Inspection·September 16, 2025

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete FSD #344 confirmed they were out of fried rice and were sending white rice to finish out the carts for second floor residents. FSD #344 confirmed if residents did not like beef they received the chicken with vegetables in gravy.Phone interview on 09/15/25 at 1:33 P.M. with [NAME] #294 revealed he did not use a recipe for fried rice, he just made white rice and added various vegetables to it and did not realize the recipe included eggs. [NAME] #294 also confirmed he did not use the pepper steak for the pureed diets or mechanical soft diets as stated on the menu. [NAME] #294 confirmed he used chicken for the mechanical soft and pureed diets and did not taste them prior to serving them for taste or texture. [NAME] #294 also confirmed he did not use a recipe for chicken with vegetables mixed with chicken gravy. [NAME] #294 stated the menu recipes are in the book in the kitchen to use but since the meat was tougher, it was suggested to use the chicken instead and just made the chicken, vegetables and gravy without a recipe and was not listed on the facility approved menu.Interview on 09/15/25 at 1:38 P.M. with FSD #344 confirmed she did not have a substitution log for review prior to 08/01/25 and confirmed the substitution of the chicken with vegetables and gravy was not listed on the substitution list. FSD #344 confirmed it was not listed on the menu, and no recipe was followed. Observation on 09/11/25 at 1:41 P.M. revealed the tray for Resident #99, who is severely cognitively impaired and receives a pureed diet, received pureed chicken, pureed vegetables, pureed wheat bread and pudding. Interview at the time of the observation with Certified Nurse Aide (CNA) #251 confirmed the above listed items received for Resident #99 were already consumed with no swallowing concerns noted at the time.Phone interview on 09/11/25 at 2:07 P.M. with Registered Dietitian (RD) #362 confirmed she has not been doing test trays and stated she recently told the dietary staff that modified diets needs to get the items listed on the menu.Review of the 2023 facility policy called Standardized Recipes revealed standardized recipes will be used when preparing menu items. Standardized recipes for planned menu items will be maintained in the facility. Cooks/chefs are expected to use and follow the recipes provided. Event ID: Facility ID: 365071 If continuation sheet Page 2 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 observation, interview and review of facility policies the facility failed to ensure palatable meals were served for resident meals. This had the potential to affect all residents receiving meals from the facility. The facility indicated three residents (Residents #6, #23, and #66 received nothing by mouth). The facility census was 102.Findings include:Review of the facility provided menu for week three lunch for Thursday 09/11/25 revealed Chinese pepper steak, fried rice, oriental blend vegetables, iced mandarin orange cake and choice of milk and other beverage.Observation on 09/11/25 at 12:13 P.M. of lunch tray line revealed pepper steak, oriental mixed vegetables, white rice mixed with peas, carrots and corn, ground chicken, pureed chicken, pureed vegetables, pureed bread, white rice, and diced chicken with mixed vegetables with chicken gravy. Review of menu production sheets revealed regular diets were to get six ounces (oz) of pepper steak with onion and green pepper, four ounces of fried rice, four ounces of oriental blend vegetables, and one slice (1 1/2 inch x 2-inch piece) of iced mandarin orange cake and 4 ounces of milk. Mechanical soft diets were supposed to receive a number eight scoop (1/2 cup) of ground Chinese pepper steak with the other menu items and the pureed diets were supposed to receive a number eight scoop (1/2 cup) of pureed Chinese pepper steak, a number eight scoop (1/2 cup) of seasoned cream of rice, a number eight scoop of pureed oriental vegetables and a number ten scoop (3/8 cup) of pureed iced mandarin orange cake.Observation on 09/11/25 at 12:13 P.M. of the lunch tray line temperatures with [NAME] #294 temperatures were as follows: pepper steak 178 F, oriental vegetables 195 F, fried rice 183 F, ground chicken 178 F, pureed chicken 172 F, pureed vegetable 179 F, pureed bread 165 F, white rice 170 F, diced chicken with vegetables and chicken gravy 169 F.Observation on 09/11/25 at 12:30 P.M. revealed no seasoned cream of rice as a pureed modification for the fried rice. Interview at the time of the observation with FSD #344 revealed residents do not like regular cream of rice so they give them pureed wheat bread instead, had been doing it for a while, but had not discussed it with the Registered Dietitian. FSD #344 also stated since the meat is sometimes tough and will probably not puree well, they usually substitute baked chicken for the beef in the mechanical soft and pureed diets. The mechanical soft diets get ground baked chicken, and the pureed diets get pureed baked chicken.Observation on 09/11/25 at 12:36 P.M. revealed the first-floor cart left the kitchen for the floor. Observation on 09/11/25 at 12:38 P.M. revealed no evidence of the pureed orange cake dessert. Interview at the time of the observation with FSD #344 stated because they ran out of orange cake, they are substituting carrot cake with cream cheese frosting. FSD #344 further stated they are sending pudding for the pureed diet residents since the carrot cake would not puree smoothly.Observation on 09/11/25 at 12:51 P.M. revealed the third-floor cart left for the floor.Observation on 09/11/25 at 12:55 P.M. revealed the cart for the second-floor residents began. Observation revealed [NAME] #294 ran out of fried rice and started sending white rice instead. FSD #344 confirmed they were out of fried rice and were sending white rice to finish out the carts for the 37 residents receiving meals on the second-floor residents.Observation on 09/11/25 at 1:15 P.M. revealed the last cart for the second floor left the kitchen. Upon arrival on the second floor three aides started passing resident meal trays. Last resident tray was passed at 1:30 P.M.A test tray initiated with FSD #344 on 09/11/25 at 1:32 P.M. Temperatures taken by FSD #344 were as follows: Chinese pepper steak was 119.5 F, chicken with vegetables in gravy 126.7 F, pureed bread 82 F, pureed vegetables 113.5 F, Oriental vegetables 113.4 F, and pureed chicken 107.6F. Taste test for each item was completed with FSD #344. FSD #344 confirmed the Chinese pepper steak was chewy with some notable gristle when chewing and was not warm enough. The oriental vegetables were watery, mushy and not warm enough to preference. The chicken with vegetables in gravy was not warm Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365071 If continuation sheet Page 3 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 enough. The pureed chicken appeared to be more a mechanical soft consistency, was not a smooth consistency and tasted bland without seasoning. FSD #344 also noted the pureed bread was grainy, tasted pasty and was not a smooth consistency and the pureed vegetable had bean strings that were evident when chewing it. Following testing the above listed items, FSD #344 confirmed the tested items were not warm enough and she now understood resident complaints about food not being warm enough seeing the drop from the initial tray line temperature to the temperature of the test tray following the last passed resident meal tray. FSD #344 confirmed she does not usually complete test trays and had not tried the pureed food items. Phone interview on 09/15/25 at 1:33 P.M. with [NAME] #294 revealed he did not use a recipe for fried rice, he just made white rice and added various vegetables to it and did not realize the recipe included eggs. [NAME] #294 also confirmed he did not use the pepper steak for the pureed diets or mechanical soft diets as stated on the menu. [NAME] #294 confirmed he used baked chicken for the mechanical soft and pureed diets and did not taste them prior to serving them for taste or texture. [NAME] #294 also confirmed he did not use a recipe for the chicken with vegetables mixed with chicken gravy. [NAME] #294 stated the menu recipes are in the book in the kitchen to use but since the meat was tougher, it was suggested to use the chicken instead and just made the chicken, vegetables and gravy without a recipe and was not listed on the facility approved menu.Interview on 09/15/25 at 1:38 P.M. with FSD #344 confirmed she did not have a substitution log for review prior to 08/01/25 and confirmed the substitution of the chicken with vegetables and gravy was not listed on the substitution list. FSD #344 confirmed it was not listed on the menu, and no recipe was followed. Phone interview on 09/11/25 at 2:07 P.M. with Registered Dietitian (RD) #362 confirmed she has not been doing test trays at the facility, menus were to be followed, and stated she recently told the dietary staff that modified diets are supposed to get the items as written on the menu production sheets.Review of the 2023 facility policy called: The Dining Experience revealed the dining experience will be person centered with the purpose of enhancing each individual's quality of life and being supportive of each individual's needs during dining. Individuals will be provided with nourishing, palatable, attractive meals that meet daily nutrition and/or special dietary needs and food preferences and are served at a safe and appetizing temperature. Review of the 2023 facility policy called: Food Temperatures revealed foods sent to the units for distribution (such as meals, snacks, nourishments, oral supplements) will be transported and delivered to unit storage areas to maintain temperatures at or below 41 degrees Fahrenheit (F) for cold food and at or above 135 degrees F for hot foods. Event ID: Facility ID: 365071 If continuation sheet Page 4 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on medical record review, observations, interviews, review of facility menus, spreadsheets, and facility policy revealed the facility failed to ensure four residents (Residents #36, #80, #82 and #99) received the physician ordered pureed diet as required. The facility indicated there were three residents (Residents #6, #23, and #66) who received nothing by mouth. The facility census was 102.Findings include:Review of the medical record for Resident #99 revealed and admission date of 01/31/22. Diagnoses included but were not limited to unspecified dementia with agitation and seizures. Review of the physician order dated 01/31/22 for Resident #99 revealed an order for a regular pureed diet with thin liquids.Review of the 08/16/25 quarterly Minimum Data Set (MDS) 3.0 for Resident #99 revealed severe cognitive impairment and she required maximum staff assistance for eating.Review of the facility provided menu for week three lunch for Thursday revealed Chinese pepper steak, fried rice, oriental blend vegetables, iced mandarin orange cake and choice of milk and other beverage.Review of menu production sheets revealed residents receiving a pureed diet were supposed to receive a number eight scoop (1/2 cup) of pureed Chinese pepper steak, a number eight scoop (1/2 cup) of seasoned cream of rice, a number eight scoop of pureed oriental vegetables and a number ten scoop (3/8 cup) of pureed iced mandarin orange cake.Observation on 09/11/25 at 12:13 P.M. of lunch tray line revealed pepper steak, oriental mixed vegetables, white rice mixed with peas, carrots and corn, ground chicken, pureed chicken, pureed vegetables, pureed bread, white rice, and diced chicken with mixed vegetables with chicken gravy. Observation on 09/11/25 at 12:30 P.M. revealed no seasoned cream of rice as a pureed modification for the fried rice. Interview at the time of the observation with FSD #344 revealed residents do not like regular cream of rice so they give them pureed wheat bread instead, had been doing it for a while, but had not discussed it with the Registered Dietitian. FSD #344 also stated since the meat is sometimes tough and probably not puree well, they usually substitute baked chicken for the beef for the mechanical soft and pureed diets. The mechanical soft diets get ground baked chicken, and the pureed diets get pureed baked chicken.A test tray was initiated with FSD #344 on 09/11/25 at 1:32 P.M. Temperatures taken by FSD #344 were as follows: Chinese pepper steak was 119.5 F, chicken with vegetables in gravy 126.7 F, pureed bread 82 F, pureed vegetables 113.5 F, Oriental vegetables 113.4 F, and pureed chicken 107.6F. Taste test for each item was completed with FSD #344. FSD #344 confirmed the Chinese pepper steak was chewy with some notable gristle with chewing and was not warm enough. The oriental vegetables were watery, mushy and not warm enough to preference. The chicken with vegetables in gravy was not warm enough. The pureed chicken appeared to be more a mechanical soft consistency, was not a smooth consistency and tasted bland without seasoning. FSD #344 also noted the pureed bread was grainy, tasted pasty and was not a smooth consistency and the pureed vegetable had bean strings that were evident when chewing it. Following testing the above listed items, FSD #344 confirmed the tested items were not warm enough and she now understood resident complaints about food not being warm enough seeing the drop from the initial tray line temperature to the temperature of the test tray following the last passed resident meal tray. FSD #344 confirmed she does not usually complete test trays and had not tried the pureed food items to ensure a safe texture or taste. Observation on 09/11/25 at 1:41 P.M. revealed the tray for Resident #99, who is severely cognitively impaired and receives a pureed diet, received pureed chicken, pureed vegetables, pureed wheat bread and pudding. Interview at the time of the observation with Certified Nurse Aide (CNA) #251 confirmed the above listed items received for Resident #99 were already consumed with no swallowing concerns noted at the time.Phone interview on 09/15/25 at 1:33 P.M. with [NAME] #294 revealed he did not use the pepper steak for the pureed diets or mechanical soft diets (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365071 If continuation sheet Page 5 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete as stated on the menu. [NAME] #294 confirmed he used chicken for the mechanical soft and pureed diets and did not taste them prior to serving them for taste or texture. Phone interview on 09/11/25 at 2:07 P.M. with Registered Dietitian (RD) #362 confirmed she has not been doing test trays at the facility, menus were to be followed and stated she recently told the dietary staff that modified diets are supposed to get the items as written on the menu production sheets.Review of the undated facility policy called; Puree Food Preparation revealed puree means that all food has been ground, pressed an/or strained to a consistency of a soft, smooth, thick paste like a thick pudding. Pureed foods should be prepared in such a manner to prevent lumps or chunks. The goal is a smooth, soft, homogenous consistency like soft mashed potatoes. Review of the 2023 facility policy called Texture and Consistency Modified Diets revealed texture and consistency modified diets should be individualized with modifications made by the speech language pathologist (SLP) and physician in conjunction with the registered dietitian nutrition (RDN) or designee and director of food and nutrition services. A written order is needed. The food and nutrition services department will be responsible for preparing and serving the correct consistency of food and beverages as ordered. Event ID: Facility ID: 365071 If continuation sheet Page 6 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 observation, interview and review of facility kitchen cleaning schedules, and facility policies the facility failed to ensure a clean and sanitary kitchen was maintained as required. This had the potential to affect 99 residents in the facility receiving meals from the kitchen. The facility identified three residents (Resident #6, #23, and #66) who received no food by mouth. Additionally, the facility failed to ensure appropriate monitoring and safe storage of outside foods for residents. This had the potential to affect 36 residents residing on the second floor (Residents #38, #39, #40, #41, #42, #43, #44, #45, #46, #47, #48, #49, #50, #51, #52, #53, #54, #55, #56, #57, #58, #59, #60, #61, #62, #63, #64, #65, #67, #68, #69, #70, #71, #72, #73, and #74) residing in the facility. The facility indicated Resident #66 received nothing by mouth. The facility census was 102.1.Initial kitchen tour on 09/09/25 at 10:05 A.M. completed with Food Service Director (FSD) #344 revealed six packages of 12 count dinner rolls with best buy date of 09/06/25, 12 count hot dog buns with best buy date of 09/06/25. FSD #344 confirmed the bread should have been discarded over the weekend. Observation in the walk in refrigerator #1 revealed a one pound plastic container of diced tomatoes with a use by date of 09/01/25, a two pound plastic container of sliced onions with a use by date of 09/07/25, a leftover ham portion (approximately 2#) with a use by date of 08/25/25, and four packages of five pound Italian four cheese blend with a best by date of 08/29/25. FSD #344 confirmed the items should have been discarded and should not have still been in the refrigerator. Interview on 09/09/25 at 10:32 A.M. with FSD#344 confirmed she was unable to provide evidence of daily staff cleaning logs for August and had some sheets partially filled out for September but were not completed as required. FSD #344 stated each of the three scheduled dietary aides are supposed to complete a daily cleaning sheet and turn it in daily. FSD #344 also confirmed tray line food temperatures for the month of August 2025 were not available for review and the ones for September revealed dinner were not recorded on 09/06/25, no temperatures were recorded for 09/07/25 and dinner was not recorded on 09/08/25. Review of the 2023 facility policy called: Food Safety and Sanitation revealed all local, stated and federal standards and regulations will be followed to assure a safe and sanitary food and nutrition services department. Stored food will be handled to prevent contamination and growth of pathogenic organisms. Leftovers are to be used within 72 hours or discarded. Perishable foods with expiration dates should be used prior to the use by date on the package. All time and temperature control for safety (TCS) foods including leftovers should be labeled, covered and dated when stored. 2. Observation on 09/09/25 at 11:17 A.M. of the second-floor resident lounge refrigerator revealed the front of the refrigerator was heavily soiled with dried food and fingerprints and the front of the door and handle were sticky. Inside of the resident refrigerator revealed a paper plate with two cheeseburgers with no name or date, an open package of microwavable chicken patties that did not have a resident name, an open date and the use by date was unable to be determined. The six chicken patties contained inside of the open bag had visible mold on each of the chicken patties and had a bad odor when the bag was moved. Observation and interview on 09/09/25 at 11:20 A.M. with Certified Nurse Aide (CNA) #316 confirmed the chicken patties were moldy and the burgers were not labeled with a name or date as required. CNA #316 stated dietary was supposed to monitor the unit refrigerator.Interview on 09/11/25 at 1:35 P.M. with Dietary Director #344 stated she thought the resident unit refrigerators were monitored by nursing staff on each floor. Review of the undated facility policy called; Foods Brought by Family/Visitors revealed perishable foods must be stored in a re-sealable container with tightly fitting lids in the refrigerator. Containers will be labeled with the residents' name, the item and the ‘use by' date. The nursing staff is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365071 If continuation sheet Page 7 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 responsible for discarding perishable foods on or before the ‘use by' date. The nursing and/or food service staff must discard any food prepared for the residents that show obvious signs of potential foodborne danger (for example, mold growth, foul odor, past due package expiration dates.) Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365071 If continuation sheet Page 8 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation ,staff interview and facility policy review, the facility failed to ensure the dumpster/refuse area was maintained in a clean and sanitary condition. This had the potential to affect all residents residing in the facility. The facility census was 102.Findings include:Observation on 09/09/25 at 10:45 A.M. of the facilities outside dumpster area revealed various loose rubbish around and underneath the stairs leading to the dumpster. The Administrator confirmed the observation and stated maintenance is supposed to clean the area week following the dumpster being emptied to prevent rodents.Review of the undated facility policy called; Disposal of Garbage and Refuse revealed the facility shall properly dispose of kitchen garbage and refuse. Storage areas, enclosures, and receptacles for refuse shall be maintained in good repair and cleaned at a frequency necessary to prevent them from developing a buildup of soil or becoming an attractant for insects and rodents. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365071 If continuation sheet Page 9 of 10 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 365071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachwood Pointe Care Center 23900 Chagrin Blvd Beachwood, OH 44122 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and policy review, the facility failed to maintain a clean and homelike environment. This had the potential to affect all residents residing in the facility. The facility census was 102.Findings include:On 09/09/25 between 10:00 A.M. and 12:30 P.M. an initial tour of the building was conducted. room [ROOM NUMBER] was noted with visible dirt at the door threshold. The resident lounge on the second floor was noted to have a floor with visible dirt and debris. The garbage can was overflowing. The common bathroom on the second floor was noted to have caked hair and visible dirt under the sink in the back right hand side of the floor. There was a stained ceiling tile. There was plastic tape hanging from the overhead light. The mirror was chipped and broken. The elevator threshold was caked with visible dirt and debris. There was built up, visible dust on all baseboards on all units. room [ROOM NUMBER] was missing the baseboard behind the bed headboard exposing the wall. Peeling paint was noted under the air conditioning unit. The window seal in the common hall outside room [ROOM NUMBER] was noted to have built up visible dust and dead insects. The blinds on the window above outside room [ROOM NUMBER] were noted to have a build up of visible dust and dirt. room [ROOM NUMBER] was noted to have the corner of the wall outside of the bathroom torn away exposing the wall. The soap dispensers outside rooms [ROOM NUMBERS] were noted to not be filled. The threshold outside room [ROOM NUMBER] was noted to have built up dirt and debris. Maintenance Director #347 verified the aforementioned findings at the time of the observations. On 09/10/25 at 11:05 A.M. another tour of the building was conducted with Environmental Service Director (ESD) #346. Built up, visible dust was noted on all baseboards of all units. Windowsills at the end of each unit were noted to have visible dirt and dead insects. Blinds at the end of every hallway on all units were noted to have built up visible dust and dirt on them. ESD #346 verified the findings at the time of the tour. On 09/10/25 at 3:10 P.M. Visible dirt and dead insects was noted at the windowsills at the end of the halls on the 200 unit. Housekeeper #314 verified the findings at the time of the observation. A review of the policy titled; Homelike Environment with a revision date of 02/2021 revealed Residents are provided with a safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the extent possible. The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect personalized, home-like setting. These characteristics include a clean, sanitary and orderly environment. This deficiency represents non-compliance investigated under Complaint Numbers 1271397, 2589543, and 1271392. Event ID: Facility ID: 365071 If continuation sheet Page 10 of 10