelling to the resident's left lower leg and the family requested the resident be sent to the local emergency room (ER). The physician was notified and order to send him per family request. Review of the progress note dated 12/17/23 at 7:44 P.M., authored by Registered Nurse (RN) #102 revealed the granddaughter came to the facility and notified the nurse regarding the resident's open blister. The resident developed a fluid filled blister and it opened up. The nurse spoke with granddaughter regarding wound care coming into facility weekly, however daughter and granddaughter wanted the resident sent to the local ER. The physician was notified and the resident was transported to the local hospital at 7:00 P.M. On 02/13/24 at 2:00 P.M., interview with the Director of Nursing (DON) verified the resident's wounds were not identified, assessed, monitored or interventions implemented to treat the wounds to the resident's lower legs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 6 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 This deficiency represents non-compliance investigated under Complaint Number OH00150351 and Complaint Number OH00150080. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 7 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 observation, record review, interviews and facility policy review, the facility failed to ensure an initial comprehensive wound assessment and subsequent wound assessments were conducted as required for one resident (#79) with a stage II (Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough or bruising. May also present as an intact or open/ ruptured blister.). This affected one ( Resident #79) of three residents reviewed for wounds. The facility census was 83. Residents Affected - Few Findings Include: Review of the medical record for Resident #79 revealed an initial admission date of 10/05/23 with the diagnoses including anoxic brain damage, respiratory failure, disorder of the autoimmune nervous system, nondisplaced posterior arch fracture of first cervical vertebra, fracture of shaft of right fibula, fracture of shaft of left tibia, gastrostomy and tracheostomy. Review of the resident's Braden scale dated 10/05/23 revealed a score of eight indicating the resident was at high risk for skin breakdown. Review of the resident's admission nursing admit/readmit care plan assessment dated [DATE] revealed the resident was admitted to the facility with no skin issues. Review of the resident's weekly wound observation dated 10/10/23 revealed the wound documented was blank for wound number one. Review of the resident's progress notes from 10/10/23 to 10/12/23 revealed no documented evidence of what type of wound the resident developed, location or assessment of the wound. Review of the resident's comprehensive minimum data set (MDS) assessment dated [DATE] revealed the resident was rarely/never understood and had a severe cognitive deficit. The resident was dependent on staff for activities of daily living. The assessment indicated the resident was frequently incontinent of bladder and always incontinent of bowel. The resident was assessed as being at high risk for skin breakdown and had no unhealed pressure ulcers/injury. The facility implemented the interventions pressure reducing device for chair/bed, turning/repositioning program, nutrition or hydration intervention to manage skin problems, application of nonsurgical dressing and application of ointments/medications other than to feet. Review of the plan of care dated 10/12/23 revealed the resident had a pressure ulcer related to immobility. Interventions included administer medications as ordered, administer treatments as ordered, assess/record/monitor wound healing, measure length, width and depth where possible, assess and document the status of wound perimeter, wound bed and healing progress, report improvements and declines to the physician, monitor dressing to ensure it is intact and adhering, report lose dressing to treatment nurse, monitor nutritional status, served diet as ordered, monitor intake and record. Review of the nutrition progress note dated 10/12/23 at 4:14 P.M. revealed the Registered Dietician (RD) was updated on skin review during Interdisciplinary Team (IDT) meeting on this date. The resident enteral nutrition remains sufficient to meet wound healing needs as was calculated into enteral nutritional needs on admission. No changes were recommended at that time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 8 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 Review of the weekly wound observations revealed no weekly skin assessment for the wound for 10/17/23 for wound number one. Review of the weekly wound observation dated 10/24/23 revealed the assessment was blank for wound number one. Residents Affected - Few Review of the resident's discontinued physician orders identified an order dated 10/06/23 to cleanse the stage II pressure ulcer to the posterior left upper thigh with normal saline (NS) and leave open to air daily and 10/12/23 cleanse the stage II pressure ulcer to the posterior left upper thigh with NS, pack with saline moisten gauze and cover with a dry clean dressing daily at bedtime for pressure injury. On 02/13/23 at 3:31 P.M., interview with the Unit Manager (UM) #160 verified the resident was admitted to the facility with a stage II pressure ulcer to the left posterior upper thigh. UM #160 revealed she opened the weekly wound observation dated 10/10/23. The UM verified the resident had no documented assessment of the stage II pressure ulcer to the posterior left upper thigh. The UM revealed the stage II pressure ulcer to the left posterior upper thigh was healed on 10/24/23. Review of the facility policy titled, Prevention of Pressure Ulcer/Injuries, dated 07/17 revealed assess the resident on admission for existing pressure ulcer/injury risk factors. Conduct a comprehensive skin assessment upon admission. This deficiency represents non-compliance investigated under Complaint Number OH00150351 and Complaint Number OH00150080. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 9 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 0687 Provide appropriate foot care. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure one resident (#33) received routine podiatry care. This affected one (Resident #33) of three reviewed for podiatry care. The facility census was 83. Residents Affected - Few Findings Include: Review of the medical record for Resident #33 revealed an initial admission date of 09/21/23 with the latest readmission of 12/21/23 with the diagnoses including alcohol abuse, falls, cerebrovascular accident with left sided hemiplegia, generalized muscle weakness, difficulty in walking, gastro-esophageal reflux disease, hypertension, unsteadiness on feet, muscle wasting and atrophy, hyperlipidemia, cognitive communication deficit, dysphagia and benign prostatic hyperplasia (BPH). Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had no cognitive deficit. The assessment indicated the resident had one venous ulcer. Review of the medical record revealed no documented evidence the resident had received podiatry care since being admitted to the facility. On 02/07/24 at 11:50 A.M., observation of Resident #33 revealed the resident's toenails on the right and left first toe were long, thick and green in color. Interview with the resident at the time of the observation revealed his family complained about his toenails and someone came in and cut all of them but his big toes. The resident revealed the facility said he would have to wait for the podiatrist to come to the facility to cut his big toes. On 02/07/24 at 3:02 P.M., interview with the Director of Nursing (DON) verified the facility had not provided routine podiatry care for Resident #33. This deficiency represents non-compliance investigated under Complaint Number OH00150080. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 10 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews and facility policy review, the facility failed to ensure one resident (#73) was not provided food inconsistent with the physician ordered diet. This affected one of thee sampled residents reviewed for special diets. The facility census was 83. Residents Affected - Few Findings Include: Review of the medical record for Resident #73 revealed an initial admission date of 07/21/23 with the latest readmission of 09/22/23 with the diagnoses including encephalopathy, human immunodeficiency virus (HIV), decreased white blood cell count, generalized muscle weakness, cognitive communication deficit, dysphagia, asthma and muscle wasting and atrophy. Review of the resident's quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. Review of the monthly physician orders for February 2024 identified orders dated 12/28/23 regular pureed diet with special instructions for one on one supervision/assistance from caregivers/staff. Review of the resident's plan of care revealed no care plan addressing the resident's eating assistance and special instructions for supervision. Review of the progress note dated 01/20/24 at 1:38 P.M. revealed the family was informed State Tested Nursing Assistant (STNA) #170 fed the resident a gummie candy despite the fact the resident's physician ordered diet was regular pureed. On 02/07/24 at 9:03 A.M., interview with the Director of Nursing (DON) verified the resident was given a gummie candy that was not consistent with the physician ordered diet of regular pureed diet. This deficiency represents non-compliance investigated under Complaint Number OH00150589. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 11 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 0729 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Verify that a nurse aide has been trained; and if they haven't worked as a nurse aide for 2 years, receive retraining. Based on nurse aide registry review, time punch detail review and staff interview, the facility failed to ensure one State Tested Nursing Assistant (STNA) nurse aide registry was in good standing. This affected one out of three personnel files reviewed and had the potential to affect all 83 residents residing in the facility. Findings Include: Review of the nurse aide registry for STNA #130 dated 02/07/24 revealed the STNA was not in good standing and was not eligible to work. Further review revealed STNA #130 had not changed her name on the nurse aide registry following a name change. Review of STNA #130's time punch card from 01/21/24 to 02/05/24 revealed the STNA was hired on 02/02/23. Further review revealed STNA #130 worked full time and last worked on 02/05/24 with the registry not in good standing and not eligible to work. On 02/07/24 at 2:32 P.M., interview with the Human Resource Director (HRD) verified STNA #130's nurse aide registry was not in good standing and she was not eligible to work. The HRD verified STNA #130 was employed full time and had been working when not eligible. This deficiency represents non-compliance investigated under Complaint Number OH00150479. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 12 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to maintain infection control practices to prevent the potential spread of infection during wound dressing change for one resident (#33). This affected one ( Resident #33) of three residents reviewed for wounds. The facility census was 83. Residents Affected - Few Findings Include: Review of the medical record for Resident #33 revealed an initial admission date of 09/21/23 with the latest readmission of 12/21/23 with the diagnoses including alcohol abuse, falls, cerebrovascular accident with left sided hemiplegia, generalized muscle weakness, difficulty in walking, gastro-esophageal reflux disease, hypertension, unsteadiness on feet, muscle wasting and atrophy, hyperlipidemia, cognitive communication deficit, dysphagia and benign prostatic hyperplasia (BPH). Review of the resident's admit/readmit plan of care dated 12/21/23 revealed the resident was readmitted to the facility with a vascular wound to the left lower rear leg and left lower front leg. The assessment contained no measurements or description of the wounds. Review of the resident's plan of care revealed no care plan addressing the resident's wounds to his legs. Review of the weekly wound assessment dated [DATE] revealed the stasis ulcer identified on 12/26/24 to the left anterior lower leg had worsened and measured 10.0 cm by 23.0 cm by 0.1 cm. The wound was describes as being 100% pink with a small amount of serosanguinous drainage. The wound treatment was changed to cleanse the left lower leg with soap and water, apply xeroform and ABD pad, wrap with Kerlix and ace wrap daily and as needed. The WNP will continue to follow weekly. Review of the weekly wound assessment dated [DATE] revealed the stasis ulcer identified on 12/26/23 to the resident's right anterior lower leg measured 1.0 cm by 1.0 cm by 0.2 cm and was 100% granulation tissue with a small amount of serosanguinous drainage. The facility implemented the treatment cleanse right anterior lower leg with soap and water, apply xeroform, cover with ABD pad, wrap with Kerlix and ace wrap daily and as needed. Review of the resident's monthly physician orders for February 2024 identified orders 12/28/23 cleanse left lower leg with soap and water, pat dry apply ammonium lactate every shift for wound care, 02/12/24 cleanse right great toe with normal saline (NS), apply betadine, ABD pad and wrap with Kerlix daily and as needed for wound care, cleanse the left lower leg with soap and water, apply Xeroform, cover with ABD pad and wrap with Kerlix and acre wrap daily and as needed and cleanse the right anterior lower leg with soap and water, apply Xeroform, cover with ABD pad and wrap with Kerlix and acre wrap daily and as needed. On 02/12/24 at 11:08 A.M., observation of Licensed Practical Nurse (LPN) #180 and Registered Nurse (RN) #102 revealed the staff entered the resident's room and used a clear plastic trash bag as a barrier on the resident's bedside table. LPN #180 placed the required supplies on the barrier. The nurses washed their hands and donned gloves. LPN #180 obtained to pink basins of water and placed the basins on the floor in front of the resident's chair. The LPN then removed the soiled dressing from the resident's right leg. The LPN then removed the soiled dressing to the left leg. The resident was noted to have multiple wounds to both legs. The LPN then washed her hands and donned gloves. The LPN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 13 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 Residents Affected - Few then cleansed the left leg with soap and water using a washcloth and one of the basins of water. The LPN then moved to the right leg and cleansed the right leg with soap and water using the same gloves. LPN #180 then cleansed a newly noted wound between the first and second toe using the same washcloth used to clean the wounds on the right leg. The LPN then washed her hands and donned gloves and set-up the required supplies. The LPN then sanitized her hands and donned gloves. The LPN then covered the wound to the left leg with Xerofoam and then covered the right leg with Xerofoam using the same gloves. The LPN then covered the left leg with an ABD pad and wrapped with Kerlix and an ace wrap. The LPN then moved to the right leg using the same gloves covered the wounds with ABD pad and wrapped with Kerlix and an ace wrap. On 02/12/24 at 11:34 A.M., interview with LPN #180 and RN #102 verified the treatment to the right and left leg was completed together instead of separate creating the potential to spread infection from one wound to the other wound. This deficiency represents non compliance investigated under Complaint Number OH00150080. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 14 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, interviews and facility policy review, the facility failed to ensure one resident's (#73) call light was in working order. This affected one ( Resident #73) of three residents reviewed for call lights. The facility census was 83. Residents Affected - Few Findings Include: Review of the medical record for Resident #73 revealed an initial admission date of 07/21/23 with the latest readmission of 09/22/23 with the diagnoses including encephalopathy, human immunodeficiency virus (HIV), decreased white blood cell count, generalized muscle weakness, cognitive communication deficit, dysphagia, asthma and muscle wasting and atrophy. Review of the resident's quarterly minimum data set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. On 02/07/24 at 4:12 P.M., observation of Resident #73's call light system revealed the emergency light was activated in the bathroom and the call light was not activated outside of the room. Further observation revealed the resident utilized a pad call light system. The resident activated the call light and the light was not activated. The call light had bright yellow tape wrapped around the cable connecting to the pad. Additionally the call light was activated on the wall and the call light system was not activated outside of the room. On 02/07/24 at 4:15 P.M., interview with Social Service Director #126 verified the call light was not working. Review of the facility policy titled, Answering the Call Light, dated 10/10 revealed ensure the call light is plugged in at all times and report all defective call lights to the nurse supervisor promptly. This deficiency represents non compliance investigated under Complaint Number OH00150351. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 15 of 16 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 366094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Gahanna 167 North Stygler Road Gahanna, OH 43230 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff interview and facility policy review, the facility failed to ensure the sit to stand lift was maintained in a sanitary manner for one resident (#33). This affected one ( Resident #33) of one resident who utilized the facility's sit to stand lift on the first floor. The facility census was 83. Findings Include: Review of the medical record for Resident #33 revealed an initial admission date of 09/21/23 with the latest readmission of 12/21/23 with the diagnoses including alcohol abuse, falls, cerebrovascular accident with left sided hemiplegia, generalized muscle weakness, difficulty in walking, gastro-esophageal reflux disease, hypertension, unsteadiness on feet, muscle wasting and atrophy, hyperlipidemia, cognitive communication deficit, dysphagia and benign prostatic hyperplasia (BPH). Review of the resident's plan of care dated 09/27/23 revealed the resident had a self-care deficit related to impaired balance. Interventions included the resident prefers dressing/grooming routine in am, avoid scrubbing and pat dry sensitive skin, check nail length and trim and clean on bath day and as needed, provide sponge bath when a full bath or shower cannot be tolerated, the resident requires supervision to limited assistance by on staff with bathing/showering as necessary, the resident requires supervision to limited assistance by one staff to turn and reposition in bed as necessary, the resident requires supervision to limited assistance by one staff to dress, the resident requires supervision to limited assistance by one staff with personal hygiene and oral care, the resident requires supervision to limited assistance by one staff for toileting, the resident requires supervision to limited assistance by one staff to move between surface as necessary, encourage resident to participate to the fullest extent possible with each interaction, praise all efforts at self care, therapy evaluation and treatment as per physician orders. Review of the resident's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had no cognitive deficit. Review of the photo of the facility's sit to stand lift with Resident #33 standing in the lift revealed the floor of the lift had excessive debris appearing to be food and dirt where the resident was standing. On 02/13/24 at 11:03 A.M., observation of the sit to stand lift revealed the lift had a dried shiny substance and an excess amount of dirt to the pads and the floor of the lift where the resident stands. Licensed Practical Nurse (LPN) #143 verified the sit to stand lift was not maintained in a sanitary manner. Review of the facility policy titled, Safe Lifting and Movements of Residents, dated 07/17 revealed the safety and well-being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. Maintenance staff shall perform routine checks and maintenance of equipment used for lifting to ensure that it remains in good working order. This deficiency represents non-compliance investigated under Complaint Number OH00150080. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366094 If continuation sheet Page 16 of 16