Inspection·January 15, 2026

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed ensure there was accurate documentation. This affected two residents (#31 and #42) out of 24 medical records reviewed for accuracy of medical records. The facility census was 103. Findings include: 1. Review of medical record for Resident #42 revealed an admission date of 05/23/24 and his diagnoses included morbid obesity, diabetes with diabetic neuropathy, chronic kidney disease, and chronic obstructive pulmonary disease (COPD). Review of care plan dated 05/24/24 revealed Resident #42 had potential for hypoglycemia and/or hyperglycemia related to diabetes. Interventions included checking glucose levels, administering insulin and monitoring labs as ordered.Review of care plan dated 05/24/24 revealed Resident #42 had a nutritional problem related to morbid obesity, history of binge eating, congestive heart failure (CHF), and excessive consumption of highly processed snacks and beverages. Interventions included administering medication as ordered, monitoring and documenting side effects and effectiveness, monitoring weights and providing and serving diet as ordered. Review of September 2025 Medication Administration Record (MAR) revealed Resident #42 had an order for Mounjaro (an injectable medication used to treat diabetes and obesity) subcutaneous (SQ) solution auto-injector 2.5 milligrams (mg) per 0.5 milliliter (ml), inject one application SQ in the afternoon every Wednesday for diabetes. The MAR indicated on 09/17/25 to see the nursing notes as it was not administered. Review of nursing note dated 09/17/25 at 6:12 P.M. revealed Resident #42's Mounjaro was not given as it was reordered. There was no documentation Primary Care Physician (PCP) #900 was notified regarding Resident #42 missing his dose and Resident #42 did not receive the medication until the next time that it was scheduled on 09/24/25. Review of November 2025 MAR revealed Resident #42 had an order for Mounjaro SQ solution auto-injector 2.5 mg per 0.5 ml, inject one application SQ in the afternoon every Thursday for diabetes. The MAR was blank on 11/06/25. Review of nursing notes dated 11/01/25 to 12/31/25 for Resident #42 revealed no documentation PCP #900 was notified regarding Resident #42 not receiving his Mounjaro on 11/06/25 and 12/11/25. Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #42 was cognitively intact. Review of Physician Progress Note dated 11/10/25 at 8:11 A.M. and completed by PCP #900 revealed Resident #42 had the following diagnoses: morbid obesity, diabetes, and COPD. He recommended to continue Mounjaro for diabetes and morbid obesity. Review of December 2025 MAR revealed Resident #42 had an order for Mounjaro SQ solution auto-injector 2.5 mg per 0.5 ml, inject one application SQ in the afternoon every Thursday for diabetes. The MAR was blank on 12/11/25. Interview on 01/12/26 at 9:40 A.M. and 01/15/26 at 8:43 A.M. with Resident #42 revealed he was supposed to receive Mounjaro once a week mainly to assist him in weight loss. He revealed at times he did not receive this medication but could not remember details of when he did not or how often. Interview on 01/14/26 at 2:22 P.M. with Director of Nursing (DON) verified on Resident #42's MAR it indicated on 09/17/25 his Mounjaro was not given as it was not available, and on 11/06/25 and (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 4 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 01/15/2026 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)