Health inspection·March 11, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety supplies/vendors removing the likelihood of situations of neglect and the resolution of shut off notices for the facility. However, during a complaint survey completed on 01/31/24, the facility failed to ensure their governing body was effective in establishing and implementing policies regarding the management and operation of the facility and their Quality Assurance and Performance Improvement Program had continued evaluations to ensure ongoing compliance with all financial obligations for the delivery of care including therapy services, payment of the electricity bill and staff payroll. Residents Affected - Many Interview with the Administrator on 03/04/24 at 8:39 A.M. revealed employees were being paid every other week and were receiving paper checks on payday. However, as of this date there were employee's checks that were being returned for insufficient funds (from the most recent pay date of 03/01/24). The Administrator revealed Epic Healthcare Solutions (the corporate management company) would then wire the funds to the affected employee's bank account after being notified the employee's check was not clearing at the bank. Interview during the survey with an anonymous staff member revealed she was very concerned with her payroll checks bouncing and being returned for sufficient funds. She stated she had both 02/16/24 and 03/01/24 paydays affected by this and would more than likely be terminating her employment and looking for another job. Interview on 03/04/24 at 9:00 A.M. with Registered Nurse (RN) #205 revealed her payroll check on 02/16/24 was returned due to insufficient funds. She stated she updated the DON on 02/19/24 who then updated corporate. RN #205 stated she received a wire transfer for her payroll check but not until 02/20/24. Interview on 03/04/24 at 9:21 A.M. with the Business Office Manager (BOM) #207 verified there were payroll checks that did not clear employee banks on 02/16/24 due to insufficient funds. She provided a list that revealed 41 out of 62 staff members did not get paid on the 02/16/24 payday as their checks bounced. BOM #207 revealed staff had been made aware by their bank their payroll checks were returned for insufficient funds for the 02/16/24 payday. The staff had reported this to the DON who then updated BOM #207. She stated she sent a list to the corporate management company who then wired the money directly into the employees' personal accounts. She stated employees who experienced wire fees or bounced check fees from the 02/16/24 pay issue, were also to be reimbursed these fees on the 03/01/24 payday. During the interview, BOM #207 also shared most of the facility bills were being sent directly from the vendors to the facility corporate office. Any bills or invoices received at the facility were scanned and emailed directly to Stampli (the company that processed and paid invoices). Review of the 02/16/24 list of employees who had their payroll checks returned for insufficient funds included the current Administrator, BOM #207, Maintenance #340, RN #205, RN #302, RN #303, RN #304, RN #339, Licensed Practical Nurse (LPN) #306, LPN #308, LPN #309, LPN #310, LPN #311, LPN #349, State Tested Nurse Aide (STNA) #203, STNA #313, STNA #314, STNA #315, STNA #316, STNA #317, STNA #318, STNA #320, STNA #321, STNA #324, STNA #325, STNA #326, STNA #327, Dietary #328, Dietary #330, Dietary #331, Dietary #332, Dietary #333, Dietary #335, Dietary #336, Housekeeping (HK) #341, HK #342, HK #343, HK #345, HK #346, HK #348 and Hospitality Aide #347. Interview on 03/04/24 at 9:57 A.M. with the Chief Financial Officer (CFO) #600 revealed his corporation had more issues with banking since the previous two surveys on 12/04/23 and 01/31/24. He stated this was an error with their Positive Pay system (an automated cash-management service used by financial institutions where checks issued by companies are matched with those presented for payment). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 2 of 12 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 03/11/2024 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many CFO #600 stated they placed the check numbers into the system and uploaded it from their human resource file to the bank and those were then paid by the bank. He stated they covered the wire fees and bounced check fees as soon as the employee updated them on the amounts. Additional interview on 03/05/24 at 10:36 A.M. With CFO #600 verified he had been updated that payroll checks were returned as having insufficient funds for the payroll date of 03/01/24. He stated he was unsure of what had occurred. He stated payroll accounts were separate then those accounts used to pay facility vendors and suppliers. He also stated they had separate accounts at the same bank (Bank of Oklahoma Financial) for all the facilities owned by the corporation. He was unable to answer the question as to why payment plans that either himself, Chief Executive Officer (CEO) #601 or Director of Finance #603 initiated, were not followed through with and why payments were missed. Interview on 03/04/24 at 11:29 A.M. with the Ombudsman revealed a resident had stated to her during a visit that she was worried the facility would be closing and she would have to find another place to live. The resident stated to the Ombudsman that she had overhead staff talking about not being paid correctly and their payroll checks being returned for insufficient funds. The Ombudsman stated she had updated Administrator #351 (the previous facility Administrator) about the concern. Interview on 03/04/24 at 12:15 P.M. with an anonymous staff member revealed she was concerned every payday about her payroll checks not clearing her bank. Review of emails from the DON dated 03/05/24 at 11:31 A.M. through 03/11/24 at 9:33 A.M. revealed 45 out of 62 staff members received returned paychecks due to insufficient funds (from the 03/01/24 pay day). These staff included the Administrator, Previous Administrator #351, BOM #207, Social Services Designee (SSD) #337, RN #204, RN #205, RN #300, RN #301, RN #303, RN #304, RN #339, Maintenance #340, LPN #307, LPN #308, LPN #309, LPN #310, LPN #311, LPN #349, STNA #203, STNA #206, STNA #312, STNA #313, STNA #314, STNA #315, STNA #316, STNA #317, STNA #318, STNA #319, STNA #320, STNA #321, STNA #322, STNA #323, STNA #324, STNA #325, STNA #326, STNA #327, Dietary Director #208, Dietary #328, Dietary #333, Dietary #336, HK #341, HK #342, HK #343, HK #348 and Hospitality Aide #347. An interview on 03/07/24 at 8:40 A.M. with Activities Director #352 revealed she had been taking her check to a local grocery store to cash as she had been afraid to take it to her bank and be returned for insufficient funds. She stated she had been taking her payroll checks to the grocery store, cashing them (for which the grocery store charged a fee based on the amount of the check) and then would take the cash and deposit it into her bank account. She stated she was aware there were employee checks that had been cashed at the grocery store that had not cleared the grocery store's bank and been returned to them for insufficient funds. An attempt to reach the grocery store manager/owner on 03/07/24 at 10:56 A.M. was unsuccessful. A message was left for the owner/manager to return the call to the surveyor, but no return call was provided. On 03/07/24 at 11:21 A.M. a phone interview with CFO #600, Chief Executive Officer (CEO) #601 and Chief Nursing Officer (CNO) #602 was held. Chief Financial Officer #600 continued to report payroll was not met due to the identified positive payroll issue with the bank. Documentation of the bank's error with the positive payroll file submission was requested. As of 03/11/24 at 11:00 A.M. no documentation had been provided. On 03/11/24 at 9:05 A.M. an interview with the DON verified the last wire transfer to staff to pay from the 02/16/24 pay day was not made until 02/29/24 (almost two weeks after the pay date). The DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 3 of 12 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 03/11/2024 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 0600 Level of Harm - Immediate jeopardy to resident health or safety stated the (unidentified) staff member notified her on 02/28/24 that their check bounced, and the corporation then wired the funds directly to the staff member's account. In addition to the facility's failure to ensure payroll obligations were met and continued to be met to ensure the ongoing effective day to day operation of the facility the following vendors/suppliers were reviewed as part of the State agency investigation with concerns identified: Residents Affected - Many a. The facility utilized a contracted service for the services of a dietitian. Review of the invoice from Nutritech Consulting Services dated 02/01/24 revealed the facility owed $1,645.00 and the due date was 02/10/24. This had been received by the facility and scanned to the corporate office on 02/02/24. Interview on 03/04/24 at 12:39 P.M. with Dietitian #135 revealed she was the owner of the nutrition services company that provided services to the facility. She stated due to previous concerns of not receiving payment, she required the facility to pre-pay for her services. Dietitian #135 stated she had terminated services on 03/01/24 as the facility was 23 days behind on their pre-pay plan. She stated CFO #600 called on 03/04/24 and paid the February 2024 balance of $1,645.00 so services would resume. The facility had until 03/10/24 to pre-pay for the March 2024 services. A follow-up interview on 03/11/24 with Dietitian #135 revealed if the facility did not make additional payment in full on this date, she would have to terminate services. b. Review of the invoice from [NAME] Recycling dated 02/13/24 revealed a total balance due of $1,531.10. This showed services due for 02/01/24 for $765.55 and 01/01/24 for $765.55. This had been received by the facility and scanned to the corporate office on 02/20/24. An interview on 03/04/24 at 11:05 A.M. with the recycling company's Accounts Receivable Clerk (AR) #213 revealed the facility was behind 60 days on their billing. c. Review of the invoice from Buckeye Pest Management dated 02/20/24 revealed a total balance due of $723.95. This showed services due for 10/05/23, 11/06/23, 12/07/23, 01/04/24 and 02/01/24. The statement was received and scanned to the corporate office on 02/28/24. Interview on 03/04/24 at 10:50 A.M. with the pest management's Accounts Receivable Clerk (AR) #133 revealed she had been in contact with the facility related to their balance of $723.95. She stated they had not received any payments from the facility since prior to October 2023. d. Interview on 03/05/24 at 11:45 A.M. with Medical Director (MD) #351 revealed he was unaware of how much the facility owed him for medical director fees. During the interview, he contacted his office and spoke to one of the staff and discovered the facility owed MD #351 for September 2023, November 2023, December 2023, January 2024 and February 2024. This totaled $15,000.00. It was noted the corporation had made payment arrangements and had kept those arrangements until January 2024. There was no payment received in the month of February 2024. e. Review of the invoice from Broad River Therapy dated 03/06/24 revealed a total balance due of $103,531.89. This was due for services from 11/02/23 to 12/02/23 for $27,251.19; 12/01/23 to 12/31/23 for $28,291.58; 01/02/24 to 02/01/24 for $22,527.73; and 02/02/24 to 03/03/24 for $25,461.39. Interview on 03/04/24 at 11:57 A.M. with Therapy Office Manager #128 revealed the facility had not paid for services since September 2023. However, she stated CFO #600 stated the corporation would be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 4 of 12 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 03/11/2024 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 0600 sending checks the week of 03/04/24. Level of Harm - Immediate jeopardy to resident health or safety f. Interview on 03/05/24 at 10:16 A.M. with Clerk #350 at the [NAME] Country Treasurer's Office revealed the facility had set-up a payment plan for the balance due which included a delinquent balance, late fees and interest. She stated the facility owed a total of $101,283.27 for property taxes and had made a payment arrangement to pay $5,000 a month and made a payment on 01/12/24. However, Clerk #350 stated the facility (corporation) had failed to make a payment in February 2024. Residents Affected - Many On 03/10/24 the Ombudsman conducted an onsite visit at the facility. The Ombudsman reported staff were worried about getting paid on Friday (03/15/24). This date is the next scheduled date for staff to be paid in the facility. Review of the Nursing Facility admission Agreement, undated, provided to all residents, revealed the facility was responsible for basic services including room and board, routine nursing care and supplies for residents and such other personal services as may be necessary for the resident's health, well-being and grooming. The facility would also provide meals, linens, housekeeping, social services and activities and other regular services required by law. Review of the Employee Handbook, dated 2020, revealed employees would receive their pay reimbursement for hours worked either through Pay Card or Direct Deposition. During orientation, the human resources representative will assist with signing up for either direct deposit or a Pay Card. Review of the facility policy titled, Abuse Prevention, Identification and Reporting, revised 08/15/22, revealed the facility defined resident abuse to include neglect which was the failure of the facility, its employees or service providers, to provide goods and services to a resident which were necessary to avoid physical harm, pain, mental anguish, or emotional distress. Review of the Facility assessment dated [DATE] revealed the facility provided all care and services as required including, but not limited to: Assistance with 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, psychiatrist services and pharmacist. This deficiency represents non-compliance investigated under Master Complaint Number OH00151629, Complaint Number OH00151626 and Complaint Number OH00151535. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 5 of 12 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 03/11/2024 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 32 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, during a complaint survey completed on 01/31/24, the facility failed to ensure their governing body was effective in establishing and implementing policies regarding the management and operation of the facility and their Quality Assurance and Performance Improvement Program had continued evaluations to ensure ongoing compliance with all financial obligations for the delivery of care including therapy services, payment of the electricity bill and staff payroll. a. Interview with the Administrator on 03/04/24 at 8:39 A.M. revealed employees were being paid every other week and were receiving paper checks on payday. However, as of this date there were employee's checks that were being returned for insufficient funds (from the most recent pay date of 03/01/24). The Administrator revealed Epic Healthcare Solutions (the corporate management company) would then wire the funds to the affected employee's bank account after being notified the employee's check was not clearing at the bank. Interview during the survey with an anonymous staff member revealed she was very concerned with her payroll checks bouncing and being returned for sufficient funds. She stated she had both 02/16/24 and 03/01/24 paydays affected by this and would more than likely be terminating her employment and looking for another job. Interview on 03/04/24 at 9:00 A.M. with Registered Nurse (RN) #205 revealed her payroll check on 02/16/24 was returned due to insufficient funds. She stated she updated the DON on 02/19/24 who then updated corporate. RN #205 stated she received a wire transfer for her payroll check but not until 02/20/24. Interview on 03/04/24 at 9:21 A.M. with the Business Office Manager (BOM) #207 verified there were payroll checks that did not clear employee banks on 02/16/24 due to insufficient funds. She provided a list that revealed 41 out of 62 staff members did not get paid on the 02/16/24 payday as their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 6 of 12 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 03/11/2024 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 checks bounced. BOM #207 revealed staff had been made aware by their bank their payroll checks were returned for insufficient funds for the 02/16/24 payday. The staff had reported this to the DON who then updated BOM #207. She stated she sent a list to the corporate management company who then wired the money directly into the employees' personal accounts. She stated employees who experienced wire fees or bounced check fees from the 02/16/24 pay issue, were also to be reimbursed these fees on the 03/01/24 payday. During the interview, BOM #207 also shared most of the facility bills were being sent directly from the vendors to the facility corporate office. Any bills or invoices received at the facility were scanned and emailed directly to Stampli (the company that processed and paid invoices). Review of the 02/16/24 list of employees who had their payroll checks returned for insufficient funds included the current Administrator, BOM #207, Maintenance #340, RN #205, RN #302, RN #303, RN #304, RN #339, Licensed Practical Nurse (LPN) #306, LPN #308, LPN #309, LPN #310, LPN #311, LPN #349, State Tested Nurse Aide (STNA) #203, STNA #313, STNA #314, STNA #315, STNA #316, STNA #317, STNA #318, STNA #320, STNA #321, STNA #324, STNA #325, STNA #326, STNA #327, Dietary #328, Dietary #330, Dietary #331, Dietary #332, Dietary #333, Dietary #335, Dietary #336, Housekeeping (HK) #341, HK #342, HK #343, HK #345, HK #346, HK #348 and Hospitality Aide #347. Interview on 03/04/24 at 12:15 P.M. with an anonymous staff member revealed she was concerned every payday about her payroll checks not clearing her bank. Review of emails from the DON dated 03/05/24 at 11:31 A.M. through 03/11/24 at 9:33 A.M. revealed 45 out of 62 staff members received returned paychecks due to insufficient funds (from the 03/01/24 pay day). These staff included the Administrator, Previous Administrator #351, BOM #207, Social Services Designee (SSD) #337, RN #204, RN #205, RN #300, RN #301, RN #303, RN #304, RN #339, Maintenance #340, LPN #307, LPN #308, LPN #309, LPN #310, LPN #311, LPN #349, STNA #203, STNA #206, STNA #312, STNA #313, STNA #314, STNA #315, STNA #316, STNA #317, STNA #318, STNA #319, STNA #320, STNA #321, STNA #322, STNA #323, STNA #324, STNA #325, STNA #326, STNA #327, Dietary Director #208, Dietary #328, Dietary #333, Dietary #336, HK #341, HK #342, HK #343, HK #348 and Hospitality Aide #347. An interview on 03/07/24 at 8:40 A.M. with Activities Director #352 revealed she had been taking her check to a local grocery store to cash as she had been afraid to take it to her bank and be returned for insufficient funds. She stated she had been taking her payroll checks to the grocery store, cashing them (for which the grocery store charged a fee based on the amount of the check) and then would take the cash and deposit it into her bank account. She stated she was aware there were employee checks that had been cashed at the grocery store that had not cleared the grocery store's bank and been returned to them for insufficient funds. An attempt to reach the grocery store manager/owner on 03/07/24 at 10:56 A.M. was unsuccessful. A message was left for the owner/manager to return the call to the surveyor, but no return call was provided. On 03/07/24 at 11:21 A.M. a phone interview with CFO #600, Chief Executive Officer (CEO) #601 and Chief Nursing Officer (CNO) #602 was held. Chief Financial Officer #600 continued to report payroll was not met due to the identified positive payroll issue with the bank. Documentation of the bank's error with the positive payroll file submission was requested. As of 03/11/24 at 11:00 A.M. no documentation had been provided. On 03/11/24 at 9:05 A.M. an interview with the DON verified the last wire transfer to staff to pay (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 7 of 12 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 03/11/2024 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 from the 02/16/24 pay day was not made until 02/29/24 (almost two weeks after the pay date). The DON stated the (unidentified) staff member notified her on 02/28/24 that their check bounced, and the corporation then wired the funds directly to the staff member's account. b. In addition to the facility's failure to ensure payroll obligations were met and continued to be met to ensure the ongoing effective day to day operation of the facility the following vendors/suppliers were reviewed as part of the State agency investigation with concerns identified: The facility utilized a contracted service for the services of a dietitian. Review of the invoice from Nutritech Consulting Services dated 02/01/24 revealed the facility owed $1,645.00 and the due date was 02/10/24. This had been received by the facility and scanned to the corporate office on 02/02/24. Interview on 03/04/24 at 12:39 P.M. with Dietitian #135 revealed she was the owner of the nutrition services company that provided services to the facility. She stated due to previous concerns of not receiving payment, she required the facility to pre-pay for her services. Dietitian #135 stated she had terminated services on 03/01/24 as the facility was 23 days behind on their pre-pay plan. She stated CFO #600 called on 03/04/24 and paid the February 2024 balance of $1,645.00 so services would resume. The facility had until 03/10/24 to pre-pay for the March 2024 services. A follow-up interview on 03/11/24 with Dietitian #135 revealed if the facility did not make additional payment in full on this date, she would have to terminate services. Review of the invoice from [NAME] Recycling dated 02/13/24 revealed a total balance due of $1,531.10. This showed services due for 02/01/24 for $765.55 and 01/01/24 for $765.55. This had been received by the facility and scanned to the corporate office on 02/20/24. An interview on 03/04/24 at 11:05 A.M. with the recycling company's Accounts Receivable Clerk (AR) #213 revealed the facility was behind 60 days on their billing. Review of the invoice from Buckeye Pest Management dated 02/20/24 revealed a total balance due of $723.95. This showed services due for 10/05/23, 11/06/23, 12/07/23, 01/04/24 and 02/01/24. The statement was received and scanned to the corporate office on 02/28/24. Interview on 03/04/24 at 10:50 A.M. with the pest management's Accounts Receivable Clerk (AR) #133 revealed she had been in contact with the facility related to their balance of $723.95. She stated they had not received any payments from the facility since prior to October 2023. Interview on 03/05/24 at 11:45 A.M. with Medical Director (MD) #351 revealed he was unaware of how much the facility owed him for medical director fees. During the interview, he contacted his office and spoke to one of the staff and discovered the facility owed MD #351 for September 2023, November 2023, December 2023, January 2024 and February 2024. This totaled $15,000.00. It was noted the corporation had made payment arrangements and had kept those arrangements until January 2024. There was no payment received in the month of February 2024. Review of the invoice from Broad River Therapy dated 03/06/24 revealed a total balance due of $103,531.89. This was due for services from 11/02/23 to 12/02/23 for $27,251.19; 12/01/23 to 12/31/23 for $28,291.58; 01/02/24 to 02/01/24 for $22,527.73; and 02/02/24 to 03/03/24 for $25,461.39. Interview on 03/04/24 at 11:57 A.M. with Therapy Office Manager #128 revealed the facility had not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 8 of 12 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 03/11/2024 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 paid for services since September 2023. However, she stated CFO #600 stated the corporation would be sending checks the week of 03/04/24. Interview on 03/05/24 at 10:16 A.M. with Clerk #350 at the [NAME] Country Treasurer's Office revealed the facility had set-up a payment plan for the balance due which included a delinquent balance, late fees and interest. She stated the facility owed a total of $101,283.27 for property taxes and had made a payment arrangement to pay $5,000 a month and made a payment on 01/12/24. However, Clerk #350 stated the facility (corporation) had failed to make a payment in February 2024. On 03/10/24 the Ombudsman conducted an onsite visit at the facility. The Ombudsman reported staff were worried about getting paid on Friday (03/15/24). This date is the next scheduled date for staff to be paid in 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 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. This deficiency represents non-compliance investigated under Master Complaint Number OH00151629, Complaint Number OH00151626, and Complaint Number OH00151535. This deficiency is also an example of continued non-compliance from the survey dated 01/31/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 9 of 12 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 03/11/2024 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 32. Residents Affected - Many 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, during a complaint survey completed on 01/31/24, the facility failed to ensure their governing body was effective in establishing and implementing policies regarding the management and operation of the facility and their Quality Assurance and Performance Improvement Program had continued evaluations to ensure ongoing compliance with all financial obligations for the delivery of care including therapy services, payment of the electricity bill and staff payroll. However, during the onsite investigation, continued concerns were identified related to financial solvency which included concerns that staff pay roll was not met on the planned pay dates of 02/16/24 and 03/01/24. a. Interview with the Administrator on 03/04/24 at 8:39 A.M. revealed employees were being paid every other week and were receiving paper checks on payday. However, as of this date there were employee's checks that were being returned for insufficient funds (from the most recent pay date of 03/01/24). Interview on 03/04/24 at 9:21 A.M. with the Business Office Manager (BOM) #207 verified there were payroll checks that did not clear employee banks on 02/16/24 due to insufficient funds. She provided a list that revealed 41 out of 62 staff members did not get paid on the 02/16/24 payday as their checks bounced. BOM #207 revealed staff had been made aware by their bank their payroll checks were returned for insufficient funds for the 02/16/24 payday. The staff had reported this to the DON who then updated BOM #207. She stated she sent a list to the corporate management company who then wired the money directly into the employees' personal accounts. During the interview, BOM #207 also shared most of the facility bills were being sent directly from the vendors to the facility corporate office. Any bills or invoices received at the facility were scanned and emailed directly to Stampli (the company that processed and paid invoices). Interview on 03/04/24 at 9:57 A.M. with the Chief Financial Officer (CFO) #600 revealed his corporation had more issues with banking since the previous two surveys on 12/04/23 and 01/31/24. He stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 10 of 12 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 03/11/2024 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many this was an error with their Positive Pay system (an automated cash-management service used by financial institutions where checks issued by companies are matched with those presented for payment). CFO #600 stated they placed the check numbers into the system and uploaded it from their human resource file to the bank and those were then paid by the bank. He stated they covered the wire fees and bounced check fees as soon as the employee updated them on the amounts. Additional interview on 03/05/24 at 10:36 A.M. With CFO #600 verified he had been updated that payroll checks were returned as having insufficient funds for the payroll date of 03/01/24. He stated he was unsure of what had occurred. He stated payroll accounts were separate then those accounts used to pay facility vendors and suppliers. He also stated they had separate accounts at the same bank (Bank of Oklahoma Financial) for all the facilities owned by the corporation. He was unable to answer the question as to why payment plans that either himself, Chief Executive Officer (CEO) #601 or Director of Finance #603 initiated, were not followed through with and why payments were missed. On 03/07/24 at 11:21 A.M. a phone interview with CFO #600, Chief Executive Officer (CEO) #601 and Chief Nursing Officer (CNO) #602 was held. Chief Financial Officer #600 continued to report payroll was not met due to the identified positive payroll issue with the bank. Documentation of the bank's error with the positive payroll file submission was requested. As of 03/11/24 at 11:00 A.M. no documentation had been provided. b. In addition to the facility's failure to ensure payroll obligations were met and continued to be met to ensure the ongoing effective day to day operation of the facility the following vendors/suppliers were reviewed as part of the State agency investigation with concerns identified: The facility utilized a contracted service for the services of a dietitian. Review of the invoice from Nutritech Consulting Services dated 02/01/24 revealed the facility owed $1,645.00 and the due date was 02/10/24. This had been received by the facility and scanned to the corporate office on 02/02/24. Interview on 03/04/24 at 12:39 P.M. with Dietitian #135 revealed she was the owner of the nutrition services company that provided services to the facility. She stated due to previous concerns of not receiving payment, she required the facility to pre-pay for her services. Dietitian #135 stated she had terminated services on 03/01/24 as the facility was 23 days behind on their pre-pay plan. She stated CFO #600 called on 03/04/24 and paid the February 2024 balance of $1,645.00 so services would resume. The facility had until 03/10/24 to pre-pay for the March 2024 services. A follow-up interview on 03/11/24 with Dietitian #135 revealed if the facility did not make additional payment in full on this date, she would have to terminate services. Review of the invoice from [NAME] Recycling dated 02/13/24 revealed a total balance due of $1,531.10. This showed services due for 02/01/24 for $765.55 and 01/01/24 for $765.55. This had been received by the facility and scanned to the corporate office on 02/20/24. An interview on 03/04/24 at 11:05 A.M. with the recycling company's Accounts Receivable Clerk (AR) #213 revealed the facility was behind 60 days on their billing. Review of the invoice from Buckeye Pest Management dated 02/20/24 revealed a total balance due of $723.95. This showed services due for 10/05/23, 11/06/23, 12/07/23, 01/04/24 and 02/01/24. The statement was received and scanned to the corporate office on 02/28/24. Interview on 03/04/24 at 10:50 A.M. with the pest management's Accounts Receivable Clerk (AR) #133 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 11 of 12 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 03/11/2024 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many revealed she had been in contact with the facility related to their balance of $723.95. She stated they had not received any payments from the facility since prior to October 2023. Interview on 03/05/24 at 11:45 A.M. with Medical Director (MD) #351 revealed he was unaware of how much the facility owed him for medical director fees. During the interview, he contacted his office and spoke to one of the staff and discovered the facility owed MD #351 for September 2023, November 2023, December 2023, January 2024 and February 2024. This totaled $15,000.00. It was noted the corporation had made payment arrangements and had kept those arrangements until January 2024. There was no payment received in the month of February 2024. Review of the invoice from Broad River Therapy dated 03/06/24 revealed a total balance due of $103,531.89. This was due for services from 11/02/23 to 12/02/23 for $27,251.19; 12/01/23 to 12/31/23 for $28,291.58; 01/02/24 to 02/01/24 for $22,527.73; and 02/02/24 to 03/03/24 for $25,461.39. Interview on 03/04/24 at 11:57 A.M. with Therapy Office Manager #128 revealed the facility had not paid for services since September 2023. However, she stated CFO #600 stated the corporation would be sending checks the week of 03/04/24. Interview on 03/05/24 at 10:16 A.M. with Clerk #350 at the [NAME] Country Treasurer's Office revealed the facility had set-up a payment plan for the balance due which included a delinquent balance, late fees and interest. She stated the facility owed a total of $101,283.27 for property taxes and had made a payment arrangement to pay $5,000 a month and made a payment on 01/12/24. However, Clerk #350 stated the facility (corporation) had failed to make a payment in February 2024. 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. This deficiency represents non-compliance investigated under Master Complaint Number OH00151629, Complaint Number OH00151626, and Complaint Number OH00151535. This deficiency is also an example of continued non-compliance from the survey dated 01/31/24. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366273 If continuation sheet Page 12 of 12