Health inspection·August 30, 2021

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few diagnoses including unspecified dementia with behavioral disturbance, nicotine dependence, opioid dependence, anxiety disorder, major depressive disorder, insomnia, gastro esophageal reflux disease without esophagitis, essential hypertension, other symbolic dysfunctions, alcohol abuse and alcohol dependence with alcohol induced persisting dementia. Review of Resident #172's MDS assessments revealed no MDS had been completed due to Resident #172 being newly admitted to the facility. Review of Resident #172's cognition care plan dated 08/23/21 revealed Resident #172 was cognitively impaired due to dementia. Interventions included administer medications as needed, communicate with resident, discuss concerns about confusion with the resident, encourage the resident to be involved in decision making, keep the resident's routine as consistent as possible and observe and report any changes in cognition to the medical provider. Review of Resident #172's activities of daily living care plan dated 08/23/21 revealed Resident #172 had an activities of daily living performance deficit that required assistance with activities of daily living. Interventions included supervision with toileting, limited assistance with bathing, limited assistance with dressing, supervision assistance with ambulation, supervision assistance with eating, supervision assistance with hygiene and supervision assistance with transfers. Review of Resident #172's fall risk care plan dated 08/23/21 revealed Resident #172 was at risk for falls. Interventions included assess risk for falls at admission, place call bell within reach, remind resident to call for assistance and ensure resident's room was free of hazards. Observation of Resident #172's room on 08/23/21 at 10:52 A.M. revealed Resident #172 was lying in bed. Resident #172's call light was not in reach and was located on top of the light on the other side of the curtain that separated the room. Observation of Resident #172's room on 08/24/21 at 8:44 A.M. revealed Resident #172 was lying in bed. Resident #172's call light was not in reach and was located on top of the light on the other side of the curtain that separated the room. Observation of Resident #172's room on 08/25/21 at 8:59 A.M. revealed Resident #172 was lying in bed. Resident #172's call light was not in reach and was located on top of the light on the other side of the curtain that separated the room. Interview with the Administrator on 08/25/21 at 8:59 A.M. verified Resident #172's call light was not in reach. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 2 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0574 The resident has the right to receive notices in a format and a language he or she understands. Level of Harm - Potential for minimal harm Based on observation and resident and staff interview the facility failed to ensure residents were provided the information needed to contact the Ohio Department of Health (ODH), the state survey agency. This had the potential to affect all residents residing in the facility. The census was 27. Residents Affected - Many Findings include: Observation on 08/24/21 at 11:25 A.M. with Activity Director (AD) #1 revealed the facility did not have information posted for residents regarding how to contact the ODH. Interview on 08/24/21 at 11:00 A.M. with Residents #2, #3, #11, and #20 confirmed the facility had not provided information on how to formally complain to and/or contact ODH. Interview on 08/24/21 at 11:25 A.M. with AD #1 confirmed the facility had not provided or posted information to the residents on how to formally complain to and/or contact ODH. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 3 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on record review, staff interview, and review of facility policy, the facility failed to ensure the resident's medical record was updated regarding a residents code status. This affected one (#17) of 13 residents sampled. The census was 27. Findings include: Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the Minimum Data Set (MDS) assessment for Resident #17 dated 07/22/21 revealed resident was cognitively impaired and required supervision and set up help of one staff with activities of daily living. Review of the care plan for Resident #17 revealed it was silent regarding code status for resident. Review of the August 2021 monthly physician orders in the electronic medical record (EMR) for Resident #17 revealed an order dated 07/01/21 for resident's code status to be do not resuscitate comfort care (DNRCC). Review of the paper medical record, hard chart for Resident #17 revealed it did not include a DNRCC form or any documentation reflecting resident's code status. Interview on 08/24/21 at 11:15 A.M. with Licensed Practical Nurse (LPN) #16 confirmed she was not sure what Resident #17's code status was and she would need to look in the chart to answer the question. LPN #16 further confirmed Resident #17's chart did not include a DNRCC form or any documentation reflecting the resident's code status. Review of the facility policy titled OHIO DNR Comfort Care and DNRCC Arrest dated 05/28/19 revealed the facility would ensure a DNRCC form signed by the attending physician or other authorized medical professional would be placed in the resident's medical record. The form was used for all healthcare providers in the state of Ohio and provided directions for a standardized protocol for care to be implemented in the event of cardiac or respiratory arrest. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 4 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations, resident and staff interview, and review of the Resident Assessment Instrument (RAI) manual, the facility failed to ensure the Minimum Data Set (MDS) assessment was accurate regarding dental status. This affected two (#4 and #17) of 13 residents sampled. The census was 27. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #4 revealed an admission date of 11/28/20 with a diagnosis of Alzheimer's disease. Review of the comprehensive MDS assessment for Resident #4 dated 12/05/20 revealed resident was not coded accurately regarding dental status and was not coded as edentulous (having no natural teeth). Review of the care area assessment worksheets for Resident #4 revealed resident did not trigger for care planning related to dental care. Review of the care plan for Resident #4 revealed it contained no documentation regarding dental care. Observation on 08/23/21 at 8:39 A.M. of Resident #4 revealed resident was edentulous. Interview on 08/23/21 at 8:39 A.M. with State Tested Nursing Assistant (STNA) #104 confirmed Resident #4 was edentulous. Resident #4 was not interviewable. Observation on 08/25/21 at 9:26 A.M. with Licensed Practical Nurse (LPN) #103 revealed Resident #4 was edentulous. Interview on 08/23/21 at 9:26 A.M. with LPN #103 confirmed Resident #4 was edentulous and his MDS assessment dated [DATE] was coded inaccurately related to dental status. 2. Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the MDS assessment for Resident #17 dated 04/21/21 revealed resident was cognitively intact and required supervision and set up help of one staff with activities of daily living. Further review of MDS revealed resident was not coded accurately regarding dental status and was not coded as edentulous. Review of the care area assessment worksheets for Resident #17 revealed resident did not trigger for care planning related to dental care. Review of the care plan for Resident #17 revealed it contained no documentation regarding dental care. Observation on 08/23/21 at 10:55 A.M. of Resident #17 revealed resident was edentulous. Interview on 08/23/21 at 10:55 A.M. with Resident #17 confirmed he was edentulous. Observation on 08/25/21 at 9:28 A.M. with LPN #103 revealed Resident #17 was edentulous. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 5 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview on 08/23/21 at 9:28 A.M. with LPN #103 confirmed Resident #17 was edentulous and his MDS dated [DATE] was coded inaccurately related to dental status. Review of the RAI manual dated October 2019 pages L-1 through L-3 revealed edentulous was defined as having no natural permanent teeth in the mouth, complete tooth loss. Further review revealed the assessor should check MDS question check question L0200B, no natural teeth or tooth fragment(s) (edentulous): if the resident was edentulous and lacked all natural teeth or parts of teeth. The assessor should perform a physical examination of the residents oral cavity. The rationale for the item's inclusion as part of the MDS assessment was as follows: poor oral health has a negative impact on quality of life, overall health, and nutritional status. Assessment could identify periodontal disease that could contribute to or cause systemic diseases and conditions, such as aspiration, malnutrition, pneumonia, endocarditis, and poor control of diabetes. Event ID: Facility ID: 366256 If continuation sheet Page 6 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 Based on record review, staff interview, the facility failed to ensure the resident's medical record included a Level II Preadmission Screening and Resident Review (PASARR) prior to admission to the facility. This affected one (#17) of 13 residents sampled. The census was 27. Residents Affected - Few Findings include: Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the Minimum Data Set (MDS) assessment for Resident #17 dated 07/22/21 revealed resident was cognitively impaired and required supervision and set up help of one staff with activities of daily living. Review of the medical record for Resident #17 revealed it did not include a Level II PASARR screen prior to admission. Interview on 08/25/21 at 9:00 A.M. with Regional Registered Nurse (RN) #99 confirmed the facility did not have evidence of completion of a Level II PASARR prior to admission for Resident #17. RN #99 confirmed Resident #17 had a diagnoses of psychosis which would require a Level II PASARR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 7 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, resident and staff interview, and review of facility policy, the facility failed to ensure resident care plans reflected resident dental status and/or elopement risk and residing in a secured unit. This affected three (#4, #17 and #19) of 13 residents sampled. The census was 27. Findings include: 1. Review of the medical record for Resident #4 revealed an admission date of 11/28/20 with a diagnosis of Alzheimer's disease. Review of the comprehensive Minimum Data Set (MDS) assessment for Resident #4 dated 12/05/20 revealed resident was not coded accurately regarding dental status and was not coded as edentulous (having no natural teeth). Review of the care area assessment worksheets for Resident #4 revealed resident did not trigger for care planning related to dental care. Review of the care plan for Resident #4 revealed it contained no documentation regarding dental care. Observation on 08/23/21 at 8:39 A.M. of Resident #4 revealed resident was edentulous. Interview on 08/23/21 at 8:39 A.M. with State Tested Nursing Assistant (STNA) #104 confirmed Resident #4 was edentulous. Resident #4 was not interviewable. Observation on 08/25/21 at 9:26 A.M. with Licensed Practical Nurse (LPN) #103 revealed Resident #4 was edentulous. Interview on 08/23/21 at 9:26 A.M. with LPN #103 confirmed Resident #4 was edentulous, his MDS dated [DATE] was coded inaccurately related to dental status, and his care plan contained no information or interventions regarding dental care. 2. Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the MDS assessment for Resident #17 dated 04/21/21 revealed resident was cognitively intact and required supervision and set up help of one staff with activities of daily living. Further review of MDS revealed resident was not coded accurately regarding dental status and was not coded as edentulous. Review of the care area assessment worksheets for Resident #17 revealed resident did not trigger for care planning related to dental care. Review of the care plan for Resident #17 revealed it contained no information regarding dental care. Observation on 08/23/21 at 10:55 A.M. of Resident #17 revealed resident was edentulous. Interview on 08/23/21 at 10:55 A.M. with Resident #17 confirmed he was edentulous. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 8 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 Observation on 08/25/21 at 9:28 A.M. with Licensed Practical Nurse (LPN) #103 revealed Resident #17 was edentulous. Interview on 08/23/21 at 9:28 A.M. with LPN #103 confirmed Resident #17 was edentulous, his MDS dated [DATE] was coded inaccurately related to dental status, and his care plan was silent regarding dental care. Residents Affected - Few 3. Review of the elopement risk assessment for Resident #17 dated 04/14/21 revealed resident was at high risk for elopement. Review of the care plan for Resident #17 revealed it contained no information regarding the resident being at an elopement risk and/or need for resident to reside on a secured unit. Review of the August 2021 monthly physician orders for Resident #17 revealed they contained no information regarding resident rationale for residing on a secured unit. Review of guardianship letter for Resident #17 dated 08/26/20 revealed resident had been adjudicated incompetent and a legal guardian was assigned as his medical decision maker. Review of psychiatric nurse practitioner (NP) progress note for Resident #17 dated 06/24/21 revealed resident was attempting to manipulate the legal guardian and staff to allow him to leave the facility and resident was perseverating on leaving the facility. Observation on 08/23/21 at 10:55 A.M. of Resident #17 revealed resident was residing on a secured unit. Interview on 08/23/21 at 10:55 A.M. with Resident #17 confirmed he resided on a secured unit and he felt it was unnecessary, but the judge had decided he needed to be there. Interview on 08/25/21 at 9:00 A.M. with Regional Registered Nurse (RN) #99 confirmed the facility had no written policy or criteria for admission to the secured unit. Interview on 08/25/21 at 9:21 A.M. with LPN #103 confirmed Resident #17's care plan contained no information regarding the residents elopement risk and rationale for residing in a secured unit. 4. Record review for Resident #19 revealed this resident was admitted to the facility on [DATE] with the following diagnoses: acute duodenal ulcer without hemorrhage or perforation, unspecified severe protein-calorie malnutrition, confusional arousals, other psychoactive substance abuse, dysphagia, adult failure to thrive, bipolar disorder, diabetes mellitus, acute hepatitis C and hypertension. Review of the quarterly MDS assessment, dated 07/23/21, revealed this resident had minimal cognitive impairment evidenced by a Brief Interview for Mental Status (BIMS) assessment score of 13. This resident was assessed to require supervision for bed mobility, transfers, and toileting. Review of the care plan for Resident #19 revealed it contained no information regarding dental care. Observation on 08/23/21 at 11:29 A.M. revealed Resident #19 had multiple teeth which were broken off at the gumline and rotted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 9 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 Interview with Resident #19 on 08/23/21 revealed his teeth were rotted and needed pulled but had yet to see a dentist. Interview on 08/25/21 at 9:28 A.M. with LPN #103 revealed the care plan for Resident #19 contained no information regarding dental care. Residents Affected - Few Observation on 08/25/21 at 9:38 A.M. with LPN #16 revealed Resident #19 had multiple teeth which were broken off at the gumline and rotted. Interview with LPN #16 on 08/25/21 at 9:38 A.M. verified Resident #19 had multiple teeth which were broken off at the gumline and rotted. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 10 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview and policy review, the facility failed to complete a recapitulation of a discharged resident's stay. This affected one (#23) out of three residents reviewed for closed records. The facility census was 27. Findings include: Medical record review revealed Resident #23 was admitted to the facility on [DATE] with diagnoses including displaced bicondylar fracture of right tibia, other fracture of upper and lower end of right fibula, fracture of nasal bones, anterior dislocation of left humerus, encounter for other orthopedic aftercare, acute pain due to trauma, pulmonary embolism, and alcohol abuse. Further review of Resident #23's discharge record revealed Resident #23 discharged home on [DATE]. Review of Resident #23's discharge Minimum Data Set (MDS) assessment dated [DATE] revealed the resident to be cognitively intact and required supervision with bed mobility, transfers, dressing, toileting, personal hygiene and eating. Review of the discharge planning review assessment dated [DATE] revealed Resident #23 expected to be discharged to community. Resident #23 was to be discharged with home health care. Further review of the discharge planning review assessment revealed the assessment did not include any diagnoses, information regarding Resident #23's course of illness, medications, treatments, therapy, pertinent labs, radiology, and consultation results. Review of Resident #23's medical record from 01/19/21 to 06/30/21 revealed Resident #23 did not have a recapitulation of Resident #23's stay that included information regarding Resident #23's course of illness, Resident #23's medications, Resident #23's treatment, Resident #23's therapy progress or Resident #23's pertinent labs, radiology, and consultation results. Interview with Director of Social Services #11 on 08/24/21 at 12:59 P.M. verified Resident #23 discharged home on [DATE]. Director of Social Services #11 verified the facility could not find Resident #23's recapitulation of his stay that included information regarding regarding Resident #23's course of illness, medications, treatments, therapy, pertinent labs, radiology, and consultation results. Review of the transfer and discharge policy dated 03/10/17 revealed the facility will develop a discharge summary that includes a summary of the resident's stay with diagnoses, course of treatment, course of therapy and pertinent labs, radiology, and consultation results. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 11 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations, resident and staff interview, and review of facility documents, the facility failed to offer activity programming per the activity calendar. This affected one (#17) of one residents reviewed for activities. The census was 27. Residents Affected - Few Findings include: Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the Minimum Data Set (MDS) assessment for Resident #17 dated 04/21/21 revealed resident was cognitively intact and required supervision and set up help of one staff with activities of daily living. Review of section F of the MDS dated [DATE] revealed Resident #17 considered the following activities to be very important: to have books, newspaper, and magazines, to listen to music he likes, to be around animals such as pets, to do things with groups of people, to do his favorite activities, to go outside when weather is good, to participate in religious services. Review of the care plan for Resident #17 dated 04/16/21 revealed resident was dependent on staff for meeting emotional, intellectual, physical, and social needs related to cognitive deficits. Goal was for resident to attend/participate in activities of choice three to five times weekly. Interventions included the following: assist with arranging community activities, arrange transportation, encourage ongoing family involvement, invite the resident's family to attend special events, activities, meals, resident will attend /participate in small group on Thursday to help with agitation, and some of his behavioral issues, Staff will encourage resident to attend or participate in activities daily, staff will assist resident with small projects to do such as cook outs, putting things up, and helping others in need, staff will provide a monthly calendar for resident to look over to see what activities are being offered, staff will transfer or show resident where activities are being held at as needed. Observation on 08/23/21 at 10:51 A.M. of Resident #17 revealed resident was in his room watching television. Interview on 08/23/21 at 10:51 A.M. with Resident #17 confirmed the only activities they had at the facility were smoking and watching television. Observation of the posted activity calendar for 08/23/21 revealed the following activities were scheduled: 10:00 A.M. Coffee Social, 11:00 Let's Get Physical, 2:30 P.M. Residents' Choice. Observation on 08/23/21 at 10:00 A.M., 11:00 A.M., and 2:30 P.M. of the common area/activity area revealed there were no activities taking place. Interview on 08/23/21 at 3:15 P.M. with Licensed Practical Nurse (LPN) #16 confirmed there was no activity staff scheduled in the facility for 08/23/21 and no scheduled activities took place. Interview on 08/23/21 at 3:55 P.M. with Activity Director (AD) #1 confirmed there was no activity staff scheduled to work in the facility on 08/23/21 and the scheduled activities did not occur. AD #1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 12 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0679 further confirmed the activity assistant had worked the weekend and Monday, 08/23/21 was his day off. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 13 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Based on medical record review, observation, staff interview, review of facility policy, and review of the Resident Assessment Instrument (RAI) manual, the facility failed to ensure bed rails were used appropriately. This affected one (#4) of two facility-identified residents with rails to their beds. The census was 27. Findings include: Review of the medical record for Resident #4 revealed an admission date of 11/28/20 with a diagnosis of Alzheimer's disease with behavioral disturbance. Review of the Minimum Data Set (MDS) assessment for Resident #4 dated 05/10/21 revealed resident was cognitively impaired, totally dependent on the assistance of two staff with bed mobility and is coded negative for the use of bed rails. Review of the side rail assessment for Resident #4 dated 11/28/20 revealed resident did not use the device to turn from side to side, resident did not express a desire to use the device, device is not in use due to a medical diagnosis. Further review of the medical record revealed the facility had not completed a reassessment regarding side rail use for the resident. Review of the care plan for Resident #4 revealed it contained no documentation regarding the use of bed rails. Review of the medical record for Resident #4 revealed it contained no documentation regarding informed consent from resident's representative for use of half side rails. Review of physician orders for Resident #4 for August 2021 revealed there was no physician's order for use of half side rails. Review of the care plan for Resident #4 dated 04/23/21 revealed resident had potential/actual impairment to skin integrity of the related to fragile skin. Interventions included use caution during transfers and bed mobility to prevent striking arms, legs, and hands against any sharp or hard surface. Observation on 08/23/21 at 9:35 A.M. of Resident #4 revealed resident had half side rails to both sides of his bed. Resident #4 was not interviewable. Interview on 08/23 21 at 9:36 A.M. with State Tested Nursing Assistant (STNA) #104 confirmed Resident #4 had half side rails in place to both sides of his bed. STNA #104 confirmed resident did not use the half side rails during care. Interview on 08/25/21 at 9:21 A.M. with Licensed Practical Nurse (LPN) #103 confirmed Resident #4 had half side rails in place to both sides of his bed and the facility had not conducted a current assessment regarding the use of side rails for Resident #4. Review of the facility policy titled Side Rail Assessment and Consent dated 05/30/19 revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 14 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete because side rails have been implicated in injury up to and including death from entrapment and strangulation, a thorough assessment and consent will be obtained prior to the routine use of side rails to be used as assistive and/or transfer devices and not as a restraint. Review of MDS manual dated October 2019 page P-5 revealed for residents who have no voluntary movement, the staff need to determine if there is an appropriate use of bed rails. Bed rails may create a visual barrier and deter physical contact from others. Some residents have no ability to carry out voluntary movements, yet they exhibit involuntary movements. Involuntary movements, resident weight, and gravity's effects may lead to the resident's body shifting toward the edge of the bed. When bed rails are used in these cases, the resident could be at risk for entrapment. For this type of resident, clinical evaluation of alternatives (e.g., a concave mattress to keep the resident from going over the edge of the bed), coupled with frequent monitoring of the resident's position, should be considered. While the bed rails may not constitute a physical restraint, they may affect the resident's quality of life and create an accident hazard. Event ID: Facility ID: 366256 If continuation sheet Page 15 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on review of the nursing staffing schedules, staff interviews and review of the staff roster, the facility failed to have a Registered Nurse (RN) in the facility for at least eight hours a day, seven days a week and failed to have a full time Director of Nursing (DON) employed at the facility. This had the potential to affect all 27 residents residing at the facility. Facility census was 27. Findings include: 1. Review of the facility nurse staffing schedules for 08/21/21 and 08/22/21 revealed there was not an RN scheduled to work in the facility. Interview with RN #100 on 08/25/21 at 11:00 A.M. verified there was not an RN present in the facility on 08/21/21 or 08/22/21. 2. Interview with the DON on 08/25/21 at 11:20 A.M. revealed she was the DON for the facility as well as the facility located next door and was the only DON employed at both facilities. The DON stated she worked approximately 50 hours per week and split the time between the two facilities. Review of the facility staff roster revealed the DON was the only RN employed as a DON at the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 16 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on record review, observation, staff interview and review of facility policy, the facility failed to ensure controlled substance medications were properly counted. This had the potential to affect five (#10, #19, #122, #172, #273) of five residents with controlled substances being stored in Cart 2. The census was 27. Findings include: 1. Review of the controlled substance count sheet for Cart 2 revealed the nurse had not signed the count sheet at the beginning of her shift, 7:00 A.M. on 08/23/21. Interview on 08/23/21 at 3:14 P.M. with Licensed Practical Nurse (LPN) #16 confirmed she had not signed the count sheet for the controlled substances at the beginning of her shift on 08/23/21. 2. Review of the medical record for Resident #122 revealed an admission date of 01/19/21 with a diagnosis of encounter for orthopedic aftercare and a discharge date of 06/30/21. Review of the physician orders for Resident #122 revealed an order dated 05/12/21 for oxycodone five milligrams. Review of the controlled substance record for Resident #122 revealed resident had six oxycodone tablets remaining. Observation on 08/23/21 at 3:15 P.M. of the controlled substance storage for Resident #122 revealed there was a card of oxycodone for resident with six tablets remaining. Interview on 08/23/21 at 3:15 P.M. with Licensed Practical Nurse (LPN) #16 confirmed there was a controlled substance sheet for Resident #122's oxycodone indicating six tablets remained and the controlled substance storage in Cart 2 included a card with six oxycodone tablets for Resident #122. LPN #16 confirmed Resident #122 was discharged from the facility in June 2021 but his oxycodone had not been removed from Cart 2. The facility confirmed there are five (#10, #19, #122, #172, #273) residents with controlled substances being stored in Cart 2. Review of the facility policy titled Medication Controlled Drugs and Security dated 07/25/18 revealed the controlled drug record must be signed by the nurse coming on duty and going off duty to verify that the count of all controlled drugs is correct after the count has been completed. Further review of the policy revealed when the prescribed drug was discontinued or the resident discharged , the container and the control sheet must be removed for drug destruction within five (5) days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 17 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the medical record for Resident #16 revealed an admission date of 03/23/21 with diagnosis including depressive disorder with psychotic symptoms, mood disorder, unspecified psychosis and bipolar disorder. Review of the quarterly MDS assessment dated [DATE] revealed the resident was cognitively intact and received antipsychotic and antidepressant medications. Review of the physician orders for 08/21 revealed Resident #16 was taking Risperidone one milligram (mg) by mouth daily for mood disorder, Venlafaxine Hydrochloride extended release 75 mg by mouth-take three tablets to equal 225 mg-daily for mood disorder and Lithium Carbonate extended release 300 mg by mouth every 12 hours for mood disorder. Review of the 07/21 pharmacy recommendations and note to the attending physician/prescriber revealed the pharmacy recommended obtaining a Lithium level now and every three months, a basic metabolic panel every every three moths, and a thyroid-stimulating hormone level every six months. The recommendations were not reviewed or signed by the physician. Interview with the Regional RN #99 on 08/25/21 at 9:54 A.M. confirmed the pharmacy recommendations for Resident #16 were not acted upon by the physician. 4. Review of the medical record for Resident #20 revealed an admission date of 06/02/21 with diagnosis including anoxic brain damage, cardiac arrest and depression. Review of the quarterly MDS assessment dated [DATE] revealed the resident was cognitively impaired with symptoms of depression and received antidepressant medication. Review of the physician orders for 08/21 revealed Resident #20 was taking Bupropion Hydrochloride 75 mg by mouth two times daily for major depressive disorder, Depakote extended release 250 mg by mouth three times daily for psychosis, Sertrailne Hydrochloride 100 mg by mouth daily for major depressive disorder and Trazadone Hydrochloride 50 mg by mouth at bedtime for insomnia. Review of the 07/21 pharmacy recommendations and note to attending physician/prescriber revealed the pharmacy stated the resident currently had an active order for Depakote 250 mg three times daily for psychosis. However, psychosis was not listed as a current medical diagnosis. The recommendations were not reviewed or signed by the physician. Interview with the Regional RN on 08/25/21 at 9:54 A.M. confirmed the pharmacy recommendations for Resident #20 was not acted upon by the physician. Based on record review, staff interview, and review of facility policy, the facility failed to ensure a pharmacist completed a monthly drug regimen review as required and failed to ensure pharmacist recommendations were reviewed and acted upon in a timely manner by the physician. This affected six (#4, #5, #10, #16, #17 and #20) of six residents reviewed for unnecessary medications. The census was 27. Findings include: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 18 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1. Review of the medical record for Resident #4 revealed resident was admitted on [DATE] with a diagnosis of early onset Alzheimer's disease. Review of the Minimum Data Set (MDS) assessment for Resident #4 dated 05/10/21 revealed resident was cognitively impaired and was totally dependent on assistance of one to two staff with activities of daily living (ADL's). Review of August 2021 Medication Administration Record (MAR) for Resident #4 revealed resident had an order dated 12/01/20 for Ativan as needed every four hours for agitation and an order dated 03/28/21 for Keflex 500 mg three times daily. Further review of MAR revealed resident received as needed doses of Ativan on 08/08/21 and 08/18/21 and resident received routine Keflex as ordered. Review of the pharmacy recommendation for Resident #4 for July 2021 revealed resident was ordered Ativan one milligram (mg) every four hours as needed for agitation. Further review recommendation revealed this was an order for an as needed psychotropic medication without a stop date and the State Operations Manual (SOM) required an assessment to continue an as needed psychotropic medication beyond 14 days. Recommendations included the following: prescriber to reassess the as needed psychotropic order, prescribe to update the order to include the duration and rationale for extending the order, consider if discontinuing the Ativan order was appropriate. Further review of the pharmacy recommendation revealed it had not been reviewed by the physician or prescriber. Review of the pharmacy recommendation for Resident #4 for July 2021 revealed resident had an order for Keflex 500 mg three times daily since March. Recommendation was for prescriber to re-evaluate the use of Keflex and consider discontinuing or if medication was to be continued to update indication of use. Further review of the pharmacy recommendation revealed it had not been reviewed by the physician or prescriber. Interview on 08/25/21 at 9:00 A.M. with Regional Registered Nurse (RN) #99 confirmed the July 2021 pharmacy recommendations for Resident #4 regarding Ativan and Keflex had not been reviewed or addressed by the physician. 2. Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the MDS assessment for Resident #17 dated 07/22/21 revealed resident was cognitively impaired and required supervision and set up help of one staff with activities of daily living. Review of the August 2021 MAR for Resident # 17 revealed an order dated 04/14/21 for Ativan as needed at bedtime. Review of the pharmacy recommendation for Resident #17 for July 2021 revealed resident had an as needed order for Ativan for anxiety and recommendations were to reassess the resident and determine if the order should be updated or discontinued. Further review of the pharmacy recommendation revealed it had not been reviewed by the physician or prescriber. Interview on 08/25/21 at 9:00 A.M. with Regional RN #99 confirmed the July 2021 pharmacy recommendations for Resident #17 regarding Ativan had not been reviewed or addressed by the physician. Review of facility policy titled Medication Regimen Review dated 09/23/19 revealed the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 19 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some attending physician must document in the medical record that the identified irregularity has been reviewed, and what, if any action has been taken to address it. 5. Medical record review revealed Resident #5 was admitted to the facility on [DATE] with diagnoses including Coronavirus Disease 2019 (COVID-19), cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery, type two diabetes mellitus without complications, major depressive disorder, moderate protein calorie malnutrition, anxiety disorder and heart failure. Review of Resident #5's quarterly MDS assessment dated [DATE] revealed the resident to be severely cognitively impaired and required extensive with transfers, bed mobility, dressing, toileting, and personal hygiene. Resident #5 also required supervision with eating. Resident #5 was reported to be on a routine antipsychotic, antianxiety, antidepressant and anticoagulant. Review of Resident #5's care plan dated 12/30/19 revealed Resident #5 had potential side effects of psychotropic medications due to antianxiety use, antidepressant use and antipsychotic use. Interventions included administer psychotropic medications as ordered, monitor side effects, approach in a non judgmental manner, assess for boredom, assess for pain, call light in reach and consult with the pharmacy and the physician to consider dosage reduction when clinically appropriate. Review of Resident #5's physician orders dated 08/24/21 revealed Resident #5 was prescribed Zoloft 100 milligrams (mg) give one tablet by mouth one time a day for major depressive disorder on 03/29/20, Zyprexa five mg give one tablet by mouth at bedtime for anxiety disorder on 02/11/20, Depakote tablet delayed release 250 mg give one tablet by mouth every morning and bedtime related to anxiety disorder on 01/09/20, and buspirone 15 mg give one tablet by mouth three times a day for anxiety disorder on 05/07/21. Review of Resident #5's chart from 08/23/20 to 08/23/21 revealed there were no monthly regimen reviews in Resident #5's chart. Interview with Regional RN #99 on 08/24/21 at 3:08 P.M. verified Resident #5 did not have monthly regimen reviews from 08/23/20 to 08/23/21. Review of the facility's medication regimen review policy dated 09/23/19 revealed the consultant pharmacist shall conduct a monthly medication regimen review for each resident in the facility. The Director of Nursing (DON) or designee will be responsible for addressing all medication irregularity reports with the attending physicians in a manner that meets the needs of the resident. 6. Record review for Resident #10 revealed an admission date of 05/19/21 with the following diagnoses: type two diabetes mellitus, dementia, COVID-19, atrial fibrillation, depression, anxiety, and suicidal ideation's. This resident had allergies to Mirtazapine and Penicillin. Review of the admission MDS assessment, dated 05/26/21, revealed this resident had moderately impaired cognition evidenced by a Brief Interview for Mental Status (BIMS) assessment score of nine. This resident was assessed to require supervision with set-up assistance for bed mobility, transfers, and toileting. Review of the August 2021 MAR for Resident #10 revealed an order for Ativan every 12 hours as needed. Further review of the MAR revealed Resident #10 had received an as needed dose of the Ativan on 08/03/21. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 20 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the pharmacy recommendation for Resident #17 for July 2021 revealed resident had an as needed order for Ativan for anxiety and recommendations were to reassess the resident and determine if the order should be updated or discontinued. Further review of the pharmacy recommendation revealed it had not been reviewed by the physician or prescriber. Interview on 08/25/21 at 9:00 A.M. with Regional RN #99 confirmed the July 2021 pharmacy recommendations for Resident #10 regarding Ativan had not been reviewed or addressed by the physician. Review of facility policy titled Medication Regimen Review dated 09/23/19 revealed the resident's attending physician must document in the medical record that the identified irregularity has been reviewed, and what, if any action has been taken to address it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 21 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of Resident #72 medical record revealed an admission order of 07/29/21. Diagnoses included bipolar, and anxiety. Review of the most recent five-day MDS assessment revealed Resident #72 was cognitively impaired. Review of the physicians orders dated on 07/29/21 and 08/01/21 revealed an order for an antianxiety medication (Ativan) 0.5 mg (milligrams) to be given every six hours as needed. The medication did not have a stop date. Review of the 08/21 Medication Administration Record (MAR) revealed the resident received one dose on 08/22/21. Observations of Resident #72 on 08/23/21 and 08/24/21 at random times noted the resident was usually in the dining room with his head on the table asleep. Interview with Registered Nurse #99 on 08/24/21 at 4:30 P.M. verified there was no stop date for the medication, and it should not have went through without clarification for a stop date. 4. Review of the medical record for Resident #16 revealed an admission date of 03/23/21 with diagnosis including depressive disorder with psychotic symptoms, mood disorder, unspecified psychosis and bipolar disorder. Review of the quarterly Minimum Data Set 3.0 (MDS) dated [DATE] revealed the resident was cognitively intact and received antipsychotic and antidepressant medications. Review of the physician orders for 08/21 revealed Resident #16 was taking Lithium Carbonate extended release 300 mg by mouth every 12 hours for mood disorder. Review of the 07/21 pharmacy recommendations and note to the attending physician/prescriber revealed the pharmacy recommended obtaining a Lithium level now and every three months, a basic metabolic panel every every three moths, and a thyroid-stimulating hormone level every six months. The recommendations were not reviewed or signed by the physician. Review of the laboratory test results for Resident #16 revealed no laboratory studies were completed to monitor the Lithium level. Interview with the Regional Nurse #99 on 08/25/21 at 9:54 A.M. confirmed there was not a Lithium level obtained for Resident #16 since his admission on [DATE]. Based on medical record review, staff interview, review of online resource Medscape, and review of facility policy, the facility failed to ensure as needed psychotropic medications had a stop date, antipsychotic medications were given for appropriate indication, gradual dose reduction (GDR) was addressed as appropriate for antipsychotic medication and failed to obtain appropriate laboratory testing for psychotropic medications. This affected six (#4, #5, #10, #16, #17, and #72) of six residents reviewed for unnecessary medications. The census was 27. Findings include: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 22 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1. Review of the medical record for Resident #4 revealed resident was admitted on [DATE] with a diagnosis of early onset Alzheimer's disease. Review of the Minimum Data Set (MDS) assessment for Resident #4 dated 05/10/21 revealed resident was cognitively impaired and was totally dependent on assistance of one to two staff with activities of daily living (ADL's). Review of the August 2021 physician orders for Resident #4 revealed an order dated 12/01/20 for resident to receive Seroquel, an antipsychotic medication on a routine basis. Further review of the record for Resident #4 revealed an order dated 08/10/21 for Resident #4 to receive an additional routine antipsychotic medication, Haldol. Review of the nurse progress notes for Resident #4 dated 08/01/21 through 08/25/21 revealed the notes contained no documentation regarding any behavioral symptoms or indications for the use of antipsychotic medications. Review of the diagnosis list for Resident #4 revealed resident did not have an appropriate diagnosis to justify the use of antipsychotic medication. Review of the August 2021 physician orders for Resident #4 revealed an order dated 12/01/20 for resident to receive an as needed Ativan with no stop date or duration for the order. Interview on 08/23/21 at 3:20 P.M. with Licensed Practical Nurse (LPN) #16 confirmed there was no indication for Resident #4 to receive antipsychotic medications and Resident #4's Ativan order did not include a stop date. Review of the online resource Medscape revealed Haldol and Seroquel had black box warnings indicating the medication placed elderly patients with dementia related psychosis at increased risk of mortality and neither medication was not approved for the treatment of patients with dementia-related psychosis. Review of the facility policy titled Medication Management dated 08/2020 revealed when a resident received medications from the same class or with similar therapeutic benefits (duplicate therapy), the clinical rationale and benefit should be documented in the resident's active record. 2. Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia with behavioral disturbance, unspecified psychosis, and mood disorder. Review of the MDS assessment for Resident #17 dated 07/22/21 revealed resident was cognitively impaired and required supervision and set up help of one staff with activities of daily living. Review of the August 2021 MAR for Resident # 17 revealed an order dated 04/14/21 for Ativan as needed at bedtime. Interview on 08/23/21 at 3:20 P.M. with Licensed Practical Nurse (LPN) #16 confirmed Resident #17's Ativan order did not include a stop date. 5. Medical record review revealed Resident #5 was admitted to the facility on [DATE] with diagnoses including Coronavirus Disease 2019 (COVID-19), cerebral infarction due to unspecified occlusion or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 23 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stenosis of unspecified cerebral artery, type two diabetes mellitus without complications, major depressive disorder, moderate protein calorie malnutrition, anxiety disorder and heart failure. Review of Resident #5's quarterly MDS assessment dated [DATE] revealed the resident to be severely cognitively impaired and required extensive with transfers, bed mobility, dressing, toileting, and personal hygiene. Resident #5 also required supervision with eating. Resident #5 was reported to be on a routine antipsychotic, antianxiety, antidepressant and anticoagulant. Review of Resident #5's care plan dated 12/30/19 revealed Resident #5 had potential side effects of psychotropic medications due to antianxiety use, antidepressant use and antipsychotic use. Interventions included administer psychotropic medications as ordered, monitor side effects, approach in a non judgmental manner, assess for boredom, assess for pain, call light in reach and consult with the pharmacy and the physician to consider dosage reduction when clinically appropriate. Review of Resident #5's physician orders dated 08/24/21 revealed Resident #5 was prescribed Zoloft 100 milligrams (mg) give one tablet by mouth one time a day for major depressive disorder on 03/29/20, Zyprexa five mg give one tablet by mouth at bedtime for anxiety disorder on 02/11/20, Depakote tablet delayed release 250 mg give one tablet by mouth every morning and bedtime related to anxiety disorder on 01/09/20, and buspirone 15 mg give one tablet by mouth three times a day for anxiety disorder on 05/07/21. Review of Resident #5's chart from 08/23/20 to 08/23/21 revealed there were no monthly regimen reviews in Resident #5's chart. There was also no indication that Resident #5's medications were contraindicated. Review of Resident #5's physician's visits dated 07/22/20, 09/27/20, 11/17/20, 01/20/21, 03/21/21, and 05/18/21 revealed there were no gradual dose reductions or documentation of contraindications of a gradual dose reduction for Resident #5's Zoloft 100 milligrams (mg) give one tablet by mouth one time a day for major depressive disorder on 03/29/20, Zyprexa five mg give one tablet by mouth at bedtime for anxiety disorder on 02/11/20, Depakote tablet delayed release 250 mg give one tablet by mouth every morning and bedtime related to anxiety disorder on 01/09/20, and buspirone 15 mg give one tablet by mouth three times a day for anxiety disorder on 05/07/21. Interview with Director of Social Services #11 on 08/24/21 at 12:59 P.M. reported Resident #5 had not received any psychiatric services from 08/23/20 to 08/24/21. Interview with Regional Registered Nurse (RN) #99 on 08/25/21 at 9:54 A.M. verified Resident #5 did not have any contraindications or gradual dose reductions for his Zoloft 100 milligrams (mg) give one tablet by mouth one time a day for major depressive disorder on 03/29/20, Zyprexa five mg give one tablet by mouth at bedtime for anxiety disorder on 02/11/20, Depakote tablet delayed release 250 mg give one tablet by mouth every morning and bedtime related to anxiety disorder on 01/09/20, and buspirone 15 mg give one tablet by mouth three times a day for anxiety disorder on 05/07/21. 6. Review of the medical record for Resident #10 revealed an admission date of 05/19/21 with the following diagnoses: type two diabetes mellitus, dementia, COVID-19, atrial fibrillation, depression, anxiety, and suicidal ideation's. Review of the admission MDS assessment for Resident #10 revealed this resident had moderately impaired cognition evidenced by a BIMS score of nine. This resident was assessed to require supervision (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 24 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 and set-up assistance for transfers, bed mobility, and toileting. Level of Harm - Minimal harm or potential for actual harm Review of the August 2021 MAR for Resident #10 revealed an order dated 05/19/21 for Ativan every 12 hours as needed. Resident #10's Ativan order did not contain a stop date. Residents Affected - Some Interview on 08/23/21 at 3:20 P.M. with LPN #16 confirmed Resident #10's Ativan order did not include a stop date. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 25 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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, review of facility policy, and review of manufacturer's recommendation, the facility failed to ensure tuberculosis (TB) testing solution was dated upon opening. This had the potential to affect all residents residing in the facility except for Resident #18 who was identified by the facility as being allergic to TB testing solution. The census was 27. Findings include: Observation on [DATE] at 3:10 P.M. with Licensed Practical Nurse (LPN) #16 revealed there were two open undated vials of TB testing solution being stored in the medication refrigerator. Interview on [DATE] at 3:10 P.M. with LPN #16 confirmed there were two open undated vials of TB testing solution being stored in the medication refrigerator. LPN #16 confirmed TB testing solution should be dated upon opening and discarded when expired. The facility confirmed this could potentially affect all the residents residing in the facility except Resident #18 who is allergic to the TB testing solution. Review of the facility policy titled Storage of Medications dated 08/20202 revealed certain medications including multiple dose injectable vials required an expiration date shorter than the manufacturer's expiration date once opened to ensure medication purity and potency. Review of manufacturer's recommendations for TB testing solution dated [DATE] revealed vials in use more than 30 days should be discarded due to possible oxidation and degradation which may affect potency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 26 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations and staff interview, the facility failed to ensure residents have adaptive feeding equipment in place per the physician orders. This affected one (#4) of one residents with adaptive devices for eating. The census was 27. Residents Affected - Few Findings include: Review of the medical record for Resident #4 revealed resident was admitted on [DATE] with a diagnosis of early onset Alzheimer's disease. Review of the Minimum Data Set (MDS) assessment for Resident #4 dated 05/10/21 revealed resident was cognitively impaired and was totally dependent on assistance of one staff with eating. Review of physician orders for Resident #4 revealed an order dated 12/17/20 for resident to utilize a sippy cup with all liquids. Review of nurse progress note for Resident #4 dated 12/17/20 revealed resident's representative was notified of new physician's order for resident to utilize a sippy cup with liquids. Review of the care plan for Resident #4 dated 05/07/21 revealed resident was at risk for impaired nutrition status due to end stage Alzheimer's diagnosis, texture modified diet and total feeding dependence, history of weight loss and decreased intakes. Interventions included to utilize adaptive equipment per order. Review of the tray ticket for Resident #4 for breakfast on 08/23/21 and 08/25/21 revealed resident was supposed to have a sippy cup with meals. Observation of the breakfast meal on 08/23/21 at 9:42 A.M. of Resident #4 revealed resident was served a plastic cup of orange juice and a plastic cup of water. There was no sippy cup on the tray. Further observation revealed State Tested Nursing Assistant (STNA) #104 assisted resident with the meal without using the sippy cup. Interview on 08/23/21 at 9:50 A.M. with STNA #104 confirmed Resident #4 did not have a sippy cup on his breakfast tray. Observation of the breakfast meal on 08/25/21 at 8:59 A.M. of Resident #4 revealed resident was served orange juice and water and had two sippy cups on the tray. Interview on 08/23/21 at 8:59 A.M. with STNA #21 confirmed Resident #4 had a sippy cup on his breakfast tray and he was supposed to have one per the doctor's order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 27 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review, observation, resident interview, and staff interview, the facility failed to accurately document the dental status for two residents (#19 and #242) of the five residents reviewed for dental concerns. The facility census was 27. Findings include: 1. Review of the medical record for Resident #19 revealed an admission date of 06/19/21 with diagnoses to include severe protein-calorie malnutrtion, dysphagia, adult failure to thrive, and bipolar disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 07/23/21, revealed this resident was cognitively intact and required supervision with set-up assistance for bed mobility, toileting, transfers, and eating. Review of the facility admission Assessment and Baseline Care Plan, dated 06/19/21, revealed Resident #19 was edentulous and did not have any broken or carious teeth. Review of the care plan for Resident #19 revealed it was silent regarding dental care. Observation of Resident #19 on 08/23/21 at 11:29 A.M. revealed Resident #19 had multiple teeth which were broken near the gum line and rotted. Interview with Resident #19 on 08/23/21 revealed his teeth were rotted and needed pulled but had not seen a dentist. Observation on 08/25/21 at 9:38 A.M. with Licensed Practical Nurse (LPN) #16 revealed Resident #19 had multiple teeth which were broken near the gum line and rotted. Interview with LPN #16 on 08/25/21 at 9:38 A.M., verified Resident #19 had multiple teeth which were broken off near the gum line and rotted. LPN #16 verified the admission Assessment and Baseline Care Plan for Resident #19, dated 06/19/21, was inaccurate and indicated Resident #19 was edentulous and did not have broken or carious teeth. 2. Review of the medical record for Resident #272 revealed an admission date of 08/19/21 with diagnoses including bipolar disorder, abnormal weight loss, and gastrointestinal hemorrhage. Review of the facility admission Assessment and Baseline Care Plan, dated 08/19/21, revealed Resident #272 was documented as having natural teeth. Observation of Resident #272 on 08/25/21 at 10:35 A.M. with LPN #16 revealed Resident #272 was edentulous and had no natural teeth or tooth fragments in his mouth. Interview with LPN #16 on 08/25/21 at 10:35 A.M. verified Resident #272 was edentulous and had no natural teeth or tooth fragments. LPN #16 verified the admission Assessment and Baseline Care Plan, dated 08/19/21, was inaccurate and indicated Resident #272 had natural teeth. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 28 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 3. An observation of the medication administration with Licensed Practical Nurse (LPN) #16 on 08/23/21 at 7:50 A.M., revealed LPN #16 obtained Resident #173's blood glucose. LPN #16 placed the glucometer on the bedside table without a barrier. After obtaining the blood glucose level, LPN #116 cleaned the glucometer with an alcohol wipe and placed it on top of the medication cart. Residents Affected - Many An interview with LPN #116 at 8:01 A.M. confirmed that she did not use a barrier to lay the glucometer on the bedside table. LPN #116 also confirmed that the alcohol wipe used to clean the glucometer was not an acceptable cleaning agent for glucometer and was not the policy/procedure. Review of the facility policy titled Cleaning and Disinfection of Glucose Meter, revised on 10/08/18, revealed that one glucose meter may be in use while the other meter was undergoing disinfection with the high-level antimicrobial wipe for wet-contact time per the manufactures recommendation. The suggested method to obtain proper disinfection times for wet-contact is to wrap the machine in the wipe ensuring that all surfaces remain wet during contact time period. Place the wrapped meter in a clean cup on the med cart for the appropriate length of time and allow the meter to air dry prior to use. Based on observation, staff interview, review of online resources per the Centers for Disease Control (CDC) and the Center for Medicare and Medicaid Studies (CMS), and review of facility policy, the facility failed to ensure staff wore eye protection in resident areas. This had the potential to affect all residents residing in the facility. The facility failed to ensure staff wore appropriate personal protective equipment (PPE) which affected one (Resident #172) of one facility-identified residents on transmission based precautions. The facility also failed to properly sanitize blood glucose meters which affected one (Resident #173) out of two facility-identified residents with physician orders for finger stick blood sugar testing. The census was 27. Findings include: 1. Observation on 08/23/21 at 8:10 A.M. of Licensed Practical Nurse (LPN) #16, at 8:15 A.M. of State Tested Nursing Assistant (STNA) #104, and at 8:20 A.M. of STNA #13, revealed staff were working in resident care areas and were not wearing eye protection. Interviews on 08/23/21 at 8:10 A.M. of LPN #16 at 8:15 A.M. of State Tested Nursing Assistant (STNA) #104, and at 8:20 A.M. of STNA #13 confirmed they were working in resident care areas and were not wearing eye protection. Interview on 08/25/21 at 11:20 A.M. with Registered Nurse (RN) #100, the facility's Infection Preventionist (IP), confirmed eye protection was required if the facility was in outbreak mode. The interview further revealed she was not aware the county positivity rate had any bearing on the facility's requirement for staff to wear eye protection in resident areas. Interview on 08/25/21 at 11:21 A.M. with Regional RN #99, confirmed the county in which the facility was situated was experiencing a moderate spread of COVID-19 positivity and staff were required to wear eye protection in resident care areas. Review of facility policy titled Criteria for COVID-19 Isolation, dated 06/22/21, revealed eye protection is not required in the resident units if the county positivity rate was less than 5 percent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 29 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 Review of an online resource from CMS titled COVID-19 Nursing Home Data found at https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data-Test-Positivity-Rates/q5r5-gjyu/ revealed the county in which the facility was situated was experiencing a moderate spread of COVID 19 with a positivity rate of 8.8% for the week ending in 08/17/21. Residents Affected - Many Review of an online resource from the CDC titled Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19) found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html revealed the use of eye protection in healthcare facilities is recommended in areas with moderate to substantial community transmission and staff should don eye protection (i.e., goggles or a face shield that covers the front and sides of the face) upon entry to the patient room or care area. 2. Review of the medical record for Resident #172 revealed an admission date of 08/20/21 with diagnoses including unspecified dementia with behavioral disturbance, nicotine dependence, opioid dependence, anxiety disorder, major depressive disorder, insomnia, gastro esophageal reflux disease without esophagitis, essential hypertension, other symbolic dysfunctions, alcohol abuse and alcohol dependence with alcohol induced persisting dementia. Review of Resident #172's coronavirus (COVID19) care plan dated 08/23/21, revealed Resident #172 was at risk for COVID19 related to potential exposure with his recent hospitalization and admission from the community. Interventions included droplet isolation precautions per physician's orders, determine appropriate barriers to apply based on isolation precautions, arrange supplies and equipment in resident's room, and explain the purpose of isolation and precautions necessary to the resident and family. Review of Resident #172's droplet precautions care plan dated 08/24/21, revealed Resident #172 was on droplet precautions. Interventions included implement droplet isolation precautions, explain the purpose for isolation, and arrange supplies and equipment. Review of Resident #172's physicians order dated 08/21/21 revealed Resident #172 was ordered to be in droplet precautions. Observation of Resident #172's room on 08/23/21 at 10:05 A.M. revealed State Tested Nurse Aide (STNA) #13 was getting items out of Resident #172's dresser and collected Resident #172's finished breakfast tray. Resident #172 was in his bed at the time of the observation. STNA #13 was observed wearing a surgical mask but was not wearing gloves or an isolation gown. There was no signage observed on Resident #172's door but Resident #172 was observed to have a set of drawers with personal protective equipment (PPE) outside of his room. Interview with STNA #13 on 08/23/21 at 10:05 A.M., verified she wore only a surgical mask into Resident #172's room, and she collected Resident #172's finished breakfast tray without donning gloves or an isolation gown. STNA #13 verified Resident #172 was on droplet precautions but did not have any droplet precautions signage on his door. Observation of Resident #172's room on 08/23/21 at 10:10 A.M. revealed Licensed Practical Nurse (LPN) #102 and Registered Nurse (RN) #15 were placing droplet precautions signage on the inside and outside of Resident #172's room. LPN #102 was observed to enter Resident #173's room and was observed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 30 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 to hang a droplet precautions sign on the wall inside of his room while only wearing a surgical mask. LPN #102 was not wearing an N-95 respirator, isolation gown, or gloves. Resident #172 was observed in his room at the time of the observation. Interview with LPN #102 and RN #15 on 08/23/21 at 10:10 A.M. verified they were hanging droplet precautions signage inside and outside Resident #172's room. LPN #102 verified she entered Resident #172's room and hung a droplet precautions sign on the wall while only wearing a surgical mask. LPN #102 verified she was not wearing a N-95 respirator, gloves, or an isolation gown. Observation of Resident #172 on 08/23/21 at 10:49 A.M., revealed Housekeeper #101 was cleaning Resident #172's room while only wearing gloves and a surgical mask. Resident #172 was observed to be present in the room at the time of the observation. Interview with Housekeeper #101 on 08/23/21 at 10:49 A.M. verified she was in Resident #172's room while only wearing a surgical mask and gloves. Housekeeper #101 verified she was not wearing an N-95 respirator or an isolation gown. Review of the facility's policy titled Criteria for COVID-19 isolation, dated 04/05/21, revealed all new admissions who are not fully vaccinated will be on the at risk unit and will have appropriate signage on or around their resident room door. An N-95 and eye protection will be required when working in the general area of the unit and full personal protective equipment (PPE) will be required when entering a resident room. Full PPE consists of an N95 respirator, face shield, isolation gown, and gloves. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 31 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. 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 interview, the facility failed to ensure residents and/or resident representatives were provided education regarding the benefits and potential side effects of the influenza immunization and pneumococcal immunization. Additionally, the facility failed to ensure residents either received the influenza immunization and pneumococcal immunization or did not receive the influenza immunization and pneumococcal immunization due to medical contraindications or refusal. This affected five (#4, #5, #13, #14, and #17) out of five residents reviewed for immunizations. The facility census was 27. Residents Affected - Some Findings include: 1. Review of the medical record for Resident #4 revealed an admission date of 11/28/20 with diagnoses including Alzheimer's disease with early onset, delirium due to known physiological condition, and type two diabetes mellitus with unspecified complications. Review of Resident #4's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was severely cognitively impaired and required total dependence with eating, transfers, bed mobility, dressing, toileting, and personal hygiene. Review of Resident #4's immunization history dated 08/24/21 revealed there was no documentation that Resident #4 received a influenza or pneumococcal immunization. Review of Resident #4's medical record dated 08/24/21 revealed there were no influenza or pneumococcal immunization education, or consents located in Resident #4's chart. Further review of Resident #4's chart revealed there was no indication whether Resident #4 received the influenza immunization and pneumococcal immunization or did not receive the influenza immunization and pneumococcal immunization due to medical contraindications or refusal. 2. Review of the medical record for Resident #5 revealed an admission date of 12/23/19 with diagnoses including coronavirus (COVID19), diabetes mellitus type two without complications, and heart failure. Review of Resident #5's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was severely cognitively impaired and required extensive with transfers, bed mobility, dressing, toileting, and personal hygiene. Review of Resident #5's immunization history dated 08/24/21 revealed Resident #5 was not eligible for the influenza immunization and Resident #5 refused the pneumococcal immunization. Review of Resident #5's medical record dated 08/24/21 revealed there were no influenza or pneumococcal education or consent forms located in Resident #5's chart. Resident #5's chart did not include the reason Resident #5 was not eligible for the influenza immunization. 3. Review of the medical record for Resident #13 revealed an admission date of 08/30/16 with diagnoses including type two diabetes mellitus, major depressive disorder, and schizophrenia Review of Resident #13's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and required supervision with eating, transfers and bed mobility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 32 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0883 Resident #13 also required limited assistance with dressing, toileting, and personal hygiene. Level of Harm - Minimal harm or potential for actual harm Review of Resident #13's immunization history dated 08/24/21 revealed Resident #13 received his influenza vaccine at the facility on 11/16/20 and his pneumovax vaccine on 12/20/16. Residents Affected - Some Review of Resident #13's medical record dated 08/24/21 revealed there were no influenza or pneumococcal immunization education or consent forms located in Resident #13's chart. 4. Review of the medical record for Resident #14 revealed an admission date of 09/26/16 with diagnoses including emphysema, asthma, and Huntington's disease. Review of Resident #14's annual Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was severely cognitively impaired and required supervision with eating, transfers, bed mobility, and personal hygiene. Resident #14 required limited assistance with dressing and toileting. Review of Resident #14's immunization history dated 08/24/21 revealed Resident #14 received his influenza immunization on 11/16/20 and Resident #14 refused the pneumovax immunization. Review of Resident #14's medical record dated 08/24/21 revealed there were no influenza or pneumococcal immunization education or consents forms located in Resident #14's chart. 5. Review of the medical record for Resident #17 revealed an admission date of 04/14/21 with diagnoses including dementia in other diseases classified elsewhere with behavioral disturbance, mood disorder due to known physiological condition, and disorder of thyroid. Review of Resident #17's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact and required supervision with eating, transfers, bed mobility, dressing, toileting, and personal hygiene. Review of Resident #17's immunization history dated 08/24/21 revealed there was no documentation that Resident #17 received an influenza or pneumococcal immunization. Review of Resident #17's medical record revealed there were no influenza or pneumococcal immunization education or consent forms located in Resident #17's chart. Further review of Resident #17's chart revealed there was no indication whether Resident #17 received the influenza immunization and pneumococcal immunization or did not receive the influenza immunization and pneumococcal immunization due to medical contraindications or refusal. Interview with Regional Registered Nurse (RN) #99 on 08/25/21 at 9:54 A.M. verified Resident #4, #5, #13, #14 and #17 did not have any influenza or pneumococcal immunization education, or consents. RN #99 also verified there was no indication either Resident #4 or #17 received the influenza immunization and pneumococcal immunization or did not receive the influenza immunization and pneumococcal immunization due to medical contraindications or refusal. Review of the facility policy titled Resident Pneumococcal Vaccine, dated 04/20/17, revealed residents in the facility will be offered education regarding pneumococcal pneumonia and residents in the facility will be offered the pneumococcal vaccine unless medically contraindicated. Review of the facility policy titled Resident Influenza Vaccine, dated 01/14/21, revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 33 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 0883 Level of Harm - Minimal harm or potential for actual harm facility will document that the resident received the influenza immunization, or the resident did not receive the influenza vaccine due to medical contraindication or refusal. The facility will also document that the resident and resident representative received education prior to the immunization. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 34 of 35 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 366256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Northwest Healthcare Center 3875 East Galbraith Road Cincinnati, OH 45236 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 Based on observation, record review and staff interview, the facility failed to ensure a resident call light was functioning. This affected one (Resident #173) out of 16 residents reviewed for call lights. The facility census was 27. Residents Affected - Few Findings include: Review of the medical record for Resident #173 revealed an admission date of 08/09/21 with diagnoses including dysphagia, weakness, type two diabetes mellitus, and chronic kidney disease. Review of Resident #173's admission initial evaluation dated 08/09/21 revealed Resident #173 was alert and cognitively intact. Review of Resident #173's activities of daily living care plan dated 08/11/21 revealed Resident #173 required assistance with activities of daily living. Interventions include place call light within reach, extensive assistance with ambulation, extensive assistance with bathing, extensive assistance with bed mobility, extensive assistance with dressing, extensive assistance with hygiene, extensive assistance with toileting, extensive assistance with transfers and supervision with eating. Observation of Resident #173's room on 08/23/21 at 10:19 A.M. revealed Resident #173's call light was in reach but was not functioning. Observation of Resident #173's room on 08/24/21 at 11:39 A.M. revealed Resident #173's call light was in reach but was not functioning. Observation of Resident #173's room on 08/25/21 at 8:59 A.M. revealed Resident #173's call light was in reach but was not functioning. Interview with the Administrator on 08/25/21 at 8:59 A.M. verified Resident #173's call light was not functioning. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366256 If continuation sheet Page 35 of 35