Inspection·January 23, 2025

F 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Minimal harm or potential for actual harm Based on observation, review of the facility's contract with therapy services, resident interview, and staff interview, the facility failed to administer the facility in a manner to maintain therapy equipment in proper working order. This affected one resident (#51) and had the potential to affect all 91 residents in the facility. Residents Affected - Many Findings include: Review of the medical record for Resident #51 revealed an admission date of 06/26/24 with diagnoses including encounter for other orthopedic aftercare, person injured in unspecified motor-vehicle, colostomy status and anxiety disorder. Review of the quarterly Minimum Data Set (MDS) assessment, dated 10/03/24, revealed Resident #51 had moderate cognitive impairment, was dependent on staff for bed/chair to chair transfers, and required partial/mod assist for bed mobility. On 01/22/25 at 7:48 A.M., an interview with Resident #51 stated the therapy gym did not have the equipment they needed and he was told by staff to just hold onto the sink and pivot while attempting to stand. On 01/22/25 at 8:33 A.M., an observation of the facility's therapy gym revealed there was an ultrasound and tens unit (electrotherapy device) on a shelf and there was a set of balance bars (parallel bars used to help people stay balanced while standing or walking) in the corner surrounded by walkers, rollators, canes, and other equipment, making the balance bars inaccessible to residents. On 01/22/25 at 8:36 A.M., an interview with Certified Occupational Therapy Assistant (COTA) #814 stated the facility did not have much therapy equipment and the ultrasound and tens unit were used for pain management but they had been unable to use them because the facility refused to pay for routine maintenance and calibration. COTA #814 also stated the balance bars could not be used because they were not secured to anything and unsafe in their current state. COTA #814 revealed they had to be super creative when providing therapy because they did not have the equipment they need. On 01/22/25 at 8:49 A.M., an interview with Rehabilitation Director #815 confirmed the ultrasound and tens unit had not been used since at least July 2024 because they needed serviced. She stated the therapy staff were contracted and the facility was responsible for maintaining therapy equipment. Rehabilitation Director #815 also confirmed therapy staff were unable to use the balance bars in the therapy gym because they were not secure and verified Resident #51 had to use a sink to support himself while standing up. Rehabilitation Director #815 revealed therapy gave the faciliy a list of (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 365129 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 365129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eastbrook Healthcare Center 17322 Euclid Ave Cleveland, OH 44112 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)