Continuing Healthcare At Willow Haven

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

1. 8. a. Interview on 08/11/25 at 11:34 A.M. with Resident #65 included she asked to have her television

mounted. She reported it and was told it was on the list. Review of the TELLS maintenance requisitions revealed a request on 04/23/25 to mount Resident #65's television. b. Review of Resident #80's record revealed a 08/04/25 admission with diagnoses including fracture fifth vertebrae T-11 to T-12, end stage renal disease, dependence on renal dialysis (hemodialysis), Chronic Obstructive Pulmonary Disease, Diabetes Mellitus, dysphagia, hypertension, hypocalcemia, and depression.

Interview on 08/12/25 at 8:46 A.M. with Resident #80 revealed the television did not work when she arrived, 08/04/25. They did not give her a new one until 08/11/25. Her air conditioner is dirty and smells musty. She said maintenance came in and cleaned it 08/11/25. Observation revealed the front half of the air vents appear to have been wiped off. The back half of the air conditioner vents were soiled dark with dirt/dust. The air conditioner did smell musty when blowing air.

Interview on 08/12/25 at 12:13 P.M. with Maintenance #173 verified the TELLS report revealed an entry on 08/05/25 that the resident needed a television. He indicated he was focusing on the fire and then had to find a television so she did not receive a working television until 08/11/25. He also looked at her air conditioner and swept the debris out of the vents of debris. He verified the vents were not clean on the air conditioner and he said he will need to teach housekeeping how to pop out the vents and clean them.

Interview on 08/19/25 at 12:06 P.M. with the Administrator revealed they buy televisions for skilled. She thinks residents are taking facility televisions home. She just bought two this weekend. The Administrator revealed maintenance told her he did not know about the air conditioner not working until 08/11/25.

2. 9. Observation on 08/20/25 at 2:17 P.M. revealed Resident #69's air conditioner had visible whitish clumps

of lint/dust in the air conditioner vents. There was a puddle of water on the floor under the air conditioner.

There was a steady drip coming out of the air conditioner onto the floor.

On 08/20/25 at 2:20 P.M. Licensed Practical Nurse #179 verified the air conditioner was dirty and leaking.

The deficiency substantiates Complaint Numbers 2588814, 2584767, 2583878, and 2569206.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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

interview with Rehab Manager (RM) #203 stated residents should be screened quarterly and she was trying to implement this at this building. RM #203 stated Resident #59 had impaired limitations in ROM at

this time and needed to improve her ROM. RM #203 verified Resident #59 did transfer herself and take steps but it was unknown what her previous ROM status was as she had not been screened or received any ROM services since being discharged from hospice in January 2025.

Residents Affected - Few

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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 - Some

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

fingers, positioned his fingernails to dig into his palm. Further verified the fingernails were long and soiled.3.

Review of Resident #19's medical record revealed a 07/17/24 readmission with diagnoses including lymphedema, dysphasia, anemia, proximal atrial fibrillation, acquired absence of left toes, chronic kidney disease stage three, venous insufficiency, chronic diastolic congestive heart failure, hyponatremia, hyperlipidemia, benign prostate hyperplasia, bladder neck obstruction, type two diabetes, severe protein calorie malnutrition, vitamin D deficiency, chronic respiratory failure, chronic kidney disease and disorder, Parkinson's disease and major depressive disorder. The resident had a plan of care dated 03/25/24 Activity of Daily Living (ADL) self care deficit related to impaired mobility, impaired balance, chronic abdominal wound, diabetic mellitus, morbid obesity, Parkinson's, chronic respiratory failure and Bell's Palsy.Review of

the 06/10/25 Quarterly Minimum Data Set Assessment revealed the resident was independent for daily decision making, had bilateral lower extremity functional impairment, was dependent for personal hygiene, did not walk or transfer, and needed substantial/maximum assistance to roll left and right. The resident was at risk for developing pressure ulcers, had pressure reducing devices, and ointments applied other than feet. The resident received insulin, antianxiety, antidepressant, anticoagulant and hypoglycemic medications. Observation on 08/11/25 at 11:07 A.M. revealed the resident was unshaven. He had long fingernails bilaterally that were heavily soiled with dark debris bilaterally.Interview on 08/11/25 at 11:08 A.M. with the resident revealed they do not offer to shave him. His sister shaved him last. Further, learned

the staff does not trim or clean his fingernails. Observation and interview on 08/11/25 at 11:09 A.M. with LPN #179 verified Resident #19 was unkept and unshaved. His fingernails were long bilaterally with dark debris under the nailbeds.4. Review of Resident #5's medical record revealed a 07/14/25 readmission with diagnosis including metabolic encephalopathy, chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, major depressive disorder, bipolar disorder, constipation, muscle weakness and atrophy, sepsis, vitamin D deficiency, pain, cyst of kidney, osteoarthritis of hip, irritable bowel syndrome with diarrhea, hypertension, retention of urine, dysphagia, anxiety, and hypercholesterolemia. A 12/06/21 plan of care had the resident at risk for declines/fluctuations in activity of daily living ability related to impaired mobility, metabolic encephalopathy, anxiety, bipolar disease, dyspnea, chronic obstructive pulmonary disease, weakness, chronic respiratory failure, and needs encouraged to get out of bed.Review of the 07/20/25 Minimum Data Set Assessment included the resident was moderately impaired for daily decision making. The resident needed some help with self care. The resident was set up for eating, and oral hygiene.

Resident #5 received continuous oxygen therapy. Observation and interview on 08/11/25 at 12:05 P.M. with Resident #5 revealed her fingernails were long and dirty. The resident said she doesn't get her nails cleaned or cut. All fingers on her right hand had debris under the nailbeds. Her left hand had debris under her index finger and thumb. Interview on 08/11/25 at 2:54 P.M. with LPN #179 verified the resident's fingernails were long and soiled.This deficiency represents non-compliance investigated under Complaint Numbers 2588814, 2569206.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

the best they can. There is not always a housekeeper on the weekends and rooms do not get cleaned. On 08/12/25 at 6:59 A.M., interview with CNA #112 stated the facility runs short of help frequently and depending on who is working determines if things all get done or not. Management does not come in to help and staff try to do room checks every two hours but sometimes they are late. On 08/12/25 between 9:05 A.M. and 9:24 A.M., interview with Family #204 revealed the facility does not have enough staff to ensure residents are checked frequently. Family #204 stated concerns have been brought to members of

the management team and nothing is done. Sometimes call lights are on for 30 minutes without being answered because they are all busy. Rooms are not cleaned and items that need fixed are reported but not fixed timely. Family #204 stated in June 2025 a concern was reported regarding an air conditioner and it was still leaking and had not been fixed. On 08/12/25 at 12:13 P.M., interview with Maintenance Director (MD) #173 revealed the electronic work order system included a 08/05/25 request to hook up a television for Resident #80. MD #173 stated he had been focusing on the fire and did not get to it until 08/11/25 as he was the only maintenance man for the facility. On 08/19/25 at 10:08 A.M., interview with Housekeeping/Laundry Manager #113 revealed on the weekends there was only one housekeeper. The facility was down a person so all the rooms do not get cleaned. On 08/21/25 between 10:29 A.M. and 10:41 A.M., interview with the Director of Nursing (DON) verified the facility assessment staffing range of staff needed to provide adequate care and services for residents residing within the facility included licensed nurses providing direct care three to four on day shift and two to three night shift and the nurse aides (CNA) five to eight (CNA) for day shift and four to six CNA on the night shift for the facility. The DON stated they should never be under the minimum number of staff needed and it was her expectation on-call nursing management staff should come it to cover any part of the shift that was needed. The DON verified the above listed shifts with staffing concerns. On 08/21/25 between 8:32 A.M. and 8:50 A.M. interview with the DON stated the following: the facility currently does not have a nursing waiver. Staffing is based on resident care needs and census. Two of the five halls have higher acuity due to the residents require more assistance e.g. hoyer lifts, feeding, two person assists, etc. If the staffing numbers exceed the needs and census, nursing staff was sent home. The DON stated the minimum staffing for direct care nursing day shift was three nurses and night shift was two nurses for the full 12 hour shift (7a-7p/7p-7a). The minimum CNA's were five on day shift and four on night shift. The DON stated it should 'never' go below the above numbers and if it did, it would be her expectation that management staff or the on-call nursing manager would come in to cover that shift. On 08/21/25 at 1:47 P.M., interview with the Administrator revealed the facility continued to be hiring to fill vacant positions. The Administrator stated the facility did not have a Staffing Policy as they use their budget to determine staffing levels. This deficiency represents non-compliance investigated under Complaint Number 2569206.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on

a full time basis.

Based on payroll-based journal review, staffing schedule review, policy review and interview, the facility failed to provide eight hours of consecutive registered nurse (RN) hours per day. This had the potential to affect all 68 residents residing within the facility. Findings include: Review of the Payroll-Based Journal second quarter 2025 revealed the facility did not meet the requirement of having a RN for eight consecutive hours daily. Review of the Facility Assessment Tool revised 03/24/25 revealed the facility average daily census was 69 to 78 residents. The facility staffing plan was based on the resident population and their varying needs for care and services, the general approach to help the facility gauge sufficient staff to assist

in meeting the needs of the residents at any given time involves various factors. Review of the Staffing Schedules dated January 2025 through July 2025 revealed there was no consecutive eight hour RN coverage on the following dates: 01/18/25, 01/19/25, 02/01/25, 02/02/25, 03/16/25, 04/12/25, 04/13/25, 04/19/25, 04/20/25, 04/26/25, 05/04/25, 05/10/25, 05/11/25, 05/18/25, 05/25/25, 06/07/25, 06/08/25, 06/14/25, 06/15/25, 06/22/25, 06/29/25, 07/20/25 and 07/27/25. On 08/13/25 at 8:35 A.M., interview with

the Director of Nursing (DON) stated the facility was not able to accept residents with central lines, TPN or orders for IV therapy more than twice a day due to the availability of a RN and/or an IV trained Licensed Practical Nurse. The DON verified the facility currently had the following direct care RN's: one on nights and 2 PRN (as needed) and the facility wound nurse: however, she was currently on a medical leave of absence. On 08/18/25 at 10:05 A.M. interview with the Assistant Director of Nursing (ADON) verified there was no RN coverage for eight consecutive hours on the following dates: 01/18/25, 01/19/25, 02/01/25, 02/02/25, 03/16/25, 04/13/25, 04/19/25, 04/26/25, 05/10/25, 06/07/25, 06/08/25, 06/14/25, 06/15/25, 07/20/25 and 07/27/25. On 08/19/25 at 8:25 A.M., interview with ADON verified there was no RN coverage for eight consecutive hours on 04/12/25, 04/20/25, 05/04/25, 05/11/25, 05/18/25, 05/25/25, 06/22/25 and 06/29/25. On 08/21/25 between 8:32 A.M. and 8:50 A.M. interview with the DON stated there has been a shortage of RN coverage in the past, as well as, currently and the concern was primarily on the weekends.

On 08/21/25 at 9:59 A.M., interview with the DON verified the facility continued to be unable to meet the requirement of having a RN for eight consecutive hours per day/seven days a week. The DON stated the facility had done the following trying to find RN's: a facility self-initiated action plan through their quality assurance program to address the need of RN staff earlier this year and had hired two of four RN's interviewed between 01/09/25 and 08/06/25. One Certified Nurse Aide transitioned to an RN position after passing her nursing boards and was scheduled to start on the schedule in September 2025. The facility had posted the RN positions on the company website, social media (unsure which one) and job fairs but have not been able to fill the positions. The DON stated RN's do not want to work in long term care facilities anymore since COVID-19. On 08/21/25 at 1:47 P.M., interview with the Administrator stated the facility did not have a Staffing Policy and the facility uses their budget to determine staffing.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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

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

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

include: sanitizer solution is in appropriate concentration (use test strip to determine this and solution is changed at least every four hours. Production, storage and service equipment to be cleaned and sanitized as required as recommended by the manufacturer. Review of the undated policy: Use and Storage of Digital and Unit Thermometers revealed all thermometers must be used, stored, calibrated and maintained in a manner that ensures accuracy, hygiene, and compliance with safety standards. Faulty or uncalibrated thermometers must be discarded or repaired promptly to prevent risks to resident health and safety. This deficiency represents non-compliance investigated under Complaint Number 2569206.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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 - Minimal harm or potential for actual harm Residents Affected - Some

multiple wounds including a Stage III pressure ulcer to the coccyx present on admission measuring 3.5 (cm) in (l) by 4.9 (cm) in (w) by 0.2 (cm) in depth (d). The wound bed was 100% granulation with scant serous drainage. Education was provided on the importance of offloading to promote wound healing and maintaining proper hygiene to support wound healing including to keep the wound site clean and dry, avoiding contamination and the importance of adhering to prescribed treatments and dressing changes to prevent infection was emphasized.

On 08/19/25 between 4:15 P.M. and 5:01 P.M., observation of incontinence care revealed licensed practical nurse (LPN) #131 and certified nursing aide (CNA) #107 were observed washing their hands and applied gloves. CNA #107 gathered incontinence supplies, positioned the resident in bed and removed the tape from the incontinence brief. The resident was observed to have been incontinent of urine and CNA #107 washed the resident's penis, groin and up under the scrotum. LPN #131 and CNA #107 rolled the resident onto his left side exposing the buttock and coccyx. An unstageable pressure ulcer irregular in shape was observed to be 75% covered with slough with scant drainage. CNA #107 proceeded to cleanse the groin under the scrotum, and wiped across the rectum and over the lower aspect of the Stage III pressure ulcer.

CNA #107 then using the same gloved hands grasped a clean wash cloth and rinsed the resident in the same order. CNA #107 and LPN #131 rolled the resident over onto his right side and LPN #131 using the same gloved hands placed her thumb on various areas of the peri-wound and wound center then applied triad cream around the wound perimeter but not the wound bed. The resident was then repositioned on his back, incontinence brief applied and head of bed raised to 30 degrees. LPN #131 removed her gloves, washed her hands and stated she was going to notify the physician of the wound due to a change in the appearance of the wound. CNA #107 changed the linens on the resident's bed and then removed her gloves and washed her hands. CNA #107 verified the above observation on 08/19/25 at 4:45 P.M. and LPN #131 verified the above observation on 08/19/25 at 5:01 P.M. and stated she had messaged the physician and was awaiting a response.

This deficiency represents non-compliance investigated under Complaint Number 2583878, 2588814,

1. 2569206. 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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Continuing Healthcare at Willow Haven

1020 Taylor Street Zanesville, OH 43701

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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

the air conditioning had not been working since he arrived two years prior. It was set up for central air and

the system was too old to get a new part.Interview on 08/21/25 at 1:55 P.M. with the Administrator revealed

she thought they were trying to get parts for the clothes dryer. She included she thought the second dryer and air conditioner had not worked since she started a couple years ago. She included she had not tried to order a new dryer. 3.On 08/11/25 between 8:20 A.M. and 8:45 A.M., observation of the reach-in refrigerator revealed water was leaking in the same reach-in refrigerator that included a gallon of whole milk, 13 glasses of chocolate milk and three additional cafeteria-style trays each containing glasses of apple juice, cranberry juice and fruit punch. The chocolate milk and juice glasses were covered with plastic lids and saran wrap. Water was observed on top of the chocolate milk lids and the glasses were sitting in water that filled the cafeteria-style trays. A metal serving pan was observed sitting on top of the chocolate milk glasses without any water in it. At the time of the observation, Dietary [NAME] #128 verified the observation and Dietary Aide #111 stated the reach-in refrigerator had been not working correctly for several weeks and had been leaking water. Dietary Aide #111 positioned the metal serving pan to the back of the shelf stating the pan should catch the leaking water now.Review of the TELLS maintenance request revealed no request to fix a leaking refrigerator in the kitchen.Interview on 08/21/25 at 11:22 A.M. with Maintenance Staff #173 revealed a lot of the work he does not get on a TELLS request. He is told in the halls things that need completed. He included he had known the refrigerator was leaking for a couple weeks. He needs to clean/fix the condensation drain and has not gotten to it yet. When asked, he confirmed he was the only maintenance man for the facility. He does have a regional maintenance staff that will assist.This deficiency represents non-compliance investigated under Complaint Numbers 2588814, 2584767, 2583878, and

1. 2569206. Event ID:

Facility ID:

If continuation sheet