Health inspection·June 24, 2024

F 0689 Level of Harm - Actual harm Residents Affected - Few center regarding a fall Resident #20 encountered during transfer off the bus. Resident #20 complained of left knee pain and bruising was noted on her right ankle. This resident was sent to the hospital after returning from dialysis for further evaluation related to injuries. Review of an incident report dated 05/03/24 revealed Resident #20 was complaining of pain to her right foot. Predisposing factors revealed uneven surface and lost balance. Nursing noted Resident #20 had right extremity swelling, bruising, and uncontrolled pain. The resident was sent to hospital for x-rays related to injury. Pain was noted at eight out of ten (with 10 being the most severe pain). Review of the hospital records dated 05/03/24 for Resident #20 revealed the resident was admitted due to complaint of right ankle injury from fall. This injury was sustained after stepping out of facility transportation bus onto a milk carton placed by their bus driver. This milk carton was unstable and flipped over under Resident #20's feet. The hospital records noted Resident #20 complained of pain rated a 10 out of 10. The physical exam revealed right ankle swelling present, tenderness over lateral malleolus, base of fifth metatarsal, and anterior [NAME]-fibular ligament. The x-ray report dated 05/03/24, revealed partially visualized fractures at the fifth metatarsal base, fourth metatarsal, third metatarsal, and second metatarsal. Probable avulsion type fracture arising from the anterior process of the talus. Resident #20 was hospitalized until 05/07/24 when she was discharged back to the facility. Review of the physician order dated 05/08/24, revealed Resident #20 was ordered non-weight bearing to right leg due to fracture of right foot. There was also a dressing order for the right foot/leg dressing to be changed every shift. Interview on 06/18/24 at 7:36 A.M. with Resident #20 revealed prior to the incident (on 05/03/24), she had no issues getting off the bus. On 05/03/24, she was stepping down off the bus, the facility transport assistant placed a milk crate under her to help with the step. After placing her second foot on the crate it flipped out from underneath her. When she fell, she was assisted up, and she stated she had refused to go to the hospital until after she received dialysis. When finished with dialysis, she was transported to the facility where nursing staff sent her out to the hospital. Resident #20 stated she was in tremendous pain due to the fall. Interview on 06/18/24 at 8:48 A.M. with Transport Driver #328 confirmed Resident #20 fell due to an unstable crate that he had placed at the steps of the transport bus. Transport Driver #328 indicated the milk crate had not been used previously as a transfer aide, and he confirmed the milk crate was not an appropriate transfer device. Interview on 06/18/24 at 10:38 P.M. with Licensed Practical Nurse (LPN) #252 confirmed prior to Resident #20's fall, she was independent with ambulation and required no assistance with getting on and off the bus. LPN #252 confirmed the dialysis center called the facility on 05/03/24 due to the reported incident of fall. LPN #252 stated Resident #20 told her she fell when stepping off the bus onto an unstable milk crate. Interview on 06/18/24 at 11:32 A.M. with Director of Nursing (DON) #224 confirmed Resident #20 fell due to stepping onto an unstable milk crate. Interview on 06/18/24 at 11:20 A.M. with the Administrator revealed he was notified of Resident #20's fall. The Administrator stated he spoke with Transportation Driver #328 about the incident, where he was informed to never use inappropriate transfer devices for ambulation. The Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366259 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366259 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scioto Rehabilitation & Care Center 433 Obetz Road Columbus, OH 43207 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 confirmed the crate should not have been placed to use as a step for the resident. Level of Harm - Actual harm This deficiency represents non-compliance investigated under Complaint Number OH00154301. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366259 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366259 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Scioto Rehabilitation & Care Center 433 Obetz Road Columbus, OH 43207 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observations, review of facility policy, and staff interviews, the facility failed to ensure garbage and food waste was disposed of in a timely manner. This had the potential to affect all 108 residents residing at the facility. Residents Affected - Many Findings include: Observation on 06/17/24 at 5:36 A.M. of the main dining room revealed ten soiled trays with uncovered food from the 06/16/24 dinner meal. Table one had four trays with the following uncovered foods: salad with Italian dressing, potatoes with gnats present and a magic cup. Table two had two trays with the following uncovered foods: banana peel, apple juice, biscuit, and ginger ale. Table three contained four trays containing the following uncovered foods: macaroni and cheese, sausages, green beans, bread, ketchup, and an unidentified chewed food substance. Observation on 06/17/24 at 5:40 A.M. of the kitchen area found 23 soiled trays of food dated 06/16/24. The following uncovered foods found were hot dogs, salads, magic cups, potatoes and hamburgers. Interview on 06/17/24 at 5:45 A.M. with Dietary Staff #329 confirmed numerous uncovered soiled trays were present in the dining room and in the kitchen. Dietary Staff #329 confirmed the trays were from dinner service conducted on 06/16/24. Interview on 06/18/24 at 5:57 A.M. with Dietary Manager (DM) #330 confirmed dinner trays were always left out overnight. DM #330 stated trays were left out because dietary staff was not present in the kitchen after the final soiled trays were returned. DM #330 confirmed trays should not be left open overnight due to risk of pest issue. Interview on 06/18/24 at 3:18 P.M. with Director of Maintenance #259 confirmed trays left out overnight could cause the risk of pest issues. Interview on 06/18/24 at 3:25 P.M. with the Administrator confirmed trays should be covered and disposed of properly after meal service. Review of the facility's undated Kitchen Cleanliness Policy revealed waste disposal requires disposing of food waste and garbage in sealed containers. In order to maintain a pest free, kitchen staff are required to maintain cleanliness and proper waste disposal. Daily tasks found staff are required to clean and sanitize food preparation surfaces and wash dishes. This deficiency represents non-compliance investigated under Complaint Number OH00153231. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366259 If continuation sheet Page 4 of 4