Health inspection·December 20, 2023

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few phone during the meal process with her head down. There was only a couple times STNA #16 was noted to provide feeding assistance to Resident #63 when she helped guide the resident's hand holding a sandwich to her mouth and to place a couple fries in the resident's mouth. STNA #63 was observed to remove the clothing protector from around Resident #63's neck in the last video and used it to wipe the resident's mouth without any verbal communication with the resident. She pulled the tray away while the resident continued to chew on a bite of food and continued doing so when the STNA was out of view of the camera. On 12/19/23 at 1:23 P.M., an interview with Resident #1 revealed she was the mother of Resident #63 and was the resident observed sitting in a recliner in Resident #63's room while the resident was being fed by STNA #16. She reported STNA #16 and other staff did not converse much with Resident #63 when they fed her. She stated the most she would hear them say would be to provide her instructions during the meal such as take a bite. She felt they could interact more with the resident while feeding her. She indicated the staff were always on their cell phones when she saw them. On 12/19/23 at 2:38 P.M., an interview with STNA #16 revealed she was the STNA in the videos that involved the feeding of Resident #63. She was asked to review the video that was from Resident #63's in room camera showing her providing feeding assistance to the resident. She agreed she was not engaged in conversation with the resident during the meal. She acknowledged the video showed her more focused on the cell phone with her head down than it did on providing feeding assistance to the resident. She reported the cell phone in most of the videos was what was provided to them by the facility and was what they used to do their charting. She confirmed in video #2 she did pull her personal cell phone out of her pocket and used it while Resident #63 was eating. She agreed it did not provide a dignified dining experience for Resident #63 when she was not interacting with her during the meal or when she was doing her charting when she should have been assisting the resident. 1 b.) A review of video #7 and #8 revealed they contained two minutes and 33 seconds of footage showing incontinence care being provided to Resident #63 by two STNA's. The two STNA's in the video were identified as STNA #45 and #68. The videos did not include a date but showed the STNA's transferring Resident #63 from her chair into bed and then the provision of incontinence care. Resident #1 (Resident #63's mother) was in the room at the time and was observed sitting in a recliner while the care was provided. STNA #45 and #68 was noted to be rushed during the care. Once the resident was laid down in bed, STNA #45 rapidly pulled her pants down to the resident's ankle area before completely removing them after taking off her shoes. They then removed her soiled brief and discarded it on the floor next to the bed. STNA #45 was heard in the video telling the resident sweetheart, if you cooperate, this could go a lot easier on her and the other aide. The aides did not provide care in a calm and relaxing tone, nor did they provide simple instructions to the resident explaining what they were doing before doing it. The resident was rapidly turned from side to side while the aides removed her soiled brief and applied a new one. The resident appeared startled with the rapid movements and was making ow sounds. The incontinence care was not provided in a dignified manner and the aides left the resident exposed in view of the in room camera and in the presence of Resident #1, who remained in the room while the care was being provided. On 12/19/23 at 3:05 P.M., the above videos from Resident #63's in room camera was reviewed with the Assistant Director of Nursing (ADON), Director of Nursing (DON) and the facility's Administrator. They acknowledged Resident #63 was not provided a dignified dining experience when STNA #16 was observed to feed her in six of the nine videos without engaging in any conversation with the resident and when using the cell phone for charting and personal reasons while the resident was eating. They also acknowledged Resident #63 was not provided incontinence care in a manner that promoted dignity for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 2 of 7 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 12/20/2023 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 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the resident as STNA #45 and #68 were rushed in their care and performed the incontinence care in a manner that was not dignified. They acknowledged Resident #63 was left exposed in view of her in room camera with no effort to provide privacy during the care by covering her private areas while changing her. They reported they were aware of the concerns with staff being rushed with the resident's care as one of the videos had been shared with one of their nurses prompting them to investigate. They reported they approached it as a customer service concern and provided education to the staff to address the concerns. A review of education that had been provided to the staff on 11/23/23 revealed it included helpful ways to supply a resident with good customer care. They were to treat them with respect, communicate clearly and concisely, and to focus on resident satisfaction to name a few. This deficiency represents non-compliance investigated under Complaint Number OH00149090. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 3 of 7 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 12/20/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of videos from an in room camera, resident interview, staff interview, and review of facility education information, the facility failed to ensure a resident was transferred in a safe and orderly manner. This affected one resident (#63) of three residents reviewed. Findings include: A review of Resident #63's medical record revealed she was admitted to the facility on [DATE]. Her diagnoses included Down's Syndrome, senile degeneration of the brain, muscle weakness, depression, and anxiety disorder. A review of Resident #63's admission Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had unclear speech and was sometimes able to make herself understood. She was sometimes able to understand others. Her vision was moderately impaired without the use of any corrective lenses. She had short and long term memory impairment and her cognitive skills for daily decision making was severely impaired. She was known to have hallucinations, physical behaviors directed at others, verbal behaviors directed at others, other behaviors not directed at others, and was known to reject care at times. She required substantial/ maximal assistance for going from a sitting to a standing position and for chair to bed transfers. A review of Resident #63's care plans revealed she had a care plan in place for requiring assistance with activities of daily living (ADL's) related to Down's Syndrome, senile degeneration of the brain, rheumatoid arthritis, and anxiety. The interventions indicated the resident could transfer with assist but was non-ambulatory. A review of video #8 that lasted for a minute and four seconds revealed State Tested Nurse Aide (STNA) #45 and STNA #68 was providing Resident #63 transfer assistance from her chair into bed. The video showed the aides grab the resident under her arms and use the waistband of her pajama pants to stand the resident up and to pivot her around to the bed. Her waistband was pulled upward to about her mid-back area. They did not use a gait belt during the transfer. When placing the resident onto the bed, the bed was noted to move as it was not in a locked position. On 12/19/23 at 1:23 P.M., an interview with Resident #1 revealed she was the mother of Resident #63 and spent most of the day in the room with the resident when she still resided in the facility. She confirmed she was in video #8 that showed the transfer of Resident #63 from the chair to the bed. She denied the staff used a gait belt when transferring Resident #63 in and out of bed. She indicated they had them available as they were hanging on the inside of the bathroom door, but was not typically used. On 12/19/23 at 2:20 P.M., an interview with STNA #68 verified she was one of the two aides that was in video #8 and transferred Resident #68 from her chair to bed. She confirmed they did not utilize a gait belt during the transfer despite having them available for use. She acknowledged the video showed them holding the resident up under her arms and had a hold of her waistband while standing and pivoting her. She denied she had been trained to transfer residents that way and they should have been using a gait belt for a safe transfer. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 4 of 7 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 12/20/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/19/23 at 3:05 P.M., an interview with the Assistant Director of Nursing (ADON), Director of Nursing (DON), and the facility's Administrator revealed they had not been shown any videos from Resident #63's in room camera but had heard there had been some concerns with her care. A nurse had been shown a video by the resident's sister that showed staff being rushed when providing care. They followed up on the concern as a customer service complaint. They reviewed the video and acknowledged the aides in the video failed to utilize a gait belt during the transfer. They reported gait belts were available to staff and they had provided education on the need to use them when transferring a resident. A review of the education on the use of gait belts that were provided to the facility's staff revealed using a gait belt while transferring or walking a resident would provide them and the resident increased safety and security. They could control a resident's balance and keep the resident from falling by using a gait belt. This deficiency represents non-compliance investigated under Complaint Number OH00149090. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 5 of 7 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 12/20/2023 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 in room camera video review, staff interview, and policy review, the facility failed to ensure appropriate infection control practices were followed during feeding assistance and with the provision of incontinence care. This affected one resident (#63) of three residents reviewed. Residents Affected - Few Findings include: A review of in room camera videos from Resident #63's room revealed there were nine separate videos that lasted between 14 seconds to one minute and 27 seconds in length. Six of the nine videos (videos #1, #2, #3, #4, #6, and #9) involved feeding assistance that was provided to Resident #63 by State Tested Nursing Assistant #16. Two of the nine videos were of Resident #63 receiving incontinence care as provided by State Tested Nurse Aide (STNA) #45 and #68. Of the six videos that showed Resident #63 being assisted with her meal, five of the videos (video #1, #2, #4, #6, and #9) had identified infection control concerns. STNA #16 was observed in those videos to be seated on the resident's bed assisting her with her meal. The aide was observed to wipe her nose with the outside of her hand, touch her face, use her cell phone, and handle the resident's food with her bare hands without performing proper hand hygiene, after coming into contact with those things. She was also observed in video #2 to cough over the resident's food without following proper cough etiquette by turning her head and coughing in the bend of her arm. Of the two videos that showed Resident #63 being provided incontinence care, both videos had identified infection control concerns being provided to Resident #63 (videos #7 and #8). STNA #45 was observed to remove Resident #63's soiled incontinent brief and dropped it directly on the floor next to the bed. The aides continued to provide incontinent care by putting a new incontinent brief on the resident without providing proper peri-care. Her skin that had been exposed to urine was not washed with soap and water, and a perineal wash was not used to properly clean the resident. On 12/19/23 at 2:20 P.M., an interview with STNA #68 revealed she was one of the two aides in videos #7 and #8 when incontinence care was provided to Resident #63. She confirmed STNA #45 dropped the soiled brief on the resident's floor next to her bed, as was seen on the video, and they failed to provide proper peri-care in between removing the soiled brief and applying the new incontinent brief. She acknowledged the soiled incontinence brief should have been discarded in a plastic bag or a trash can and not thrown on the floor. She further acknowledged they should have washed and rinsed the resident's perineal area, as part of their incontinence care, to help reduce the risk of infections. On 12/19/23 at 2:38 P.M., an interview with STNA #16 confirmed she did not perform proper hand hygiene after wiping her nose, touching her face, or handling her cell phone before she touched Resident #63's food with her bare hands. She also confirmed in video #2 she coughed in the direction of the resident's food without turning her head or coughing in the bend of her arm as she should have. She acknowledged cough etiquette should be followed to help limit the spread of respiratory viruses. A review of the facility's policy on Skin: Incontinence Care Protocol revised September 2017 revealed the facility would provide incontinence care for the resident to assist in maintaining skin integrity, preventing skin breakdown, controlling odor and providing comfort and self-esteem for the resident. The procedure included cleansing area with perineal wash or with a mild cleanser. They were then to pat dry and apply a protective or barrier ointment per product directions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 6 of 7 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 12/20/2023 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 Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy on Hand Hygiene revised 11/28/17 revealed hand hygiene would be properly performed to assist in the prevention of spreading infections. Hand hygiene was a general term that applied to either handwashing or the use of an antiseptic hand rub. Staff would perform hand hygiene when indicated, using proper technique. Residents Affected - Few This deficiency represents non-compliance investigated under Complaint Number OH00149090. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366352 If continuation sheet Page 7 of 7