Health inspection·July 30, 2024

F 0689 educated to always use his walker. Level of Harm - Actual harm Review of the Incident and Accident Investigation, dated 06/24/24, (authored by Licensed Practical Nurse (LPN) #34) revealed Resident #14 sustained a fall on 06/24/24 at 11:48 A.M. when he was hit with a dietary cart by staff who could not see the resident while pushing the cart, resulting in a fall. The resident sustained a fractured right hip and multiple skin tears. The investigation further revealed the incident occurred in the hallway and the immediate actions taken following the fall was the assessment of range of motion and vital signs. The resident was unable to straighten his right, lower extremity and rotation was noted. The resident was sent to the emergency room for evaluation and treatment. A bright colored sign was placed on the walker to remind the resident to use the walker. Residents Affected - Few Review of the Emergency Department (ED) Provider Note, dated 06/24/24 at 12:52 P.M., revealed Resident #14 presented with a chief complaint of a fall and stated a staff member at the nursing home accidentally struck him with a dinner cart and he fell, landing on his right hip. The resident sustained skin tears to his left hand and right arm. Review of the right hip revealed deformity, tenderness, and decreased range of motion. Minor skin tears to the left, third and fourth digits and right elbow, forearm, and hand were noted. Review of a Hospital History and Physical (H and P) report, dated 06/24/24 at 2:01 P.M., revealed Resident #14 had diagnoses including Alzheimer's disease, who presented to the emergency room on [DATE] with right hip pain following a mechanical fall. The resident stated that he was at his nursing home facility, and someone was walking by with a cart that hit him and he lost his balance and fell on his right side. The resident was found to have a right hip fracture and was admitted for an orthopedic evaluation. The pre-operative evaluation determined the resident had a moderate risk for surgery, but the final decision to take the resident to the operating room was left to the surgical and anesthesia teams. Review of a progress note, dated 06/25/24 at 9:54 A.M., revealed the interdisciplinary team met to discuss Resident #14's fall on 6/24/24. All proper notifications were made. Immediate intervention was put in place and education was provided to all staff about using two staff to move the tall dietary cart. The interdisciplinary team agreed with interventions and plan. Review of a nurse practitioner progress note, dated 07/01/24, revealed Resident #14 was seen for a hospital follow-up. The resident was hospitalized from [DATE] through 06/28/24 due to a right hip fracture. His hospital course included surgical repair of a closed fracture of the right hip on 06/25/24, intravenous (IV) iron therapy, and aggressive bowel regimen for constipation. The resident's pain was controlled with narcotic pain medication. Interview on 07/16/24 at 9:15 A.M. with the Administrator verified Resident #14 had a fall on 06/24/24. The Administrator revealed the resident was walking in the main lobby without his walker when Dietary [NAME] #20, who was pushing the large dietary cart, accidentally bumped into the resident with the dietary cart. The Administrator stated the facility investigation revealed the staff member only looked around one side of the dietary cart and not both sides of the cart prior to pushing the dietary cart. The Administrator stated the staff member never saw Resident #14 and when the dietary cart bumped the resident, it caused him to lose his balance and fall. The Administrator confirmed the fall caused the resident to fracture his hip/femur which required a surgical repair. The Administrator stated the facility now requires two staff to move the large dietary cart to ensure residents are not bumped by the cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366286 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366286 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Cedar Hill 1136 Adair Avenue Zanesville, OH 43701 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 - Actual harm Residents Affected - Few Interview on 07/30/24 at 8:39 A.M. with Dietary [NAME] #20 revealed on 06/24/24 she was transporting the food cart through the corridor between the dining room and therapy area when she made a sharp turn. Resident #10 was located by the wall on the right side of the cart and Resident #14 was standing near the puzzles on the left side of the cart. Dietary [NAME] #20 stated that she was trying to avoid bumping into Resident #10 and did not see Resident #14 at the time. Dietary [NAME] #20 stated that she felt something, stopped pushing the cart, and then heard Resident #14 yelling. Dietary [NAME] #20 stated she looked around the cart and observed Resident #14 lying on the ground, grabbing the metal cart, and he must have hit something sharp which resulted in bleeding from one of his hands. Dietary [NAME] #20 stated a nurse came and assessed the resident immediately after the incident. Dietary [NAME] #20 confirmed she could not see over the tall, metal cart while pushing it from behind. The Dietary [NAME] verified she only looked around the right side of the cart but not the left side of the cart before she hit Resident #14. On 07/30/24 at 9:50 A.M., an interview with Regional Administrator #120 revealed she was unaware of any facility policy regarding safe transportation of dietary carts prior to the incident involving Resident #14. Review of facility policy and procedures revealed the facility did not have any type of policy in place related to moving the dietary carts prior to Resident #14's fall, nor did the facility have specific education for staff regarding the movement of dietary carts prior to Resident #14's fall. The deficient practice was corrected on 06/24/24 when the facility implemented the following corrective actions: • On 06/24/24 the facility initiated a Facility Self-Imposed Action Plan which included the following: • On 06/24/24, Resident #14 was immediately assessed by LPN #34 on 06/28/24 at 11:45 A.M. and sent to the emergency department for evaluation. The resident was admitted and his right hip was surgically repaired. • On 06/24/24, one-on-one education was provided by the Administrator to Dietary [NAME] #20 that moving forward, all tall meal carts need to be taken to/from the unit/kitchen by two staff members to ensure the hallway is clear for the cart. • On 06/24/24, 46 nursing, dietary, and housekeeping staff were educated by the Administrator via in-person or over the phone, that all tall meal carts will be transported to/from kitchen by two staff members (one in front and one in back). • (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366286 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366286 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare at Cedar Hill 1136 Adair Avenue Zanesville, OH 43701 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 On 06/24/24, an initial audit was completed by the DON during the supper meal, to ensure the tall meal carts were being transported to/from the kitchen/unit with two staff members. Level of Harm - Actual harm • Residents Affected - Few On 06/24/24, the DON initiated an audit by observation to ensure tall meal carts are being transported to/from the unit/kitchen by two staff members. Audits will be completed twice weekly for four weeks then as determined by the DON or designee. The audits began on 06/28/24. • All audits will be reviewed by Quality Assessment and Performance Improvement (QAPI) during meetings held monthly and any concerns will be addressed. • Two new dietary carts, shorter in design and permit visibility over the cart during transport, were approved by corporate and ordered. The new carts will replace the current tall dietary carts. • No further injuries have resulted from the dietary carts since 06/24/24. This deficiency represents non-compliance investigated under Complaint Number OH00155268. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366286 If continuation sheet Page 4 of 4