Health inspection·July 24, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of an incident report, staff interview, and facility policy review, the facility failed to complete a thorough investigation to determine potential neglect of a resident. This affected one (#114) of three residents reviewed for neglect. The census was 110.Findings Include:Review of the medical record revealed Resident #114 was admitted to the facility on [DATE]. Diagnoses included urinary tract infection, enterocolitis, pulmonary fibrosis, muscle weakness, difficulty walking, cognitive communication deficit, morbid obesity, obstructive sleep apnea, major depressive disorder, hereditary and idiopathic neuropathy, repeated falls, hypocalcemia, hyperkalemia, acute kidney failure, hypertension, obstructive and reflux uropathy, chronic obstructive pulmonary disease, atherosclerotic heart disease, and lymphedema. Review of Resident #114's Minimum Data Set (MDS) assessment, dated [DATE], revealed the resident was cognitively intact.Review of Resident #114 progress notes dated [DATE] revealed an incident in where Resident #114 slid from her bed to near the side rail and nursing staff needed to provide interventions related to the incident. Further review of the progress notes revealed very little specific documentation about what happened to Resident #114 prior to and at the time she was found during the incident.Review of facility incident report for Resident #114 dated [DATE], written by Licensed Practical Nurse (LPN) #104, revealed Certified Nurse Aide (CNA) #111 reported Resident #114 was sliding out of the bed at the time she walked in the room. Resident #114 was lowered to the ground and was assessed for injuries. Further review of the incident reported documented no mention of Resident #114 being unconscious, presenting with blue color to the face, requiring interventions to revive the resident, or the last time Resident #114 was observed well prior to the incident. There was a written statement attached to the incident reported written by CNA #111, but no statement from LPN #110 who was the the first nurse into Resident #114's room on [DATE] after CNA #111 called for help. Interview with LPN #110 on [DATE] at 3:44 P.M. revealed she walked into Resident #114's room and saw the resident hanging from the bed near the side rail. LPN #110 saw CNA #111 moving Resident #114 to the ground and when she got to Resident #114's side, she was blue in color and not breathing. LPN #110 stated she performed sternal rubs to Resident #114 which caused the resident to begin breathing again. LPN #110 confirmed she did not write a statement for the incident and did not fill out an incident report or write a progress note as she was told by the Director of Nursing (DON) and LPN #104 they would take care of filling out the documentation.Interview with CNA #111 on [DATE] at 9:53 A.M. confirmed she wrote a statement for the incident that occurred with Resident #114 on [DATE]. CNA #111 stated she had to move Resident #114's head, but her head was never stuck between the bed rail and the mattress. CNA #111 confirmed she was never asked further questions about the incident other than writing her statement.Interview with the DON and LPN #104 on [DATE] at 11:30 A.M. confirmed they did not get a statement or receive documentation about the incident from LPN #110. They stated LPN #104 walked in almost simultaneously as CNA #111, so they would have seen the same things. They also confirmed they did not do any interviews with any of the staff members who were working on Resident #114's unit that day, including LPN #110, CNA #111, and CNA #140, who they did not know was actually assigned to Resident #114's room the morning of the incident.Review of facility policy titled, Abuse, Neglect, Exploitation, and Misappropriation of Resident Property, dated [DATE], revealed it is the facility's policy to investigate all alleged violations involving abuse, neglect, exploitation, mistreatment of a resident, or misappropriation of resident property, including injuries of unknown source. The policy also revealed the facility must have evidence that all alleged violations are thoroughly investigated.This deficiency represents an incidental finding discovered during the investigation of Complaint Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366353 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366353 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tuscany Gardens 7400 Hazelton Etna Road SW Pataskala, OH 43062 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0610 Number 2565658. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366353 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 366353 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tuscany Gardens 7400 Hazelton Etna Road SW Pataskala, OH 43062 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to complete the physician order for a urine culture in an appropriate timeframe for one (#27) of three residents reviewed for orders for urine cultures. The facility census was 110. Findings include:Record review for Resident #27 revealed the resident was admitted to the facility on [DATE] with diagnoses including hemiplegia, hemiparesis, chronic pulmonary obstructive disease (COPD), history of urinary tract infections (UTIs), and pyonephrosis.Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #27 had intact cognition evidenced by a Brief Interview for Mental Status (BIMS) score of 15. The resident was assessed to require staff assistance with bathing, dressing and grooming.Review of the care plan dated 06/24/25 revealed Resident #27 was at risk for infection related to a history of UTIs. Interventions included completing laboratory values as ordered and notifying the provider of abnormal results.Review of Resident #27's progress notes on 06/27/25 revealed the resident's physician's office was notified the same day because the resident was experiencing symptoms of a UTI, including painful urination. The physician ordered a urine culture, to be obtained by performing a straight catheter procedure, from Resident #27.Review of laboratory results for Resident #27 revealed the straight catheter procedure was not completed until 07/08/25.During an interview with Regional Registered Nurse on 07/24/25 at 11:37 P.M. she confirmed Resident #27's physician's order for a straight catheter procedure to obtain a urine culture was not completed until 07/08/25.This deficiency represents non-compliance investigated under Master Complaint Number 2570008. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366353 If continuation sheet Page 4 of 4