Inspection·January 14, 2026

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the witness statement taken by the Administrator on 01/01/26 from Resident #01 (Resident #85 ' s roommate) for SRI #269286 revealed he had not heard any inappropriate statements and was only aware of the situation because Resident #85 had told him. Review of a hand-written witness statement by Licensed Practical Nurse (LPN) #392, dated 01/01/26, revealed she was sitting in the conference room having lunch and heard a loud commotion coming from the smoking area. LPN #392 went to investigate and saw CNA #413 standing in the doorway passing out cigarettes and screaming profanities. It was unclear who CNA #413 was yelling at. She stated the situation then settled down. LPN #392 did not hear her making specific threats toward any patients, only cursing. Review of a typed witness statement by LPN #392, dated 01/01/26, revealed she was sitting in the conference room with several staff having lunch when there was a commotion coming from the smoking area. Resident #85 was agitated yelling out. LPN #392 did not hear CNA #413 making any specific threats toward any residents. Review of a witness statement by LPN #386, dated 01/01/26, observed CNA #413 cursing and yelling near the common lounge area. CNA #413 was sent home by the supervisor for her behavior. Interview on 01/08/26 at 9:28 A.M. with Resident #85 revealed CNA #413 was very inappropriate and always mean to people. He stated during the smoke break on 01/01/26, CNA #413 stated to him that he had a very small dick and her husband ' s was bigger. Resident #85 stated she was swearing at him. Resident #85 indicated his roommate (Resident #01) overheard the statements made because he was right next to him during the smoke break. He stated there were no other staff present. Interview on 01/08/26 at 9:30 AM with Resident #01 revealed CNA #413 made inappropriate comments to Resident #85 including the size of his penis and was using profanities at him. Resident #01 indicated the comments were made at smoking break and no other staff were present. Interview on 01/08/26 at 9:39 A.M. with the Director of Nursing (DON) revealed CNA #413 was no longer employed by the facility but she was unsure why she was terminated. Interview on 01/08/26 at 10:14 A.M. with the DON revealed CNA #413 was terminated due to her lack of professionalism. Previously CNA #413 had disciplinary action for professionalism so she was terminated due to this being her second offense. Interview on 01/08/26 at 1:46 P.M. with the Human Resources (HR) Director #370 indicated the DON was given the witness statements related to CNA #413 ' s termination. Observation and interview on 01/08/26 at 1:49 P.M. of the HR Director #370 speaking with the DON revealed the HR Director #370 revealed she had given the witness statements to the DON by placing them in her mailbox the previous day. The DON indicated the witness statements were given to Regional Director #503. Interview on 01/08/26 at 2:26 P.M. with CNA #348 revealed on 01/01/26 there was a commotion at the smoking door. She stated she had observed CNA #413 and two residents arguing. CNA #348 was unsure why CNA #413 was not sent home immediately after, but she did not leave the facility until 3:00 P.M. CNA #348 indicated the facility was short-staffed that day. CNA #348 indicated CNA #413 had been observed treating residents without respect and dignity in the past. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 2 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0550 Level of Harm - Minimal harm or potential for actual harm Interview on 01/12/26 at 10:54 A.M. with the Administrator revealed when Resident #01 was interviewed the verbiage used was Resident #85 told Resident #01 about the situation. The Administrator stated it was a he said, she said situation. She stated she had never asked Resident #01 if he was present during the incident between Resident #85 and CNA #413. The Administrator indicated Resident #01 was cognitively intact. Residents Affected - Few Interview on 01/12/26 at 10:54 A.M. with the Administrator verified it was documented on the SRI that CNA #413 had no previous disciplinary actions. After review with her with CNA #413 ' s employee file, she verified CNA #413 had a previous disciplinary action in her employee file dated 05/02/25 for arguing with another employee at the nurse ' s station and yelling on the floor. The Administrator indicated the reason it was documented on the SRI that way was due to CNA #413 not having disciplinary actions toward residents or their care. The Administrator revealed CNA #413 was not terminated due to the SRI allegation but due to her unprofessional behavior and profanities she was yelling at the smoking area. Interview on 01/12/26 at 11:14 A.M. with Regional Director #503 revealed CNA #413 was having a bad day, acting inappropriately, and was sent home early on 01/01/26. She stated that CNA #413 was displaying behaviors that the company would not tolerate so she was terminated. Regional Director #503 denied CNA #413 making any derogatory comments to Resident #85 but did admit to using profanities while on duty. Interview on 01/12/26 at 2:40 P.M. with LPN #384 revealed she was the charge nurse that weekend. LPN #384 revealed she was in the conference room eating and heard CNA #413 using profanities. She indicated there were residents out in the smoking area as it was smoke break. She stated she cannot remember which residents were in the smoking area, but it was multiple residents and were the normal smokers. LPN #384 revealed she could not hear who CNA #413 was specifically cursing at but when they arrived at the smoking door, CNA #413 calmed down. Interview on 01/12/26 at 2:44 P.M with LPN #386 revealed he was present in the facility on 01/01/25. LPN #386 indicated he was eating in the conference room when he heard a commotion from the smoking area. He stated CNA #413 was cursing but had calmed down when he got to the door. CNA #413 stated Mother [expletive] stated he was going to hit me. LPN #386 revealed Resident #85 had never made false accusations about staff. Interview on 01/14/26 at 9:30 A.M. with LPN #392 who was working in the facility on 01/01/26. She stated she was in the conference room near the 400-hall eating lunch and heard a loud noise that sounded like chaos and voices. She stated CNA #413 was in the doorway handing out cigarettes to residents and using profanities at someone in the smoking area. She was unsure who CNA #413 was speaking too. LPN #392 verified there were no residents having behaviors or noted to be agitated. She was unsure what residents were in the smoking area but stated it was the usual smokers. LPN #392 revealed she wrote a handwritten statement and was told by management it had been misplaced so she was asked to email another statement on 01/02/26. LPN #392 did not remember seeing Resident #85 in the smoking area during the incident and verified that her typed statement was inaccurate. Review of the emailed witness statement dated 01/06/26 from LPN #392 to LPN #339 revealed on 01/01/26 LPN #392 was sitting in the conference room with several other staff having lunch when there was a loud commotion from the smoking area. LPN #392 followed the nursing supervisor to check on the situation. CNA #413 was standing in the doorway, passing out cigarettes, and screaming profanities. LPN #392 was unsure who CNA #413 was screaming the profanities too. LPN #392 did not hear any specific (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 3 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0550 threats toward any patients, only cursing. Level of Harm - Minimal harm or potential for actual harm Review of the employee file for CNA #413 revealed she had a hire date of 12/09/24. CNA #413 had received her job description on hire which included for her to follow all resident rights and adhere to all facility policy and procedures. On 05/02/25 there was a disciplinary action form stating CNA #413 was arguing with the appearance of aggressive behavior or use of inappropriate, abusive or foul language towards or in the presence of a resident, employee or visitor. This was a final written warning. CNA #413 refused to sign the disciplinary action form. On 01/01/26 there was a disciplinary action form stating CNA #413 had been arguing with the appearance of aggressive behavior and use of foul language towards or in the presence of resident, employee or visitor. The CNA #413 was notified by phone of the termination by the Director of Nursing (DON) and HR Director #370. Residents Affected - Few Review of the employee handbook, revised 06/15/23, revealed the facility has established certain rules, regulations and standards guiding employee behavior and conduct. Employees were expected to project a mature, professional and courteous attitude toward residents, visitors, and co-workers. The level of discipline given would be dependent upon the seriousness of the offense or performance concern. Class 2 work rule violations were considered serious. If they did not result in immediate termination, they would result in a final written warning for the first occurrence. Arguing, the appearance of aggressive behavior, or use of inappropriate abusive or foul language towards or in the presence of a resident, employee, or visitor is an example of class 2 work rule violations. This deficiency represents noncompliance investigated under Complaint Number 2645564. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 4 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, personnel file review, and policy review, the facility failed to implement their abuse protocol when an allegation of verbal abuse was reported to staff. This affected one resident (Resident #80) of seven residents reviewed for abuse. The facility census was 141. Findings Include: Resident #80 was admitted to the facility on [DATE] with diagnoses including congestive heart failure, high blood pressure, atrial fibrillation, dementia without behavioral disturbance, anxiety disorder, high risk heterosexual behavior, major depressive disorder, and liver cell carcinoma. Review of the comprehensive Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #80 was cognitively intact and exhibited no behaviors. Review of the nursing notes revealed an Interdisciplinary Team (IDT) note dated 12/19/25 at 12:28 P.M. revealed Licensed Practical Nurse (LPN) #505 reviewed Resident #80's behaviors in the last 90 days included cursing at others, destructive behavior, public sexual act, delusions and grabbing. The resident last saw the Psychiatric Nurse Practitioner (PNP) #506 on 12/10/25. Review of PNP #506's evaluation dated 12/10/25 revealed Resident #80 was observed touching himself inappropriately during the interview, with audible rustling of his Depends noted and calling female staff derogatory names. The resident also had a recent episode of agitation with nursing staff who he felt were calling him names (pissy-ass), leading to cursing and behavioral issues. Review of the facility's Self Reported Incidents (SRI) to the state agency revealed no allegations of verbal abuse for Resident #80 dated 12/10/25 or 12/11/25. Interview with Resident #80 on 01/05/26 at 10:18 A.M. revealed he is scared of the aides as they call him abusive names. The resident said he told the nurse but they brush it off. The red head aide is mean to him and tells him everyone is going to die here. Interview with LPN #397 on 01/05/25 at 11:04 A.M. revealed Resident #80 was very sexually inappropriate with female staff. LPN #397 confirmed the resident does have a problem with the aides. LPN #397 said if you put your foot down and tell him his behavior is inappropriate the resident will agree and apologize. LPN #397 identified Certified Nurse Aide (CNA) #350 as the aide Resident #80 complained about. LPN #397 said she did not think CNA #350 would be verbally abusive towards him but she has heard CNA making comments but not about anyone specifically. LPN #397 said management is aware as far as she knows. Interview with the Administrator and the Director of Nursing (DON) on 01/13/26 at 11:15 A.M. revealed neither one was aware of the allegation of verbal abuse Resident #80 informed PNP #506 about on 12/10/25. The Administrator asked if the facility should file an SRI since they were just made aware of the concern and was advised to follow their policy regarding allegations of abuse. The Administrator confirmed PNP #506 had not advised them of her visit with Resident #80 and his allegation of verbal abuse. The Administrator said she believes PNP #506 emails the facility with a summary of her visits. The DON said the nurse practitioner notes do not show up on the daily summary of care report they receive for each day. Interview with Resident #80 on 01/13/26 at 1:30 P.M. revealed the red haired aide was nasty to him and called him names, tells him he stinks and that he is going to die here. The resident said he just saw her today as she was working. The resident said he will not talk to the aide anymore as she does not talk respectfully to him. Resident #80 said the nurses know about his concerns but was unaware if the Director of Nursing or the Administrator knew. Interview was conducted with the Administrator and the Regional Administrator (RA) #503 on 01/13/26 at 2:00 P.M. and they were informed of Resident #80's comments and the description of the aide involved had red hair and, according to Resident #80, was working today. The Administrator said they will file an SRI with the state agency, interview Resident #80, and suspend the aide pending an investigation if they are able to identify the person. The Administrator said the resident is Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 5 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete known for his behaviors and this may be attention seeking behavior. The Administrator said she spoke with PNP #506 and educated her on the need to advise the facility when concerns are made by a resident. Interview with the Administrator and the DON on 01/13/25 at 3:30 P.M. revealed they had identified the aide Resident #80 had made his allegation of abuse against and identified her as CNA #350 and she was suspended pending investigation. Review of CNA #350's personnel file revealed a background check had been completed, her license was in good standing with the Nurse Aide Registry, reference checks were completed, and had received no disciplinary actions since she was hired in 2024. Review of the facility's SRIs revealed the facility filed an SRI on 01/13/26 regarding Resident #80's allegation of verbal abuse and had begun their investigation of the incident reported on 12/10/25. Review of the facility's Abuse, Neglect, Exploitation & Misappropriation of Resident Property policy, implemented on 11/21/16, revealed the facility will investigate all alleged allegations of abuse, neglect, and misappropriation. Staff are trained to report all allegations of abuse to administration upon hire and annually thereafter. The facility policy is to protect the resident from further abuse. All allegations will be reported to the state agency within two to twenty-four hours and complete the investigation within five days. Event ID: Facility ID: 365134 If continuation sheet Page 6 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0610 Respond appropriately to all alleged violations. 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, observations, interviews, and facility policy reviews, the facility failed to ensure a thorough investigation was completed for verbal abuse during a self-reported incident (SRI) investigation. This affected one (Resident #85) out of eight residents reviewed for abuse. The facility census was 141.Findings Include:Review of the medical record for Resident #85 revealed an admission date on 08/25/22 with diagnoses including, but not limited to, unspecified dementia, alcohol dependence with alcohol-induced dementia, vascular dementia, anxiety, depression, insomnia, encephalopathy, and unspecified psychosis. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #85 had a Brief Interview Mental Status (BIMS) score of 09 indicating impaired cognition.Review of SRI #269286 from the facility on 01/01/26 revealed Certified Nursing Assistant (CNA) #413 made inappropriate comments to Resident #85. The staff member was suspended but had no previous disciplinary actions. A head-to-toe assessment, pain assessment, and skin assessment was completed on 01/01/26 with no negative findings. Resident #85 denied any physical contact with CNA #413. His guardian and doctor were notified of the incident. Interviews conducted with residents with BIMS of 09 or greater completed with no additional concerns identified. Assessments of residents with BIMS of less than 09 completed with no significant findings. Interviews with staff revealed no concerns. Social services followed up and Resident #85 was at baseline for mood and behaviors. The staff was re-educated on the abuse policy. CNA #413 had no previous disciplinary actions and a valid CNA license. The facility unsubstantiated the abuse allegation. The discovery date of the allegation was 01/01/26 and the SRI was completed on 01/04/26.Review of the witness statement from CNA #413 on 01/01/26 revealed Resident #85 was extremely agitated most of the day. CNA #413 denied making any other derogatory statements to Resident #85 or any other residents. This statement was taken by the Administrator and originally had CNA #413's last name incorrect.Review of the witness statement taken by the Administrator on 01/01/26 from Resident #01 (Resident #85's roommate) for SRI #269286 revealed that he had not heard any inappropriate statements and was only aware of the situation because Resident #85 had told him.Review of a hand-written witness statement by Licensed Practical Nurse (LPN) #392, dated 01/01/26, revealed she was sitting in the conference room having lunch and heard a loud commotion coming from the smoking area. LPN #392 went to investigate and saw CNA #413 standing in the doorway passing out cigarettes and screaming profanities. It was unclear who CNA #413 was yelling at. She stated the situation then settled down. LPN #392 did not hear her making specific threats toward any patients, only cursing.Review of a typed witness statement by LPN #392, dated 01/01/26, revealed she was sitting in the conference room with several staff having lunch when there was a commotion coming from the smoking area. Resident #85 was agitated yelling out. LPN #392 did not hear CNA #413 making any specific threats toward any residents.Review of a witness statement by LPN #386, dated 01/01/26, observed CNA #413 cursing and yelling near the common lounge area. CNA #413 was sent home by the supervisor for her behavior. Review of the emailed witness statement from 01/06/26 from LPN #392 to LPN #339 revealed on 01/01/26 she was sitting in the conference room with several other staff members having lunch. She stated there was a loud commotion coming from the smoking area. LPN #392 followed the nursing supervisor to check on the situation. CNA #413 was standing in the doorway, passing out cigarettes, and screaming profanities. LPN #392 was unsure who CNA #413 was yelling at and then the situation calmed down. LPN #392 did not hear specific threats toward any patients, only cursing.Interview on 01/08/26 at 9:28 A.M. with Resident #85 revealed CNA #413 was very inappropriate and always mean to people. He stated during the smoke break on 01/01/26, CNA #413 stated to him that he had a very small dick and her husband's was bigger. Resident Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 7 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #85 stated she was swearing at him. Resident #85 indicated his roommate (Resident #01) overheard the statements made because he was right next to him during the smoke break. He stated there were no other staff present.Interview on 01/08/26 at 9:30 AM with Resident #01 revealed CNA #413 made inappropriate comments to Resident #85 including the size of his penis and was using profanities at him. Resident #01 indicated the comments were made at smoking break and no other staff were present.Interview on 01/08/26 at 1:46 P.M. with the Human Resources (HR) Director #370 revealed CNA #413's last name on her employee file was correct and not the SRI.Interview on 01/08/26 at 2:26 P.M. with CNA #348 revealed on 01/01/26 there was a commotion at the smoking door. She stated she had observed CNA #413 and two residents arguing. CNA #348 was unsure why CNA #413 was not sent home immediately after, but she did not leave the facility until 3:00 P.M. CNA #348 indicated the facility was short-staffed that day. CNA #348 indicated CNA #413 had been observed treating residents without respect and dignity in the pastInterview on 01/12/26 at 10:54 A.M. with the Administrator revealed CNA #413's last name was not correct on the SRI. It was documented on the SRI that CNA #413 had no previous disciplinary actions however she had a previous disciplinary action in her employee file. The Administrator indicated the reason it was documented on the SRI that way was due to CNA #413 not having disciplinary actions toward residents or their care. CNA #413 was not added as the perpetrator to the SRI due to an oversight. The Administrator indicated being unaware of Resident #85's roommate being present during the incident. When the roommate was interviewed the verbiage used was what Resident #85 told him. The Administrator stated it was a he said, she said situation and the roommate was not asked if he was present during the incident. Resident #85's roommate was cognitively intact. The Administrator indicated not being aware of the allegation made until approximately 8:00 P.M. on 01/01/26.Interview on 01/14/26 at 9:30 A.M. with LPN #392 revealed she worked at the facility on 01/01/26. She stated she was in the conference room near the 400 hall eating lunch and heard a loud noise that sounded like chaos and voices. She stated CNA #413 was in the doorway handing out cigarettes to residents and using profanities at someone in the smoking area. She was unsure who CNA #413 was speaking too. LPN #392 verified there were no residents having behaviors or noted to be agitated. She was unsure what residents were in the smoking area but stated it was the usual smokers. LPN #392 revealed she wrote a handwritten statement and was told by management it had been misplaced so she was asked to email another statement on 01/02/26. LPN #392 did not remember seeing Resident #85 in the smoking area during the incident and verified that her typed statement was inaccurate.Review of the employee file for CNA #413 revealed she had a hire date of 12/09/24. CNA #413 had received her job description on hire which included for her to follow all resident rights and adhere to all facility policy and procedures. On 05/02/25 there was a disciplinary action form stating CNA #413 was arguing with the appearance of aggressive behavior or use of inappropriate, abusive or foul language towards or in the presence of a resident, employee or visitor. This was a final written warning. CNA #413 refused to sign the disciplinary action form. On 01/01/26 there was a disciplinary action form stating CNA #413 had been arguing with the appearance of aggressive behavior and use of foul language towards or in the presence of resident, employee or visitor. The CNA #413 was notified by phone of the termination by the Director of Nursing (DON) and HR Director #370.Review of the employee handbook, revised 06/15/23, revealed the facility has established certain rules, regulations and standards guiding employee behavior and conduct. Employees were expected to project a mature, professional and courteous attitude toward residents, visitors, and co-workers. The level of discipline given would be dependent upon the seriousness of the offense or performance concern. Class 2 work rule violations were considered serious. If they did not result in immediate termination, they would result in a final written (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 8 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete warning for the first occurrence. Arguing, the appearance of aggressive behavior, or use of inappropriate abusive or foul language towards or in the presence of a resident, employee, or visitor is an example of class 2 work rule violations. Review of the facility policy titled, Abuse, Neglect, Exploitation and Misappropriation of Resident Property, dated 11/21/16, revealed the facility was to have evidence that all alleged violations of abuse are thoroughly investigated and to report the results of all investigations to the State Survey Agency within five working days of the incident.This deficiency represents noncompliance investigated under Complaint Number 2615601. Event ID: Facility ID: 365134 If continuation sheet Page 9 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure safe smoking interventions were in place for Resident #106 and failed to ensure fall interventions were implemented at all times for Resident #16 and Resident #25. This affected three residents (Resident #16, Resident #25, and Resident #106) out of eight residents reviewed for accidents. The facility census was 141.1.Review of the medical record for Resident #106 revealed an admission date of 05/17/17. Diagnoses included but not limited to chronic atrial fibrillation, chronic obstructive pulmonary disease and nicotine dependence. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #106 had intact cognition and required supervision for activities of daily living. Review of the physician's orders for January 2026 revealed that Resident #106 was ordered to wear a fire-retardant apron when smoking for safety. Review of the care plan dated 08/26/21 with a revision date of 9/21/22 for Resident #106 revealed that a smoking apron must be worn when smoking. Observation on 01/05/2026 at 1:37 P.M. revealed Resident #106 was observed smoking in designated area. Resident #106 had a cigarette burn hole on his left pant leg and was not wearing a smoking apron. This was verified by Certified Nursing Assistant (CNA) #502 at time of observation. Observation on 01/05/26 at 1:39 P.M. revealed Resident #106 was propelling himself to the door with the cigarette hanging from his mouth. CNA #502 approached resident politely and took the cigarette from his mouth. CNA #502 stated that she told a nurse a while back but couldn't remember which one that he needed a smoking apron. Interview on 01/08/26 at 8:03 A.M. with Director of Nursing (DON) verified that Resident #106's physician's order and care plan stated that Resident #106 should wear a smoking apron. Review of the facility policy dated 11/23/11 with a most recent revision date of 10/21/22 revealed that the facility provides a safe and healthy environment for residents including safety as related to smoking. 2. Review of the medical record for Resident #25 revealed they were admitted to the facility on [DATE] with diagnoses that included stroke, dementia, epilepsy, unsteadiness on feet, chronic kidney disease, and weakness. Review of the annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #25 used corrective lenses, was cognitively intact, required supervision or touching assistance for transfers, and had two or more falls since admission. Review of the physician orders revealed an order dated 09/10/25 for a pressure alarm to the wheelchair and for placement and function to be checked every shift. Review of the progress notes revealed on 09/08/25 Resident #25 had fallen when transferring from their wheelchair to the bedside commode and on 12/16/25 they had fallen out of their recliner while (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 10 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0689 trying to pick up an item up from the floor. Level of Harm - Minimal harm or potential for actual harm Review of the care plan revealed Resident #25 was at risk for falls due to weakness, impaired balance, and impaired cognition and the goal was to minimize risk factors related to falls with interventions that included a chair alarm. Residents Affected - Few An observation on 01/08/26 at 9:26 A.M. revealed Resident #25 was in their wheelchair self-propelling in the room, and then the resident was visualized self-transferring from their wheelchair to the bedside commode. On observation of the transfer an alarm pressure pad and alarm speaker were visualized on the wheelchair. When Resident #25 transferred out of the wheelchair to the bedside commode the alarm did not sound. An interview on 01/08/26 at 9:28 A.M. with Licensed Practical Nurse (LPN) #383 revealed the wheelchair alarm should have sounded when Resident #25 transferred out of the wheelchair. LPN #383 checked the function of the wheelchair alarm and verified it was not disconnected; it was not turned off; it did not function correctly and should have sounded when the resident transferred out of the wheelchair. When LPN #383 assisted Resident #25 from the bedside commode to the wheelchair it was noted the left wheel lock for the wheelchair was broken and did not lock the wheel. LPN #383 verified the wheel lock did not function correctly. Review of the facility policy titled Fall Management, dated 10/17/16 revealed the facility would reduce the risk of falls and reoccurrence of falls by care plan development, implementation of interventions, and ongoing monitoring. 3. Review of the medical record for Resident #16 revealed they were admitted to the facility on [DATE] with diagnoses that included Alzheimer's disease, Parkinson's, dementia, repeated falls, weakness, unsteadiness on feet, and history of falling. Review of the physician orders revealed an order dated 12/11/25 for a call don't fall sign in the room. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #16 was cognitively intact, required supervision or touching assistance for transferring and ambulating, and had a history of falls prior to admission. Review of the fall risk assessment dated [DATE] revealed Resident #16 was at risk for falls due to three or more falls in the last 90 days, displayed cognition behaviors, ambulated with problems, and was unsteady transferring. Review of the care plan dated 12/12/25 revealed Resident #16 was at risk for falls related to Alzheimer's disease, Parkinson's, generalized weakness, dementia, and history of falling the goal was to minimize fall risk factors; interventions included analyze previous falls to determine pattern or trends, call don't fall sign to room, and to ensure the call light is within reach. Review of the fall investigation dated 11/08/25 revealed Resident #16 fell in their room while independently ambulating. It was noted that the call light was not in reach and a new intervention of a call don't fall sign was implemented. An observation on 01/07/25 at 10:56 A.M. revealed Resident #16 was sitting in their recliner near (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 11 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on the left side of the room nearest to the hallway. On observation it was noted the call light was clipped to the room divider curtain outside of Resident #16's reach and the absence of a call don't fall sign in the room. An interview on 01/07/26 at 11:05 A.M. with LPN# 384 revealed interventions for a resident that is at risk for falls could include a call don't fall sign, assistive devices in reach, and a call light in reach. LPN# 384 verified the absence of a call don't fall sign and that the call light was out of reach for Resident #16. An interview on 01/07/26 at 12:00 P.M. with the Director of Nursing (DON) revealed the facility doesn't not have a call light policy. A review of the Treatment Administration Record (TAR) from 01/01/26 to 01/07/26 revealed documentation that a call don't fall sign was in Resident #16's room. Review of the facility policy titled Fall Management, dated 10/17/16 revealed the facility would reduce the risk of falls and reoccurrence of falls by care plan development, implementation of interventions, and ongoing monitoring. This deficiency represents noncompliance investigated under Complaint Numbers 2645564 and 2637112. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 12 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 observation, interview, and record review, the facility failed to ensure proper diets were followed. This affected three residents (Residents #17, #71, and #106) out of five residents for nutrition. The facility census was 141.1. Review of the medical record for Resident #17 revealed an admission date of 12/19/25. Diagnoses included but not limited to fracture of the upper end of right tibia, muscle weakness, and osteoarthritis. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #17 had intact cognition and required supervision for eating and partial assistance for other activities of daily living. Review of the physician's orders for January 2026 revealed that Resident #17 was ordered a regular diet with regular texture and thin liquids diet with double entrees all meals, eggs grits and meat related to at risk for malnutrition. Review of the care plan dated 11/20/25 for Resident #17 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to provide diet as ordered and honor preferences. Review of Resident 17's breakfast diet ticket revealed that he was on a regular diet with double meat/entree with sausage at breakfast. Interview on 01/05/26 at 2:17 P.M. with Resident #17 revealed that the portions sizes are not correct especially at breakfast. Observation on 01/06/26 at 8:06 A.M. of Resident #17's breakfast tray revealed that he did not receive double portions and no meat for breakfast. This was verified at time of observation with Certified Nursing Assistant (CNA) #350. Interview on 01/08/26 at 8:03 A.M. with Director of Nursing (DON) verified that Resident #17's physician orders for a regular diet with regular texture and thin liquids diet with double entrees all meals, eggs grits and meat related to at risk for malnutrition. 2. Review of the medical record for Resident #71 revealed an admission date of 03/30/16 and a readmission date of 09/23/16. Diagnoses included but not limited to anorexia, vascular dementia, and major depressive disorder. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #71 had severely impaired cognition and required supervision for eating and substantial assistance activities of daily living. Review of the physician's orders for January 2026 revealed that Resident #71 was ordered a regular diet with regular texture and thin liquids diet with fortified cereal and fortified eggs at breakfast. Review of the care plan dated 04/03/16 with the most recent revision date of 10/31/25 for Resident #71 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to provide diet as ordered, honor preferences, and nutrient dense foods offered at meals. Review of Resident 71's breakfast diet ticket revealed that he was on a regular diet with fortified cereal and fortified eggs. Observation on 01/06/25 at 8:14 A.M. revealed that Resident #71 did not get his fortified cereal for breakfast. This was verified by CNA # 502 at time of observation. Interview on 01/08/26 at 8:03 A.M. with DON verified that Resident 71's physician orders for a regular diet with regular texture and thin liquids diet with fortified cereal and fortified eggs at breakfast. 3. Review of the medical record for Resident #106 revealed an admission date of 05/17/17. Diagnoses included but not limited to chronic atrial fibrillation, chronic obstructive pulmonary disease and nicotine dependence. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #106 had intact cognition and required supervision for activities of daily living. Review of the physician's orders for January 2026 revealed that Resident #106 was ordered to a no added salt, mechanical soft texture and thin liquids diet with fortified cereal and fortified eggs at breakfast. Review of the care plan dated 05/25/17 with the most recent revision date of 09/09/25 for Resident #106 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to provide diet as ordered and honor preferences. Review of Resident 106's breakfast diet ticket Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 13 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 that he was on a no added salt mechanical soft diet with fortified cereal and fortified eggs. Observation on 01/06/26 at 8:28 A.M. revealed that Resident #106 did not receive his fortified cereal. This was verified by Corporate Dietary Manager #500 at time of observation. Interview on 01/06/25 at 9:03 A.M. with Dietary Manager (DM) #378 revealed that there were two new employees on the trayline being trained and must have missed the fortified cereals. Interview on 01/08/26 at 8:03 A.M. with Director of Nursing (DON) verified that the Resident #106's physician orders for a regular diet with regular texture and thin liquids diet with fortified cereal and fortified eggs at breakfast. Review of the facility policy dated 10/18 titled, Food First Program, revealed that when managing the nutritional status of the resident, it is vital to obtain their preferences. Honoring their food and beverage preferences and incorporating them into the resident's diet is an effective intervention. This deficiency represents non-compliance investigated under Complaint Number 2674639. Event ID: Facility ID: 365134 If continuation sheet Page 14 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on record review, observations and interviews, the facility failed to ensure respiratory equipment was maintained in a sanitary manner and oxygen orders were individualized to meet resident specific needs to reduce the risk of complications from variations in oxygen treatment. This affected two (Residents #127 and #136) of two residents reviewed for respiratory care with the potential to affect 20 residents who utilized oxygen. The facility census was 141.Findings include:1. Review of the medical record for Resident #127 revealed an admission date of 09/25/23 with diagnoses including dementia, chronic obstructive pulmonary disease (COPD) and protein-calorie malnutrition.Review of the care plan dated 09/28/23 for Resident #127 revealed she had respiratory deficiencies or abnormalities of pulmonary function related to COPD, allergic rhinitis and emphysema. She also had shortness of breath on exertion. Interventions included for staff to monitor lung sounds as ordered, monitor oxygen saturation as ordered, administer oxygen as ordered, respiratory assessments as ordered and to update the physician with any abnormal or new findings for possible evaluation or further treatment as ordered.Review of the care plan dated 02/27/25 for Resident #127 revealed she required oxygen related to COPD. The goal was to keep her oxygen level at the desired level as set per the physician. Staff were to administer oxygen as ordered, monitor oxygen saturation as ordered and observe for signs and symptoms of shortness of breath.Review of the physician's orders for Resident #127 revealed she had an orders related to respiratory function as follows:-Respiratory Therapy: Respiratory system observation, monitoring, and data collection of current respiratory deficiencies or abnormalities of pulmonary function: COPD, asthma, every day and night shit. Update the physician as needed based upon findings dated 04/17/25. Staff were to document the lung sounds, minutes assessed, temperature and oxygen saturation. -Check oxygen saturation every shift while on oxygen dated 04/28/25. -Change oxygen tubing/cannula/mask weekly every night shift on Sunday dated 05/04/25.-Vital signs weekly every day shift on Friday for monitor dated 11/21/25. Staff were to document the blood pressure, temperature, heart rate, respiratory rate and oxygen saturation.-Oxygen 0 to 5 liters per nasal cannula to maintain saturation of 90 percent (%) every shift dated 11/26/25. Staff were to document the liters of oxygen and oxygen saturation.Review of the Treatment Administration Record (TAR) for December 2025 revealed staff had documented Resident #127 received 8 liters of oxygen on nightshift on 12/10/25 and the oxygen liters were documented as not applicable on 12/28/25 on dayshift. Observation on 01/05/25 at 2:26 P.M. of Resident #136 revealed she was wearing the oxygen via a nasal cannula at 2 liters. The oxygen tubing had a whitish residue on the outside of the tubing. Resident #136 stated staff did not change the tubing very often.Interview on 01/05/26 at 2:29 P.M. with Licensed Practical Nurse (LPN) #397 verified Resident #136's oxygen tubing was not dated. She stated when she would change oxygen tubing and nasal cannulas she placed a date at the connector end that connected to the oxygen concentrator. She stated it was the facility's policy but there were staff who did not date it when changing the tubing.Observation on 01/07/26 at 9:09 A.M. of Resident #127 revealed she was on 3 liters of oxygen. The oxygen tubing was not dated to show the staff had changed the tubing or cannula per the weekly order. Interview on 01/07/26 at 9:11 A.M. with LPN #385 verified the oxygen tubing was not dated for Resident #127 and confirmed the whitish residue on the tubing. She stated she was educated on 01/06/26 nursing staff were not dating the oxygen tubing per their policy. LPN #385 stated she always dated the oxygen tubing and had ensured all of her oxygen tubing was dated on her unit on 01/06/26, however, LPN #339 had come to the unit and replaced all of the residents oxygen tubing to ensure none of the tubing was dated.Interview on 01/07/26 at 10:04 A.M. with the Director of Nursing (DON) revealed she was unsure why the oxygen orders for residents were noted to be between 0 to 5 liters and not an Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 15 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few individualized order. She stated the facility policy did not state staff had to date the oxygen tubing when changing it as there was a physician order the nursing staff were signing off on.Interview on 01/07/26 at 12:00 P.M. with the DON revealed it was the facility's policy to place orders for all residents for oxygen at 0 to 5 liters to allow nursing judgement to titrate the oxygen and increase and decrease it as needed. She stated Medical Director (MD) #508 provided the orders. She stated Resident #127's TAR for 12/10/25 and 12/28/25 were probably errors in documentation.Interview on 01/07/26 at 2:35 P.M. was attempted with MD #508. There was no answer when he was called and voicemail message was left. There was no return contact made.Interview on 01/07/26 at 2:37 P.M. was attempted with Nurse Practitioner (NP) #507. There was no answer when she was called and voicemail message was left. There was no return contact made.Interview on 01/12/26 at 2:30 P.M. with LPN #388 stated she knew what oxygen liter each resident was on from the physician's orders. She stated the physician's order stated the exact liter of oxygen and she followed the order.Interview on 01/12/26 at 2:40 P.M. with LPN #384 verified the oxygen orders were in the electronic medical records. She stated nursing staff normally set the oxygen liters at 2 to 3 liters for each resident.Review of the facility policy titled, Respiratory Equipment Cleaning/Disinfection, revised on 07/30/24, revealed the facility would maintain respiratory equipment in a manner that prevents the spread of disease and infections. Staff were to change tubing weekly or as needed. Review of the facility policy titled, Oxygen Administration, revised on 07/30/24, revealed oxygen was to be administered to residents who needed it, consistent with professional standards of practice, comprehensive person-centered care plans and the residents' goals and preferences. Oxygen was to be administered under orders of a physician. Oxygen tubing and mask/cannula may be changed weekly and as needed if it became soiled or contaminated. The physician would be notified as needed for changes or complications associated with the use of oxygen.2. Review of the medical record for Resident #136 revealed an admission date of 07/02/23 with diagnoses including chronic obstructive pulmonary disease (COPD), acute and chronic respiratory failure with hypercapnia (a buildup of too much of carbon dioxide in the blood), acute and chronic respiratory failure with hypoxia (low oxygen) and congestive heart failure.Review of the care plan dated 07/20/23 for Resident #136 revealed she had respiratory deficiencies or abnormalities of pulmonary function related to COPD, chronic respiratory failure and shortness of breath. Interventions included for staff to monitor lung sounds as ordered, monitor oxygen saturation as ordered, administer oxygen as ordered, respiratory assessments as ordered and to update the physician with any abnormal or new findings for possible evaluation or further treatment as ordered.Review of the care plan dated 07/20/23 for Resident #136 revealed she required oxygen related to COPD and chronic respiratory failure. The goal was to keep her oxygen level at the desired level as set per the physician. Staff were to administer oxygen as ordered, monitor oxygen saturation as ordered and observe for signs and symptoms of shortness of breath.Review of the physician's orders for Resident #136 revealed she had an orders related to respiratory function as follows:-Respiratory Therapy: Respiratory system observation, monitoring, and data collection of current respiratory deficiencies or abnormalities of pulmonary function: COPD, asthma, every day and night shit. Update the physician as needed based upon findings dated 07/28/25. Staff were to document the lung sounds, minutes assessed, temperature and oxygen saturation. -Check oxygen saturation every shift while on oxygen dated 07/28/25. -Change oxygen tubing/cannula/mask weekly every night shift on Tuesday dated 07/29/25.-Weekly vital signs on night shift on Thursday dated 11/06/25. Staff were to document the blood pressure, temperature, heart rate, respiratory rate and oxygen saturation.-Oxygen 0 to 5 liters per nasal cannula to maintain saturation of 90 percent (%) every shift dated 11/26/25. Staff were to document the liters of oxygen and oxygen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 16 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete saturation.Review of the Treatment Administration Record (TAR) for January 2026 revealed staff had documented they changed Resident #136's oxygen tubing on 01/06/26. Observation on 01/05/25 at 2:26 P.M. of Resident #136 revealed she was wearing the oxygen via a nasal cannula at 2 liters. The oxygen tubing had a whitish residue on the outside of the tubing. Resident #136 stated staff did not change the tubing very often.Interview on 01/05/26 at 2:29 P.M. with Licensed Practical Nurse (LPN) #397 verified Resident #136's oxygen tubing was not dated and had a whitish residue on the tubing. She stated when she would change oxygen tubing and nasal cannulas she placed a date at the connector end that connected to the oxygen concentrator. She stated it was the facility's policy but there were staff who did not date it when changing the tubing.Observation on 01/07/26 at 9:09 A.M. of Resident #127 revealed she was on 3 liters of oxygen. The oxygen tubing was not dated to show the staff had changed the tubing or cannula per the weekly order. Interview on 01/07/26 at 9:11 A.M. with LPN #385 verified the oxygen tubing was not dated for Resident #127. She stated she was educated on 01/06/26 nursing staff were not dating the oxygen tubing per their policy. LPN #385 stated she always dated the oxygen tubing and had ensured all of her oxygen tubing was dated on her unit on 01/06/26, however, LPN #339 had come to the unit and replaced all of the residents oxygen tubing to ensure none of the tubing was dated.Interview on 01/07/26 at 10:04 A.M. with the Director of Nursing (DON) revealed she was unsure why the oxygen orders for residents were noted to be between 0 to 5 liters and not an individualized order. She stated the facility policy did not state staff had to date the oxygen tubing when changing it as there was a physician order the nursing staff were signing off on.Interview on 01/07/26 at 12:00 P.M. with the DON revealed it was the facility's policy to place orders for all residents for oxygen at 0 to 5 liters to allow nursing judgement to titrate the oxygen and increase and decrease it as needed. She stated Medical Director (MD) #508 provided the orders. Interview on 01/07/26 at 2:35 P.M. was attempted with MD #508. There was no answer when he was called and voicemail message was left. There was no return contact made.Interview on 01/07/26 at 2:37 P.M. was attempted with Nurse Practitioner (NP) #507. There was no answer when she was called and voicemail message was left. There was no return contact made.Interview on 01/12/26 at 2:30 P.M. with LPN #388 stated she knew what oxygen liter each resident was on from the physician's orders. She stated the physician's order stated the exact liter of oxygen and she followed the order.Interview on 01/12/26 at 2:40 P.M. with LPN #384 verified the oxygen orders were in the electronic medical records. She stated nursing staff normally set the oxygen liters at 2 to 3 liters for each resident.Review of the facility policy titled, Respiratory Equipment Cleaning/Disinfection, revised on 07/30/24, revealed the facility would maintain respiratory equipment in a manner that prevents the spread of disease and infections. Staff were to change tubing weekly or as needed. Review of the facility policy titled, Oxygen Administration, revised on 07/30/24, revealed oxygen was to be administered to residents who needed it, consistent with professional standards of practice, comprehensive person-centered care plans and the residents' goals and preferences. Oxygen was to be administered under orders of a physician. Oxygen tubing and mask/cannula may be changed weekly and as needed if it became soiled or contaminated. The physician would be notified as needed for changes or complications associated with the use of oxygen. Event ID: Facility ID: 365134 If continuation sheet Page 17 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interviews, medical record review, and facility policy review, the facility failed to ensure a resident who required dialysis received ongoing assessments of condition before and after dialysis treatments. This affected one Resident (#14) of one resident identified as receiving dialysis. The facility census was 141.Review of the medical record for Resident #14 revealed an admission date of 06/19/19 and diagnoses including end stage renal disease (ESRD), diabetes mellitus, dependence on renal dialysis, morbid obesity, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF).Review of the plan of care dated 05/13/20 revealed Resident #14 received dialysis treatments three times per week for ESRD. It was noted Resident #14 frequently refused to go to dialysis treatments. Interventions included assist with transfer needs when going to dialysis, auscultate lung sounds as ordered, monitor for edema, check for new orders upon return from dialysis, send lunch with resident to dialysis, maintain communication with dialysis staff and physician, monitor labs, monitor shunt site for bleeding and signs/symptoms (s/s) of infection, monitor bruit and thrill, replace dressing as needed, and provide education regarding consequences of refusing dialysis.Review of physician's order dated 11/01/22 revealed order to check left arm arteriovenous (AV) fistula for bruit and thrill every shift.Review of physician's order dated 04/20/24 revealed Resident #14 had dialysis every Tuesday, Thursday, and Saturday at a location outside the facility. Resident #14's appointment time was 11:00 A.M.Review of Medicare Minimum Data Set (MDS) quarterly assessment dated [DATE] revealed Resident #14 had a brief interview for mental status (BIMS) score of 15 indicating intact cognition. Resident #14 had no refusal behaviors noted on the assessment. Resident #14 received dialysis treatments.Further review of the medical record revealed no evidence of pre-treatment or post-treatment assessments related to dialysis treatments for Resident #14 were completed by the facility.Review of the dialysis center's communication forms from October 2025 to January 2026 revealed the center provided Resident #14's pre-treatment and post-treatment weights, blood pressure, temperature, and status/condition. The center also provided a list of medications administered while in center.Interview on 01/08/26 at 2:22 P.M. with Licensed Practical Nurse (LPN) #435 revealed she was Resident #14's regularly assigned nurse. LPN #435 stated Resident #14 had a binder he took with him to dialysis. LPN #435 stated she filled out a form with vitals and any s/s of pain or sickness. LPN #435 was unable to produce Resident #14's binder as he was at dialysis. LPN #435 was also unable to provide a sample of the form they filled out.Interview on 01/12/26 at 4:22 P.M. with Director of Nursing (DON) revealed she was unable to locate any assessments filled out by the facility pre and post treatment for Resident #14. DON confirmed the communication forms provided were completed by the dialysis center.Review of facility policy Dialysis Management dated 10/11/18 revealed the facility would assess monitor for complications, and provide adequate intervention in the management of those receiving dialysis based on physician orders and plan of care.This deficiency represents noncompliance investigated under Master Complaint Number 2712681. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 18 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure behavioral health interventions were implemented for Resident #45 with PICA (a mental health condition where a person eats things that aren't food). This affected one resident (Resident #45) out of three residents reviewed for behaviors. The facility census was 141. Findings include: Review of the medical record for Resident #45 revealed they were admitted to the facility on [DATE] with diagnoses that included diabetes mellitus type two, dementia with behavioral disturbance, hearing loss, anxiety disorder, peripheral vascular disease, and chronic kidney disease. Review of the physician orders from 12/01/25 to 01/07/26 revealed the absence of any orders to monitor Resident #45 for gastrointestinal (GI) symptoms related to PICA or to monitor Resident #45's physical environment for broken or damaged items that could be ingested. Review of the progress notes revealed the following: on 11/21/25 Resident #45 was documented as having [NAME] like behavior by Nurse Practitioner (NP) #507; on 12/28/25 Resident #45 was documented as having [NAME] like behavior by NP #507; on 12/29/25 at 6:12 P.M. Resident #45 was documented as eating the plastic rim off the bedside table and the resident was educated and redirected by nursing staff; on 12/29/25 at 6:13 P.M. Resident #45 spit out the plastic that was in his mouth and the request for a new tray table was initiated by nursing staff; and on 01/06/26 Resident #45 was seen by NP #506 due to [NAME] behaviors, [NAME] behaviors were likely related to progressive dementia, and nursing staff confirmed Resident #45 had been eating non-food items over the past year such as plaster from the wall and pulling items from their recliner. Review of the annual Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #45 was moderately cognitively impaired, they did not have a change in behaviors, and they required supervision or touching assistance for activities of daily living. Review of the care plan revealed the following: Resident #45 has altered health maintenance related to mental status and disease process, the goal was to avoid injury, no interventions to monitor GI symptoms or monitor the physical environment for damaged items were noted; Resident #45 experienced alteration in mood or behavior as evidenced by picking at wall paper, wall lining, bedside tables and attempted to chew or eat furniture, the wall, and bedside table material. The goal was to display appropriate affect for the situation with an intervention for the bedside table to be removed except for meals, there was no intervention to monitor GI symptoms or the physical environment for damaged items that could be ingested; Resident #45 has altered cognitive function and has impaired decision making abilities the goal was for Resident #45 to make decisions on a consistent basis despite cognitive impairment with assistance as needed, there were no interventions to monitor for GI symptoms or monitor the physical environment for damaged items. An observation on 01/12/26 at 2:38 P.M. revealed Resident #45 was on their right side and was picking at the bed linen and mattress. Resident #45 was noted to be spitting phlegm on the hard plastic wall protector and then using their finger to move it around on the wall protector. An interview on 01/12/26 at 2:43 P.M. with Licensed Practical Nurse (LPN) #386 revealed they had witnessed Resident #45 picking at the wall, eating materials from the wall, and that the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 19 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0740 Level of Harm - Minimal harm or potential for actual harm still attempts to pick at the wall. LPN #38 verified Resident #45 did not have orders or interventions to monitor GI symptoms or to monitor the physical environment for damaged items. An interview on 01/14/26 at 12:30 P.M. with the Administrator revealed the facility doesn't have a behavior management policy, the facility follows the regulations. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 20 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and facility policy review, the facility failed to honor preferences. This affected six residents (#9, #17, #71, #105, #106, and #129) out of six residents for beverage preferences. This had the potential to affect 141 residents who received meals from the facility. No residents were identified as receiving nothing by mouth (NPO). The facility census was 141.Findings include: 1. Review of the medical record for Resident #17 revealed an admission date of 12/19/25. Diagnoses included fracture of the upper end of right tibia, muscle weakness, and osteoarthritis.Review of the care plan dated 11/20/25 for Resident #17 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to providing diet as ordered and honoring preferences.Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #17 had intact cognition and required supervision for eating and partial assistance for other activities of daily living. Review of the physician's orders for January 2026 revealed that Resident #17 was ordered a regular diet with regular texture and thin liquids with double entrees all meals, eggs, grits, and meat related to at risk for malnutrition. Review of Resident 17's breakfast dietary ticket revealed that he was to receive eight ounces of orange juice.Interview on 01/05/26 at 2:17 P.M. with Resident #17 revealed that the portions sizes were not correct, especially at breakfastObservation on 01/06/26 at 8:06 A.M. of Resident #17's breakfast tray revealed that he did not receive orange juice for breakfast. This was verified at time of observation with Certified Nursing Assistant (CNA) #350.2. Review of the medical record for Resident #9 revealed an admission date of 08/26/20 with a readmit date of 02/01/24. Diagnoses included anxiety disorder, schizoaffective disorder, and osteoarthritis.Review of the care plan dated 09/01/20 with a most recent revision date of 11/11/25 for Resident #9 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to providing diet as ordered and honoring preferences.Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #9 had intact cognition and was dependent on staff for eating.Review of the physician's orders for January 2026 revealed Resident #9 was ordered a regular diet with pureed texture and thin liquids. Review of Resident 9's breakfast dietary ticket revealed that she was supposed to get orange juice and coffee.Observation on 01/06/26 at 8:13 A.M. of Resident #9's breakfast tray revealed that she did not receive orange juice or coffee. This was verified at time of observation with CNA #350.3. Review of the medical record for Resident #71 revealed an admission date of 03/30/16 and a readmission date of 09/23/16. Diagnoses included anorexia, vascular dementia, and major depressive disorder.Review of the care plan dated 04/03/16 with the most recent revision date of 10/31/25 for Resident #71 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to providing diet as ordered, honoring preferences, and nutrient dense foods offered at meals.Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #71 had severely impaired cognition and required supervision for eating and substantial assistance activities of daily living. Review of the physician's orders for January 2026 revealed that Resident #71 was ordered a regular diet with regular texture and thin liquids diet with fortified cereal and fortified eggs at breakfast.Review of Resident 71's breakfast dietary ticket revealed that he was supposed to get orange juice.Observation on 01/06/25 at 8:14 A.M. revealed that Resident #71 did not get orange juice for breakfast. This was verified by CNA # 502 at time of observation.4. Review of the medical record for Resident #129 revealed an admission date of 08/06/19. Diagnoses included multiple sclerosis, chronic obstructive pulmonary disease and schizophrenia disorder.Review of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 21 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete care plan dated 08/08/19 with the most recent revision date of 11/15/25 for Resident #129 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to providing diet as ordered and honoring preferences.Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #129 had intact cognition and required supervision for eating and dependent on staff or other activities of daily living. Review of Resident #129's breakfast dietary ticket revealed that he was supposed to receive eight ounces of orange juice.Observation on 01/06/26 at 8:17 A.M. revealed that Resident #129 did not receive orange juice. This was verified by Licensed Social Worker (LSW) #372 at the time of the observation.5. Review of the medical record for Resident #105 revealed an admission date of 08/23/24. Diagnoses included metabolic encephalopathy, diabetes mellitus, and unspecified severe protein-calorie malnutrition. Review of the care plan dated 08/26/24 with the most recent revision date of 11/01/25 for Resident #105 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to providing diet as ordered, honoring preferences, and nutrient dense foods offered at meals.Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #105 had slightly impaired cognition and required supervision for eating and was dependent on staff for activities of daily living. Review of Resident 105's breakfast dietary ticket revealed that he was supposed to get four ounces of orange juice.Observation on 01/06/25 at 8:22A.M. revealed that Resident #105 did not get orange juice for breakfast. This was verified by LSW #372 at the time of the observation.6. Review of the medical record for Resident #106 revealed an admission date of 05/17/17. Diagnoses included chronic atrial fibrillation, chronic obstructive pulmonary disease and nicotine dependence.Review of the care plan dated 05/25/17 with the most recent revision date of 09/09/25 for Resident #106 revealed there was a potential for alteration in nutrition due to diagnoses. Interventions included but not limited to providing diet as ordered and honoring preferences.Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #106 had intact cognition and required supervision for activities of daily living. Review of Resident 106's breakfast dietary ticket revealed that he was supposed to receive four ounces of orange juice.Observation on 01/06/26 at 8:28 A.M. revealed that Resident #106 did not receive orange juice. This was verified by Corporate Dietary Manager #500 at time of observation.Interview on 01/06/26 at 9:03 A.M. with Dietary Manager (DM) #378 revealed that there were two new employees on the tray line being trained and when they ran out of orange juice, they did not put another type of juice on the tray.Interview on 01/06/26 at 9:03 A.M. with Registered Diet Technician (DTR) #340 revealed that the average fluid amount per resident, who was not on a fluid restriction, was 1440 milliliters (ml) and the juice served at breakfast is equal to approximately 60 ml for four ounces.Review of the spreadsheet for breakfast on 01/06/26 revealed that residents were supposed to get four ounces of juice for breakfast. Review of the facility policy titled, Food First Program, dated 10/18, revealed that when managing the nutritional status of the resident, it is vital to obtain their preferences. Honoring their food and beverage preferences and incorporating them into the resident's diet is an effective intervention.This deficiency represents non-compliance investigated under Complaint Number 2628778. Event ID: Facility ID: 365134 If continuation sheet Page 22 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and facility policy review, the facility failed to ensure clean food service areas. This had the potential to affect all residents who received meals from the kitchen. The facility did not identify any residents who received nothing by mouth. The facility census was 141.Findings include:Observation of the kitchen area on 01/05/26 between 8:14 A.M. and 8:35 A.M. with Dietary Manager (DM) #378 revealed the following that was verified at the time of discovery:- There were mold and dried liquid droplets on four out of four racks in reach-in #1.- There were mold and dried liquid droplets on five out of six racks in reach-in #1.- The shelf underneath the steam table had food residue, food crumbs and pieces of parchment paper.- The back splash of the mixer had dried batter on it.- In the dish area, the final rinse of the dish machine registered 169 degrees Fahrenheit (F). Dietary Aide (DA) #447 put a rack of plate lids that were not stacked appropriately to be washed on top of a rack of plastic bowls. DM #378 stated that racks should not be put on top of each other. Review of the facility policy titled, Infection ControlDietary/Food Handling, dated 10/18/01, revealed the guidelines for the date preparation, handling and storage of perishable food and proper environmental cleaning. It also stated that the dish machine should have a final rinse of 180 degrees F and dishes should not be stacked one top of another. Event ID: Facility ID: 365134 If continuation sheet Page 23 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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 record review and interview, the facility failed to ensure Resident #135's medical record was complete and accurate to reflect secured unit placement. This affected one resident (Resident #135) of three residents reviewed for medical records related to behavioral health services.Findings include:Review of the medical record for Resident #135 revealed they were admitted to the facility on [DATE] with diagnoses that included epilepsy, bipolar disorder, suicidal ideation, impulsiveness, anxiety, and need for assistance with personal care. Review of the current physician orders revealed the absence of an order for Resident #135 to reside in a secured unit. On 12/03/24 the order for placement on a secured unit was discontinued.Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #135 was cognitively intact, exhibited delusions, exhibited verbal behaviors, and required supervision or touching assistance for activities of daily living. An interview on 01/13/26 at 10:12 A.M. with LPN #382 revealed a resident required a physician's order to reside in a secured unit. An interview on 01/12/26 at 12:08 P.M. with the Director of Nursing (DON) revealed the facility did not have a secured unit policy.An interview on 01/13/26 at 12:50 P.M. with LPN #383 revealed residents needed a physician's order to reside in a secured unit. LPN #383 verified Resident #135 did not have a current order to reside in a secured unit. Event ID: Facility ID: 365134 If continuation sheet Page 24 of 25 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 365134 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hickory Ridge Nursing & Rehabilitation Center 721 Hickory St Akron, OH 44303 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 observation, interview, and facility policy review, the facility failed to ensure staff utilized appropriate hand hygiene during medication administration. This affected four residents (#27, #68, #105, and #116) out of eight residents observed for medication administration. The facility census was 141.Findings include:Observation on 01/08/26 from 8:23 A.M. to 8:39 A.M. of medication administration with Licensed Practical Nurse (LPN) #388 revealed the following: on 8:23 A.M. LPN #388 dispensed and administered medications to Resident #19 and did not complete hand hygiene after; LPN #388 then immediately dispensed and administered medications to Resident #27 and did not complete hand hygiene after; and then LPN #388 immediately dispensed and administered medication to Resident #105.An interview on 01/08/26 at 8:43 A.M. with LPN #388 verified the above findings. Observation on 01/08/26 from 8:45 A.M. to 9:11 A.M. of medication administration with LPN #435 revealed the following: LPN #435 dispensed and administered medications to Resident #137 and did not complete hand hygiene after; LPN #435 then immediately dispensed and administered a nutritional supplement to Resident #116 and did not complete hand hygiene after; and then LPN #435 then immediately dispensed and administered medications to Resident #68.An interview on 01/08/26 at 9:18 A.M. with LPN #435 verified the above findings. A review of the facility policy titled Medication Administration-General Guidelines for Medication Administration, dated 06/21/17, revealed medications were to be administered consistent with accepted standards of practice and hands were to be cleansed as appropriate.A review of the facility policy titled Hand Hygiene, dated 11/28/17, revealed hand hygiene was to be performed to prevent the spread of infection, staff were to perform hand hygiene when indicated, and hand hygiene was to be performed before and after resident contact. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365134 If continuation sheet Page 25 of 25