Warren Nursing & Rehab

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

maintenance came in that morning and discovered a breaker was down.Review of a maintenance document from a heating company dated 11/09/25 revealed the heat exchanger needed replaced, and it was recommended a new inducer and burners be replaced.Review of a maintenance document from a heating company dated 11/20/25 revealed all heating units on-site seemed to operate with incorrect gas pressure settings. The gas pressure was adjusted on the three units that were part of the scheduled service, but the remaining units on-site still required gas pressure adjustments, and must be set up to ensure proper combustion, efficient heating performance, and compliance with equipment standards.Review of the facility policy entitled, Temperature Extremes, dated February 2025 revealed the temperature throughout the facility would be maintained between 71 and 81 degrees (F). Any temperature outside of the range required specific interventions to avoid potential negative impact on the residents' well-being.This deficiency represents non-compliance investigated under Complaint Number 2687759, Complaint Number 2674189, Complaint Number 2684242, Complaint Number 2679591, Complaint Number 2688137, Complaint Number 2672693, Complaint Number 2647699 and Complaint Number

1. 2614520. Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 Residents Affected - Few Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

10/17/25. Significant diagnoses included chronic respiratory failure with hypoxia, morbid obesity due to excess calories, and need for assistance with personal care. Review of a care plan dated 10/17/25 revealed Resident #51 had a self-care deficit related to chronic respiratory failure and morbid obesity. Interventions included assistance with activities of daily living as needed.Review of the admission MDS assessment dated [DATE REDACTED] revealed a BIMS of 15, indicating intact cognition. The MDS further revealed Resident #51 was a set up for oral care and dependent for all other activities of daily living. On 12/04/25 at 11:02 A.M. an

observation of Resident #51 revealed them to be in bed. Resident #51 was tearful and stated they had just got a shower but their teeth had not been brushed since admission despite having oral care items available

in their bathroom. Resident #51 was noted to have visible dirt under their fingernails. Licensed Practical Nurse #380 verified the dirt under Resident #51's fingernails at the time of the observation.On 12/16/25 at 3:00 P.M. observation and interview with Resident #51 revealed their teeth had still not been brushed. There was no toothbrush observed on Resident #51's bedside table. Resident #51 stated to look in the bathroom, and you will see my toothbrush that needs charged. One toothbrush that had dry bristles without signs of use was noted in the battery-operated toothbrush holder and two new toothbrushes were noted to be in a clear plastic, unopened covering. There was an unopened tube of toothpaste also observed. Social Worker Designee #351 verified the findings at the time of the observation.A review of the policy titled Activities of Daily Living (ADL), Supporting dated 03/24 revealed residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Appropriate care and services will be provided to residents who are unable to carry out activities of daily living independently with the consent of the resident and in accordance with the plan of care.This deficiency represents noncompliance investigated under Complaint Numbers 2687759, 2684242, 2641584, and 2655919.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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

[DATE REDACTED] measured the wound as 4 cm by 2 cm with a depth of 0.9 cm, and the assessment dated [DATE REDACTED] measured the wound as 5 cm by 1.8 cm with a depth of 0.7 cm. Review of her facility assessments revealed she was admitted with a stage 2 pressure sore, the wound progressed to a stage 4 during a hospitalization in 07/2024, and a skin graft was placed on 12/31/24.

Record review of Resident #18's progress notes revealed she was hospitalized [DATE REDACTED] for unresponsiveness and returned to the facility 11/05/25. Prior to this hospitalization, she had an order for wound care to the coccyx including Dakins-soaked gauze covered with an ABD pad twice daily. Wound care was not re-ordered following the hospitalization until 11/11/25, with no evidence of any dressing changes done from 11/05/25 to 11/11/25.

Interview with Wound Nurse #431 on 12/24/25 at 8:32 A.M. confirmed the above findings. She said it was

the receiving nurse's responsibility to re-enter wound care orders and this was apparently not done.

1. 3. A review of medical record revealed Resident #28 was admitted to the facility on [DATE REDACTED] with diagnoses

including peripheral vascular disease. Significant orders included Magic cup two times daily with lunch and dinner (nutritional supplement), house supplement two times daily, cleanse right and left calf with Hibiclens (antiseptic soap), rinse with normal saline pat dry, apply oil emulsion dressing and a pad and wrap with Kerlix gauze every day shift and as needed dated 12/16/25.

Review of the quarterly MDS 3.0 assessment dated [DATE REDACTED] revealed a BIMS score of 15, indicating Resident #28 was cognitively intact. The MDS further revealed Resident #28 had no pressure areas and six arterial ulcers.

Review of the care plan dated 10/14/25 revealed Resident #28 had impairment of skin integrity related to vascular areas on admission. Interventions included consulting the wound care practitioner as needed and ordering and providing treatments as ordered.

On 12/17/25 at 12:01 P.M. an interview with CNP #820 revealed there were problems with the facility not doing dressings as ordered.

On 12/18/25 at 10:30 A.M. an observation of the bilateral lower extremity dressings for Resident #28 revealed them to be dated for 12/16/25. Licensed Practical Nurse (LPN) #843 verified the dates of 12/16/25 at the time of the observation. LPN #843 stated the dressings would have been dated for 12/17/25 if they had been done daily.

This deficiency represents noncompliance investigated under Complaint Number 2621765, 2647699, and

2. 2621447. FORM CMS-2567 (02/99)

Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0686

-Administer oral nutritional supplements and/or tube feeding in between in regular meals to avoid reduction of normal food and fluid intake during regular mealtimes

Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

1. 6. Review of the medical record revealed Resident #58 was admitted to the facility on [DATE REDACTED] with

diagnoses including acute respiratory failure with hypoxia, brain stem stroke syndrome, osteomyelitis of vertebra, cervical region, neuromuscular dysfunction of bladder, other seizures, pseudomonas, resistance to vancomycin, local infection of the skin and subcutaneous tissue, klebsiella pneumoniae, extended spectrum beta lactamase, methicillin resistant staphylococcus aureus infection, supraventricular tachycardia, dependence on respirator [ventilator] status, muscle weakness, dysphagia, major depressive disorder, acute embolism and thrombosis of left internal jugular vein, gastrostomy status, generalized anxiety disorder, tracheostomy status, quadriplegia, chronic viral hepatitis c and nonrheumatic mitral (valve) prolapse.

Review of Resident #58's care plan dated 10/25/25 revealed the resident had impairment of skin integrity due bowel and bladder incontinence, impaired mobility, quadriplegia, activities of daily living (ADL) dependence, altered nutritional status and had pressure injuries to the coccyx and bilateral heels.

Interventions included wound treatment as ordered, weekly treatment documentation to include measurement of each area of skin breakdown's width, length, depth, type of tissue and exudate and any other notable changes or observations.

Review of Resident #58's MDS 3.0 assessment dated [DATE REDACTED] revealed a BIMS score of 15, indicatin

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Actual harm Residents Affected - Few Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

P.M. revealed Resident #38 was noted to have altered mental status, an assessment was completed and vital signs were within normal limits, the physician was notified and gave additional orders for a UA to be completed and to continue to monitor.Review of LPN #379's progress note dated 10/16/25 at 7:22 A.M. the nurse documented a Change in Condition related to altered mental status, vital signs noted at blood pressure (bp) 152/74, pulse 103, respiratory rate (RR) 28, temperature 98.7 degrees Fahrenheit (F), pulse oxygen 97 percent and was vent dependent, physician was notified and gave orders again to obtain a UA and to send the resident to the emergency room.Review of Resident #38's hospital documentation dated 10/16/25 revealed Resident #38 was sent to the Emergency Department (ED) and admitted for Altered Mental Status (AMS), acute UTI, bacteremia, and acute kidney injury. Resident #38 was treated with broad spectrum antibiotics and was hospitalized from [DATE REDACTED] to 10/24/25 when they returned to the facility and continued intravenous (IV) antibiotics for UTI.Review of Resident #38's Minimum Data Set (MDS) 3.0 assessment dated [DATE REDACTED] revealed the resident had intact cognition. Resident #38 required substantial to maximal assistance with eating and was dependent on staff for all other Activities of Daily Living (ALDs) including incontinence care, showering, dressing, personal hygiene, and bed mobility.An interview on 12/11/25 at 12:37 P.M. with Resident #38 revealed she did not feel staff took her complaints of UTI symptoms seriously in October when she complained of pain, burning and frequent urination. Resident #38 stated she had been telling the nurse for at least two days about the pain in her bladder before the NP came in to see her. Resident #38 stated she had a history of UTIs and knew what they felt like. She stated

she had questions about how they would obtain the UA C&S and was agreeable to it, but the facility staff did not get it right away and waited multiple days to get it. Resident #38 stated she continued to complain of pain, burning and frequent urination the whole time. Resident #38 confirmed the NP saw her twice before

she went to the hospital. Resident #38 was upset because she ended up in the hospital and felt if they had gotten the UA C&S when first ordered she would not have ended up in the hospital and would not have been as sick as she was.Two attempts were made on 12/11/25 at 1:45 P.M. and on 12/22/25 at 4:05 P.M. to contact NP #842 with no return calls received.Interview on 12/22/25 at 3:40 P.M. with LPN #341 revealed

they confirmed Resident #38 complained of burning and frequent urination on 10/13/25 and that the NP was into see the resident and ordered a UA C&S but did not obtain it and did not enter it into the physician orders. LPN #341 Could not give a reason why they did not obtain the UA C&S or why they did not enter it into the physician orders on 10/13/25.Interview on 12/22/25 at 3:52 P.M. with LPN #379 revealed they obtained the UA C&S on 10/15/25 at 6:06 P.M. with the assistance of the RT, another nurse and a CNA.

However, they did not send the UA to the lab due to the resident going out to the hospital for altered mental status and that Resident #38 was admitted for a UTI, acute kidney injury and sepsis. When asked why the facility staff did not obtain the UA C&S when originally ordered on 10/13/25 they could not give a reason.An

interview on 12/22/25 at 4:15 P.M. with the Director of Nursing (DON) verified Resident #38 was ordered a UA C&S on 10/13/25 by NP #842 which was not entered as an order nor collected from Resident #38 until 10/15/25. The DON confirmed the urine was collected on 10/15/25 and was to be sent out to the lab for testing on the morning of 10/16/25 but when the lab showed Resident #38 had been sent to the hospital that morning, so the urine was not carried through to the lab. Review of facility policy titled Urinary Continence and Incontinence-Assessment and Management last revised September 2024 revealed identification of urinary tract infections will follow relevant clinical guidelines. The policy did not identify the relevant clinical guidelines in the policy.This deficiency represents noncompliance investigated under Complaint Number 2687759.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0694

Provide for the safe, appropriate administration of IV fluids 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

record review, interview and facility policy review, the facility failed to have interventions in place to maintain

a peripherally inserted central catheter (PICC) line for Resident #31. This affected one resident (#31) of one resident reviewed for intravenous (IV) access and had the potential to affect three additional residents (#1, #2, and #25) identified by the facility with IV access. The facility census was 72.Findings include:A review of

the medical record revealed Resident #31 was admitted to the facility on [DATE REDACTED] and discharged on 12/12/25. Significant diagnoses included diabetes type two with a foot ulcer, local infection of the skin and subcutaneous tissue, and methicillin resistant staphylococcus aureus (MRSA) of unspecified site.

Significant orders included de-clotting by thrombolytic agent of vascular access device or catheter dated 09/11/25, flush PICC line with 10 milliliters (ml) of 0.9 percent sodium chloride every day shift (09/06/25), replace PICC line (09/25/25), cathflo activase (a medication given through the PICC line to de-clot or clear

an obstruction) use two milligram (mg) IV as needed for PICC line (09/10/25), and cefazolin (an antibiotic for infection) use two grams IV every eight hours for infection. There were no orders to monitor the PICC line for infection, change the PICC line dressing or to flush PICC line before and after medication administration.A review of Resident #31's medication administration record (MAR) dated 09/01/25 through 09/30/25 revealed no administration of cathflo activase.A care plan dated 09/05/25 revealed Resident #31 was on IV medications related to a wound infection. Interventions included monitoring for infection at the site and monitoring for signs of leaking. There were no interventions noted for routine care of the PICC line site.A progress note dated 09/09/25 at 11:46 P.M. revealed Resident #31 did not receive her antibiotics due to the PICC line being occluded.A progress note dated 09/10/25 at 5:02 A.M. revealed Resident #31 did not receive her antibiotic as the facility was waiting for PICC line replacement.Upon further review of the progress notes from 09/10/25 through discharge, 12/12/25, revealed no documentation as to when the PICC line was replaced or discontinued.A five-day Medicare Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed a Brief Interview for Mental Status (BIMS) score of 15 out of 15, indicating Resident #31 was cognitively intact.On 12/30/25 at 11:30 A.M. an interview with the Director of Nursing (DON) verified there were no orders for PICC maintenance or flushing after medication administration for Resident #31. A

review of the facility policy titled Central Venous and Midline Catheter Flushing, dated 04/16, revealed catheters are to be flushed at regular intervals to maintain patency and before and after administration of intermittent solutions, administration of medications, obtaining blood samples and or converting from continuous to intermittent therapies.A review of the facility policy titled Central Venous Catheter Dressing Changes, dated 04/16, revealed dressings to central venous catheters are to be changed if it becomes damp, loosened or visibly soiled and at least every seven days.This deficiency represents noncompliance investigated under Master Complaint Number 2702276 and Complaint Number 2621447.

Residents Affected - Few Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm

tracheostomy status. Physician orders effective December 2025 included oxygen at one to ten LPM via mechanical breathing support for continuous inhalation to keep oxygen saturation at 92 percent or greater, and to change the oxygen tubing weekly.

Residents Affected - Few

Review of the quarterly MDS assessment dated [DATE REDACTED] revealed Resident #67 had severe cognitive impairment, received oxygen therapy and had a tracheostomy.

Note: The nursing home is disputing this citation.

Review of Resident #67's plan of care dated 12/29/25 revealed Resident #67 had oxygen use continuously via a tracheostomy as ordered.

Observation on 12/11/25 at 12:20 P.M. of Resident #67 revealed the resident in bed with oxygen being administered via mechanical breathing support. The oxygen tubing was dated as 11/26/25, which was greater than two weeks prior. Interview at the time of the observation with the Director of Nursing (DON) verified the date on the oxygen tubing as 11/26/25. The DON stated that oxygen tubing was to be changed weekly by respiratory therapy when a resident was on mechanical ventilation.

Interview on 12/30/25 at 4:08 P.M. with Respiratory Therapist #328 confirmed oxygen tubing was to be changed weekly. Residents who were on mechanical ventilation had tubing changed by respiratory therapy and residents who had nasal cannulas had tubing changed by floor nurses.

Review of facility policy entitled, Oxygen Administration, dated October 2022 revealed to change oxygen cannulas and tubing every seven days or as needed.

This deficiency represents noncompliance investigated under Complaint Number 2679591 and Complaint Number 2655919.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0698

symptoms of infection, and monitoring for signs and symptoms of hypovolemia or hypervolemia.

Level of Harm - Minimal harm or potential for actual harm

A review of a facility documents titled Dialysis Handoff Communication Reports for Resident # 67 revealed

the following:

Residents Affected - Some

- 12/01/25: No pre or post dialysis assessments completed. The sections of the form were blank.

Note: The nursing home is disputing this citation.

- 12/02/25: No post dialysis assessment. The section of the form was blank. - 12/03/25: No pre or post dialysis assessments completed. The sections of the form were blank. - 12/04/25: No pre or post dialysis assessments completed. The sections of the form were blank. - 12/05/25: No pre or post dialysis assessments completed. The sections of the form were blank.

On 12/10/25 at 4:00 P.M. an interview with Dialysis Registered Nurse (DRN) #841 revealed the facility was to complete pre and post dialysis assessments on the communication document. DRN #844 further stated most often the pre and post dialysis assessments are blank for those residents' receiving dialysis.

On 12/15/25 at 2:40 P.M. an interview with DON verified the lack of pre and post dialysis pre and assessments for Residents #02, #21, #29, #44, #63 and #67. The DON also verified no physician orders for pre and post dialysis assessments or care plan interventions for Residents #02, #21, #29, #44, #63 and #67.

A review of the policy titled End Stage Renal Disease, Care of a Resident with, dated 09/24, revealed residents with end-stage renal disease will be cared for according to currently recognized standards of care. The policy further stated staff caring for residents with end-stage renal disease, including residents receiving dialysis care shall assess data that is to be gathered about the residents' condition on a daily or per shift basis, review signs and symptoms of worsening condition or complications of end stage renal disease, and monitor care of grafts and fistulas.

This deficient practice represents noncompliance investigated under Complaint Number 2687759.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Review of Resident #41's physician order dated 11/18/25 at 11:58 A.M. revealed RN #431 placed an order for Amoxicillin-Pot Clavulanate 875-125 milligram (mg) tablet, one tablet every 12 hours for 14 days for proteus mirabilis wound infection. Further review of the physician order revealed RN #431 entered the antibiotic to not begin until 11/19/25 at 7:00 P.M.

Interview on 12/30/25 at 4:30 P.M. with RN #431 revealed she spoke with Infectious Disease (ID) Physician #809 on 11/18/25 and reviewed the wound culture results with him and then received a verbal order for Amoxicillin-Pot Clavulanate 875-125 mg, one tablet every 12 hours for 14 days for proteus mirabilis wound infection. RN #431confirmed she entered the order for Resident #41's antibiotic on 11/18/25 at 11:58 A.M. and put it in to start the antibiotic on 11/19/25 at 7:00 P.M. When questioned why she put in the start date and time of 11/19/25 at 7:00 P.M., she stated she wanted to make sure there was enough time for the antibiotic to be delivered from the pharmacy. When questioned if the antibiotic was available in the facility's contingency box of medications provided by the pharmacy, she stated she did not look and just assumed it was not available. When questioned if she notified the physician of the start date and time of the antibiotic,

she stated she did not notify the physician. When questioned what the facility protocol was when an order was given to start an antibiotic, she stated antibiotics should be started within hours of the order being given by the physician. When asked why she did not notify ID Physician #809 on 11/17/25 at 3:00 P.M. at

the time when the wound culture and sensitivity results were reported to the facility, she stated it was the end of her day and thought it could wait until the next morning. RN #431 confirmed from the time the wound culture and sensitivity results were available until when the antibiotic was started, it was a total of 52 hours.

Interview on 12/31/25 at 11:10 A.M. with ID Physician #809 revealed he was unaware that Resident #41's wound culture and sensitivity results were reported to the facility on [DATE REDACTED] at 3:00 P.M. and assumed when RN #431 reached out to him on 11/18/25 was when it was available. ID Physician #809 stated RN #431 should have notified him as soon as the results were available on 11/17/25 and not waited until 11/18/25. ID Physician #809 stated he was unaware RN #431 waited until 11/19/25 at 7:00 P.M. to start the antibiotic. ID Physician #809 stated it was unacceptable that a total of 21 hours had lapsed from the time the wound culture and sensitivity was reported to the facility until he was notified of results, and that another 31 hours had lapsed from the time the order for the antibiotic was given to the time the first dose was administered.

ID Physician #809 stated that when he gives an order for antibiotics he expects them to be administered within hours. He stated this was why the pharmacy provided a contingency box with commonly used medications including antibiotics.

Interview on 12/31/25 at 11:30 P.M. with RN #431 confirmed Amoxicillin-Pot Clavulanate 875-125 mg was available in the facility's automated medication machine at the time ID Physician #809 gave the antibiotic order for Resident #41.

Review of facility's automated medication machine inventory list revealed there were five tablets of Amoxicillin-Pot Clavulanate 875-125 mg available for administration at time of the physician order for Resident #41 on 11/18/25.

Review of the facility policy entitled, Administering Medications, last revised April 2019, revealed all medications were to be administered in a safe and timely manner and as prescribed.

This deficiency represents noncompliance investigated under Complaint Number 2621765, Complaint Number 2621447, and Complaint Number 2688137.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

stored all drugs and biologicals in a safe, secure and orderly manner. All discontinued, outdated or deteriorated drugs or biologicals were returned to the dispensing pharmacy or destroyed. Review of the facility policy entitled, Administering Medication, dated [DATE REDACTED] revealed medications were administered in a safe and timely manner as prescribed. Residents may self-administer their own medications only if the attending physician, in conjunction with the interdisciplinary team had determined that they have the decision-making capacity to do so. This deficiency represents non-compliance investigated under Complaint Number 2668507.

Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Interview on 12/30/25 at 11:23 A.M. with the DON confirmed the CBC, CMP, A1C, uric acid level and TSH was not completed every three months as ordered by the physician.

1. 3. Review of Resident #27's medical record revealed an admission date of 12/07/07, a significant diagnosis

of diabetes mellitus type two, and current physician orders to obtain lab work for a Hemoglobin A1C quarterly (every three months).

Review of Resident #27's care plan dated 12/04/25 revealed the resident had potential for hypo/hyperglycemic episodes related to diabetes. Interventions included obtaining blood work as ordered and reporting any abnormal lab values to the physician.

Additional review of Resident #27's medical record revealed a Hemoglobin A1C test was completed on 03/10/25, 06/09/25 and 12/02/05. There was no test completed in September 2025.

Interview on 12/23/25 at 11:44 A.M. with Assistant Director of Nursing (ADON) #350 verified Resident #27 had no lab test completed in September 2025 as ordered. ADON #350 stated the floor nurses and she were responsible for tracking the labs, and there was no system in place for the tracking of labs due and being completed.

Interview on 12/30/25 at 4:26 P.M. with [NAME] President of Clinical Services #806 and Regional Director of Clinical Services #803 revealed there was no facility lab policy. The facility would just follow physician orders.

This deficiency represents noncompliance investigated under Complaint Numbers, 2695949, 2687759, and

2. 2688137. FORM CMS-2567 (02/99)

Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 - Some Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observation and interview, the facility did not serve food in a manner consistent with professional standards for food service safety. This had the potential to affect 35 residents (#3, #8, #9,#12, #13, #14, #16, #19, #23, #26, #28, #29, #30, #31, #32, #33, #34, #35, #37, #38, #44, #47, #48, #49, #51, #50, #55, #56, #57, #63, #64, #65, #66, #83, and #84) receiving meals from the second floor kitchenette out of 57 residents who received meals from the facility. The facility identified 15 residents (Resident #90, #18, #21, #22, #25, #27, #02, #10, #41, #42, #11, #58, #01, #62, #67) who did not eat by mouth (NPO). The facility census was 72.Findings include:An observation was conducted on 12/18/25 at 5:00 P.M. of the evening meal service on the second floor and revealed an open to air food transport cart was being pushed off the elevator towards the kitchenette near the common areas dining room. On the cart were three full trays of mini pizza that were not covered during transport. An interview on 12/18/25 at 5:05 P.M. with Dietary Manager (DM) #317 verified the uncovered trays of pizza were transported uncovered from the kitchen on

the first floor, up the elevator and to the second floor dining room for the resident meal service. DM #317 verified the pizza should have been covered during transport. This deficiency represents non-compliance investigated under Complaint Number 2687759.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

record review, interview, and review of facility policy, the facility failed to ensure a complete and accurate medical record for Resident #80. This affected one resident (#80) of 53 residents reviewed for the annual survey. The facility census was 72.Findings include:Review of the medical record revealed Resident #80 was admitted to the facility on [DATE REDACTED] with diagnoses including cervical disc disorder with myelopathy, high cervical region, spinal stenosis, cervical region, anemia, hyperkalemia, obesity, benign neoplasm of right ovary, type 2 diabetes mellitus with diabetic polyneuropathy, essential (primary) hypertension, acute respiratory failure with hypoxia, altered mental status, acute kidney failure, obstructive sleep apnea, metabolic encephalopathy, quadriplegia, iron deficiency anemia, pain in right knee, vitamin D deficiency, muscle weakness, history of methicillin resistant staphylococcus aureus infection.Review of the Minimum Data Set (MDS) 3.0 assessment for Resident #80 dated 06/25/25 revealed a Brief Interview for Mental Status (BIMS) score of 15, which indicated intact cognition. The MDS further revealed Resident #80 required set-up with eating, moderate assistance with oral hygiene, and maximum assistance to dependence with all other activities of daily living (ADLs). No significant moods or behaviors were indicated

in the MDS.Review of Resident #80's medical record revealed an ultrasound of the pelvis on 03/14/24 that stated Impressions: large 11-centimeter suspicious right adnexal mass with recommendation for follow-up Magnetic Resonance Imaging (MRI) study. Further review of the Resident's medical record revealed an MRI was scheduled on three different occasions (05/15/25, 05/29/25 and 06/30/25) but no results or documentation about the MRI results were available in the medical record for review during the time of the survey.Review of the nursing progress notes in Resident #80's medical record revealed a note on 04/29/25 at 4:49 P.M. authored by Licensed Practical Nurse (LPN) #372 that revealed the resident stated she was not feeling right, blood pressure was checked and was 174/101, the pulse was 88. The nurse notified the physician and received a new order for a one-time dose of 0.25 (milligrams (mg)) of Catapress and to resume blood pressure (BP) medications: Amlodipine 10 mg in the morning and Lisinopril 20 mg at bedtime. No additional follow-up or communication with the physician was documented regarding this incident with the resident's blood pressure until the resident's vital signs were documented again on 05/16/25.Interview with the Director of Nursing (DON) on 12/15/2025 at 2:50 P.M. confirmed the lapse in charting or the lack of follow up documentation. The DON was also unable to confirm if the resident ever received the MRI as ordered or why it was rescheduled three times. The DON also stated she was unfamiliar with the facility's documentation policy.Interview on 12/30/25 at 3:00 P.M. with LPN #372 revealed

she was able to recall Resident #80 and stated she provided care to her in the past while she lived in the facility, but did not recall her change in condition, ultrasound, or her need for the MRI. She stated nurses were responsible for arranging appointments and transportation but did not recall whether the resident received the MRI as ordered or why the appointment was rescheduled three times.Review of the facility's policy titled Charting and Documentation revised July 2023 revealed the medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care.This deficiency represents noncompliance investigated under Complaint Number 2695949, Complaint Number 2614520, Complaint Number 2621447 and Complaint Number 2679591, and Complaint Number

1. 2655919. Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

at the time of the observation revealed the stain was from a roof leak about a month ago. When asked if water got inside the air duct work he stated, yes, but we had a company come replace the duct work.An

observation was conducted on [DATE REDACTED] at 1:24 P.M. of the attic on the even room number side of the Aspen unit to inspect the stained area. Observation revealed duct work was not replaced, a plastic drain pipe was disconnected, wet insulation removed from the duct work was left in the area, and signs of what appeared to be water stains and mold on drywall. Observation also revealed a decomposed rodent resembling an opossum outside of Resident #76's room in the ceiling. Photographs were taken at the time of the

observation by the life safety surveyor and verified by MS #368. MS #368 stated the air flow from the attic ran into Resident #76's room. An interview and observation were conducted on [DATE REDACTED] at 2:06 P.M. with MS #368 of the Somerset unit. MS #368 stated the Somerset unit had been flooded by creek water back in [DATE REDACTED] and had not been in use for some time. When asked about stagnant water lines/deadlines on the unit, MS #368 stated the water is shut off. Observation of water faucets in the mop closet and the shower room at 2:10 P.M. on the Somerset Unit, revealed the water was still turned on to that part of the building.

MS #368 verified the taps and pipes were not being flushed on that unit. MS #368 verified there were no other log books of documentation to review regarding testing and monitoring for the water management plan. A request for water flushing logs was made at this time and MS #368 stated there were no logs to prove flushing was being done on the Somerset unit. Despite his prior statement that the water to the [TRUNCATED]

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0882

2018, revealed the objectives of the infection control policies were to:

Level of Harm - Minimal harm or potential for actual harm

Prevent, detect, investigate, and control infections in the facility Establish guidelines for implementing isolation precautions, including Transmission-based precautions

Residents Affected - Many Note: The nursing home is disputing this citation.

Review of the facility policy titled Antibiotic Stewardship-Review and Surveillance of Antibiotic Use and Outcomes, last revised July 2025, revealed as part of the facility Antibiotic stewardship program all clinical infections treated with antibiotics will undergo review by the Infection Preventionist or designee and be documented on facility approved surveillance tracking forms.

This deficient practice represents noncompliance investigated under Complaint Number 2655919.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Warren Nursing & Rehab

2473 North Rd NE Warren, OH 44483

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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Observation on 12/08/25 at 10:57 A.M. with MS #368 revealed the first floor office of the facilitys' Infection Preventionist had a ceiling with over half the ceiling heavily covered in dark brown staining indicative of water infiltration from prior roof leaks. The staining went from the perimeter of the bricked wall, to the window and to the center of the ceiling where the ceiling light was mounted. An observation was conducted

on 12/09/25 at 11:55 A.M. upon entering the facility dialysis unit revealed 17 chipped and cracked gray floor panels measuring approximately 30 inches long by five inches wide each were either lifting around the edges and/or ends or had large missing pieces exposing subfloor. The dialysis unit also had a foul, biological-waste odor consistent with drain back-up.An interview on 12/09/25 at 12:03 P.M. with Dialysis RN #841 verified the chipped and cracked floor panels and revealed the floor panels were never installed correctly since installed and after the flood back in June the tiles lifting and cracking from the floor got worse. RN #841 revealed she was concerned of it being a trip hazard, has been asking for months for it to get fixed and it has still not been fixed. RN #841 stated the flood water was in the common area out side of dialysis and was several inches deep and it flowed in under the entry door to dialysis which afffected those tiles. RN #841 also stated the foul odor on the unit was the resident body waste that was going into the drains from the multiple dialysis machines which went under the floors to the outside. RN #841 said a company had come out several times to clean the drains but the odor will not go away. RN #841 stated a dialysis unit should not have an odor of body waste. Interview on 12/11/25 at 12:11 P.M. with Restoration Contractor (RC) #845 revealed his company provided the water mitigation after the facility flooded in June

1. 2025. RC #845 revealed he spoke with the facility about the flooring in the dialysis unit after the flood and

that water had gone underneath the floor in the dialysis unit. RC #845 stated he recommended the facility close the dialysis unit to properly restore the unit and the facility told him they could not close the unit. RC #845 stated the facility told him that a flooring company would be coming the following Monday to replace

the floor.Observation on 12/15/25 at 10:26 A.M. revealed the bottom half of room [ROOM NUMBER] entrance door was covered by thin plastic door protector than had separated from the door and was hanging loose exposing a sharp corner sticking out into the doorway entrance. Inside the room hung a privacy curtain separating the two beds in the room. On the privacy curtain was an approximate three feet by two feet area of dark purplish brown staining of either dried blood or feces. Certified Nurse Assistant (CNA) #404 was present during the observation and verified the findings. CNA #404 stated the plastic door protector kept coming off because the resident's wheelchairs get stuck on the door cover going in and out of the room. CNA #404 verified a resident could get injured on the loose sharp corner of the plastic door protector hanging off the door. Observation on 12/18/2025 at 11:41 A.M. of room [ROOM NUMBER] revealed the plastic door protector was now attached to the door with duct tape and the privacy curtain was cleaned and replaced.Observation and interview on 12/29/2025 at 2:47 P.M. with Unit Manager (UM) #846 of room [ROOM NUMBER] door protector revealed the duct tape had come unstuck and the door protector was not attached to the door. UM#846 stated she would put in another work order.Observation on 12/31/2025 at 11:08 A.M. of room [ROOM NUMBER] door protector revealed the door protector was now secured to the door with screws.Review of facility policy titled Quality of Life Homelike Environment, date revised May 2017, revealed facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics include a clean, sanitary and orderly environment.This deficiency represents non-compliance investigated under Complaint Numbers 2683142, 2687759, 2674189, 2684242, and 2688137.

Event ID:

Facility ID:

If continuation sheet