Health inspection·May 16, 2022

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on record review, review of a facility Self-Reported Incident (SRI), facility policy and procedure review and interview the facility failed to prevent the misappropriation of the anti-anxiety medication, Xanax prescribed for Resident #304. This affected one resident (#304) of one resident reviewed for abuse and misappropriation of funds/property. Residents Affected - Few Findings include: Review of Resident #304's medical record revealed an admission date of 02/09/22. The resident was discharged on 02/25/22 to home with her family. Resident #304 had diagnoses including congestive heart failure, chronic pulmonary edema, diabetes mellitus, Sjogren syndrome, fatty liver, major depressive disorder, obstructive sleep apnea and anxiety. Review of the physician's medication orders, revealed an order, dated 02/09/22 for Xanax 0.25 milligrams (mg) by mouth every 12 hours as needed for anxiety. Review of the narcotic count sheet, dated 02/09/22 at 6:22 P.M. revealed Licensed Practical Nurse (LPN) #21 counted 50 Xanax tablets upon admission to the facility for the resident. Review of a self-reported incident (SRI), dated 02/10/22 revealed during the shiftly narcotic count on the morning of 02/10/22, six Xanax tablets was discovered to be missing. Licensed Practical Nurse (LPN) #189 denied administering the medication to the resident. Review of the narcotic count sheet documents revealed LPN #92 and #195 counted 44 Xanax tablets with no tablets signed out by LPN #189 during her shift from 7:00 P.M. to 7:00 A.M. Review of the resident's comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 02/16/22 revealed the resident had clear speech, understood others, made herself understood and had no cognitive deficit as evidenced by a Brief Interview for Mental Status (BIMS) score of 15 of 15. On 05/13/22 at 1:50 P.M., interview with the Director of Nursing (DON) verified six Xanax tablets were missing for Resident #304 and the facility had not replaced the tablets. Review of the facility policy titled Abuse, Neglect and Exploitation Policy, dated 06/02/21 revealed it was the intent of the facility to prevent the abuse, mistreatment, neglect of residents or the misappropriation of their property, corporal punishment and/or involuntary seclusion and to provide guidance to direct staff to manage any concerns or allegations of abuse, neglect or misappropriation of their property. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 2 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of Pre-admission Screening and Resident Review (PASARR) documentation and interview the facility failed to ensure updated PASARR's were completed following changes in condition, including the identification of mental health diagnoses and psychoactive medications for Resident #12 and Resident #36. This affected two residents (#12 and #36) of two residents reviewed for PASARR. Findings include: 1. Review of the medical record for Resident #12 revealed and admission date on 12/23/16. Resident #12 had diagnoses including psychotic disorder with delusions due to known physiological condition (10/14/21), psychotic disorder with hallucinations due to known physiological condition (03/02/21) and major depressive disorder-recurrent severed with psychotic symptoms (03/02/21). Review of PASARR, dated 12/19/16 revealed the resident had no indications of any mental health diagnoses or use of any psychoactive medications. There were not any additional PASARR's included in Resident #12's medical record. Review of the care plan, dated 03/01/22 revealed psychoactive medication was required due to alteration in mood and behavior related to depression, difficulty sleeping/insomnia, disease process, and hallucinations/delusions. Interventions included give medications per physician orders, monitor for adverse reactions related to psychoactive medications, monitor for effectiveness of medications, nursing to continue to implement non-pharmalogical approaches to decrease behaviors such as but not limited to food, fluids, activity of choice for resident and/or time and space to calm, monitor daily for target behaviors, and monitor for side effects related to administration of psychoactive medications. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #12 had intact cognition and scored a 15 out of 15 on the Brief Interview for Mental Status (BIMS) assessment. Resident #12 required extensive assistance with two people for Activities of Daily Living (ADLs). On 05/11/22 at 3:41 P.M. interview with Social Service Designee (SSD) #70 verified an updated PASARR for Resident #12 had not been completed to include all mental health diagnoses and psychoactive medication use. SSD #70 confirmed a new PASARR should have been completed. A policy related to completing PASARR's was requested during the survey period but per the Director of Nursing (DON), the facility did not have a policy. 2. Review of the medical record for Resident #36 revealed an admission date on 02/12/21. Resident #36 had diagnoses including unspecified psychosis not due to substance or known physiological condition (09/07/21), physiological and behavioral factors associated with disorders or diseases classified elsewhere (02/12/21) and insomnia. Review of the PASARR, dated 02/12/21 indicated Resident #36 did not have any mental health diagnoses and was not taking any psychoactive medications. There were no additional PASARR's included in Resident #36's medical record. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 3 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of current physician's orders revealed Resident #36 had an order for Perphenazine with instructions to give two milligrams (mg) by mouth at bedtime related to psychological and behavioral factors to include target behaviors of paranoia and delusions. The order was dated 06/16/21. Review of the care plan, dated 03/15/22 revealed Resident #36 required psychoactive medication due to an alteration in mood and behavior related to yelling out reported by staff and insomnia. Interventions included monitor for adverse reactions related to psychoactive medications, monitor for effectiveness of medications, monitor mental status and mood state changes when new medications was added, and nursing to continue to implement non-pharmacological approaches to decrease behaviors such as but not limited to food, fluids, activity of choice for resident and/or time and space to calm. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/11/22 revealed Resident #36 had impaired cognition and scored a four out of 15 on the Brief Interview for Mental Status (BIMS) assessment. Resident #36 required extensive assistance from two staff to complete transfers and bed mobility and extensive assistance from one staff to complete toileting. No behaviors were noted for Resident #36. Psychotic disorder was listed as a health condition and the resident receiving antipsychotic medication on a routine basis. On 05/11/22 at 3:43 P.M. interview with SSD #70 verified Resident #36 had a new mental health diagnosis of unspecified psychosis added on 09/07/21. SSD #70 verified an updated PASARR was not completed for Resident #36 and confirmed a new PASARR should be completed for Resident #36 to include all mental health diagnoses as well as any psychoactive medication use. A policy related to completing PASARR's was requested during the survey but per the Director of Nursing (DON), the facility did not have a policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 4 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Based on observation, record review and interview the facility failed to ensure Resident #5, who was assessed to require staff assistance for activities of daily living (ADL) care received adequate and timely nail care to promote optimal hygiene. This affected one resident (#5) of two residents reviewed for activities of daily living (ADL). Residents Affected - Few Findings include: Review of Resident #5's medical record revealed an initial admission date of 10/12/13 with the latest readmission date of 03/31/22 and diagnoses including cerebrovascular accident (CVA) with right sided hemiplegia, congestive heart failure, benign neoplasm of right choroid, seasonal allergic rhinitis, history of COVID-19, dysphasia, metabolic encephalopathy, peripheral vascular disease, hyperlipidemia, dysthymia, aphasia, chronic obstructive pulmonary disease, major depressive disorder, hypertension, insomnia and anxiety disorder. Review of the plan of care, dated 05/10/19 revealed the resident had an alteration in ADL performance/participation related to CVA with right hemiplegia, non-ambulatory, requiring a mechanical lift and leg pain. Interventions included provide assist with one or two for all care, tubi-grip stocking to right leg (on in the morning and off at bedtime), allow time for rest breaks, encourage activity during daily care, encourage geri legs when out of bed, encourage resident to participate while performing ADL, monitor for decline in care and report to clinical staff as needed and notify nursing of any complaints of pain or discomfort. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 02/15/22 revealed the resident had clear speech, understands others, makes herself understood had a moderate cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of 10 of 15. The resident as assessed to require extensive assistance from two assists for personal hygiene. Review of the monthly physician's orders for May 2022 revealed no orders specific to ADL care. On 05/09/22 at 3:22 P.M. observation of the resident revealed his fingernails were long and dirty. On 05/11/22 at 10:20 A.M. observation of the resident revealed his fingernails remained long and dirty. On 05/11/22 at 2:50 P.M. observation of the resident revealed his fingernails remained long and dirty. On 05/11/22 at 2:58 P.M. interview with Assistant Director of Nursing (ADON) #50 verified the resident's nails were long and dirty. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 5 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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** 3. Review of Resident #27's medical record revealed an admission date of 05/28/21 with the admitting diagnoses of Alzheimer's disease, adjustment disorder with mixed anxiety and depressed mood, hypertension, hyperlipidemia, hypothyroidism, osteoarthritis and personal history of COVID-19. Residents Affected - Few Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/04/22 revealed the resident had clear speech, understood others, makes himself understood and had a severe cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of six of 15. The assessment revealed the resident required extensive assistance of one staff for dressing. Review of the monthly physician's orders, for May 2022 revealed an order, dated 05/28/21 for knee high TED hose with the special instruction to be on for 12 hours and off 12 hours every day. Review of the resident's plan of care failed to identify a plan of care addressing the resident's use of thrombo-embolic-deterrent (TED) hose. On 05/09/22 at 2:32 P.M. interview with Resident #27's family revealed the facility was not applying the resident's TED hose as ordered even with multiple requests by family to ensure they were being applied. On 05/09/22 at 3:28 P.M. observation revealed the resident did not have her TED hose on. On 05/10/22 at 8:35 A.M. observation of the resident revealed she did not have her TED hose in place. On 05/10/22 at 4:20 P.M. observation of the resident revealed she had no TED hose in place. On 05/10/22 at 4:23 P.M. interview with Licensed Practical Nurse (LPN) #92 verified the resident did not have her TED hose in place. On 05/10/22 at 4:21 P.M. interview with State Tested Nursing Assistant (STNA) #61 revealed the resident does not wear TED hose. Review of the May 2022 Treatment Administration Record (TAR) revealed nursing staff were documenting on the TAR to indicate TED hose were in place as ordered despite no observations being made of the resident having the TED hose on. Based on observation, record review, facility policy and procedure review and interview the facility failed to ensure all residents received adequate care and treatment. The facility failed to monitor bowel movements for Resident #45, who had a history of constipation, failed to provide thromboembolism-deterrent (TED) hose as ordered for Resident #27 and failed to complete accurate skin assessments to monitor bruising for Resident #202. This affected three residents (#27, #45, and #202) of three residents reviewed for quality of care. Findings include: 1. Review of the medical record for Resident #45 revealed an admission date of 05/08/17 and a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 6 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few readmission date of 10/26/21. Resident #45 had diagnoses including Parkinson's disease, bipolar disorder, dysthymic disorder, anxiety disorder, major depressive disorder, insomnia and irritable bowel syndrome with constipation. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/27/22 revealed Resident #45 had mildly impaired cognition with Brief Interview for Mental Status (BIMS) score of 12 of 15. The assessment revealed Resident #45 required supervision with set up assistance from staff for bed mobility, transfers and toileting. The assessment also revealed Resident #45 was always continent of bowel and bladder. Review of the current physician orders revealed Resident #45 had orders for Simethicone Tablet chewable 80 mg every eight hours as needed for constipation related to irritable bowel syndrome, Lactulose Solution 10 grams (gm)/15 milliliters (mL) with instructions to give 10 mL by mouth every eight hours as needed for constipation and Bisacodyl Suppository 10 mg with instructions to insert one suppository rectally every 24 hours as needed for constipation. Review of the Bowel and Bladder assessments, dated 03/31/22 and 04/08/22 revealed Resident #45 used the toilet and had control of her bowels and bladder. The assessment revealed the resident was always continent and no constipation was present. Resident #45 was on medications that could affect continence. Review of the care plan, dated 04/08/22 revealed Resident #45 was at risk for constipation related to decreased mobility, fluid restriction and a history of constipation. Bowel medications/laxatives were noted to have been discontinued and changed. Interventions included administer medications as ordered and monitor for constipation and causes. Review of the Bowel Control/Frequency Task, dated from 04/12/22 through 05/12/22 revealed Resident #45 did not have a bowel movement documented from 04/29/22 through 05/10/22 (12 days). The resident had a medium bowel movement documented on 05/11/22. Review of progress notes, dated from 04/01/22 through 05/12/22 revealed no documentation related to monitoring Resident #45's bowel movements was present until 05/11/22 at 11:45 P.M., Licensed Practical Nurse (LPN) #71 noted follow up with Resident #45 regarding recent constipation. Milk of Magnesia was offered to the resident and the resident declined. Resident #45 requested the nurse drop it off in the morning. A new physician order, dated 05/12/22 at 11:21 A.M. was added for Milk of Magnesia Suspension 400 mg/5 mL with instructions to give 30 mL by mouth every 12 hours as needed for constipation if the resident does not have a bowel movement after three days. Review of the Medication Administration Record (MAR) for May 2022 revealed Resident #45 did not receive any of the ordered as needed constipation medications in the month of May 2022. On 05/10/22 at 9:36 A.M., 05/11/22 at 6:00 P.M. and 05/12/22 at 8:50 A.M. revealed Resident #45 did not have prune juice on her meal trays. On 05/10/22 at 9:23 A.M. and 05/11/22 at 6:00 P.M. interview with Resident #45 revealed she had trouble with constipation off and on. The resident stated the medication did not seem to help. The resident revealed facility staff were in and out quickly and did not spend any time to talk with her. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 7 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #45 reported she had not had a bowel movement in several days and complained of having stomach pain. The resident stated she felt bloated and her stomach was distended (swollen outward). Resident #45 stated she told the nurse when she felt constipated and was not able to have a bowel movement. Resident #45 revealed she had not received any medications to help relieve constipation. On 05/11/22 at 6:07 P.M. interview with Licensed Practical Nurse (LPN) #170 revealed Resident #45 had chronic constipation. The nurse revealed the resident had orders for as needed medications to help relieve constipation. The resident would also drink prune juice if needed. LPN #170 revealed Resident #45 had a documented bowel movement this morning on 05/11/22. However, prior to this morning, the last documented bowel movement for Resident #45 was on 04/29/22. On 05/12/22 at 12:11 P.M. interview with the Director of Nursing (DON) revealed the facility did not have a specific bowel protocol in place. The DON revealed staff should proceed based on an individual assessment and history of a resident because not all residents were regular and had bowel movements daily or every three days. On 05/12/22 at 1:31 P.M. and 05/12/22 at 1:50 P.M. interview with the DON revealed Resident #45 was able to take herself to the bathroom and may not be reporting it when she does have a bowel movement. The DON confirmed Resident #45 had a history of constipation. The DON reported Resident #45 was to received prune juice on her meal trays with every meal. The DON confirmed the expectation of staff was to ask Resident #45 daily if she had a bowel movement and document it in the resident's electronic medical record. The DON confirmed according to documentation, Resident #45 did not have a bowel movement from 04/29/22 until 05/11/22 and did not receive any as needed constipation medications. On 05/12/22 at 1:55 P.M. and 05/12/22 at 3:19 P.M. interview with Dietary Supervisor #98 and Diet Technician (DT) #200 confirmed Resident #45 did not receive prune juice with meals and revealed there had not been any special requests for the resident to receive it. Review of the facility policy titled Bowel and Bladder Management, dated 2018 revealed the policy did not address monitoring for signs of constipation or provide a bowel protocol for staff to follow. 2. Review of Resident #202's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including posthemorrhagic anemia, abdominal aortic aneurysm, peripheral vascular disease, atherosclerotic heart disease and post operative after surgery. Resident #202's physician's orders, dated 04/28/22 included an order for the anti-coagulant medication, Enoxaparin Sodium 40 milligrams (mg) to be administered daily for seven days. Resident #202 was also ordered Aspirin 81 mg for peripheral vascular disease. The physician order revealed for staff to monitor for signs and symptom of bleeding. A plan of care, dated 04/29/22 revealed the resident received anti-coagulation therapy and to monitor, document and report any signs of bruising. Resident #202's peripheral vascular disease care plan also directed staff to monitor, document and report any signs of bruising. Resident #202's admission assessment, dated 04/28/22 and signed by Registered Nurse (RN) #95 revealed the resident's skin was normal. There was no documentation of bruising noted to either arm. Resident #202's weekly skin check documentation, dated 04/29/22 and signed by RN #140 revealed the resident had scattered ecchymotic areas to bilateral (both) upper extremities consistent with intravenous access and lab draws. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 8 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Level of Harm - Minimal harm or potential for actual harm Review of the MDS 3.0 assessment, dated 05/04/22 revealed the resident had moderate cognitive impairment. On 05/10/22 at 2:30 P.M. Resident #202 was observed laying in bed watching television. The resident was observed to have multiple areas of bruising to both arms. Residents Affected - Few On 05/11/22 at 8:19 A.M. Resident #202 was observed sitting at his bedside eating breakfast. Bruising was noted to multiple areas of the resident's arms. On 05/10/22 at 2:30 P.M. interview with Resident #202 revealed he had bruising to his skin for the last ten years. The resident reported this was even prior to starting anti-coagulants. The resident reported the current bruising was due to intravenous access he had while in the hospital for surgery. On 05/12/22 at 9:00 A.M. interview with RN #95 verified the admission skin assessment she completed, dated 04/28/22 was not accurate and therefore, monitoring for improvement or worsening of bruising could be difficult without a baseline. Review of the facility policy titled Skin Assessment, dated 04/20/20 revealed that although there were several suggested and recommended treatments to accommodate various types of wounds, treatment would be ordered by the physician and administered according to the physician's order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 9 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Based on record review, review of facility policy and procedure and interview the facility failed to properly assess Resident #48's skin upon admission, timely identify a pressure area and implement a timely treatment to the pressure ulcer wound. This affected one resident (#48) of two residents reviewed for pressure ulcers. The facility identified two residents with pressure ulcers. Residents Affected - Few Findings include: Review of the medical record for Resident #48 revealed an admission date of 04/01/22. Resident #48 had diagnoses including right above the knee amputation, seizure disorder, stage three chronic kidney disease and anemia. Review of the Self Functional Status assessment, dated 04/01/22 revealed Resident #48 was assessed as requiring extensive to dependent assistance from staff transfers and was non-ambulatory. An initial skin assessment performed on 04/01/22 at 5:11 P.M. was blank showing no evidence of skin impairment. A second skin assessment performed on 04/01/22 at 5:48 P.M. revealed the only skin impairment was an infected left great toenail. Review of the baseline plan of care, dated 04/01/22 revealed it was silent for evidence Resident #48 was admitted with skin alterations. Review of the admission document titled, Becket House Health and Rehabilitation New Resident Report Sheet dated 04/01/22 revealed Resident #48 had an infection to her left great toenail, it was silent for evidence of any other wounds. Review of the skin assessment, dated 04/04/22 at 10:08 A.M. revealed Resident #48 had a loose left great toenail and a stable scabbed area to the left outer foot. The wound to the left outer foot measured 1.5 cm long by 1.0 cm wide. Resident #48 also was assessed as high risk for skin problems related to chronic kidney disease. A new treatment for Betadine ointment was ordered to the left outer foot wound to being 04/04/22. Review of Resident #48's physician's orders revealed an order, dated 04/04/22 for a new treatment order for Betadine ointment to the left outer foot wound. Review of the plan of care, dated 04/04/22 revealed Resident #48 was at risk for impaired skin integrity. The plan of care was updated on 04/06/22 to reflect Resident #48 had a deep tissue injury pressure wound (purple or maroon area of discolored intact skin due to damage of underlying soft tissue) to her left outer foot. Review of the wound nurse practitioner consult, dated 04/06/22 revealed Resident #48 had a pressure induced deep tissue injury to the left outer foot, it was assessed as being days old and a recommendation to continue the treatment with Betadine ointment was made. Review of the April 2022 Treatment Administration Record (TAR) for Resident #48 revealed no treatment to the left great toe wound or the pressure injury wound to the left outer foot began until 04/04/22. On 05/12/22 at 9:15 A.M. interview with the Director of Nursing (DON) revealed the wound on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 10 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Resident #48's foot was there on admission and did not know why there was no documentation until 04/04/22. The DON was not able to give a reason why all the progress notes and skin assessments performed on 04/01/22 did not indicate there was a deep tissue injury to Resident #48's left outer foot. Subsequent interview on 05/12/22 at 11:15 A.M. with the DON provided a skin assessment, dated 04/01/22 that indicated Resident #48 had a wound to her left outer foot. The DON stated the skin assessment form was in the soft chart and was not normally uploaded in the resident's electronic record. The DON confirmed no documentation in the electronic medical record until 04/04/22. On 05/12/22 at 11:30 A.M. interview with the DON confirmed Resident #48's physician was not notified of the resident's deep tissue issue to the left outer foot on 04/01/22 and confirmed there was a delay in treatment to Resident #48's pressure induced deep tissue injury. The DON confirmed the wound treatment began three days after the wound was identified on 04/04/22. Review of the facility skin assessment policy, dated 04/20/20 revealed a skin assessment was to be initiated immediately upon admission and completed within 24 hours of admission by a licensed nurse. If an area was identified, the licensed nurse would document the appearance, measurements and initiate a skin grid flow record. The physician, responsible party, dietary and DON would be notified of any skin areas and a treatment would be initiated according to physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 11 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 observation, record review and interview the facility failed to ensure Resident #48 was provided adequate assistance during a transfer to the toilet to prevent an injury. Actual Harm occurred on 04/07/22 when Resident #48, who was assessed to require two staff for transfers and toileting was lowered to the floor while being assisted by only one staff member resulting in a displaced fracture of the left femur/hip. The resident was hospitalized as a result of the injury and required surgical repair of the fracture. This affected one Resident (#48) of three residents reviewed for accidents and falls. Findings include: A review of the medical record for Resident #48 revealed an admission date of 04/01/22 with diagnoses including right above the knee amputation, rheumatoid arthritis, seizure disorder, and hypertension. Resident #48 was admitted to the facility from home because of difficulty with caring for herself. A pre-admission referral document, dated 03/25/22 included a progress note (dated 03/01/22) from the resident's family physician. The progress note included details regarding an inability of the resident to live at home. The resident was not able to walk because of her amputation, could not safely transfer herself and assisted living or nursing home care would be needed for the resident. A review of the admission document titled, [NAME] House Health and Rehabilitation New Resident Report Sheet, dated 04/01/22 revealed Resident #48 required two assist from staff for transfers, was not able to ambulate and needed a wheelchair for mobility. Review of the baseline care plan, dated 04/01/22 revealed a goal indicating Resident #48 was to have minimal fall risk with an intervention to anticipate and meet her needs. Upon admission, an assessment completed by Licensed Practical Nurse (LPN) #72 revealed Resident #48 required staff assistance with bed mobility and transfers because of weakness as well as being at moderate risk for falls. On 04/01/22 the Assistant Director of Nursing (ADON) completed an assessment of the resident's usual performance for toilet transfer which identified the resident was dependent on staff. Subsequent assessments for usual performance with toilet transfers completed on 04/01/22, 04/02/22, and 04/03/22 revealed the resident did not assist with the effort, the resident did none of the effort or two assistance of staff was required. On 04/05/22 LPN #85 again assessed the resident to be dependent on staff for toilet transfers. A review of the State Tested Nursing Assistant (STNA) documentation for Resident #48 revealed the resident was dependent with two staff assist for toilet assistance and transfers on 04/01/22. The documentation further revealed Resident #48 required extensive assistance from two staff for toileting and transfers on 04/02/22, 04/03/22, 04/05/22, 04/06/22 and 04/07/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 12 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Residents Affected - Few A review of a nursing progress note, dated 04/07/22 at 6:49 P.M. revealed LPN #10 was notified by an aide that Resident #48 was on floor. The note further revealed Resident #48 was being assisted to the bathroom, stood up from the wheelchair, then was lowered to floor. No injuries were observed at that time. On 04/07/22 at 10:50 P.M. Resident #48's daughter had called LPN #85 to tell her Resident #48 was complaining of more pain in her leg. An X-ray was ordered on 04/07/22 for her left leg. Review of the facility fall investigation, dated 04/07/22 revealed Resident #48's leg had given out while she was being transferred to the toilet. Resident #48 had no prior history of falls. A statement by STNA #16 revealed she was unsure of how much assistance Resident #48 needed to go to the restroom so she asked another staff member. STNA #16 stated she was told by an unidentified staff member that Resident #48 was a stand-pivot transfer. STNA #16 stated Resident #48 was in a standing position when her knee gave out a split second after moving the wheelchair so she lowered her to the floor. A statement from STNA #74 revealed it took three staff to assist Resident #48 back up and into her bed after the fall. Further review of the nursing progress notes revealed a note, dated 04/08/22 at 4:46 A.M. which revealed an X-ray of the left leg showed a a displaced supracondylar fracture of the left femur. Resident #48 was discharged to the hospital to undergo surgical repair of the fracture. A review of the Minimum Data Set (MDS) 3.0 assessment, dated 04/08/22 revealed the resident had no short term memory problems and had modified independence with decision making. The assessment revealed the resident had no behaviors and required extensive assistance with transfers and toileting during the seven day look back period. On 05/09/22 at 11:51 A.M. interview with Resident #48 revealed she had suffered a fall several days after admission that resulted in a fracture of her left leg. Observation of the resident's room at the time of the interview revealed the resident did not have access to a bedside commode in the room. On 05/11/22 at 2:25 P.M. during a follow up interview with Resident #48, the resident revealed she was admitted to the facility because her husband could not take care of her anymore as it was too hard for him to assist her. The resident reported she had hoped to receive therapy services following her admission, but no therapy had been provided. Resident #48 further shared it took two staff to transfer her and she had asked for a bedside commode because that was what she was used to using at home. During the interview, the resident reported she had sustained the fall and fracture because one staff member was trying to transfer her alone despite the resident stating she told the staff member it normally took two staff to assist her to the bathroom. On 05/11/22 at 3:37 P.M. interview with the Director of Nursing (DON) revealed Resident #48 did not have therapy upon her admission because she was private pay. The DON also denied any knowledge of the resident requesting a bedside commode for use in toileting. On 05/12/22 at 3:30 P.M. during a follow up interview with the DON, the DON confirmed Resident #48 was being assisted/transferred by one STNA on 04/07/22 at the time she was lowered to the floor resulting in the left hip/femur fracture. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 13 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to provide supplements as ordered to Resident #44 who had experienced weight loss and was on hemodialysis. This affected one resident (#44) of five residents reviewed for nutrition. Residents Affected - Few Findings include: Review of the medical record revealed Resident #44 was admitted on [DATE] with diagnoses including acute on chronic systolic heart failure, end stage renal disease, type two diabetes mellitus, paroxysmal atrial fibrillation, unspecified protein-calorie malnutrition, hypertension, major depressive disorder and acquired absence of left leg below knee. Review of the plan of care, dated 04/13/22 revealed Resident #44 had a nutritional problem or potential problem related to diagnoses of heart failure, end stage renal disease on hemodialysis, major depression, vitamin D deficiency, severe metabolic acidosis. The care plan revealed the resident had increased needs due to a wound requiring supplementation. Interventions included providing and serving supplements as ordered, monitoring for signs of malnutrition, providing and serving diet as ordered and the dietitian evaluating and making changes as needed. Review of Resident #44's weights revealed on 04/14/22 he weighed 150.5 pounds, on 04/21/22 he weighed 141.7 pounds, and on 05/04/22 he weighed 135.7 pounds. Review of Resident #44's physician's orders revealed an order, dated 04/13/22 for hemodialysis on Monday, Wednesday and Friday. The order indicated transportation was to pick up the resident between 9:45 A.M. and 10:00 A.M. and his chair time was 10:30 A.M. to 2:30 P.M. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 04/19/22 revealed Resident #44 had intact cognition. The resident received dialysis during the look back period. Review of the physician's orders revealed an order, dated 04/21/22 for Resident #44 to receive a renal house supplement once a day. Review of the April 2022 Medication Administration Record (MAR) for Resident #44 revealed he did not receive the renal house supplement as ordered on 04/25/22 and 04/27/22. The record revealed the supplement was not provided due to leave of absence. Review of the May 2022 Medication Administration Record (MAR) for Resident #44 revealed he did not receive the renal house supplement as ordered on 05/06/22 or 05/09/22. On 05/11/22 at 2:11 P.M. documentation revealed Resident #44 did not receive his supplement as ordered on 05/11/22 due to a leave of absence. On 05/11/22 at 2:11 P.M. interview with Licensed Practical Nurse (LPN) #10 revealed Resident #44's supplement was to be given in the afternoon between 12:00 P.M. to 4:00 P.M. or it would be considered late in the electronic MAR. She confirmed she had already marked Resident #44 as not receiving the supplement due to a leave of absence because he would not be back until 4:30 P.M. LPN #10 confirmed this had been done on additional days in the MAR. She reported she had not sent the supplement with him to dialysis and she was unsure if he received a supplement at dialysis. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 14 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 FORM CMS-2567 (02/99) Previous Versions Obsolete On 05/11/22 at 3:32 P.M. interview with Diet Technician #200 revealed she had been speaking with the dialysis dietitian about Resident #44. She stated due to Resident #44 being a new dialysis resident they had been unable to determine his dry weight yet. Diet Technician #200 revealed they were unsure of his true weight loss due to this. She reported when recommending a supplement, dietary recommend they were served between meals, however, nursing determined the actual timing. She reported she was unaware of concerns related to the timing of Resident #44's supplement. Event ID: Facility ID: 366173 If continuation sheet Page 15 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 observation, record review, facility policy and procedure review and interview the facility failed to ensure Resident #8 and Resident #28 received the correct administration rate of oxygen as ordered. This affected two residents (#8 and #28) of four residents reviewed for respiratory care. Residents Affected - Few Findings include: 1. Review of Resident #8's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses of hypertensive heart disease with heart failure, chronic kidney disease, unspecified diastolic (congestive) heart failure, chronic obstructive pulmonary disease and panlobular emphysema. Review of Resident #8's physician's orders, dated 01/08/22 revealed the resident was to receive oxygen at two liters per minute (LPM) via nasal cannula. The order indicated the oxygen may be removed for care, ambulation or as needed. A plan of care, dated 04/22/22 addressed the resident's alteration in cardiac and respiratory function with an intervention to administer oxygen per orders. On 05/10/22 at 2:19 P.M. Resident #8 was observed talking on the telephone. The resident's nasal cannula was observed laying on the bed beside her. The oxygen concentrator was set at three LPM. On 05/11/22 at 8:09 A.M. observation and interview with Licensed Practical Nurse (LPN) #185 revealed Resident #8 way laying in bed with her oxygen on via a nasal cannula. The oxygen concentrator was set at three LPM. On 05/11/22 at 8:12 A.M. interview with LPN #185 verified Resident #8's oxygen was ordered for two LPM. LPN #185 indicated Resident #8's oxygen should be running at two LPM instead of three LPM. She also verified there was currently no order to adjust the resident's oxygen based on her oxygen saturation. 2. Review of Resident #28's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses of disorders of plasma-protein metabolism, essential hypertension, abdominal aortic aneurysm and emphysema. A plan of care, dated 10/22/21 addressed the resident's alteration in respiratory function and emphysema with an intervention to administer oxygen as ordered with a rate of two LPM via nasal cannula continuously. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/07/22 revealed the resident had moderate cognitive impairment and was administered oxygen. Review of Resident #28's current physician's orders, revealed she was to receive oxygen at two LPM via nasal cannula to keep oxygen saturation above 92%. On 05/10/22 at 2:23 P.M. Resident #28 was observed laying in bed with her oxygen on via a nasal cannula. The oxygen concentrator was set at three LPM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 16 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 05/11/22 at 8:16 A.M. observation and interview with LPN #185 revealed Resident #28 laying in bed with her oxygen on via a nasal cannula. The oxygen concentrator was set at three LPM. On 05/11/22 at 8:17 A.M. interview with LPN #185 verified Resident #28's oxygen was ordered for two LPM. LPN #185 indicated Resident #28 oxygen should be running at two LPM instead of three LPM. She also verified there was currently no order to adjust the resident's oxygen based on her oxygen saturation. On 05/12/22 at 11:43 A.M. interview with the Director of Nursing (DON) revealed the facility does not have a separate oxygen administration policy and therefore, oxygen administration would fall under the facility medication administration policy. Review of the facility policy titled Administration and Documentation of Medications, revised 01/2020 revealed it was the policy of the facility that every resident received medications by a licensed nurse as prescribed by a licensed physician or other healthcare provider legally permitted to prescribe medications, safely, properly and in a timely manner and that medications shall be accurately and completely documented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 17 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. 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 complete pre-dialysis and post-dialysis assessments for Resident #44. This affected one resident (#44) of one resident reviewed for dialysis. Residents Affected - Few Findings include: Review of the medical record revealed Resident #44 admitted to the facility on [DATE] with diagnoses including acute on chronic systolic heart failure, end stage renal disease, type two diabetes mellitus, paroxysmal atrial fibrillation, unspecified protein-calorie malnutrition, hypertension, major depressive disorder and acquired absence of left leg below knee. Review of the care plan, dated 04/13/22 revealed Resident #44 needed hemodialysis related to end stage renal disease. Interventions included encouraging the resident to go to dialysis appointments, monitoring access port to right upper chest every shift, monitoring intake and output, monitoring vital signs as ordered, monitoring for signs of infection, monitor for new or worsening peripheral edema and working with the resident to relieve discomfort for side effects of the disease and treatment. Review of the physician's orders revealed an order, dated 04/13/22 for hemodialysis on Monday, Wednesday and Friday. The order indicated transportation was to pick up the resident between 9:45 A.M. and 10:00 A.M. and his chair time was 10:30 A.M. to 2:30 P.M. Review of the comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 04/19/22 revealed Resident #44 had intact cognition. The assessment revealed the resident received dialysis during the look back period. Review of Resident #44's assessments revealed pre and post dialysis assessments were not completed for every dialysis session: On 04/13/22 one pre and post dialysis assessment was done at 10:17 A.M. On 04/15/22 one pre and post dialysis assessment was done at 3:10 P.M. On 04/18/22 one pre and post dialysis assessment was done at 10:02 A.M. On 04/20/22, 04/22/22, 04/25/22, 04/27/22, and 04/29/22 two pre and post assessments were completed. On 05/02/22 one pre and post dialysis assessment was done at 9:54 A.M. On 05/04/22 no pre or post dialysis assessment was completed. On 05/06/22 one pre and post dialysis assessment was done at 9:07 A.M. On 05/09/22 no pre or post dialysis assessments were completed. Review of the progress notes from 04/13/22 to 05/09/22 revealed nothing to indicate Resident #44 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 18 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 0698 had missed any dialysis appointments. Level of Harm - Minimal harm or potential for actual harm On 05/11/22 at 2:11 P.M. interview with Licensed Practical Nurse (LPN) #10 revealed assessments were to be completed before and after dialysis. The LPN revealed all pre and post dialysis assessments should be in the electronic medical record under the assessments tab. Residents Affected - Few On 05/11/22 at 5:06 P.M. and 05/12/22 at 2:36 P.M. and 3:54 P.M. interview with the Director of Nursing (DON) confirmed the missing assessments. She reported she viewed the dialysis communication forms that dialysis completed and sent back with residents as sufficient post dialysis assessments. Review of the dialysis communication forms revealed the following: Review of the dialysis communication form, dated 04/20/22 revealed it contained Resident #44's weight, blood pressure, temperature, medications received during treatment and that he was without signs of infection. Review of the dialysis communication form, dated 04/22/22 revealed it contained the Resident #44's weight, blood pressure, temperature, medications received during treatment and information related to his skin condition. Review of the dialysis communication form, dated 04/25/22 revealed it contained the Resident #44's weight, blood pressure, temperature, medications received during treatment and information related to shortness of breath he experienced. Review of the dialysis communication form, dated 05/04/22 revealed it contained the Resident #44's weight, blood pressure, temperature, medications received during treatment and that he was without signs of infection. Review of the dialysis communication, form dated 05/06/22 revealed it contained the Resident #44's weight, blood pressure, temperature, medications received during treatment and that he was without signs of infection. Review of the dialysis communication form, dated 05/09/22 revealed it contained Resident #44's pre dialysis weight, medications given during treatment and information about his skin. Review of the dialysis communication form, dated 05/11/22 revealed it contained the Resident #44's weight, blood pressure, temperature, medications received during treatment and information related to a dressing change. Review of the medical record revealed no additional dialysis communication forms. Review of a pre or post dialysis evaluation revealed it contained information related to transportation, meals, and medications. The resident was to be evaluated including temperature, blood glucose, pulse, respiration, weight, intake, output, incontinence and pain. Additionally, the resident was supposed to be assessed for orientation, mood, edema, breathing, cough and recent labs. The dialysis site was to be identified and skin assessed including checking for bruit and thrill. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 19 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on record review, facility policy and procedure review and interview the facility failed to discontinue the medication Acidophilus for Resident #46 timely after a pharmacy recommendation/physician agreement was obtained related to the medication. This affected one resident (#46) of five residents reviewed for unnecessary medication use. Residents Affected - Few Findings include: Review of the medical record for Resident #46 revealed an admission date 08/24/18. Resident #46 had diagnoses including stroke, hemiplegia, chronic kidney disease and vascular dementia. Review of a pharmacy recommendation, dated 09/09/21 revealed the pharmacist recommended a review of the vitamin supplement Acidophilus. The physician addressed the recommendation on 09/13/21 and documented agreement with the discontinuation of the Acidophilus. Review of the September 2021 Medication Administration Record (MAR) for Resident #46 revealed the Acidophilus was still given every day from 09/13/21 through 09/30/21. The October 2021 Medication Administration Record (MAR) for Resident #46 revealed the Acidophilus was still given every day from 10/01/21 through 10/31/21. Review of the pharmacy recommendation, dated 11/04/21 revealed the pharmacist again recommended a review of the vitamin supplement Acidophilus. The physician addressed the recommendation on 11/06/21 and documented agreement with the discontinuation of the Acidophilus. Review of the November 2021 MAR for Resident #46 revealed the Acidophilus was still given every day through 11/08/21. This was approximately two months since the physician agreed to discontinue the vitamin supplement Acidophilus. On 05/11/22 at 2:30 P.M. interview with the Director of Nursing (DON) confirmed the pharmacy recommendation dated 09/09/21 had not been timely implemented after the physician review. The medication was not discontinued until after the second pharmacy recommendation on dated 11/08/21. Review of the facility policy titled Medication Regimen Review (MRR), dated 01/2021 revealed the facility would have a consultant pharmacist perform a MRR monthly. The physician shall act upon the suggestion or provide documentation for the rejection within 30 days. The DON or designee would be responsible to follow through with all MRR recommendations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 20 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 adequate justification for the increase in the medication Depakote prescribed for Resident #51 for agitation related to bipolar disorder. This affected one resident (#51) of five residents reviewed for unnecessary medication use. Findings include: Review of Resident #51's medical record revealed an admission date of 07/12/21 with the admitting diagnoses of atherosclerotic heart disease, chronic kidney disease, hypertension, major depressive disorder, personal history of COVID-19, Alzheimer's disease, polyosteoarthritis, vitamin D deficiency, gastro-esophageal, bipolar disease, anemia, hyperparathyroidism, hypothyroidism and glaucoma. Review of the resident's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 04/22/22 revealed the resident had clear speech, understood others, made himself understood and had a severe cognitive deficit as indicated by a Brief Interview for Mental Status (BIMS) score of five of 15. The assessment revealed the resident required extensive assistance from two staff for bed mobility, transfers and was non ambulatory. The assessment also indicated the resident was always incontinent of both bowel and bladder and received anti-anxiety, anti-depressant, diuretic and opioid medications. Review of the monthly physician's orders for May 2022 revealed an order, dated 03/04/22 to increase the medication Depakote 500 milligrams (mg) by mouth two times a day for agitation related to bipolar disorder. Review of the medical record documentation failed to provided identified justification or collaboration to support an increase in the medication Depakote. On 05/11/22 at 4:18 P.M. interview with Assistant Director of Nursing (ADON) #50 verified no there was no written justification to support an increase in the resident's Depakote on 03/04/22. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 21 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, facility policy and procedure review and interview the facility failed to maintain Resident #303's medical record in a complete and accurate manner related to documentation of oxygen rate of administration. This affected one resident (#303) of four residents reviewed for respiratory care. Findings include: Review of Resident #303's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including acute congestive heart failure, pneumonia, other nonspecific abnormal findings of the lung, chronic obstructive pulmonary disease and unspecified asthma. Review of Resident #303's physician's orders revealed an order, dated 04/27/22 to administer oxygen at 1.5 liters per minute (LPM) via a nasal cannula continuously every shift for congestive heart failure and pneumonia. A plan of care, dated 04/27/22 addressed the resident's altered cardiac status and chronic obstructive pulmonary disease with an intervention to administer oxygen via a nasal cannula at 1.5 LPM continuously. Review of Resident #303's progress notes revealed skilled documentation dated 04/27/22 at 9:12 P.M., 04/28/22 at 9:12 A.M., 04/28/22 at 9:12 P.M., 04/29/22 at 9:12 A.M., 05/05/22 at 10:27 P.M., 05/06/22 at 10:27 A.M., 05/06/22 at 10:27 P.M. and 05/09/22 at 11:22 P.M. indicating an oxygen administration rate of two LPM. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 05/03/22 revealed Resident #303 had moderate cognitive impairment. The assessment revealed the resident had shortness of breath or trouble breathing with exertion and when lying flat and used oxygen prior to being a resident and while a resident. On 05/11/22 at 8:08 A.M. Resident #303 was observed laying in bed with her nasal cannula on and receiving oxygen from an oxygen concentrator at 1.5 LPM. On 05/12/22 at 11:43 A.M. interview with the Director of Nursing (DON) verified the documentation was most likely inaccurate in the progress notes regarding the resident's oxygen being administered at two LPM. The DON revealed the facility does not have a separate oxygen administration policy and therefore, oxygen administration would fall under the facility medication administration policy. Review of the facility policy titled Administration and Documentation of Medications, revised 01/2020 revealed it was the policy of the facility that every resident received medications by a licensed nurse as prescribed by a licensed physician or other healthcare provider legally permitted to prescribe medications, safely, properly and in a timely manner and that medications shall be accurately and completely documented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 22 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the facility timeline for positive COVID-19 residents and staff, review of resident vaccination status, review of contact tracing, review of facility COVID-19 policies and procedures, review of the current Centers of Disease Control (CDC) Guidance Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes and interview the facility failed to implement adequate infection control measures including comprehensive contact tracing, proper personal protective equipment (PPE) use and implementation of transmission based precautions (TBP) following the identification of COVID-19 positive staff to prevent the spread of infection including COVID-19. This affected three residents (#20, #25 and #303) and had the potential to affect all 59 residents residing in the facility. Residents Affected - Many Findings include: Observations of all residents completed during the survey period between 05/09/22 and 05/11/22 revealed no residents were in isolation/transmission based precautions for suspected or confirmed cases of COVID-19 in the facility. On 05/10/22 at 10:45 A.M. interview with the Director of Nursing (DON) revealed Physical Therapy Assistant (PTA) #39 tested positive for COVID-19 on this date. The DON revealed the facility would test all residents and staff to see if there were any additional positive results. If there were additional positive results, the facility would start outbreak mode and would change and begin wearing N95 masks and eye protection throughout the facility. The DON stated the facility would complete contact tracing to determine which residents and staff were in contact with the positive staff person. On 05/10/22 at 11:49 A.M. interview with the DON revealed all other residents and staff had tested negative for COVID-19. PTA #39 left the facility. The DON revealed, per the facility policy, due to only one staff positive result, the facility would not be considered in outbreak mode and would continue to have staff wear surgical masks and eye protection for PPE use. Review of the facility's COVID-19 timeline from 08/31/21 to current date of 05/10/22 revealed two facility staff had tested positive as of 05/10/22, not one. Housekeeper #31 tested positive at a local hospital on [DATE] and reported the positive result to the facility on [DATE]. During additional whole house testing completed on 05/10/22, PTA #39 tested positive for COVID-19. Housekeeper #31 was fully vaccinated but had not received a booster vaccine and had mild symptoms including headache and fever at the time of testing. PTA #39 was fully vaccinated but had not received a booster vaccine and was asymptomatic. Housekeeper #31 last worked on 05/09/22 prior to testing positive at the hospital and PTA #39 worked on 05/09/22 and 05/10/22 until he tested positive for COVID-19 and was sent home. Review of the resident vaccination status documentation on 05/12/22 at 3:00 P.M. revealed the facility had eight residents who were unvaccinated and ten residents who were not up to date with all recommended vaccination doses. Review of the staff vaccination matrix revealed there were 22 staff who had been granted vaccination exemptions and 38 staff who were fully vaccinated but had not received a booster vaccination. Review of a contact tracing document, provided by the Administrator revealed the tracing was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 23 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many completed on a resident census sheet, dated 05/10/22. Housekeeper #31 was noted to be in 30 resident rooms and PTA #39 was noted to have seen four residents. The information provided by the facility revealed all were up to date with all recommended COVID-19 vaccination doses. There was no contact tracing completed to identify any facility staff who may have been in close contact with Housekeeper #31 or PTA #39. On 05/12/22 at 4:10 P.M. interview with the Administrator revealed Housekeeper #31 was only present in resident rooms for approximately five minutes and wore a surgical mask and eye protection at all times on her last day worked on 05/09/22. The Administrator initially stated the contact tracing completed for PTA #39 was prior to the PTA testing positive on 05/10/22 but then indicated the contact tracing was for the day worked prior to PTA #39 testing positive, 05/09/22. Housekeeper #31 and PTA #39 did not work over the weekend. On 05/12/22 at 4:16 P.M. interview with the Director of Rehabilitation (DOR) revealed PTA #39 saw a full caseload of residents (more than four) on 05/09/22 prior to testing positive for COVID-19 on 05/10/22. The DOR confirmed each session PTA #39 completed with the residents would have been longer than 15 minutes. The DOR confirmed residents did not wear any personal protective equipment during their sessions with PTA #39 and PTA #39 wore a surgical mask and eye protection during his sessions. Review of the list of residents seen by PTA #39 on 05/09/22 revealed he completed physical therapy sessions with Resident #20 who was unvaccinated, Resident #25 who was fully vaccinated but had not received a booster vaccination, and Resident #303 who was fully vaccinated but had not received a booster vaccination. All other residents PTA #39 saw were up to date with all recommended COVID-19 vaccinations. On 05/12/22 at 5:13 P.M. interview with the DON confirmed Resident #20, #25, and #303 were in close contact with PTA #39 and were either unvaccinated or not up to date with all recommended COVID-19 vaccinations. The DON stated according to their facility policy, it was a recommendation that residents who were not up to date with all recommended COVID-19 vaccinations be placed in quarantine under TBP but stated this was not a requirement. Additional information provided from the DON on 05/13/22 at 11:45 A.M., 05/13/22 at 2:47 P.M., 05/13/22 at 3:13 P.M. and 05/13/22 at 3:45 P.M. revealed the DON felt since rooms were divided with a physical wall (1/2 wall) and a curtain, the exposed residents did not need to be quarantined as the staff member who exposed them was wearing full personal protective equipment (PPE). After review of the facility policy again, it did indicate not up to date residents were to be quarantined after exposure. On 05/12/22 at 5:00 P.M. (three days after exposure), Resident #20, #25 and #303 were placed in quarantine for COVID-19. The DON confirmed no contact tracing had been completed to determine if any facility staff were exposed to the positive staff as the DON indicated it was not necessary according to CDC guidelines since the staff wore surgical masks and eye protection. Review of the facility policy titled Infection Control Guidance, dated 02/2022 revealed work restrictions for asymptomatic healthcare personnel (HCP) with SARS-CoV-2 exposures who are not up to date with all recommended COVID-19 vaccinations should be restricted from work for ten days or seven days with a negative test within 48 hours before returning to work or no work restriction with negative tests on days one, two, three, and five through seven in the facility is under contingency. During an outbreak, residents who are not up to date and had close contact with an infected person should be quarantined up to ten days. Staff caring for residents with suspected or confirmed COVID-19 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 24 of 25 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 366173 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Beckett House 1280 Friendship Drive New Concord, OH 43762 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many infection should use full PPE (gowns, gloves, eye protections, and N95 or equivalent or higher-level respirator). Unvaccinated residents who have had close contact with someone with COVID-19 infection should be placed in quarantine. Because of the risk of unrecognized infection among residents, a single new case of COVID-19 infection in any staff member or a nursing home-onset COVID-19 infection in a resident should be evaluated as a potential outbreak. It is recommended that the center investigate the outbreak at a center-level or group-level as centers typically do not have the expertise, resources, or ability to identify all close contacts. Recommendation is to quarantine residents who are not up to date during an outbreak. Residents who are up to date should wear source control and should be tested as applicable under the center's outbreak investigation approach. Review of CDC guidance, Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes, updated 02/02/22 revealed the guidance included, empiric use of TBP (quarantine) is recommended for residents who are newly admitted to the facility and for residents who have had close contact with someone with SARS-CoV-2 infection if they are not up to date with all recommended COVID-19 vaccinations. Residents who are not up to date with all recommended COVID-19 vaccine doses and who have had close contact with someone with SARS-CoV-2 infection should be placed in quarantine after their exposure, even if viral testing is negative. HCP caring for them should use full PPE (gowns, gloves, eye protection, and N95 or higher-level respirator). Perform contact tracing to identify all HCP who have had a higher-risk exposure or residents who may have had close contact with the individual with SARS-CoV-2 infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366173 If continuation sheet Page 25 of 25