Health inspection·February 26, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #6 and Resident #11 and then returned to the table to resume assisting with eating. At 6:40 P.M., STNA #310 got up from the table again to retrieve a drink and a tissue for another resident seated at a different table. After retrieving the items, STNA #310 returned again to the table to resume assisting Resident #6 and Resident #11 with eating. Resident #54, who was also seated at the table, did not receive assistance with eating until 6:46 P.M. (14 minutes after she was served the dinner meal) when the Aide in Training (AIT) #212 sat next to Resident #54. All 14 residents residing in the memory care unit were served dinner and dessert on 02/21/24 by 7:05 P.M. (45 minutes after the first meal was served). Interview on 02/21/24 at 7:05 P.M. with Unit Manager (UM) #316 confirmed the above findings. UM #316 stated the dinner meal service was not usually served in that manner. UM #316 stated there were a couple of new aides working on the unit who were not as familiar with the meal service process. UM #316 stated all of the residents should have received a beverage while waiting for the meal to be delivered, residents who were seated at the same table should be served at the same time, staff who were assisting residents with eating should remain seated until the resident had completed the meal or were finished eating, and residents who required assistance with eating should be assisted immediately when the meal was served. Review of the facility policy titled Dining Room Service, dated 03/2017, revealed the policy stated, water shall be available for each resident at the mealtime unless otherwise indicated per specific resident need. Milk, coffee, juice, and other temperature sensitive beverages shall be offered to residents as they are seated in the dining room from the beverage cart. All residents seated at the same table shall be served meals at the same time. Review of the facility policy titled Resident Rights, updated 10/2016, revealed the policy stated, it is the facility's policy that employees shall treat all residents with kindness, respect, and dignity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 2 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. 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, review of insurance records, review of financial records, and staff interview, the facility failed to provide spend down notices to residents and/or resident representatives when their personal funds account was within $200 of the Medicaid personal funds limit. This affected two (Residents #2 and #20) of five residents reviewed for personal funds accounts. The census was 80. Residents Affected - Few Findings include: 1. Review of Resident #2's medical record revealed Resident #2 was admitted to the facility on [DATE]. Resident #2's diagnoses included but were not limited to cerebrovascular disease, hemiplegia, chronic ischemic heart disease, and heart failure. Review of Resident #2's Minimum Data Set (MDS) assessment, dated 12/31/23, revealed Resident #2 had a mild cognitive impairment. Review of Resident #2's insurance records revealed she had Medicaid as insurance. Review of Resident #2's financial records, dated 12/31/22 to 12/29/23, revealed her balance for her person funds account was within the $200 threshold of the resource limit during this entire period of time. Her balance was $1,816.81 as of 12/31/22, and the highest balance between 12/31/22 and 12/29/23 was $2,173.27. At the start of each quarter, the facility sent a letter with the quarterly banking statement to Resident #2. Within that letter, it stated the facility will notify the resident if the account reached a high balance. There was no evidence the facility provided a spend down notice to Resident #2 or her representatives at any point from 12/31/22 to 12/29/23 while she was within $200 of the limit. 2. Review of Resident #20's medical record revealed Resident #20 was admitted to the facility on [DATE]. Her diagnoses included but were not limited to congestive heart failure, major depressive disorder, and cognitive communication deficit. Review of Resident #20's MDS assessment, dated 12/31/23, revealed she had no cognitive impairment. Review of Resident #20's insurance records confirmed she had Medicaid as insurance. Review of Resident #20's financial records, dated 12/31/22 to 12/29/23, revealed her balance for her personal funds account was within the $200 threshold of the resource limit during this entire period of time. Her balance was $2,056.48 as of 12/31/22, and the highest balance she had between 12/31/22 and 12/29/23 was $2,196.60. At the start of each quarter, the facility sent a letter with the quarterly banking statement to Resident #20's representative. Within that letter, it stated the facility will notify the resident if the account reached a high balance. There was no evidence the facility provided a spend down notice to Resident #20 or Resident #20's representative at any point from 12/31/22 to 12/29/23 while Resident #20 was within $200 of the limit. Interview with Receptionist #323 on 02/26/24 at 2:30 P.M. revealed spend down notices were to be sent to the resident/representative when they get within $200 of the resource limit. She revealed the corporate office was the entity that will monitor the amounts and send the letters as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 3 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 0569 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with Regional Business Office Staff #410 on 02/26/24 at 3:08 P.M. revealed they work with the local facility when a resident needs to spend down money. They are able to send the spend down notices, but the local facility has access to them as well and will send them occasionally. She revealed she would look for the spend down notices for Resident #2 and Resident #20. Interview with Administrator on 02/26/24 at 3:25 P.M., 4:15 P.M., and 4:55 P.M. revealed they were still looking for the spend down notifications for Residents #2 and #20. Interview with Regional Nurse #400 on 02/26/24 at 5:10 P.M. confirmed they were not able to find any spend down notifications for Resident #2 and Resident #20. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 4 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on resident interview, observation, staff interview, and facility policy review, the facility failed to maintain air temperature at a comfortable level in the small dining room. This had the potential to affect 54 (Residents #2, #3, #6, #8, #9, #10, #12, #13, #15, #16, #20, #22, #23, #27, #28, #29, #30, #31, #34, #37, #40, #41, #43, #44, #46, #47, #48, #49, #53, #56, #57, #58, #59, #62, #68, #69, #71, #72, #73, #74, #77, #134, #136, #137, #139, #140, #141, #142, #284, #285, #334, #335, #336, and #337) of 80 residents in the facility who could go to the small dining room. The census was 80. Findings include: Interview with Resident #23 and Resident #30 on 02/21/24 at 9:28 A.M. revealed they don't like to sit in the small dining room for meals because it was very cold. They revealed it had been cold in the small dining room for quite some time. Observation on 02/21/24 at 3:21 P.M. revealed the small dining room thermostat read 68 degrees Fahrenheit. Observation on 02/26/24 at 8:30 A.M. revealed the temperature in the small dining room was 68 degrees Fahrenheit. Observation on 02/26/24 at 10:46 A.M. revealed four residents (Residents #46, #48, #77 and #139) were in the small dining room with a volunteer leader for a prayer/rosary group. Residents #46, #48, and #77 had blankets on during the service. The thermostat in the small dining room was at 67 degrees Fahrenheit. Interview with Resident #48 on 02/26/24 at 10:52 A.M. revealed it was very cold in the small dining room. She confirmed it had been that way for a while and revealed she had no idea why the facility was unable to make that room warmer. Interview with Regional Nurse #400 on 02/26/24 at 1:53 P.M. confirmed the temperature in the small dining room was less than 71 degrees Fahrenheit. It was checked at that time, and it was at 69 degrees Fahrenheit. Review of the facility Air Temperature policy, undated, revealed all buildings are required to maintain an ambient temperature throughout resident and patient areas in a temperature range of 71 to 81 degrees Fahrenheit. Exceptions to this range may be available for brief periods of unseasonably warm or cold temperatures; however, the variance in temperatures must not adversely affect resident or patient health and safety. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 5 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on review of quality assurance and performance improvement (QAPI) meeting sign in sheets, staff interview, and facility policy review, the facility failed to ensure the infection preventionist attended the QAPI meetings. This had the potential to affect all 80 residents in the facility. The census was 80. Residents Affected - Many Findings include: Review of the facility QAPI meeting sign in sheets, dated March 2023 to January 2024, revealed Registered Nurse (RN) Supervisor #311, who was the facility's only infection preventionist, did not attend any of the QAPI meetings. Interview with RN Supervisor #311 on 02/22/24 at 4:07 P.M. confirmed she was the only infection preventionist in the facility. She confirmed the Director of Nursing (DON) attends the QAPI meetings with the infection reports and documentation to report to the committee however RN Supervisor #311 does not. Interview with the DON on 02/26/24 at 1:46 P.M. confirmed he was not an infection preventionist but would be going through the training soon. Interview with the Administrator on 02/26/24 at 3:25 P.M. confirmed RN Supervisor #311 did not attend any of the QAPI meetings since March 2023. He stated if they needed her input for any pattern/trend they found for infections, they would make arrangements to call her or move the meeting so she would attend but indicated they have not had any patterns/trends since March 2023 to require her attendance at the meetings. Review of the facility Infection Reporting Policy, undated, revealed the infection preventionist/designee summarizes the information using the monthly summary report to present at the monthly QAPI committee meeting. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 6 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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** 2. Review of the medical record for Resident #11 revealed Resident #11 was admitted to the facility on [DATE] with diagnoses including vascular dementia, weakness, anxiety, heart disease and unspecified urinary incontinence. Residents Affected - Many Review of the quarterly Minimum Data Set (MDS) assessment, dated 11/14/23, revealed Resident #11 had severely impaired cognition, required staff assistance for activities of daily living (ADL) tasks and was always incontinent of urine and bowel. Review of Resident #11's ADL care plan, dated 12/29/22, revealed Resident #11 required assistance from staff for incontinence care. Further review of the incontinence care plan, dated 09/02/21, revealed Resident #11 required staff to assist with changing clothing, incontinence briefs, and linens as needed due to soiling. Observation on 02/26/24 at 9:49 A.M. revealed perineal incontinence care for Resident #11 was being completed by State Tested Nursing Assistants (STNAs) #280 and #334. STNA #280 and STNA #334 sanitized their hands and donned gloves. STNA #280 removed Resident #11's pants and unclasped the adult brief. STNA #280 then took several personal care wipes and cleaned Resident #11's perineal area. Both STNA #280 and STNA #334 then repositioned Resident #11 onto her right side. STNA #280 used new personal care wipes to clean Resident #11's buttocks and removed the soiled brief from under Resident #111's right hip. STNA #280 removed her gloves, threw them in the trash can, and donned a clean pair of gloves. STNA #280 and STNA #334 repositioned Resident #11 onto her back and placed a clean adult brief and a new pair of pants on Resident #11. Resident #11 was transferred into the wheelchair by STNA #280 and STNA #334 and taken to the unit lounge area. Interview on 02/26/24 at 10:00 A.M. with STNA #280 revealed staff were to wash or sanitize their hands after doffing their gloves in between removal of the soiled adult brief and the placement of a clean adult brief. STNA #280 confirmed she did not wash or sanitize her hands when she doffed her gloves after removing Resident #11's soiled adult brief and placed a new clean adult brief on Resident #11. Review of the facility's policy titled Perineal Care, undated, revealed step #12 stated, remove gloves and discard into designated container. Wash and dry your hands thoroughly. Based on review of Monthly Infection Tracking Reports, staff interview, medical record review, observation and review of facility policy, the facility failed to identify the type of infectious organism and failed to identify or address potential infection trends within the facility. This had the potential to affect all 80 residents in the facility. Additionally, the facility failed to perform hand hygiene appropriately during perineal incontinence care. This affected one resident (#11) out of one resident reviewed for incontinence care. The census was 80. Findings include: 1. Review of the Monthly Infection Tracking Report, dated October 2023, revealed Resident #51 had a facility acquired urinary tract infection (UTI). The resident did not have a culture completed to identify an organism. There was one additional facility acquired UTI identified on the same unit. Review of the Monthly Infection Tracking Report, dated November 2023, revealed Resident #26 had a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 7 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 facility acquired UTI without a culture completed to identify an organism. There were two additional facility acquired UTI's identified on the same unit where Resident #26 resided. Additionally, Residents #24 and #60, who resided on the same unit, had facility acquired UTI infections with Escherichia coli (e-coli) bacteria identified as the organism. Review of the Monthly Infection Tracking Report, dated December 2023, revealed Resident #42 had a facility acquired UTI with a catheter in place and a culture was not completed to identify an organism. There was one additional facility acquired UTI identified on the same unit where Resident #42 resided. Additionally, Resident #253 had a facility acquired UTI and there was no culture completed to identify an organism. There was one additional facility acquired UTI identified on the same unit where Resident #253 resided. Review of the Monthly Infection Tracking Report, dated January 2024, revealed Residents #9, #31, and #44 had facility acquired UTI's with e-coli bacteria identified as the organism. All three residents resided on the same unit. Interview on 02/22/24 at 4:07 P.M. with Registered Nurse (RN) Infection Preventionist (IP) #311 confirmed she had completed the monthly infection tracking logs for the facility. IP #311 stated two or more of the same type of infection with the same organism identified would be considered a trend or pattern and should be followed up on by the facility staff. IP #311 stated if she identified any infection trends she would notify the Director of Nursing (DON), who attended monthly Quality Assurance (QA) meetings, so a plan of action could be discussed. IP #311 stated if the trend was UTI's, typically education with the staff would be completed to review proper hand hygiene and review infection prevention policies and procedures. IP #311 stated she had not identified any possible trends or patterns in several months. IP #311 confirmed the above noted facility acquired UTI infections did not have an organism identified. IP #311 confirmed there were additional facility acquired UTI's on the same units as indicated above that may have constituted a trend or pattern had an organism been identified. IP #311 confirmed the two residents (Residents #26 and #60) in November 2023 and the three residents (Residents #9, #31, and #44) in January 2024 with facility acquired UTI infections with e-coli bacteria identified as the organism on the same unit would constitute a trend and should have been addressed. IP #311 confirmed she did not attend QA meetings because she works third shift. IP #311 also stated the facility did not have a full-time IP. IP #311 was only able to designate approximately 24 hours per month (two shifts) to infection control and really only was able to complete the monthly infection tracking logs. IP #311 confirmed she was not able to conduct any infection control rounds or audits of the facility. Interview on 02/26/24 at 1:46 P.M. with DON #248 confirmed he had not completed the training to become a certified Infection Preventionist yet but planned to complete the training in the near future. DON #248 was not able to recall when a pattern or trend of infections had been identified and addressed with staff but stated it was prior to October 2023. DON #248 stated he would review the type of infection as well as the organism in order to confirm a pattern or trend on the same unit. DON #248 stated he felt a pattern would constitute more than two of the same infection and organism on the same unit to be a trend and should be addressed with staff. DON #248 stated he had not been able to communicate with IP #311 as frequently as he would like because IP #311 worked night shift. DON #248 stated he used to meet with IP #311 monthly but has not met with her for awhile now. DON #248 stated IP #311 did notify him of past concerns related to UTI's but no concerns had been brought to his attention recently. DON #248 confirmed organisms had not been identified for the above mentioned facility acquired UTI's. DON #248 stated if a urinalysis culture and sensitivity (UA C&S) lab test was ordered immediately (STAT) or ordered on the weekend, the lab was not able to accommodate the orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 8 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 DON #248 stated the lab would collect the urine sample but would not complete a culture so the physicians started ordering broad spectrum antibiotics without an organism identified. DON #248 confirmed a trend could not be confirmed without an identified organism. DON #248 confirmed the facility had not provided any education related to infections or infection control with the staff recently. Interview on 02/26/24 at 3:25 P.M. with the Administrator confirmed Infection Preventionist (IP) #311 had not attended any of the Quality Assurance and Performance Improvement (QAPI) meetings since March 2023. The Administrator stated if input from IP #311 was needed for any identified patterns or trends of infections, the Quality Assurance Assessment (QAA) Committee would make arrangements to call IP #311 or move the meeting to another date or time when IP #311 was available to attend. The Administrator confirmed no infection patterns or trends had been identified since March 2023, therefore, IP #311's attendance was not necessary. Review of the facility policy titled Infection Control Program, undated, revealed the policy stated, the infection control program is to ensure the prevention and control of health care associated infections (HAI) for the protection of our residents, families, and employees. The infection control process strives to improve the trends and patterns of significant infections. Furthermore, an action plan will be provided to control identified outbreaks of HAI. The Administrator is responsible for the Infection Control Program. The Infection Preventionist (IP) is to monitor the infection control program. Reports of infections are presented to the QAA Committee monthly for review and recommendations as necessary. Resident infection cases are monitored by the IP who completed the Monthly Summary Report and reports to the DON and monthly to the QAA Committee. The infection control prevention program will follow the criteria for all types of infections either HAI or community associated based on national guidelines provided either by the CDC, APIC, or state and local regulations as approved by the QAA Committee. The IP/designee in conjunction with the LHNA/DON/Designee will conduct environmental rounds. The IP will review the findings, identify concerns and develop action plans as part of the QAA process. The IP will review infection information for trends and unusual occurrences and make recommendations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 9 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm Based on review of Monthly Infection Tracking Logs, staff interviews, and facility policy review, the facility failed to ensure the appropriate use of antibiotics according to their antibiotic stewardship program (ASP). This affected six (Residents #7, #40, #42, #51, #58, and #253) out of 80 residents in the facility. The facility census was 80. Residents Affected - Some Findings include: Review of the Monthly Infection Tracking Log, dated October 2023, revealed Resident #51 had a healthcare associated (HA) urinary tract infection (UTI). A McGeer's criteria (criteria used to identify infections) was completed and the criteria for a UTI was not met. There was no culture completed. Resident #51 received Macrobid (an antibiotic) from 09/29/23 to 10/01/23. Resident #7 received Macrodantin (an oral antibiotic) as a UTI prophylactic with a start date on 03/23/23 and no stop date indicated. Resident #58 had a HA UTI and kidney stones noted and did not meet McGeer's criteria for an infection. The resident received Keflex (an oral antibiotic) with a start date of 07/14/23 and no stop date. Review of the ASP Monthly Infection Tracking Log, dated November 2023, revealed Residents #7 and #58 continued receiving the same antibiotics. Review of the ASP Monthly Infection Tracking Log, dated December 2023, revealed Resident #40 had a HA cellulitis infection and did not meet McGeer's criteria for a skin infection. Resident #40 received Keflex (an oral antibiotic) from 12/18/23 to 12/28/23. Resident #42 had a HA UTI and met McGeer's criteria, however, a culture was not completed to confirm the organism. Resident #42 received Keflex (an oral antibiotic) from 11/02/23 to 01/05/24. Resident #58 continued on the same antibiotics. Review of the ASP Monthly Infection Tracking Log, dated January 2024, revealed Resident #253 had a HA UTI. The resident did not meet McGeer's criteria for a UTI. There was no culture completed to identify an organism. Resident #253 received Bactrim/Keflex (oral antibiotic) starting on 12/21/23 with no stop date. Resident #58 remained on the same antibiotics. Interview on 02/22/24 at 4:07 P.M. with Registered Nurse (RN) Infection Preventionist (IP) #311 confirmed the above findings. IP #311 stated when antibiotics were ordered by the physician even though the resident did not meet McGeer's criteria for an infection, she did not request the physician document justification for continuing with antibiotic treatment. IP #311 also stated antibiotics ordered with no stop date indicated were reviewed every 30 days with the physician and if the physician wanted to continue with the antibiotic treatment then the medications were continued regardless of whether the resident displayed signs or symptoms of an infection. IP #311 indicated no justification for continued use of antibiotics was requested from the physician. Interview on 02/26/24 at 1:46 P.M. with Director of Nursing (DON) #248 confirmed the above findings. DON #248 stated if the physician ordered an antibiotic, the orders were not questioned and were administered to the resident. A documented justification for antibiotic use was not requested from the physician. Review of the facility policy titled Antibiotic Stewardship Program, updated 11/2019, revealed the policy stated, The ASP committee will develop, endorse, or adopt established guidelines for use by facility staff for appropriate identification and assessment of infections and treatment guidelines. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 10 of 11 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 366215 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lanfair Center for Rehab & Nsg Care Inc 1590 Chartwell Street Lancaster, OH 43130 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 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Effective communication among nursing staff and between nurses and physicians/prescribers was essential. Treatment with antimicrobials is only appropriate when the practitioner determines the most likely cause of the patient's symptoms is a bacterial infection. Antimicrobials will be used only for as long as needed to treat infections, minimize the risk of relapse, or control active risk to others. When facility staff suspects a resident has an infection, the nurse performs and documents an assessment of the resident using established and accepted protocols to determine if the resident's status meets minimum criteria for initiating antimicrobials prior to calling the physician. When prescribing antimicrobials, the physician/prescriber should determine if an antimicrobial is needed based on documented assessment information provided by the facility staff, considering the most likely infecting organisms, and select an antimicrobial with organism susceptibility and determine the dose and duration of therapy. The physician/prescribers will provide antimicrobial orders, which should include the following elements: duration of therapy, including start date, stop date, number of planned days of therapy. Cultures should be obtained before starting antimicrobial therapy. Physician/practitioner should not treat asymptomatic. Event ID: Facility ID: 366215 If continuation sheet Page 11 of 11