Inspection·January 31, 2024

F 0568 Level of Harm - Minimal harm or potential for actual harm trying to reach the administrator. Administrator stated Guardian #400 had requested to speak to someone at corporate and had been provided their phone number. An interview via a three-way call on 01/30/24 at 11:07 A.M. was conducted with Guardian #400 and SBM #599. Residents Affected - Few Guardian #400 and SBM #599 agreed Resident #29's brother had been the previous guardian and was Resident #29's representative payee. SBM #599 revealed since they were not the representative payee, they billed Medicaid and accepted the amount Medicaid paid as payment in full. Guardian #400 stated they received a new bill on 01/29/24 for $12,118.26 for services from 07/01/23 through 02/01/24. SBM #599 verified this was a billing error and Resident #29 did not owe any money. Guardian #400 asked SBM #599 to send a detailed bill via email to the facility. Guardian #400 asked that the detailed bill be printed out and left at the front desk for Guardian #400 to pick up. SBM #599 agreed to send the bill but stated the $12,118.26 balance would show as owed until the billing could be corrected. This deficiency represents non-compliance investigated under Complaint Number OH00150502. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 2 of 8 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 366273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave at Cambridge 8420 Georgetown Road Cambridge, OH 43725 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, financial statements, interviews, and policy review the facility failed to ensure an overpayment of $4,200.00 from June of 2022 was refunded to a resident and/or family. This affected one (Resident #31) out of three residents reviewed for proper billing and accounting of resident accounts. The facility census was 30. Residents Affected - Few Findings include: Review of the medical record revealed former Resident #31 was admitted on [DATE] and expired at the facility on [DATE] with diagnoses that included Alzheimer's disease, atrial fibrillation, and glaucoma. Power-of-attorney (POA) papers dated [DATE] revealed Resident #31's daughter was appointed POA in all business, financial, legal, and all other matters. Review of the medical record revealed Resident #31 was private pay from [DATE] until [DATE]. Resident #31's payor source was Medicare A from [DATE] through [DATE]. On [DATE], Resident #31's payor source was hospice-private. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #31 had moderately impaired cognition. Review of a financial statement dated [DATE] for the resident's account revealed Resident #31 had a $4,200.00 credit. Interview on [DATE] at 7:48 A.M. with Business Office Manager (BOM) #93 verified the facility was not aware a refund was owed to Resident #31's POA. BOM #93 provided a copy of check #1051 dated [DATE] in the amount of $4,200.00 made payable to Resident #31's POA. Interview on [DATE] at 10:33 A.M. with Chief Financial Officer (CFO) #600 verified the refund to Resident #31's POA was a surprise. CFO #600 verified $4,200.00 had been owed to Resident #31's POA since [DATE]. CFO #600 stated a new system for identifying refunds would be investigated. On [DATE] at 10:55 A.M. interview with POA of Resident #31 revealed they had been asking for a refund of $4200.00 for almost two years and had given up thinking it would be refunded. POA of Resident #31 verified they had called the facility asking about the refund as it was her father's money and it was expected to be returned especially when he passed away A female would tell the POA the money would be refunded and a check would be mailed. POA of Resident #31 stated that was what they were told every time they called the facility. Review of the facility Abuse Prevention, Identification, Investigation and Reporting Policy dated [DATE] and revised [DATE] revealed all residents have the rights to be free from abuse, neglect, misappropriation of resident property, exploitation, corporal punishment, involuntary seclusion ad any physical or chemical restraint not required to treat the residents medical symptoms. Misappropriation of Resident property is means the deliberate misplacement, exploitation, or wrongful permanent use of a resident's belongings or money without the resident's consent. This deficiency represents non-compliance investigated under Complaint Number OH00149856. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 3 of 8 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 366273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave at Cambridge 8420 Georgetown Road Cambridge, OH 43725 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 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, facility policy review, facility assessment review, and interviews, the facility failed to ensure an effective governing body, legally responsible to establish and implement policies regarding the management and operation of the facility, including but not limited to compliance with all financial obligations for the delivery of care. This had the potential to affect all 30 residents in the facility. Findings include: Review of the facility survey history revealed on 12/04/23 a complaint survey was completed which resulted in concerns related to financial solvency. An issue identified at that time was related to employee payroll. On 11/16/23 at 8:32 A.M., an interview with the Director of Nursing (DON) revealed some of the employee checks had been returned for insufficient funds but corporate (management located in Florida) had wired money to the employees the same day. Further interview revealed corporate also covered any fees that occurred at the employees' banks. At the time of the survey, the Administrator did not provide any additional information as to why payroll was not met for these employees on this date. This payroll issue was in addition to the identification of other vendors/suppliers with past due balances, non-payment and shut off notices being issued to the facility. Following the 12/04/23 survey, the facility provided evidence of payments being made to various different supplies/vendors removing the likelihood of situations of neglect and the resolution of shut off notices for the facility. However, at the time of this complaint survey, the facility failed to ensure their governing body was effective in establishing and implementing policies regarding the management and operation of the facility, which included ongoing compliance with all financial obligations for the delivery of care as detailed below: a. Interview on 01/29/24 at 8:39 A.M. with the Director of Nursing (DON) verified there were some employee payroll checks that did not clear on 01/19/24. The DON stated corporate had wired money to cover the checks that did not clear. The facility provided a list of 14 employees that had paychecks returned from payroll on 01/19/24. Interview on 01/29/24 at 10:31 A.M. Administrator revealed himself, the Assistant Administrator, STNA #54, STNA #55, LPN #59, RN #62, STNA #63, STNA #66, STNA #69, STNA #72, STNA #75, LPN #89, Social Service #90, and Hairdresser #110 all had payroll checks returned due to an error with processing of the checks. Corporate either wired money to employees in the amount of their pay or had the bank rerun the checks through. Interview on 01/29/24 at 8:49 A.M. with State Tested Nursing Assistant (STNA) #54 verified their payroll check did not clear. Interview on 01/29/24 at 8:50 A.M. with STNA #55 verified their payroll check did not clear. Interview on 01/29/24 at 8:54 A.M. with Licensed Practical Nurse (LPN) #59 verified payroll check did not clear. Interview on 01/29/24 at 10:26 A.M. with STNA #63 verified their payroll check did not clear. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 4 of 8 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 366273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave at Cambridge 8420 Georgetown Road Cambridge, OH 43725 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 0837 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many STNA #54, STNA #55, LPN #59, and STNA #63 verified corporate did provide the money through wire transfer or having the checks rerun. If the money was wired to an employee's account, the employee would be reimbursed on the payroll check for 02/02/24. Interview on 01/30/24 at 10:33 A.M. with Corporate Financial Officer (CFO) #600 revealed there had been a positive pay upload error. CFO #600 explained each check was matched for payment to be made. If the check number or amount was incorrect or not listed, then the check would be returned. CFO #600 stated this was done to decrease the risk of check fraud. CFO #600 stated once the error was discovered the file was corrected and the check numbers were added so the checks could be rerun by the banks. If the employee did not want the check rerun, the money was wired to their bank. CFO #600 stated they had already identified the error that occurred when some of the check numbers were left off the file and would be working on a process to ensure that did not happen again. b. On 01/29/24 at 4:06 P.M., with the Administrator present, a telephone interview with the electric company (AEP) Representative #100 revealed the facility had a balance of $13,010.70 due on 02/06/24 with a past due balance of $661.83, due immediately. She stated the past due balance was from 12/11/23. The electric company had received multiple payments on 01/24/24 but the past due amount remained. Lastly, AEP Representative #100 confirmed there were no pending shut off notices for the facility. On 01/29/24 at 4:10 P.M.interview with the Administrator verified he was unaware of the outstanding balance owed to the electric company despite the weekly calls regarding bill payment. c. On 01/31/24 at 11:02 A.M. interview with Broad River Therapy [NAME] President (VP) #200 revealed the corporation had not paid the balance for October, November or December therapy services at this time. She was unsure of the amount owed offhand but there were concerns arranging payment with the facility. Review of the facility's undated Governing Body policy revealed the Governing Body had a fiduciary duty, duty of care, and duty of loyalty to act in the best interests of the Facility. The governing body should be comprised of the operator (s), c-suite level executives, and other individuals who were legally responsible for the establishment and implementation of policies regarding management and operations of the facility. The Governing Body member responsibilities included to be active, engaged, and involved in the affairs of the facility and to have direct access to the administrator and to the compliance and ethics officer by scheduling executive board sessions with the compliance and ethics officer that allows for a free flow of information without potential for conflict. The governing body consisted of Chief Financial Officer #600, Chief Executive, Officer #601, and Chief Nursing Officer/Compliance Officer #602. Review of the administrator job description revealed they would operate the facility in accordance with the established policies and procedures of the facility. The job description indicated the administrator would supervise the recruitment, employment and discharge of staff. And work closely with the DON to assure there were adequate numbers of staff to meet the needs of each resident and to comply with the state of Ohio licensure law. The administrator would act as a liaison with the facility owners and the medical, nursing, and other supervisory staff through regular meetings. Review of the facility assessment dated [DATE] revealed the facility provided all care and services as required in the requirements of participation including, but not limited to assistance with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 5 of 8 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 366273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave at Cambridge 8420 Georgetown Road Cambridge, OH 43725 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 0837 Level of Harm - Minimal harm or potential for actual harm activities of daily living, personal care services, medication administration, pain management, infection prevention and control, nutritional services, skin care, fall and injury prevention, pharmacy, and therapy services. Additionally, the facility provided medical director, attending physicians, physician assistants, nurse practitioners, dentist, podiatrist, ophthalmologist, and psychiatrist services, and pharmacist. Residents Affected - Many This deficiency represents non-compliance investigated under Complaint Number OH00150407. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 6 of 8 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 366273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave at Cambridge 8420 Georgetown Road Cambridge, OH 43725 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 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on record review, staff interview and policy review, the facility failed to ensure continuous evaluations were in place to verify financial obligations were met as planned to prevent a potential disruption in resident care and services through the Quality Assurance Performance Improvement (QAPI) program committee. This had the potential to affect all facility residents.The facility census was 30. Residents Affected - Many Findings include: Review of the provided QAPI started 10/01/23 revealed the identified problem of vendors not being paid promptly. The root cause revealed invoices were not being entered electronically when received. Review of invoices and calls with administrator and business office manager were to be completed weekly. The QAPI did not identify any type of monitoring or ensuring staff were paid on the agreed payroll date. Review of the plan of correction dated 12/27/23 revealed action plan for ensuring staff received payroll on the agreed payroll date. a. During the onsite investigation, the facility provided a list of 14 employees who had paychecks returned from payroll on 01/19/24. Interview on 01/29/24 at 10:31 A.M. Administrator revealed himself, the Assistant Administrator, State Tested Nursing Assistant (STNA) #54, STNA #55, Licensed Practical Nurse (LPN) #59, Registered Nurse (RN) #62, STNA #63, STNA #66, STNA #69, STNA #72, STNA #75, LPN #89, Social Service #90, and Hairdresser #110 all had payroll checks returned due to an error with processing of the checks. Administrator verified 21 employees also had checks returned on 10/13/23 due to insufficient funds. Administrator verified payroll was not listed as one of the concerns listed as discussed at the weekly or monthly QA meetings. Interview on 01/30/24 at 10:33 A.M. Corporate Financial Officer (CFO) #600 revealed there had been a positive pay upload error that caused 14 employee checks to be returned. CFO #600 stated once the error was identified, it was corrected. CFO #600 stated corporate was looking at ways to ensure the upload error did not occur again. CFO #600 verified payroll was not listed as one of the concerns listed on the weekly QA calls. b. On 01/29/24 at 4:06 P.M., with the Administrator present, a telephone interview with the electric company (AEP) Representative #100 revealed the facility had a balance of $13,010.70 due on 02/06/24 with a past due balance of $661.83, due immediately. She stated the past due balance was from 12/11/23. The electric company had received multiple payments on 01/24/24 but the past due amount remained. Lastly, AEP Representative #100 confirmed there were no pending shut off notices for the facility. On 01/29/24 at 4:10 P.M.interview with the Administrator verified he was unaware of the outstanding balance owed to the electric company despite the weekly calls regarding bill payment. c. On 01/31/24 at 11:02 A.M. interview with Broad River Therapy [NAME] President (VP) #200 revealed the corporation had not paid the balance for October, November or December therapy services at this time. She was unsure of the amount owed offhand but there were concerns arranging payment with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 7 of 8 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 366273 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/31/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Enclave at Cambridge 8420 Georgetown Road Cambridge, OH 43725 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 0865 facility. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy dared February 2020 titled, Quality Assurance and Performance Improvement (QAPI) Program revealed the facility shall develop, implement, and maintain an ongoing, facility-wide, data-driven QAPI program that is focused on indicators of the outcomes of care and quality of life for our residents. The QAPI plan describes the process for identifying and correcting quality deficiencies. Key components of this process include tracking and measuring performance; establishing goals and thresholds for performance measurement; identifying and prioritizing quality deficiencies; systematically analyzing underlying causes of systemic quality deficiencies; developing and implementing corrective action or performance improvement activities; and monitoring or evaluating the effectiveness of corrective action/performance improvement activities and revising as needed. Residents Affected - Many This deficiency represents non-compliance investigated under Complaint Number OH00150407. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 8 of 8