Inspection·November 15, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many revealed upon receiving an email or phone call from a vendor inquiring on payment for an invoice, the Administrator would direct the vendor to contact the Chief Financial Officer of the company. A follow-up phone interview with the Administrator on 11/15/23 at 9:28 A.M. revealed the frequency of venders requesting payment via an email or telephone call varied depending on that vendor. The frequency could be daily, weekly or a couple times during the month. The vendors that do not understand the industry would expect payment almost immediately following the services that were provided and those vendors would be the ones that would contact the facility on a regular basis. On 11/07/23 at 10:02 A.M. an interview with an anonymous staff member revealed the facility was not paying their bills and included that the facility could no longer use services through a guardian service and staffing agency because of the facility's failure to pay their bills timely. Review of the facility's vendor listing revealed the facility currently received services from vendors including but not limited to [NAME] Food Service, Medline for medical supplies, and Respiratory Care Partners (RCP) Review of the facility's previous vendor listing revealed the facility no longer received services from Avalon Foods, Guardian Oversite Council - Volunteer Guardianship Services, Premier Healthcare Staffing Solutions, and Arbor Rehabilitation and Healthcare Services. The following vendor/suppliers were reviewed as part of the State agency investigation: a. Review of the Guardian Oversite Council current account statement, dated 10/31/23 revealed the facility had an outstanding balance owed of $6,572.00 for resident guardianship services utilized at the facility from 11/30/20 to 10/18/23. On 11/07/23 at 10:15 A.M. phone interview with Representative from the Guardian Oversite Council verified the facility owed an outstanding balance of $6,572.00 and the facility had not established a payment plan with the provider. Further interview verified the Guardian Oversite Council was no longer accepting new wards from the facility due to the facility not making payments. Representative #700 verified current wards in the facility were continuing to receive services despite the facility's outstanding balance. On 11/15/23 at 9:28 A.M. phone interview with the Administrator verified the outstanding balance of $6,572.00 owed to Volunteer Guardianship Services. b. On 11/07/23 at 1:21 P.M. interview with Avalon Foods account manager revealed Epic Healthcare Solutions was currently on a payment plan of $5,000.00 per month for the outstanding balance on the account. The last payment was received on 11/03/23 for $2,000.00. This was the first payment received in the past 45 days from Epic Healthcare Solutions. Review of Avalon Food's account statement dated 11/08/23 and provided by CFO #375 revealed an outstanding balance owed of $23,471.79 for food services and delivery utilized at the facility from 12/13/22 to 10/31/23. c. On 11/07/23 at 1:33 P.M. interview with the Respiratory Care Partners Director revealed Epic Healthcare Solutions was over three months behind on their payments for oxygen services at the facility. A payment plan had been instituted; however, the amount of the agreed payment was not available/provided to the surveyor during the investigation. The director indicated Respiratory Care Partners (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0600 continued to service the facility oxygen needs. Level of Harm - Minimal harm or potential for actual harm Review of an email dated 11/13/23 at 3:17 P.M. from the Respiratory Care Partners (RCP) director revealed oxygen service outstanding invoices included the following: April 2023 - $667.69, May 2023 - $669.05, June 2023 - $613.95, July 2023 - $539.25, August 2023 - $647.69, September 2023 - $441.25 and October 2023 - $539.35 with the amount of overdue payments totaling $7,697.11 for oxygen services currently being utilized at the facility. Residents Affected - Many d. On 11/08/23 at 11:49 A.M. interview with the invoice processing manager for ECapital Commercial Finance company representing Premier Healthcare Staffing Solutions revealed Epic Healthcare Solutions had an outstanding balance for staffing services and Premiere no longer provided staffing services to the facility due to the continued outstanding account balance. Review of an email dated 11/13/23 at 1:26 P.M. from the Associate General Counsel for ECapital Commercial Finance company revealed there was a $5,000.00 payment received from Epic Healthcare Solutions on 11/13/23 which had not yet posted, once the payment had posted the payment would be applied to the current outstanding balance of $238,678.05. Review of Premier Healthcare Staffing Solutions account statement dated 11/13/23 revealed an outstanding balance owed of $238,678.05 for staffing services utilized at the facility from 02/20/23 to 07/17/23. e. Review of an email dated 11/13/23 at 5:28 P.M. from Chief Financial Officer #375 revealed Epic Healthcare Solutions had a payment plan instituted with Medline for weekly payments around $2,000.00 on behalf of the facility. Review of the Medline Statement dated 11/14/23 and emailed to the State Survey Agency on 11/14/23 at 2:53 P.M. revealed a current balance of $18,833.86 from invoices dated 05/31/23 through 11/11/23. Each invoice date provided a scheduled due date three months after the invoice date and contained the purchase order number. The Medline Statement did not identify when payments were made, and the facility did not respond to requests for outstanding balance verification. f. Further review of the email dated 11/13/23 at 5:28 P.M. from CFO #375 revealed the service agreement with Arbor Rehabilitation and Healthcare Services was mutually terminated with the facility and the individual company owners. There are currently weekly calls between the two companies with discussion of payments and the finalizing of a payment plan. Review of an Excel Spreadsheet (no creation date) titled Aging Report-EPIC-Oakhill Manor, emailed from CFO #375 on 11/14/23 at 2:53 P.M. revealed varying money amounts ranging from $3,867.02 to $194,145.51. The State Agency was unable to determine the outstanding balance owed to Arbor Rehabilitation. The facility did not respond to requests for outstanding balance verification. On 11/15/23 at 2:34 P.M. interview with the Chief Executive Officer from Arbor Rehabilitation revealed Epic was not paying their bills to his company timely and he found it very difficult to work with Epic. Since Arbor had not received payment, it was becoming a burden to the company and the CEO had to pull his services out of the building. The CEO stated he discusses bill payments with Epic weekly but they are not making payments to his company. During the interview the Chief Executive Officer (CEO) of Arbor Healthcare and Rehabilitation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0600 Level of Harm - Minimal harm or potential for actual harm Services revealed the termination of therapy services at the facility was due to the lack of payment for the services rendered from 01/16/22 to 09/17/23. There was a payment plan in place with Epic Healthcare Solutions to reduce the outstanding balance on the account. However, Epic Healthcare Solutions had been late with the monthly payments, which has led to weekly telephone conferences between the two companies. Residents Affected - Many Review of the Aging Report-EPIC-Oakhill Manor Excel Spreadsheet (not dated), provided by the CEO of Arbor Rehabilitation and Healthcare revealed the facility had an account balance of $194,145.51 and the account was greater than 390 days past due. The last payment made was 08/14/23 for $8.518.86. Review of the Facility assessment dated [DATE] revealed the facility's residents were at a clinically complex and special high categories who oftentimes have one or more chronic or comorbid conditions including their acuity. Residents of the facility were at risk for falls, pressure ulcers, infections, incontinence, increased disability, weight loss, depression, and other potential areas of decline. Review of the facility's policy titled, Abuse Prevention, Identification, Investigation and Reporting Policy revised 08/15/22 revealed, Neglect was the failure of the facility, its employees or service providers to provide goods and services to a resident that were necessary to avoid physical harm, pain, mental anguish, or emotional distress. 2. Interview on 11/05/23 at 10:45 A.M. with Licensed Practical Nurse (LPN) #10 revealed the company was issuing paper paychecks instead of using direct deposit. Interview on 11/05/23 at 11:15 A.M. with State Tested Nursing Assistant (STNA) #130 revealed she had heard other staff had their paychecks bounce when they tried to cash them on payday. Interview on 11/05/23 at 12:20 P.M. with the Administrator revealed Epic Healthcare Solutions had recently changed payroll companies from Paycor to ADP payroll services and then back to Paycor. Due to these changes, the staff was receiving paper paychecks instead of utilizing direct deposit of the paychecks. During the pay period at the beginning of October 2023 there were approximately ten staff members who were unable to cash their pay checks due to issues with insufficient funds in Epic Healthcare Solutions account. Furthermore, the local banks would hold the paychecks for up to five days to ensure there were sufficient funds to cash the paycheck for the staff member. Interview on 11/05/23 at 3:23 P.M. with Licensed Practical Nurse (LPN) # 250 revealed in early October 2023 there was notification from the bank stating there was insufficient funds to cash the current paycheck. LPN #250 stated, I notified the Administrator and then the corporate office wired the money into my account within the next couple days. Interview on 11/06/23 at 2:50 P.M. with Activities staff #240 revealed in early October 2023 the bank sent notification of the inability to cash the current paycheck due to insufficient funds in Epic Healthcare Solution's account. Activities staff #240 stated, It took almost four days for the company to wire my paycheck money into my account. Since then, my bank will put my paycheck on hold for several days. I must call the bank to request the hold to be removed so that I can receive my money. Interview on 11/06/23 at 3:15 P.M. with Maintenance Staff #280 revealed the bank sent notification of insufficient funds in the account and the bank was unable to cash the paycheck from early October 2023. Maintenance staff #280 stated, It took four days for the company to wire the money due into (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0600 my account. Level of Harm - Minimal harm or potential for actual harm Interview on 11/06/23 at 2:12 P.M. with the Administrator revealed during the recent pay cycles, the bank had placed her paychecks on hold until there was proof of sufficient funds in Epic Healthcare Solution accounts. The Administrator stated, During the pay period in early October when some of the staff was unable to cash their paychecks, I helped an employee that was unable to cash out that particular paycheck, with money so that they were able to have cash to live on. The company reimbursed my account. Residents Affected - Many Interview on 11/07/23 at 2:30 P.M. with Registered Nurse (RN) #220 revealed she has submitted a 30-day notice for resignation to the Administrator related to the financial instability that was currently occurring at the facility and with Epic Healthcare Solutions. Review of the facility Employee Handbook effective 2023 revealed, employees would receive their pay reimbursement for hours worked either through pay card, check or direct deposit. This deficiency represents non-compliance investigated under Master Complaint Number OH00147877 and Complaint Numbers OH00147658 and OH00147718. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy review, the facility submitted plan of correction to the state agency, facility assessment review, and interviews, the facility failed to establish an effective governing body, legally responsible to establish and implement policies regarding the management and operation of the facility, including but not limited to compliance with all financial obligations for the delivery of care. This had the potential to affect all 30 residents in the facility. Findings include: Review of the facility survey history revealed on 11/15/23 a complaint survey was completed which resulted in concerns related to financial solvency. A plan of correction was submitted to the state agency to correct the deficient practice of not paying invoices on time in which the facility/company would pay any outstanding balance to vendors through payment plans if the past due invoice could not be paid in full. Following the 11/15/23 survey, the facility provided evidence of payments being made to various supplies/vendors removing the likelihood of situations of neglect. However, at the time of this post-survey revisit, the facility failed to ensure their governing body was effective in establishing and implementing policies regarding the management and operation of the facility, which included ongoing compliance with all financial obligations for the delivery of care as detailed below: Interview on 02/05/24 at 9:00 A.M. with Administrator revealed that there is a weekly meeting to go over invoices. The Administrator stated that the Business Office Manager/Human Resources (BOM/HR) #211 enters invoices into the system and then there is a weekly meeting about the invoices. The Administrator stated she does follow up and make extra notes on the spreadsheet to tell corporate if there are any discrepancies in what was written or any comments that should be documented. The administrator stated that utilities, Medline, therapy, cable, internet, and any other vendor that are companywide, the invoices are sent directly to corporate through a portal. BOM/HR #211 enters invoices such as psych services, oxygen company, agency billing, and guardian oversight council. The meeting does not discuss the past vendors that have not been utilized recently such as Premier staffing, Avalon Foodservice and Arbors Therapy. A phone interview on 02/05/24 at 9:57 A.M. with Chief Financial Officer (CFO) #203 revealed that the plan of correction was put in place for safeguards regarding essential companies for continued services for residents. A weekly phone call with the facility Administrator, Chief Executive Officer #204, and Chief Nursing Compliance Officer #205 (CCO) related to outstanding invoices. CFO #203 stated that the goal of the meeting was to check the flow of payment and ensure that everything is on track. CFO #203 stated that Medline is a vendor that is used throughout the company and is on a global payment plan weekly. Premier staffing (collection is done by e-Capital Commercial Finance) is no longer a vendor and on a payment plan. Arbors Rehab is no longer a vendor, and the account is with Epic's legal team. Broad River Therapy is the current therapy department, under contract with the corporation, and is on a payment plan. Interview on 02/05/24 at 1:55 P.M. with Manager of Invoice Processing #200 for e-Capital Commercial Finance (Premier Staffing) stated that the facility's parent company (Epic) was to have a payment plan but had broken the payment plan several times. She stated that Epic was to pay $5,000.00 per (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many week but they haven't made a payment since November 2023. A payment was made by Epic today (02/05/24) for $5,000 but was still pending in the system. Phone interview on 02/05/23 at 2:30 P.M. with Chief Financial Officer (CFO) #203 revealed that Manager of Invoice Processing #200 is the new contact person and the email that was in the plan of correction binder does state that the company was on a payment plan with e-Capital Commercial Finance. CFO #203 did state that a payment was made today (02/05/24) of $5,000.00. CFO #203 stated that he did not go through with submitting a payment by 01/12/24, as requested in the email between CFO #203 and Managing Director of Underwriting #207 at e-Capital Commercial Finance. A phone interview on 02/06/24 at 9:01 A.M. with Broad River Chief Financial Officer (BCFO) #208 revealed that the facility is not up to date with payments. He stated that he spoke with the parent company yesterday and did so on a regular basis. They had arranged a payment plan but there had not been a payment made since September. Further interview revealed Epic owes his company a few hundred thousand dollars. BCFO #208 shared that CFO #203 informed him Epic was working on their credit line and will straighten things out. Phone interview on 02/06/24 at 10:27 A.M. with Accounts Receivable Manager (ARM) #202 from Avalon Foodservice revealed that Epic made a payment on 01/29/24 for $5,000.00 and on 02/01/24 a notification was received stating that there were insufficient funds in the account to cover the $5,000.00. Further interview revealed Epic had a balance with Avalon Foodservice of $24,500.00. Phone interview on 02/06/24 at 10:31 A.M. with Chief Nursing and Compliance Officer (CCO) #205 revealed that she is on the weekly phone meetings. The company does not use Premier Staffing, Avalon Foodservice and Arbors Therapy anymore, so payment to them is not a priority and Arbors Therapy was turned over to the legal department. The company had to prioritize payments so resident services would not be disrupted. She follows up on current vendors and makes sure that resident services are not interrupted. She believed that there are written contracts for the current vendors except Medline, who has a verbal contract. Lastly, the CCO shared it was the Administrator's responsibility to make sure that vendors are paid. On 02/06/24 at 12:48 P.M. interview with the Administrator verified she was unaware Broad River had not been paid despite the vendor being discussed in the weekly invoice meetings. Invoices were requested from Broad River Therapy however, those were not provided. Review of the facility's undated Governing Body policy revealed the Governing Body had a fiduciary duty, duty of care, and duty of loyalty to act in the best interests of the Facility. The governing body should be comprised of the operator (s), c-suite level executives, and other individuals who were legally responsible for the establishment and implementation of policies regarding management and operations of the facility. The Governing Body member responsibilities included to be active, engaged, and involved in the affairs of the facility and to have direct access to the administrator and to the compliance and ethics officer by scheduling executive board sessions with the compliance and ethics officer that allows for a free flow of information without potential for conflict. The governing body consisted of Chief Financial Officer #203, Chief Executive, Officer #204, and Chief Nursing Officer/Compliance Officer #205. Review of the facility assessment dated [DATE] revealed the facility provided all care and services as required in the requirements of participation including, but not limited to assistance with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete activities of daily living, personal care services, medication administration, pain management, infection prevention and control, nutritional services, skin care, fall and injury prevention, pharmacy, and therapy services. Additionally, the facility provided medical director, attending physicians, physician assistants, nurse practitioners, dentist, podiatrist, ophthalmologist, and psychiatrist services, and pharmacist. Review of the administrator job description revealed they would operate the facility in accordance with the established policies and procedures of the facility. The job description indicated the administrator would supervise the recruitment, employment, and discharge of staff. And work closely with DON to ensure there were adequate numbers of staff to meet the needs of each resident and to comply with the state of Ohio licensure law. The administrator would act as a liaison with the facility owners and the medical, nursing, and other supervisory staff through regular meetings. Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on record review and staff interview, the facility failed to ensure continuous evaluations were in place to verify financial obligations were met as planned to prevent a potential disruption in resident care and services through the Quality Assurance Performance Improvement (QAPI) program committee. This had the potential to affect all facility residents. The facility census was 30. Residents Affected - Many Findings include: Review of the provided QAPI documentation for December 2023 and January 2024, revealed an identified problem of vendors not being paid promptly. The root cause revealed invoices were not being entered electronically when received. Review of invoices and calls with the Administrator and Business Office Manager were to be completed weekly. Review of the facility survey history revealed on 11/15/23 a complaint survey was completed which resulted in concerns related to financial solvency. A plan of correction was submitted to the state agency to correct the deficient practice of not paying invoices on time in which the facility/company would pay an outstanding balance to vendors through payment plans if the past due invoice could not be paid in full. The QAPI Committee would monitor for compliance and the facility alleged compliance on 12/18/23. Interview on 02/05/24 at 9:00 A.M. with Administrator revealed that there is a weekly meeting to go over invoices. The Administrator stated that the Business Office Manager/Human Resources (BOM/HR) #211 enters invoices into the system and then there is a weekly meeting about the invoices. The Administrator stated she does follow up and make extra notes on the spreadsheet to tell corporate if there are any discrepancies in what was written or any comments that should be documented. The administrator stated that utilities, Medline, therapy, cable, internet, and any other vendor that are companywide, the invoices are sent directly to corporate through a portal. BOM/HR #211 enters invoices such as psych services, oxygen company, agency billing, and guardian oversight council. The meeting does not discuss the past vendors that have not been utilized recently such as Premier staffing, Avalon Foodservice and Arbors Therapy. A phone interview on 02/05/24 at 9:57 A.M. with Chief Financial Officer (CFO) #203 revealed that the plan of correction was put in place for safeguards regarding essential companies for continued services for residents. A weekly phone call with the facility Administrator, Chief Executive Officer #204, and Chief Nursing Compliance Officer #205 (CCO) related to outstanding invoices. CFO #203 stated that the goal of the meeting was to check the flow of payment and ensure that everything is on track. CFO #203 stated that Medline is a vendor that is used throughout the company and is on a global payment plan weekly. Premier staffing (collection is done by e-Capital Commercial Finance) is no longer a vendor and on a payment plan. Arbors Rehab is no longer a vendor, and the account is with Epic's legal team. Broad River Therapy is the current therapy department, under contract with the corporation, and is on a payment plan. Interview on 02/05/24 at 1:55 P.M. with Manager of Invoice Processing #200 for e-Capital Commercial Finance (Premier Staffing) stated that the facility's parent company (Epic) was to have a payment plan but had broken the payment plan several times. She stated that Epic was to pay $5,000.00 per week but they haven't made a payment since November 2023. A payment was made by Epic today (02/05/24) for $5,000 but was still pending in the system. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 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 366141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Louisville Gardens Care Center 4466 Lynnhaven Avenue NE Louisville, OH 44641 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 0865 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Phone interview on 02/05/23 at 2:30 P.M. with Chief Financial Officer (CFO) #203 revealed that Manager of Invoice Processing #200 is the new contact person and the email that was in the plan of correction binder does state that the company was on a payment plan with e-Capital Commercial Finance. CFO #203 did state that a payment was made today (02/05/24) of $5,000.00. CFO #203 stated that he did not go through with submitting a payment by 01/12/24, as requested in the email between CFO #203 and Managing Director of Underwriting #207 at e-Capital Commercial Finance. A phone interview on 02/06/24 at 9:01 A.M. with Broad River Chief Financial Officer (BCFO) #208 revealed that the facility is not up to date with payments. He stated that he spoke with the parent company yesterday and did so on a regular basis. They had arranged a payment plan but there had not been a payment made since September. Further interview revealed Epic owes his company a few hundred thousand dollars. BCFO #208 shared that CFO #203 informed him Epic was working on their credit line and will straighten things out. Phone interview on 02/06/24 at 10:27 A.M. with Accounts Receivable Manager (ARM) #202 from Avalon Foodservice revealed that Epic made a payment on 01/29/24 for $5,000.00 and on 02/01/24 a notification was received stating that there were insufficient funds in the account to cover the $5,000.00. Further interview revealed Epic had a balance with Avalon Foodservice of $24,500.00. Phone interview on 02/06/24 at 10:31 A.M. with Chief Nursing and Compliance Officer (CCO) #205 revealed that she is on the weekly phone meetings. The company does not use Premier Staffing, Avalon Foodservice and Arbors Therapy anymore, so payment to them is not a priority and Arbors Therapy was turned over to the legal department. The company had to prioritize payments so resident services would not be disrupted. She follows up on current vendors and makes sure that resident services are not interrupted. She believed that there are written contracts for the current vendors except Medline, who has a verbal contract. Lastly, the CCO shared it was the Administrator's responsibility to make sure that vendors are paid. Review of the facility policy dated February 2020 titled, Quality Assurance and Performance Improvement (QAPI) Program revealed the facility shall develop, implement, and maintain an ongoing, facility-wide, data-driven QAPI program that is focused on indicators of the outcomes of care and quality of life for our residents. The QAPI plan describes the process for identifying and correcting quality deficiencies. Key components of this process include tracking and measuring performance; establishing goals and thresholds for performance measurement; identifying and prioritizing quality deficiencies; systematically analyzing underlying causes of systemic quality deficiencies; developing and implementing corrective action or performance improvement activities; and monitoring or evaluating the effectiveness of corrective action/performance improvement activities and revising as needed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366141 If continuation sheet Page 10 of 10