Health inspection·May 27, 2021

F 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Potential for minimal harm Based on interviews and review of residents rights, the facility failed to ensure mail delivered on weekends was provided to residents in a timely manner. This had the potential to affect all 48 residents currently residing in the facility. Residents Affected - Many Findings include: During a meeting with resident council members on 05/18/21 at 10:04 A.M., Residents #27 and #42 reported residents were only able to receive mail on Monday through Friday. No mail was delivered on Saturdays. On 05/18/21 at 10:14 A.M., Activity Director #31 stated when mail was delivered to the facility, the Business Office Manager sorted mail or that she (Activity Director #31) would sort through the mail for cards or items she was sure needed delivered to residents then the mail was delivered. Activity Director #31 indicated she and the Business Office Manager worked Monday through Friday. On weekends, nurses and nursing assistants would deliver newspapers. If a package was delivered for a resident on Saturday nursing staff would deliver the package but not the mail. On 05/19/21 at 11:35 A.M., Registered Nurse (RN) #64 stated when mail was delivered to the facility on Saturdays, it was placed up front and nurses did not receive it to deliver it to residents. Review of the Residents' Rights revealed the residents had the right to receive mail. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 2 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Potential for minimal harm Based on review of the facility new hire list, review of timecards, review of Bureau of Criminal Investigation (BCI) log, interviews, and policy review the facility failed to ensure the facility maintained a comprehensive BCI log. This had the potential to affect all 48 residents currently residing in the facility. Residents Affected - Many Findings include: Review of the facility new hire staffing list dated 04/20/21 to 05/20/21 revealed the facility hired 16 new staff including State Tested Nurse Aide (STNA) #200, Temporary Nurse Aide (TNA) #28, Hospitality Aide (HA) #201, STNA #202, Registered Nurses (RN) #203, HA #204, Licensed Practical Nurse (LPN) #205, HA #206, STNA #207, and HA #208. Review of timecards for 05/2021 revealed STNA #200's first day providing direct care was 05/03/21, TNA #28's first day of direct care was 05/04/21, and HA #204's first day of work was 05/20/21. Review of the BCI log revealed no evidence STNA #200, TNA #28, HA #201, STNA #202, RN #203, HA #204, LPN #205, HA #206, STNA #207, and HA #208 were listed on the BCI log. Interview on 05/25/21 at 8:53 A.M., with the Administrator confirmed the facility did not have a Human Resource (HR) staff and the HR job duties were currently split between the Social Service Designee and the Business Office Manager. The facility's sister facility was currently performing fingerprints upon hire. The Administered confirmed STNA #200 had provided direct care to residents one day, then she was terminated for no call no show. TNA #28 and HA #204 had been and were currently working with residents. HA #201, STNA #202, RN #203, HA #204, LPN #205, HA #206, STNA #207, and HA #208 had been hired, however, had not yet been put on the schedule to work at this time. The Administrator confirmed STNA #200, TNA #28, HA #201, STNA #202, RN #203, HA #204, LPN #205, HA #206, STNA #207, and HA #208 were not on the BCI log and it must have been overlooked. Interview on 05/25/21 at 10:31 A.M., with Social Service Designee (SSD) #70 confirmed the facility did not have copies of BCI results for STNA #200, TNA #28, HA #201, STNA #202, RN #203, HA #204, LPN #205, HA #206, STNA #207, and HA #208. She had to call their sister facility to obtain copies of BCI results today for STNA #200, TNA #28, HA #204 and #206, and would obtain the others. SSD #70 confirmed STNA #200, TNA #28, and HA #204 had been scheduled to work, however, the other new hires had not been scheduled to work at this time. SSD #70 reported two sister facilities had been helping with the hiring process and the BCI results were never sent to her and she totally forgot about updating the BCI log. Review of the abuse policy and procedure dated 11/21/16 revealed prior to hiring a new employee, the facility would conduct a criminal background check in accordance with Ohio laws and policies. Review of the Human Resource (HR) job description undated revealed the responsibility of the HR would be to interpret all federal, state, and local regulations related to human resource, payroll, and benefits administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 3 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure Resident #24, who had indicators of serious mental illness, had a pre-admission screening and resident review (PASARR) completed to determine whether the resident qualified for Level II services. This affected one (Resident #24) of one reviewed for PASARR. Findings include: Record review revealed Resident #24 was admitted to the facility on [DATE]. The resident's current mental health diagnoses include schizoaffective disorder, psychosis, major depressive disorder, anxiety, and mental disorder. Review of Resident #24's problematic manner plan of care revealed risk related to inappropriate behaviors as evidence by easily angered, irritable, unstable mood, cures at staff and family members at times, anxiousness, and repetitive concerns. The resident demonstrated difficulty adjusting to change in routine, attempted to manipulate staff/family members, and had a poor appetite at times. The resident stated feelings of sadness, little interest in group activities, and feeling bad about self. At times he was noncompliant with care and disliked different staff members who provided him care. Review of a Social Service note dated 05/09/21 revealed the resident had diagnoses of unspecified psychosis, major depressive disorder, anxiety, and schizoaffective disorder. He had five documented incidents of yelling/screaming. Review of Resident #24's PASARR dated 09/01/92 revealed the resident had no mental health diagnoses. Review of Resident #24's Minimum Data Set (MDS) dated [DATE] revealed the resident was not currently considered by the state level II PASARR process to have a serious mental illness. Further review revealed the resident had psychiatric/mood disorders including anxiety, depression, psychotic disorder, and schizophrenia. Interview on 05/19/21 at 8:37 A.M., with the Administrator confirmed Resident #24 had not have an updated PASARR to reflect his current mental health diagnoses. The last MDS on file was from 1992 which reflected the resident did not have any mental health diagnoses. Interview on 05/20/21 at 12:05 P.M., with Register Nurse (RN) #76 revealed the facility did not have a PASARR policy, however a new PASARR should been completed when there was a new mental health diagnosis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 4 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 5. Resident #14's medical record revealed diagnoses including quadriplegia (paralysis of all four limbs), chronic pain syndrome, and anxiety disorder. A quarterly MDS assessment dated [DATE] revealed Resident #14 was able to make herself understood, was able to understand others, was cognitively intact, did not reject care, and was totally dependent for ADLs including bathing. Residents Affected - Some A plan of care indicated Resident #14 required assistance with ADLs and could be at risk of developing complications associated with decreased ADL self-performance. Resident #14 would get up in the shower chair for showers. Interventions included bathing per Resident #14's preference and referred to the bathing schedule. The care plan indicated Resident #14 preferred a shower. On 05/17/21 at 11:32 A.M., Resident #14 stated she wanted a shower at least twice a week. Although staff tried really hard to provide two showers a week, she was sometimes only able to receive one shower. Review of shower schedules revealed Resident #14 was scheduled for showers twice a week on Monday and Saturday. Review of bathing records indicated Resident #14 received one shower the week of 05/09/21 to 05/15/21. On 05/18/21 at 5:16 P.M. STNA #20 verified residents did not get a shower on day shift on 05/15/21. 6. Resident #28's medical record revealed diagnoses including heart disease, osteoarthritis, depression, and Alzheimer's disease. A care plan initiated 06/08/20 indicated Resident #28 required assistance with ADLs and could be at risk of developing complications associated with decreased ADL self-performance. Interventions included bathing per preference with instructions to see the bathing schedule. A quarterly MDS dated [DATE] indicated Resident #28 was severely cognitively impaired and required physical help in part of the bathing activity. Review of the facility's shower schedule revealed Resident #28 was to receive a shower on day shift (6 A.M. to 6 P.M.) on Wednesday and Saturday. The shower schedule was dated 05/15/21. Review of shower records revealed Resident #28 did not receive a shower on Saturday, 05/15/21. On 05/18/21 at 5:16 P.M. STNA #20 verified residents did not get a shower on day shift on 05/15/21. On 05/20/21 at 10:52 A.M. Temporary Nursing Assistant (TNA) #28 verified showers were not provided on day shift on 05/15/21. 7. Resident #44's medical record revealed diagnoses including muscular dystrophy, contracture, and asthma. A care plan initiated 10/30/18 revealed Resident #44 preferred bed baths, stating he did not like water. Interventions included to bathe per preference and refer to the bathing schedule. A quarterly MDS dated [DATE] revealed Resident #44 was cognitively intact and was dependent on staff for bathing. Review of the facility's shower schedule revealed Resident #44 was to receive a bed bath on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 5 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0677 Tuesday, Thursday and Saturday day shift. Level of Harm - Minimal harm or potential for actual harm Review of Resident #44's bathing records revealed no bath was documented as provided on 05/15/21. On 05/18/21 at 5:16 P.M. STNA #20 verified residents did not get a shower on day shift on 05/15/21. Residents Affected - Some Based on record review, review of the facility shower schedule, review of bathing preferences, review of the facilities shower preference and shower documentation process, and interviews the facility failed to ensure dependent residents were provided showers per their schedule/preference. This affected eight (Resident #5, #14, #28, #34, #36, #41, #44, and #151) of nine reviewed for bathing/showers. The current census was 48. Findings include: 1. Resident #9 was admitted to the facility on [DATE] with diagnoses including dementia, muscle weakness, chronic pain, osteoporosis, and cerebral infarction. Review of Resident #9's Minimum Data Set (MDS) dated [DATE] revealed the resident required extensive assistance of one person for bathing. Review of Resident #9's self-care deficit plan of care revealed her intervention included to bathe per the resident's preference and to see bathing schedule. Review of Resident #9's current shower schedule and bathing preference revealed Resident #9 requested showers twice weekly on Wednesday and Saturday day shift. Review of Resident #9's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident did not receive a shower on Saturday 05/15/21. There was no evidence of resident refusal. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the Director of Nursing (DON) confirmed Resident #9 did not receive a shower on Saturday 05/15/21 per the shower schedule and resident's preference. The DON reported she was unable to locate a shower sheet for 05/15/21. 2. Resident #36 was admitted to the facility on [DATE] with diagnoses including unsteadiness on feet, muscle weakness, fatigue, and malaise. Review of Resident #36's MDS dated [DATE] revealed Resident #36 required extensive assistance of two or more persons with bathing. Review of Resident #36's plan of care for activities of daily living (ADL) revealed the resident could bathe with assistance. Review of Resident #36's current shower schedule and bathing preference revealed the resident preferred bed baths on Tuesday and Saturday day shift. Review of Resident #36's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident did not receive or refuse a bed bath on Saturday 05/15/21. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the DON confirmed Resident #36 did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 6 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0677 Level of Harm - Minimal harm or potential for actual harm receive a bed bath on Saturday 05/15/21 per the shower schedule and resident's preference. The DON reported she was unable to locate a shower sheet for 05/15/21. Interview on 05/20/21 at 10:13 A.M. with Resident #36 confirmed she did not get a bed bath on Saturday 05/15/21. Residents Affected - Some 3. Resident #34 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease. Review of Resident #34's MDS dated [DATE] revealed Resident #36 required extensive assistance of two or more persons with bathing. Review of Resident #34's current shower schedule and bathing preference revealed the resident preferred bed baths daily on day shift. Review of Resident #34's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident did not receive or refuse a bed bath on 05/07/21, 05/10/21, 05/15/21, or 05/16/21. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M., with the DON confirmed Resident #34 did not receive a bed bath on 05/07/21, 05/10/21, 05/15/21, or 05/16/21 per the shower schedule and resident's preference. The DON reported she was unable to find shower sheets for 05/15/21. 4. Resident #151 was admitted to the facility on [DATE] with diagnoses including cellulitis and muscle spasm. Review of Resident #151's MDS dated [DATE] revealed the resident required extensive assistance of one with bathing. Review of Resident #151's plan of care for ADLs revealed the resident required assistance with bathing. Review of Resident #151's current shower schedule and bathing preference revealed the resident preferred bed baths on Thursday and Saturday day shift. Review of Resident #151's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident only received one bath during the 14 day time frame. There was no evidence the resident refused a bath. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the DON confirmed Resident #151 did not receive a bed bath per the shower schedule and resident's preference. The DON verified she was unable to find shower sheets for 05/15/21. Interview on 05/20/21 at 9:03 A.M. interview with Resident #151 verified he had only had one bath since his admission. Review of the facility shower preference and shower documentation process (undated) revealed shower were completed per a resident's preference. The nurse would hand out shower sheets for residents requiring a shower for that shift based on the shower schedule. The shower sheet would be filled out based on what was completed and signed off by the State Tested Nurse Aide (STNA). The Unit Nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 7 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0677 Level of Harm - Minimal harm or potential for actual harm would be responsible for reviewing shower sheets and re-evaluation of shower needs if a resident refused. The shower sheets would be reconciled to the shower schedule to ensure all sheets were completed and returned and then signed off. The Point of Care documentation should reflect if a shower/bath was given or if resident refused for that day. Documentation for the shower day should reflect what occurred. The shower sheets should be turned in at the end of the shift to the Assistant Director of Nursing (ADON). Residents Affected - Some The facility currently did not have an ADON. 8. Resident #5's medical record revealed an admission date of 04/13/21 with diagnoses that included muscle weakness, unsteadiness on feet, and anxiety disorder. Review of Resident #5's admission MDS dated [DATE] revealed the resident required one-person physical help in part of the bathing activity. Review of the facility's shower schedule revealed Resident #5 preferred her bed baths to be done twice a week. Review of the facility task information for bathing from 05/06/21 through 05/18/21 revealed Resident #5 only received a bed bath on 05/11/21, 05/12/21, and 05/17/21. Interview on 05/20/21 at 12:44 P.M. interview DON #35 confirmed Resident #5's bed bath was not completed on 05/15/21 per the resident's preference. This deficiency substantiates Complaint Number OH00122215. This deficiency is a recite to the survey dated 04/12/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 8 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the activity schedule, review of the facility assessment, and interviews the facility failed to timely comprehensively assess resident preferences for activities and failed to provide activities on the weekend per preferences. This affected four (Residents #2, #26, #27, and #42) and had the potential to affect all 48 residents currently residing in the facility. Residents Affected - Some Findings include: 1. Resident #26 was admitted to the facility on [DATE] with diagnoses including stroke, diabetes, major depressive disorder, aphasia, hemiplegia, dysphagia, and difficulty walking. Review of Resident #26's plan of care revealed no evidence of an activity plan of care. Review of Resident #26's activity assessments revealed no evidence of an activity assessment was completed. Review of Resident #26's admission Minimum Data Set (MDS) dated [DATE] revealed no evidence the activities and preference section F was completed. Review of Resident #26's activity documentation dated April 01, 2021 to May 19, 2021 revealed no evidence the resident received activities from 04/02/21 to 04/05/21, 04/07/21 to 04/08/21, 04/11/21 to 04/18/21, 05/01/21 to 05/02/21, 05/05/21 to 05/13/21, or 05/15/21 to 05/19/21. Random observation of Resident #26 during the day on 05/17/21 to 05/19/21 revealed no evidence Resident #26 participated in activities. The resident was seen sleeping in bed during the observations. Interview on 05/17/21 at 4:01 P.M. with Resident #26's representative revealed the facility did not offer many activities the resident was able to participate in due to his health condition and cognition. Interview on 05/19/21 at 12:11 P.M. with Register Nurse (RN) #60 verified section F (resident activities and preferences) were not completed on several resident MDS assessments due to the Activities Director (AD) was the only one working in the activities department and she was not able to complete the section F before the ARD (due) date. The MDS were submitted without section F completed due to the AD could not complete timely. Interview on 05/19/21 at 11:56 A.M. and 12:30 P.M. with Activities Director (AD) #31 verified Resident #26 did not have an activity assessment on admission and she had just recently completed a paper assessment on 05/03/21. However, it was missed and not entered into the electronic medical record nor was a plan of care initiated for activities. The facility was aware assessments had not been completed and they brought a team from a sister facility to audit charts, however, Resident #26 was missed. The AD verified there was no documented evidence the resident received activities on the above dates. The facility had recently started an electronic charting program and she stopped keeping paper records of resident activity participation. 2. Review of the activity schedules dated 02/2021 to 05/2021 revealed only in-room activities (TV time, reading, puzzles) were offered on Saturday and Sunday. There was no evidence of group (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 9 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0679 activities. Level of Harm - Minimal harm or potential for actual harm A. Resident #2 was admitted to the facility on [DATE] with diagnoses including major depression disorder and cerebral palsy. Residents Affected - Some Review of Resident #2's annual MDS dated [DATE] revealed section F (activities and preferences) was not completed. Review of Resident #2's activity plan of care revealed to invite and encourage the resident to attend daily activity groups of interest. He was interested in socializing with other residents and staff. Interview on 05/20/21 at 9:59 A.M., with Resident #2 and his sister confirmed the facility did not have a staff member to provide activities on the weekends. Resident #2 and his sister reported they would like to have activities on the weekend. The resident confirmed he would attend if they were offered. B. Resident #27 was admitted to the facility on [DATE] with diagnoses including major depression disorder, and Parkinson's disease. Review of Resident #27's annual MDS dated [DATE] revealed section F (activities and preferences) was not completed. Review of Resident #27's activity plan of care revealed he liked to do things with a group of people. Interview on 05/20/21 at 9:45 A.M. with Resident #27 confirmed the facility did not have activities on the weekends and he wished the facility would offer them. Resident #27 confirmed he would attend activities on the weekends if they were offered. C. Resident #42 was admitted to the facility on [DATE] with diagnoses including major depressive disorder and heart disease. Review of Resident #42's activity plan of care revealed the resident was interested in socializing. Her interventions included to engage the resident in group activities. Review of Resident #42's MDS dated [DATE] revealed it was very important for the resident to do activities with a group of people. Interview on 05/20/21 at 9:45 A.M. with Resident #42 confirmed the facility did not have activities on the weekends and she would attend activities on the weekend if they were offered. Interview on 05/19/21 at 11:56 A.M. and 12:30 P.M. with AD #31 revealed she had been the only staff member working in the activities department since March of 2020. She only worked Monday through Friday. AD #31 verified there were no group activities offered on the weekends due to no activity staff available on the weekends. AD #31 said she tried to leave crossword puzzles and games out in the common area for the residents. Review of the facilities assessment dated [DATE] revealed the facility would have one full time AD (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 10 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0679 and one to two activity staff. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 11 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Record review revealed Resident #28 was admitted to the facility on [DATE] with diagnoses including heart disease, osteoarthritis, weakness, muscle wasting and atrophy. Residents Affected - Few Review of Resident #28's current orders revealed to apply lamb's wool to the legs of the wheelchair for skin protection and tubal grips to bilateral lower legs to be applied in the morning and removed at night. Review of Resident #28's care plan revealed alteration in skin integrity as evidence by skin tears to the right leg, right ankle, right lower distal leg, right lateral lower leg, left medial lower leg, left lower leg above the ankle, left lateral proximal log, and left wrist. Interventions included lambs wool to the top of the bed frame and tubal grips to bilateral lower legs to be applied in the morning and taken off at night. There was no information regarding applying lambs wool to the legs of the wheelchair. Review of Resident #28's care plan revealed at risk for alteration in skin integrity related to weakness, decreased mobility, fragile skin, incontinence, pain, medication use, arthritis, self-propels wheelchair, bumps extremities when self-propelling, and bites fingernails. Interventions included to encourage the resident to wear geri sleeves and tubal grips as ordered to protect skin. There was no mention of applying lambs wool to the legs of the wheelchair. Review of Resident #28's non-pressure skin assessments dated 05/17/21 revealed the resident currently had six skin tears/abrasions on her lower body. Observation of Resident #28 on 05/17/21 at 10:17 A.M. revealed there was no lambs wool on the legs of the wheelchair or tubal grips to her bilateral lower extremities. Observation and interview of Resident #28 on 05/18/21 at 7:46 A.M. revealed she was sitting in her wheelchair in the dining room. The resident only had one geri sleeve on the right arm. There was no geri sleeve on her left arm. There was no lambs wool on the wheelchair legs nor tubal grips on either of her lower legs. The resident pulled up her pant legs to show her lower legs. Observation of Resident #28 on 05/19/21 at 7:39 A.M. with Registered Nurse (RN) #64 revealed the resident did not have lambs wool on the legs of her wheelchair or the top of the bed frame per the plan of care and orders. Observation of Resident #28 on 05/19/21 at 9:12 A.M. with the DON revealed the resident did not have lambs wool on the legs of her wheelchair or the top of the bed frame. The DON verified the plan of care was not updated to reflect the new order on 05/03/21 to apply lambs wool to the wheelchair legs. The DON confirmed the resident currently had several skin tears due to bumping into objects when she self-propelled in her wheelchair. This deficiency is a recite to the survey dated 03/11/21. Based on observation, interview, medical record review, and policy review the facility failed to ensure Resident #32 received treatments per her physician's orders and Resident #28's skin intervention were in place. This affected two of three residents reviewed for skin conditions (Residents #24, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 12 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0684 #28 and #32). The facility census was 48. Level of Harm - Minimal harm or potential for actual harm Findings include: Residents Affected - Few 1. Medical record review revealed Resident #32 was admitted to the facility on [DATE] with diagnoses of Parkinson's Disease, diabetes mellitus type two, and dementia. Review of Resident #32's quarterly Minimum Data Set (MDS) dated [DATE] revealed she required extensive assistance of one person for bed mobility and two person extensive assistance for transfers. Review of the facility provided skin grid documentation, dated 05/17/21, revealed Resident #32 had Moisture Associated Skin Damage (MASD) that was first noted on 05/05/21. Review of Resident #32's May 2021 physician's orders revealed an order from 05/06/21 to 05/10/21 for zinc oxide to buttocks every six hours and as needed during incontinence care. The order was scheduled to be done at 12:00 A.M., 6:00 A.M., 12:00 P.M., and 6:00 P.M., and an order dated 05/10/21 for zinc oxide to MASD on coccyx every six hours and as needed during incontinence care. The order was scheduled to be done at 12:00 A.M., 6:00 A.M., 12:00 P.M., and 6:00 P.M. Review of the Medication Administration Record (MAR) for May 2021 revealed zinc oxide was not applied every six hours per Resident #32's physician's orders. Zinc oxide was not applied on 05/07/12 at 6:00 A.M., on 05/08/21 at 6:00 A.M. and 6:00 P.M., on 05/09/21 at 6:00 A.M. and 6:00 P.M., on 05/11/21 at 6:00 P.M., on 05/12/21 at 6:00 P.M., on 05/13/21 at 6:00 A.M. and 6:00 P.M., on 05/14/21 at 6:00 A.M. and 6:00 P.M., on 05/15/21 at 6:00 A.M. and 6:00 P.M., and on 05/16/21 at 6:00 A.M. Interview on 05/20/21 at 12:00 P.M. with the Director of Nursing (DON) #35 confirmed that the facility was not completing the treatments on the Resident #32 as ordered by the physician. Review of the facility policy, Skin Assessment Policy, dated 12/02/15 and revised 09/2017, revealed areas of alternation in skin that are present, or which develops subsequently to admission, are treated according to medical direction and are conscientiously followed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 13 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interviews, and policy review the facility failed to ensure pressure ulcer treatments were administered per physician orders. This affected one (Resident #26) of two residents reviewed for pressure ulcers. The facility census was 48. Residents Affected - Few Findings include: Resident #26 was admitted to the facility on [DATE] with diagnoses including osteomyelitis, cerebral infarction, Parkinsonism, type two diabetes, hemiplegia and hemiparesis, and muscle weakness. Review of Resident #26's orders and Medication Administration Records (MAR) dated 04/2021 to 05/2021 revealed to apply zinc to right upper buttocks every six hours and as needed. There were 38 times the zinc was not signed off as administered per the orders. Review of Resident #26's alteration in skin integrity plan of care revealed the resident had pressure areas on the left heel, the right buttocks, and on the right heel. The intervention included to provide treatments per physician orders. Review of Certified Nurse Practitioner (CNP) wound notes dated 05/04/21 revealed the resident had a stage 3 (full-thickness skin loss) area on the coccyx measuring 0.9 centimeters (cm) by 0.5 cm by 0.1 cm. The wound base was composed of 90% granulation tissue and 10% slough (nonviable tissue). Orders included to continue to apply the zinc every six hours and as needed with a notation indicating they would consider debridement the following week. Review of the CNP wound notes dated 05/10/21 revealed the area on the coccyx measured 0.9 cm by 0.5 cm by 0.1 cm and the wound base was 50% granulation and 50% slough. The area was very similar in size; however, this week there was more slough. The area was cauterized with silver nitrate. Orders included to continue to apply zinc every six hours and as needed. There was an additional notation to please consider applying the zinc widely and thickly over the open area. Review of the CNP wound note dated 05/17/21 revealed the area on the coccyx measured 0.9 cm by 0.6 cm and the depth was not able to be determined. The wound base was composed of 80% granulation tissue and 20% slough. Orders included to continue to apply a thick glob of zinc every six hours and as needed. Interview on 05/19/21 at 8:35 A.M. with the Director of Nursing (DON) confirmed lack of evidence the zinc was administered for 38 times in April and May 2021. Interview on 05/20/21 at 10:18 A.M.,with Physician #73 revealed he did write the order for zinc to be applied every six hours as needed. The Physician reported he would like to see the zinc applied every time the resident was moist/wet which may vary during the day, however, he would expect the zinc to be applied at least three to eight times daily. The Physician was not aware the staff were not applying the zinc per his orders and indicated it was not good if the staff were not even applying the zinc at least every six hours. Physician #73 indicated he would usually use a more aggressive treatment than zinc for a wound with more than 20% slough, however, he would need to investigate the concern and talk with the CNP. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 14 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 05/20/21 at 11:15 A.M. with Corporate Nurse #300 revealed the facility staff were assessing the wounds at the same time as the CNP and were charting what the CNP was stating about the wound healing process (improving) due to the CNP was the expert. Interview with CNP #74 on 05/24/21 at 10:00 A.M. revealed her expectation would be for the zinc to be applied at least three to eight times daily depending on how moist the resident's skin was, however, the order was written for the zinc to be applied every six hours and as needed. The CNP reported she had to cauterize the coccyx wound on 05/10/21 due to the wound had deteriorated slightly and the wound bed was covered with 50% slough. She reported usually zinc was not appropriate for a wound with 50% slough, however, she felt after she cauterized the wound the zinc could be continued. The CNP reported her wound notes had indicated the wound had improved on every visit because the drop box only had two options to choose from. She didn't feel the declines were huge, so she chose the drop box for improving. Review of the skin assessment policy dated 09/2017 revealed areas of skin alteration are treated according to medical directions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 15 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and interview the facility failed to provide range of motion services to two (Residents #14 and #24) of 16 residents observed for and/or interviewed regarding range of motion. The facility identified eight residents with contractures. Findings include: 1. Review of Resident #14's medical record revealed diagnoses included quadriplegia (paralysis of all four limbs), muscle spasms, and chronic pain syndrome. A quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 was cognitively intact and was able to make herself understood. The MDS indicated Resident #14 had functional limitation in range of motion (ROM) to both upper and both lower extremities. There were no orders, no care plan, and no record of any ROM services. On 05/17/21 at 11:45 A.M. Resident #14 verified she had limitations in ROM of all her joints due to quadriplegia. Resident #14 reported she did not get ROM services provided, even during hands on care. On 05/18/21 at 5:16 P.M. State Tested Nursing Assistant (STNA) #20 stated Resident #14 was not provided ROM services. On 05/19/21 at 2:00 P.M. the lack of ROM services was addressed with Registered Nurse (RN) #76. On 05/20/21 at 9:47 A.M. Resident #14 revealed she did feel as if her joints were stiffening. Resident #14 stated she addressed the feeling of her joints stiffening with Therapy Director #29 a few weeks prior to this interview, stating she requested Therapy Director #29 speak to the Administrator to determine if she could get services to address the concern. On 05/20/21 at 10:29 A.M. Therapy Director #29 stated Resident #14 had been screened by therapy on 11/24/20, 12/15/20, and 02/02/21. A screen dated 02/02/21 indicated Resident #14 was referred to therapy and Occupational Therapy (OT) assessed her for positioning/use of heel boots. OT services were not initiated. Therapy Director #29 was interviewed regarding whether ROM services would be beneficial for Resident #14. Therapy Director #29 stated Resident #14 had stayed at baseline and there was no justification for therapy. Therapy Director #29 stated she did not recall a conversation with Resident #14 about her joints being stiff or wanting to pursue any services due to that. Therapy Director #29 stated therapy and ROM services would not improve Resident #14's functional status. When Resident #14's statements about feeling her joints tightening and possible risk of contractures which could lead to additional complications were addressed, Therapy Director #29 acknowledged that there were additional complications which could present if Resident #14 developed contractures. Therapy Director #29 stated she could probably evaluate Resident #14 and provide short term services to develop a ROM program and do staff education. 2. Record review revealed Resident #24 was admitted to the facility on [DATE] with diagnoses including focal traumatic brain injury, hemiplegia, muscle spasm, and peripheral vascular disease. Review of Resident #24's noncompliance plan of care revealed the resident refused to wear a left hand splint to prevent further contractures. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 16 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of self-care deficit activity of daily living (ADL) plan of care revealed decline may be expected related to dependence on staff for mobility, hemiplegia, traumatic brain injury, cardiac disease, schizophrenia, behaviors, and incontinence. The goal was to maintain and prevent decline in range of motion (ROM) through the review date. The interventions included to perform active/passive ROM to upper and lower extremity during routine completion of dressing, bathing, and personal hygiene, and restorative nursing to evaluate and treat as needed. Review of Resident #24's task and progress notes revealed no evidence the resident was receiving ROM services. Review of Resident #24's MDS dated [DATE] revealed no evidence of splints or ROM. The resident was noted to have limited ROM with upper and lower extremities. Interview on 05/19/21 at 7:51 A.M. with STNA #20 revealed she was not aware the resident had splints. The STNA reported she was also not aware of any order/plan of care the resident was to receive ROM. Interview on 05/19/21 at 9:41 A.M., with TD #29 revealed she had recently taken over as manager, however, had been with the company for seven years. She reported the resident had refused to wear the splints in the past and his ROM had not been assessed since 2018. Interview on 05/20/21 at 10:58 A.M. revealed STNA #5 reported Resident #24 did not have a ROM plan of care/order or an order for splints. The STNA reported she only performed ROM exercises if it was ordered for restorative and noted on the resident task list. The STNA verified she did not perform ROM during ADL care with Resident #24 and stated he hardly did anything for himself during ADL care. Interview on 05/20/21 at 11:18 A.M. RN #76 revealed the facility did not have a policy for ROM. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 17 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure catheter care for a resident in accordance with the plan of care and physician's orders. This affected one (Resident #14) of two residents reviewed for urinary catheters. The facility identified eight residents with indwelling urinary catheters. Findings include: During an interview on 05/17/21 at 11:39 A.M. Resident #14 reported she had an indwelling urinary catheter since March of 2020. Upon inquiry about catheter care, Resident #14 stated she did not receive routine catheter care. Catheter care was provided during showers once or twice a week. Resident #14 indicated she was very prone to urinary tract infections, especially since the catheter was initiated. Review of Resident #14's medical record revealed diagnoses including quadriplegia (paralysis of all four limbs) and neuromuscular dysfunction of the bladder. On 12/04/20, a physician's order was written for Foley catheter care every shift and as necessary. A plan of care initiated 12/07/20 indicated Resident #14 had an alteration in elimination and used a Foley catheter. Interventions included providing catheter care every shift and as necessary. A quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #14 was cognitively intact and did not reject care. Resident #14 was dependent for physical hygiene and bathing. Resident #14 had an indwelling urinary catheter. On 05/18/21 at 8:08 A.M. Licensed Practical Nurse (LPN) #49 stated catheter care was supposed to be provided twice a day. Nurses provided catheter care to Resident #14 on night shift. On 05/18/21 at 5:16 P.M. State Tested Nursing Assistant (STNA) #20 stated Resident #14 was provided catheter care on her shower days. STNA #20 was uncertain if night shift did catheter care also but thought they did. This deficiency is a recite to the surveys dated 03/11/21 and 04/12/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 18 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, review of the facility assessment and interview the facility failed to ensure adequate staffing levels to provide timely care and services including assistance with activities of daily living, individualized activity programs, and weekend activities. This affected 12 (Residents #9, #36, #34, #151, #26, #2, #27, #42, #5, #14, #28 and #44) and had the potential to affect all 48 residents currently residing in the facility. Findings include: 1. Resident #9 was admitted to the facility on [DATE] with diagnoses including dementia, muscle weakness, chronic pain, osteoporosis, and cerebral infarction. Review of Resident #9's Minimum Data Set assessment (MDS) dated [DATE] revealed the resident required extensive assistance of one person for bathing. Review of Resident #9's self-care deficit plan of care revealed interventions included to bathe per the resident's preference and to see the bathing schedule. Review of Resident #9's current shower schedule and bathing preference revealed Resident #9 requested showers twice a week on Wednesday and Saturday day shift. Review of Resident #9's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident did not receive a shower on Saturday 05/15/21. There was no evidence of resident refusal. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the Director of Nursing (DON) confirmed Resident #9 did not receive a shower on Saturday 05/15/21 per the shower schedule and resident's preference. The DON reported she was unable to locate a shower sheet for 05/15/21. 2. Resident #36 was admitted to the facility on [DATE] with diagnoses including unsteadiness on feet, muscle weakness, fatigue, and malaise. Review of Resident #36's MDS dated [DATE] revealed Resident #36 required extensive assistance of two or more persons with bathing. Review of Resident #36's plan of care for activities of daily living (ADLs) revealed the resident could bathe with assistance. Review of Resident #36's current shower schedule and bathing preference revealed the resident preferred bed baths on Tuesday and Saturday day shift. Review of Resident #36's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident did not receive or refuse a bed bath on Saturday 05/15/21. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the DON confirmed Resident #36 did not receive a bed bath on Saturday 05/15/21 per the shower schedule and resident's preference. The DON reported she was unable to locate a shower sheet for 05/15/21. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 19 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interview on 05/20/21 at 10:13 A.M. with Resident #36 confirmed she did not get a bed bath on Saturday 05/15/21. 3. Resident #34 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease. Review of Resident #34's MDS dated [DATE] revealed Resident #34 required extensive assistance of two or more persons with bathing. Review of Resident #34's current shower schedule and bathing preference revealed the resident preferred bed baths daily on day shift. Review of Resident #34's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident did not receive or refuse a bed bath on 05/07/21, 05/10/21, 05/15/21, or 05/16/21. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the DON confirmed Resident #34 did not receive a bed bath on 05/07/21, 05/10/21, 05/15/21, or 05/16/21 per the shower schedule and resident's preference. The DON reported she was unable to find shower sheets for 05/15/21. 4. Resident #151 was admitted to the facility on [DATE] with diagnoses including cellulitis and muscle spasm. Review of Resident #151's MDS dated [DATE] revealed he required extensive assistance of one with bathing. Review of Resident #151's plan of care for assistance with ADLs revealed the resident required assistance with bathing. Review of Resident #151's current shower schedule and bathing preference revealed he preferred bed baths on Thursday and Saturday day shift. Review of Resident #151's bathing documentation dated 05/06/21 to 05/18/21 revealed the resident only received one bath during the 14 day time frame. There was no evidence the resident refused a bath. Interview on 05/20/21 at 8:01 A.M. and 12:44 P.M. with the DON confirmed Resident #151 did not receive a bed bath per the shower schedule and resident's preference. The DON verified she was unable to find shower sheets for 05/15/21. On 05/20/21 at 9:03 A.M. Resident #151 verified he had only had one bath since his admission. Review of the facility shower preference and shower documentation process (undated) revealed showers were completed per the resident's preference. The nurse would hand out shower sheets for residents requiring a shower for that shift based on the shower schedule. The shower sheet would be filled out based on what was completed and signed off by the STNA. The Unit Nurse would be responsible for reviewing shower sheets and re-evaluation shower needs if a resident refused. The shower sheets would be reconciled to the shower schedule to ensure all sheets were completed and returned and then signed off. The Point of Care documentation should reflect if a shower/bath was given or if resident refused for that day. Documentation for the shower day should reflect what occurred. The shower sheets (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 20 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0725 should be turned in at the end of the shift to the Assistant Director of Nursing (ADON). Level of Harm - Minimal harm or potential for actual harm 5. Resident #26 was admitted to the facility on [DATE] with diagnoses including stroke, diabetes, major depressive disorder, aphasia, hemiplegia, dysphagia, and difficulty walking. Residents Affected - Many Review of Resident #26's plan of care revealed no evidence of an activity plan of care. Review of Resident #26's activity assessments revealed no evidence an activity assessment was completed. Review of Resident #26's admission MDS dated [DATE] revealed no evidence the activities and preference section F was completed. Review of Resident #26's activity documentation for April and May 2021 revealed no evidence the resident received activities from 04/02/21 to 04/05/21, 04/07/21 to 04/08/21, 04/11/21 to 04/18/21, 05/01/21 to 05/02/21, 05/05/21 to 05/13/21, or 05/15/21 to 05/19/21. Random observation of Resident #26 during the day on 05/17/21 to 05/19/21 revealed no evidence Resident #26 participated in activities. The resident was noted asleep in bed during the observations. Interview on 05/17/21 at 4:01 P.M. with Resident #26's representative revealed the facility did not offer many activities the resident was able to participate in due to his health condition and cognition. Interview on 05/19/21 at 12:11 P.M. with Registered Nurse (RN) #60 verified section F of the MDS (resident activities and preferences) was not completed on several residents due to the Activities Director (AD) being the only one working in the activities department and she was not able to complete the section F before the ARD (Assessment Reference Date) date. They had to submit them without section F being completed due to the AD could not complete it timely. Interview on 05/19/21 at 11:56 A.M. and 12:30 P.M. with AD #31 verified Resident #26 did not have an activity assessment on admission and she had just recently completed a paper assessment on 05/03/21. However, it was missed and not entered into the electronic medical record nor was a plan of care initiated for activities. The facility was aware assessments had not been completed and they brought a team from a sister facility to audit charts, however, Resident #26 was missed. The AD verified there was no documented evidence the resident received activities on the above dates. The facility had recently started an electronic charting program and she stopped keeping paper records of resident activity participation. 6. Review of the activity schedules dated 02/2021 to 05/2021 revealed only in-room activities (TV time, reading, puzzles) were offered on Saturday and Sundays. There was no evidence of group activities. A. Resident #2 was admitted to the facility on [DATE] with diagnoses including major depression disorder and cerebral palsy. Review of Resident #2's annual MDS dated [DATE] revealed section F (activities and preferences) was not completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 21 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of Resident #2's activity plan of care revealed to invite and encourage the resident to attend daily activity groups of interest. He was interested in socializing with other residents and staff. Interview on 05/20/21 at 9:59 A.M. with Resident #2 and his sister confirmed the facility did not have a staff member to provide activities on the weekends. Resident #2 and his sister reported they would like to have activities on the weekend. The resident confirmed he would attend if they were offered. B. Resident #27 was admitted to the facility on [DATE] with diagnoses including major depression disorder, and Parkinson's disease. Review of Resident #27's annual MDS dated [DATE] revealed section F (activities and preferences) was not completed. Review of Resident #27's activity plan of care revealed he liked to do things with a group of people. Interview on 05/20/21 at 9:45 A.M. with Resident #27 confirmed the facility did not have activities on the weekends and he wished the facility would offer them. Resident #27 confirmed he would attend activities on the weekends if they were offered. C. Resident #42 was admitted to the facility on [DATE] with diagnoses including major depressive disorder and heart disease. Review of Resident #42's activity plan of care revealed the resident was interested in socializing. Her interventions included to engage the resident in group activities. Review of Resident #42's MDS dated [DATE] revealed it was very important for the resident to do activities with a group of people. Interview on 05/20/21 at 9:45 A.M. with Resident #42 confirmed the facility did not have activities on the weekends and she would attend activities on the weekend if they were offered. Interview on 05/19/21 at 11:56 A.M. and 12:30 P.M. with AD #31 revealed she was the only staff member working in the activities department since March of 2020. She only worked Monday through Friday. AD #31 verified there were no group activities offered on the weekends due to no activity staff being available on the weekend. She tried to leave crossword puzzles and games out in the common area for the residents. The AD verified section F of the MDS assessments had not been completed on several residents regarding activities. Interview on 05/19/21 at 12:54 P.M. with RN #64 confirmed there was no one in the activities department on the weekend for activities. 7. Interview during the survey process with Licensed Practical Nurse (LPN) #49 and RN #46 revealed the staffing had not changed. Sometimes it was rough with only two nurses on days and night shift. RN #46 reported call lights were not answered timely and residents were not getting the attention they needed. The nurses were not able to complete a thorough assessment for the residents, especially on 400 hall. The 400 hall was split between the two nurses. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 22 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 8. Review of shower schedules, documentation in the electronic health record, and shower sheets revealed Residents #5, #14, #28, and #44 had bathing scheduled but did not have records of bathing provided for 05/15/21. Interview of a staff member, who requested anonymity, revealed the facility was not consistently staffed sufficiently to provide needed care to it's residents. On 05/15/21, showers were not provided related to lack of sufficient staffing. 9. Review of the facilities staffing list (undated) revealed the last day worked by Human Resources (HR) staff was 03/29/21 and the wound nurse's last day worked was 02/02/21. The HR position was split between the Business Office Manger (BOM) and Social Services Designee (SSD). The wound nurse position was not replaced. There was no ADON and only one staff member for the activities department. Review of the facility assessment dated [DATE] revealed the facility would have a full time (40 hours per week) ADON/RN, a full time Nurse Manger/Wound Care/LPN, one full time HR staff person, one full time BOM, one full time SSD, and one full time AD plus one to two additional activity staff. This deficiency substantiates Complaint Number OH00122215. This deficiency is a recite to a complaint survey completed 04/12/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 23 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and policy review the facility failed to ensure prescription drugs were dated when opened and properly stored in their original packaging. This affected three residents (Resident #1, #13 and #16) whose medications were found opened and not dated and had the potential to affect all 48 residents currently residing in the facility. Findings include: 1. Resident #1 was admitted to the facility on [DATE] with diagnoses of Parkinson's disease, hypertension, and vitamin d deficiency. Review of Resident #1's [DATE] physician orders revealed an order for Fluticasone propionate suspension 50 micrograms to be administered one spray in each nostril one time a day for nasal congestion. Observation on [DATE] at 2:06 P.M. of the 400 hall medication cart with Registered Nurse (RN) #62 revealed Resident #1's Fluticasone nasal spray was opened, but was not labeled with the date it was opened. Interview on [DATE] at 2:10 P.M. RN #62 confirmed than nasal spray was open and should have the date opened marked on it in order to determine the expiration date. RN #62 verified all medications should be labeled with the date when they were opened and without knowing the date opened she would not be able to tell when it had expired. 2. Resident #13 was admitted to the facility on [DATE] with diagnoses of dementia, hypertension, and osteoarthritis. Review of Resident #13's [DATE] physician orders revealed and order for Fluticasone propionate suspension 50 micrograms to be administered one spray in each nostril one time a day for chronic rhinitis. Observation on [DATE] at 2:06 P.M. of the 400 hall medication cart revealed Resident #13's Fluticasone nasal spray was opened but did not have an opened date marked on it. Interview on [DATE] at 2:10 P.M. with RN #62 confirmed that the medication was open and did not have a date indicating when it was opened. Therefore, she would not be able to tell when it had expired. 3. Resident #16 was admitted to the facility on [DATE] with diagnoses of diabetes mellitus, heart failure, and hypertension. Review of Resident #16's [DATE] physician orders revealed and order for calcitonin salmon solution 200 units to be administered by one spray into one nostril daily and alternate nostril used daily. Observation on [DATE] at 2:06 P.M. of the 400 hall medication cart with RN #62 revealed Resident #16's calcitonin salmon nasal spray was opened but did not have an opened date marked on it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 24 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0761 Level of Harm - Minimal harm or potential for actual harm Interview on [DATE] at 2:10 P.M. RN #62 confirmed that the medication was open and did not have a date indicating when it was opened. Therefore, she would not be able to tell when it had expired. 4. Observation on [DATE] at 2:06 P.M. of the 200 hall medication cart with RN #62 revealed a loose tablet sitting in an open medication cup. Residents Affected - Some Interview on [DATE] at 2:06 P.M. RN #62 confirmed the medication was a docusate (stool softener) tablet that she borrowed from the 400 hall medication cart since there was none on the 200 hall medication cart. Review of the facility's policy, Medication Storage dated [DATE] revealed medications and biological's are stored safely, securely and properly following manufacturer's recommendations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 25 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0867 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. Based on record review, policy review, and interview, the facility failed to develop a sustainable plan of correction to correct staffing deficiencies identified and cited during previous survey activity exited 04/12/21. This had the potential to affect all 48 residents currently residing in the facility. Findings include: Review of survey activity Statement of Deficiencies from a previous survey with an exit date of 04/12/21 revealed deficient practices were identified with staffing and activities of daily living. During the current survey, deficient practices were identified with staffing and activities of daily living. Review of the facility's Quality Assurance Performance Improvement (QAPI) policy, dated 11/28/17, revealed the QAPI program would address performance improvement processes and a system for tracking performance to ensure improvements were realized and sustained. The Administrator was responsible for ensuring the QAPI program was sustained during transitions of leadership and staffing, the QAPI program was adequately resourced, including ensuring staff time, equipment and technical training as needed. On 05/24/21 at 3:52 P.M. the Director of Nursing (DON) was interviewed. The DON stated most of the staffing shortages were a result of staff reporting off work. The DON stated when the facility was previously cited for staffing and inability to provide care they were working with three to four aides and two nurses. The DON stated although the facility strived to have 4-5 aides they generally still worked with 3-4 aides and two nurses. The facility was using agency staffing but were unable to cover all needs. The DON stated after the facility's previous citations and violations were issued regarding staffing and assistance with activities of daily living she told staff to notify her if they were unable to provide activities of daily living for residents. Staff failed to notify her that baths/showers were not able to be provided on 05/15/21. The DON verified the facility continued to staff the same as when they were previously cited. During an interview on 05/25/21 initiated at 10:42 A.M., the Administrator stated the facility had recently hired 11 direct care staff with eight of the 11 having been added to the schedule. The DON, who was present, stated some staff were cross-trained and were able to provide direct care. Staff members who were cross trained were identified as the Administrator, Business Office Manager (BOM) #37, and Medical Records clerk #63. The Administrator indicated the facility strove for five nursing assistants on day shift and four nursing assistants on night shift. The Administrator indicated when there was a report off she attempted to get management who were cross trained to work as nursing assistants. The Administrator and DON indicated there had to be a minimum of three aides (one for each hall). The management employees who were cross trained would be expected to take a section if needed to ensure there was a nursing assistant for each hall. Staffing schedules for night shift on 05/15/21 were discussed as daily assignment sheets indicated there were three nursing assistants and an orientee from 6:00 P.M. until 12:00 A.M. After 12:00 A.M., staffing levels decreased to two nursing assistants and the orientee. Instructions on the assignment sheet requested the two other nursing assistants help the orientee after the third nursing assistant left. The Administrator stated there was probably a group text out to managers to try to cover the shift and stated the orientee was already (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 26 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0867 a State Tested Nursing Assistant (STNA) with experience. Level of Harm - Minimal harm or potential for actual harm On 05/25/21 at 12:31 P.M., the Administrator verified the night of 05/15/21 was the orientee's first night worked. Although the orientee was a STNA she was not familiar with the residents. The Administrator verified the orientee had an assignment once her preceptor left but stated there were two other nursing assistants to provide any assistance she needed. The Administrator also provided communication with other staff that been sent out asking if they were available to work the night of 05/15/21 and verified it was known that additional nursing assistants were needed for night shift on 05/15/21. The Administrator was unable to locate any communication with the managers who were cross-trained stating it was probably verbal communication and none of them could work. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 27 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and policy review the facility failed to ensure proper infection control procedures were followed during catheter care for Resident #200. This affected one of two residents reviewed for the use of indwelling urinary catheters (Resident #200 and #14). The facility census was 48. Residents Affected - Few Findings include: Resident #200 was admitted to the facility on [DATE] with diagnoses including acute kidney failure, hypertension, and chronic ischemic heart disease. Review of Resident #200's May 2021 physician orders revealed an order for an indwelling urinary catheter (Foley) to gravity drainage related to intractable pain, and for catheter care every shift. Observation on 05/19/21 at 2:45 P.M. of catheter care for Resident #200 revealed State Tested Nursing Assistant (STNA) #16 gathered supplies, washed her hands, and donned gloves. The Director of Nursing (DON) was present and helped position the resident. STNA #16 began by cleaning the tubing of the catheter from the point of insertion to approximately four inches down the tubing. STNA #16 then used a another wash cloth which she dipped in the basin of water, and applied perineal cleanser to and cleansed the resident's vaginal area. STNA #16 then obtained a dry towel and dried the resident's vaginal area. Next she picked up the perineal cleanser and the basin of water, walked to the resident's bathroom, opened the bathroom door with the same soiled gloves she used during catheter care, emptied the basin of water and left the basin and perineal cleanser in the bathroom. STNA #16 exited the bathroom removed her gloves and used hand sanitizer before exiting the resident's room. Interview on 05/19/21 at 3:00 P.M. with STNA #16 and the DON confirmed proper infection control procedures were not followed. STNA #16 should have cleansed the vaginal area first. Then disposed of the used water, washed her hands and applied clean gloves prior to completing catheter care, and washed her hands before exiting the room. Review of the facility policy, Catheter Care/Urinary revised 07/2006, stated the facility staff should wash the resident's genitalia and perineum with soap and water, rinse the area well, towel dry, dispose of the water, wash dry hands, apply clean gloves, and then complete catheter care. The policy further revealed after completing catheter care the staff should discard disposable items in to designated containers, remove gloves, wash and dry hands thoroughly, make the resident comfortable, clean the wash basin, return it to designated storage area, clean bedside stand, and wash and dry hands thoroughly. This deficiency is a recite to the survey dated 03/11/21. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 28 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of the infection control log, review of antibiotic stewardship log, review of Loeb and McGeer criteria, interviews, and policy review the facility failed to ensure appropriate use of antibiotics. This affect two (Resident #18 and #19) of four reviewed for infections. The facility census was 48. Residents Affected - Few Findings include: 1. Closed record review revealed Resident #18 was admitted to the facility on [DATE] with diagnoses including urinary tract infection (UTI) and benign prostatic hyperplasia with lower urinary tract symptoms. Review of Resident #18's progress note dated 03/31/21 revealed the resident continued to have gross hematuria (blood in the urine). The resident denied urinary pain or discomfort. Review of Resident #18's progress notes dated 04/03/21 revealed the resident returned from the emergency room with an order for Bactrim DS (antibiotic) to be given twice daily for 10 days for hematuria. Review of Resident #18's urine culture report dated 04/03/21 revealed there was no growth. The physician recommended a urology consult. Review of Resident #18's orders and the Medication Administration Record (MAR) dated 04/2021 revealed Resident #18 received Bactrim DS twice daily from 04/04/21 to 04/13/21 for an UTI. There was no evidence the resident had an indwelling urinary catheter. Review of the infection control log dated 04/2021 revealed Resident #18 received Bactrim DS twice daily for 10 days for and UTI and hematuria. There was nothing noted on the log regarding a date or results from the urine culture specimen. Review of the antibiotic stewardship log dated 04/2021 revealed Resident #18 was ordered Bactrim for 10 days for a UTI and hematuria. The antibiotic was not warranted. Review of the Loeb minimum criteria for initiation of antibiotics (undated) revealed with an indwelling catheter at least one of the following must be met: fever increased above baseline temperature, new costovertebral tenderness, rigors, or new onset of delirium. Foul smelling or cloudy urine was not a valid indication for imitating antibiotics. Asymptomatic bacteria should not be treated with antibiotics. Review of the McGeer criteria dated 10/2013 revealed for residents with an indwelling catheter criterion one and two must be present. Criteria one included at least one of the following: fever, change in mental status, new onset of pain in suprapubic or costovertebral area, and purulent discharge. Criteria two the urine specimen culture must have a least 100,000 cfu/ml of any organism. Interview on 05/24/21 at 10:57 A.M. with the Director of Nursing (DON) revealed the resident was sent to the emergency room and came back with the antibiotic order. The resident had a urinary catheter at the time the specimen was collected. The DON confirmed the resident did not meet criteria for treatment and the physician did not indicate the antibiotic was necessary. The DON confirmed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 29 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0881 Level of Harm - Minimal harm or potential for actual harm urine culture indicated there was no growth and she should have not been treated with the Bactrim. The facility utilized both Loeb and McGeer criteria to determine antibiotic treatment. 2. Closed record review revealed Resident #19 was admitted to the facility on [DATE] with diagnoses including UTI, diabetes, and chronic kidney disease. Residents Affected - Few Review of Resident #19's progress notes dated 02/25/21 revealed the resident was admitted from the hospital with abdominal pain, UTI, and weakness. Further review of progress notes dated 02/26/21 to 03/02/21 revealed no evidence the resident had dysuria or frequency. The assessment indicated the gastro-intestinal and the genitourinary assessments were completed with negative findings. Review of Resident #19's orders and MAR dated 02/2021 revealed the resident received two antibiotics for a UTI. The Augmentin was given twice daily from 02/26/21 to 03/02/21 and Azithromycin daily from 02/26/21 to 03/02/21. Review of the infection control log dated 02/2021 revealed Resident #19 had a UTI. The culture date and results were blank. The resident received Augmentin was given twice daily from 02/26/21 to 03/02/21 and Azithromycin daily from 02/26/21 to 03/02/21. Review of the antibiotic stewardship log dated 02/2021 revealed Resident #19 was ordered Augmentin and Azithromycin for five days for a UTI. The resident had frequency and dysuria. Review of the Resident #19's hospital records dated 02/24/21 revealed the urine culture was a clean catch urine that had greater than 10,000 of mixed gram positive and negative flora. Further review revealed the resident had abdominal pain related to diverticulosis and constipation. The resident had lower lobe infiltrate suspected pneumonia. Azithromycin was started in addition to the Rocephin for UTI. The resident did not have fever/chills, no burning, no flank pain, no urinary frequency, no urinary hesitancy, no urinary urgency, and no confusion. Review of the Loeb minimum criteria for initiation of antibiotics with no indwelling catheter revealed acute dysuria or fever or new or worsening urgency, frequency, suprapubic pain, gross hematuria, tenderness, or urinary incontinence. Review of McGeer criteria for UTI without indwelling Foley catheter revealed the resident must meet criteria one and two. In criteria one the resident must have one of the following: acute dysuria, fever, and if absent of fever or leukocytosis they must have at least two of the following: suprapubic pain, gross hematuria, new or increased urinary incontinence, urgency, or frequency. The second criteria that must be meet was the urine culture must no show more than two species of a microorganism and a least 100, 000 cfu/ml. Interview on 05/24/21 at 10:57 A.M. with the DON confirmed Resident #19 did not meet criteria for antibiotic treatment due to the culture results showed more than two organisms. The DON reported she did not have documentation from the physician indicating treatment was necessary. Review of the antibiotic stewardship program policy dated 11/28/17 revealed the program included to use protocols and a system to monitor the antibiotic use. Laboratory testing shall be in accordance with the current standard of practice. The McGeer criteria would be used to define infections and the Loeb to be used to determine whether to treat an infection with antibiotics. Reassessment of empiric antibiotics was conducted for appropriateness and necessity, factoring in results of diagnostic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 30 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0881 Level of Harm - Minimal harm or potential for actual harm testing, laboratory reports, and/or changes in the clinical status of the resident. The facility would monitor antibiotic use. Antibiotic orders obtained on admission or re-admission to the facility shall be reviewed for appropriateness, as well as those obtained from consulting, specialty, and emergency providers. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 31 of 32 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 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/27/2021 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Emerald Pointe Health and Rehab Ctr 100 Michelli Street Barnesville, OH 43713 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and policy review the facility failed to ensure residents received pneumococcal immunizations timely. This affected two (Residents #151 and #200) of five residents reviewed for immunizations. The facility census was 48. Residents Affected - Few Findings include: 1. Resident #151 was admitted to the facility on [DATE] with diagnoses including hypertension and cough. Review of Resident #151's updated consents revealed the resident and physician had signed consents for pneumococcal consent. Review of Resident #151's medical record revealed no evidence the resident had received the pneumococcal vaccine. 2. Resident #200 was admitted to the facility on [DATE] with diagnoses including heart disease, kidney failure, and shortness of breath. Review of Resident #200's consents dated 05/13/21 revealed the resident representative had signed consent for the pneumococcal vaccine. Review of Resident #200's medical record revealed no evidence the resident had received the pneumococcal vaccine. Interview on 05/19/21 at 11:11 P.M. with Registered Nurse (RN) #60 verified Resident #151 and #200 did not received their pneumococcal vaccine and should have received them by now. Interview on 05/24/21 at 8:15 A.M. with the Director of Nursing (DON) revealed upon admission the nurses completes the consents for pneumococcal vaccine. The consents were given to her to review, then she would put the order into the computer. The DON confirmed Residents #151 and #200 had signed consents for the pneumococcal vaccine and they had not received them timely. The DON reported ideally the vaccines should be given within 72 hours after the consents were signed. Review of the resident immunization policy dated 11/2015 revealed the facility would facilitate the delivery of appropriate vaccinations in a timely manner accordance with current Centers for Disease Control (CDC) guidelines and recommendations. Following admission, residents would be offered a pneumococcal vaccine unless contraindicated or the individual had already been immunized. A physician order would be obtained for the vaccine. The appropriate pneumococcal vaccine would be administered in accordance with the current CDC guidelines and recommendations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 32 of 32