Health inspection·September 1, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Review of Resident #73's behavior plan of care dated 03/27/23 revealed the resident had behaviors related to dementia with behavioral disturbance, psychosis, anxiety, and hallucinations. His interventions included to anticipate his needs, offer comfort item to hold, and when redirecting the resident, approach with a calm, quiet voice. Residents Affected - Few Review of Resident #73's nursing progress notes dated 04/01/23 to 09/01/23 revealed: • 04/06/23 Resident #73 was attempting to hit and kiss other resident and staff (resident and staff not identified) • 04/10/23 Resident attempting to grab at residents and pulled his fist back at two different residents (residents not identified). As needed Xanax and Depakote administered and was ineffective. Resident #73 still acting aggressively and grabbing at other residents. New orders to send to emergency room. • 04/15/23, Resident #53 noted to be sitting at table in day room, Resident #73 noted to have hand on resident's (#53) back of neck, witnessed by activity aide. Redirected by staff. Resident #73 noted to become aggressive with staff while being redirected, grabbing onto staff members arms. • 04/19/23 Resident #73 observed pushing a female resident in her wheelchair throughout the unit. The female resident (unidentified) was yelling stop it and the more she yelled stop it, the faster he would push her chair. The writer approached the residents and attempted to get Resident #73 to stop pushing, which he would not. The writer stopped the wheelchair from moving and attempted to redirect Resident #73, which took several tries. Resident #73 began to get agitated and threw his hands into the air. The writer removed the female resident from the situation to an area out of sight and then Resident #73 wandered down the back hall. • 04/26/23 Staff reported the resident was in the day room on the memory care unit and approached a female resident (Resident #44) and grabbed her right arm and was yelling. Staff intervened and redirected Resident #73 away for Resident #44 and reported the incident to the nurse. Five minutes later Resident #73 was walking next to a female resident (Former Resident #75) as she was sitting in the day room and his hands were around her wrist and he was holding her arms above her head. Staff separated and took Resident #73 to his room and reported incident to the nurse. Resident #73 was given Xanax prior to the incident for agitation. Resident #73's medical provider was updated and new orders to send to the emergency room. • 06/26/23 Resident #73 was up and ambulating throughout memory care unit, passing by activity room (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 2 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 - Minimal harm or potential for actual harm door when another female resident (Former Resident #75) was exiting the activity room. Resident #73 reached his hand out and grabbed a hold of Resident #75's side, as if he were trying to hold onto something, just below her armpit and then used his other hand and placed it on the female resident's right wrist area. STNA approached and Resident #73 was redirected/relocated. Resident #73 continued to pace the unit. Residents Affected - Few Review of Resident #53's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including nontraumatic subdural hemorrhage, psychosis, vascular dementia, anxiety, depression, and cerebrovascular disease. The resident resided on the secured memory care unit. Review of Resident #53's MDS 3.0 dated 07/21/23 revealed the resident had severe cognition impairment. Review of Resident #53's progress note dated 4/15/23 revealed a male resident (Resident #73) was noted to have his hand on the back of the resident's neck while she was sitting in day room. No injuries noted. Closed record review revealed Resident #75 resided on the secured memory care unit. She was admitted to the facility on [DATE] with diagnoses including unspecified dementia without behavioral disturbances, psychotic disturbances, mood disturbances and anxiety, depression, and anxiety disorder. Review of Resident #75's MDS 3.0 dated 07/13/23 revealed the resident cognition was intact. Review of Resident #75's progress note dated 06/26/23 revealed the resident was exiting the activity room when male resident (Resident #73) was passing by. The male resident reached out and grabbed at the resident and with one hand and then placed his other hand on her right wrist area. Resident #75 yelled out get away from me. STNA intervened and redirected the male resident. Resident #75 had three very small linear light red areas on left armpit. No physical, mental, or emotional distress noted. Interview on 09/01/23 at 6:50 A.M., with Licensed Practical Nurse (LPN) #153 reported the residents on the secured memory care were non- interviewable due to impaired cognition. Interview on 09/01/23 1:55 P.M., with the Director of Nursing (DON) revealed he was a floor nurse and had just taken the DON role in August 2023. The DON verified the resident to resident abuse from Resident #73. 2. Review of the facility SRI form (236951) dated 07/11/23 revealed the interim Director of Nursing (DON) was notified on 07/11/23 at 3:30 P.M., of an allegation of verbal abuse. All three residents (#76, #77, and #78) were interviewed and felt STNA #300 was verbally rude and felt it could be abuse. STNA #300 was placed on administrative leave. All alert and oriented residents on the unit where STNA #300 worked were interviewed and only one additional resident reported the STNA said mean things but denied abuse. The facility felt the allegation should be substantiated due to the statements of the three residents and they felt STNA #300 was verbally abusive. Review of a concern form dated 07/11/23 revealed Registered Nurse (RN)/Assistant Director of Nursing (ADON) #130 completed a concern from Resident #77 regarding Resident #76 and #78. The nature of the concern was a pink haired girl had been disrespectful to her roommate (Resident #76). Telling her that her urine stunk and telling her she should mind your own business when Resident #76 told her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 3 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 - Minimal harm or potential for actual harm Residents Affected - Few that she knew eight people had bowel movements today. It was reported that STNA #300 comes in the room with her arms crossed asking us what do you need now. The resident reported she overheard the girl with pink hair tell another resident to shut up when he rang out to tell her that his roommate Resident #78 needed help to the bathroom. Review of Former Resident #77's typed, unsigned statement dated 07/11/23 revealed Registered Nurse (RN) #189 and RN #130 had spoken to Resident #77 with her husband present. Resident #77 stated that last night around 11:00 P.M. or so that the aide with the pink hair (STNA #300) was on the warpath. The aide was rude and yells at them (indicating her and her roommate). Resident #77 further stated that she also overheard her yelling shut up, I'm not talking to you, stay out of this to the male resident that lives across the hall. Resident #77 said she (STNA #300) comes in and says terrible things to her and her roommate like we don't need your input and told her roommate that she wouldn't help her to the bathroom because she has stinky urine. She said her roommate asked for coffee last night and she (STNA #300) told her that the kitchen doesn't open until 5:30-6:00 A.M. The aide then stated if you want it, you can go get it yourself. The resident reported she felt the aide was very abusive, and you never know what will set her off. If you say one thing she doesn't like, she turns. Resident #77 reported the aide will throw bags around when she is in the mood and is intimidating. Review of Former Resident #76's typed, unsigned statement dated 07/11/23 revealed RN #189 and RN #130 had spoken to Resident #76 and confirmed the aide with pink hair told her she had stinky urine and she never heard of anyone having that problem. Th aide told her Your urine stinks and I've never smelled anything so bad in my life. Resident #76 reported she overheard STNA #300 talking about someone having eight bowl movements and told the aide she might want to let the nurse know. The aide responded, We don't need your information; we are experienced, and we don't need to hear from you. Resident #76 further stated the aide treated the men up the hall terrible. The resident confirmed the aide will throw bags around all night when she's wound up. Resident #76 felt the aide was verbally abusive. Review of Former Resident #78's typed, unsigned statement dated 07/11/23 revealed RN #189 and RN #130 had spoken to Resident #78 and confirmed last night, the aide with the pink hair (STNA #300) told him to shut up a couple of times. He was just trying to get help of his roommate. He stated that she comes in and tells us what you're going to do and how to do it. Per Resident #78's statement, she will tell him if you don't do it my way, I'll leave you here. The resident reported she did leave him during providing care once during turning because he wasn't doing it the way she wanted. She did come back. Resident #78 denied anything physical in her abuse and stated he feels she was verbally abusive. Review of STNA #166's written signed statement dated 07/11/23 revealed last night during report she heard Resident #76 say to let the nurse know she pooped. STNA #300 replied rudely to the resident we know how to do our jobs; we don't need resident's help. The STNA walked away saying I get so sick and tired of her butting in when I'm trying to do my job. STNA #166 identified that she reported this to the nurse. An addendum was handwritten on the bottom of STNA #166's statement from RN #189 that indicated upon speaking to STNA #166, she stated that the nurse was at the medication cart with her back to her when she had mentioned STNA #300 was rude to a female resident and maybe the nurse didn't hear her. Staff was educated to get verification from the nurse that the information was received, and it was also ok to report to the Director of Nursing (DON) and ADON. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 4 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 - Minimal harm or potential for actual harm Residents Affected - Few Review of RN #189 and RN #130 written statements dated 07/11/23 revealed STNA #300 was called in and was advised she was on administrative leave pending an investigation. STNA #300 stated she has never verbally abused a resident. STNA #300 was advised that she couldn't enter the building or be on the campus until the resolution of the investigation. Interview on 09/01/23 at 1:35 P.M., with the Administrator and RN #189 confirmed the facility was able to substantiate the resident's allegation of verbal abuse (by STNA #300) due to the residents were reliable and a staff interview. The STNA was terminated. Review of the facility policy titled Abuse, Neglect, and Exploitation (dated 2019 and revised 06/2021) revealed abuse was the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting in physical harm, pain, or mental anguish. Verbal abuse was the use of oral, written, or gestured language that willfully includes despairing and derogatory term to residents or their families, or within hearing distance, to describe residents, regardless of age disability, or ability to comprehend. The accurate and timely reporting of the incidents, both alleged and substantiated, will be sent to the official in accordance with the state law. If the alleged violation was verified, appropriate corrective action would be taken by the facility. In the event of alleged abuse involves a resident-to-resident altercation, the resident would be placed in separate area by staff and the appropriate physical assessment would be completed on each resident. Documentation of the facts and findings would be completed in each resident medical record. Aggressive residents may be placed in a quiet area to reduce stimulation. The physician would be notified of each resident as well as the representative. Update the care plan and complete any appropriate referrals for the physician that may include mental health assessment. This deficiency is cited as an incidental finding to Complaint Number OH00145693. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 5 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, facility self-reported incident (SRI) review, and policy review, the facility failed to report physical abuse to the state agency. This affected four residents (#44, #53, #73, #75). Findings included: Review of Resident #73's medical record revealed an initial admission on [DATE] and a readmission on [DATE]. The resident had diagnoses including Alzheimer's disease, dementia in other diseases classified elsewhere, major depressive disorder, anxiety disorder, hallucinations, and unspecified psychosis not due to a substance of known physiological condition, manic disorder, insomnia, cognitive disorder. On 05/12/23 intermittent explosive disorder diagnosis was added. Review of Resident #73's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had severe cognition impairment and was rarely/never understood. His cognitive skills for daily decision making were moderately impaired and his decisions were poor and he required supervision and cues. He had disorganized thinking and inattention. He was short tempered, easily annoyed. He had physical behavioral symptoms directed toward others four to six days a week and verbal symptoms directed towards others one to three days a week. He put others at significant risk for physical injury and significantly disrupted care or living environment. When asked if he had pain, he was not to be unable to answer. He had taken antipsychotics, anti-anxiety, antidepressants, and opioids in the last seven days. Review of Resident #73's plan of care dated 08/05/22 and revised on 09/23/22 revealed the resident required a room on the secured memory care unit related to unaware of safety needs and to promote psycho-social wellbeing due to dementia and wandering. Review of Resident #73's situational/coping problem areas plan of care dated 03/21/23 revealed the resident has mood and behavioral issues that could affect others related to cognitive deficits (poor reasoning, poor judgement), mood distress, anger, anxiety, sadness, and insomnia. The resident's interventions included to attempt diversional activities to alleviate anger/depression symptoms such as allow the resident to wander in safe areas, one on one visits, music, offer food and snack. Intervene on an incidental or episodic basis to re-direct behavior symptoms that impact others. Complete objective documentation showing an increase in functional ability and or decrease in maladaptive behaviors. Review of Resident #73's behavior plan of care dated 03/27/23 revealed the resident had behaviors related to dementia with behavioral disturbance, psychosis, anxiety, and hallucinations. His interventions included to anticipate his needs, offer comfort item to hold, and when redirecting the resident, approach with a calm, quiet voice. Review of Resident #73's nursing progress notes dated 04/01/23 to 09/01/23 revealed: • 04/06/23 Resident #73 was attempting to hit and kiss other resident and staff (resident and staff not identified). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 6 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 0609 • Level of Harm - Minimal harm or potential for actual harm 04/10/23 Resident #73 attempting to grab at residents and pulled his fist back at two different residents (residents not identified). As needed Xanax and Depakote administered and was ineffective. Resident #73 still acting aggressively and grabbing at other residents. New orders to send to emergency room. Residents Affected - Few • 04/15/23, Resident #53 noted to be sitting at table in day room, Resident #73 noted to have hand on resident's (#53) back of neck, witnessed by activity aide. Redirected by staff. Resident #73 noted to become aggressive with staff while being redirected, grabbing onto staff members arms. • 04/19/23 Resident #73 observed pushing a female resident in her wheelchair throughout the unit. The female resident (unidentified) was yelling stop it and the more she yelled stop it, the faster he would push her chair. The writer approached the residents and attempted to get Resident #73 to stop pushing, which he would not. The writer stopped the wheelchair from moving and attempted to redirect Resident #73, which took several tries. Resident #73 began to get agitated and threw his hands into the air. The writer removed the female resident from the situation to an area out of sight and then Resident #73 wandered down the back hall. • 04/26/23 Staff reported the resident was in the day room on the memory care unit and approached a female resident (Resident #44) and grabbed her right arm and was yelling. Staff intervened and redirected Resident #73 away for Resident #44 and reported the incident to the nurse. Five minutes later Resident #73 was walking next to a female resident (Former Resident #75) as she was sitting in the day room and his hands were around her wrist and he was holding her arms above her head. Staff separated and took Resident #73 to his room and reported incident to the nurse. Resident #73 was given Xanax prior to the incident for agitation. Resident #73's medical provider was updated and new orders to send to the emergency room. • 06/26/23 Resident #73 was up and ambulating throughout memory care unit, passing by activity room door when another female resident (Former Resident #75) was exiting the activity room. Resident #73 reached his hand out and grabbed a hold of Resident #75's side, as if he were trying to hold onto something, just below her armpit and then used his other hand and placed it on the female resident's right wrist area. STNA approached and Resident #73 was redirected/relocated. Resident #73 continued to pace the unit. Review of Resident #53's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including nontraumatic subdural hemorrhage, psychosis, vascular dementia, anxiety, depression, and cerebrovascular disease. The resident resided on the secured memory care unit. Review of Resident #53's MDS 3.0 dated 07/21/23 revealed the resident had severe cognition impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 7 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #53's progress note dated 4/15/23 revealed a male resident (Resident #73) was noted to have his hand on the back of the resident's neck while she was sitting in day room. No injuries noted. Closed record review revealed Resident #75 resided on the secured memory care unit. She was admitted to the facility on [DATE] with diagnoses including unspecified dementia without behavioral disturbances, psychotic disturbances, mood disturbances and anxiety, depression, and anxiety disorder. Review of Resident #75's MDS 3.0 dated 07/13/23 revealed the resident cognition was intact. Review of Resident #75's progress note dated 06/26/23 revealed the resident was exiting the activity room when male resident (Resident #73) was passing by. The male resident reached out and grabbed at the resident and with one hand and then placed his other hand on her right wrist area. Resident #75 yelled out get away from me. STNA intervened and redirected the male resident. Resident #75 had three very small linear light red areas on left armpit. No physical, mental, or emotional distress noted. Interview on 09/01/23 1:55 P.M., with the Director of Nursing (DON) verified the resident to resident abuse by Resident #73 was not reported to the state survey agency. The DON revealed he was a floor nurse and just had taken the DON role over in August 2023. He stated he thought the previous DON did not report the resident-to-resident altercations due to there was no physical harm to the residents. Review of the facility policy titled Abuse, Neglect, and Exploitation (dated 2019 and revised 06/2021) revealed abuse was the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting in physical harm, pain, or mental anguish. The accurate and timely reporting of the incidents, both alleged and substantiated, will be sent to the officials in accordance with the state law. If the alleged violation was verified, appropriate corrective action would be taken by the facility. In the event of alleged abuse involves a resident-to-resident altercation, the resident would be placed in separate area by staff and the appropriate physical assessment would be completed on each resident. Documentation of the facts and findings would be completed in each resident medical record. Aggressive residents may be placed in a quiet area to reduce stimulation. The physician would be notified of each resident as well as the representative. Update the care plan and complete any appropriate referrals for the physician that may include mental health assessment. This deficiency is cited as an incidental finding to Complaint Number OH00145693. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 8 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 0610 Respond appropriately to all alleged violations. 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, facility self-reported incident (SRI) review, and policy review, the facility failed to have evidence that allegations of physical abuse was thoroughly investigated. This affected four residents (#44, #53, #73, #75). Residents Affected - Few Findings included: Review of Resident #73's medical record revealed an initial admission on [DATE] and a readmission on [DATE]. The resident had diagnoses including Alzheimer's disease, dementia in other diseases classified elsewhere, major depressive disorder, anxiety disorder, hallucinations, and unspecified psychosis not due to a substance of known physiological condition, manic disorder, insomnia, cognitive disorder. On 05/12/23 intermittent explosive disorder diagnosis was added. Review of Resident #73's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident had severe cognition impairment and was rarely/never understood. His cognitive skills for daily decision making were moderately impaired and his decisions were poor and he required supervision and cues. He had disorganized thinking and inattention. He was short tempered, easily annoyed. He had physical behavioral symptoms directed toward others four to six days a week and verbal symptoms directed towards others one to three days a week. He put others at significant risk for physical injury and significantly disrupted care or living environment. When asked if he had pain, he was not to be unable to answer. He had taken antipsychotics, anti-anxiety, antidepressants, and opioids in the last seven days. Review of Resident #73's plan of care dated 08/05/22 and revised on 09/23/22 revealed the resident required a room on the secured memory care unit related to unaware of safety needs and to promote psycho-social wellbeing due to dementia and wandering. Review of Resident #73's situational/coping problem areas plan of care dated 03/21/23 revealed the resident has mood and behavioral issues that could affect others related to cognitive deficits (poor reasoning, poor judgement), mood distress, anger, anxiety, sadness, and insomnia. The resident's interventions included to attempt diversional activities to alleviate anger/depression symptoms such as allow the resident to wander in safe areas, one on one visits, music, offer food and snack. Intervene on an incidental or episodic basis to re-direct behavior symptoms that impact others. Complete objective documentation showing an increase in functional ability and or decrease in maladaptive behaviors. Review of Resident #73's behavior plan of care dated 03/27/23 revealed the resident had behaviors related to dementia with behavioral disturbance, psychosis, anxiety, and hallucinations. His interventions included to anticipate his needs, offer comfort item to hold, and when redirecting the resident, approach with a calm, quiet voice. Review of Resident #73's nursing progress notes dated 04/01/23 to 09/01/23 revealed: • 04/06/23 Resident #73 was attempting to hit and kiss other resident and staff (resident and staff not identified). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 9 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 0610 • Level of Harm - Minimal harm or potential for actual harm 04/10/23 Resident #73 attempting to grab at residents and pulled his fist back at two different residents (residents not identified). As needed Xanax and Depakote administered and was ineffective. Resident #73 still acting aggressively and grabbing at other residents. New orders to send to emergency room. Residents Affected - Few • 04/15/23, Resident #53 noted to be sitting at table in day room, Resident #73 noted to have hand on resident's (#53) back of neck, witnessed by activity aide. Redirected by staff. Resident #73 noted to become aggressive with staff while being redirected, grabbing onto staff members arms. • 04/19/23 Resident #73 observed pushing a female resident in her wheelchair throughout the unit. The female resident (unidentified) was yelling stop it and the more she yelled stop it, the faster he would push her chair. The writer approached the residents and attempted to get Resident #73 to stop pushing, which he would not. The writer stopped the wheelchair from moving and attempted to redirect Resident #73, which took several tries. Resident #73 began to get agitated and threw his hands into the air. The writer removed the female resident from the situation to an area out of sight and then Resident #73 wandered down the back hall. • 04/26/23 Staff reported the resident was in the day room on the memory care unit and approached a female resident (Resident #44) and grabbed her right arm and was yelling. Staff intervened and redirected Resident #73 away for Resident #44 and reported the incident to the nurse. Five minutes later Resident #73 was walking next to a female resident (Former Resident #75) as she was sitting in the day room and his hands were around her wrist and he was holding her arms above her head. Staff separated and took Resident #73 to his room and reported incident to the nurse. Resident #73 was given Xanax prior to the incident for agitation. Resident #73's medical provider was updated and new orders to send to the emergency room. • 06/26/23 Resident #73 was up and ambulating throughout memory care unit, passing by activity room door when another female resident (Former Resident #75) was exiting the activity room. Resident #73 reached his hand out and grabbed a hold of Resident #75's side, as if he were trying to hold onto something, just below her armpit and then used his other hand and placed it on the female resident's right wrist area. STNA approached and Resident #73 was redirected/relocated. Resident #73 continued to pace the unit. Review of Resident #53's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including nontraumatic subdural hemorrhage, psychosis, vascular dementia, anxiety, depression, and cerebrovascular disease. The resident resided on the secured memory care unit. Review of Resident #53's MDS 3.0 dated 07/21/23 revealed the resident had severe cognition impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 10 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #53's progress note dated 4/15/23 revealed a male resident (Resident #73) was noted to have his hand on the back of the resident's neck while she was sitting in day room. No injuries noted. Closed record review revealed Resident #75 resided on the secured memory care unit. She was admitted to the facility on [DATE] with diagnoses including unspecified dementia without behavioral disturbances, psychotic disturbances, mood disturbances and anxiety, depression, and anxiety disorder. Review of Resident #75's MDS 3.0 dated 07/13/23 revealed the resident cognition was intact. Review of Resident #75's progress note dated 06/26/23 revealed the resident was exiting the activity room when male resident (Resident #73) was passing by. The male resident reached out and grabbed at the resident and with one hand and then placed his other hand on her right wrist area. Resident #75 yelled out get away from me. STNA intervened and redirected the male resident. Resident #75 had three very small linear light red areas on left armpit. No physical, mental, or emotional distress noted. Interview on 09/01/23 1:55 P.M., with the Director of Nursing (DON) verified the resident to resident abuse by Resident #73 was not thoroughly investigated. The DON revealed he was a floor nurse and just had taken the DON role over in August 2023. He stated he thought the previous DON did not report the resident-to-resident altercations and investigate due to there was no physical harm to the residents. Review of the facility policy titled Abuse, Neglect, and Exploitation (dated 2019 and revised 06/2021) revealed abuse was the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting in physical harm, pain, or mental anguish. The accurate and timely reporting of the incidents, both alleged and substantiated, will be sent to the officials in accordance with the state law. If the alleged violation was verified, appropriate corrective action would be taken by the facility. In the event of alleged abuse involves a resident-to-resident altercation, the resident would be placed in separate area by staff and the appropriate physical assessment would be completed on each resident. Documentation of the facts and findings would be completed in each resident medical record. Aggressive residents may be placed in a quiet area to reduce stimulation. The physician would be notified of each resident as well as the representative. Update the care plan and complete any appropriate referrals for the physician that may include mental health assessment. This deficiency is cited as an incidental finding to Complaint Number OH00145693. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 11 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure residents were adequately supervised to assist in the prevention of resident to resident altercations. This affected one resident (#73) of three residents reviewed for resident-to-resident abuse. Findings include: Review of Resident #73's medical record revealed an initial admission on [DATE] and a readmission on [DATE] with diagnoses including Alzheimer's disease, dementia in other diseases classified elsewhere, major depressive disorder, anxiety disorder, hallucinations, and unspecified psychosis not due to a substance of known physiological condition, manic disorder, insomnia, cognitive disorder. On 05/12/23 the diagnosis of intermittent explosive disorder was added. Review of Resident #73's Minimum Data Set (MDS) 3.0 dated 08/13/23 revealed the resident had severe cognition impairment and was rarely/never understood. His cognitive skills for daily decision making was moderately impaired and his decisions were poor and required supervision and cues. He had disorganized thinking and inattention. He was short tempered, easily annoyed. He had physical behavioral symptoms directed toward others four to six days a week and verbal symptoms directed towards others one to three days a week. He put others at significant risk for physical injury and significantly disrupted care or living environment. When asked if he had pain, he was not to be unable to answer. He had taken antipsychotics, anti-anxiety, antidepressants, and opioids in the last seven days. Review of Resident #73's plan of care dated 08/05/22 and revised on 09/23/22 revealed the resident required a room on the secured memory care unit related to unaware of safety needs and to promote psycho-social wellbeing due to dementia and wandering. Review of Resident #73's situational/coping problem areas plan of care dated 03/21/23 revealed the resident has mood and behavioral issues that could affect others related to cognitive deficits (poor reasoning, poor judgement), mood distress, anger, anxiety, sadness, and insomnia. The residents' interventions included to attempt diversional activities to alleviate anger/depression symptoms such as allow the resident to wander in safe areas, one on one visits, music, offer food and snack. Intervene on an incidental or episodic basis to re-direct behavior symptoms that impact others. Complete objective documentation showing an increase in functional ability and or decrease in maladaptive behaviors. Review of Resident #73's behavior plan of care dated 03/27/23 revealed the resident had behaviors related to dementia with behavioral disturbance, psychosis, anxiety, and hallucinations. His interventions included to anticipate his needs, offer comfort item to hold, and when redirecting the resident, approach with a calm, quiet voice. Review of Resident #73's nursing progress notes dated 04/01/23 to 09/01/23 revealed multiple incidents where Resident #73 had physically aggressive behaviors towards residents and staff On 04/27/23 Resident #73 was placed on one to one supervision. There was no documentation Resident #73 received one to one supervision on 05/01/23, 05/02/23, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 12 of 13 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 366285 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Shadyside 60583 State Route 7 Shadyside, OH 43947 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 05/06/23, 05/09/23, 05/10/23, and 05/11/23. Level of Harm - Minimal harm or potential for actual harm On 05/19/23 one to one supervision was discontinued and Resident #73 was placed on 15-minute check supervision by nursing. Residents Affected - Few Review of Resident #73's hourly one on one supervision documentation reports dated 04/27/23 to 05/19/23 revealed the direction for staff to initial next to each hour and indicate what Resident #73 was doing. The facility provided the surveyor with documentation of hourly sheets for 05/17/23, 05/18/23, and 05/19/23 due to they had been scanned in the electronic medical records. Review of the documentation dated 05/19/23 revealed staff had signed name only at noon, 1:00 P.M., 2:00 P.M., and 3:00 P.M. and then scratched their name out. Interview on 09/01/23 at 1:55 P.M., with the Director of Nursing (DON) revealed he was a floor nurse and just had taken the DON role over in August 2023. The DON revealed the facility did not have a policy regarding one to one supervision, however ,staff are required to fill out an hour by hour sheet with their initials and what the resident was doing. The only sign in sheets he could find for the one on one for Resident #73 was 05/17/23 to 05/19/23. Per the DON, the nurses charted in the nursing progress notes almost daily that one on one continued, however he could not find sheets for 04/27/23 to 05/16/23 that the task was completed. This deficiency represents non-compliance investigated under Complaint Number OH00145693. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366285 If continuation sheet Page 13 of 13