Inspection·January 18, 2024

F 0646 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the nursing progress note for Resident #05 dated 01/16/24 revealed the resident was seated in the lobby and was yelling out. The staff asked resident what was wrong, and the resident replied that everything was wrong and that she was dying. The staff attempted to reassure the resident of her safety. Interview on 01/10/24 at 11:05 A.M. with Admissions Director #79 confirmed Resident #5 should have had a new PASARR completed and a referral for PASARR Level II evaluation based on her change in behaviors. Further interview confirmed the facility did not have policy for PASARR completion. Event ID: Facility ID: 366443 If continuation sheet Page 2 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview the facility failed to ensure the development of comprehensive resident care plans. This affected two (Residents #15 and #20) of 12 residents reviewed for care plans. The facility census was 44. Findings include: 1.Review of the medical record for Resident #20 revealed an admission date of 10/31/23 with diagnoses including metabolic encephalopathy, transient ischemic attack (TIA) and congestive heart failure (CHF). Review of the physician orders for Resident #20 dated January 2024 revealed orders for order for oxygen at three liters per minute via nasal cannula. Review of the care plan for Resident #20 updated 11/29/23 revealed it did not include a plan of care related to oxygen therapy administration. Review of the nutritional progress note dated 12/28/23 at 3:31 P.M. the Dietary Technician #105 did not make any indications of Resident #20 using built up silverware with meals. Review of the care plan for Resident #20 updated 11/29/23 revealed the resident had a potential for alteration in nutrition and hydration. Weighted silverware was not included as an intervention in the care plan. Observation on 01/11/24 at 4:35 P.M. revealed Resident #20 was eating dinner. Resident #20 was feeding himself using built-up utensils. The meal ticket on his tray did not include the built-up utensil as adaptive equipment. Further observation revealed resident was receiving oxygen per nasaul cannula at three liters per minute. Interview on 01/16/24 at 11:11 A.M. with Certified Occupational Therapist (COTA) #142 confirmed Resident #20 used built- up utensils to feed himself his meals. COTA #142 stated Resident #20 was admitted to the facility with the built-up silverware for use in self-feeding at meals. Interview on 01/16/23 at 3:40 P.M. with the Director of Nursing (DON) confirmed the facility had not developed a care plan for Resident #05's oxygen use nor did the resident's nutritional plan of care include the use built-up utensils. 2. Review of the medical record review for Resident # 15 revealed the resident was admitted on [DATE] with diagnoses including sacroiliitis, urinary tract infections, and anxiety. Review of the monthly physician orders dated January 2024 for Resident #15 revealed the resident was allergic to ciprofloxacin (antibiotic), codeine and morphine (narcotic). Review of the medical record for Resident #15 revealed no care plan was developed for the resident's medication allergies. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 3 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0656 Interview on 01/11/24 at 3:15 P.M. with Registered Nurse (RN) #4 confirmed Resident #15's medication allergies were not included in his care plan. 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: 366443 If continuation sheet Page 4 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 Based on medical record review, observation, staff interview, and review of the facility policy, the facility failed to accurately assess residents' skin and obtain timely treatment for areas of impaired skin integrity. This affected two (Residents #01 and #35) of three residents reviewed for skin integrity. The facility census was 44. Residents Affected - Few Findings include: 1.Review of the medical record for Resident #01 revealed an admission date of 02/27/23 with diagnoses including chronic respiratory failure with hypercapnia, type two diabetes mellitus, severe morbid obesity, chronic kidney disease and obstructive sleep apnea. Review of the plan of care for Resident #01 dated 11/28/23 revealed the resident was at risk for impaired skin integrity/pressure ulcers related to fragile skin, impaired mobility and diabetes mellitus with a goal for open areas to be healed without complications. Interventions included the following: inspect skin during routine daily care, skin assessment as ordered, treatments as ordered. Review of the weekly skin assessments for Resident #01 dated 12/05/23, 12/19/23, 12/26/23, 01/02/24, and 01/09/24 revealed there was no documentation regarding a red, flaky area to the left side of the resident's face. Review of the quarterly Minimum Data Set (MDS) assessment for Resident #01 dated 12/06/23 revealed the resident was cognitively intact and required assistance to complete activities of daily living. Resident #1 was assessed to have no skin impairments. Review of the monthly physician orders Resident #01 for January 2024 revealed there were no treatment orders for the red, flaky area to left side of the resident's face. Observations on 01/09/24 at 10:55 A.M., on 01/10/24 at 1:25 P.M., and on 01/16/24 at 2:50 P.M. of Resident #01 revealed the resident was lying in bed and had a red, flaky area of skin covering the left side of her face. Interview on 01/16/24 at 2:50 P.M. with Licensed Practical Nurse (LPN) #77 confirmed Resident #01 had a red, flaky area of impaired skin integrity to the left side of her face. Further interview with LPN #77 confirmed Resident #01 did not have a treatment ordered for the area of impaired skin integrity and she would notify the Nurse Practitioner (NP) of the area. Review of the facility policy titled Skin Assessment undated revealed a licensed nurse would assess residents' skin every week and document findings in the medical record. The nursing assistants would audit residents' skin during care daily and report to the nurse any abnormal findings. 2. Review of the medical record for Resident #35 revealed an admission date of 10/11/23 with diagnoses including multiple sclerosis, myopathy, weakness, osteoarthritis and venous insufficiency-peripheral. Review of the plan of care for Resident #35 dated 10/12/23 revealed the resident was at risk for impaired skin integrity/pressure ulcers related to fragile skin. The plan of care did not address redness or edema to Resident #35 lower extremities. Interventions included assessing the skin during (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 5 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 routine daily care and conducting weekly skin assessments. Level of Harm - Minimal harm or potential for actual harm Review of the January 2024 monthly physician orders for Resident #35 revealed an order to wrap left lower extremity in the morning and remove in the evening. Residents Affected - Few Review of the Treatment Administration Record dated January 2024 for Resident #35 revealed the nursing staff had signed the wrap was on the resident's left leg on 01/08/24, 01/09/24, 01/10/24 and 01/11/23. Review of the skilled nursing notes for Resident #35 dated 01/08/24, 01/09/24, 01/10/24, and 01/11/24 revealed they did not include documentation regarding edema or redness to the resident's lower extremities. Review of the weekly skin assessments for Resident #35 dated 01/01/24 and 01/08/23 revealed they did not include documentation regarding edema or redness to the resident's lower extremities. Observations of Resident #35 on 01/09/24, 01/10/24, 01/11/24 and 01/16/24 revealed the resident did not have a wrap to her lower extremities. Resident #35's lower extremities were red, tight, and edematous. Interview on 01/11/24 at 1:20 P.M. with Resident #35 confirmed the staff had not wrapped her legs in some time. Interview on 01/16/24 at 3:40 P.M. with the Director of Nursing (DON) confirmed Resident #35 had edema and redness to her lower extremities and did not have a wrap in place as ordered to her lower extremities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 6 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 medical record review, observation, staff interview and review of the facility policy, the facility failed to accurately assess resident risk for falls and failed to ensure fall prevention interventions were implemented to prevent falls. This affected one (Resident #11) of one resident reviewed for accidents. The facility census was 44. Findings include: Review of the medical record for Resident #11 revealed the resident was admitted on [DATE] with diagnoses including dementia, atrial fibrillation, coronary artery disease, heart failure, hypertension, diabetes mellitus and respiratory failure. Review of the care plan for Resident #11 dated 02/28/23 revealed the resident was at risk for falls and potential injury related to debilitation, weakness, dementia and unsteady gait. Interventions included the following: minimize potential risk factors, bed stabilizers, lock bed, encourage resident to wear non-skid footwear, have commonly used articles within easy reach, low bed, maintain a clear pathway, provide rest periods, rehab referral, resident education. The care plan had not been revised since 02/28/23. Review of the nursing progress note for Resident #11 dated 03/29/23 revealed the nurse was walking past the resident's room and saw him slide out of his wheelchair onto the floor. The resident sustained no injuries during the fall and said he slid out of the bed, and he didn't know his shoes were so slippery. Review of the fall investigation for Resident #11 dated 03/29/23 revealed resident had no previous falls and interventions in place at the time of the fall included a low bed and physical/occupational therapies. The resident had a poor memory and a history of non-compliance with medical recommendation/safety recommendations. The cause of the fall was determined to be resident was wearing shoes without a non-skid surface. The new intervention to be added to plan of care to prevent further falls included the resident's family would bring in shoes with a non-skid surface. Review of the significant Minimum Data Set (MDS) assessment for Resident #11 dated 04/26/23 revealed the resident was moderately impaired for daily decision-making and was coded for one prior fall with no injury. Review of the quarterly fall risk evaluation for Resident #11 dated 12/20/23 revealed the resident required assistance with activities of daily living (ADL) self-performance and used an assistive device for mobility. The resident's fall risk score was 10, but there was no legend or definition of what this number meant. The risk assessment did not indicate if the resident was at low or high risk for falls. Observation on 01/08/24 at 11:34 A.M. of Resident #11 revealed there was a pair of shoes on top of the resident's heater unit located below the window. Resident #11 was seated on his bedside facing the doorway to the hallway. There were no shoes were observed within the resident's reach. Observation on 01/08/24 at 11:46 A.M. of Resident #11 revealed the resident was sitting on edge of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 7 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 bed and was barefoot and holding a pair of dress socks without grippers. Level of Harm - Minimal harm or potential for actual harm Observation on 01/08/24 at 12:23 P.M. and 12:38 P.M. of Resident #11 revealed the resident was self-transferring from bed to wheelchair, walking independently in his room and walking to the bathroom by himself. He was wearing black dress socks with no gripper. Residents Affected - Few Observation on 01/08/24 at 2:31 P.M. of Resident #11 revealed the resident was observed walking in his room and wearing slip-on shoes without a non-skid surface. Observation on 01/10/24 at 8:59 A.M. of Resident #11 revealed the resident was observed ambulating in his room in his bare feet. Interview on 01/10/24 at 9:02 A.M. with State Tested Nursing Assistant (STNA)#5 confirmed Resident #11 was walking around the room in his bare feet and was not aware the resident's fall care plan indicated he should wear non-skid footwear. Interview on 01/11/24 at 8:38 A.M. with Registered Nurse (RN)#4 confirmed Resident #11's fall care plan did not indicate if the resident was at high risk for falls or not. RN #4 further confirmed Resident #11 was supposed to wear non-skid footwear. Interview on 01/11/24 at 10:59 A.M. with the Director of Nursing (DON) confirmed Resident #11's fall risk assessment did not indicate if the resident was a high or low risk for falls. The DON stated there was no legend to determine the assessment outcome. Review of the facility policy titled Fall Management undated revealed the facility would identify each resident who was at high risk for falls and would develop a plan of care and implement interventions to manage falls. The facility was to provide an environment free from potential hazards. Review of the facility policy titled Falls Program revealed the purpose of the falls program was to determine and monitor those residents that were at risk for falls and increase the awareness of the staff to attempt in the prevention of falls. The falls program would promote a pro-active approach to nursing care and resident safety. The goal was to enhance and heighten the staff awareness and to focus on frequent and timely response to resident needs specific to assistance with toileting, offering of food and fluids, intervening with unsafe self-transfer, redirecting and assisting more frequently with care or redirection. The fall risk assessment was used to assess fall risk factors to develop interventions for the residents' plan of care based on the reason for the fall. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 8 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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** Based on medical record review, staff interview, and review of the facility policy the facility failed to ensure residents were provided with oxygen therapy as ordered. This affected one (Resident #11) of one resident reviewed for respiratory care. The facility census was 44. Residents Affected - Few Findings include: Review of the medical record for Resident #11 revealed the resident was admitted on [DATE] with diagnoses including dementia, atrial fibrillation, coronary artery disease, heart failure, hypertension and respiratory failure. Review of the significant change Minimum Data Set (MDS) assessment for Resident #11 dated 09/24/23 revealed the resident was moderately impaired for daily decision-making and had a life expectancy of less than six months. Review of the hospice care plan for Resident #11 dated 11/11/23 revealed the resident utilized oxygen therapy. Interventions including the following: collaborate with facility staff to ensure proper oxygen flow is prescribed, ensure nasal cannula was connected, ensure oxygen concentrator was turned on to the appropriate flow rate. Review of the hospice certification for Resident #11 revealed benefits started 12/20/23 with a qualifying diagnosis of atherosclerosis heart disease. The resident had a documented prognosis of less than six months to live if disease process continued and had shortness of breath at rest required three liters per minute of continuous oxygen per nasal cannula. Review of the monthly physician orders for Resident #11 dated January 2024 revealed the resident had an order to wear oxygen at three liters per minute continuously. Review of the Treatment Administration Record (TAR) for Resident #11 dated January 2024 revealed staff signed off the resident was receiving continuous oxygen at three liters per minute. Observation on 01/08/24 at 11:34 A.M. of Resident #11 revealed the resident was seated on his bed with an oxygen concentrator in his room. The nasal cannula and oxygen tubing were laying on the floor. Observation on 01/08/24 at 11:46 A.M. of Resident #11 revealed the oxygen tubing and nasal cannula were laying on the floor. The resident was sitting on the edge of the bed putting on his socks without the use of oxygen. Observations on 01/08/24 at 12:23 P.M. and 12:38 P.M. revealed Resident #11 was self-transferring from bed to wheelchair, walking independently in his room and walking to the bathroom by himself. He was not wearing his oxygen. Observation on 01/08/24 at 2:31 P.M., 01/09/24 at 2:30 P.M., and 01/10/24 at 9:02 A.M. revealed Resident #11 was walking in his room without the use of oxygen. Observation on 01/11/24 at 7:27 A.M. of Resident #11 revealed Resident #11 was in bed with his eyes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 9 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 closed and was receiving oxygen via nasal cannula at three liters per minute. Level of Harm - Minimal harm or potential for actual harm Interview on 01/09/24 at 3:10 P.M. with Registered Nurse (RN) #6 confirmed Resident #11 had a physician's order to receive oxygen continuously at three liters per minute per nasal cannula and staff were responsible to ensure the order was implemented. Residents Affected - Few Interview on 01/10/24 at 9:02 A.M. with State Tested Nursing Assistant (STNA) #5 confirmed Resident #11 was a long-term care resident and he did not have to use oxygen. STNA #5 stated he only had to use it when he felt he needed it, and it was okay if he took it off whenever he wanted to do so. STNA #5 the resident was not wearing oxygen at the time of the interview. Review of the facility policy titled Oxygen Therapy undated revealed the objective of oxygen therapy was to provide relief from hypoxemia (low levels of oxygen in the blood). Review of the facility policy titled Nasal Cannula undated revealed staff should assemble the oxygen source and delivery device to administer oxygen per the physician's orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 10 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 staff interview, the facility failed to provide necessary behavioral health services to residents. This affected one (Resident #5) of one resident reviewed for behavioral health. The facility census was 44. Findings include: Review of the medical record for Resident #05 revealed an admission date of 10/19/23 with diagnoses including schizoaffective disorder, schizophrenia, psychological conversion disorder, anxiety disorder and history of traumatic brain injury. Review of the hospital discharge instructions for Resident #05 dated 10/19/23 revealed the resident was admitted to the hospital on [DATE] for cough, shortness of breath, low oxygen saturations and history of recurrent pneumonia. The medication list upon admission to the hospital included Haloperidol 5 milligrams (mg), take one half tablet by mouth at bedtime, Clozapine 100 mg, take three tablets by mouth at bedtime and Clozapine 25 mg, take three tablets by mouth every morning. Resident #05 had diagnoses of anxiety and schizoaffective disorder. The Discharge summary dated revealed the resident had a history of psychiatric illness and was on psychiatric medications at home, but they were discontinued during the resident's hospital stay. Review of the Preadmission Screening and Resident Review (PASARR) dated 11/02/23 revealed Resident #05 was admitted with diagnosis of mood disorder, schizophrenia and psychologic conversion disorder. The PASARR did not indicate Resident #05 was referred to state agency for PASARR Level II screening. Review of the nursing progress note for Resident #05 dated 12/08/23 revealed the resident was having crying episodes and verbalized feelings of depression. The Nurse Practitioner (NP) was notified and a gave a new order to start Zoloft (antidepressant) 25 milligram (mg) by mouth daily. Review of the nursing progress note for Resident #05 dated 12/12/23 revealed the resident was seated in the common area and repeatedly verbalized that she did not kill the baby. Resident also verbalized she was having visual hallucinations of a dead baby. Staff notified the resident's physician when he arrived at the facility of the resident's delusions and visual hallucinations. The physician reviewed Resident #05's previous records and spoke with the resident's psychiatrist who told the physician Resident #05 had been on multiple medications throughout the years for schizophrenia, and the only medications that seemed helpful were Clozaril and Haldol. The physician gave new orders to start Haldol 5 mg by mouth two times daily. Review of the nursing progress note for Resident #05 dated 12/12/23 revealed during care the resident stated she was hearing a man's voice in her head, and he was telling her to say things that were not true. During the conversation, Resident #05 went from being pleasant and cooperative to demanding and raising her voice. Review of the nursing progress note for Resident #05 dated 01/16/24 revealed the resident was seated in the lobby and was yelling out. The staff asked resident what was wrong, and the resident replied that everything was wrong and that she was dying. The staff attempted to reassure the resident of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 11 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 her safety. Level of Harm - Minimal harm or potential for actual harm Interview on 01/17/24 at 10:31 A.M. with the Director of Nursing (DON) confirmed Resident #05 had a history of mental illness and was seen by the facility psychologist on 10/26/23. The DON confirmed the resident had not received cognitive behavioral therapy as was recommended by the psychologist. The DON confirmed the resident had not been examined by a behavioral health provider since 10/26/23. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 12 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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. Based on medical record review and staff interview the facility failed to ensure physicians documented a rationale indicating why consultant pharmacist medication regimen recommendations were rejected. This affected one (Resident #32) of five residents reviewed for unnecessary medications. The facility census was 44. Findings include: Review of the medical record for Resident #32 revealed an admission date of 11/27/23 with diagnoses including respiratory failure, morbid obesity, type two diabetes mellitus, hyperparathyroidism, anxiety and depression. Review of the physician orders for Resident #32 revealed Resident #an order dated 11/27/23 for Lexapro 20 milligrams (mg) by mouth in the morning for depression. Review of the medication regimen review (MRR) per the consultant pharmacist for Resident #32 dated 12/01/23 revealed a recommendation to decrease the dosage of Lexapro 20 mg by mouth daily. Further review of the MRR revealed according to new dosing guidelines, the antidepressant Lexapro should no longer be used at doses greater than 10 mg per day in patients over the age of 60 because it could cause abnormal changes in the electrical activity of the heart and could lead to abnormal and possibly fatal heart rhythms. Review of the MRR revealed Resident #32's physician documented to continue the current dose but gave no rationale regarding the same. Interview on 01/11/24 at 3:40 P.M. with the Director of Nursing (DON) confirmed Resident #32's physician did not document a rationale as required for declining the pharmacy recommendation to reduce the dose of the resident's Lexapro. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 13 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. Based on medical record review, observation, staff interview, review of alternate menu and review of the facility policy, the facility failed to ensure alternate menu items included a variety based on resident preferences, likes or dislikes and failed to ensure residents knew what was on the alternate menu and where to find it. This affected two (Residents #15 and #20) of two residents reviewed for food preferences. The facility census was 44. Findings include: 1.Review of the medical record for Resident #15 revealed an admission date of 01/24/23 with diagnoses including diabetes mellitus, Parkinson's disease, tremors, osteoarthritis, generalized anxiety, hyperlipidemia and atrial fibrillation. Review of the physician orders for Resident #15 dated January 2024 revealed the resident was ordered a consistent carbohydrate, no added salt, regular texture diet with thin liquids. Review of the plan of care revealed for Resident #15 dated 01/24/23 revealed the resident had a potential for alteration in nutrition and hydration related to chronic diseases, therapeutic diet and body mass index (BMI) greater than 40. Interventions included the following: assist with meals as needed, honor food preferences as able, offer alternative fluid options, offer meal alternate if resident refused meal, provide diet as ordered, dietitian referral as needed. The plan of care did not include the resident's personal preferences and/or likes/dislikes of food. Review of the alternate menu undated revealed the following choices: chef salad, hamburger, cheeseburger, hot dog, grilled cheese sandwich, cottage cheese, mashed potatoes, side salad. Interview on 01/11/24 at 7:30 A.M. with Resident #15 confirmed she was not aware of what was on the alternate menu or where to find the information. Interview on 01/17/24 at 1:22 P.M. with the Director of Nursing (DON) confirmed Resident #15's care plan did address the resident's personal preferences and/or likes and dislikes for food. 2. Review of the medical record for Resident #20 revealed an admission date of 10/31/23 with diagnoses including metabolic encephalopathy, weakness, protein-calorie malnutrition, congestive heart failure, hyperlipidemia and transient ischemic attacks (TIA). Review of the physician orders for Resident #20 dated January 2024 revealed the resident had an order for a regular diet, regular texture and thin liquids. Review of the dietary progress note progress note for Resident #20 dated 12/22/23 revealed it did not include documentation of the resident's references and/or likes/dislikes of food. Review of the plan of care for Resident #20 dated10/21/23 revealed the resident had potential for alteration in nutrition and hydration related to chronic disease, therapeutic diet, diuretic treatment, BMI greater than 25, increased nutritional needs and inadequate oral intake. Interventions included the following: assist with meals as needed, honor food preferences as able, medications as ordered, offer alternative fluid options, offer meal alternate if resident refused meal, provide diet as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 14 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0803 Level of Harm - Minimal harm or potential for actual harm ordered, supplements as ordered, dietitian referral as needed. The plan of care did not include the resident's personal preferences and/or likes/dislikes of food. Observation on 01/11/24 at 4:35 P.M. of the dinner meal for Resident #20 revealed the meal ticket did not indicate Resident #20's food preferences and/or likes/dislikes. Residents Affected - Few Interview on 01/09/24 at 2:00 P.M. with Resident #20's representative confirmed the food variety was poor. The menu repeated itself and offered very little variety. Resident #20's representative stated Resident #20 liked fresh fruit which was rarely available, and the alternate menu was limited to a few items. The representative stated she brought food in for the resident to eat, and she did not recall anyone asking her or Resident #20 what foods he liked or disliked. Interview on 01/16/24 at 3:40 P.M. with DON confirmed Resident #20's nutritional care plan was generic and was not individualized to meet resident preferences. Review of the facility policy titled Resident Interview/Food Preferences undated revealed the Resident Interview/Food Preferences form would be completed for all new residents. The form would be updated annually, and any time the residents' food preferences changed. A copy of the form would be kept in the residents' medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 15 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 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 facility policy review, the facility failed to maintain sanitary conditions in the kitchen. This had the potential to affect all 44 residents residing in the building. Residents Affected - Many Findings include: Observation on 01/08/24 at 8:53 A.M. revealed there was heavy dust/grease build-up on the sprinkler heads and piping located above the six-burner gas stove. The metal can opener attached to the side of the prep table revealed there were metal shavings on the point of the opener and also on the indentation behind the metal spike. Interview on 01/08/24 at 8:53 A.M. with [NAME] #1 confirmed the sprinkler heads and piping above the stove and the can opener were not clean. Observation on 01/10/24 at 7:08 A.M. of the kitchen dry stock room revealed there was a metal scoop inside a clear plastic bin that was half-full of white flour. Further observation revealed there was a 112 ounce can of apple pie filling and a 50 ounce can of cream of chicken soup which were dented on the bottom seam. Interview on 01/10/24 at 7:08 A.M. with Dietary Manager (DM) #2 there was a metal scoop stored inside the flour bin, and scoops should not be stored inside storage bins. DM #2 further confirmed the dry storage area had a dented can of pie filling and a dented can of soup and dented items should be discarded. Review of the facility policy titled Dry Storage undated revealed food storage and preparation areas should be kept clean. Further review of the policy revealed dented cans of food should be discarded. Review of the facility policy titled Food Storage undated revealed scoops for food should be kept covered in a protected area near the containers and should not be stored in the container of food. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 16 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm Based on medical record review, staff interview, and review of Centers for Disease Control and Prevention (CDC) documents, the facility failed to provide education to residents regarding influenza and pneumonia vaccines and failed to ensure residents received the recommended pneumonia vaccines. This affected four (Residents #15, #20, #32 and #97) of four residents reviewed for immunizations. The facility census was 44. Residents Affected - Some Findings included: 1.Review of the medical record for Resident #20 revealed an admission date of 10/31/23 with diagnoses including metabolic encephalopathy, weakness, protein-calorie malnutrition, congestive heart failure, hyperlipidemia and transient ischemic attacks (TIAs). Review of the vaccine consent form for Resident #20 dated 11/23/23 revealed the resident did not wish to receive the influenza or pneumococcal pneumonia vaccine. The record did not include documentation regarding education provided to the resident regarding risks and benefits of the vaccines. Interview on 01/10/24 at 1:09 P.M. with the Director of Nursing (DON) confirmed the facility did not have documentation of education to Resident #20 regarding the risks and benefits of the influenza and pneumococcal pneumonia vaccines. 2. Review of the medical record for Resident #15 revealed an admission date of 01/24/23 with diagnoses including atrial flutter, diabetes mellitus with diabetic neuropathy, Parkinson's disease and generalized anxiety disorder. Review of the vaccine consent form for Resident #15 dated 01/24/23 revealed the resident consented to receive the pneumococcal polysaccharide vaccine. Review of the immunization record for Resident #15 received a Pneumovac-23 on 11/09/22. Review of the Medication Administration Record (MAR) for Resident #15 dated November 2023 revealed Resident #15 was administered a Prevnar-13 vaccination on 11/10/23. Interview on 01/10/24 at 1:09 P.M. with the DON confirmed Resident #15 was not administered the correct pneumococcal vaccination in 2023. The DON verified Resident #15 should have received a PCV15 or PCV20 per CDC guidance and facility policy. Review of the CDC document dated 04/01/22 titled Pneumococcal Vaccine Timing for Adults undated revealed for those previously received PPSV23 but who have not received any pneumococcal conjugate vaccine may receive one dose of PCV15 OR PCV20. Regardless of which vaccine was used the minimum interval was at least one year and then their pneumococcal vaccinations were considered completed. 3. Review of the medical record for Resident #97 revealed an admission date of 12/01/23 with diagnoses including congestive heart failure, weakness, type two diabetes mellitus, dementia and clostridium difficile. Review of the vaccine consent form for Resident #97 dated 12/11/23 revealed the resident did not wish to receive the influenza or pneumococcal pneumonia vaccines. The record did not include (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 17 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0883 documentation regarding education provided to the resident regarding risks and benefits of the vaccines. Level of Harm - Minimal harm or potential for actual harm Interview on 01/10/24 at 1:09 P.M. with the DON confirmed the facility did not have documentation of education to Resident #97 regarding the risks and benefits of pneumococcal pneumonia vaccines. Residents Affected - Some 4. Review of the medical record for Resident #32 revealed an admission date of 11/27/23 with diagnoses including morbid obesity, type two diabetes mellitus, respiratory failure, anemia, depression, anxiety, chronic kidney disease stage three, congestive heart failure and atrial fibrillation. Review of the vaccine consent form for Resident #32 dated 11/27/23 revealed the resident had received a pneumococcal pneumonia vaccine prior to admission. The record did not include documentation regarding education provided to the resident regarding risks and benefits of the vaccines nor did it include information regarding the next eligible pneumonia vaccine. Interview on 01/10/24 at 1:09 P.M. interview with the DON confirmed the facility did not have documentation of education to Resident #97 regarding the risks and benefits of pneumococcal pneumonia vaccines nor did the facility have information regarding the resident's next eligible pneumonia vaccine. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 18 of 19 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 366443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Belpre Landing Nursing and Rehabilitation 1915 Hill Street Belpre, OH 45714 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 0887 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. Based on medical record review and staff interview the facility failed to ensure residents were educated regarding the risk and benefits of Coronavirus (COVID-19) vaccination. This affected three (Residents #20, #32, and #97) of four residents reviewed for vaccines. The facility census was 44. Findings include: 1. Review of the medical record for Resident #20 revealed an admission date of 10/31/23 with diagnoses including metabolic encephalopathy, weakness, protein-calorie malnutrition, congestive heart failure, hyperlipidemia and transient ischemic attacks (TIAs). Review of the vaccine consent form dated 11/23/23 revealed Resident #20 did not wish to receive the COVID-19 vaccine. The record did not include documentation regarding education provided to the resident regarding risks and benefits of the COVID-19 vaccine. Interview on 01/10/24 at 1:09 P.M. with the Director of Nursing (DON) confirmed the facility did not have documentation of education to Resident #20 regarding the risks and benefits of the COVID-19 vaccine. 2. Review of the medical record for Resident #97 revealed an admission date of 12/01/23 with diagnoses including congestive heart failure, weakness, type two diabetes mellitus, dementia and clostridium difficile. Review of the vaccine consent form dated 12/11/23 revealed Resident #97 did not wish to receive the COVID-19 vaccine. The record did not include documentation regarding education provided to the resident regarding risks and benefits of the COVID-19 vaccine. Interview on 01/10/24 at 1:09 P.M. with the DON confirmed the facility did not have documentation of education to Resident #97 regarding the risks and benefits of the COVID-19 vaccine. 3. Review of the medical record for Resident #32 revealed an admission date of 11/27/23 with diagnoses including morbid obesity, type two diabetes mellitus, respiratory failure, anemia, depression, anxiety, chronic kidney disease stage three, congestive heart failure and atrial fibrillation. Review of the vaccine consent form dated 11/27/23 revealed Resident #32 did not wish to receive the COVID-19 vaccine. The record did not include documentation regarding education provided to the resident regarding risks and benefits of the COVID-19 vaccine. Interview on 01/10/24 at 1:09 P.M. with the DON confirmed the facility did not have documentation of education to Resident #32 regarding the risks and benefits of the COVID-19 vaccine. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366443 If continuation sheet Page 19 of 19