Health inspection·November 21, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Interview on 11/13/23 at 11:00 A.M. with LPN #230 revealed she knew Resident #47 at times refuse her weights. LPN #230 stated she could have the physician change the time of the physician order. Review of the facility document titled The Resident Rights revealed residents had the right to have staff assist in rising and retiring in accordance with their requests. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 2 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record, interviews, and policy review, the facility failed to complete a comprehensive care plan. This affected three (#15, #20, and #84) out of 21 residents reviewed for care plans. The facility census was 91. Findings include: 1. Review of the medical record for Resident #15 revealed an admission date of 04/03/23. Diagnoses included type two diabetes mellitus (DM II), COVID-19, chronic kidney disease, stage three, morbid obese, and hypertension. Review of the admission Morse fall risk assessment dated [DATE] revealed Resident #15 was at moderate risk for falls Review of the medical chart revealed Resident #15 had falls on 10/30/23 and 10/31/23. No care plan was initiated to identify the residnet to be at risk for falls and no intervention were put into place to prevent further falls. Interview on 11/14/23 at 10:41 A.M. with Registered Nurse Infection Control Preventionist (RNICP) #235 verified there was no care plan created for Resident #15 related to falls. 2. Review of the medical record revealed Resident #20 was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease (COPD), chronic respiratory failure with hypoxia, pulmonary hypertension, major depressive disorder, and congestive heart failure. Review of the physician order dated 09/13/22 revealed Resident #20 was ordered to remove filter from oxygen concentrator, clean and replace every week. Review of the physician order dated 09/13/22 revealed Resident #20 was ordered to change hand held nebulizer tubing monthly and date and initial tubing. Review of the physician order dated 03/13/23 revealed Resident #20 was ordered oxygen at 2-3 liters via nasal cannula to keep oxygen saturation above 90%. Review of the medical chart revealed Resident #20 did not have a care plan initiated for oxygen therapy. Interview on 11/14/23 at 10:44 A.M. with RNCIP #235 verified Resident #20 was currently receiving oxygen therapy but did not have a care plan for oxygen therapy. 3. Review of the medical record revealed Resident #84 was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation, supraventricular tachycardia, localized edema, hyperkalemia, heart failure, hypomagnesemia, anxiety disorder, and hyperlipidemia. Review of the active physician orders revealed an order for Eliquis oral tablet 5 milligrams (mg) to be given by mouth two times a day related to heart failure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 3 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Review of the plan of care revealed no care plan related to anticoagulant use. Level of Harm - Minimal harm or potential for actual harm Interview on 11/15/23 at 11:17 A.M. with the Director of Nursing (DON) confirmed there was no care plan for anticoagulant use. Residents Affected - Few Review of the facility policy titled Care Planning Interdisciplinary Team, reviewed 08/16/18, revealed the care planning/interdisciplinary team would develop a comprehensive care plan for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 4 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the medical record, staff interviews, and policy review, the facility failed to complete care conferences for two residents (#6, #39) and failed to update the care plan for one (#84) of 21 residents reviewed for care conferences. The facility census was 91. Findings include: 1. Review of the medical record for Resident #39 revealed an admission date of 04/29/21. Diagnoses included Parkinson's disease, chronic obstructive pulmonary disease (COPD), generalized anxiety disorder, and major depressive disorder. Review of the annual Minimum Data Set (MDS) assessment, dated 08/30/23, revealed this resident had intact cognition. Review of the medical record for Resident #39 revealed social services reached out to Resident #39's sister, which was his Power of Attorney (POA), through email and voicemail in attempt to schedule a care conference on 11/04/22, 01/09/23, 04/07/23, 06/13/23, and 09/07/23. Review of the medical record for Resident #39 revealed no care conferences had been completed in the last 12 months. Interview on 11/14/23 at 1:42 P.M. with the Director of Nursing (DON) verified social services had not completed any care conferences with Resident #39, who had intact cognition, for the last 12 months. 2. Review of the medical record for Resident #84 revealed she was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation, supraventricular tachycardia, localized edema, hyperkalemia, heart failure, hypomagnesemia, anxiety disorder, and hyperlipidemia. Review of the quarterly MDS 3.0 assessment, dated 08/06/23, revealed this resident had intact cognition. Review of the physician orders revealed an order dated 06/01/23 to obtain weight every Monday, Wednesday, and Friday, which was discontinued on 10/10/23 when a new order was placed for a daily weight. Review of the plan of care initiated on 08/20/23 revealed the resident had congestive heart failure. Interventions included weight monitoring on Monday, Wednesday, and Friday. Interview on 11/15/23 at 11:17 A.M. with the DON confirmed the care plan was not updated to reflect change to daily weight monitoring. 3. Review of the medical record for Resident #6 revealed she was admitted to the facility on [DATE]. Diagnoses included heart failure, anemia, unspecified protein-calorie malnutrition, morbid (severe) obesity due to excess calories, acute respiratory failure with hypoxia, chronic obstructive pulmonary disease, acute kidney failure, hypothyroidism, hyperkalemia, anxiety disorder, and major (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 5 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0657 depressive disorder. Level of Harm - Minimal harm or potential for actual harm Review of the quarterly MDS 3.0 assessment, dated 08/31/23, revealed this resident had intact cognition. Residents Affected - Few Interview on 11/07/23 at 2:26 P.M. with Resident #6 revealed she had not had a recent care conference with facility staff. Review of the progress notes from 08/01/23 through 11/13/23 revealed no documentation related to care conferences. Interview on 11/14/23 at 2:48 P.M. with the DON confirmed no documentation related to care conferences conducted for Resident #6. Review of the facility policy titled Care Conferences, revised 2019, revealed care conferences should be held at least quarterly after initial care conference upon admission, with a change in condition, or upon request. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 6 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and policy review, the facility failed to ensure dependent residents received assistance with bathing. This affected two (#78 and #84) out of three residents reviewed for activities of daily living. The facility census was 91. Residents Affected - Few Findings include: 1. Review of the closed medical record for Resident (FR) #78 revealed the following admissions to the facility: 05/23/22 to 06/10/22, 06/21/22 to 12/03/22, 12/03/22 to 06/26/23, 06/30/23 to 07/05/23, 07/15/23 to 07/19/23, 07/22/23 to 07/23/23, 07/25/23 to 10/02/23, 10/04/23 to 10/31/23. Diagnoses included chronic obstructive pulmonary disease, acute respiratory failure with hypoxia, major depressive disorder, generalized anxiety disorder, atherosclerotic heart disease, heart failure, metabolic encephalopathy, cerebral infarction, and emphysema. Review of the significant change Minimum Data Set (MDS) 3.0 assessment, dated 07/31/23, revealed this resident had intact cognition. This resident was assessed to be dependent on staff for bathing. Review of the plan of care initiated on 06/10/22 revealed the resident had an activities of daily living self-care performance deficit related to impaired balance. Interventions included provide sponge bath when a full bath or shower cannot be tolerated. Review of the shower documentation for Resident #78 revealed no documentation related to bathing provided from 09/01/23 through 09/20/23. Interview on 11/14/23 at 11:21 A.M. with Unit Manager Licensed Practical Nurse (LPN) #238 confirmed there was no bathing documentation for Resident #78 from 09/01/23 through 09/20/23. 2. Review of the medical record for Resident #84 revealed she was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation, supraventricular tachycardia, localized edema, hyperkalemia, heart failure, hypomagnesemia, anxiety disorder, and hyperlipidemia. Review of the quarterly MDS 3.0 assessment, dated 08/06/23, revealed this resident had intact cognition. This resident was assessed to require one person physical assistance for bathing. Review of the plan of care initiated on 06/15/23 revealed the resident had an activities of daily living self-care performance deficit related to impaired balance, limited mobility, and pain. Interventions included provide a sponge bath when a full bath or shower cannot be tolerated. Interview on 11/07/23 at 2:34 P.M. with Resident #84 revealed she had not received scheduled showers. Review of shower documentation for Resident #84 on 11/14/23 revealed there was no showers documented since 11/02/23. Interview on 11/14/23 at 11:21 A.M. with Unit Manager LPN #238 confirmed there was no shower documentation for Resident #84 since 11/02/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 7 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the facility policy titled Resident Bathing, revised 05/21/14, revealed all residents had the right to choose when and how often they are bathed and/or showered, and all residents would be scheduled for a minimum of two showers per week for general cleanliness and proper hygiene purposes. This deficiency represents non-compliance investigated under Master Complaint Number OH00148336 and Complaint Number OH00148158. Event ID: Facility ID: 366167 If continuation sheet Page 8 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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, staff interview, and policy review, the facility failed to ensure weights were obtained per physician order for one resident (#84) and failed to follow physician orders to notify the physician of weight changes within prescribed parameters for one (#47) resident. This affected two (#47 and #84) out of 21 residents reviewed for physician orders. The facility census was 91. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #84 revealed she was admitted to the facility on [DATE]. Diagnoses included atrial fibrillation, supraventricular tachycardia, localized edema, hyperkalemia, heart failure, hypomagnesemia, anxiety disorder, and hyperlipidemia. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/06/23, revealed this resident had intact cognition. This resident was assessed to require limited assistance for transfers. Review of the physician orders revealed an order dated 10/10/23 for a daily weight. Review of the Medication Administration Record (MAR) from 10/01/23 through 10/31/23 revealed daily weights were not obtained on 10/13/23 through 10/15/23, 10/17/23, 10/21/23 through 10/22/23, 10/24/23 through 10/26/23, 10/28/23, and 10/30/23. Interview on 11/14/23 at 4:58 P.M. with Unit Manager Licensed Practical Nurse (LPN) #238 confirmed the order was changed to daily weight monitoring for Resident #84. Unit Manager LPN #238 verified there was no documentation of the daily weights on the above dates. Review of the facility policy titled Weight Protocol, 08/20/18, revealed weights would be completed based on clinical judgement and/or physician order. 2. Review of medical record for Resident #47 revealed an admission date 01/17/23. Diagnosis included Alzheimer's disease, myocardial infarction, chronic obstructive pulmonary disease, cardiac pacemaker, and atherosclerotic heart disease. Review of the Minimum Data Set assessment, dated 10/15/23, revealed Resident #47 was cognitively intact. Review of physician order dated 09/20/23 for Resident #47 revealed an order for daily weight to be obtained. Notify provider of gain greater than three pounds in a day or five pounds in a week. Review of weights dated 10/15/23 was 231.2 pounds, 10/16/23 was 234.6 pounds, 10/28/23 was 228.6 pounds, and 10/29/23 was 232.4 pounds. There was no evidence the phsician was notified of the weight changes greater than three pounds in a day. Interview on 11/14/23 at 3:55 P.M. with Director of Nursing (DON) verified on 10/16/23 the resident had a 3.4-pound increase,and 10/29/23 there was a 3.8-pound increase. The DON verified no one notified the physician of the weight gain. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 9 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interviews, resident interview, review of the facility's fall investigation, and policy review, the facility failed to provide adequate staff assistance to prevent accidents. This resulted in actual harm when Resident #73 was receiving care by one staff, fell out of bed and fractured her left femur. Additionally, the facility failed to ensure Resident #2 received adequate staff assistance during care that resulted in an avoidable fall which resulted in no actual harm with the potential for more than minimal harm. This affected two (#2 and #73) out of four residents reviewed for falls. The facility census was 91. Findings include: 1. Review of the closed medical record for Resident #73 revealed she was admitted to the facility from 08/25/21 to 04/10/23, and from 04/14/23 through 10/30/23. Diagnoses included acute and chronic respiratory failure with hypercapnia, metabolic encephalopathy, peripheral vascular disease, generalized anxiety, pulmonary hypertension, fibromyalgia, hypothyroidism, and other specified disorders of bone density and structure. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 08/02/23, revealed this resident had intact cognition. This resident was assessed to require extensive assistance of two staff for bed mobility and personal hygiene, extensive assistance of one staff for dressing and was totally dependent on two staff for transfer and toilet use. Review of the plan of care, initiated on 08/27/21, revealed the resident had an activities of daily living self-care performance deficit related to impaired balance. Interventions included extensive assistance to dependence by one to two staff to turn and reposition in bed. Review of the progress note dated 10/30/23 revealed Resident #73 was found lying on her left side on the floor. Resident #73 was assessed and no obvious injuries were noted, but the resident reported severe pain in her left knee. Further assessment revealed the resident had severe pain in her left leg. Resident #73 was not moved off the floor until emergency medical services arrived and transferred the resident to a stretcher. Review of the facility's fall investigation, dated 10/30/23, revealed Resident #73 reported My leg went over and I went down on my knees. My face hit on the way down. The investigation also revealed a new intervention of a wide/bariatric bed was in place and the resident was changed to two-person assistance for all bed mobility, including but not limited to turning and repositioning, incontinence care, and activities of daily living. The investigation stated Resident #73's morbid obesity contributed to her inability to maintain balance. The interdisciplinary team note at the conclusion of the investigation revealed Resident #73 was laying on her bed and receiving incontinence care when her left leg pulled her over and caused her to fall off the bed. Resident #73 was still holding onto the side rails and landed on her knees. The facility noted Resident #73 sustained a left femur fracture and educated all staff. Review of the hospital record dated 10/30/23 revealed Resident #73 had a closed bicondylar fracture of the left femur. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 10 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0689 Level of Harm - Actual harm Review of the facility counseling form for State Tested Nursing Assistant (STNA) #216, dated 10/30/23, revealed STNA #216 was providing care to Resident #73 in bed and the resident rolled over too far, which caused her to fall out of bed. The form stated STNA #216 was counseled that the resident needed two-person assistance during care due to her size and bed mobility. Residents Affected - Few Interview on 11/13/23 at 10:40 A.M. with STNA #216 revealed Resident #73's level of assistance fluctuated depending on how well she was moving. STNA #216 stated Resident #73 was moving well on the date of the incident. STNA #216 reported she was providing incontinence care for Resident #73 while she was in bed and lying on her side. STNA #216 expressed it was time for the resident to roll back and her feet went over the bed, which caused her to fall on her knees out of bed while still holding onto the handrails. STNA #216 stated Resident #73 had already let go and was on the floor by the time she made it around the bed. She yelled for help and ran into the hall to find assistance. Interview on 11/13/23 at 3:50 P.M. with the Director of Nursing (DON) revealed it was a gray area when deciding if a resident needed the assistance of one or two staff. The DON stated Resident #73 could move around in bed by herself, but if she needed help to roll then they would use two staff. Interview on 11/14/23 at 1:15 P.M. with the DON revealed Resident #73 could turn herself and turn to her side. The DON stated Resident #73 had a wider mattress but not a bariatric bed at the time of the incident. The DON expressed the aide is unable to assess the number of staff needed for resident assistance. Review of the facility policy titled Falls Prevention, revised 01/20/16, revealed it was the policy of the facility to have a system in place to prevent initial and/or subsequent falls. 2. Review of the medical record for Resident #2 revealed she was admitted [DATE]. Diagnoses included Schmorl's node of lumbar region, cardiomegaly, insomnia, chronic obstructive pulmonary disease, anxiety disorder, plantar fascial fibromatosis, atherosclerotic heart disease, epilepsy, malignant neoplasm of colon, poly osteoarthritis, metabolic encephalopathy, congestive heart failure, type 2 diabetes, hypertension, morbid obesity, sleep apnea, peripheral vascular disease, anemia, chronic kidney disease, and dementia. Review of the MDS assessments, dated 06/09/23 and 08/01/23, revealed the resident had moderate cognitive impairment. She was dependent for completing activities of daily living (ADL's). Review of her Morse Fall Scale dated 06/01/23 revealed she had no previous falls and knew her own limits, but had an impaired gait. Review of her Care Plan dated 10/24/23 revealed she had a self-care performance deficit related to impaired balance and was at risk for falls related to balance problems, incontinence status and the use of psychoactive medication. Review of the progress notes for Resident #2 dated 06/23/23 revealed Resident #2 was getting a bed bath from an aide when she rolled, fell out of bed and landed on her right side on the floor. She was sent to the emergency room (ER) for further evaluation. Review of the hospital records dated 06/23/23 revealed a computed tomography (CT) scan of Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 11 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0689 #2's head and spine revealed no acute fractures or obvious traumatic injuries. Level of Harm - Actual harm Review of the fall investigation dated 06/23/23 revealed Resident #2 was getting a bed bath by an aide when she rolled and fell out of bed on her right side to the floor. Resident #2 was sent to the ER for further evaluation as she was slow to respond to verbal response and it was unclear if she hit her head. No injuries were observed at time of the incident or post incident. The Interdisciplinary Team Note (IDT) note included with the investigation revealed Resident #2 remained on the floor until the squad arrived to transport her to the ER for evaluation. She returned from the hospital without any known injuries. Residents Affected - Few During an interview on 11/13/23 at 12:10 P.M. Resident #2 verified one staff member was assisting her with her bath when she fell. During an interview on 11/14/23 at 1:26 P.M. with the Director of Nursing (DON) she reported at the time of the fall Resident #2 had a geriatric bed, was normally able to assist with care, and normally was able to have one staff person assist with her care. She stated on 06/23/23 when receiving her bed bath one of Resident #2's legs went over the other while she was laying on her side. This caused her to roll over out of the bed. The DON reported Resident #2 was sent directly to the ER for evaluation with no injuries noted. During an interview on 11/14/23 at 2:38 P.M. with STNA #293 she reported she was the only staff assisting Resident #2 with her bed bath. She stated she had finished the bed bath, Resident #2 was still lying on her side, the resident coughed which threw her body forward, and she landed on the floor on her right side. STNA #293 reported Resident #2 stated she was fine but was sent to the emergency room for evaluation as a precaution and was found to have no injuries. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 12 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations, and staff interviews, the facility failed to properly date oxygen tubing according to physician orders. This affected one (#20) out of 19 residents reviewed for oxygen therapy. The facility census was 91. Residents Affected - Few Findings include: Review of the medical record revealed Resident #20 was admitted to the facility on [DATE]. Diagnoses included chronic obstructive pulmonary disease (COPD), chronic respiratory failure with hypoxia, pulmonary hypertension, major depressive disorder, and congestive heart failure. Review of the Minimum Data Set (MDS) assessment, dated 08/23/23, revealed Resident #20 had intact cognition. Review of the physician order dated 09/13/22 revealed Resident #20 was ordered to remove filter from oxygen concentrator, clean and replace every week. Review of the physician order dated 09/13/22 revealed Resident #20 was ordered to change hand held nebulizer tubing monthly and date and initial tubing. Review of the physician order dated 03/13/23 revealed Resident #20 was ordered oxygen at two to three liters via nasal cannula to keep oxygen saturation above 90%. Observation on 11/13/23 at 1:20 P.M. revealed Resident #20 was wearing two liters of oxygen via nasal cannula with no date or initials labeled on the oxygen tubing. Interview on 11/13/23 with the Director of Nursing (DON) verified Resident #20's oxygen tubing was not dated or labeled since the tubing was changed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 13 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interviews, and policy review, the facility failed to ensure a resident's medications were administered without error. This affected one resident (#43) of five reviewed for unnecessary medications. The facility census was 91. Residents Affected - Few Findings include: Review of the medical record for Resident #43 revealed an admission date of 09/26/22. Diagnoses included cerebral infarction, left bundle branch block, major depressive disorder, and functional urinary incontinence. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #43 had intact cognition. Review of the medication error report dated 10/23/23 revealed Resident #43 was administered Lasix 40 milligrams (mg), Coreg 6.25 mg, Tylenol 650 mg, and Colace 100 mg. Licensed Practical Nurse (LPN) #293 reported she confused two residents (#43 and #74). Resident #43 noticed a pill that was different from her usual medications. LPN #293 told Resident #43 that she would check and see when the order was written and what it was. Resident #43 had already consumed the pills at that time. On-call provider was notified at 6:15 P.M. and provided instructions to LPN #293 to monitor blood pressure for 24 hours. Resident #43 was also aware that her output for the night will increase. An order was placed to monitor Resident #43's blood pressure every four hours for 24 hours. Review of the physician order dated 10/23/23 revealed Resident #43 was ordered to have her blood pressure monitored every four hours for 24 hours. Interview on 11/14/23 at 1:35 P.M. with the Director of Nursing (DON) revealed Resident #43 was given Resident #74's medication. The DON reported no adverse reactions occurred. The physician, family, and the resident were notified. Orders were given to monitor blood pressure every four hours for 24 hours. The DON reported LPN #293 was educated and instructed to complete an incident report. Review of the facility policy titled Physician orders, dated 08/18/18 revealed all medications administered to the resident must be ordered by the resident's attending physician. This deficiency is non-compliance discovered during the investigation for Complaint Number OH00148158. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 14 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 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 0851 Level of Harm - Minimal harm or potential for actual harm Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Many Review of Payroll Based Journal , facility documents, and interview with staff, the facility failed to submit the Payroll Based Journal report in first quarter of 2023. The facility censu was 91. Findings include: Review of the Payroll Based Journal revealed the facilty had not submitted their report for the first quarter of 2023. Interview on 11/14/23 at 2:50 P.M. with Data Service (DS) #266 stated he did submit the Payroll Based Journal report on the first quarter. DS #266 stated he was not sure why it did not go through. Review of an email date 05/17/23 revealed Data Service (DS) #266 had reached out to Centers for Medicare and Medicaid Services (CMS) to fix the data that was that not submitted on 02/09/23. DS #266 stated he was stumped on why it was not submitted with success. The deficient practice was corrected on 05/17/23 when the facility implemented the following corrective actions: -On 05/15/23, the second quarter of 2023 Payroll Based Journal data was due. The facility successfully submitted the data. -On 05/17/23, DS #266 reached out to CMS BetterCare to determine the reason for the missing first quarter 2023 data. DSS #266 received information on how to verify successful submission of the staffing information for the Payroll Based Journal. As a result, the facility began tracking the verifications received each month. -Since the implementation of the new procedure, no additional concerns have been identified related to Payroll Based Journal reporting. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 15 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on review of the posted COVID-19 signage regarding personal protective equipment (PPE), observations, review of the facility policies and procedures, staff interviews, and review of the Centers for Disease Control and Prevention guidelines, the facility failed to implement effective and recommended infection control practices including a system to ensure the availabilty and appropriate use of PPE by staff, a system to ensure staff were donning and doffing PPE when required, and ensuring staff were practicing proper hand hygiene to prevent the spread of COVID-19 in the building. This resulted in Immediate Jeopardy and the potential for serious negative health outcomes and/or life-threatening harm when 25 residents (#10, #15, #23, #30, #37, #40, #44, #48, #52, #53, #55, #58, #65, #68, #71, #76, #83, #86, #190, #193, #194, #195, #196, #200 and #240) and 13 staff (Licensed Practical Nurse [LPN] #210, #224, #239, #242, #256, #277, and #291, State Tested Nursing Assistant [STNA] #240, #275 and #299, Housekeeper #233, and Certified Occupational Therapist Assistant [COTA] #208 and #288 tested positive for COVID-19 without the aforementioned systems in place to prevent the transmission and spread of COVID-19 to the vulnerable residents in the facility. The lack of current effective infection control practices during a COVID-19 outbreak in the facility placed all 91 residents at potential risk for the likelihood of serious life-threatening harm, negative health complications and/or death. The facility census was 91. Residents Affected - Many On 11/07/23 at 11:36 A.M., the Administrator, Director of Nursing (DON), and Registered Nurse Infection Control Preventionist (RNICP) #235 were notified that Immediate Jeopardy began on 10/31/23 when Resident #65 and LPN #291 tested positive for COVID-19. The facility failed to implement appropriate and recommended infection control practices during a COVID-19 outbreak at the facility including inappropriate donning and doffing of PPE when entering and exiting a COVID-19 isolation room, improper hand hygiene, and ensuring PPE was readily available to staff. Upon entrance to the facility on [DATE], a total of 10 residents had tested positive with five additional positive residents that day within a six-day time frame since 10/31/23. The Immediate Jeopardy was removed on 11/10/23 when the facility implemented the following corrective actions: • The facility continued to educate staff on the appropriate use of PPE to include what to wear, when to utilize it, and appropriate hygiene in all COVID-19 positive resident rooms to include Residents #10, #15, #23, #30, #37, #40, #44, #48, #53, #55, #71, #76, #86, and #196. Resident #58 no longer resided at the facility. • On 11/07/23, RNICP #235 or designee, immediately started in-servicing all staff via the company messaging system to each staff member. Additionally, in-servicing will continue via in person in-service, telephone in-service, and an in-service will be an sent by email. Education during the in-service included all COVID-19 resident rooms will display a green magnet containing pictures and explanations of what PPE is required. All COVID-19 positive residents require the following: o Location of all appropriate PPE accessible to all staff either on the over the door hanger, central supply (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 16 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 or the nurse ' s station. Level of Harm - Immediate jeopardy to resident health or safety o Transmission based precautions include contact, droplet, and droplet/contact. Residents Affected - Many o Gown - Must be donned prior to entering a room and removed prior to exit in COVID-19 positive rooms o Mask N95 only (surgical mask is not acceptable) in COVID-19 positive rooms o Gloves - Must be donned prior to entering a room and removed prior to exit. o Face Shield or Goggles - Must be donned prior to entering a room and either disposed of or cleaned utilizing a sanitizing wipe found on nurse ' s carts, central supply room, or nurse's stations. o Using hand sanitizer or washing hands prior to entering room and exiting the resident room. o Contact precautions - residents known or suspected to be infected with pathogens transmitted by contact. Employees should wash their hands before and after resident care. Gloves, gowns and dedicated disposable equipment should be used. In our building there will be a yellow magnet displayed outside the residents ' room. All items should be thrown away prior to exiting the room. o Droplet precautions (COVID-19) - patients known or suspected to be infected with pathogens transmitted by respiratory droplets (Coughing, sneezing, or talking). Employees should wash their hands before and after resident care. Mask, eye wear, gown, and gloves should be used. In our building there will be a green magnet displayed outside the residents ' room. All items should be thrown away prior to exiting the room. o Hand Hygiene Technique - Wet hands and wrists thoroughly o Apply soap to hands. o Lather all surfaces of wrists, hands, and fingers producing friction, for at least 20 seconds, keeping hands lower than the elbows and the fingertips down. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 17 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 o Clean fingernails by rubbing fingertips against palms of the opposite hand. Level of Harm - Immediate jeopardy to resident health or safety o Rinse all surfaces of wrist, hands, and fingers, keeping hands lower than the elbows and the fingertips Residents Affected - Many o Use clean dry paper towels/towels to dry all surfaces of fingers, hands, and wrists starting at the fingertips down. then disposes of paper towels/towels in the waste container in the room. o Using clean dry paper towels/towel to turn of facet then dispose of paper towels/towel into waste container in the room. o Do not touch inside of sink at any time. o Biohazard bags - are no longer required when bagging COVID-19 positive resident ' s trash or other items that need thrown away. Education was completed for all staff on 11/10/23. • On 11/07/23, RNICP #235 or designee, began to audit employee adherence to PPE use in COVID-19 rooms at a minimum of five days a week. Five random COVID-19 positive residents (or remaining number if less than five) will be audited each day for five days every week during the outbreak. The IP or designee will be monitoring in the form of an audit to ensure all appropriate PPE is worn correctly by staff in COVID-19 positive rooms. This will include: N95, gown, gloves, faces shield or goggles. Both donning and doffing will be observed. • On 11/07/23, RNICP #235 or designee, will be responsible for ensuring the PPE is readily available on each unit twice daily, covering each 12 hour shift, during outbreak. PPE will be readily available to staff either in the over the door hangers, the central supply room, or at the nurse ' s station. PPE will include N95, gown, gloves, faces shield or goggles. • The facility will continue to test both residents and staff on Mondays and Thursdays for 14 days following the last positive staff or resident. The facility will also test any resident or staff member that exhibits symptoms to include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body ache, headache, new loss of taste or smell, sore throat and cold like symptoms. Residents will be monitored with a pulse oximeter and temperatures will be taken at least (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 18 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 daily for each resident during the COVID-19 outbreak. Level of Harm - Immediate jeopardy to resident health or safety • Residents Affected - Many Observation on 11/08/23 from 11:20 A.M. through 2:00 P.M. revealed the facility staff providing care for residents were wearing correct PPE and performing hand hygiene. All halls had PPE stocked on the doors for access to correct PPE for residents with COVID-19. • Interviews on 11/08/23 with Housekeeper #254, LPN #290, LPN #291, and STNA #275 verified they had been educated on COVID-19 isolation precautions, the proper PPE to wear in the room of a resident who was positive for COVID-19, and hand hygiene. Although the Immediate Jeopardy was removed on 11/10/23, the facility remained out of compliance at Severity Level 2 (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility was still in the process of implementing their corrective action plan and monitoring to ensure on-going compliance. Findings include: Review of an email dated 11/01/23 documented the Administrator notified the local health department that a staff member and three residents were positive for COVID-19. The local health department recommended the following: COVID-19 Close Contact: Someone who was within six feet of an infected person (regardless of masks or personal protective equipment worn) for at least fifteen minutes (total/cumulative time) starting from two days or (48 hours) before the illness onset or (for asymptomatic clients), two days prior to positive specimen collection and through their isolation period. Testing was recommended immediately but no earlier than 24 hours after the exposure. If negative, then 48 hours after the first negative test. If negative, then 48 hours after the second negative test. This will typically be at day one, (where day of exposure was day zero), day three, and day five. If additional cases were identified or if contact tracing was not possible, strong consideration should be given to shifting to the broad-based approach if not already being performed. As part of the broad-based approach, testing should continue on affected unit(s) or facility-wide every three to seven days until there were no new cases for 14 days. If antigen testing was used, more frequent testing (every three days), should be considered. Observations on 11/06/23 between 8:05 A.M. through 9:15 A.M. revealed residents diagnosed with COVID-19 were spread throughout the facility and the facility did not have a designated COVID-19 unit. During an observation on the 400 Hall on 11/06/23 at 10:09 A.M., STNA #218 came out of Resident #10 and Resident #15 ' s room, who were COVID-19 positive, with a shower chair and linen cart. STNA #218 left the shower chair and linen cart in the hall next to two Hoyer lifts without completing sanitation. During an interview on 11/06/23 at 10:10 A.M., STNA #218 verified she did not sanitize the shower chair or linen cart after being in a COVID-19 positive room and would get to it later. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 19 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many During an observation on the 400 Hall on 11/06/23 at 11:42 A.M., Maintenance Staff (MS) #297 was in Resident #10 and Resident #15 ' s room, who were COVID-19 positive. Maintenance Staff #297 was changing a smoke detector wearing no PPE and the room door was open. During an observation on the 400 Hall on 11/06/23 at 11:45 A.M., MS #211 was in Resident #37 and Resident #86 ' s room, who were COVID-19 positive. MS #211 was changing a smoke detector wearing no PPE and the room door was open. During an interview on 11/06/23 at 11:48 A.M., MS #211 stated he was not aware he was in a COVID-19 positive room, and if he had known he would have worn a gown, mask, and gloves. During an interview on 11/06/23 at 11:50 A.M., MS #297 verified he was not wearing any PPE in the COVID-19 positive room. During an observation of the 400 Hall on 11/06/23 at 1:14 P.M., the rooms of Residents #10, #15, #37, and #86, who were COVID-19 positive, did not have appropriate PPE supplies readily available for use prior to entering the room. There were surgical masks, gowns, and gloves available. No face shields, eye protection or N-95 masks were available. During an observation on 11/06/23 at 1:16 P.M., STNA #218 came out of Resident #30 ' s room, who was COVID-19 positive, wearing a face shield and surgical mask. STNA #218 did not sanitize the face shield or change the surgical mask prior to entering Resident #03, #80, and #141 ' s room, who were not in isolation. During an interview on 11/06/23 at 1:19 P.M., STNA #218 stated she did not change her surgical mask or sanitize her face shield after being in a COVID-19 positive room. During an observation of the 600 Hall on 11/06/23 at 1:38 P.M., Residents #53 and #65, who were COVID-19 positive, did not have appropriate PPE supplies readily available outside their room. There were surgical masks, gowns, and gloves available. No face shields, eye protection or N-95 masks were available. During an observation of the 400 Hall on 11/06/23 at 1:42 P.M., Residents #30, #23 and #55, who were COVID-19 positive, did not have appropriate PPE supplies readily available outside their room. There were surgical masks, gowns, and gloves available. No face shields, eye protection or N-95 masks were available. During an observation on 11/06/23 at 1:45 P.M., Housekeeping Aide (HA) #203 went into the room of Resident #44 to clean the room. HA #203 was wearing only a surgical mask and gloves. HA #203 came out of the room to get the sweeper with her surgical mask below her nose. During an interview on 11/06/23 at the time of observation, HA #203 did not think Resident #44 was positive with Covid-19. She thought it was the room across the hall. HA #203 verified she was not wearing eye protection, a gown or an N-95 mask prior to entering Resident #44 ' s room. During an observation of the 400 Hall on 11/06/23 at 1:48 P.M., STNA #218 went into Resident #30 ' s room, who was COVID-19 positive, wearing a gown, gloves, and a N-95 mask. She was not wearing eye protection. STNA #218 left the room wearing an N-95 mask. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 20 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many During an interview on 11/06/23 at 1:50 P.M., STNA #218 verified she did not wear eye protection, which was on the desk. STNA #218 stated she did not need to change her N-95 mask because most residents on the 400 Hall had COVID-19. During an observation on 11/06/23 at 1:59 P.M., MS #211 and MS #227 entered the room of Resident #71, who was COVID-19 positive. Both MS #211 and MS #227 were wearing surgical masks and did not perform hand hygiene. During an interview on 11/06/23 at 2:02 P.M., MS #227 verified he went into the COVID-19 positive room with only a surgical mask on. MS #211 stated he did not know Resident #71 was positive for COVID-19. MS #211 stated the other resident, who was moved out of the room, had COVID-19. MS #211 verified he did not have eye protection, gown, gloves, or an N-95 mask on when he entered Resident #71 ' s room. MS #211 stated he did not perform hand hygiene in or out of Resident #71 ' s room. During an observation of the 400 Hall on 11/07/23 at 8:50 A.M., STNA #263 answered the call light for Resident #10 and Resident #15 ' s room, who were COVID-19 positive. STNA #263 donned PPE prior to entering the room which included a gown, gloves, and surgical mask. STNA #263 put an N-95 mask over top of the surgical mask. She was not wearing eye protection. During an interview on 11/07/23 at 8:59 A.M., STNA #263 revealed when entering a COVID-19 positive room, she should don a gown, gloves, N-95 mask, and a face shield. STNA #263 reported there were no face shields/eyewear available. She said she doesn ' t work in central supply, so she didn ' t know about the availability of the face shield, so she did not put one on. STNA #263 also reported she wore a surgical mask under the N-95 mask when going into a COVID-19 positive room. During an interview on 11/07/23 at 9:25 A.M., RNICP #235 and the DON stated they test for COVID-19 routinely every Monday and Thursday. RNICP #235 stated they would test anytime if a resident had symptoms. RNICP #235 stated they leave it up to the nurse to perform vitals and nurse assessments if the resident was not feeling well. During an interview on 11/07/23 at 2:03 P.M., the DON and RNICP #235 verified the appropriate PPE supplies were not readily available outside the rooms of residents positive for COVID-19. Review of the facility policy titled COVID-19 Policy revealed the policy of the facility was to follow the guidance of the CDC and Ohio Department Health (ODH) for recommendations related to the treatment and testing of COVID-19. The objective of this policy was to protect our residents and staff while reducing the risk of spreading COVID-19 by abiding by the current ODH and CDC guidelines. Review of the facility policy titled Infection Control Extended Transmission Based and Isolation Precautions, dated 03/15/2019, revealed transmission-based precautions will be used for residents who are documented or suspected to have infections or communicable disease that can be transmitted by airborne or droplet transmission or by contact with dry skin or contaminated surfaces. Transmission based isolation precautions are to be used in addition to standard precautions. Review of the CDC guidelines titled Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, May 8, 2023, revealed under Bullet #2 Recommended infection prevention and control (IPC) practices when caring for a patient (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 21 of 22 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 366167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anderson, The 8139 Beechmont Ave Cincinnati, OH 45255 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many with suspected or confirmed SARS-CoV-2 infection Health Care Professionals (HCP) who enter the room of a patient with suspected or confirmed SARS-CoV-2 infection should adhere to standard precautions and use a National Institute for Occupational Safety and Health (NIOSH) approved particulate respirator with N95 filters or higher, gown, gloves, and eye protection (i.e., goggles or a face shield that covers the front and sides of the face). The facility had 25 residents (#10, #15, #23, #30, #37, #40, #44, #48, #52, #53, #55, #58, #65, #68, #71, #76, #83, #86, #190, #193, #194, #195, #196, #200 and #240) and 13 staff (LPN #210, LPN #224, LPN #239, LPN #242, LPN #256, LPN #277, LPN #291, STNA #240, STNA #275, STNA #299, Housekeeper #233, COTA #208, and COTA #288 test positive for COVID-19. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366167 If continuation sheet Page 22 of 22