Inspection·May 19, 2023

F 0600 of one for bathing. Level of Harm - Minimal harm or potential for actual harm Review of the nursing progress note dated 5/06/23 at 1:49 P.M. for Resident #213 revealed STNA #418 was rough and loud with Resident #213. Resident #213 did not recall the incident, felt safe at the facility, did not have any noted skin issues, and did not voice any other concerns. Residents Affected - Few Review of the 05/06/23 facility self-reported incident report revealed State Tested Nurse Aide (STNA) #411 observed STNA #418 being rough and loud with Resident #213 and STNA #411 told STNA #418 not to be so rough with him. STNA #411 proceeded to assist STNA #418 with a mechanical lift transfer of Resident #259. During the transfer of Resident #259, his arm became pinched, and he requested STNA #418 to stop. STNA #418 told Resident #259, Are you bleeding, if not cry about it. Interview on 05/18/23 at 8:55 A.M. with STNA #411 revealed on 05/06/23 she heard Resident #213 yelling and went to his room. She stated STNA #418 was being loud and aggressive towards Resident #213. STNA #411 stated she told STNA #418 to be gentler. About five minutes later, STNA #411 was assisting STNA #418 with the mechanical lift for Resident #259 and he got pinched. Resident #259 asked STNA #418 to stop and STNA #418 did not listen. STNA #411 stated she told STNA #418 to stop. STNA #418 looked at Resident #259 and told him, Are you bleeding, then cry about it. STNA #411 confirmed she had not told the nurse about the incident with Resident #213 until after Resident #259 got injured. Interview on 05/18/23 at 12:54 P.M. with Licensed Practical Nurse (LPN) #420 revealed after being made aware of the incidents involving Resident #213 and Resident #259, she interviewed Resident #213 who stated he did not recall the incident and Resident #259 stated the aide was rough during his transfer while using the mechanical lift and his arm became pinched. Resident #259 stated he asked STNA #418 to stop but she did not until STNA #411 told her to stop. STNA #418 then told Resident #259, Are you bleeding, then cry about it. Interview on 05/18/23 at 1:36 P.M. with the Administrator revealed he was not at the facility when the incident involving Residents #213 and #259, was made aware of it, and advised the supervisor to initiate the abuse investigation. The Administrator stated the facility takes allegations of abuse very seriously to ensure safety. Review of the 09/01/19 revised facility policy called: Resident Rights revealed employees shall treat all residents with kindness, respect, and dignity. These rights include the resident's right to be treated with respect, kindness, and dignity and be free from abuse. Review of the 01/21/20 revised facility policy called: Abuse, Neglect, Exploitation, Mistreatment of a Resident and Misappropriation of Resident Property revealed the facility will not tolerate any type of abuse. This deficiency represents non-compliance investigated under Complaint Number OH00142712. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 2 of 7 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 05/19/2023 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on record review, self-reported incident (SRI) review, policy review and interview, the facility failed to ensure a report of alleged abuse was reported timely. This affected two residents (#213 and #259) of three residents reviewed for abuse. The facility census was 79. Findings included: 1. Review of the medical record review for Resident #259 revealed an admission date of 01/08/21. Diagnoses included but were not limited to Neurocognitive disorder with Lewy bodies, Parkinson's disease, dysphagia, and stage III chronic kidney disease. Review of 04/03/23 quarterly Minimum Data Set (MDS) 3.0 for Resident #259 revealed a Brief Interview of Mental Status (BIMS) score of 03 out of 15 which indicated severe cognitive impairment. Review of activities of daily living (ADLs) for Resident #259 revealed he required extensive assist of two staff for bed mobility, dressing, personal hygiene, total dependence of two staff for transfer, locomotion on and off the unit, toileting, total dependence of one staff for bathing and supervision for eating meals. Review of Resident #259's care plan revealed he needed assistance with ADL's. Interventions included transfer and toileting with a mechanical lift with blue sling with assistance of two staff. Review of Resident #259's nursing progress notes dated 05/06/23 revealed a staff member pulled the sling to the mechanical lift up while Resident #259 was in it and pinched his arm. Resident #259 was noted to have a 3.5 x 1 x <.1 cm reddened area on his right forearm with intact skin. Resident #259 stated a lady was rough with me in the mechanical lift, and I was yelling at her to stop. Interview on 05/18/23 at 9:11 A.M. with Resident #259 revealed he got his arm pinched during a transfer, he asked the aide to stop, but she did not and said to him; Are you bleeding, then cry about it. 2. Medical record review for Resident #213 revealed an admission date of 02/13/23. Diagnoses included but were not limited to hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, vascular dementia, and abnormal posture. Resident code status is DNRCC. Review of 02/20/23 quarterly MDS 3.0 for Resident #213 revealed a Brief Interview of Mental Status (BIMS) score of 04 out of 15 which indicated severe cognitive impairment. Review of activities of daily living (ADLs) revealed resident requires extensive assist of two staff for bed mobility, toileting, transfer, walk in room, locomotion on/off unit, extensive assist of one for dressing, supervision for eating, and total dependence of one for bathing. Review of the nursing progress note dated 5/06/23 at 1:49 P.M. for Resident #213 revealed STNA #418 was rough and loud with Resident #213. Resident #213 indicated he did not recall the incident, felt safe at the facility, did not have any noted skin issues, and did not voice any other concerns. Review of the 05/06/23 facility self-reported incident report revealed State Tested Nurse Aide (STNA) #411 observed STNA #418 being rough and loud with Resident #213 and STNA #411 told STNA #418 not to be so rough with him. STNA #411 proceeded to assist STNA #418 with a mechanical lift transfer of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 3 of 7 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 05/19/2023 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #259. During the transfer of Resident #259, his arm became pinched, and he requested STNA #418 to stop. STNA #418 told Resident #259, Are you bleeding, if not cry about it. Interview on 05/18/23 at 8:55 A.M. with STNA #411 revealed on 05/06/23 she heard Resident #213 yelling and went to his room. She stated STNA #418 was being loud and aggressive towards Resident #213. STNA #411 stated she told STNA #418 to be gentler. About five minutes later, STNA #411 was assisting STNA #418 with the mechanical lift for Resident #259 and he got pinched. Resident #259 asked STNA #418 to stop and STNA #418 did not listen. STNA #411 stated she told STNA #418 to stop. STNA #418 looked at Resident #259 and told him, Are you bleeding, then cry about it. STNA #411 confirmed she had not told the nurse about the incident with Resident #213 until after Resident #259 got injured. Interview on 05/18/23 at 12:54 P.M. with Licensed Practical Nurse (LPN) #420 revealed after being made aware of the incidents involving Resident #213 and Resident #259, she interviewed Resident #213 and Resident #259 and conducted skin assessments on them both. LPN #420 stated she provided an in-service on abuse to both LPN #419 and STNA #411 related to the importance of timely reporting and proper procedures and indicated she did not provide abuse in-services to any additional staff following the incident. Interview on 05/18/23 at 1:15 P.M. with the Director of Nursing (DON) confirmed all incidents of alleged abuse are to be reported immediately. Interview on 05/18/23 at 1:36 P.M. with the Administrator confirmed any type of alleged abuse is to be reported immediately. Review of the 01/21/20 revised facility policy called: Abuse, Neglect, Exploitation, Mistreatment of a Resident and Misappropriation of Resident Property revealed the facility staff should immediately report all allegations of abuse to the Administrator and to the Ohio Department of Health in accordance with the procedures in this policy. This deficiency represents non-compliance investigated under Complaint Number OH00142712. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 4 of 7 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 05/19/2023 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on record review, self-reported incident (SRI) review, policy review and interview, the facility failed to complete a thorough abuse investigation. This affected two residents (#213 and #259) of three residents reviewed for abuse. The facility census was 79. Residents Affected - Few Findings included: 1. Review of the medical record review for Resident #259 revealed an admission date of 01/08/21. Diagnoses included but were not limited to Neurocognitive disorder with Lewy bodies, Parkinson's disease, dysphagia, and stage III chronic kidney disease. Review of 04/03/23 quarterly Minimum Data Set (MDS) 3.0 for Resident #259 revealed a Brief Interview of Mental Status (BIMS) score of 03 out of 15 which indicated severe cognitive impairment. Review of activities of daily living (ADLs) for Resident #259 revealed he required extensive assist of two staff for bed mobility, dressing, personal hygiene, total dependence of two staff for transfer, locomotion on and off the unit, toileting, total dependence of one staff for bathing and supervision for eating meals. Review of Resident #259's care plan revealed he needed assistance with ADL's. Interventions included transfer and toileting with a mechanical lift with blue sling with assistance of two staff. Review of Resident #259's nursing progress notes dated 05/06/23 revealed a staff member pulled the sling to the mechanical lift up while Resident #259 was in it and pinched his arm. Resident #259 was noted to have a 3.5 x 1 x <.1 cm reddened area on his right forearm with intact skin. 2. Medical record review for Resident #213 revealed an admission date of 02/13/23. Diagnoses included but were not limited to hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, vascular dementia, and abnormal posture. Resident code status is DNRCC. Review of 02/20/23 quarterly MDS 3.0 for Resident #213 revealed a Brief Interview of Mental Status (BIMS) score of 04 out of 15 which indicated severe cognitive impairment. Review of activities of daily living (ADLs) revealed resident requires extensive assist of two staff for bed mobility, toileting, transfer, walk in room, locomotion on/off unit, extensive assist of one for dressing, supervision for eating, and total dependence of one for bathing. A nursing progress note dated 5/06/23 at 1:49 P.M. for Resident #213 revealed State Tested Nurse Aide (STNA) #418 was reported being rough and loud with Resident #213. Resident #213 did not recall the incident, felt safe at the facility, did not have any noted skin issues, and did not voice any other concerns. Review of the facility incident investigation report revealed STNA #411 observed STNA #418 being rough and loud with Resident #213 and STNA #411 told STNA #418 not to be so rough with him. STNA #411 then assisted STNA #418 with a mechanical lift transfer of Resident #259 in which STNA #418 spoke loudly and rudely to Resident #259. STNA #411 reported the two incidents of verbal abuse involving STNA #418 with Resident #213 and Resident #259. The investigation report included witness statements from STNA #411, Licensed Practical Nurse (LPN #419), LPN #420 and resident interviews and skin assessments for Resident #213 and #259. No additional resident interviews or skin assessments were provided for review. STNA #418 was noted to have been removed from the facility, but a witness statement was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 5 of 7 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 05/19/2023 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 0610 not obtained. Level of Harm - Minimal harm or potential for actual harm Review of the 05/06/23 facility self-reported incident report (SRI) reported to the state agency revealed State Tested Nurse Aide (STNA) #411 observed STNA #418 being rough and loud with Resident #213. STNA #411 proceeded to assist STNA #418 with a mechanical lift transfer of Resident #259. During the transfer of Resident #259, his arm became pinched, and he requested STNA #418 to stop. STNA #418 told Resident #259, Are you bleeding, if not cry about it. Residents Affected - Few Interview on 05/18/23 at 8:55 A.M. with STNA #411 revealed on 05/06/23 she heard Resident #213 yelling and went to his room. STNA #411 stated STNA #418 was being loud and aggressive towards Resident #213. STNA #411 stated she told STNA #418 to be gentler. About five minutes later, STNA #411 assisted STNA #418 with the mechanical lift for Resident #259 and he got pinched. Resident #259 asked STNA #418 to stop and STNA #418 did not listen. STNA #411 stated she told STNA #418 to stop. STNA #418 looked at Resident #259 and told him, Are you bleeding, then cry about it. STNA #411 confirmed she had not told the nurse about the incident with Resident #213 until after Resident #259 got injured. Interview on 05/18/23 at 9:11 A.M. with Resident #259 revealed he got his arm pinched during a transfer, he asked the aide to stop, but she did not and said to him; Are you bleeding, then cry about it. Interview on 05/18/23 at 12:54 P.M. with Licensed Practical Nurse (LPN) #420 revealed after being made aware of the incidents involving Resident #213 and Resident #259, she interviewed Resident #213 and Resident #259 and conducted skin assessments on them both. LPN #420 indicated she did not do any interviews or skin assessments of other residents on the unit. LPN #420 stated she provided an in-service on abuse to both LPN #419 and STNA #411 related to the importance of timely reporting and proper procedures and indicated she did not provide abuse in-services to any additional staff following the incident. Interview on 05/18/23 at 12:45 P.M. with the Administrator confirmed following the incidents involving Resident #213 and #259, staff in-services were only provided to LPN #419 and STNA #411 and he did not have any additional information to provide for review regarding SRI # 234752. The Administrator also confirmed a thorough investigation would include ensuring safety of the resident, following up the investigation with statements from staff and residents and skin assessments of all potentially affected residents. Interview on 05/18/23 at 1:15 P.M. with the Director of Nursing (DON) confirmed the facility did not have additional interviews of skin assessments to provide related to the incident involving Resident #213 and #259. The DON revealed all incidences of potential alleged abuse are to be reported immediately and conduct interviews and skin assessments on all residents who were potentially involved in the incident. Review of the 01/21/20 revised facility policy called: Abuse, Neglect, Exploitation, Mistreatment of a Resident and Misappropriation of Resident Property revealed the facility will investigate all alleged violations of abuse. The facility will conduct a thorough, evidence-based investigation in which the investigator may interview the additional residents with information, conduct skin evaluations of those with cognitive impairment. The investigator will thoroughly collect evidence, observations, interviews, and record review and corroborate information about the incident. Staff training would be completed as determined by the results of the investigation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366152 If continuation sheet Page 6 of 7 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 05/19/2023 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 0610 This deficiency represents non-compliance investigated under Complaint Number OH00142712. 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: 366152 If continuation sheet Page 7 of 7