Health inspection·June 11, 2025

F 0692 Level of Harm - Minimal harm or potential for actual harm weighed 141.2 pounds. On 06/02/25 he weighed 138.4 pounds. On 06/09/25 he weighed 133.6 pounds. This represents a 7.6 pound, 5 percent significant weight loss in three weeks. This deficiency represents an incidental finding of non-compliance investigated under Complaint Number OH00165834. Residents Affected - Few This deficiency is evidence of continued non-compliance from the survey dated 05/08/25. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 2 of 4 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 06/11/2025 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** Based on observation, interview, record review, facility policy review and review of The Center for Clinical Standards and Quality QSO-24-08-NH memo, the facility failed to follow enhanced barrier precautions (EBP) during wound care. This affected one resident (#61) of one resident observed for wound care. The facility census was 82. Residents Affected - Few Findings included: During the annual survey completed 05/08/25, a deficiency was issued related to the facility's failure to implement EBP during wound care. Review of the medical record for Resident #61 revealed an admission date of 04/25/25 and diagnoses including fracture of right lower leg with orthopedic surgery and sepsis with surgical wound infection. Review of hospital records revealed the resident was admitted with severe sepsis secondary to a right ankle wound infection. The resident had surgery on the right ankle on 04/15/25 and 04/22/25. The surgical culture showed Enterococcus facialis. The resident then admitted to the facility on [DATE]. The resident had physician's orders for a soft cast splint to right lower extremity to stay in place until follow up with surgeon. Review of a communication sheet dated 05/14/25 from the physician revealed presents with stable x-rays. Delayed wound healing. Leave steri strips intact. Paint with betadine. Change absorbable pads/dressing and reapply ace bandage. A physician's order was written on 05/14/25 to paint betadine over right ankle surgical incision. Leave steri strips applied. Change dressing and reapply ace bandage daily and as needed. The resident was started on an antibiotic (Amoxicillin) 500 milligrams every eight hours on 05/15/25 until bone/soft tissue heals. The antibiotics were to continue until 06/26/25. The resident did not have a physician's order for EBP. Review of a wound management report revealed on 06/05/25 Resident #61 had an 18 centimeter (cm) long by 0.1 cm wide surgical incision on the right ankle. She also had a 12 cm long by 0.1 cm wide surgical incision on the right medial ankle. Observations on 06/10/25 at 1:45 P.M. revealed a sign beside the door to Resident #61's room that stated EBP- staff must wear gown and gloves for high contact resident care activities which included wound care-any skin opening requiring a dressing. Observations at that time, revealed Registered Nurse (RN) #95 to perform a dressing change to the resident's right lower leg. She applied gloves but did not wear a gown. She removed a wrap to the resident's leg then removed the soiled dressing. The resident had an incision on each side of her leg. RN #95 then cleansed the incisions, applied betadine, applied padded dressings to each incision, wrapped the leg in Kerlix, then applied an ace wrap to the lower leg. Interview with RN #95 after the dressing change on 06/10/25 at 1:45 P.M. confirmed she did not wear a gown for the dressing change. RN #95 later on 06/10/25 at 2:30 P.M. stated Resident #61 was not on EBP precautions. Review of the facility policy titled Enhanced Barrier Precautions (updated 05/01/25) revealed the facility will utilize EBP as part of their infection prevention and control program to help prevent the development and transmission of communicable disease and infection. EBP refers to an infection (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 3 of 4 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 06/11/2025 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 - Few control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities. EBP are indicated for residents with chronic wounds. Examples of chronic wounds include unhealed surgical wounds. For residents identified requiring EBP, staff will wear gloves and a gown when performing high contact resident care activities including wound care: chronic wounds that require a dressing. Signage will be posted alerting caregivers that the resident is on EBP. Review of QSO-24-08-NH memo from the Center for Medicare/Medicaid Services (CMS) Center for Clinical Standards and Quality dated 03/20/24 revealed EBP were indicated for residents with wounds. Wounds included unhealed surgical wounds. This deficiency represents incidental findings of non-compliance investigated under Complaint Number OH00165834. This deficiency is evidence of continued non-compliance from the survey dated 05/08/25. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366215 If continuation sheet Page 4 of 4