Health inspection·April 6, 2023

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 3. Review of the medical record revealed Resident #62 had an admission date of 11/08/22. Diagnoses included displaced communicated fracture of shaft of left femur, COVID-19, unspecified lack of coordination, and history of falling. Review of the physician orders dated 01/21/23 revealed an order for an alarm to the chair and an order for an alarm to the bed. Review of the care plan dated 11/16/22 revealed Resident #62 was high risk for falls related to not positioning in bed correctly, not using call light, and self-transferring despite redirection and visual cues to ask for assistance. Interventions included an alarm to the bed and the chair. Review of the quarterly 03/07/23 MDS assessment revealed a bed and chair alarm were not used. Observation on 04/03/23 at 12:25 P.M. revealed Resident #62 had a bed and chair alarm in use. Interview on 04/05/23 at 8:50 A.M. with Registered Nurse #472 confirmed bed and chair alarms not being marked was in error since Resident #62 did have alarms in place during the reference period for the quarterly 03/07/23 MDS. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 2 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure a Pre-admission Screening and Resident Review (PASARR) Assessment was completed following a new diagnosis of schizoaffective disorder. This affected one resident (#2) of one resident reviewed for PASARR. The facility census was 65. Findings include: Review of the medical record for Resident #2 revealed an admission date of 09/10/21. Diagnoses included major depressive disorder, bipolar disorder, and chronic pain. A new diagnosis of schizoaffective disorder was added 01/31/22. Review of the PASARR assessment dated [DATE] indicated Resident #2 did not have a serious mental illness or developmental disability. No other PASARR Assessments were identified for Resident #2. On 04/03/23 at 4:55 P.M., interview with Social Services Designee (SSD) #406 and SSD #470 verified Resident #2 had a new diagnosis of schizoaffective disorder on 01/31/22. They also confirmed no new PASARR Assessment was completed after the new diagnosis to determine if Resident #2 required mental health services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 3 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 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 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #20 was provided effective discharge planning. This finding affected one resident (#20) of one resident reviewed for discharge planning. The facility census was 65. Residents Affected - Few Findings include: Review of Resident #20's medical record revealed she was admitted on [DATE] and discharged on 03/30/23 with diagnoses including mechanical loosening of the internal left knee prosthetic joint and presence of the left artificial knee. Review of Resident #20's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed she exhibited intact cognition. Review of Resident #20's physician orders revealed an order dated 03/22/23 for the resident to return home with physical therapy (PT) and nursing after discharge home with Home Health Care (HHC) #1. Review of Resident #20's progress note dated 03/29/23 at 1:45 P.M. indicated the phone for HCC #1 would not ring and the resident approved HHC #2. Review of Resident #20's Discharge Instructions form dated 03/29/23 revealed she would be discharged on 03/30/23 at 1:00 P.M. with HHC #2 to evaluate and treat for therapy services. Review of Resident #20's progress note dated 04/03/23 at 8:58 A.M. indicated the resident was contacted to check on her condition and she stated she had purchased frozen dinners and her sister-in-law had provided sandwiches. HHC #2 had declined to accept the resident and the resident stated she would contact HHC #1 and she had the phone numbers. Interview on 04/04/23 at 2:06 P.M. with Social Service Designee (SSD) #470 indicated the facility was aware HHC #2 had declined to accept Resident #20 and the referral for HHC #1 was not sent to the company to setup her PT and nursing. Interview on 04/04/23 at 2:13 P.M. with HHC #1 Worker #620 indicated her company had sent a face sheet and visit note on 03/22/23 to the facility and then called the facility on three separate occasions to let them know when Resident #20 would be discharged so that the HHC #1 could be setup. She stated the facility did not contact them to let them know Resident #20 was set to be discharged or that she was actually discharged until Resident #20's physician contacted her on 04/04/23 to setup her PT and nursing services as soon as possible. She stated she did not receive any documentation from the facility related to Resident #20's discharge home or the PT and nursing referral. Interview on 04/05/23 at 8:29 A.M. with HCC #2 Worker #622 indicated they received Resident #20's HHC #2 referral on 03/29/23 at 1:47 P.M. and replied back on 03/29/23 at 2:27 P.M. that they were unable to accept the resident. Interview on 04/05/23 at 9:40 A.M. with Licensed Social Worker (LSW) #406 indicated she attempted to call HHC #1 on several occasions and was unable to get in touch of them, so she sent the consult to HHC #2. She stated she did not get the email that HHC #2 did not accept the resident until after (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 4 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 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 0660 Resident #20 was discharged and did not realize her HHC with HCC #1 was not setup. Level of Harm - Minimal harm or potential for actual harm Review of the Discharge Planning Policy, revised 11/17, indicated the facility reviews discharge planning in the overall admission process as part of the continuous and comprehensive care of the resident. The goal was for the physical, mental, and psychosocial needs to be met without interruption as the resident moves from one level of care to another. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 5 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident interview, and staff interview, the facility failed to provide timely assistance with activities of daily living (ADL) for Resident #23. This affected one resident (#23) of two residents reviewed for ADL. The facility census was 65. Residents Affected - Few Findings include: Review of the medical record for Resident #23 revealed an admission date of 04/04/18. Diagnoses included quadriplegia, bipolar disorder, personality disorder, and major depressive disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #23 had no cognitive impairment. Resident #23 required total dependence of two staff for transfers. Review of the care plan revised on 04/19/19 revealed Resident #23 preferred to go to bed at 9:00 P.M. and was totally dependent on two staff for transfers with a Hoyer (mechanical) lift. Review of the physician's orders for April 2023 identified orders for a Hoyer lift for all transfers. On 04/03/23 at 10:36 A.M., an interview with Resident #23 stated his care needs were not being met timely because Resident #3 monopolized the staff. He stated facility staff spent two or three hours at a time with Resident #3 and the needs of the other residents were not met while staff were in Resident #3's room. Resident #23 stated he did not get timely assistance with transfers from his bed to his wheelchair or from his wheelchair to his bed. On 04/03/23 at 3:48 P.M., an interview with Licensed Practical Nurse (LPN) #452 confirmed personal care for Resident #3 took one and a half to two hours each time. LPN #452 also stated there was usually only one nurse and two state tested nurse aides (STNAs) on the unit. On 04/05/23 at 8:45 A.M., an interview with Corporate Quality Assurance Nurse #480 stated Resident #3 required two staff for all care due to a history of being accusatory toward staff. She confirmed there were usually only three staff members on the unit. She said when two staff were providing care to Resident #3, the one staff member who was not in the room would be responsible for meeting the needs of all other residents on the unit until care for Resident #3 was completed. Corporate Quality Assurance Nurse #480 stated Resident #23 was very demanding of staff as well. On 04/06/23 at 7:05 A.M., an interview with Resident #23 stated he was one and a half hours late getting to bed on 04/05/23 because all staff on the B unit were in Resident #3's room. He stated there were no other staff providing care for other residents on the B unit until care for Resident #3 was finished. On 04/06/23 at 7:25 A.M., an interview with LPN #625 verified on the evening of 04/05/23, all three staff members assigned to the B unit were in Resident #3's room for over an hour providing care and there were no other staff on the B unit. She stated Resident #3 had issues that required the attention of both STNAs and the nurse on the B unit. LPN #625 stated multiple residents on the B unit were upset because their care needs were not met timely while care was being provided to Resident #3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 6 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few She confirmed that care for the other residents on the B unit was delayed because all staff were busy caring for Resident #3. On 04/06/23 at 7:50 A.M., an interview with the Administrator confirmed all three staff members for the B unit were in Resident #3's room on the evening of 04/05/23 and no other staff were called from another unit to assist. On 04/06/23 at 12:09 P.M., an interview with LPN #437 stated care for Resident #3 always took at least an hour and required two staff at all times. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 7 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on resident interviews, staff interviews, review of activity calendars, and review of activity policy, the facility failed to ensure group activities were offered and provided per the resident's preferences and the activity calendar. This finding had the potential to affect 28 residents who participate in group activities including Residents #1, #2, #4, #5, #8, #12, #15, #16, #17, #22, #23, #25, #28, #30, #32, #34, #35, #36, #39, #42, #43, #48, #50, #56, #62, #121, #278, and #281. The facility census was 65. Residents Affected - Some Findings include: On 04/05/23 2:03 P.M. during the Resident Council Meeting, Residents #16 and #56 stated they were unhappy that there were no activities on the weekends. Review of the activity calendar for January 2023 revealed weekend activities planned for 01/07/23 included daily visits, word search, and afternoon chats. 01/08/23 included daily visits, visits with a friend, and afternoon chats. 01/21/23 included daily visits, phone a friend, and afternoon chats. 01/22/23 included daily visits, word scramble, and afternoon chats. Review of the activity calendar for February 2023 revealed weekend activities planned for 02/04/23 included daily visits, phone a friend, and Hallmark movies. 02/05/23 included daily visits, mass on television, and family visits. 02/18/23 included daily visits and be a friend. 02/19/23 included daily visits, mass on television, and family visits. Review of the activity calendar for March 2023 revealed weekend activities planned for 03/04/23 included daily visits and be a friend. 03/05/23 included daily visits and family visits. 03/18/23 included daily visits and phone a friend. 03/19/23 included daily visits and family visits. Interview on 04/05/23 at 2:26 P.M. with Activity Director #449 verified there were no activities every other weekend when Activity Aide #476 was not working due to lack of activity staff. She stated the other activity aide who worked the opposing weekend from Activity Aide #476 quit in 12/22, and the facility had not replaced the activity aide. An additional interview on 04/06/23 at 12:55 P.M. with Activity Director #449 indicated the only activity nursing staff would complete would be for them to occasionally pass out coloring sheets or word puzzles. She stated they did not have time to sit and engage with the residents. Activity Director #449 provided a list of 28 residents (#1, #2, #4, #5, #8, #12, #15, #16, #17, #22, #23, #25, #28, #30, #32, #34, #35, #36, #39, #42, #43, #48, #50, #56, #62, #121, #278, and #281) that participated in group activities. Interview on 04/06/23 at 1:03 P.M. with Activity Aide #476 indicated nursing staff do not complete the activities on the activity calendars on the weekends he was not working. Review of the Activity policy dated revised 03/13 indicated the facility would provide an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interest and the physical, mental, and psychosocial well-being of each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 8 of 9 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 366460 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canfield Acres LLC Dba Windsor House at Canfield 6445 State Route 446 Canfield, OH 44406 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, black box warning review, and facility policy review, the facility failed to ensure appropriate diagnosis for the use of psychotropic medications. This affected one resident (#21) of five residents reviewed for unnecessary medications. The census was 65 residents. Findings include: Review of the medical record for Resident #21 revealed an admission date of 03/01/19. Diagnoses included cerebral infarction, vascular dementia with agitation, and major depressive disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #21 had severe cognitive impairment. The assessment also indicated Resident #21 had active diagnoses of a stroke, non-Alzheimer's dementia, and depression, and received an antipsychotic medication. Review of the physician's orders for April 2023 identified orders for Seroquel (an antipsychotic medication) 25 milligrams (mg) twice daily for restlessness, yelling out, and disruptive behavior related to vascular dementia. Review of the black box warning for Seroquel indicated Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Quetiapine (Seroquel) is not approved for the treatment of patients with dementia-related psychosis. On 04/04/23 at 1:58 P.M., interview with Corporate Quality Assurance Nurse #480 verified Resident #21 was receiving Seroquel to treat vascular dementia. She also confirmed Resident #21 did not have a diagnosis that warranted the use of Seroquel. On 04/05/23 at 8:40 A.M., interview with Corporate Quality Assurance Nurse #480 stated Resident #21's order for Seroquel was from hospice and there was no gradual dose reduction attempt or monitoring for side effects. She confirmed the black box warning for Seroquel verified it was not approved for the treatment of dementia. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366460 If continuation sheet Page 9 of 9