Health inspection·April 13, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Based on record review, interview, and facility policy review the facility failed to ensure care planning conferences were conducted quarterly. This affected one Resident (Resident #27) of one resident reviewed for care planning. The facility census was 52. Findings included: Review of Resident #27's medical record revealed an initial admission date of 12/22/20 with diagnoses including fibromyalgia, major depressive disorder, anxiety disorder, hyperlipidemia, and muscle weakness. Review of Resident #27's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 03/15/23, revealed she was moderate cognitive impairment. Review of Resident #27's care conferences revealed care conferences were conducted on 09/23/21, 10/28/21, 05/19/22, 08/18/22 and 02/23/23 Review of Resident #27's progress notes revealed she declined a care planning conference on 11/28/22 and had a care planning conference scheduled 02/22/23. There was no documentation to confirm the care planning conference scheduled for 02/22/23 occurred. Interview on 04/10/23 at 11:20 A.M. with Resident #27 revealed she did not remember having care conferences every quarter and would like to have care conferences every quarter. Interview on 04/11/23 at 3:02 P.M. with Social Worker (SW) #103 revealed care planning conferences are to be completed quarterly or every three months. She reported she started in the position 01/22 and did not know why care planning conferences were not completed quarterly for Resident #27. She reported she keeps track of care planning conferences in a book and must have missed the February 2023 care conference. Interview on 04/12/23 at 11:30 A.M. with SW #103 revealed she did find a progress note dated 02/22/23 that revealed a care conference was scheduled but there is no documentation to support it was completed. Review of the facility policy titled, Resident/Resident Representative Care Conference, revised 05/09/18, revealed on admission, the resident and/or resident representative will be informed of the facility's care conference protocols. They will be offered an initial care conference meeting. They will also be informed of a projected schedule for quarterly care conferences for the year, and that they may request a care conference at any time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 2 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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** Based on observation, record review and interview the facility failed to ensure residents were assisted with activities of daily living. This affected one resident (Resident #35) of two residents reviewed for activities of daily living (ADL). The facility census was 52. Residents Affected - Few Findings included: Review of Resident #35's medical record revealed an initial admission date of 07/17/18 and readmission on [DATE] with diagnoses including Alzheimer's disease, type two diabetes, essential hypertension, and muscle weakness. Review of Resident #35's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 02/18/23, revealed she was cognitively impaired and needed limited assistance of one person with personal hygiene. Review of Resident #35's current care plan revealed she required assistance with ADLs and may be at risk of developing complications associated with decreased ADL self-performance (weakness, pain, impaired cognition, wheelchair for mobility and non-ambulatory). Interventions included resident can groom (nails, shave, hair) herself with assistance. Review of Resident #35's Shower/Bath Skin Sheets dated 02/01/23, 02/02/23, 02/08/23, 02/10/23, 02/15/23, 02/17/23, 02/22/23, 02/24/23, 03/01/23, 03/03/23, 03/08/23, 03/10/23, 03/15/23, 03/17/23, 03/22/23, 03/24/23, 03/29/23, 03/31/23, 04/01/23, 04/05/23, and 04/07/23 revealed no check mark or x beside shaved and there was no documentation regarding facial hair. Observation on 04/10/23 at 10:18 A.M. of Resident #35 revealed multiple long facial hairs noted on her chin. An interview at the time with Resident #35 revealed staff had never offered to remove her chin hairs and she would like them removed. Observation on 04/11/23 at 11:50 P.M. of Resident #35 sitting in her recliner and the multiple long hairs remaining on her chin. Interview on 04/11/23 at 3:35 P.M. with State Tested Nursing Assistant (STNA) #114 revealed ADL care included bathing, brushing teeth, cleaning nails, brushing hair, applying deodorant and removing facial hair from both men and women. Observation on 04/11/23 at 3:36 P.M. with STNA #114 of Resident #35's face verified several long chin hairs. An interview after leaving the room with STNA #114 verified Resident #35's multiple chin hairs were close to one inch long and should have been removed during ADL care. Interview on 04/11/23 at 3:48 P.M. with the Assistant Director of Nursing (ADON) verified facial hair should be assessed when ADL care is provided and should be removed per the resident's wishes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 3 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Review of the medical record revealed Resident #14 was admitted to the facility on [DATE]. Diagnoses included chronic kidney disease, chronic obstructive pulmonary disease (COPD), hypertension, heart disease, restless leg syndrome, anemia, and muscle weakness. Residents Affected - Few Review of the Minimum Data Set (MDS) assessment, dated 03/03/23, revealed Resident #14's Brief Interview for Mental Status (BIMS) score was 15, which indicated intact cognition. There were no behaviors or rejection of care. The resident received oxygen therapy. Review of the physician order dated 07/09/22 revealed oxygen per nasal cannula to maintain saturation above 90 % every shift related to COPD and an order dated 07/15/22, revealed to change oxygen tubing every night shift every Friday. Observation on 04/10/23 at 3:50 P.M. revealed Resident #14's oxygen tubing was dated 01/27/23. During interview on 04/10/23 at 3:57 P.M., the Assistant Director of Nursing (ADON) confirmed Resident #14's oxygen tubing was dated 01/27/23 and had not been changed weekly as ordered. Review of the facility policy titled, Respiratory Equipment Cleaning/Disinfecting, revised 09/14/18, revealed nebulizer tubing and medication cup was to be changed weekly or as needed and stored clean and dry in a plastic bag between usages. 2. Review of Resident #3's medical record revealed an admission of 04/18/10 with diagnoses including chronic respiratory failure and chronic obstructive pulmonary disease (COPD). Review of the significant change Minimum Data Set (MDS) 3.0 assessment, dated 03/20/23, revealed the resident was not cognitively intact and had current diagnosis including chronic respiratory failure, chronic lung disease and the resident used oxygen. Review of the current physician orders revealed an order for ipratropium-albuterol solution 0.5-2.5 three milligrams (mg)/three milliliters (ml) give one dose inhalation every four hours as needed for shortness of breath or wheezing via nebulizer and one dose inhalation three times a day (scheduled) for shortness of breath. Review of the April 2023 Medication Administration Record (MAR) revealed the resident received nebulizer treatments of ipratropium-albuterol solution 0.5-2.5 three mg/three ml three times a day for shortness of breath as scheduled through 04/12/23. Review of the current care plan revealed the resident had a potential for impaired respiratory function related to COPD, chronic respiratory failure, cardiac disease, rhinitis, required oxygen as times and became short of breath lying flat and with exertion at times. Interventions included administering oxygen as ordered and aerosol (nebulizer) treatments as ordered. Observation on 04/10/23 at 9:10 A.M. of Resident #3's mask and tubing for the nebulizer treatments was laying on a table in the resident's room. The mask was not in a bag and there was no date to verify when the mask was changed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 4 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and interview on 04/10/23 at 4:01 P.M. with Registered Nurse (RN) #107 verified the nebulizer mask and tubing were not in a bag and the mask was not dated. RN #107 also verified the mask and tubing should be in a dated storage bag when not in use. Interview on 04/10/23 at 5:05 P.M. with RN #170 verified nebulizer masks should be stored in a bag to keep them clean. Based on observation, medical record review, interview and policy review, the facility failed to properly store nebulizer masks for two residents (Resident #3 and Resident #9) and failed to change oxygen tubing weekly for one resident (Resident #14). This affected three residents (Resident #3, #9 and #14) of four residents reviewed for respiratory care. The facility census was 52. Findings include: Record review revealed Resident #9 was admitted to the facility on [DATE] with diagnoses of congestive heart failure, pneumonia, and unspecified cough. Review of current medication orders revealed Resident #9 was ordered Albuterol Sulfate inhalation solution 2.5 milligrams per three milliliters four times per day via nebulizer for unspecified cough. Observation of Resident #9, on 04/10/23 at 11:31 A.M., revealed the resident was in their room, seated in a wheelchair and receiving two liters of oxygen via nasal cannula. A nebulizer machine (used to administer breathing treatments) was sitting on a nightstand. A handheld nebulizer mouthpiece was laying on the floor without a barrier or bag and was connected to the nebulizer by undated tubing Observation and interview on 04/10/23 at 3:57 P.M. with Licensed Practical Nurse (LPN) #129 verified the nebulizer handheld mouthpiece was not properly stored as it was laying on the floor and the tubing was not dated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 5 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to ensure antibiotics were discontinued per physician orders. This affected one resident (Resident #15) of six residents reviewed for unnecessary medication use. The facility census was 52. Residents Affected - Few Findings included: Review of Resident #15's medical record revealed an admission date of 09/09/22 with diagnoses including unspecified dementia, atherosclerotic heart disease of native coronary artery, chronic kidney disease stage four, essential hypertension, and hemiplegia affecting the left nondominant side. Review of Resident #15's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 01/25/23, revealed she was not cognitively intact and during the assessment period, received one day of an antibiotic. Review of Resident #15's progress note dated 01/24/23 at 2:58 P.M. revealed a urinalysis result was reviewed by the physician and ampicillin 500 milligrams (mg) bid (twice a day) for three days was ordered. The progress note was entered by Registered Nurse (RN) #163. Review of Resident #15's physician orders revealed an order dated 01/24/23 for ampicillin oral capsule 500 mg, give one capsule by mouth two times a day for urinary tract infection. Registered Nurse (RN) #163 entered the order and there was no stop date entered until 01/30/23. Review of Resident #15's January 2023 Medication Administration Record (MAR) revealed she received the ampicillin 500 mg oral capsule two times a day from 01/25/23 to 01/29/23 and in the morning on 01/30/23. Resident #15 had received the ampicillin for five- and one-half days. Interview on 04/12/23 at 4:53 P.M. with RN #163 revealed she did enter the order for the ampicillin for Resident #15 on 01/24/23. She verified there was no stop date on the order she entered and the order should have had a stop date. She verified she entered the progress note on 01/24/23 at 2:58 P.M. regarding the physician ordering the ampicillin twice a day for three days. RN #163 verified Resident #15 received five extra doses of ampicillin which was an unnecessary medication due to the order not being entered correctly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 6 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Based on record review and interview, the facility failed to provide an appropriate diagnosis for a resident receiving an antipsychotic medication. This affected one resident (Resident #48) of six residents reviewed for unnecessary medications. The facility census was 52. Findings include: Review of the medical record for Resident #48 revealed an admission date of 0/19/22. Diagnoses included Alzheimer's disease, dementia with psychotic disturbance, hypertension, muscle weakness, and severe protein-calorie malnutrition. Review of the Minimum Data Set (MDS) assessment, dated 01/26/23, indicated Resident #48's Brief Interview for Mental Status (BIMS) score was 04, which indicated severely impaired cognition. The resident did not have any hallucinations, delusions, physical or verbal behaviors, or rejection of care. Review of a psychiatric nurse practitioner progress note, dated 02/06/23, revealed the resident did not have behaviors or paranoia. Review of a physician progress note, dated 02/25/23, revealed the resident denied depression, anxiety, or nervousness. Review of a physician order, dated 02/09/23, revealed the order for Risperdal oral tablet, 0.25 milligrams (mg) by mouth at bedtime for mood disorder. Review of the Medication Administration Record (MAR), dated April 2023, indicated the resident received Risperdal 0.25 milligrams (mg) every night. During an interview on 04/11/23 at 2:26 P.M., the Director of Nursing (DON) verified the resident received Risperdal, which is an antipsychotic medication. The DON confirmed the physician order, dated 02/09/23, stated the indication for use was a mood disorder and this was not an approved diagnosis for the use of an antipsychotic medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 7 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and facility policy review the facility failed to store foods properly to prevent spoilage and/or contamination. This had the potential to affect 51 residents receiving food from the kitchen. The facility identified one resident (Resident #155) as receiving nothing by mouth. The facility census was 52. Findings included: Observation on 04/10/23 at 8:15 A.M. of the kitchen revealed the following items in the walk-in refrigerator which were opened and not dated: one large bag of mixed green salad, one squeeze bag of whipped cream, and a partial ham wrapped in aluminum foil. There was also one resealable plastic bag of hot dogs, dated 04/08/23, with the seal not completely closed. Observation on 04/10/23 at 8:23 A.M. of the following items in the reach in the dining refrigerator which were opened and not dated: one large container of International Delight Amaretto coffee creamer which was one-half full. Observation on 04/10/23 at 8:25 A.M. of the cooks' reach in refrigerator revealed the following items, opened, and not labeled or dated: a five-gallon container and a smaller container of an unidentifiable gravy/soup-like substance. Interview on 04/10/23 at 8:30 A.M. with Dietary Supervisor (DS) #102 verified the observations and all food should be labeled and dated when it was opened and/or prepared. Review of the facility policy titled, Date Labeling - use By Dates for Perishable food, dated August 2017, revealed items must be dated after opening with an Open date and a Used by Date, unless specified in the table below. The use-by-date will be seven days (today plus six), unless the original manufacturer expiration date is before the seven days (meaning, the food service operation may not exceed a manufacturer's use-by-date). All food should be discarded prior to or on day seven. Further review revealed all foods should be properly labeled with the food name unless it is unmistakably recognized (such as dried pasta). All food should be securely closed to avoid being exposed to air. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 8 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview the facility failed to ensure outside garbage was contained in a receptacle. This had the potential to affect all 52 residents residing in the facility. Residents Affected - Few Findings included: Observation on 04/11/23 at 11:25 A.M. with Dietary Supervisor (DS) #102 revealed two garbage dumpsters in the back corner of the facility parking lot. Each dumpster had two lids which could be moved to create an approximate six-inch gap between them. There was a large amount of garbage observed on the ground. The garbage started around six feet from the dumpsters and went down the hill into the woods approximately 20 yards. An interview at the time of the observation with DS #102 revealed she believed raccoons got in the dumpsters and took out items. She stated the garbage down the bank into the woods was from raccoons and the garbage had been down the bank and into the woods for quite a long time. Interview on 04/11/23 at 1:55 P.M. with the Administrator verified garbage should be in the dumpsters and not scattered down the hill. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 9 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 Based on observation, record review, interview and facility policy review the facility failed to ensure the appropriate transmission based precautions were posted for a resident in isolation. This affected one resident (Resident #36) of one resident reviewed for transmission based precautions. The facility census was 52. Residents Affected - Few Findings include: Review of Resident #36's medical record revealed an initial admission date of 05/04/21 with diagnoses including Guillain-Barre syndrome (a rapid- onset muscle weakness caused by the body's immune system damaging the peripheral nervous system), type two diabetes mellitus without complications, essential hypertension, hyperlipidemia, and muscle weakness. Review of Resident #36's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 01/09/23, revealed he was cognitively intact. Review of Resident #36's physician order dated 03/31/23 to 04/10/23 revealed he was on contact isolation for Methicillin Resistance Staphylococcus Aureus (MRSA) (a staph bacteria that has become resistant to many of the antibiotics used to treat ordinary staph infections and is the bacteria is contagious) in his urine. Review of Resident #36's progress note dated 03/31/23 to 04/10/23 revealed only one noted documentation of contact isolation. This was on 04/10/23 at 2:33 P.M. when the order was received to discontinue isolation. Observation on 04/10/23 at 9:47 A.M. of an isolation cart outside of Resident #36's room containing hand sanitizer, gowns, surgical masks, and alcohol wipes. The signage on Resident #36's door revealed he was in droplet isolation (health care personnel caring for a resident on these precautions must wear a face mask for close resident contact). Speech Therapist (ST) #171, exited the door wearing a surgical mask and personal glasses and was rubbing her hands. She reported she had a gown and gloves on and removed them prior to exiting the room and used hand sanitizer to clean her hands. The ST denied wearing any other eye protection or face shield. She changed her surgical mask to a new surgical mask. When ST #171 was asked the type of isolation Resident #36 required, she responded, I think for MRSA in a wound. She verified that the signage outside the door was for droplet isolation and not contact precautions (requiring a gown and gloves while in the resident's room to prevent the spread of infection). She verified she did not use an N-95 mask or eye protection as needed for droplet precautions as indicated on the resident's door. She verified if Resident #36 did have MRSA of a wound, he should be on contact isolation and not droplet precautions. Interview on 04/10/23 at 9:50 A.M. with ST #171 revealed she had just spoke with the nurse and Resident #36 was on contact isolation precautions due to MRSA in his urine and not his wound. The ST verified the signage posted was incorrect. Review of the facility policy titled, Standard and Transmission-based Precautions, revised 11/28/17, revealed information regarding the particular type of precaution to be utilized will be communicated through verbal reports, written in-house communication forms, and signage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 10 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 Based on record review, interview, Loeb's Minimum Criteria for Initiating Antibiotic Therapy review and facility policy review the facility failed to ensure residents met the minimum criteria for initiating antibiotic use. This affected one resident (Resident #15) of six residents reviewed for unnecessary medication use. The facility census was 52. Residents Affected - Few Findings included: Review of Resident #15's medical record revealed an admission date of 09/09/22 with diagnoses including unspecified dementia, atherosclerotic heart disease of native coronary artery, chronic kidney disease stage four, essential hypertension, and hemiplegia affecting the left nondominant side. Review of Resident #15's quarterly Minimum Data Set (MDS) 3.0 assessment, dated 01/25/23, revealed she was not cognitively intact and during the assessment period, received one day of an antibiotic. Review of Resident #15's progress note dated 01/24/23 at 2:58 P.M. revealed a urinalysis result was reviewed by the physician and ampicillin 500 milligrams (mg) bid (twice a day) for three days was ordered. The progress note was entered by Registered Nurse (RN) #163. Review of Resident #15's physician orders revealed an order dated 01/24/23 for ampicillin oral capsule 500 mg, give one capsule by mouth two times a day for urinary tract infection. Registered Nurse (RN) #163 entered the order and there was no stop date entered until 01/30/23. Review of Resident #15's January 2023 Medication Administration Record (MAR) revealed she received the ampicillin 500 mg oral capsule two times a day from 01/25/23 to 01/29/23 and in the morning on 01/30/23. Resident #15 had received the ampicillin for five- and one-half days. Review of Resident #15's urinalysis with culture and sensitivity, collected on 01/19/23, revealed it was faxed to the resident's physician on 01/21/23. In handwriting was the information indicating the resident was asymptomatic and her medication allergies. The results revealed she had more than 100,000 colonies per milliliter of urine of Escherichia Coli (E. Coli) and the bacteria was susceptible to the antibiotic, ampicillin. Review of Resident #15's Loeb's Minimum Criteria for Initiating Antibiotic Therapy, dated 01/19/23, revealed the resident did not meet the requirements for an antibiotic for a urinary tract infection for a resident without a catheter. The Loeb's revealed the minimum criteria for starting antibiotic therapy for a urinary tract infection without a catheter were either of the following criteria: acute dysuria (pain with urination), OR a temperature greater than 100 degrees Fahrenheit or 2.4 degrees above baseline, AND greater or equal to one of the following (new or worsening symptoms: urgency, suprapubic pain, urinary incontinence, frequency, gross hematuria, costovertebral angle tenderness). Review of Resident #15's progress notes revealed no documentation of symptoms to warrant the use of the antibiotic or evidence her physician was notified that she did not meet the requirement for antibiotic use. Interview on 04/12/23 at 5:20 P.M. with the Director of Nursing (DON), who is also the Infection Preventionist (IP), revealed the faxed urine culture results had handwritten on it that Resident #15 did not have urinary symptoms. She verified she did not reach out to Resident #15's physician to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 11 of 12 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366352 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 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 Residents Affected - Few inform the physician Resident #15 did not meet the requirements for antibiotic use. The DON revealed she relied on the nurses to inform the physicians when they get the order. Interview on 04/12/23 at 5:25 P.M. with RN #163 revealed she did not inform the physician when she received the order for the ampicillin that Resident #15 did not meet the requirements for the use of an antibiotic. Review of the facility policy titled Antibiotic Stewardship Program, dated 11/28/17, revealed it is the policy of this facility to implement an Antibiotic Stewardship Program as part of the facility's overall infection prevention and control program. The purpose of the program is to optimize the treatment of infections while reducing the adverse events associated with antibiotic use. Further review revealed the Loeb Minimum Criteria are used to determine whether or not to treat an infection with antibiotics. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 12 of 12