Health inspection·February 27, 2020

F 0558 Reasonably accommodate the needs and preferences of each resident. 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 provide a dining table at an appropriate height to accommodate Resident #57's needs. This affected one resident (#57) of one resident reviewed for accommodation of needs. Residents Affected - Few Findings include: Medical record review revealed Resident #57 was admitted to the facility on [DATE] with diagnoses including coronary artery disease, weakness, lack of coordination and pain in left shoulder. Review of Resident #57's Minimum Data Set (MDS) 3.0 assessment, dated 12/17/19 revealed the resident required extensive assistance from one person for bed mobility, transfers, and dressing. For eating, the resident required supervision and set-up help. During observation on 02/24/20 at 12:10 P.M., Resident #57 was sitting in her wheelchair at a dining table in the main ding room. The top of table was level with the resident's upper chest, requiring the resident to reach up with her arms to access the food. During a subsequent observation on 02/27/20 at 5:10 P.M., the resident was again observed sitting in her wheelchair in the main dining room reaching up for her food due to the table being too high for the resident. During an interview on 02/27/20 at 5:13 P.M. Dietary Manager (DM) #100 confirmed Resident #57 sits lower than she should be at the dining table. DM #100 revealed the facility had tried different booster seats, however the resident didn't like either of them. DM #100 revealed she would speak with management regarding obtaining a new, lower table at an appropriate height for Resident #57. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 2 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview the facility failed to ensure Minimum Data Set (MDS) 3.0 assessments were accurately completed for Resident #53 and Resident #86. This affected two residents (#53 and #86) of 31 residents whose MDS assessments were reviewed. Residents Affected - Few Findings include: 1. Review of Resident #53's medical record revealed an admission dated of 04/02/18 with diagnoses including chronic kidney disease, cerebral infarction, contracted left elbow and peripheral vascular disease. Review of a 01/16/20 Skin and Wound Evaluation revealed a new in house acquired right buttock abrasion measuring 2.0 centimeters (cm) by 5.2 cm with a pink/red wound bed and light serous exudates. Review of a 01/16/20 Skin and Wound Evaluation revealed an in house acquired left buttock abrasion measuring 2.8 centimeters (cm) by 2.6 cm with a pink/red wound bed and light serous exudates. A 01/22/20 nurse's note indicated the physician visualized the areas on the buttocks and reviewed the Skin and Wound evaluations. The physician was aware of and agrees with the origin of wound being an abrasion that is healing. Areas show improvement. No pressure injuries noted. Review of the 01/23/20 quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident was independent for daily decision making, required extensive assist of two staff for bed mobility, was totally dependent of two staff for transfers, did not walk, was at risk for pressure ulcers and had two unhealed Stage II (partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough or bruising. May also present as an intact or open/ ruptured blister) pressure ulcers. Interview on 02/25/20 at 03:31 P.M. with Licensed Practical Nurse (LPN) #27 verified the MDS nurse read the description and thought the areas were Stage II pressure ulcers and coded the MDS as such which was different than the assessments. LPN #27 verified since the physician visualized the area the day prior and said they were abrasions not pressure ulcers they should not have been coded pressure ulcers. 2. Review of Resident #86's medical record revealed an admission dated of 12/06/19 with diagnoses including diabetes, anxiety, depression and history of falling. Review of the 12/18/19 Discharge MDS 3.0 assessment revealed the resident was discharged to an acute hospital resulting in a review for hospitalization. However, review of the corresponding nursing notes revealed the resident was discharged to home 12/18/19 with home health. Interview on 02/25/20 at 4:46 P.M. with LPN #27 verified the MDS 3.0 assessment was coded in error as discharge to acute hospital when it should of been discharge to home. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 3 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 - Some 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 staff interview the facility failed to ensure Preadmission Screening and Resident Reviews (PASARRs) were completed and accurate to capture changes in diagnosis warranting a reassessment. This affected four residents (#9, #24, #34 and #51) of four residents reviewed for PASARR. Findings include: 1. Review of Resident #24's 08/09/17 PASSAR revealed no diagnoses under the question Does the individual have a diagnosis of any of the mental disorders listed below? The question was answered no. The list included other psychotic disorders and Schizophrenia. Record review revealed Resident #24's was admitted to the facility on [DATE]. Review of Resident #24's diagnoses list revealed an added diagnosis of unspecified psychosis not due to substance or known physiological condition added 11/12/17 and schizoaffective disorder added 10/19/18. Record review revealed as 02/25/20 the facility had not completed/submitted a new PASARR for the resident to capture the new diagnoses and to determine if Level II services were indicated. Interview on 02/25/20 at 12:29 P.M. with Social Services (SS) #121 revealed in her training she learned a new diagnosis could trigger a new PASSAR. SS #121 verified the facility did not complete a new PASSAR with the psychosis diagnosis of 11/12/17 or schizoaffective diagnosis of 10/19/18. SS #121 verified a new PASSAR should be completed for Resident #24. 2. Review of Resident #34's 04/09/12 admission PASARR revealed the only pertinent diagnosis included was Mood Disorder. The list included other psychotic disorders and Another mental disorder other than Mental Retardation that may lead to chronic disability. Record review revealed Resident #34 was admitted to the facility on [DATE]. Review of Resident #34's diagnoses list included a diagnosis of unspecified psychosis not due to substance or known physiological condition and diagnosis of major depression added 08/31/15. Record review revealed as 02/25/20 there was no evidence a new PASARR had been completed/submitted for Resident #34 to capture the new diagnoses and to determine if Level II services were indicated. Interview on 02/25/20 at 12:36 P.M. with SS #121 verified the diagnoses of psychosis and depressive disorder were added as new diagnoses after admission and a new PASARR had not been completed and should have been. 3. Review of Resident #9's 05/11/18 admission PASARR revealed the only pertinent diagnosis listed was mood disorder. The list included other psychotic disorders, Another mental disorder other than Mental Retardation that may lead to chronic disability and severe anxiety disorder. Review of the 11/21/18 readmission PASSAR revealed no pertinent diagnoses listed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 4 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 - Some Review of Resident #9's medical record revealed a readmission date of 11/21/18 with diagnoses including bipolar disorder (05/11/18), mood disorder (05/11/18) and anxiety disorder (11/21/18). Record review revealed no evidence the PASARR documentation accurately reflected the resident's diagnosis on the 05/11/18 or the 11/21/18 PASSAR. As of 02/25/20 there was no evidence an accurate and complete PASSAR had been completed/submitted for Resident #9 to determine if Level II services were indicated. Interview on 02/25/20 at 12:31 P.M. with SS #121 verified the diagnoses of bipolar and anxiety disorders were present on admission and were not captured on the 05/11/18 or 11/21/18 PASARRs. SS #121 revealed a new PASARR new/corrected PASARR should have been completed. 4. Review of Resident #51's Preadmission Screening and Resident Review (PASARR) Identification Screen dated 11/12/19 revealed diagnoses including schizophrenia and bipolar disorder. No other diagnoses were documented on the PASARR. Further review revealed the resident consented to receiving mental health and counseling services, did not meet nursing home criteria and her needs could be met in an appropriate community setting that could provide for her ongoing need for psychiatric support such as a group home or assisted living facility and these options should be explored for the resident. The resident had been evicted from her apartment recently and that was why she was being placed in a nursing home until other housing was found. The resident required assistance with finding other housing. Medical record review revealed Resident #51 was admitted on [DATE] with diagnoses including paranoid schizophrenia, catatonic schizophrenia, major depressive disorder and anxiety disorder. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #51 was impaired for daily decision making, the resident and family/significant other participated in the assessment and the family/significant other, not the resident, indicated the expectation was the resident was to remain within the facility. Review of the record revealed no evidence another PASARR was completed after admission to capture the diagnoses of major depression disorder and anxiety disorder, or regarding the resident staying long term at the facility. On 02/25/20 at 12:22 P.M. and 12:50 P.M., interview with SS #121 revealed she had not reviewed Resident #51's PASRR because she only looked at them if she was told to do one. SS #121 verified a new PASARR should have been submitted with the addition of new diagnoses and the plan to remain at the facility long term. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 5 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview the facility failed to develop, implement and provide residents/representatives with a baseline plan of care as required. This affected two resident (#58 and #284) of eight residents reviewed for baseline plans of care. Findings include: 1. Review of Resident #284's medical record revealed an admission date of 02/15/20 with diagnoses including major depressive disorder, unspecified psychosis, anxiety disorder and congestive heart failure. Review of the physician's orders included an order for the medication, Seroquel (an antipsychotic), an order for the medication, Sertraline (an antidepressant) and daily weights. Record review revealed no evidence the facility had provided the resident and the resident's representative with a summary of a baseline care plan that included but was not limited to: (i) The initial goals of the resident. (ii) A summary of the resident's medications and dietary instructions. (iii) Any services and treatments to be administered by the facility and personnel acting on behalf of the facility. (iv) Any updated information based on the details of the comprehensive care plan, as necessary. Interview on 02/27/20 at 10:41 A.M. with the Director of Nursing (DON) verified there was no evidence of a baseline or comprehensive plan of care being provided to the resident/representative within 48 hours of admission. The DON verified if there was a care plan ever provided it would be scanned into the residents electronic record. The DON verified there was not a plan of care ever provided to the resident or representative for any area of the resident's diagnoses and/or care. 2. Medical record review revealed Resident #58 was admitted to the facility on [DATE] with diagnoses including congestive heart failure and diabetes mellitus. The resident was discharged to the hospital on [DATE] and returned to the facility on [DATE]. Review of the physician's orders, dated 02/16/20 revealed the resident was to receive Hospice care. Record revealed no evidence of a baseline care plan or any care plan regarding the resident receiving Hospice services upon return to the facility provided to the resident and/or the resident's responsible party. On 02/26/20 at 2:07 P.M. interview with Assistant Director of Nursing (ADON) #1 revealed baseline care plans were to be completed if the resident was at the hospital a minimum of five days and upon their return a baseline care plan was to be completed until the comprehensive assessment and care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 6 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0655 Level of Harm - Minimal harm or potential for actual harm plans were completed due to changes that might have occurred during the course of the resident's hospitalization. ADON #1 verified Resident #58 had been hospitalized for six days, there was no baseline care plan for Hospice services and stated this was due to it not being an option on the admission nursing assessment and that was the only way to populate the care plan. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 7 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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, medical record review and interview the facility failed to ensure Resident #7, who was dependent on staff for personal care was provided timely care and care according to the resident's preferences. This affected one resident (#7) of five residents reviewed for activities of daily living (ADL). The facility identified 28 residents dependent on staff for bathing. The facility census was 95. Residents Affected - Few Findings include: Medical record review revealed Resident #7 was admitted to the facility on [DATE] with diagnoses including a spinal cord injury, osteoarthritis and heart failure. Review of the quarterly Minimum Data Set 3.0 assessment dated [DATE] revealed the resident was cognitively intact for daily decision-making, required extensive assist of two staff with personal hygiene and was dependent on staff for bathing. Review of the care plan titled ADL Self-Care Performance Deficit, revised 01/09/20 revealed Resident #7 had a very specific routine of how he preferred his daily ADL's to be completed. Interventions included the resident preferred his bathing two to three times a week on the 10:00 P.M. to 6:00 A.M. shift. Other interventions included the use of consistent routines, to keep fingernails trimmed and clean, and the nail length was to be checked, trimmed, and cleaned on bath days and as needed (PRN). Review of the Tasks: Shower/Bath and Personal Hygiene dated 02/24/20 and 02/25/20 revealed bathing and hygiene was provided to the resident during the 6:00 A.M. to 2:00 P.M. shift. There was no documented evidence Resident #7 had been offered a shower or personal hygiene on the 10:00 P.M. to 6:00 A.M. shift and no evidence Resident #7 had been shaved or provided nail care. On 02/24/20 at 10:18 A.M., observation revealed Resident #7 sitting in the hallway outside his room in a specialized wheelchair. The resident had whiskers, food debris on his clothing and on his face and long fingernails with yellow/brown debris under the nails. On 02/26/20 at 10:29 A.M., observation revealed Resident #7's fingernails were jagged with yellow and dark debris noted under the fingernails and he also had heavy facial hair growth. Interview with Resident #7 at the time of the observation revealed today was his shower day, he was not growing a beard and wanted shaved but no one had helped him. Resident #7 stated he was in the bathroom yesterday and someone had asked him if his nails needed trimmed and he said yes but they did not trim or clean his nails. Resident #7 also stated he had not been shaved since his last shower and only gets shaved on shower days but he doesn't want facial hair. At the time of the observation, Nurse Manager #2 was informed of the above, looked at the resident's personal hygiene including nails and facial hair and agreed with the above observation. Nurse Manager #2 stated shaving and nail care was to be provided on shower days and PRN. Nurse Manager #2 further stated residents should not have to wait for their assigned shower day to receive personal hygiene. At the conclusion of the interview, a staff member took the resident to the shower room. On 02/26/20 at 11:25 A.M., interview with Registered Nurse #4 revealed it was her expectation that bathing and personal hygiene was to be completed when needed and per resident preference as care planned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 8 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of Resident #34's medical record revealed the resident was admitted to the facility on [DATE] with diagnoses including glaucoma, diabetes and depression. Residents Affected - Few Review of the admission consent, dated 04/12/12 revealed the resident consented to optometry, and audiology. Review of a 06/12/19 impaired communication plan of care related to a hearing deficit revealed a 06/12/19 intervention to ensure bilateral hearing aids were in place and functioning every shift while awake. Review revealed the resident's last audiology visit was on 08/07/19. The consult read The patient complained of hearing loss. Hearing loss is long standing. The hearing loss and options for hearing aides were discussed. Impressions were taken to begin a trial with binaural in the ear hearing aides. Follow up at the next facility visit for a hearing aide fitting. The patient is interested in a trial with hearing aides. Hearing aide recommendation: In the ear bilateral earmold. Impressions were completed. A Certificate of Medical Need/Physician statement was left at the facility and will be signed by the primary care doctor prior to a hearing aide fitting. The examine concluded severe to profound hearing loss with fair speech discrimination. Follow up: Hearing aide fitting in 1-3 months. Record review revealed there was no evidence of a follow up. The resident was on the list to be seen for a return visit on 12/04/19 but was not seen. Review of the 02/16/20 quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident was independent for daily decision making, with moderately impaired hearing, wore hearing aides and had impaired vision with no corrective lenses. Interview on 02/24/20 at 1:58 P.M. with Resident #34 revealed her hearing was not very good. Questions needed to be repeated in order for the surveyor to be understood. The resident did not have hearing aids in during the interview. Interview on 02/26/20 at 2:00 P.M. with Licensed Practical Nurse (LPN) #27 revealed the resident had had hearing aids since arriving. When he did the MDS on 02/16/20 he asked the STNA staff if her hearing aids were in and they said yes. He said the had a merger of the care plans and the intervention with a 06/12/19 date to place hearing aids because the plans were merged that day. LPN #27 revealed the intervention would have been added on admission if she arrived with them. Interview on 02/26/20 at 02:05 P.M. with Registered Nurse (RN) #2 revealed the resident's daughter said the resident refused to wear the hearing aids she had at times. There was an old hearing aid case with her name in the medication cart that contained new batteries but no hearing aids. Interview on 02/26/20 at 2:13 P.M. with STNA #65 revealed she did not remember ever seeing the resident with hearing aids. She was unable to find them in the room. Interview on 02/26/20 at 2:15 P.M. with STNA #4 revealed it had been two to three years since she last saw the resident's hearing aids. She was unable to find them in the room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 9 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 02/27/20 at 11:26 A.M. with SS #121 revealed the audiology company left a prescription for the doctor to sign for the hearing aids. When they returned the prescription was not signed so they did not do the fitting for the hearing aids. SS #121 said she did not know where the prescription was. She said she spoke to the resident and she wanted hearing aids. The staff looked in her room and could not locate her old ones. No one could say when she had them last. SS#121 verified getting the prescription signed so the resident could be fitted for hearing aids fell through the cracks. Based on record review and interview the facility failed to ensure Resident #27's hearing aids were in proper working order and failed to obtain hearing aids for Resident #34. This affected two residents (#27 and #34) of three residents reviewed for hearing. Findings include: 1. Medical record review revealed Resident #27 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, pulmonary fibrosis, and a history of falling. Review of the plan of care, dated October 2019 revealed no documentation of hearing aids. Review of the progress notes, dated October 2019 through 02/25/20 revealed no documentation of improperly working hearing aids. Review of Resident #27's Minimum Data Set (MDS) 3.0 assessment, dated 12/17/19 revealed the resident required extensive assistance from one person for bed mobility, transfers and dressing. During an interview on 02/25/20 at 2:11 P.M., Resident #27 revealed she was very hard of hearing and had not been able to wear her hearing aids for a couple of weeks because the volume hasn't been functioning properly. The resident revealed she had notified staff but had not been offered audiology services. During an interview at 02/25/20 at 2:20 P.M., State Tested Nursing Assistant (STNA) #65 revealed Resident #27 does have hearing aids, however, she hasn't been wearing them because the hearing aids were broken. During an interview on 02/25/20 at 3:03 P.M., Social Services (SS) #121 revealed she had not been notified of the resident's hearing aids not working properly and confirmed the resident was not on the list for an audiology visit, however, she would speak with the resident and refer her for audiology services. During an interview on 02/25/20 at 3:18 P.M. Licensed Practical Nurse (LPN) #27 revealed he was unaware the resident wore hearing aids. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 10 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 observation, record review and interview the facility failed to ensure Resident #14, who was at risk for falls was provided fall safety interventions as care planned. This affected one resident (#14) of two residents reviewed for accidents. Findings include: Medical record review revealed Resident #14 was admitted to the facility on [DATE] with diagnoses including dementia without behavioral disturbance, epilepsy and history of cardiovascular accident with right-sided weakness. Review of the plan of care, dated 06/18/19 revealed the resident as at risk for falls with an intervention to wear non-skid footwear when out of bed. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 09/05/19 revealed Resident #14 required extensive assistance from one person for locomotion and extensive assistance from two persons for bed mobility and transfers. Review of a nursing progress note, dated 11/10/19 at 6:30 P.M., revealed Resident #14 was found on floor following a fall, without injury. On 02/25/20 at 11:23 A.M. Resident #14 was observed out of bed without non-skid footwear. At the time of the observation, interview with State Tested Nursing Assistant (STNA) #44 confirmed Resident #14 was not wearing anti-skid socks (non-skid footwear) and the STNA revealed she would get a pair immediately. During an interview on 02/25/20 at 3:15 P.M. the Director of Nursing (DON) confirmed Resident #14 should have non-skid socks on at all times when out of the bed due to the resident's fall risk. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 11 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 observation, record review and interview the facility failed to ensure adequate and necessary care and treatment was provided for Resident #42 related to the use of an indwelling urinary catheter. The facility also failed to ensure a bowel program was initiated for Resident #58 after a noted decline in bowel function. This affected one resident (#42) of three residents reviewed for UTI/catheters and one resident (#58) of one resident reviewed for bowel function. Findings include: 1. Record review revealed Resident #42 was admitted to the facility on [DATE] with diagnoses including retention of urine, urinary tract infection, indwelling foley catheter and fracture of right femur. Review of Resident #42's nursing progress notes and orders dated 02/2020 revealed on 02/13/20 Resident #42 had complaints of bladder spasms and requested a prescription for Pyridium for the spasms. The physician was notified, and new orders were received for Pyridium 100 milligrams (mg) three timed daily for three days and for a urinalysis. On 02/17/20 at 3:24 P.M., additional orders were received for the antibiotic, Cipro 500 mg twice daily for 10 days, Pyridium 200 mg three times daily for two days, and Florastor (a probiotic) twice daily for one month. Review of Resident #42's urine laboratory results revealed on 02/13/20 at 8:00 P.M., the urine specimen was collected. The lab received the urine on 02/14/20 at 8:56 A.M. The urine and culture results were reported to the facility on [DATE] at 11:45 A.M. The resident's urine culture indicated the resident had Escherichia coli and Cipro was sensitive. There as a handwritten note dated 02/17/20 by Registered Nurse (RN) #3 that indicated to start Cipro 500 mg twice daily for 10 days, Pyridium 200 mg three times daily for two days, and Florastor twice daily for one month. Review of Resident #42's Medication Administration Records (MAR) dated 02/2020 revealed Resident #42 did not receive the first dose of Cipro until 02/17/20 at 9:00 P.M. Review of Resident #42's Treatment Administration Records (TAR) dated 02/2020 revealed to provide Foley maintenance three times daily. There was no evidence the Foley maintenance/catheter hygiene was performed as ordered. Review of Resident #42's State Tested Nursing Assistant (STNA) documentation under the task section in the electronic medical record revealed no evidence catheter hygiene was provided for the resident. Review of Resident #42's plan of care, dated 02/17/20 revealed Resident #42 had a UTI and catheter-related trauma (indwelling catheter) related to obstructive uropathy and bladder spasms. Interventions included to administer medication as ordered, change catheter and tubing per facilities policy, position catheter bag and tubing below the level of the bladder, check the tubing for kinks, and provide catheter care per policy. Interview and observation on 02/26/20 at 9:05 A.M., revealed Resident #42 reported the facility staff was not providing catheter hygiene. The resident reported the staff set her up with bathing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 12 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 supplies and then usually leave the room. The resident reported she was not knowledgeable on providing her own catheter care and didn't know even what she should be cleaning the catheter with. The resident's catheter drainage bag was observed lying directly on the floor. The resident reported the bladder spasms had increased the last day or two. Interview on 02/26/20 at 7:58 A.M. and 9:15 A.M., with Registered Nurse (RN) #3 verified Resident 42's urine culture results were available on Sunday 02/16/20 at 11:45 A.M., however they were not addressed until Monday 02/17/20 at 3:45 P.M., and the resident was not started on antibiotics until 9:00 P.M. on 02/17/20 (33-34 hours after the results were available). The RN revealed the lab faxes the result when completed, however the nurses have access to the labs system and can check the testing progress at any time. RN #3 confirmed Resident #42 was independent with bathing and staff reported the resident was providing her own hygiene care. The RN reported she would provide the resident with catheter hygiene education today, including not to place the catheter bag directly on the floor. Interview on 02/26/20 at 10:00 A.M., with the Director of Nursing (DON) revealed she would have to ask staff what catheter maintenance included as this was not one of the standing orders, however she would assume it would include catheter hygiene. She confirmed the catheter hygiene should have been noted under the STNA task to direct the resident's care and she would add it to the STNA documentation. The DON stated the facility was going to provide catheter care hygiene education to the resident today. Review of the undated policy related to urinary catheter care and management revealed do not replace the drainage bag on the floor to reduce the risk of contamination and subsequent catheter associated urinary tract infections. Provide routine hygiene using soap and water or perineal cleaner or plain disposable wipes and document the procedure. 2. Medical record review revealed Resident #58 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including prostatic adenocarcinoma (cancer), constipation and a history of fecal impaction. Review of the discharge return anticipated Minimum Data Set (MDS) 3.0 assessment assessment dated [DATE] revealed Resident #58 was moderately impaired for daily decision-making and was always incontinent of bowel. Review of the admission Nursing Comprehensive Evaluation v 1.1-V 9 dated 02/17/20 revealed Resident #58 was continent of bowel with a bowel movement of at least one movement every three days. Review of the care plan titled At Risk for Constipation due to decreased mobility and opioid use revised 02/17/20 revealed to encourage resident to sit on toilet and noted the resident required extensive assist of two staff. The care plan also revealed to assist the resident to the bathroom with toileting as needed. Review of the Task List: Bowel Movement dated 02/16/20 through 02/26/20 revealed Resident #58 had two episodes of bowel continence and 10 episodes of bowel incontinence. On 02/24/20 at 4:03 P.M. interview with Resident #58 revealed he had the capability to be continent of bowel but has had accidents of incontinence when staff do not come in right away when he puts on his call light. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 13 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 Review of the facility Restorative Program list dated 02/26/20 revealed no evidence of any resident, including Resident #58 participating in a restorative bowel program. On 02/26/20 at 2:39 P.M. interview with Licensed Practical Nurse (LPN) #27 revealed the facility did not have or initiate any bowel retraining programs for any residents, including Resident #58. LPN #27 further verified he completed the comprehensive assessments and when it indicated a decline in bowel continence, there was no intervention implemented to restore or maintain bowel function. On 02/26/20 at 2:59 P.M. interview with Assistant Director of Nursing (ADON) #1 verified currently no interventions were being implemented when a resident had a decline in bowel continence and the facility had not established a protocol for bowel restorative programs. On 02/26/20 at 3:45 P.M. interview with ADON #1 revealed she spoke with the physician, they discussed ways to address Resident #58's bowel incontinence and the resident did have a pattern of incontinence that could be addressed and retrained by offering toileting every two hours. ADON #1 stated a protocol would still need to be developed to address declines in bowel continence; however, as of this date one was going to be ordered for Resident #58. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 14 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 Resident #25's medical record revealed an admission dated of 06/14/19 with diagnoses including chronic obstructive pulmonary disease with acute exacerbation, chronic heart failure and chronic respiratory failure. Residents Affected - Few Record review revealed physician's orders included a 06/18/19 order for oxygen at four liters/minute via nasal cannula continuous every shift for shortness of breath. Ipratropium Bromide Solution 0.02 % 2.5 milliliters (ml) inhale orally as needed for shortness of breath two times a day and twice a day as needed ordered 09/25/19. Review of the 01/01/20 quarterly Minimum Data Set (MDS) 3.0 assessment revealed the resident was severely impaired for daily decision making, required supervision from one staff for bed mobility, transfers and walking, and had oxygen. Review of the treatment administration record did not include changing of the humidification bottle or tubing/mask. Observation on 02/24/20 at 10:35 A.M. revealed the resident was in bed with oxygen on per nasal cannula at two liters per minute. The humidification bottle was dry and dated 02/04/20. A nebulizer mask was on the bedside table face down and not contained in a bag for sanitation. Observation and interview on 02/24/20 at 4:56 P.M. with RN #2 verified the humidification bottle was dry and dated 02/04/20. The RN verified the resident wears oxygen continuous and the bottle would have been dry a while ago. The humidification would last a few day not the 20 days the bottle was on. RN #2 verified the nebulizer mask was on the bedside table and not stored in a sanitary manner. RN #2 revealed the new oxygen company was supposed to come around every Friday. RN #2 included it was their responsibility to change the humidification bottles. Based on observation, record review and interview the facility failed to ensure physician orders were in place for the administration of oxygen, failed to ensure humidification was properly used and/or failed to ensure respiratory equipment was maintained in a clean/sanitary manner for Resident #25, #37, and #56. This affected three residents (#25, #37 and #56) of four residents reviewed for respiratory care. Findings include: 1. Medical record review revealed Resident #56 was admitted to the facility on [DATE] with diagnoses including shortness of breath and heart failure. Review of the plan of care, dated 07/01/19 revealed Resident #56 would be free of signs and symptoms of respiratory infections. Observation on 02/24/20 at 9:50 A.M. and again at 11:00 A.M., revealed Resident #56's oxygen tubing/nasal cannula was draped over the edge and laying in the trash can. The resident was not in the room at the time of the observation. Record review revealed the resident did not have a physician order for the use of oxygen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 15 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 During an interview on 02/24/20 at 11:20 A.M. Registered Nurse (RN) #2 verified Resident #56's oxygen tubing was laying on and in contact with the trash can and that it should be placed in a plastic bag when not in use. 2. Medical record review revealed Resident #37 was admitted to the facility on [DATE] with diagnoses including chronic respiratory failure, diabetes mellitus and chronic obstructive pulmonary disease. Review of the plan of care, dated 06/18/19 revealed Resident #37 had a potential for difficulty breathing with interventions to provide oxygen and respiratory treatments as ordered. Review of Resident #37's physician's orders, dated February 2020 revealed no order for the use of oxygen at 4.5 liters per minute (LPM). There was no order for any oxygen. Observation on 02/24/20 at 11:10 A.M., revealed Resident #37 was receiving oxygen at 4.5 LPM per nasal cannula. The oxygen tubing was connected to the oxygen concentrator, without a humidifier bottle. On 02/24/20 at 11:22 A.M. RN #2 verified Resident #37 was receiving oxygen at 4.5 LPM per nasal cannula, without a humidifier bottle. She further revealed the facility policy was for oxygen flow rates of four liters or more to be humidified. During an interview on 02/24/20, the Assistant Director of Nursing (ADON) revealed the physician had given a verbal order for the oxygen therapy to infuse at 4.5 LPM per nasal cannula. on 02/23/20. However, the nurse failed to document the order. Review of the facility policy titled Oxygen Administration, dated 02/25/20 revealed the practitioner's order for oxygen therapy should verify the following: method of delivery, flow rate of delivery and oxygen saturation, if ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 16 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and interview the facility failed to ensure Resident #51 received behavior health services to assist the resident to attain or maintain her highest level of well-being. This affected one resident (#51) of four residents reviewed for Preadmission Screening and Resident Review (PASARR) Identification Screen. Findings include: Review of the Preadmission Screening and Resident Review (PASARR) Identification Screen dated 11/12/19 revealed no evidence Resident #51 had major depressive disorder or anxiety disorder, the resident consented to receiving mental health and counseling services. Further review revealed the resident did not meet nursing home criteria and her needs could be met in an appropriate community setting that could provide for her ongoing need for psychiatric support. A group home, assisted living facility should be explored for the resident. The resident had been evicted from her apartment recently and that was why she was being placed in a nursing home until other housing was found. The resident required assistance with finding other housing. Medical record review revealed Resident #51 was admitted to the facility on [DATE] with diagnoses including paranoid schizophrenia, catatonic schizophrenia, major depressive disorder and anxiety disorder. Review of the admission Minimum Data Set 3.0 assessment dated [DATE] revealed Resident #51 was impaired for daily decision making, the resident and family/significant other participated in the assessment and the family/significant other, not the resident, indicated the expectation was the resident was to remain at the facility long term. Review of the care plan titled LTC (long term care) placement dated 11/29/19 revealed the resident/family/legal decision maker had verbalized acceptance of remaining at facility. Review of the medical record revealed Resident #51 was a long term resident and there was no evidence the facility was assisting her with finding other suitable housing. Review of the Medication Review Report dated 12/14/19 revealed an order to consult psychiatry; however, only medication management per psychiatry had been implemented. There was no evidence of counseling or other mental health services provided as indicated. Review of the Potential for Fluctuations in Mood, Depression, Anxiety and Schizoaffective Disorder plan of care, revised 01/27/20 revealed no evidence of mental health services, therapy, or coordinator. On 02/25/20 between 12:22 P.M. and 1:24 P.M., interview with Social Services (SS) #121 revealed she had not reviewed Resident #51's PASARR because she only looked at them if she was told to do one. SS #121 revealed she was unaware Resident #51 had consented to mental health services, there had been no referral, services or alternate placement looked into as of this date for the resident. On 02/25/20 at 1:46 PM and 1:56 P.M., interview with the Director of Nursing revealed the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 17 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0740 Level of Harm - Minimal harm or potential for actual harm psychiatrist was responsible for medication management only and the resident did not have a mental health counselor or have mental health/behavioral health therapy since admission. The only intervention provided had been medication adjustments. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 18 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 record review and interview the facility failed to ensure the justified use of narcotic pain medication for Resident #284 and Resident #58. The facility failed to ensure parameters were in place related to medication administration, failed to ensure medication was administered only after a comprehensive pain assessment had been completed and/or failed to ensure evidence of non-pharmacological interventions prior to the medication administration. This affected two residents (#58 and #284) of five residents reviewed for unnecessary medication use. The facility identified five residents on a pain management program. Residents Affected - Few Findings include: 1. Review of Resident #284's medical record revealed an admission date of 02/15/20 with diagnoses including osteoarthritis and an artificial hip joint. A 02/15/20 plan of care was developed for actual pain acute/chronic related to chronic pain and history of back pain. The plan of care revealed the use of non pharmacological interventions. Review of the 02/20/20 admission Minimum Data Set (MDS) 3.0 assessment revealed the resident was independent for daily decision making with no mood or behaviors identified. The resident received routine and as needed pain medication for a frequent pain level of a ten on a scale of 0-10 that affected sleep. Record review revealed a physician order, dated 02/21/20 for the narcotic analgesic, Oxycodone 10 milligrams (mg), one tablet every eight hours as needed for breakthrough pain. Review of the Medication Administration record revealed Oxycodone give mg was administered 15 times for breakthrough pain between 02/15/20 and 02/21/20. Oxycodone 10 mg was administered for breakthrough pain 11 times between 02/22/20 and 02/26/20. Record review revealed there were not comprehensive pain assessments that included the location and character of pain or the use of non pharmacological interventions for 10 of the 26 doses administered. A location and characteristic of pain was not identified 02/16/20 at 5:29 A.M., location, characteristic of pain and non pharmacological interventions were not identified 02/17/20 at 3:08 P.M., location and characteristic of pain was not identified 02/19/20 at 3:27 A.M The pain level identified for the administration on 02/19/20 at 3:27 A.M. was a one on a scale of 0-10 with 10 being the worst pain. The location, characteristic of pain and non pharmacological interventions were not identified 02/20/20 at 5:10 A.M. for the administration of Oxycodone. The pain level was documented as a zero when the Oxycodone was administered. The location, characteristic of pain and non pharmacological interventions were not identified 02/20/20 at 11:22 P.M. for the administration of Oxycodone. On 02/21/20 at 3:43 P.M. Oxycodone was administered without the use of non pharmacological intervention. The 02/24/20 2:26 P.M. and 02/25/20 9:05 A.M. administration did not include the area and characteristic of the pain. The location, characteristic of pain and non pharmacological interventions were not identified 02/25/20 at 8:13 P.M. for the administration of Oxycodone. Oxycodone was administered 02/26/20 at 3:49 P.M. without the use of non pharmacological interventions. Interview on 02/27/20 at 11:42 A.M. with Registered Nurse (RN) #1 verified pain medication was administered to Resident #284 when the resident was assessed for pain rated a zero and one on a scale of zero to ten. RN #1 verified the location and characteristic of the pain and the use of non (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 19 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pharmacological interventions were not documented for all as needed pain medication administered as noted above which had the possibility in the medication not being necessary when it was being administered. 2. Medical record review revealed Resident #58 was readmitted after a hospitalization on 02/16/20 with diagnoses including prostate cancer, constipation and history of fecal impaction. Review of the electronic Medication Administration Record (eMAR) dated February 2020 revealed Oxycodone HCL, an opioid five milligrams (mg) every four hours was to be given as needed for severe pain. The order did not indicate what was determined to be severe pain for Resident #58. Further review of the eMAR dated 02/03/20 to 02/25/20 revealed Resident #58 was administered the Oxycodone HCL, 5 mg once for a pain rated at a level of two, once for a pain rated at a level of three, twice for a pain rated a level of four and five times for a pain rated a level of five. Review of the care plan titled At Risk for Pain and Has Chronic Pain, revised 02/17/20 revealed an acceptable pain level for the resident was a three out of 10. Interventions included to administer medications as ordered and evaluate characteristics of pain on a scale of zero to 10. Further review of the care plan revealed no interpretation of mild, moderate or severe pain on a scale of zero to 10 for Resident #58. On 02/24/20 at 2:48 P.M., interview with Resident #58 revealed he had pain in his back and legs, he was bedridden and medication was not always given timely for pain relief. On 02/26/20 at 6:01 P.M. interview with Assistant Director of Nursing (ADON) #1 verified there were no physician parameters indicating what severe pain was in order to administer the Oxycodone HCL 5 mg. ADON #1 verified the resident's care plan indicated an acceptable pain level was a three out of 10 and the resident had received Oxycodone for pain that had been care planned as being acceptable for the resident. ADON #1 further stated severe pain would be rated as a seven to 10. On 02/26/20 at 6:25 P.M. interview with ADON #1 verified the physician's pain scale was not clear and clarification was needed stating the current pain medication PRN order was subjective and did not indicate what severe pain was to be rated by the resident in order to administer the opioid. Review of the policy titled Pain Management, revised October 2019 revealed the facility was to evaluate and identify residents for pain, determine the type, location and severity and develop a care plan for pain management. Staff was to implement the care plan, monitor and administer therapeutic interventions for pain, if ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 20 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on observation, record review and interview the facility failed to ensure evening snacks were provided to all residents. This affected ten residents (#20, #41, #48, #75, #192, #51, #46, #8, #33 and #35) and had the potential to affect all 95 residents residing in the facility. Findings include: Review of Resident Council Minutes dated 02/11/19 to 02/10/20 revealed during the meetings held on 02/11/19, 03/11/19, 04/08/19, 06/03/19, 07/15/19, 10/14/19 and 02/10/20 the residents present at the meeting voiced concerns regarding snacks not being delivered every night or they were delivered after 9:00 P.M. when the residents were asleep or not delivered if their door was shut. The council minute notes revealed staff were provided education each month that concerns were noted. Review of the snack list revealed Resident #192 was to receive a turkey sandwich with cheese, Resident #51 a deli sandwich, Resident #46 cottage cheese with tomatoes, Resident #8 ham and cheese on gluten free bread, Resident #33 a meat sandwich and Resident #35 deli sandwich. Observation on 02/27/20 at 8:42 A.M., of the nursing station refrigerator revealed there was a deli sandwich dated 02/26/20 for Resident #51, a deli sandwich for Resident #35 dated 02/26/20 and two meat sandwiches for Resident #33 one dated 02/25/20 and the other 02/26/20. Interview on 02/26/20 at 1:16 P.M., with four residents, Resident #20, #41, #48, and #75 during a resident council meeting revealed there were on ongoing issues regarding night snacks not being delivered timely or at all sometimes. The residents present reported they have voiced concerns numerous times to the facility staff and it was still on ongoing issue. Interview on 02/27/20 at 8:50 A.M., with the Administrator revealed she was aware there were concerns with snacks in the past, however she thought it had been resolved. Interview on 02/27/20 at 8:53 A.M. and 9:26 A.M., with Dietary Manager (DM) #100 verified there had been on ongoing concerns with evening snacks not being delivered or delivered timely. DM #100 revealed the kitchen sends the snack cart to the floors around 6:00 P.M. nightly. The kitchen staff leaves the cart behind the nurse's station and places the cold food in the refrigerator. The nursing staff were responsible for delivering the snacks to the residents. Around 11:00 A.M., her dietary staff check the nurse's station refrigerators and restocks them. The dietary staff had noted the previous night snacks were still in the refrigerators the next day. Interview on 02/27/20 at 9:25 A.M. with Resident #192 revealed he had not been receiving or offered a turkey sandwich at night per the snack list. Interview on 02/27/20 at 9:21 A.M. with Resident #33 revealed she had not gotten her night sandwich the last couple of nights. She reported she doesn't always get a sandwich at night. Interview on 02/27/20 at 9:27 A.M. with Resident #35 revealed she was not sure if she was getting a snack at night, but she knew she doesn't always get a sandwich. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 21 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0809 Level of Harm - Minimal harm or potential for actual harm Review of the night snack policy, dated 04/2010 revealed the dietary department shall prepare the night snacks for all guests and deliver them to the nurses' station's nourishment pantry. A night snack shall consist of a choice of a beverage and a food item from a basic food group. Guests who require or request a specific night snack shall have their snack labeled with name, room number, diet, date, and time of the snack was to be given. The night snacks shall be distributed by the nursing department. Residents Affected - Many This deficiency substantiates Complaint Number OH00110075. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 22 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to ensure Resident #190's medical record was complete and accurate related to infection and antibiotic use. This affected one resident (#190) of 31 residents whose medical records were reviewed. Findings include: Record review revealed Resident #190 was admitted to the facility on [DATE] and re-admitted on [DATE] after a hospitalization. The resident's diagnosis list indicated respiratory syncytial virus (RSV) detected on 02/20/20. Review of Resident #190's hospital discharge orders, dated 02/20/20 revealed an order for the antibiotic, Amoxicillin-pot clavulanate 875 milligrams (mg) every 12 hours for seven days (quantity #14). Review of Resident #190's medication administration records (MAR) dated 02/2020 revealed on 02/21/20 an order was entered for Amoxicillin 875 mg one tablet by mouth every 12 hours for bacterial infection for 7 days. The order was discontinued and rewritten on 02/21/20 for Amoxicillin 875-125 mg one tablet every 12 hours for RSV for ten (10) days. Further review of Resident #190's medical record revealed no evidence the Amoxicillin was changed to 10 days nor evidence the facility obtained the laboratory testing to confirm the RSV. Review of the February infection control log dated 02/2020 revealed no evidence Resident #190 was noted on the infection control log nor was a McGeer paper completed to ensure the resident met the criteria for treatment of the infection. Interview on 02/25/20 at 2:31 P.M., with Registered Nurse (RN) #3 verified there was no documented evidence the Amoxicillin was changed from seven days to ten days. RN reported she called the physician and clarified the order was for twice daily for seven days not 10 days. The RN reported the infection control nurse did not document the resident's RSV on the February 2020 infection control log and the McGeer criteria form was not in the log, however she had completed the McGeer criteria form and it was in her desk. The facility called to get the laboratory testing to confirm the RSV following surveyor intervention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 23 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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** 2. Medical record review revealed Resident #58 was readmitted to the facility after a hospitalization on 02/16/20 with diagnoses including prostate cancer, urinary retention and a urinary tract infection. Residents Affected - Few Review of the admission Nursing Comprehensive Evaluation v 1.1-V 9 dated 02/17/20 revealed Resident #58 had an indwelling urinary catheter. Review of the care plan titled Active Urinary Tract Infection dated 02/17/20 revealed to administer medications as ordered. Review of the Urinalysis/Culture, Urine results dated 02/21/20 revealed Resident #58 had >100,000 CFU/mL of Extended Spectrum Beta-Lactamases escherichia coli (enzymes produced by bacteria that can be resistance to a range of frequently used antibiotics including penicillin's and cephalosporins) and >100,000 CFU/mL of Pseudomonas Aeruginosa (a multi-drug resistant pathogen). Review of the physician orders, dated 02/21/20 revealed to administer Ciprofloxacin (antibiotic) 250 milligrams (mg) every 12 hours for seven days and Bactrim DS 800-180 (mg) twice a day for seven days for infection. Review of the electronic Medication Administration Record dated 02/21/20 through 02/26/20 revealed Resident #58 received 10 doses of Ciprofloxacin 250 (mg) and 10 doses of Bactrim DS 800-180 (mg) for infection. On 02/26/20 at 4:17 P.M., interview with Assistant Director of Nursing (ADON) #1 revealed she contacted the nurse practitioner and she stated the bacteria (Extended Spectrum Beta-Lactamases escherichia coli and Pseudomonas Aeruginosa) was colonized and the resident did not need the antibiotics and ordered to discontinue the Bactrim DS and Ciprofloxacin. ADON #1 verified the antibiotics Resident #58 had received between 02/21/20 and 02/26/20 were unnecessary and should not have been given due to the organisms were colonized. Review of the policy and protocols titled Infection Control Antibiotic Stewardship & MDRO's (multi-drug resistant organisms), revised September 2019 revealed protocols were to be developed and followed that promote health and wellness through responsible use of antimicrobials in an effort to prevent unnecessary treatment and resultant antibiotic resistance. Based on record review and interview the facility failed to implement a comprehensive antibiotic stewardship program to monitor and prevent the unnecessary/inappropriate use of antibiotics. This affected two residents (#58 and #195) of five residents reviewed for infections. Findings include: 1. Record review revealed Resident #195 was admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease, cellulitis, acute and chronic respiratory failure, pneumonia, acute upper respiratory infections, atelectasis, acute bronchitis, heart failure, cough, dyspnea and history of lung cancer. Review of Resident #195's chest x-ray results dated 02/11/20 and 02/17/20 revealed the resident had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 24 of 25 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 366363 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurels of Steubenville The 500 Stanton Boulevard Steubenville, OH 43952 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 cardiomegaly. There was no evidence of pneumonia or acute cardiopulmonary disease process noted. Level of Harm - Minimal harm or potential for actual harm Review of Resident #195's nursing progress notes dated 02/18/20 revealed the resident had noted weight gain, increase sputum of yellow/green color and wheezing. New orders were received to start Aldactone (diuretic) 50 milligrams (mg) twice daily, increase Lasix (diuretic) to 40 mg twice daily, DuoNeb's four times daily, and start a Zithromax and Medrol dose pack for increased sputum and wheezing. Residents Affected - Few Review of Resident #195's McGeer criteria form dated 02/18/20 documented the resident met criteria, however there was no evidence the resident had actually meet the criteria for upper respiratory infection (URI). There was a handwritten note indicating the resident had yellow/green sputum and wheezes. The criteria for URI included the resident must meet two of the following criteria: runny nose, sneezing, stuffy nose, sore throat, hoarseness, difficulty swallowing, dry cough, swollen/tender glands, fever, leukocytosis, or change in mental status. Review of Resident #195's medication administration records (MAR) dated 02/2020 revealed the resident received the antibiotic, Zithromax 500 milligrams (mg) on 02/19/20 and 250 mg on 02/20/20, 02/21/20, 02/22/20, and 02/23/20 for wheezing and increase sputum. Interview on 02/26/20 at 11:04 A.M. with Registered Nurse (RN) #3 confirmed the resident did not met the McGeer criteria even though she had checked yes on the form. The RN reported the Nurse Practitioner had ordered the antibiotic even though resident's chest x-rays were negative. She confirmed the resident was also receiving the Vancomycin (antibiotic) for cellulitis at the same time she received the Zithromax. Review of the antibiotic stewardship policy dated 09/2019 revealed the protocol was developed to prevent unnecessary treatment and resultant antibiotic resistance. The facility had adopted the McGeer's criteria for criteria for infection surveillance definition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366363 If continuation sheet Page 25 of 25