Inspection·August 1, 2022

F 0558 Level of Harm - Minimal harm or potential for actual harm and should be ordered and care planned prior to use. The DON verified Resident #21 was never evaluated for appropriate use of a scoop mattress. Review of the manufacturer's specifications for the mattress Resident #21 was using, dated 03/20 revealed the mattress came with three inch raised edges around the perimeter. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 2 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on record review, observation, resident interview, and staff interview, the facility failed to provide a homelike environment for Resident #54. This affected one (Resident #54) of three residents reviewed for homelike environment. The census was 66. Findings include: Review of the medical record for Resident #54 revealed an admission date of 08/17/21 with a diagnosis of chronic obstructive pulmonary disease (COPD). Review of the MDS for Resident #54 dated 06/07/22 revealed the resident was cognitively intact and required extensive assistance of one staff with hygiene and bathing. Observation on 07/25/22 at 12:31 P.M. of Resident #54's room revealed the resident had three large pictures hung in her room. Two of the pictures were of landscapes and the other picture was some type of fabric/needlework in a wooden frame. Interview on 07/25/22 at 12:31 P.M. Resident #54 confirmed the picture with the fabric was brought from home and Maintenance Director (MD) #31 hung it on the wall for her. Resident #54 further confirmed the two other landscape pictures were hanging on the wall when she moved in, and she asked MD #31 to remove them, but he refused to do so. Interview on 07/27/22 at 4:08 P.M. with MD #31 confirmed Resident #31 asked him to take down the landscape pictures in her room shortly after she moved in. MD #31 confirmed the pictures were in the room when the resident moved in. MD #31 reported he told the resident he would not take the pictures down because he didn't have anywhere to store them, and it would leave a hole in the wall, which he would have to repair. MD #31 confirmed he did not share the resident's request with facility administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 3 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, resident interview, staff interviews, and review of facility policy, the facility staff failed to report an allegation of abuse. This affected one (Resident #68) of one resident reviewed for abuse. The facility's census was 66. Findings include Review of the medical record for the Resident #68 revealed an admission date of 09/13/21. Diagnoses included calculus gallbladder, contusion of the left, lack of coordination, epilepsy, depression, hypoxemia, respiratory failure, and contusion of abdominal wall. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #68 was cognitively intact and required limited assistance with bed mobility and transfers. Review of the plan of care dated 06/29/22 revealed Resident #68 was frequently incontinent of bowel and bladder with an intervention to provide incontinence care as needed. Interview on 07/25/22 at 1:34 P.M. with Resident #68 revealed on 07/24/22 the dayshift State Tested Nurse Aide (STNA) was rough while providing the resident with incontinence care. The resident reported the STNA hurt her, and she felt abused. Resident #68 reported she received Lovenox (anticoagulant) shots in her belly and the area was bruised and sore. The STNA grabbed the resident's incontinence brief without loosening it or disconnecting the side and ripped it from her body. Additionally, the STNA leaned and placed weight on the resident's knee and leg, which had an injury and wound. Resident #68 reported she requested for the STNA to get off her knee as she was hurting her and was told, I am not hurting you, and continued to place pressure and weight on her leg. Resident #68 stated she told another STNA about her concerns. On 07/25/22 at 2:00 P.M. the surveyor notified the Director of Nursing (DON) of Resident #68's abuse allegations. The DON was unaware of the resident's abuse allegation and initiated a Self-Reported Incident (SRI) within an hour of being told. Interview on 07/27/22 at 12:22 P.M. with STNA #57 revealed on 07/24/22 at approximately 9:30 P.M. Resident #68 reported concerns about a dayshift agency STNA being abusive. STNA #57 reported she reported Resident #68's allegations to the nightshift nurse. Interview on 07/27/22 at 12:29 P.M. with Licensed Practical Nurse (LPN) #74 revealed STNA #57 did not inform her of Resident #68's abuse allegations, but overheard staff talking about the resident's complaints regarding how she was treated by the dayshift STNA. LPN #74 reported she did not talk to Resident #68 about her allegations and did not report the concerns to management. Review of facility policy titled, Abuse, Neglect, Exploitation and Misappropriation of Resident Property, dated 11/21/16, revealed the facility failed to implement their policy. Facility staff should immediately report allegations of abuse to the Administrator. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 4 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 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 interviews and record review, facility failed to ensure abuse allegations where immediately investigated once reported to staff. This affected one Resident (#68) of one reviewed for abuse. Facility census was 66. Residents Affected - Few Findings include Review of the medical record for the Resident #68 revealed an admission date of 09/13/21. Diagnoses included calculus gallbladder, contusion of the left, lack of coordination, epilepsy, depression, hypoxemia, respiratory failure, and contusion of abdominal wall. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #68 was cognitively intact and required limited assistance with bed mobility and transfers. Review of the plan of care dated 06/29/22 revealed Resident #68 was frequently incontinent of bowel and bladder with an intervention to provide incontinence care as needed. Interview on 07/25/22 at 1:34 P.M. with Resident #68 revealed on 07/24/22 the dayshift State Tested Nurse Aide (STNA) was rough while providing the resident with incontinence care. The resident reported the STNA hurt her, and she felt abused. Resident #68 reported she received Lovenox (anticoagulant) shots in her belly and the area was bruised and sore. The STNA grabbed the resident's incontinence brief without loosening it or disconnecting the side and ripped it from her body. Additionally, the STNA leaned and placed weight on the resident's knee and leg, which had an injury and wound. Resident #68 reported she requested for the STNA to get off her knee as she was hurting her and was told, I am not hurting you, and continued to place pressure and weight on her leg. Resident #68 stated she told another STNA about her concerns. On 07/25/22 at 2:00 P.M. the surveyor notified the Director of Nursing (DON) of Resident #68's abuse allegations. The DON was unaware of the resident's abuse allegation and initiated an investigation. Interview on 07/27/22 at 12:22 P.M. with STNA #57 revealed on 07/24/22 at approximately 9:30 P.M. Resident #68 reported concerns about a dayshift agency STNA being abusive. STNA #57 reported she reported Resident #68's allegations to the nightshift nurse. STNA #57 was unaware if the facility initiated an investigation regarding the abuse allegations. Interview on 07/27/22 at 12:29 P.M. with Licensed Practical Nurse (LPN) #74 revealed STNA #57 did not inform her of Resident #68's abuse allegations, but overheard staff talking about the resident's complaints regarding how she was treated by the dayshift STNA. LPN #74 reported she did not talk to Resident #68 about her allegations and did not report the concerns to management. LPN #74 further verified she never assessed Resident #68 nor was she aware if the facility initiated an investigation regarding the abuse allegations. Review of facility policy titled Abuse, Neglect, Exploitation and Misappropriation of Resident Property, dated 11/21/16, revealed the facility failed to implement their policy. The policy revealed the facility would investigate all alleged violations involving abuse, neglect, and mistreatment of a resident. If the resident was injured during the suspected incident, staff should immediately report all incidents and allegations to the administrator or designee, the nurse should complete an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 5 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 Level of Harm - Minimal harm or potential for actual harm assessment for possible injuries and the physician should be notified. The policy revealed if the accused, was not an employee, a third party shall be contacted to address the issue and prevent their return during the outcome of the investigation. An investigation should be started immediately and must be finalized and reported to the state survey agency within five business days. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 6 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record reviews, resident interviews, staff interviews, and review of facility policy, the facility failed to conduct care conferences. This affected four (Resident #21, #26, #3, and #7) of four residents reviewed for care conferences. The facility's census was 66. Findings include: 1. Review of the medical record for Resident #21 revealed an admission date of 04/30/22 with a diagnosis of diabetes mellitus (DM). Review of the Minimum Data Set (MDS) assessment for Resident #21 dated 05/07/22 revealed the resident was cognitively impaired and required extensive assistance of staff with activities of daily living (ADLs). Review of the progress note for Resident #21 dated 05/03/22 revealed staff offered to have a care conference for the resident, but she declined to attend. Further review of the medical record for Resident #21 revealed no documentation or record of care conferences being held for the resident since admission to the facility. Interview on 07/25/22 at 9:27 A.M. Resident #21 reported she had not been invited to a care conference since her admission to the facility and she would like to attend a care conference. Interview on 07/28/22 at 10:25 A.M. with Social Worker (SW) #63 revealed the facility had not conducted a care conference for Resident #21 since her admission on [DATE] because the resident did not want to have a care conference. Further interview with SW #63 revealed it was her understanding that a care conference was not required if the resident declined to attend. 2. Review of the medical record for Resident #26 revealed an admission date of 12/13/18 with a diagnosis of acute respiratory failure (ARF) with hypoxia. Review of the MDS for Resident #26 dated 05/13/22 revealed the resident was cognitively impaired and required extensive assistance with ADLs. Review of the progress notes for Resident #26 dated 08/10/21, 11/10/21, 02/10/22, and 05/10/22 revealed staff offered to have a care conference for the resident, but he declined to attend. Further review of the medical record for Resident #21 revealed no documentation or record of a care conferences being held for the resident in the past 12 months. Interview on 07/25/22 at 10:21 A.M. Resident #26 reported he had not been invited to a care conference in a long time, and he would like to attend a care conference. Interview on 07/28/22 at 10:25 A.M. with Social Worker (SW) #63 revealed the facility had not conducted a care conference for Resident #26 in the past 12 months because the resident did not want to attend. Further interview with SW #63 revealed it was her understanding that a care conference was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 7 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0657 not required if the resident declined to attend. Level of Harm - Minimal harm or potential for actual harm 3. Review of the medical record for the Resident #3 revealed an admission date of 09/09/21. Diagnoses included dementia with behaviors, muscle weakness, lack of coordination, diabetes type two, vascular dementia, and dysphagia. Residents Affected - Some Review of the MDS assessment dated [DATE] revealed Resident #3 was cognitively intact and required supervision set up assistance for mobility and transfers. Review of the progress notes dated 03/20/22 and 07/06/22 revealed the resident was offered a care conference and declined to attend. Review of care conference dated 09/20/21 revealed the resident attended a care conference meeting. Further review of the medical record revealed no documentation or reports of additional care conferences being completed. Interview on 07/25/22 at 10:57 A.M. with Resident #3 revealed she only remembered having one care conference since admission. Interview on 07/27/22 at 1:10 P.M. the Director of Nursing (DON) and Manager of Clinical Services (MCS) #96 confirmed no additional care conference summaries were completed for Resident #3. Interview on 07/28/22 at 10:35 A.M. with SW #63 revealed care conferences were offered every quarter when MDS assessments were updated. SW #63 revealed she was not aware of facility responsibilities and requirements to have a care conference even if the resident declined attendance. SW #63 revealed care conferences were not completed for Resident #3. 4. Review of the medical record for the Resident #7 revealed an admission date of 10/24/18. Diagnoses included schizo affective disorder bipolar type, anxiety, morbid obesity, muscle weakness, lack of coordination, bipolar disorder, and mood disorder. Review of the MDS assessment dated [DATE] revealed Resident #7 was cognitively intact and required limited assistance of one staff member for mobility and transfers. Review of the progress notes dated 04/20/21, 07/20/21, 09/28/21, 01/11/22, 04/05/22, and 07/06/22 revealed the resident was offered a care conference and declined to attend. Further review of medical record found no evidence of care conferences being completed. Interview on 07/25/22 at 1:22 P.M. with Resident #7 revealed the resident had no memory of having care conferences. Interview on 07/27/22 at 1:10 P.M. the DON and Manager of Clinical Services (MCS) #96 confirmed no additional care conference summaries were completed for Resident #7. Interview on 07/28/22 at 10:35 A.M. with SW #63 revealed care conferences were offered every quarter when MDS assessments were updated. SW #63 revealed she was not aware of facility responsibilities and requirements to have a care conference even if the resident declined attendance. SW #63 revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 8 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0657 care conferences were not completed for Resident #7. Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled, Resident and Resident Care Conferences, dated 05/09/18, revealed the facility would hold care conferences upon admission, quarterly, and as needed. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 9 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 Based on record review, observation, and staff interview, the facility failed to ensure residents received proper nail care and regular showers, including washing of hair. This affected three (Residents #8, #21, and #54) of four residents reviewed for activities of daily living (ADL) care. The census was 66. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #8 revealed an admission date of 04/17/22 with a diagnosis of diabetes mellitus (DM). Review of the Minimum Data Set (MDS) for Resident #8 dated 04/27/22 revealed the resident was cognitively intact and required physical assistance of one staff with bathing and hygiene. Review of the care plan for Resident #8 dated 04/29/22 revealed the resident may require assistance with activities of daily living (ADLs) and may be at risk for developing complications associated with decreased ADL self-performance due to disease process/condition, weakness. Interventions included staff should assist with grooming, including nail care. Observation on 07/25/22 at 11:04 A.M. of Resident #8 revealed the resident's toenails were long and extending approximately one quarter inch past the end of the toe. Interview on 07/25/22 at 11:04 A.M. Resident #8 reported her toenails were too long and the great toenails were somewhat painful and it felt like they were becoming ingrown. Resident #8 further confirmed she had not had her toenails trimmed since admission to the facility. Interview on 07/25/22 at 1:34 P.M. with State Tested Nursing Assistant (STNA) #76 confirmed Resident #8's toenails were long and needed to be trimmed. STNA #76 further confirmed she thought resident needed to have toenails trimmed by a podiatrist because she was a diabetic. Interview on 07/27/22 at 12:13 P.M. with the Director of Nursing (DON) confirmed the facility had no record of podiatry visits for Resident #8 and confirmed the facility had no written policy on nail care. 2. Review of the medical record for Resident #21 revealed an admission date of 04/30/22 with a diagnosis of diabetes mellitus (DM.) Review MDS for Resident #21 revealed the resident was cognitively intact and required extensive assistance of one staff with bathing. Review of the care plan for Resident #21 dated 05/19/22 revealed the resident may require assistance with ADLs and may be at risk for developing complications associated with decreased ADL self-performance related to disease process/condition, recent hospitalization, weakness, vision impairment. Interventions included the following: assistance with bathing, bathing per resident preference, assist with grooming (nails, shaving, hair) Review of the shower sheets for Resident #21 revealed on 06/27/22 the resident had a full shower and on 07/21/22 the resident had a bed bath. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 10 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Further review of Resident #21's bathing records from 07/15/22 to 07/25/22 revealed no documentation on if the resident received a bed bath or shower and/or refused a bath or shower. Observation on 07/25/22 at 9:20 A.M. revealed Resident #21's long hair appeared greasy and wet as if it had been slicked back. Residents Affected - Few Interview on 07/25/22 at 9:20 A.M. with Resident #21 revealed she had not had a bed bath for the past two weeks and she had not had her hair washed at all in the month of July 2022. Interview on 07/25/22 at 1:37 P.M. with State Tested Nursing Assistant (STNA) #76 confirmed Resident #21 did not refuse care and that staff were supposed to offer to wash the resident's hair at the time of the bath or shower. STNA #76 further confirmed Resident #21's hair appeared greasy. 3. Review of the medical record for Resident #54 revealed an admission date of 08/17/21 with a diagnosis of chronic obstructive pulmonary disease (COPD). Review of the MDS for Resident #54 dated 06/07/22 revealed the resident was cognitively intact and required extensive assistance of one staff with hygiene and bathing. Review of the care plan for Resident #54 dated 12/22/21 revealed the resident required assistance with ADLs and may be at risk for developing complications associated with decreased ADL self-performance. Interventions included staff should provide assistance with grooming, nail care, and bathing. Review of the shower sheets for Resident #54 for the month of July 2022 revealed the resident received a full bed bath on 07/07/22 and 07/27/22 per the hospice aide. Further review of Resident #54's bathing record in the electronic medical record from 07/15/22 to 07/27/22 revealed the resident was coded as having a bath on 07/27/22 but was not coded for having a bath on any of the other dates. Observation on 07/25/22 at 12:45 P.M. of Resident #54 revealed the resident's fingernails were long (extending approximately one quarter inch behind the end of the fingers) and had dirt under them. Interview on 07/25/22 at 12:45 P.M. Resident #54 verified her fingernails were too long and needed to be cleaned and trimmed. Resident #54 confirmed she usually got a bed bath by the hospice aide but she hadn't had a bath in the past few weeks. Resident #54 reported when she did get a bath earlier in the month, the aide did not trim or clean her nails. Interview on 07/25/22 at 12:50 P.M. STNA #58 verified Resident #54's fingernails were long and needed to be trimmed and cleaned. STNA #58 further confirmed aides usually trimmed fingernails during baths/showers unless the resident was diabetic, in which the nurse had to trim the nails. STNA #58 confirmed Resident #54 received her baths per the hospice aide. Interview on 07/27/22 at 12:13 P.M. with the Director of Nursing (DON) confirmed the facility had no record of bathing for Resident #54 between 07/07/22 and 07/27/22. The DON confirmed Resident #54 had no contraindications to having the aides trim and clean her fingernails as needed. The DON confirmed the facility did not have a policy on bathing. This deficiency substantiates Complaint Number OH00133207. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 11 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, observations, staff interviews and review of facility policy, the facility failed to monitor and treat newly found wounds and skin impairments. This affected one (Resident #68) of two residents reviewed for skin conditions and wounds. The facility census was 66. Residents Affected - Few Findings include: Review of the medical record for Resident #68 revealed an admission date of 09/13/21. Diagnoses included calculus gallbladder, contusion of the left, lack of coordination, epilepsy, depression, hypoxemia, respiratory failure, and contusion of abdominal wall. Review of the MDS assessment dated [DATE] revealed Resident #68 was cognitively intact and required limited assistance with bed mobility and transfers. Review of the plan of care dated 06/29/22 revealed Resident #68 had alteration in skin integrity as evidenced by a surgical wound on the left knee with interventions to assess the area for size, color, and drainage as needed, assess for pain, provide assistance with ADLs and positioning as needed and provide skin care as needed. Review of physician orders for 07/26/22 at 3:19 P.M. identified orders for treatment to cleanse the left elbow with normal saline and pat dry, apply a small piece of adaptic and cover with ABD and secure with kerlix and tape and change daily and as needed. Review of physician order for 07/26/22 at 3:32 P.M. identified order for geri sleeve to left upper extremity at all times as tolerated and to remove the sleeve every shift for hygiene and to inspect skin. No previous orders were found regarding treatments to skin tear on resident's left elbow. Review of the progress note dated 07/26/22 as a late entry from 07/22/22 revealed the resident was found to have a skin tear on the left arm. The area was cleaned and steri-strips were applied. Progress note dated 07/26/22 revealed the resident stated during the night (a few nights ago) she had bumped her left elbow on the side rail. The resident was agreeable to geri-sleeves, as she reported she bumps her arms often. The physician was notified and measurements were taken. The wound was cleaned and treatment was applied. No other progress notes were found regarding the wound. Review of skin assessment dated [DATE] revealed a new wound on the left elbow was found on 07/26/22 (actual date found was 07/22/22). The wound was a skin tear and measured 1.2 cm by 0.2 cm with moderate drainage. The physician and family were notified on 07/26/22. Observation and interview on 07/25/22 at 1:55 P.M. with Resident #68 revealed she had blood on her left elbow with several steri-strips in place. The resident reported she had a skin tear that occurred from reaching between her bed rails to grab something off her end table. She reported the nurse placed the steri-strips but stated she has bled through them and had blood on several spots of her bedding. Observation on 07/26/22 at 12:02 P.M. revealed the resident's elbow had a large Band-Aid covering the skin tear. Interview on 07/26/22 at 3:34 P.M. with the DON revealed the facility had no documentation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 12 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete regarding the resident's skin tear being found, assessed, or treated, but revealed the nurse would place a note today. The DON revealed the wound occurred 07/22/22. Review of the facility policy titled, Skin Assessment, dated 09/2017 revealed areas of alteration in skin that are present, or which develop subsequently to admission, are treated according to medical direction and are conscientiously followed on a weekly basis. An assessment of the area is performed and recorded in the resident's medical record. Event ID: Facility ID: 366421 If continuation sheet Page 13 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 Based on record review, observation, staff interview, and review of the facility policy, the facility failed to oxygen tubing and handheld nebulizer mask and tubing were maintained in proper and sanitary condition. This affected three (Residents #26, #38, #54) of 13 facility-identified residents with orders for respiratory treatment. The census was 66. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #54 revealed an admission date of 08/17/21 with a diagnosis of chronic obstructive pulmonary disease (COPD). Review of the Minimum Data Set (MDS) for Resident #54 dated 06/07/22 revealed resident was cognitively intact and required extensive assistance of one staff with activities of daily living (ADLs.) Review of the July 2022 monthly physician orders for Resident #54 revealed an order dated 08/17/21 for Albuterol solution per HHN two times per day and an order for oxygen at three liters via nasal canula. Review of July 2022 Medication Administration Record (MAR) for Resident #54 revealed resident received Albuterol per HHN twice daily during the month of July 2022. Review of the July 2022 Treatment Administration Record (TAR) for Resident #54 revealed resident received oxygen at three liters via nasal cannula Review of the care plan for Resident #54 dated 10/07/21 revealed resident had altered health maintenance related to progressive physical and mental status, chronic obstructive pulmonary disease (COPD), emphysema, and seizure disorder. Interventions included the following: administer medications as ordered, administer oxygen per physician order, elevate head of bed per order or as tolerated. Observation on 07/25/22 at 12:52 P.M. of Resident #54's revealed resident's oxygen tubing with nasal canula was dated 07/04/22 and resident was receiving oxygen via concentrator at three liters, and the HHN mask and tubing was undated. Interview on 07/25/22 at 12:52 P.M. of Resident #54 confirmed she was unsure when the tubing for her oxygen and HHN had last been changed. She thought it had a been a few weeks. Interview on 07/25/22 at 07/25/22 at 1:41 P.M. with Registered Nurse (RN) #94 confirmed resident's oxygen tubing dated was dated 07/04/22 and HHN tubing was not dated. RN #94 confirmed oxygen and HHN tubing should be changed weekly and as needed and the nurse should date the tubing at the time of the tubing change. 2. Review of the medical record for Resident #26 revealed an admission date of 12/13/18 with a diagnosis of acute respiratory failure (ARF) with hypoxia. Review of the MDS for Resident #26 dated 05/13/22 revealed resident was cognitively impaired and required extensive assistance with ADLs. Review of the July 2022 TAR for Resident #26 revealed an order for oxygen at two liters per nasal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 14 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 cannula as needed for shortness of breath. Level of Harm - Minimal harm or potential for actual harm Observation on 07/25/22 at 10:28 A.M. of Resident #26 revealed resident's oxygen tubing and nasal cannula was laying directly on the floor and was dated 07/17/22. Residents Affected - Few Interview on 07/25/22 at 10:28 A.M. of Resident #26 confirmed resident's oxygen tubing was laying on the floor. Resident #26 confirmed he did not use oxygen very often and he was unsure when the tubing had been changed last. Observation on 07/25/22 at 1:38 P.M. with Licensed Practical Nurse (LPN) #73 revealed resident's oxygen tubing was laying on the floor and was dated 07/17/22. Interview on 07/25/22 at 1:38 P.M. with LPN #73 confirmed resident's oxygen tubing was laying directly on the floor which was not sanitary and also confirmed the tubing was dated 07/17/22 which was outdated. 3. Review of the medical record for Resident #38 revealed an admission date of 08/24/21 with a diagnosis of end stage renal disease (ESRD.) Review of the MDS for Resident #38 dated 06/05/22 revealed resident was cognitively intact and required extensive assistance of staff with ADLs. Review of the July TAR for Resident #38 revealed an order dated 05/23/22 for oxygen at three liters per nasal cannula as needed for shortness of breath. Interview on 07/25/22 at 1:30 P.M. revealed resident used oxygen at night, and she was unsure how often staff changed the tubing. Observation on 07/25/22 at 1:36 P.M. with LPN #73 revealed Resident #38's oxygen tubing and nasal cannula was laying directly on the floor in resident's room. Oxygen tubing was dated 07/16/22. Interview on 07/25/22 at 1:36 P.M. with LPN #73 confirmed oxygen tubing for Resident #38 was laying directly on the floor and was dated 07/16/22 which was outdated. Interview on 07/27/22 at 12:13 P.M. with the Director of Nursing (DON) confirmed oxygen tubing should not be stored directly on the floor, tubing should be changed once weekly at a minimum, and tubing should be dated when changed. Review of the policy titled Respiratory Equipment Cleaning/Disinfecting dated 09/14/18, revealed tubing/masks/nasal cannula should be changed weekly and as needed. Tubing should be stored clean and dry, in a plastic bag between usages. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 15 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure pharmacy recommendations were timely and thoroughly addressed. This affected two residents (#32 and #49) of five reviewed for pharmacy recommendations. Facility census was 66. Findings include 1. Review of the medical record for the Resident #32 revealed an admission date of 10/20/20. Diagnoses included chronic heart failure, hypertension, bipolar disorder, atrial fibrillation, constipation, anxiety, depression and COVID-19. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #32 was cognitively intact and required limited assistance of one for mobility and transfers. Review of the physician orders for 12/18/20 revealed Resident #32 had orders for hydroxyzine (antihistamine) HCl Tablet 10 milligram (mg) for itching, promethazine HCl Tablet 25 mg for nausea. Both medications were discontinued on 10/07/21. A physician order dated 06/29/21 to 05/30/22 for Seroquel (an antipsychotic medication) tablet with instructions to give 50 mg by mouth at bedtime. Review of the pharmacy recommendation dated 08/18/21 revealed Resident #32 was on hydroxyzine HCl Tablet 10 mg and Promethazine HCl Tablet 25 mg both ordered as needed (PRN) and unused for over 60 days with recommendation to discontinue the order. The Nurse Practitioner reviewed the recommendation on 10/05/21 and discontinued the orders on 10/07/21. Review of the pharmacy recommendation dated 09/20/21 revealed Resident #32 received antipsychotic therapy and therefore required an abnormal involuntary movement tests (AIMS) at baseline and every six months. The form was not reviewed, signed and dated by a physician or medical professional and no decision box was checked. A note was written on the page saying an AIMS was completed on 10/04/21. Review of the AIMS assessments revealed they were completed on 10/20/20, 10/04/21, and 06/09/22. Review of the nurse practitioner note dated 10/12/21 revealed no mention of the pharmacy recommendations or a rationale for continuing the medication. Interview on 07/28/22 at 9:19 A.M., with Physician #97 revealed she was provided pharmacy recommendations each time she was at the facility which was twice weekly as well as the nurse practitioner being at the facility twice weekly. Physician #97 acknowledged the pharmacy recommendation dated 08/18/21 was responded to about seven weeks after the recommendation was made. She revealed the recommendation dated 09/20/21 was likely for nursing staff to complete. The physician acknowledged no staff signed or dated the form of when it was reviewed and no decision box was marked and no explanation was provided. Physician #97 would follow up on the AIMS as it had not been completed every 6 months according to the request. 2. Review of the medical record for the Resident #49 revealed an admission date of 01/12/22. Diagnoses included stenosis of left carotid artery, heart failure, muscle weakness, vascular dementia, hyperlipidemia, atrial fibrillation, diabetes, depression, spinal stenosis, and cerebral aneurysm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 16 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #49 was cognitively intact with a BIMS of 15 and required limited assistance of one staff member. Review of the physician orders for 01/17/22 identified orders for Memantine HCl Tablet 5 mg with instructions to give one tablet daily for dementia. Review of the physician orders for 06/08/22 identified orders for Memantine HCl Tablet 5 mg with instructions to give one tablet daily for dementia. Review of the physician orders for 07/03/22 identified orders for Memantine HCl Tablet 5 mg with instructions to give one tablet daily for dementia. Review of the pharmacy recommendation dated 03/22/22 revealed resident was receiving medication (memantine). The manufacturer recommends increasing the daily dose by 5 mg every week until maximum dose of 20 mg. Would you consider titrating dose to 10 mg twice daily? The Physician signed the pharmacy recommendation on 04/21/22 and marked other with explanation saying continue. Interview on 07/28/22 at 9:19 A.M. with Physician #97 confirmed no rationale was provided regarding why the physician did not agree with the pharmacy recommendation. During the interview with surveyor, Physician #97 wrote an explanation and dated it for 07/28/22. Review of facility policy titled Medication Monitoring, dated 06/21/17, revealed the facility failed to implement the policy in regards to the allegation. The policy revealed the facility and Physician must address the recommendations in a timely manner tat meets the needs of the residents and no later than their next routine visit. The Provider should also document what irregularity was reviewed and what action was taken to address the issue. If the Physician declines or rejects the recommendation, an explanation as to the rationale for the rejection must be documented in the residents medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 17 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on record review, resident and staff interview, review of manufacturer's recommendations, and review of facility policy, the facility failed to administer insulin as ordered. This affected one (#21) of 16 facility-identified residents with orders for insulin. The census was 66. Residents Affected - Few Findings include: Review of the medical record for Resident #21 revealed an admission date of 04/30/22, with a diagnosis of diabetes mellitus (DM.) Review of the Minimum Data Set (MDS) assessment for Resident #21 dated 05/07/22 revealed resident was cognitively intact and required extensive assistance with activities of daily living (ADLs.) Review of the care plan for Resident #21 dated 05/19/22 revealed resident was at risk for hypo/hyperglycemia episodes related to DM and required daily insulin and sliding scale insulin. Interventions included monitor for signs and symptoms of hypo/hyperglycemia, administer insulin as ordered, monitor blood sugar levels as ordered, report abnormalities to the attending physician. Review of the June 2022 Medication Administration Record (MAR) for Resident #21 revealed an order dated 05/06/22 for resident to receive Lantus insulin 15 units at bedtime. There were not parameters for holding the insulin. Further review of the MAR for Resident #21 revealed insulin was noted as held on 06/10/22 and 06/22/22. Review of nurse progress note for Resident #21 dated 06/10/22 revealed Lantus insulin was held due to resident's blood sugar was 99. The progress note did not include physician notification of the insulin being held. Review of the medical record for Resident #21 revealed the notes did not include an explanation regarding hold insulin for resident on 06/22/22. Review of the July 2022 MAR for Resident #21 revealed an order dated 07/13/22 for resident to receive Lantus insulin 10 units at bedtime. There were no parameters for holding the insulin. Further review of the MAR for Resident #21 revealed insulin was noted as held for 07/16/22. Review of nurse progress note for Resident #21 dated 07/16/22 revealed Lantus insulin was held due to resident's blood sugar was low. The progress note did not include physician notification of the insulin being held. Interview on 07/25/22 at 9:31 A.M., with Resident #21 confirmed staff sometimes told her they were going to hold her insulin at night because her blood sugar was low. Interview on 07/28/22 at 12:12 P.M., with the Director of Nursing (DON) confirmed Lantus insulin orders for Resident #21 had no parameters for withholding and the nurses' notes did not include physician notification of withholding the medication. Review of manufacturer's recommendation for Lantus insulin online resource per Medscape revealed Lantus was a long-acting insulin and it was very important to follow the insulin regimen exactly, and the doctor should be consulted ahead of time regarding what to do it resident missed a dose of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 18 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0760 insulin. Level of Harm - Minimal harm or potential for actual harm Review of the policy titled Insulin Administration dated 06/21/17 revealed nurses should be familiar with the type of insulin ordered and if the insulin dose is not administered, the prescriber should be notified. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 19 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview, and policy review, the facility failed to ensure food was labeled, dated, and stored in a safe manner. This had the potential to affect all 66 residents residing in the facility who received their meals from the kitchen. The facility census was 66. Findings include: Observations during the initial tour on 07/25/22 from 9:01 A.M. to 9:28 A.M. revealed the following: Observation on 07/25/22 at 9:05 A.M. revealed one dented can of tropical fruit salad and one dented can of fancy midwest tomato sauce. Observation on 07/25/22 at 9:07 A.M. revealed one unlabeled and undated bag of breadcrumbs. Observation on 07/25/22 at 9:09 A.M. revealed one bag of fried chicken legs, unlabeled and undated, in the freezer. Observation on 07/25/22 at 9:10 A.M. revealed one bag of ribs, unlabeled and undated, in the freezer. Interview on 07/25/22 at 9:15 A.M., with the dietary supervisor #44 verified the above findings and discarded those items. Review of the facility policy titled Food Storage - Labeling and Dating, dated July 2018 revealed all food must have a date that includes month, day, and year on package indicating the date in which it entered the facility. All items removed from its original packaging must be dated. Items must be dated after opening with an open date and use by date unless specified. The use-by-date will be seven days. All foods should be discarded prior to or on day seven. All items considered to be leftovers shall be properly dated and labeled. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 20 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0825 Provide or get specialized rehabilitative services as required for a resident. 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, resident and staff interviews, and review of the hospital continuity of care form, the facility failed to arrange for and provide timely therapy services. This affected one resident (#21) of three residents reviewed for therapy services. The facility census was 66. Residents Affected - Few Findings include: Review of the medical record for Resident #21 revealed an admission date of 04/30/22 with a diagnosis of diabetes mellitus (DM.) Review of the Minimum Data Set (MDS) for Resident #21 dated 05/07/22 revealed the resident was cognitively intact and required extensive assistance of two staff with activities of daily living (ADL). Resident #21 was coded for zero minutes of therapy during the assessment period. Review of the hospital continuity of care form for Resident #21 dated 04/14/22 revealed it included a list of resident's current medications and order for rehabilitation therapies included physical therapy (PT) and occupational therapy (OT). Review of the admission history and physical per the physician for Resident #21 dated 04/29/22 revealed the resident was admitted with generalized weakness and debility and had difficulty caring for herself. Further review of the examination note revealed resident needed PT and OT services. Review of the baseline care plan for Resident #21 dated 05/02/22 revealed the resident was new to the facility and the resident needs would be met and care would be provided based on admission physician orders and professional standards of quality care. Interventions included to provide therapy services as ordered. Review of the nurse progress note for Resident #21 dated 05/01/22 revealed skilled PT services and skilled OT services were required. Review of the therapy records for Resident #21 revealed the resident was not evaluated for PT until 05/17/22 at which time the resident was picked up for PT three times weekly to work on gait training, transfer training, and mobility. Interview on 07/25/22 at 9:31 A.M., with Resident #21 confirmed she had thought she would receive PT and/or OT upon admission to the facility, but she had not started being treated by therapy until 05/17/22. Interview on 07/28/22 at 12:14 P.M. of Physical Therapy Assistant (PTA) #86 confirmed she was the Program Manager for the facility's therapy department. PTA #86 further confirmed all newly admitted residents should be screened for therapy services within one to two days of their admission. PTA #86 confirmed she thought Resident #21 was screened upon admission but could find no record of a screening by therapy. PTA #86 further confirmed the facility admission department told her it was not urgent for Resident #21 to be screened or begin receiving therapy services. PTA #86 confirmed Resident #21 was admitted on [DATE] and was not evaluated and started with PT until 05/17/22. PTA #86 confirmed the facility did not have a written policy regarding screening for therapy services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 21 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 0825 This deficiency substantiates Complaint OH00133207. 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: 366421 If continuation sheet Page 22 of 23 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 366421 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Florentine Gardens 409 Wards Corner Road Loveland, OH 45140 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 medical record review, observation, staff interviews, and review of facility policy, the facility failed to ensure infection control standards were followed during a blood sugar check for Resident #36. This affected one (Resident #36) of one resident observed for blood sugar checks. The facility's census was 66. Residents Affected - Few Findings include Review of the medical record for Resident #36 revealed an admission date of 05/30/22 with a diagnosis of diabetes mellitus (DM). Review of the Minimum Data Set (MDS) for Resident #36 dated 06/06/22 revealed the resident was cognitively impaired and required supervision and set up help of one staff with activities of daily living. Review of the July 2022 monthly physician orders for Resident #36 revealed an order dated 06/28/22 for the resident to receive Humulin insulin 25 units twice daily via injection. Observation on 07/27/22 at 8:08 A.M. of blood sugar check prior to insulin administration for Resident #36 per Registered Nurse (RN) #86 revealed RN #86 used a lancet (small needle) and obtained a large drop of blood from the resident's finger. RN #86 was not wearing gloves when she obtained Resident #36's blood sample and said aloud, I should be wearing gloves right now, shouldn't I? Interview on 07/27/22 at 8:11 A.M. RN #86 confirmed she was not wearing gloves when she obtained Resident #36's blood sample to check the residents blood sugar. RN #86 further confirmed staff should wear gloves whenever having contact with a resident's blood or body fluids is likely. Review of the facility policy titled, Testing Blood Glucose Levels, dated April 2015 revealed staff should apply gloves before obtaining blood samples from the resident and should discard the gloves and perform hand hygiene after the procedure. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366421 If continuation sheet Page 23 of 23