Health inspection·March 7, 2019

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 facility records review, staff interview and review of facility policy, the facility failed to provide notification of spend-down for resident funds over the $2000 limit, also the facility failed to convey funds of resident closed accounts within the required 30 day limit. This affected two Residents (#58 and #228) of five reviewed for spend-down notification, and also affected seven, Resident's (#53, #231, #235, #236, #237, #238, an #239), of 11 accounts the facility noted as closed with funds not conveyed within the required 30 days. The facility identified 45 Residents with funds accounts. This facility census was 75. Residents Affected - Some Findings include: 1. Review of facility funds conducted on 03/06/19 revealed as of 03/04/19 Resident #58 had a balance of $4,194.08 and Resident #228 had a balance of $2844.04. Interview conducted on 03/06/19 at 10:56 A.M. Business Office Manager (BOM) #39 verified both Resident's (#58 and #228) received Medicaid benefits, and were over the $2000 notification of spend-down amount. BOM #39 stated the resident's had not received the required notification of spend-down. BOM #39 stated she was aware the resident's should have received the notification, however she was new to the position. 2. Review of facility's closed account revealed Resident #53 was discharged [DATE], Resident #231 discharged [DATE], Resident #235 discharged [DATE], Resident #236 discharged [DATE], Resident #237 discharged [DATE], Resident #238 discharged [DATE], and Resident #239 discharged [DATE]. Further reviewed of the facility closed resident accounts revealed a check dated 02/26/19 in the amount of $19,977.85 to the Attorney General. Interview conducted on 03/06/19 at 10:56 A.M. BOM #39 verified all of the resident accounts had been closed out on 02/26/19 and the funds check was written and still needed to be returned to the state. BOM #39 stated she was aware the funds should be returned within 30 days however she was new to the facility and was trying to fix the accounts. BOM #39 confirmed this affected Resident #53, #231, #235, #236, #237, #238 and #239. Review of the facility policy titled Resident Trust Fund revealed resident accounts must be closed within 30-days of discharge. Also, on open accounts for residents receiving medicaid benefits, the facility will send out a letter when an account is within $200.00 of exceeding the maximum limit, notifying the resident/responsible party that the current balance is approaching. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 2 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm Based on facility record review and staff interview, the facility failed to provide the required Notice of Medical Non-Coverage (NOMNC) and Denial Letter/Advance Beneficiary Notice (ABN) when residents, receiving Medicare Part A, were discharged from services with skilled days remaining and remained in the facility. This affected two Resident's (#60 and #232) of three reviewed for Beneficiary Notices during the annual survey. The facility census was 75. Residents Affected - Few Findings include: Review of the facility completed Beneficiary Notice Form revealed Resident's (#60 and #232) were both discharged from Medicare Part A services on 09/26/18 with skilled days remaining and remained in the facility. Further review of the facility records were silent of verification either resident was provided the required NOMNC and ABN notices prior to being cut from services. Interview conducted on 03/07/19 at 11:08 A.M. Social Services Supervisor(SSS) #133 verified both Resident's (#60 and #232) were cut from Medicare Part A services and remained in the facility. SSS #133 stated the facility was unable to provide verification either resident received the NOMNC and/or ABN/Denial Letter before services were discontinued. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 3 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, and interview, the facility failed to provide notices to the Ombudsman after a resident's transfer to the hospitals. This affected two Residents (#28 and #79) out of two reviewed for hospitalization. The facility census was 75. Findings include: 1. A chart review completed revealed Resident #28 was admitted to the facility on [DATE] with diagnosis including a displaced intertrochanteric left hip, dementia, muscle weakness, gait abnormalities, dysphasia, osteoporosis, paranoid schizophrenia, syncope/collapse, constipation, anemia, gastro esophageal reflux disease, hypertension, anxiety, arthropathy, and dementia. Review of the Significant Change Minimum Data Set (MDS) dated [DATE] revealed severe cognitive deficits, requires extensive assist with locomotion, bed mobility, transfers, toileting, personal hygiene, limited assist, always incontinent bladder, and frequently incontinent of bowel. Review of care plan dated 02/27/19 revealed that Resident #28 is at risk for pain related to limited mobility, as evidenced by recent surgical procedure to repair fractured femur. Review of nursing note dated 02/12/2019 per charge nurse at the local emergency room, Resident #28 has been admitted for closed displaced fracture of left femur. Interview on 03/05/19 at 1:00 P.M. with the Director of Nursing (DON) reported Resident #28 was complaining of pain since January 31, 2019 and they had x-rays taken on 01/31/19 revealed no fractures were present; however, Resident #28 had continued to have complaints of pain and more x-rays were taken on 02/05/19 with no evidence of fracture, a doppler was also performed on left leg with negative results. Resident #28 with continued complaints of pain, and a CAT scan which did reveal the left femur fracture on 02/12/19 and Resident #28 was sent to a local emergency room for evaluation and treatment. There was no evidence in the medical record the Ombudsman was notified regarding Resident #28's hospitalization 2. A chart review revealed Resident #79 was admitted to the facility on [DATE] with diagnosis including sepsis, cellulitis of abdominal wall, obesity, congestive heart failure, diabetes, disorientation, bilateral lower extremities cellulitis and buttocks, pulmonary hypertension, cognitive communication deficit, chronic respiratory failure, sleep apnea, hyperlipidemia, anemia, hypertension, osteoarthritis, muscle weakness, urinary tract infection, and respiratory disorders. Resident #79 was discharged to hospital on [DATE]. Discharge Return not Anticipated MDS dated [DATE] revealed that Resident #79 had no cognitive deficits, required extensive assistance with activities of daily living, and always incontinent of bowel and bladder. Review of nursing notes dated 01/26/19 revealed Resident #79 vital signs were blood pressure 94/73, pulse 113, respirations 18, temperature 101.2 axillary, and oxygen saturation of 89% on room air. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 4 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0623 Physician notified and a new order to send Resident #78 out to hospital. Level of Harm - Minimal harm or potential for actual harm There was no evidence in the medical record the Ombudsman was notified regarding Resident #79's hospitalization. Residents Affected - Few Interview on 03/07/19 11:11 A. M. with the Social Services Designee (SSD) #133 verified that she could not find any evidence for notification of discharge reported to the Ombudsman for Resident #28 and #79. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 5 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and staff interviews, the facility failed to conduct a Significant Change Minimum Data Set (MDS) assessment in a timely manner for one resident with declines in mood, incontinence, and activities of daily living. This affected one resident (#70) of 18 residents sampled in Stage Two of the survey. The resident census was 75. Residents Affected - Few Findings include: Resident #74 was admitted to the facility on [DATE]. Diagnoses include anemia, hypertension, diabetes mellitus, other fracture, non-Alzheimer's dementia, chronic kidney disease. A review of quarterly 10/17/18 Minimum Data Set (MDS) Assessment revealed she had a severe cognitive impairment and was dependent on two staff with bed mobility, transfers, limited assistance of one for eating, dependent on two staff for toilet use and dependence of two staff with total dependence. A review of the MDS of 10/17/18 revealed her Brief Interview of Mental Status (BIMS) was five which indicated a severe cognitive impairment. The resident was 63 inches tall and weighed 120 pounds. Her mood severity score was three. She answered no to these questions: little interest or pleasure in doing things, feeling down, depressed or hopeless, trouble falling or staying asleep or sleeping too much, poor appetite or overeating, feeling bad about herself, trouble concentrating on things, such as reading the newspaper or watching television. Resident #74 required the extensive assistance of two staff with bed mobility, transfer, toilet use and required dependence on one staff with locomotion on and off the unit, dressing and personal hygiene. She required supervision with setup help only with eating. The resident was frequently incontinent of bowel and bladder continence. Resident #74 was not steady and only able to stabilize with staff assistance with moving from seating to standing position, moving on and off toilet and surface to surface transfer. She did not have any impairment in the upper and lower extremities. Further review of a quarterly MDS dated [DATE] was conducted. Her BIMS was four points which indicated a severe cognitive impairment. A review of her Mood Severity Score was 15. The resident answered yes with questions of: little interest or pleasure in doing things, feeling down, depressed or hopeless, trouble falling asleep or staying asleep or sleeping too much, feeling tired or having little energy, poor appetite or trouble concentrating on things, such as reading the newspaper or watching television, moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that she had been moving around a lot more than usual. Resident #74 was dependent on one staff physical assistance with bed mobility, transfer, toilet use and personal hygiene. She required limited assistance with one person physical assist with eating. The resident was dependent on one person physical assist with locomotion on and off the unit and dressing. The resident was always incontinent with bowel and bladder functions. Activity did not occur with moving from seated to standing position, walking, turning around and facing the opposite direction while walking. The resident was not steady, only able to stabilize with staff assistance with moving on and off the toilet and surface to surface transfer. The resident had impairment on both sides of her upper and lower extremities. On 03/05/19 at 3:37 P.M. an interview was conducted with Registered Nurse (RN) #119. RN #119 said the staff was coding residents who were transferred with a lift as extensive assist and the resident was really dependent. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 6 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0637 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 03/06/19 at 10:38 A.M. an interview with RN #119 was conducted. During the interview, it was shared the resident had declined in her activities of daily living from the MDS of 10/17/19 compared to the MDS of 02/01/19. RN #119 stated a significant change MDS assessment was not completed as she did not consider this a significant change from the MDS dated [DATE] and 02/01/19. On 03/07/19 at 2:25 P.M. an interview was conducted with Licensed Practical Nurse (LPN) #83. LPN #83 said the resident was dependent on two staff for her activities of daily living. On 03/07/19 at 2:30 P.M. State Tested Nurse Aide (STNA) #114 stated the resident was totally dependent with care with the exception of eating. On 03/07/19 from 3:01 P.M. to 3:17 P.M. an observation was made as Resident #74 was transferred from the chair to the bed. It took two staff to transfer her to the bed. The resident was dependent on two staff to transfer her to the bed from the chair. The resident was completely undressed with complete assistance, and needed complete assistance of two staff with bed mobility. STNA #114 reported they had to cut up her food, open her containers, and ensure that resident was close enough and the resident would feed herself. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 7 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities 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 staff interviews, the facility failed to conduct a Level One Preadmission Screening Resident Review PASARR on one Resident (#70) in a timely manner. This affected one Resident (#70) of five residents sampled for PASARR. The resident census was 75. Residents Affected - Few Findings include: Resident #70 was admitted to the facility on [DATE] with diagnoses of anemia, heart failure, hypertension, obstructive uropathy, hyperlipidemia, stroke, psychotic disorder, atherosclerotic heart disease and unspecified mood (affective) disorder. A review of Resident #70 quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed he had a severe cognitive impairment and he was independent with his activities of daily living. A review of Resident #70 plan of care documented he was at risk for psychosocial well-being problems related to disease process. The goal was the resident would utilize effective coping mechanisms as evidenced by increased interaction with others and increased attendance at some activities or social situations. Pertinent interventions included allowing the resident time to answer questions and to verbalize feelings, perceptions and fears whenever the conversation leads to feelings or resident displays/voices need to talk to someone. Review of Resident #70's medical record revealed no evidence of a PASARR being completed prior to admission. On 03/06/19 at 1:15 P.M. the Director of Nursing (DON) verified a Level One PASARR should have been done prior to the residents' admission. On 03/07/19 at 12:50 P.M. Social Services Supervisor (SSS) #133 stated the Level One PASARR was not completed until today when she submitted the Level One assessment. During this survey, the Administrator was made aware that the Level One Assessment was not completed until today. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 8 of 23 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 366238 B. Wing (X3) DATE SURVEY COMPLETED A. Building 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff and resident interviews, the facility failed to initiate comprehensive person-centered care plans regarding residents overall care needs. This affected four (#1, #12, #21, and #77) of 19 residents reviewed during the investigation stage of the annual survey. The facility census was 75. Findings include: 1. A chart review revealed Resident #1 was admitted [DATE] with a re-entry on 09/28/17 with diagnosis including chronic kidney disease, muscle weakness, chronic obstructive pulmonary disease, heart failure, venous insufficiency, atrial flutter, spondylosis without myelopathy, poly neuropathy, peripheral vascular disease, cellulitis, pneumonia, symbolic dysfunctions, abnormal gait, respiratory failure with hypoxia, epilepsy, mild intellectual disabilities, hypertensive retinopathy, vitamin D deficiency, vascular myelopathies, anemias, hypercholesterolemia, hypertension, morbid obesity, and polyosteoarthritis. Review of the Quarterly Minimum Data Set, dated [DATE] revealed Resident #1 has moderate cognitive deficits, requires extensive assist with activities of daily living with the exception of personal hygiene being total dependence, and is occasionally incontinent with bowel and bladder. Review of physician order dated 11/02/18 revealed that Resident #1 may be admitted to Hospice care. Further review of physician order dated 01/11/19 revealed that Resident #1 was admitted to Hospice care for hypertensive heart disease on 12/30/18. Review of care plans for Resident #1 revealed no care plan for hospice care. Interview on 03/07/19 at 10:55 A.M. with Registered Nurse (RN) #87 verified there was no care plan developed for Resident #1 hospice care. 2. Review of the medical record revealed Resident #12 was admitted to the facility 02/31/13 with diagnoses including chronic respiratory failure, spastic hemiplegia affecting left dominant side, quadriplegia, left hand contracture, major depressive disorder, tracheostomy status, muscle wasting and atrophy, muscle spasm, driver injured in collision with other motor vehicles in traffic accident, and gastrostomy. Further review of the medical record was silent of a care plan for Resident #12's tracheostomy. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #12 was moderately cognitively impaired with no behaviors. Review of Section G-Functional Status revealed the resident required total dependence with bed mobility, transfer, locomotion, dressing, eating, toileting, personal hygiene, and walking did not occur. Review of Section K- Swallowing and Nutrition Status revealed the resident receives 3.51% or more total calories through parentral or tube feeding. Review f Section O-Special Treatments, Procedures and Program revealed the resident received oxygen, suctioning, and tracheostomy care. Interview conducted on 03/07/19 at 8:48 A.M. Director of Nursing (DON) #84 stated she would expect Resident #12 to have a care plan related to his tracheostomy and personal care and services provided for it. DON #84 verified Resident #12's medical record was silent of such care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 9 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 3. Review of the medical record revealed Resident #21 was admitted [DATE], readmitted [DATE], with diagnoses including acute respiratory failure with hypercapnia, amnesia, cognitive communication deficit, muscle weakness, cellulitis, chronic congestive heart failure, chronic pain, major depressive disorder, social exclusion and rejection, hypothyroidism, and morbid severe obesity. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact. Review of Section B- Hearing, Speech, and Vision revealed the resident was able to see in adequate areas with adequate lighting with corrective lenses. Review of Section E- Behaviors revealed the resident had no behaviors noted during the look back period. Review of Section G-Functional status revealed the resident required extensive two-person assistance with bed mobility, transfer, walking, locomotion, dressing, toileting, personal hygiene, and supervision with eating. Review of Section K- Swallowing/Nutritional Status revealed the resident had no noted swallowing issues, no significant weight loss/gain, and resident was noted as having therapeutic diet ordered. Review of Section L-Oral/Dental Status revealed the resident had no dental concerns noted. Review of Section M-Skin Conditions revealed the resident had no noted pressure injuries, however was at risk for pressure, and was noted with moisture associated skin damage with pressure treatments consisting of pressure reducing device for bed and chair, and application of ointments/medication. Interview conducted on 03/05/19 at 10:28 A.M. Resident #21 stated he has been in and out of the facility for almost a year, and has requested to see the Dentist and Optometrist since his admission. Resident #21 stated he would like updated glasses and to have his teeth cleaned. Further review of the medical record was silent of verification of a care plan for Resident #21's use of corrective lenses for his vision. Interview conducted on 03/07/19 at 12:15 P.M. DON #84 verified Resident #21's medical record was silent of care plans for Resident #21's vision and/or dental. 4. Review of the medical record revealed Resident #77 was admitted to the facility 12/30/14 with diagnoses including spastic hemiplegia affecting left non-dominant side, cerebral infarction, muscle weakness, type two diabetes, muscle wasting and atrophy, cardiovascular disease, anxiety disorder, chronic pain, constipation, unspecified asthma, mood disorder due to known physiological condition, hypothyroidism, shortness of breath, major depressive disorder, nausea, nonmedical substance allergy status, unspecified psychosis not due to substance or known physiological condition, other schizophrenia, and emphysema. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact. Review of Section B- Vision revealed the resident vision was adequate with corrective lenses. Review of Section E-Behaviors revealed the resident had hallucination, delusions, and rejection of care behaviors noted during the look back period. Review of section G- Functional Status revealed the resident required total two-person assistance with bed mobility, transfer, locomotion, toileting, personal hygiene, total one-person assistance with dressing, supervision and one person assistance with eating, and walking did not occur. Review of Section H-Bladder and Bowel revealed the resident was always incontinent of bowel and bladder. Review of Section K- revealed the resident had no know significant weight loss or gain noted during the look back period. Review of Section L-Dental revealed revealed no dental concerns noted. Review of Section N-Medications revealed the resident received insulin injections, antipsychotics, antianxiety, anticoagulants, and opioids seven of the seven days during the look back. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 10 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview conducted on 03/04/19 at 10:49 A.M. Resident #77 stated she has needed to see the eye doctor to get some new eye glasses, and hasn't been able to see them. Resident #77 stated she also had some dental pain and requested to see the Dentist and also has not been able to see them. Review of the medical record revealed a physician order dated 01/09/19 for Orajel Gel (oral pain relief) to be provided as needed for tooth/gum discomfort. However, review of the comprehensive care plan revealed there was no care plan regarding the residents vision or dental needs. Interview conducted on 03/07/19 at 12:15 P.M. DON #84 verified Resident #77's medical record was silent of care plans for vision and/or dental needs and/or services provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 11 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff and resident interviews, the facility failed to offer care planning conferences to involve residents and families in the care planning process. This affected two (#56 and #71) out three Residents reviewed for quarterly care conferences. The facility census was 75. Findings include: 1. A chart review revealed Resident #56 was admitted on [DATE], with diagnosis including osteomyelitis, hypertension, end stage renal disease, gangrene, peripheral vascular disease, diabetes, muscle weakness, cognitive communication deficit, hemorrhoids, enterocolitis, anemia, and hyperlipidemia. Review of the Quarterly Minimum Data Set (MDS) dated [DATE] revealed that Resident #56 has no cognitive deficits, requires extensive assistance with activities of daily living (ADL), and is frequently incontinent of bowel/bladder. Further record review revealed no evidence of any care conferences. Interview on 03/04/19 at 3:23 P.M. Resident #56 reported that she has not had a care conference since she was admitted . Interview on 03/07/19 at 3:22 P.M. with Social Service Designee (SSD) #133 verified that there has not been any care conference with Resident #56 since her admission. 2. Review of the medical record revealed Resident #71 was admitted to the facility on [DATE] with diagnoses including schizophrenia, hypertension, muscle weakness, morbid obesity, heart failure, anxiety disorder, type two diabetes, anemia, major depressive disorder, and asthma. Further review of the medical record was silent of verification of the residents having a quarterly care conference. Review of the Significant Change Care Plan dated 01/29/19 revealed in Section A-Identification Information revealed the resident was not currently considered by the state level II Preadmission Screening and Resident Review (PASARR) to have serious mental illness and/or intellectual disability. Review of Section C-Cognitive Patterns revealed the resident was cognitively intact. Review of Section E-Behaviors revealed the resident had rejection of care behaviors noted one to three days during the look back period. Review of Section G-Functional Assessment revealed the resident required extensive two-person assistance for bed mobility, transfer, toileting, extensive one-person assistance with walking, locomotion, dressing, supervision and setup for eating, and limited one person assistance with personal hygiene. Review of Section H- Bowel and Bladder revealed the resident was occasionally incontinent of bowel and bladder. Interview conducted on 03/04/19 at 2:58 P.M. Resident #71 stated she had not had a care conference or care plan review in about eight months. Interview conducted on 03/07/19 at 11:08 A.M. Social Services Supervisor (SSS) #133 stated she is the one who does and schedules care conferences in the facility. SSS #133 stated she is new to the position and is still catching up on things. SSS #133 stated the last care for Resident #71 was in 04/18. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 12 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff and resident interviews, and review of facility policy, the facility failed to provided vision services to residents. This affected two (#21 and #77) of two residents reviewed for vision services during the investigation stage of the annual survey. The facility census was 75. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #21 readmitted to the facility 12/14/18 with diagnoses including acute respiratory failure with hypercapnia, amnesia, cognitive communication deficit, muscle weakness, cellulitis, chronic congestive heart failure, chronic pain, major depressive disorder, social exclusion and rejection, hypothyroidism, and morbid severe obesity. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact. Review of Section B- Hearing, Speech, and Vision revealed the resident was able to see in adequate areas with adequate lighting with corrective lenses. Review of Section E- Behaviors revealed the resident had no behaviors noted during the look back period. Review of Section G-Functional status revealed the resident required extensive two-person assistance with bed mobility, transfer, walking, locomotion, dressing, toileting, personal hygiene, and supervision with eating. Review of Section K- Swallowing/Nutritional Status revealed the resident had no noted swallowing issues, no significant weight loss/gain, and resident was noted as having therapeutic diet ordered. Review of Section L-Oral/Dental Status revealed the resident had no dental concerns noted. Review of Section M-Skin Conditions revealed the resident had no noted pressure injuries, however was at risk for pressure, and was noted with moisture associated skin damage with pressure treatments consisting of pressure reducing device for bed and chair, and application of ointments/medication. Review of Physician Orders dated 12/14/18 revealed the resident may see ophthalmology (eye doctor) services as needed. Review of Social Services Progress Note dated 12/20/18 revealed Resident #21 had a care conference and was requesting to be put on the list to be seen by optometry services. Progress note documented Social Services would bring the consent back for services, to have it signed by the resident. Interview conducted on 03/05/19 at 10:28 A.M. Resident #21 stated he had been in and out of the facility for almost a year, and he has requested to see Optometrist services since his admission and has not seen anyone yet. Resident #21 stated he would like updated glasses. 2. Review of the medical record revealed Resident #77 was admitted to the facility 12/30/14 with diagnoses including spastic hemiplegia affecting left non-dominant side, cerebral infarction, muscle weakness, type two diabetes, muscle wasting and atrophy, cerebrovascular disease, anxiety disorder, chronic pain, constipation, unspecified asthma, mood disorder due to known physiological condition, hypothyroidism, shortness of breath, major depressive disorder, nausea, unspecified psychosis not due to substance or known physiological condition, other schizophrenia, and emphysema. Further review of the medical record was silent of verification of the resident being seen by Optometry services. Review of the quarterly Minimum Data Set(MDS) dated [DATE] revealed the resident was cognitively intact. Review of Section B- Vision revealed the resident vision was adequate with corrective lenses. Review of Section E-Behaviors revealed the resident had hallucination, delusions, and rejection of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 13 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few care behaviors noted during the look back period. Review of section G- Functional Status revealed the resident required total two-person assistance with bed mobility, transfer, locomotion, toileting, personal hygiene, total one-person assistance with dressing, supervision and one person assistance with eating, and walking did not occur. Review of Section H-Bladder and Bowel revealed the resident was always incontinent of bowel and bladder. Review of Section K- revealed the resident had no know significant weight loss or gain noted during the look back period. Review of Section L-Dental revealed revealed no dental concerns noted. Review of Section N-Medications revealed the resident received insulin injections, antipsychotics, antianxiety, anticoagulants, and opioids seven of the seven days during the look back. Interview conducted on 03/04/19 at 10:49 A.M. Resident #77 stated she has needed to see the eye doctor to get some new eye glasses, and hasn't been able to see anyone. Interview conducted on 03/07/19 at 11:08 A.M. Social Services Supervisor (SSS) #133 stated she schedules services for dental and vision services, and both the dentist and eye doctor were in the facility in 02/19 to see residents. SSS #133 stated Resident #21 had not ben seen for services due to he just signed the consent form, after the dentist and eye doctor had already come to the facility. SSS #133 verified the progress note documented on 12/20/18 that the resident requested to be seen by services and was supposed to be provided the consent at that time. SSS #133 stated she was new to the Social Services position and the old social worker must have dropped the ball or having the consent signed and the residents seen for services. SSS #133 stated she was unable to provide any verification Resident #77 had been offered and/or has been seen by Optometry Services. Review of the facility policy Vision/Hearing Services dated 02/15 revealed the facility will assist residents in obtaining routine and prompt vision care, and the social services department will work to assist and coordinate services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 14 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, staff interview, and policy review, the facility failed to use appropriate technique while performing incontinence care. This affected one (#74) out of one resident observed for incontinence care. The facility census was 75. Findings include: A chart review revealed Resident #74 was admitted on [DATE] with diagnoses including anemia, hypertension, diabetes mellitus, other fracture, non-Alzheimer's dementia, chronic kidney disease. Review of the Quarterly Minimum Data Set, dated [DATE] revealed Resident #74 had a severe cognitive impairment and was dependent on two staff with bed mobility, transfers, limited assistance of one for eating, dependent on two staff for toilet use and dependence of two staff with total dependence. An observation on 03/06/19 from 3:01 P.M. to 3:17 P.M. with two State Tested Nursing Assistants (STNA) #114 and #120 revealed while providing incontinence care to Resident #74 it was noted that STNA #120 wiped the buttock area with stool and moved the rag towards the vaginal area instead of away from the vaginal area. Interview on 03/06/19 at 3:17 P.M. with STNA's #114 and #120 verified STNA #120 wiped the buttocks the wrong way while providing incontinence care. Review of the Nursing Procedure Manual for Perineal Care dated 04/2013, revealed to clean, rinse, and dry the anal area, starting at the posterior vaginal opening and wiping from front to back. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 15 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0697 Provide safe, appropriate pain management 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 staff, physician and resident interviews, the facility failed to ensure one Residents' (#60) narcotic pain medication was available for administration. This occurred when Resident #60 missed 11 doses of narcotic pain medication over three days in 02/19. This affected one resident (#60) of six residents sampled for medication administration. The resident census was 75. Residents Affected - Few Findings include: Resident #60 was admitted to the facility on [DATE] with diagnoses of anemia, hypertension, diabetes mellitus, other fracture, anxiety, depression and unspecified mood disorder. A review of Resident #60 quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed her cognition was intact and she required supervision of one staff with bed mobility, transfer required supervision of one staff, supervision with eating and supervision with one staff for toilet use. A review of Resident #60 physician orders revealed 15 milligrams (mg) of Oxycodone (narcotic pain medication) was to be administered three times a day for pain. Also, Tylenol 500 mg was to be given three times a day for pain and 650 mg of Tylenol could be administered every four hours as needed for pain. A review of the Pain Evaluation Form dated 01/03/19 at 7:19 P.M. was conducted. The resident had generalized pain that was moderate in intensity. Resident #60 described the pain as achy and was related to arthritis and a back injury. A review of the care plan for pain revealed the resident reported generalized pain with complaint of pain all over. The resident takes medications routinely - opioid non-narcotic analgesic. On 02/22/19 at 12:34 A.M. a Health Status Note Late Entry documented the writer was unable to give Oxycodone (narcotic pain medication) due to resident being out of medication. When asked if any pain was present resident stated a little and requested and received Tylenol per PRN (as needed) order. Tylenol was effective. On 02/22/19 at 1:52 P.M. Health Status Note Late Entry documented the resident didn't received Oxycodone as the medication was out. A call was made to the physician. Pharmacy made writer aware that resident needs a new script. Resident aware, no complaint of pain and did receive schedule Tylenol. On 02/25/19 at 6:37 P.M. a Health Status Note documented the residents' Oxycodone 15 mg IR noted and was not available. This nurse called pharmacy and spoke with pharmacy technician who stated she needed a script. This nurse then called Physician #250 and spoke with Physician Assistant (PA) to get a script faxed. Script faxed to facility and, this nurse re-faxed script to pharmacy and spoke with pharmacy technician to STAT (immediate) the order. Resident made aware. On 03/05/19 at 5:18 P.M. an interview was conducted with Registered Nurse (RN) #87. She said the physician had not signed a prescription for Oxycodone so the resident had missed 11 doses of Oxycodone from 02/22/19 to 02/25/19. On 03/06/19 at 5:41 P.M. an interview was conducted with RN #87 and the Director of Nursing (DON). The DON stated the resident missed 11 doses of Oxycodone. The resident missed three doses of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 16 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medication on 02/22/19, three doses on 02/23/19, three doses on 02/24/19 and two doses on 02/25/19 for a total of eleven doses. The residents' pain level was assessed and she received Tylenol 500 mg three times a day as scheduled. She received three doses on 02/23/19, 02/24/19 and 02/25/19 of PRN Tylenol 325 mg for three doses; every four hours as needed. The facility assessed her pain. The DON said the resident needed a script from the physician for the Oxycodone. The nurses sent the order over and did not realize they needed a script. The physician was notified on 02/22/19 at 1:52 P.M. and pharmacy was made aware. On 02/23/19 at 7:05 P.M. the nursing progress note documented a call was out to physician. On 02/24/19 Physician #250 was notified. On 02/25/19 Physician #250 and PA were notified. The DON said when the nurses re-ordered a narcotic, the nurses put a sticker on the form and faxed the pharmacy or they could call the Pharmacy. The last delivery of Oxycodone was on 02/11/19. These nurses said the resident did not demonstrate any signs of pain and she was receiving Tylenol routine and Tylenol PRN (as needed) during this time period. On 03/06/19 at 6:12 P.M. Licensed Practical Nurse (LPN) #122 said she was off three days and was not working when the medication was not available. When she gave her 9:00 A.M. medications on 02/25/19, the resident said the pain was a nine or a 10 on a scale of one to 10 with 10 being the worst pain. However, she documented the highest pain level documented on the medication Administration Record was a seven. She said at that time the resident had facial grimacing which the nurse took as signs of pain. On 03/07/19 at 11:52 A.M. a telephone interview was conducted with Physician #250 who stated usually the pharmacy notified him 14 days in advance of the need to write a script for the narcotic. The physician stated he was not aware of the issue that caused the resident to miss 11 doses of her narcotic. He said the residents' pain was controlled and she was not exhibiting any signs or symptoms of withdrawal. On 03/07/19 at 12:00 P.M. an interview was conducted with Resident #60. Resident #60 said she had ran out of her medication over the last week. Resident #60 said her pain was generalized and in her back. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 17 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and policy review the facility failed to properly store and label medications. This had he potential to affect four Residents (#29, #30, #48, & #62) receiving insulin on the second floor and the potential to affect one Resident (#52) identified by the facility as receiving Lantus from the south medication cart on the first floor. The facility census was 75. Findings include: 1. An observation on [DATE] at 9:05 A.M. of the even medication cart on the second floor with Registered Nurse (RN) #14 revealed a Novolog insulin kwik pen for Resident #30 and a basaglar kwik pen insulin for Resident #29 were not dated when opened. An interview on [DATE] at 9:07 A.M. with RN #14 verified that the insulin pens were not dated and should have been. 2. An observation on [DATE] at 9:18 A.M. of the odd medication cart on the second floor with Licensed Practical Nurse (LPN) #83 revealed a Novolog quick pen for Resident #48 was opened on [DATE] and should have been discarded as expired on [DATE] and a basaglar kwik pen insulin for Resident #29 was not dated when opened. An interview on [DATE] at 9:20 A.M. with LPN #83 verified that Resident's #48 insulin pen should have been discarded, and that there was no date of open on Resident's #29 basaglar insulin pen. 3. An observation on [DATE] at 9:25 A.M. of the south cart on the first floor with LPN #122 revealed a Lantus solar insulin pen with no open date and no resident name on pen. An interview on [DATE] at 9:27 A.M. with LPN #122 verified that she did not know who the pen belonged to and that there was no open date on the pen. During the survey, the facility identified this had the potential to affect Resident #52, who is the only resident who receives Lantus in this area/from this medication cart. Review of the Preparation and General Guidelines for Vials and Ampules of Injectable Medications (dated 08/2014) revealed the date opened and this triggered expiration dated are both important to be recorded on multi-dose vials on the vial label or an accessory label affixed for that purpose. At a minimum, the date must be recorded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 18 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0791 Provide or obtain dental services for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff, resident and dentist office receptionist interviews, and review of facility policy, the facility failed to provided dental services to residents. This affected two Resident's (#21 and #77) of two residents reviewed for dental services during the investigation stage of the annual survey. The facility census was 75. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #21 was readmitted to the facility 12/14/18 with diagnoses including acute respiratory failure with hypercapnia, amnesia, cognitive communication deficit, muscle weakness, cellulitis, chronic congestive heart failure, chronic pain, major depressive disorder, social exclusion and rejection, hypothyroidism, and morbid severe obesity. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed the resident was cognitively intact. Review of Section B- Hearing, Speech, and Vision revealed the resident was able to see in adequate areas with adequate lighting with corrective lenses. Review of Section E- Behaviors revealed the resident had no behaviors noted during the look back period. Review of Section G-Functional status revealed the resident required extensive two-person assistance with bed mobility, transfer, walking, locomotion, dressing, toileting, personal hygiene, and supervision with eating. Review of Section K- Swallowing/Nutritional Status revealed the resident had no noted swallowing issues, no significant weight loss/gain, and resident was noted as having therapeutic diet ordered. Review of Section L-Oral/Dental Status revealed the resident had no dental concerns noted. Review of Section M-Skin Conditions revealed the resident had no noted pressure injuries, however was at risk for pressure, and was noted with moisture associated skin damage with pressure treatments consisting of pressure reducing device for bed and chair, and application of ointments/medication. Review of Social Services Progress Note dated 12/20/18 revealed Resident #21 had a care conference and was requesting to be put on the list to be seen by dental services. Progress note documented Social Services would bring the consent back for services, to have it signed by the resident. Interview conducted on 03/05/19 at 10:28 A.M. Resident #21 stated he had been in and out of the facility for almost a year, and he has requested to see Dental services since his admission and has not seen anyone yet. 2. Review of the medical record revealed Resident #77 was admitted to the facility 12/30/14 with diagnoses including spastic hemiplegia affecting left non-dominant side, cerebral infarction, muscle weakness, type two diabetes, muscle wasting and atrophy, cerebrovascular disease, anxiety disorder, chronic pain, constipation, unspecified asthma, mood disorder due to known physiological condition, hypothyroidism, shortness of breath, major depressive disorder, nausea, unspecified psychosis not due to substance or known physiological condition, other schizophrenia, and emphysema. Review of the quarterly Minimum Data Set(MDS) dated [DATE] revealed the resident was cognitively intact. Review of Section B- Vision revealed the resident vision was adequate with corrective lenses. Review of Section E-Behaviors revealed the resident had hallucination, delusions, and rejection of care behaviors noted during the look back period. Review of section G- Functional Status revealed the resident required total two-person assistance with bed mobility, transfer, locomotion, toileting, personal hygiene, total one-person assistance with dressing, supervision and one person assistance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 19 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0791 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with eating, and walking did not occur. Review of Section H-Bladder and Bowel revealed the resident was always incontinent of bowel and bladder. Review of Section K- revealed the resident had no know significant weight loss or gain noted during the look back period. Review of Section L-Dental revealed revealed no dental concerns noted. Review of Section N-Medications revealed the resident received insulin injections, antipsychotics, antianxiety, anticoagulants, and opioids seven of the seven days during the look back. Review of Physician Orders dated 01/09/19 revealed an order for Orajel (oral pain relive) as needed for tooth/gum discomfort. Review of Nursing Progress Notes revealed on 01/09/19 the residents had complaints of mouth pain and there was a physician order obtained for Orajel. Also, Social Service note documented obtaining an appointment for a local dentist services for 01/16/19 at 1:00 P.M. Further review of the medical record was silent of verification that the resident attended the appointment. Interview conducted on 03/04/19 at 10:49 A.M. Resident #77 stated she has had some mouth pain about a month or so ago and requested to see the Dentist, and hasn't been able to see anyone. Telephone interview conducted on 03/07/19 at 8:40 A.M. the local dental office Receptionist #199, where Resident #77 had an appointment, stated the resident was scheduled for an appointment and did not show up. Interview conducted on 03/07/19 at 11:08 A.M. Social Services Supervisor(SSS) #133 stated she schedules services for dental and vision services, and both the dentist and eye doctor were in the facility in 02/19 to see residents. SSS #133 stated Resident #21 had not been seen for services due to he just signed the consent form, after the dentist and eye doctor had already come to the facility. SSS #133 verified the progress note documented on 12/20/18 that the resident requested to be seen by services and was supposed to be provided the consent at that time. SSS #133 stated she was new to the Social Services position and the old social worker must have dropped the ball or having the consent signed and the residents seen for services. SSS #133 stated she was unable to provide any verification Resident #77 had been seen by Dental Services and/or attended her appointment. Review of the facility policy Dental Services dated 02/15 revealed the facility will assist residents in obtaining routine and emergency dental care, and the social services department will work to assist and coordinate services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 20 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on record review, and interview the facility failed to have an up-to-date facility assessment. This had the potential to affect all 75 residents residing in the facility. The facility census was 75. Findings include: Review of the facility assessment provided by Regional Registered Nurse (RN) #210 revealed the only assessment provided to the surveyor team was dated from 10/31/16 to 10/31/17. Interview on 03/07/19 at 11:00 A.M. with the Administrator verified that was all he had for the facility assessment. Interview on 03/07/19 at approximately 4:00 P.M. with Regional RN #210 verified that was the only facility assessment that could be found that was on file. The facility confirmed this had the potential to affect all 75 residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 21 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to have functional call lights in all the resident rooms. This affected two Rooms (132 Door, & 135 Window) out of five resident rooms observed for functional call lights. The facility census was 75. Residents Affected - Few Findings include: An observations on 03/05/19 from 8:52 A.M. to 9:15 A.M. revealed two rooms (132 door, & 135 window) out of five rooms observed with inoperative call light, room [ROOM NUMBER]'s call light was inoperable, and room [ROOM NUMBER] Window's call light attached to itself at the wall out of reach, with no push button to push for assistance. Interview on 03/05/19 at 9:15 with Registered Nurse (RN) #14 verified that the call lights in room [ROOM NUMBER], and 135 were not functioning properly and the residents residing in these rooms are capable of using the call light to call for assistance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 22 of 23 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 366238 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Norwood Towers Post-Acute 1500 Sherman Avenue Cincinnati, OH 45212 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and staff interview, the facility failed to maintain a clean, safe, homelike environment for residents. This had the potential to affect all 75 residents residing in the facility. Facility census was 75. Residents Affected - Many Findings include: Observations of the facility conducted from 03/04/19 through 03/07/19 revealed in the first and second floors common areas had large areas of scuffed up walls, missing paint exposing drywall, missing corner trim exposing metal, and holes in the walls around the residents chairs. Staff interview and observation conducted on 03/07/19 at 10:45 A.M. with Maintenance Supervisor(MS) #49 revealed he is notified of repairs though staff notification and observation. MS #49 verified areas in both the the first and second floor common areas as needing drywall repairs, painted and some corners fixed. MS #49 stated he was aware of the repairs needing to be completed, he just has not been able to get it to everything yet. The facility confirmed this had the potential to affect all 75 residents residing in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366238 If continuation sheet Page 23 of 23