Inspection·October 14, 2025

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facilities). Review of the progress note authored by the [NAME] Services Nurse Practitioner (NP) #441 on 09/25/25 at 10:25 A.M. revealed Resident #6 had a history of increased behaviors associated with bacteriuria and UTI related to chronic urinary indwelling catheter. Review of the Resident Infection Control Log for September 2025 revealed Resident #6 first began on an antibiotic for signs and symptoms of a UTI, including a change in mental status, on 09/08/25, and that the antibiotic was changed on 09/10/25, after receiving results of the urine culture and sensitivity. Observation on 10/07/25 from 2:45 P.M. to 3:04 P.M. of catheter care and bowel incontinence care for Resident #6, performed by Certified Nurse Aide (CNA) #413 revealed Resident #6 was not checked for bowel incontinence prior to the start of catheter care. Further observation revealed CNA #413 wet two washcloths in a sink of warm running water and laid the wet washcloths, plus one dry washcloth, directly on the uncleaned overbed table which had some of Resident #6's personal items on it. Once the appropriate personal protective equipment (PPE) was donned and Resident #6's brief was loosened and opened on the front, CNA #413 took one of the wet washcloths off the overbed table and briskly washed back and forth under the abdominal fold, just above the pubic area, then back and forth between skin folds of the left groin, then briefly on the head of the penis with two swipes, and then back and forth between the skin folds of the right groin. During this observation, CNA #413 did not use any method with the washcloth to ensure that a different, clean part of the cloth was used with each stroke, there were no soap suds noted during the cleansing of the perineal area, the area around the catheter insertion site was not fully cleaned from meatus outward, and no part of the catheter was secured or cleaned using the first washcloth during catheter care. Continued observation revealed CNA #413 picked up the second wet washcloth from the overbed table and followed the same steps as with the first washcloth (briskly swiped back and forth above the suprapubic area under the abdominal fold, then wiped back and forth between skin folds of the left groin, then wiped briefly on the head of the penis using two swipes along the edges, and then wiped back and forth between the skin folds of the right groin). The second washcloth was not folded in a manner to ensure a different, clean part of the cloth was used to rinse each part of the body during catheter and perineal care. At no time was CNA #413 observed cleaning or rinsing directly around the urinary meatus/catheter insertion site or any portion of the catheter. CNA #413 then took the dry washcloth from the overbed table to pat dry the left groin area, the suprapubic area, then the shaft and left lateral ridge of the head of the penis, and then the right groin area, in that order. Resident #6 was assisted to the right side to place a clean brief once catheter care was completed but was then noted to have had a small smear of stool between the buttocks and brownish discoloration along the backside of the brief. Incontinence care was performed by CNA #413 after leaving and re-entering the room with the same gown and gloved left hand (used for catheter care) and a new glove that was applied by the soiled left hand with no hand hygiene. Once incontinence care was completed, CNA #413 used the same soiled gloved hands to position the catheter tubing inside the brief to prevent accidental tugging and then fastened the dry brief. Interview on 10/07/25 at 3:05 P.M. with CNA #413 confirmed a basin for soapy or clean water was not used for catheter care, a barrier was not used for placing clean rags on the overbed table prior to using for catheter care, and the table was not cleaned prior to placing the washcloths on top. During the interview, CNA #413 revealed staff would normally clean around the catheter insertion site and while securing the catheter, were supposed to wash part way up the catheter to keep the portion near the insertion site clean. At the time of the interview, CNA #413 confirmed leaving Resident #6's room between catheter care and incontinence care, only one glove was changed, and no hand hygiene was performed before donning a clean glove. Interview on 10/09/25 at 9:55 A.M. with CNA #383 confirmed that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 2 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete basins and clean washcloths were to be used for catheter care and that staff were never to use the same part of the washcloth for cleaning around the catheter insertion site, catheter, or other body parts during catheter and perineal care. Interview on 10/09/25 at 2:40 P.M. with Registered Nurse (RN) #398 confirmed staff were to clean the urinary meatus of a male with an indwelling catheter by securing the catheter and cleaning in a circular motion from inner to outer areas, using a clean part of the washcloth with each stroke, and care should be taken to ensure cleanliness of the catheter near the insertion site. RN #398 further confirmed that staff were to use a barrier or a wash basin and not lay washcloths on an unclean overbed table before commencing care. RN #398 also confirmed hand hygiene was always to be performed between glove changes. Review of the policy titled Handwashing-Hand Hygiene, last reviewed on 01/06/25, revealed hand hygiene was to be performed before and after donning and doffing gloves and after handling used linens or supplies. The policy further revealed the use of gloves did not replace hand hygiene. Review of the policy titled Catheter Care (Indwelling Catheter), dated 01/06/25, revealed staff were to clean the area well at the catheter insertion site and that all debris was to be removed from around the catheter, near the insertion site. Further review of the policy revealed if the resident was soiled or had an involuntary bowel movement, the incontinence care should be provided prior to catheter care to ensure the area was not contaminated with feces. This deficiency represents noncompliance investigated under Complaint Number 2623950. Event ID: Facility ID: 365033 If continuation sheet Page 3 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interviews, hospital record review and facility policy review, the facility failed to timely address a significant weight loss for Resident #104. This affected one resident (#104) out of three residents reviewed for nutrition. The facility census was 102. Findings include:Review of the closed medical record for Resident #104 revealed an admission date of 08/22/23 and a discharge date of 09/04/25. Pertinent diagnoses included schizophrenia, severe sepsis with septic shock, adrenocortical insufficiency (a condition when adrenal glands don't make enough of the hormone cortisol with weight loss being one of the symptoms), other diseases of plasma-protein metabolism, depression, thyrotoxicosis (a condition when there is too much thyroid hormone in the body with unexplained weight loss being one of the symptoms) with diffuse goiter. Review of Resident #104's care plan initiated on 08/29/23 revealed the resident had altered nutritional status related to thyroid disorder, schizophrenia, fluid shifts, refusal of meals, weights, and supplements, and significant weight loss. Interventions included diet per dietitian recommendations and physician's orders, encourage adequate meal intake, accommodate food preferences, give supplements as ordered and alert nurse/dietitian if not consuming on a routine basis, and monitor and record resident's intake of food/fluids after each meal. Offer and appropriate meal substitutions or dietary supplement when the resident consumes less than 75% of a meal or when a resident refuses a meal. Review of Resident #104's physician orders revealed the resident had been on a regular diet, regular texture, and thin liquids diet for her entire stay at the facility. Review of Resident #104's Significant Change Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident was cognitively intact, rejection of behaviors were exhibited one to three days of the seven-day assessment reference period, required set-up help for eating for eating, had no weight loss with a weight of 191 pounds. Review of Resident #104's medical record revealed the resident's weight had been stable between 190 and 192 pounds between 02/13/25 and 05/08/25. On 06/23/25, the residents refused to be weighed. On 07/10/25, the resident weighed 146 pounds, which reflected a significant weight loss of 46 pounds or 23.9 percent (%) weight loss between 05/08/25, when the resident had last been weighed by the facility and had weighed 192 pounds, and 07/10/25. Review of the hospital records revealed Resident #104 was hospitalized between 05/29/25 to 06/05/25 for an altered mental status. Resident #104's initial weight at the hospital was noted to be 190.0 pounds on 05/30/25 at 2:00 A.M. A second weight of 166.2 pounds was obtained on 05/30/25 at 4:16 A.M. which reflected a 23.8 pound or 12.5 % weight loss from the first weight of 190.0 pounds. A third weight of 166.2 pounds was obtained on 05/30/25 at 4:47 P.M. which verified the 166.2 weight was the accurate weight for the resident. Continued review of Resident #104's weights in the medical record revealed the 07/10/25 weight of 146 pounds reflected a 20 pound or 12.0% significant weight loss from the hospital weight of 166.2 pounds on 05/30/25. Further review of Resident #104's medical record revealed there had been nothing noted in the record about the resident's significant weight loss between 05/08/25 and 07/10/25. Continued review of Resident #104's medical record revealed a quarterly nutritional assessment, dated 08/04/25, which noted the last weight of Resident #104 was 192 pounds on 05/08/25 and a new monthly weight was pending. (The assessment didn't address the hospital weights on 05/30/25 or the 07/10/25 facility weight). The assessment noted Resident #104 hadn't had any significant weight loss but did indicate Resident #104's meal intakes were varied with the resident averaging 50 percent of meals being consumed over the past seven days. A supplement of Ensure twice a day was recommended for added calories and protein and with diet and the recommended supplement, the resident nutritional needs would likely meet the resident's estimated nutritional needs. Review of the physician's orders for Resident #104 Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 4 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete revealed an order dated 08/04/25 for Ensure twice a day. Continued review of Resident #104's medical record revealed the resident was not weighed again until 08/07/25 when the resident weighed 139 pounds, which reflected a seven pound or 4.7% additional weight loss from the 07/10/25 weight. Weights of 139 pounds on 08/11/25 and 138 on 08/26/25 revealed weight loss appeared to have stabilized. Further review of Resident #104's medical record revealed the resident had a seizure like activity on 08/12/25 and was sent to the hospital and was admitted for bradycardia, seizure like activity, altered mental status, and septic shock due to a urinary tract infection (UTI). The resident didn't readmit back to the facility until 08/26/25. The Ensure order was discontinued on 08/12/25 when the resident was admitted to the hospital. Review of Resident #104's five-day Medicare MDS 3.0 assessment dated [DATE] revealed the resident was cognitively intact, exhibited other behavioral symptoms not directed toward others, was independent for eating, had a significant weight loss which had not been prescribed and was not on any therapeutic diet. Continued review of Resident #104's medical record revealed a readmission nutrition assessment, dated 09/01/25, which indicated the resident's most recent weight was 138 pounds on 08/26/25 which reflected a significant loss of ten percent or greater over the past six months, which was likely related to decreased meal intakes and behaviors. It was recommended that Magic cups (supplement) be added twice a day to increase caloric and protein intake to help promote weight stability, and it was noted other supplements had been refused by the resident in the past. Further review of Resident #104's physician orders revealed an order dated 09/01/25 for a nutritional treat two times a day. Continued review of Resident #104's medical record revealed a nurse practitioner note dated 09/04/25 which indicated the resident had become lethargic and nursing was reporting the resident wasn't eating well and was being sent to the hospital due to concern of sepsis. On 09/05/25 it was noted in the progress notes that the resident had been admitted to the hospital's intensive care unit for hypothermia. Interview on 10/09/25 at 11:28 A.M. with Restorative Certified Nursing Assistant (CNA) #440 revealed restorative staff were responsible for obtaining most of the weights. She stated she had weighed Resident #104 on 07/10/25 and had used a Hoyer (mechanical lift) to weigh her. She stated typically when a resident lost five or more pounds a resident would be put on weekly weights for closer monitoring. She indicated the dietitian would be the one who would indicate if a resident should be put on weekly weights. Interviews on 10/09/25 at 11:54 A.M. and 12:30 P.M. with Corporate Lead Dietitian (CLD) #651 revealed the current facility dietitian was currently out on leave of absence. He stated if a monthly weight triggered a significant weight loss of five % or more, a reweight would be obtained. If the reweight still showed a significant weight loss, the dietitian would address the weight loss in a note or an assessment and normally the resident would be put on weekly weights for closer monitoring. LCD #651 confirmed Resident #104's weight loss on 07/10/25 had not been addressed in a timely manner by the dietitian. Interview on 10/09/25 at 2:10 P.M. with the Director of Nursing (DON) revealed the dietitian reviewed all the weights and would be the one who requested a resident be put on weekly weights for closer monitoring. She acknowledged Resident #104's weight loss and stated the resident would skip meals. The DON indicated Resident #104 should have been put on weekly weights for closer monitoring. Review of facility policy Weight Monitoring, with a last review date of 01/06/25, revealed reweights would be obtained within 48 hours if there was at least a five-pound deviation from the last weight obtained. The dietitian would evaluate weights and initiate appropriate interventions as indicated and would follow up with nursing to confirm that reweights had been completed and the requested orders had been obtained. This deficiency represents non-compliance under Complaint Number 2623950. Event ID: Facility ID: 365033 If continuation sheet Page 5 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, observation, interviews and facility policy review, the facility failed to ensure Residents #9, #35 and #36 received a two-gram sodium (low sodium) and/or cardiac diet as ordered. This affected three residents (#9, #35, and #36) out of four residents reviewed for therapeutic diets but had the potential to affect an additional six residents (#3, #7, #42, #54, #70, and #84) the facility identified as being on a two-gram sodium and/or a cardiac diet. The facility census was 102. Findings include:1. Review of the medical record for Resident #9 revealed an admission date of 01/07/25. Pertinent diagnoses included type two diabetes mellitus, chronic obstructive pulmonary disease (COPD), respiratory failure, hypertension (HTN), and hyperlipidemia. Review of the physician orders for Resident #9 revealed an order dated 03/27/25 for a low sodium, regular texture, thin consistency, two-gram sodium diet. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #9 was cognitively intact, required setup or cleanup assistance for eating and was on a therapeutic diet. Further review of Resident #9's medical record revealed a quarterly nutritional assessment dated [DATE] which indicated the low sodium diet was appropriate due to the diagnosis of HTN. Review of Resident #9's nutritional care plan dated 01/14/25 revealed Resident #9 had altered nutritional needs related to COPD diagnosis and difficulty breathing while eating. Interventions included administering medications as ordered and provide diet per dietitian recommendations and physician's order. 2. Review of the medical record for Resident #35 revealed an admission date of 11/01/22. Pertinent diagnoses included type two diabetes mellitus, chronic pulmonary edema, diastolic congestive heart failure (CHF), chronic kidney disease (CKD), and hyperlipemia. Review of Resident #35's nutritional care plan dated 11/09/22 revealed the resident had altered nutritional status related to being on a therapeutic diet and having type two diabetes mellitus, CKD, HTN, and hyperlipidemia diagnoses. Interventions included administering medications as ordered and providing diet per dietitian recommendations and physician's orders. Review of the physician orders for Resident #35 revealed an order dated 02/04/24 for a low sodium (two-gram), controlled carbohydrate diet (CCD), regular texture, thin consistency. Review of Resident #35's quarterly MDS 3.0 assessment dated [DATE] revealed Resident #9 was cognitively intact, required setup or cleanup assistance for eating and was on a therapeutic diet. Further review of Resident #35's medical record revealed a nutritional assessment dated [DATE] which indicated the resident was receiving a low sodium and CCD diet due to the diagnoses of CHF, CKD, and diabetes mellitus type two. 3. Review of the medical record for Resident #36 revealed an admission date of 08/14/25. Diagnoses included hypertensive heart disease with heart failure, acute on chronic systolic CHF, ischemic cardiomyopathy, and atherosclerotic heart disease. Review of Resident #36's nutritional care plan dated 08/18/25 revealed Resident #36 had altered nutritional status as evidenced by systolic heart failure/ischemic cardiomyopathy and hypertension requiring a cardiac diet and a fluid restriction. Interventions included administering medications as ordered, diet per dietitian recommendations and physician order, and fluid restriction as ordered. Review of Resident #36's physician orders revealed an order dated 08/18/25 for a cardiac diet, regular texture, thin consistency, 70-gram fat, two to three grams sodium and a 2000 milliliter (ml) fluid restriction. Review of Resident #36's admission MDS 3.0 assessment dated [DATE] revealed the resident was cognitively intact, required setup or cleanup assistance for eating and was on a therapeutic diet. Further review of Resident #36's medical record revealed a significant change nutrition assessment dated [DATE] which indicated the resident was on a cardiac, regular texture, thin consistency fluids diet and meal intakes would be monitored for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 6 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete adequacy and tolerance. 4. Review of the facility's week four fall and winter menu for 2024 and 2025 revealed for lunch on 10/08/25 creamy mushroom chicken, herb buttered noodles, zucchini and onion, and creamy lemon pie was to be served. Review of the facility's four week fall and winter menu's spread sheet for lunch on day 25 (10/08/25) revealed residents on a cardiac diet or a two-gram (low sodium) diet were to receive one three-ounce chicken breast with sauteed mushrooms instead of one three-ounce chicken breast with mushroom gravy. Observation of the steam table on 10/08/25 prior to the start of tray line at 11:48 A.M. revealed there was no pan of sauteed mushrooms in the steam table. Observation of tray line on 10/08/25 from the beginning at 12:38 P.M. to the end at 1:27 P.M. revealed all residents, which included Residents #9, #35, and #36, had received mushroom gravy over their chicken, except for one unidentified resident who had received brown gravy over the chicken due to either a dislike or an allergy to mushroom gravy. Interview during tray line on 01/08/25 at 12:41 P.M. with Dietary [NAME] #311 confirmed everyone was receiving mushroom gravy over the chicken, unless it was a dislike or an allergy. Interview on 10/08/25 at 1:28 P.M. with Dietary Consultant #650 confirmed no sauteed mushrooms had been served to residents on a two-gram sodium (low salt) or a cardiac diet. When asked why residents who were on a two-gram sodium (low sodium) or cardiac diet had not been served sauteed mushrooms on their chicken instead of mushroom gravy, DC #650 stated I would assume it was an error. Review of the undated facility policy Accuracy and Procedure Manual revealed the meal would be checked against the therapeutic diet spread sheet to assure that foods were served as listed on the menu, and each meal tray would be checked for accuracy following the therapeutic extension. This deficiency represents non-compliance investigated under Complaint Number 2618032. Event ID: Facility ID: 365033 If continuation sheet Page 7 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, record reviews, review of facility menus and facility policy review, the facility failed to ensure the zucchini and onions were palatable and served at a preferred temperature and failed to ensure the noodles were palatable for lunch on 10/08/25. This affected five residents (#5, #29, #41, #60, and #100) out of five residents reviewed for meal palatability but had the potential to affect an additional 94 residents the facility identified as receiving meals from the kitchen. The facility identified three residents (#21, #43, and #55) as not receiving meals from the kitchen. The facility census was 102. Findings include:1. Observation on 10/08/25 at 11:48 A.M. of Dietary [NAME] #311 taking the temperatures of meal items in the steam table revealed the parsley noodles were 161.3 degrees Fahrenheit (F), the baked chicken was 130.4 degrees F, the mushroom gravy was 157.9 degrees F, the zucchini and onions were 169.1 degrees F. Observation of the items on the steam table revealed the noodles appeared to seasoned with dried herbs, the chicken appeared to be moist, and the zucchini and onions were in a large pan with a large amount of what appeared to be water. At the time of observation, the chicken was reheated until it reached a temperature of 180 degrees F. Interviews on 10/08/25 between 12:12 P.M. and 12:17 P.M. with Dietary Consultant (DC) #650 revealed three wells of the steam table weren't working correctly, and the steamer was not operational, which had negatively affected the facility's ability to maintain a holding temperature of 135 degrees F. Observation at the time of the interview revealed the steamer was not being used, and part of the steam table didn't appear warm to the touch. Interview on 10/08/25 at 12:41 P.M. with Dietary [NAME] #311 revealed he used basil and parsley to season the herb noodles and hadn't put any seasoning or margarine on the zucchini and onions. Interview on 10/08/25 at 12:49 P.M. with DC #650 revealed the facility only had enough thermal pellet bases, used to help keep food items warm, for the residents on the third floor. He stated all residents received a heated plate and a dome lid to help with heat retention. Observations throughout the tray line revealed residents on the first and second floor had food placed on a heated plate and a dome lid was then placed over the plate. There was no observation of any thermal bases being used until meal trays were being plated for residents who resided on the third floor. On 10/08/25 at 1:09 P.M. at the start of the last food cart, the surveyor asked for a test tray. At 1:15 P.M., the kitchen ran out of noodles and mushroom gravy resulting in the tray line being stopped until more noodles and mushroom gravy could be made. Heated thermal pellets were observed sitting on residents' meal trays on the tray line while more food was being made. At 1:24 P.M. Dietary [NAME] #311 drained the cooked noodles into a colander and then dumped the noodles from the colander into a pan in the steam table without adding anything else. Dietary Consultant #650 poured new cooked mushroom gravy into a pan in the steam table and tray line started back up at 1:25 P.M. There was no observation of the heated thermal pellets, which had been left sitting on residents' meal trays on the tray line while more food items were made, being reheated. At 1:27 P.M. test tray was plated and placed onto a thermal pellet base and covered with a dome lid and then was placed into a covered food cart. The food cart then immediately left the kitchen to be delivered to the third floor. At 1:29 P.M. the food cart with the test tray arrived on the third floor, and staff immediately started to pass the meal trays. At 1:37 P.M. the last resident meal tray had been passed, and the test tray was taken out from the covered food cart by DC #650 and was placed on top of the food cart. DC #650 then took the temperature of the items on the meal tray using a facility thermometer while the surveyor tasted the meal items. The zucchini and onions were 101.5 degrees F and tasted cold and had no flavor. The herb butter noodles were 121 degrees F and tasted warm but had no flavor. There was no observation of any herbs on the noodles. The creamy mushroom chicken was 130 degrees Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 8 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some F, tasted warm, had a good flavor, and was moist. After taking the temperature of the meal items, DC #650 tasted the zucchini and onions and stated it tastes like zucchini to me but confirmed the 101.5 degrees F was too cold. After tasting the noodles, he confirmed no margarine, or herbs had been added to the noodles made after the kitchen had run out of cooked noodles. Review of the facility recipe for zucchini and onions revealed for 104 servings, one pound and one ounce of margarine, one tablespoon and one teaspoon of margarine, and one teaspoon of pepper should be added to cooked zucchini and sauteed onions. Review of the facility recipe for herb buttered noodles revealed for 104 servings a herb mixture consisting of four tablespoons of rosemary, parsley flakes, oregano, and paprika should be added along with one pound and one ounce of margarine to the cooked egg noodles. Review of the facility policy Food Temperatures at Point of Service, revised on 01/06/25, revealed hot food items must be cooked to appropriate internal temperature, held and served at a temperature of at least 135 degrees F., and the facility should utilize methods to maintain safe temperatures such as plate warmers, insulated bases, domes, and insulated tray carts. 2. Review of the medical record for Resident #41 revealed an admission date of 02/25/25 with diagnoses including acute posthemorrhagic anemia, acute kidney failure, stage three hypertensive chronic kidney disease, stage three pressure ulcer of the sacral region, primary hypertension, urinary retention, depression, and acidosis. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment completed on 09/24/25 revealed Resident #41 had intact cognition, was independent for eating, and was not on a therapeutic diet. Further review of the MDS revealed Resident #41 had experienced a weight loss of five percent (%) or more in the last month or 10% or more in the past six months and was not on a prescribed weight loss regimen. Review of the diet order dated 09/17/25 revealed Resident #41 was on a regular diet with regular consistency and thin liquids consistency. Review of the care plan last completed 09/24/25 revealed Resident #41 had an altered nutritional status as evidenced by chronic kidney disease, dysphagia, food allergies, history of bariatric surgery, and weight loss. Interventions included providing supplements and diet per dietitian and physician recommendation, encouraging oral food and fluid intake, providing preferred beverages, and honoring food preferences. Interview on 10/08/25 at 3:00 P.M. with Resident #41 revealed meals suck and are not tasteful. The resident went on to state lunch was terrible today. 3. Review of the medical record for Resident #29 revealed an admission date of 06/22/20 with diagnoses including chronic respiratory failure with hypoxia, type two diabetes mellitus, hypertensive heart disease with heart failure, chronic obstructive pulmonary disease (COPD), hyperosmolality and hypernatremia, depression, anxiety, and gastroesophageal reflux disease (GERD). Review of the diet order dated 07/17/20 revealed Resident #29 was prescribed a controlled carbohydrate diet (CCD) with no added salt (NAS) at regular consistency and thin liquid fluid consistency. Review of the quarterly MDS 3.0 assessment completed on 07/17/25 revealed Resident #29 had intact cognition and required setup or clean-up for eating. Further review of the MDS revealed Resident #29 was on a therapeutic diet. Review of the care plan last completed 07/17/25 revealed Resident #29 had identified preferences, including choosing what to eat, making her own choices from the weekly menus, and having snacks available. The care plan further revealed Resident #29 had altered nutrition and a history of weight fluctuations. Interventions included discussion with Resident #29 to identify any cultural, ethnic, religious, or other food preferences and to accommodate for those preferences. Interview on 10/08/25 at 3:03 P.M. with Resident #29 revealed the zucchini could have used more flavor and the food was at room temperature and could have been warmer. 4. Review of the medical record for Resident #60 revealed an admission date of 05/30/24 with diagnoses including right femur fracture, malignant neoplasm of the right kidney, emphysema, type two diabetes mellitus, atrial fibrillation, chronic gastritis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 9 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete without bleeding, acute kidney failure, malignant neoplasm of the pancreas, and temporomandibular joint disorder. Review of the diet order dated 11/25/24 revealed Resident #60 was prescribed a regular diet with regular consistency and thin fluid consistency. Review of the quarterly MDS 3.0 assessment completed on 07/10/25 revealed Resident #60 had moderately impaired cognition and needed setup or clean-up assistance with eating. Further review of the MDS revealed Resident #60 was not on a prescribed therapeutic diet. Review of the care plan last completed 07/17/25 revealed Resident #60 had the potential for altered nutrition secondary to advanced age, cancer, diabetes mellitus, malnutrition, and decrease in oral intake. Interventions included discussion with Resident #60 to identify any cultural, ethnic, religious, or other food preferences and to accommodate for, and honor, those preferences. Interview on 10/08/25 at 3:11 P.M. with Resident #60 revealed lunch wasn't good today. Food was blah, and the food could have been warmer. This deficiency represents non-compliance investigated under Complaint Number 2618032. Event ID: Facility ID: 365033 If continuation sheet Page 10 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, food temperature log review and facility policy review, the facility failed to ensure the mechanical soft chicken was held at a safe holding temperature for lunch on 10/08/25, which had the potential to affect 18 residents (#3, #4, #8, #10, #11, #15, #20, #22, #30, #42, #45, #52, #61, #63, #69, #82, #93, and #99) the facility identified as receiving a mechanical soft diet. The facility census was 102. Findings include:Review of the facility Food Temperature Log, dated 10/08/25, revealed all regular, mechanical and puree items for lunch had been cooked to safe internal temperatures with the regular texture chicken 179 degrees Fahrenheit (F), the noodles 169 degrees F, zucchini and onions 169 degrees F, mechanical soft chicken 176 degrees F, mechanical soft zucchini and onions 168 degrees F, puree chicken 174 degrees F, puree noodles 174 degrees F, and the puree zucchini and onions 169 degrees F. Observation on 10/08/25 at 11:48 A.M. of Dietary [NAME] #311 taking the food temperatures of the food items on tray line revealed the following concerns: The regular texture baked chicken was 130.4 degrees F. The mechanical chicken was 123.0 degrees F. The puree chicken was 96.6 degrees F. At the time of observation and prior to tray line starting, the puree chicken and the regular texture baked chicken were taken out of the steam table, and the puree chicken was reheated to 170.2 degrees F and the regular texture baked chicken was reheated to 178 degrees F and both were placed back into the steam table. The mechanical soft chicken remained on the steam table and had not been reheated. Interviews conducted between 12:12 P.M. and 12:17 P.M. with Dietary Consultant (DC) #650 revealed three wells of the steam table had not been working correctly for an unknown amount of time and the steamer hadn't been operational for approximately a week and half, which had negatively affected the facility's ability to hold hot food items at a safe temperature of 135 degrees F or higher. He indicated he had obtained a quote from an equipment repair company, and the reason why the steam table hadn't been fixed was because the steam table was old and there were no parts available to repair it. He indicated the steamer hadn't been repaired due to a parts issue. Observation at the time of interview confirmed the steamer was not operational and parts of the steam table were not fully operational with some wells not being able to be filled with water and some areas of the steam table not warm to the touch. At 12:32 P.M. DC #650 stated tray line was ready to go. At 12:33 P.M. the surveyor asked for a verification of the temperature of the ground chicken. Dietary [NAME] #311 took the temperature using a facility thermometer of the ground chicken and it was 109.2 degrees F. At time of observation, DC #350 stated to the dietary staff all items needed to be checked to ensure all items were being held at a safe temperature of 135 degrees F or higher and if items didn't meet the 135 degrees holding temperature, those items would need to be reheated. Various food items were reheated on the tray line, but the mechanical soft chicken was never reheated. At 12:37 P.M. all reheated food items had been returned to the tray line, and DC #650 confirmed the tray line was ready to go. At 12:38 P.M. the surveyor asked for tray line to be stopped and asked for the temperature of the mechanical soft chicken to be taken. DC #650 used a facility thermometer to take the temperature of the ground chicken, and it was 108.7 degrees F. At the time of observation, DC #650 confirmed the mechanical soft chicken was not at a safe holding temperature and then took the pan of mechanical soft chicken off the steam table to reheated it. At 12:40 P.M. DC #650 took the temperature of the reheated mechanical soft chicken, using a facility thermometer, and it had reached a safe holding temperature of 180 degrees F. The tray line then restarted. Review of the facility policy Food Temperatures at Point of Service, revised on 01/06/25, revealed hot food items needed to be held and served at a temperature of at least 135 degrees F. Temperatures should be taken periodically to assure hot foods stayed above (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 11 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 FORM CMS-2567 (02/99) Previous Versions Obsolete 135 degrees F., and the tray line and service areas would avoid holding food in the danger zone (41 degrees F to 135 degrees). Review of a professional kitchen equipment supplier/repair company Repair Estimate Summary, dated 10/01/25, revealed the heating elements and thermostat needed replaced for the steam table to be functional. There was no indication noted on the Repair Estimate Summary that parts were unavailable for the repair or the facility had okayed the repair. Review of a professional kitchen equipment supplier/repair company invoice, dated 10/09/25, revealed the steamer was able to be repaired the same day as the service call by replacing the hose with a PVC pipe. There was no indication noted in the service report that parts were unavailable for the repair. Interview on 10/15/25 at 12:09 P.M. with Representative #675 from the professional kitchen equipment supplier/repair company revealed the request to repair the steamer had not been called in by the facility until 10/08/25 at 3:05 P.M. This deficiency was an incidental finding identified at the time of the complaint survey. Event ID: Facility ID: 365033 If continuation sheet Page 12 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation, interview and review of the facility policy, the facility failed to ensure proper infection control procedures were followed during care for Resident #6, including appropriate donning and doffing procedures with use of personal protective equipment (PPE), appropriate catheter care, and proper handling of soiled linen and other soiled items. This affected one resident (#6) of one resident reviewed for catheter care and had the potential to affect all 16 residents (#6, #10, #19, #28, #31, #33, #43, 348, #56, #63, #68, #71, #75, #78, #98, and #102) who resided on the North unit of the second floor. The facility census was 102. Findings include:Review of the medical record for Resident #6 revealed an admission date of 11/12/24 with diagnoses including paranoid schizophrenia, arthritis due to bacteria right hip, hemiplegia or hemiparesis following cerebral infarction affecting right dominant side and left non-dominant side, paraplegia, slow transit constipation, benign prostatic hyperplasia without lower urinary tract symptoms, and neuromuscular dysfunction of the bladder. Review of the care plan initiated on 11/12/24 and last updated on 06/12/25 revealed Resident #6 had bowel incontinence. Interventions included checking Resident #6 for incontinence, removing soiled briefs, providing incontinence care, and applying a protective barrier after each incontinent episode. Further review of the care plan revealed Resident #6 was at risk for infection related to an indwelling catheter (a thin, flexible tube inserted into the bladder to drain urine), obstructive uropathy, and a neurogenic bladder. Interventions included provision of catheter care every shift and maintaining enhanced barrier precautions (EBP), including the use of a gown and gloves, for catheter care and toileting hygiene. The care plan for EBP further stated that EBP was to be maintained throughout the duration of Resident #6's stay or until reason for the precautions was resolved, such as discontinuation of the indwelling urinary catheter. Review of the Minimum Data Set (MDS) 3.0 assessment completed on 07/16/25 revealed Resident #6 had intact cognition and was dependent on staff for bathing, dressing, grooming, and toileting hygiene. Resident #6 had an indwelling catheter and was always incontinent of bowel. Review of the physician's order dated 09/23/25 revealed Resident #6 was to have EBP, which included use of a gown and gloves for high-contact resident care, including dressing, bathing, showering, transfers, hygiene care, changing linens, changing briefs, assisting with toileting, dressing changes, and device care related to having an indwelling urinary catheter. Observation on 10/07/25 from 2:45 P.M. to 3:04 P.M. of catheter care and incontinence care for Resident #6, performed by Certified Nurse Aide (CNA) #413, revealed CNA #413 wet two washcloths in sink of warm running water and laid the wet washcloths, plus one dry washcloth, directly on the uncleaned overbed table which had some of Resident #6's personal items on it. While wearing a surgical mask, a gown, and the gloves used to carry the washcloths from the sink on the room to the overbed table, CNA #413 proceeded to pull down the bedsheet, loosen and open Resident #6's brief, and explain that she was about to clean the catheter. Using the same gloves, CNA #413 was observed using one washcloth to briskly swipe back and forth under the abdominal fold, above the pubic area, then back and forth between skin folds of the left groin, then briefly on the head of the penis with two swipes, and then back and forth between the skin folds of the right groin. During this observation, CNA #413 was not observed using any method with the washcloth to ensure that a different, clean part of the cloth was used with each stroke, there were no soap suds noted during the cleansing of the perineal area, the area around the catheter insertion site was not fully cleaned from meatus outward, and no part of the catheter was secured or cleaned using the first washcloth during catheter care. The observation continued with CNA #413 laying the soiled washcloth on the outside corner of the opened brief, which remained underneath Resident #6, picking up the second wet washcloth from the overbed table, and following the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 13 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 - Few same steps as with the first washcloth (briskly swiped back and forth above the suprapubic area under the abdominal fold, then back and forth between skin folds of the left groin, then briefly on the head of the penis using two swipes, and then back and forth between the skin folds of the right groin). At no time was CNA #413 observed cleaning or rinsing directly around the urinary meatus/catheter insertion site or any length of the catheter. The second washcloth was not folded in a manner to ensure a different, clean part of the cloth was used to rinse each part of the body during catheter and perineal care. The second wet washcloth was laid on the outside corner of the brief that remained under Resident #6, and the dry cloth was taken from the overbed table to pat dry the left groin area, the suprapubic area, then the shaft and left lateral ridge of the head of the penis, then the right groin. Further observation revealed CNA #413 rolled Resident #6 on the right side to remove the brief and noted it was lightly soiled. Resident #6 was rolled back onto the soiled brief, and CAN #413 walked to the door of the room, removed the right glove with the left gloved hand, stated Now I have to start over, then exited the room with the gown and left glove used to render care to Resident #6 still on, and the soiled glove from the right hand clutched in the left hand. CNA #413 returned to the room approximately one minute later with additional washcloths, while wearing the same gown used to render catheter care and search the clean linen cart down the hallway, and used the soiled gloved left hand to apply a clean glove on the right hand and wet the new washcloth. Observation of care continued while CNA #413 rolled Resident #6 onto the right side, rolled the soiled linen up in the soiled brief and laid them on the floor beside the bed, cleaned the buttocks and intergluteal cleft (the groove or fold that separates the buttocks), laid the soiled washcloths on top of the soiled brief, which was on the floor, then rolled Resident #6 onto a clean brief. Using the same soiled gloves, the clean brief was secured, the catheter tubing was positioned inside the clean brief to minimize pulling and tugging, and Resident #6 was covered with a sheet. CNA #413 was then observed picking up the soiled linen and soiled brief, carrying them to the resident's bathroom, then laying the soiled items on the floor in the doorway between the bedroom and the bathroom. Continued observation on 10/07/25 from 3:01 P.M. to 3:02 P.M. revealed CNA #413, wearing the same gown used to render catheter and incontinence care to Resident #6, exited the room, walked up and down the hall on two north, opened linen cart and moved items around before closing the flap to the linen cart, walked to the medication cart, removed two trash bags from the medication cart and returned to Resident #6's room. At this time, CNA #413 was observed performing hand hygiene, applying clean gloves, bagging the linen and trash that was on the floor in the bathroom doorway, removing the gown and placing in a trash bag, tying up the trash, then placing on new clean gloves before taking the trash to the soiled utility room and placing linen in the laundry chute. Once the soiled trash bags were properly disposed of, CNA #413 walked into the South Dining Hall, entered the kitchenette, disposed of the gloves in the garbage, then used the sink in the South Dining Hall's kitchenette to perform hand hygiene. Interview on 10/07/25 at 3:05 P.M. with CNA #413 confirmed a basin for soapy or clean water was not used for catheter and incontinence care, a barrier was not used for placing clean rags on the overbed table, the table was not cleaned prior to placing the washcloths on top for resident care use. CNA #413 further confirmed placing the soiled brief and soiled linen on the floor next to the bed of Resident #6 and again on the floor in the bathroom doorway that there should have been trash bags ready, prior to performing resident care. During the interview, CNA #413 revealed staff would normally clean well around the catheter insertion site and while securing the catheter, were supposed to wash part way up the catheter to keep the portion near the insertion site clean. CNA #413 also confirmed leaving Resident #6's room twice while wearing the same gown on used to perform care and that gowns (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365033 If continuation sheet Page 14 of 15 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 365033 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedarwood Plaza 12504 Cedar Road Cleveland Heights, OH 44106 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete were supposed to be removed prior to exiting the room. At the time of the interview, CNA #413 confirmed leaving Resident #6's room between catheter care and incontinence care and that only one glove was removed at that time, staff were not to be in the hall with soiled gloves, and no hand hygiene was performed before donning a clean glove. Interview on 10/09/25 at 9:55 A.M. with CNA #383 confirmed basins and clean washcloths were to be used for washing residents and that staff were never to use the same part of the washcloth for cleaning around the catheter insertion site, catheter, and other body parts during catheter and perineal care. Interview on 10/09/25 at 10:33 A.M. with CNA #390 confirmed staff were to make sure two bags were ready for linen and trash disposal prior to rendering perineal or catheter care and that soiled items were never to be placed on the floor. During the interview, CNA #390 reported PPE was to always be removed prior to exiting resident rooms. Interview on 10/09/25 at 2:40 P.M. with Registered Nurse (RN) #398 confirmed staff were to clean the urinary meatus of a male with an indwelling catheter by securing the catheter and cleaning in a circular motion from inner to outer areas, using a clean part of the washcloth with each stroke, and care should be taken to ensure cleanliness of the catheter near the insertion site. RN #398 further confirmed that staff were to use a barrier or a wash basin and not lay washcloths on an unclean overbed table before commencing care. During the interview, RN #398 stated two bags were to be readily available during care, one for soiled disposable items and one for soiled linen, and that PPE was to be removed after care, prior to leaving a resident's room. RN #398 also confirmed hand hygiene was always to be performed with glove changes. Review of the policy titled Handwashing-Hand Hygiene, last reviewed on 01/06/25, revealed hand hygiene was to be performed before and after donning and doffing gloves and after handling used linens or supplies. The policy further revealed the use of gloves did not replace hand hygiene. Review of the policy titled Enhanced Barrier Precautions, dated 01/06/25, revealed PPE was to be removed and placed in a receptacle inside the resident room after resident care activities were completed. Review of the policy titled Catheter Care (Indwelling Catheter), dated 01/06/25, revealed staff were to clean the area well at the catheter insertion site and that all debris was to be removed from around the catheter, near the insertion site. Further review of the policy revealed if the resident was soiled or had an involuntary bowel movement, the incontinence care should be provided prior to catheter care to ensure they are not contaminated with feces. Review of the policy titled Incontinence Care, last reviewed 11/30/25, revealed soiled linen was to be disposed of appropriately. This deficiency represents noncompliance investigated under Complaint Number 2618032. Event ID: Facility ID: 365033 If continuation sheet Page 15 of 15