Inspection·September 19, 2019

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. 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 Resident #48 was comprehensively assessed for the use of a seatbelt restraint in a motorized wheelchair. This affected one resident (#48) of one resident reviewed for restraints. Residents Affected - Few Findings Include: Review of Resident #48's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses of multiple sclerosis, paraplegia, diabetes, foot drop and depression. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #48 had moderately impaired cognition, required staff extensive assistance with bed mobility and toilet use and required total assistance from staff for transfer. The assessment revealed the resident did not have a restraint. Observations on 09/17/19 at 9:15 A.M., 1:45 P.M., 4:20 P.M. and on 09/18/19 at 9:00 A.M. revealed Resident # 48 was in a motorized wheelchair with a seatbelt restraint fastened around his waist. An interview on 09/17/19 at 9:15 A.M. Resident #48 revealed he did not need the seat belt but it came with the wheelchair and if you did not fasten it then it would drag on the ground. He indicated no one had attempted to remove it from the wheelchair. An observation on 09/19/19 at 12:03 P.M. revealed State Tested Nursing Assistant (STNA) #661 asked Resident #48 to release his seatbelt and the resident stated he was not able to release it on his own. STNA # 661 verified Resident #48 was unable to release his seatbelt restraint at that time. An interview on 09/19/19 at 3:08 P.M. with Registered Nurse (RN) #639 revealed Resident #48 had waned the seatbelt fastened. However, she verified there was not a restraint assessment or a plan of care completed to indicate the resident preferred the seatbelt fastened. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 2 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on review of personnel files, review of the facility new hire list, review of the facility abuse policy, and staff interview, the facility failed to effectively implement their abuse policy and procedure to ensure all potential staff hires were checked against the Nurse Aide Registry (NAR) prior to employment to ensure the employee did not have a finding entered into the State Nurse Aide Registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of property. This affected 15 dietary personnel, three Housekeeping personnel, one Maintenance personnel, one Life Enrichment Director, one Medical Records Coordinator and one Director of Dietary Services and had the potential to affect all 69 residents residing in the facility. Residents Affected - Many Findings Include: Review of the new hire list dated 06/20/18 to 08/27/19 and review of employee personnel file revealed Dietary Personnel #620, #721, #647, #673, #757, #680, #630, #679, #746, #770, #670, #731, #729, #612 and #686, Housekeeping Personnel #738, #768 and #740, Maintenance Personnel #678, Life Enrichment Director #773, Medical Records Coordinator #636 and Director of Dietary Services #727 had not been checked against the Nurse Aide Registry prior to hire. An interview on 09/17/19 at 1:20 P.M. with Administrative Personnel #626 revealed the facility had found out they were supposed to be checking all new hires on the nurse aide registry last week on 09/11/19. She verified she did not have the physical evidence to show the Nurse Aide Registry had been checked for Dietary Personnel #620, #721, #647, #673, #757, #680, #630, #679, #746, #770, #670, #731, #729, #612 and #686, Housekeeping Personnel #738, #768 and #740, Maintenance Personnel #678, Life Enrichment Director #773, Medical Records Coordinator #636 or Director of Dietary Services #727. Review of the facility policy titled Abuse, Neglect, Exploitation & Misappropriation of Resident Property, dated 01/24/17 revealed the facility would not tolerate Abuse, Neglect, Exploitation of its residents or the Misappropriation of Resident Property. It was the facility policy to investigate all alleged violations involving Abuse, Neglect , Exploitation, Mistreatment of a resident, or Misappropriation of Resident Property, including Injuries of Unknown Source, in accordance with this policy. It was the policy of the facility to undertake background checks of all employees and to retain on file applicable records of current employees regarding such checks. The facility would do the following prior to hiring a new employee: a. Check with the Ohio Nurse Assistant Registry and any other nurse assistant registries that the facility had reason to believe contained information on an individual, prior to using the individual as a nurse assistant. b. Check with all applicable licensing and certification authorities to ensure employees held the requisite license and/or certification status to perform their job functions and did not have a disciplinary action in effect against his or her professional license by a State licensure agency as a result of a finding of abuse, neglect, exploitation or misappropriation of resident property; c. Conduct a criminal background check in accordance with Ohio law and the facility's policy. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 3 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 0607 d. Verify the applicant was not excluded from any Federally-funded health care programs. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 4 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 record review and interview the facility failed to ensure adequate and ongoing monitoring and comprehensive assessments were completed of skin impairments identified by the facility to be non-pressure related for Resident #120. This affected one resident (#120) of two residents reviewed for non-pressure skin concerns. Residents Affected - Few Findings Include: Review of Resident #120's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses that included heart failure, chronic non-pressure ulcers to bilateral lower legs, and cellulitis of bilateral legs. Review of progress note dated 09/12/19 at 9:55 P.M. revealed Resident #120's dressings to bilateral lower legs were changed. A scant amount of serosanguineous (mixture of blood and serum) drainage was noted from the left leg. A progress note dated 09/17/19 revealed Resident #120's Lac-Hydrin cream (used to treat dry, scaly skin) was applied to the resident's bilateral legs and feet. The open wounds were avoided. A progress note dated 09/18/19 at 4:36 P.M. revealed dressings to Resident #120's left leg were changed. Interview on 09/18/19 at 10:53 A.M. with Wound Nurse #724 revealed skin concerns were only measured when they were a stageable ulcer. Interview on 09/18/19 at 4:24 P.M. Wound Nurse #724 revealed she only looked at skin concerns that were pressure, stasis, venous, or diabetic ulcers unless a floor nurse asked her to look at a wound. Wound Nurse #724 verified there was no documentation of Resident #120's wounds other than what was in the progress notes. Wound Nurse #724 could not verify the size or condition of the open areas or wounds to Resident #120's legs. A progress note dated 09/19/19 at 8:21 A.M. revealed Resident #120 was admitted on [DATE] with cellulitis of bilateral lower legs, and multiple skin issues. Interview on 09/19/19 at 2:40 P.M. Registered Nurse (RN) #706 verified non-pressure skin concerns were only documented in the progress notes. Non-pressure wounds were not measured or described unless the nurse documenting in the progress notes did so. RN #706 verified the wound nurse only looked at pressure ulcers and did not monitor non-pressure areas. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 5 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 and interview the facility failed to adequately assess and monitor pressure ulcers for Resident #27 #120 and #22. This affected three residents (#27, #120 and #22) of three residents reviewed for pressure ulcers. Residents Affected - Few Findings Include: 1. Review of Resident #27's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses that included displaced fracture of third cervical, venous insufficiency, and pressure ulcer of sacral region. A progress note dated 02/12/19 at 4:20 P.M. revealed Resident #27's bottom was reddened and had shearing. Resident #27 was admitted to the facility with a Mepilex (foam dressing) to the buttocks for protection. Further review of February 2019 progress notes revealed no mention of a wound or Resident #27 rejecting care. The quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/01/19 revealed Resident #27 was cognitively impaired. No rejection of care was identified during the assessment period. Resident #27 required extensive assistance from one staff for bed mobility and limited assistance from one staff for toilet use. The MDS also revealed the resident did not have any pressure ulcers. A progress note dated 03/01/19 at 8:00 A.M. revealed Resident #27 had multiple skin concerns. Resident #27 had moisture associated skin damage (MASD) to the coccyx. The area measured one centimeter (cm) long by 0.5 cm wide, and was less than 0.1 cm deep. The wound bed was red and no drainage was noted. Further review of March 2019 progress notes revealed no mention of the wound or rejection of care. Review of physician's orders revealed from 04/03/19 to 06/27/19 an order was in place to cleanse Resident #27's coccyx with house cleanser, pat the area dry, and apply a foam dressing to promote and maintain skin integrity. The dressing was to be changed every three days. Review of progress notes for April and May 2019 revealed no documentation of a wound to Resident #27's coccyx. There was no mention of Resident #27 refusing to be turned or repositioned. A physician order dated 06/27/19 revealed Resident #27's coccyx and an open area to the right buttock were to be cleansed with house cleanser, patted dry, a skin sealant applied to the peri wound, and covered with a exuderm (provides protection and moist environment to promote healing) dressing every three days and as needed. A physician order dated 07/10/19 revealed the resident's coccyx area and open area to right buttock were to be cleansed with house cleanser, patted dry, a skin sealant applied to the peri wounds, and covered with foam dressing daily and as needed. A progress note dated 07/30/19 at 10:43 A.M. revealed the wound nurse assessed Resident #27's MASD coccyx wound due to the area not responding to current treatment. A new order was put in place to discontinue the foam dressing and a Duoderm (to absorb excretions from a wound and protect the wound) dressing was to be changed every five days and as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 6 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 Residents Affected - Few A progress note dated 08/20/19 at 3:02 P.M. revealed the wound care physician visited Resident #27. A new order was written to cleanse open areas at sacrum/bilateral buttocks (MASD/excoriation) with soap and water, dry the area, apply Aquacel AG (a layer of ionic silver that gels with wound fluid to provide wound healing) to sacrum and barrier cream to bilateral buttocks. A foam dressing was to be applied to pad areas due to complaints of discomfort. The dressing was to be changed twice daily and as needed. Wound documentation dated 08/20/19 by wound doctor revealed Resident #27 had moisture associated dermatitis and a pressure ulcer to buttocks and sacrum. The wound was new and had continuous maceration due to moisture/incontinence associated dermatitis. The plan of care initiated on 09/04/19 revealed Resident #27 had a pressure ulcer to sacrum/bilateral buttocks. Interventions included to keep off affected area, low air loss mattress to the bed, monitor the pressure ulcer, and do the treatment as ordered. A wound note dated 09/04/19 at 12:13 P.M. by the facility wound nurse revealed Resident #27 had a 4.1 cm long, 3.9 cm wide, and 0.3 cm deep Stage III (involves full-thickness skin loss potentially extending into the subcutaneous tissue layer) pressure ulcer. The pressure ulcer had heavy seropurulent (mixture of serum and pus) exudate that was yellow/tan, cloudy, and thick. The wound had slough (necrotic tissue that slows wound healing) that covered 65 percent of the wound. The surrounding skin was dark purple/rusty colored. The wound had declined. The MASD was a Stage III with a heavy amount of dark brownish drainage. Wound documentation by the wound doctor dated 09/10/19 revealed Resident #27 had a deterioration to an unstageable pressure ulcer to sacral and MASD to buttocks. A wound note dated 09/10/19 at 2:36 P.M. by the facility wound nurse revealed Resident #27 had a 4.1 cm long, 3.6 cm wide, and 0.8 cm deep unstageable (full thickness tissue loss in which the base of the ulcer is covered by slough/and or eschar) pressure ulcer. The pressure ulcer had moderate purulent (opaque, milky, sometimes green) exudate. The wound had declined and 60 percent of the wound was covered with slough/eschar. Wound documentation by the wound doctor dated 09/17/19 revealed Resident #27 had dermatitis to the buttocks and an unstageable pressure ulcer to sacral. A wound note dated 09/17/19 at 2:02 P.M. by the facility wound nurse revealed Resident #27 had a 4 cm long, 2.4 cm wide, and 0.7 cm deep unstageable pressure ulcer. The pressure ulcer had moderate seropurulent (yellow/tan, cloudy and thick) exudate with a faint musty odor. The wound had 75 percent of the wound covered with slough/eschar. The wound had improved and had less slough/necrosis. The plan of care was revised on 09/18/19 at 9:10 A.M. and revealed Resident #27 was noncompliant with treatment and regimen of repositioning, turning, hygiene, diet/nutrition, and offloading. Interview on 09/18/19 at 10:53 A.M. with Wound Nurse #724 revealed skin concerns were only measured once they became a staged ulcer. Wound Nurse #724 stated Resident #27's Stage III pressure ulcer went form a minor skin concern to a full blown Stage III overnight. Wound Nurse #724 stated the wound must have healed sometime between March and July 2019. Observation on 09/18/19 at 11:02 A.M. of the dressing change to Resident #27's coccyx by Wound Nurse #724 revealed the resident had an unstageable pressure ulcer to the coccyx with slough to the wound bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 7 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 Residents Affected - Few Interview on 09/18/19 at 4:24 P.M. with Wound Nurse #724 verified there were no measurements or evidence of monitoring the wound to Resident #27's coccyx and buttocks until September 2019. 2. Review of Resident #120's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses that included heart failure, chronic non-pressure ulcers to bilateral lower legs, and cellulitis of bilateral legs. A progress note dated 09/15/19 at 1:30 P.M. revealed Resident #120 was non-compliant with turning and repositioning to stay off buttocks. Staff encouraged resident as much as possible due to wound. A progress note dated 09/15/19 at 11:00 P.M. revealed a dressing change to the left gluteal fold had redness with a scant amount of red drainage. A physician order dated 09/17/19 revealed moisture associated skin damage (MASD) to Resident #120's gluteal cleft was to be cleansed with house cleanser, patted dry, and foam dressing applied daily. An additional physician order dated 09/17/19 revealed the open area to Resident #120's left gluteal fold was to be cleansed with house cleanser, patted dry, a nickel size amount of Santyl (debridement ointment) was to be applied to the wound bed, the area covered with gauze, and secured with medipore tape. A progress note dated 09/17/19 at 11:45 P.M. revealed a dressing change to the left gluteal fold had redness with a small amount of red drainage. A progress note dated 09/18/19 at 4:36 P.M. revealed dressings to Resident #120's gluteal cleft and left leg/buttock were changed. Slough was removed from the gluteal cleft. The wound bed to the left leg/buttock was dark purple and no drainage was observed. The peri wound was intact and Santyl (debriding ointment) was applied. Interview on 09/18/19 at 10:53 A.M. with Wound Nurse #724 revealed skin concerns were only measured when they were a stageable ulcer. Interview on 09/18/19 at 4:24 P.M. Wound Nurse #724 revealed she only looked at skin concerns that were pressure, stasis, venous, or diabetic ulcers unless a floor nurse asked her to look at a wound. Wound Nurse #724 verified there was no documentation of Resident #120's wounds other than what was in the progress notes. Wound Nurse #724 could not verify the size or condition of the open areas or wounds to Resident #120's buttocks, gluteal fold, or gluteal cleft. Wound Nurse #724 verified Santyl was an ointment used to remove dead skin and tissue. A progress note dated 09/19/19 at 12:08 A.M. revealed a dressing change to the left gluteal fold had redness with a small amount of red drainage. A progress note dated 09/19/19 at 8:21 A.M. revealed Resident #120 was admitted on [DATE] with a non pressure ulcer of the left gluteal fold and multiple skin issues. The resident had a 6.3 centimeter (cm) long and 3.5 cm unstageable wound that was gray/black in color due to slough and necrosis to the gluteal fold. There was a moderate amount of seropurulent (mixture of serum and pus). Resident #120 also had MASD to gluteal cleft that was brown/ecchymotic in color. The area measured 3.4 cm long, 0.9 cm wide, and 0.1 cm deep with minimal serous drainage. Interview on 09/19/19 at 2:40 P.M. Registered Nurse (RN) #706 revealed non-pressure skin concerns were only documented in the progress notes. Non-pressure wounds were not measured or described unless the nurse documenting in the progress notes did so. RN #706 verified the wound nurse only looked at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 8 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 pressure ulcers and did not monitor non-pressure areas. Level of Harm - Minimal harm or potential for actual harm 3. Review of the medical record revealed Resident #22 was admitted to the facility on [DATE] with diagnoses of multiple sclerosis, chronic obstructive pulmonary disease, rhabdomyolysis, need for assistance with personal care, and non-pressure chronic ulcer of skin of other sites limited to breakdown of skin. Residents Affected - Few Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #22 had moderately impaired cognition, required extensive assistance of two staff members for bed mobility and transfers and required total assistance of two staff members for toilet use and personal hygiene. The resident did not have any pressure ulcers. Review of the licensed Nurse Weekly Skin assessment dated [DATE] revealed three small open area to the resident's buttocks (two in left buttocks and one on the right buttock) and a reddened area that remained after 30 minutes. Review of the progress note dated 09/15/19 at 6:46 P.M. revealed the staff noted a fair amount of red drainage coming from open areas on the resident's gluteal cleft. The note indicated the wounds were pre-existing and being treated. Hospice was updated on status of wounds. The nurse would examine and re-evaluate tomorrow. The note indicated staff would continue to monitor. An interview on 09/17/19 at 2:00 P.M. with Licensed Practical Nurse (LPN) #622 revealed Resident #22 had an open area to his bottom. She indicated the resident's mother, hospice and the wound nurse had decided to place him on Diflucan, an antifungal cream and leave the area open to air with no briefs. An interview on 09/17/19 at 3:23 P.M. with LPN # 724 verified there was no documentation/skin grid/assessment for Resident #22 gluteal cleft because it was determined to be moisture associated dermatitis. She indicated only stageable wounds were assessed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 9 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 observation, record review and interview the facility failed to ensure Resident #55 received nutritional supplements and thickened liquids as ordered, the amount of supplement consumed was documented and re-weights were obtained to ensure the resident maintained adequate parameters of nutrition. This affected one resident (#55) of two residents reviewed for nutrition. Residents Affected - Few Findings Include: Review of Resident #55's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses of Alzheimer's disease, dementia, tremor, abdominal aortic aneurysm, and dysphagia. Review of the plan of care, dated 04/25/19 revealed Resident #55 was at risk for alteration in nutrition as evidenced by history of hypertension, coronary artery disease, dementia, anxiety, depression, diarrhea, hypotension, norovirus, gastric esophageal reflux disease and Alzheimer's disease that could potentially affect nutrition. Interventions included to give four ounces of magic cup (nutritional supplement) with lunch or four pounces of magic cup mixed with nectar thickened root beer (added 05/16/19), allow adequate time to finish meal, encourage fluids per preferences,120 milliliters of Ensure (chocolate) three times daily, honor food preferences, offer an alternate if the main meal served was not desired, monitor intakes at meals and bedtime snacks and record, provide diet as ordered, consult with the registered dietitian and licensed speech pathologist as needed, weighted silverware for all meals. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/20/19 revealed Resident #55 had severely impaired cognition, required supervision from staff for eating, had no swallowing disorders, weighed 205 pounds with no weight loss and received a mechanically altered and therapeutic diet. Review of the September 2019 physician's orders revealed Resident #55 had an order dated 03/29/19 to receive nectar thick liquids, an order dated 05/16/19 for four ounces of magic cup (nutritional supplement) with lunch or four ounces of magic cup with four ounces of thickened root beer. Review of weights revealed on 08/12/19 Resident #55 weighed 205 pounds and on 09/11/19 weighed 186.8 pounds for an 8.88 percent weight loss in one month. The next weight documented, on 09/17/19 was 186.6 pounds There was no evidence the facility had done a reweight after the 09/11/19 significant weight loss per the facility policy. An observation on 09/16/19 at 12:30 P.M. revealed Resident #55 received two-eight ounce glasses of regular consistency (thin) chocolate milk. Review of the meal ticket dated 09/16/19 revealed Resident #55 was to receive nectar thick liquids and a magic cup for lunch or a magic cup mixed with nectar thick root beer. During an interview on 09/16/19 at 12:50 P.M. State Tested Nursing Assistant (STNA) #68 verified the chocolate milk for Resident #55 was not nectar thick. The resident consumed 220 ml of one 240 glass of chocolate milk and he had not received his magic cup. Observation on 09/17/19 at 8:33 A.M. revealed Resident #55 was in the dining. He had a bowl of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 10 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few oatmeal, scrambled eggs, a biscuit and an eight ounces glass of nectar thick liquids. At 8:40 A.M. the staff member took Resident #55 out of the dining room because he indicated he had to go to the restroom. Review of the meal ticket dated 09/17/19 revealed Resident #55 was to have a yogurt with breakfast. An interview on 09/17/19 at 8:43 A.M. with STNA #661 indicated the nursing assistants would pass out yogurt to the residents. She verified Resident #55 did not receive a yogurt with his meal. An interview on 09/18/19 at 3:22 P.M. Registered Dietitian #801 indicated she was in the facility 16-20 hours a week. She indicated they have a nutrition at risk meeting every Thursday at 1:30 P.M. and Resident #55 had been on the agenda for six months but since his last hospitalization he had taken a nose dive with his weight. She indicated if there was a significant weight loss from the previous weight the facility was to reweigh the resident and notify her and the physician within 24 hours. She indicated the nurse was to document the reweight in the computer because the facility did not want anyone else documenting due to the errors that could occur. She indicated the supplement consumption was to be documented on the Medication Administration Record and it was very important for the resident to receive his supplements as ordered and for the staff to document the amount of supplement consumed to determine his nutritional needs. She indicated the yogurt was a preference of his because he liked it, so if he does not eat his meal he would usually eat the yogurt but she said it was not a physician order. An interview on 09/19/19 at 10:36 A.M. with Licensed Speech Pathologist #800 indicated for a resident to be on thickened liquids the resident had to have an issue with aspiration. She indicated Resident #55 was already on thickened liquids prior to her starting employment in the facility in July 2019 of this year. She indicated Resident #55 would cough with thin liquids. She indicated chocolate milk was to be thickened also due to it was not a nectar thick consistency. Review of Speech Therapy notes dated 09/19/19 revealed the speech therapist educated the STNA staff regarding patients chocolate milk and its' need to be thickened. An interview on 09/19/19 at 3:40 P.M. with Registered Nurse #639 indicated the magic cup for Resident #55 was a general order and was documented with his meal intake and was not documented separate to indicated how much he had consumed each time. Review of the facility policy titled Weight Assessment and Interventions, dated 09/2008 revealed the multidisciplinary team would strive to prevent, monitor and intervene for undesirable weight loss for our residents. The weight assessment would include any weight change of five percent or more since the last weight assessment and would be verified. If the weight was verified, nursing would respond within 24 hours of receipt of written notification. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 11 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #46's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses that included Alzheimer's disease, major depressive disorder, and anxiety. Review of the pharmacy recommendation dated 07/25/19 revealed a gradual dose reduction (GDR) may be appropriate. Resident #46 was currently receiving Buspar (antianxiety) 10 milligram (mg) twice a day and Cymbalta (antidepressant) 60 mg daily. If a GDR was not appropriate, the physician needed to document the rationale. The physician signed the pharmacy recommendation on 08/07/19 but did not indicate if he agreed or disagreed with the recommendation. The quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/23/19 revealed Resident #46 was cognitively intact and did not have any behaviors in the assessment period. Interview on 09/19/19 at 12:19 P.M. with [NAME] President of Operations #723 verified the physician did not address the pharmacy recommendation dated 07/25/19 for Resident #46. Based on record review and interview the facility failed to ensure the attending physician provided rationale for continued use of psychotropic medications for Resident #31 and failed to ensure the physician addressed a gradual dose reduction for Resident #46. This affected two residents (#31 and #46) of five residents reviewed for unnecessary medication use Findings Include: 1. Review of a consultation report, dated 09/12/18 revealed a pharmacist recommendation to the attending physician for Resident #31. The recommendation stated Resident #31 had been receiving Diazepam at 5 mg three times a day as needed for anxiety, agitation and restlessness. The order was written on 03/03/18. If the as needed (PRN) use was to continue, the physician must document indication, duration and rationale for an extended time frame. The recommendation reflected, the Center for Medicare and Medicaid Services required that PRN orders for non-antipsychotic psychotropic drugs be limited to fourteen days unless the prescriber documented the diagnosed specific condition being treated, the rationale for the extended time period and the duration for the PRN order. The physician response dated 09/27/18 revealed he had accepted the recommendation and noted to extend the Diazepam for thirty days more. There was no rationale given. Record review of the consultation summary report for 09/12/18 revealed the pharmacist recommendation for Resident #31 stated she received a PRN anxiolytic which exceeded the fourteen day limit. The response was to continue for thirty more days without rationale being provided. Record review of the physician progress notes from 09/01/18 through 09/30/18 revealed there was no documentation which provided rationale for continued use of Diazepam for Resident #31. Review of a note to the attending physician, dated 02/20/19 revealed Resident #31 received a PRN order for Diazepam for anxiety and restlessness. Sedative or hypnotic medications were limited to fourteen days. The attending physician may extend the order beyond the fourteen days if he or she felt it was appropriate. If the PRN use was extended the medical record must contain a documented rationale and determined duration. The attending physician response was to continue the medication for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 12 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few another sixty days. There was no rationale provided in his note dated 02/20/19 in response to the pharmacist. Review of the consultant pharmacist's medication regimen review between 02/01/19 and 02/26/19 revealed on 02/20/19, the pharmacist relayed to the physician Resident #31 had been receiving Diazepam at 5 mg three times a day for anxiety and restlessness. Regulations effective 11/2017 stated PRN orders for any anxiolytic, antidepressant, sedative or hypnotic medication was limited to fourteen days or could be extended beyond the fourteen days with documented physician rationale and determined duration. The physician response dated 02/28/19 was to extend the PRN Diazepam to sixty days without rationale noted. Review of the physician's notes from 02/01/19 through 02/28/19 revealed no rationale provided for continued use of Diazepam for Resident #31. An interview with the [NAME] President of Clinical Operations #723 on 09/17/19 at 5:12 P.M. revealed the attending physician for Resident #31 was aware of the regulations and he knew he could not continue to give Diazepam to this resident beyond 14 days without a rationale. She verified there was no record of any rationale given by the physician for continued use of Diazepam. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 13 of 14 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on record review and interview the facility failed to ensure Resident #31 was prescribed an antipsychotic medication with a clinical indication for use. This affected one resident (#31) of five residents reviewed for unnecessary medication use. Findings Include: Review of a note to the attending physician dated 03/06/19 and the consultant pharmacist's medication regimen review dated 03/06/19 revealed Resident #31 had been receiving Quetiapine (Seroquel) 50 milligrams (mg) twice a day since December 2018 for anxiety, agitation and restlessness. Record review revealed Resident #31 had an order dated 04/01/19 for Quetiapine (Seroquel) 50 milligrams (mg) twice a day for dementia with Lewy bodies. Review of the Medication Administration Record (MAR) from 04/01/19 through 09/17/19 revealed the Seroquel medication was administered to Resident #31 with target behaviors listed on the MAR as anxiety, agitation and restlessness. Review of a note to the attending physician dated 08/07/19 from the consultant pharmacist revealed Resident #31 had been receiving Quetiapine twice a day. Any antipsychotic medication should generally be used for long term care only for certain conditions and diagnoses. Please review and clarify the supportive diagnosis for this order. The physician agreed and revealed a diagnosis of mood disorder with psychotic features as of 08/07/19. Review of the physician and nurse practitioner progress notes from 04/01/19 through 09/17/19 indicated nothing in regard to any behaviors with psychotic features or any incidents of harm or attempted harm of patient to herself or others. Review of all behavior documentation revealed few noted behaviors related to depression, weeping, anxiety, agitation and restlessness. Documentation was only recorded for the months of April, May and June 2019. An interview with the [NAME] President of Clinical Operations #723 on 09/17/19 at 5:12 P.M. revealed the physician of Resident #31 knew about medication regulations and that you could not give Seroquel to a resident without an appropriate diagnosis. She verified and confirmed there was no documentation to support the initial order for Quetiapine regarding behaviors or diagnoses. There was no documentation regarding any psychotic features with this resident to warrant the continued use of the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 14 of 14