Inspection·October 5, 2023

F 0600 the incident. Level of Harm - Immediate jeopardy to resident health or safety On 09/28/23 at 12:30 A.M. the DON filed a self-reported incident with the Ohio Department of Health. Residents Affected - Few On 09/28/23 at approximately 9:30 A.M. the DON initiated interviews with alert and oriented residents with Brief Interview for Mental Status (BIMS) greater than or equal to 12 to ensure they had no concerns and initiated education on abuse and behavioral residents with staff. On 09/28/23 Resident #72 returned to facility from the hospital emergency room with no new orders. On 09/28/23 Resident #72 was seen by Psychiatrist # 403 to follow for any psychological effects. A new order for sleep aid was obtained for Resident #72. On 10/03/23 from 1:00 P.M. to 4:00 P.M., RN #320, LPN/Unit Manager (UM) #301 and LPN/UM #300 completed full body assessments on 90 of 90 residents with no negative findings on the skin assessments. On 10/03/23 at approximately 1:00 P.M. LNHA #900 began education on Abuse/Neglect/Misappropriation Policy as well as the Unmanageable Resident Policy on how to manage residents with behaviors with the management team including SSD #354, Staffing Coordinator (SC) #355, Human Resources (HR)#352, Physical Therapist (PT)#371, Housekeeping Supervisor (HS) #380 and Dietary Supervisor (DS) #389. The management team then went on to educate all staff working in the facility in each department. The DON also assisted with the education beginning at 1:50 P.M. with facility staff present in the facility and by phone. Education would be completed on 102 of 102 staff members by 10/03/23 at 11:59 P.M. On 10/03/23 at approximately 1:15 P.M. LNHA #900 and Activity Director (AD) #396 initiated QIS Abuse Questionnaires to ensure 90 of 90 residents felt safe in the facility. The questionnaires to be completed by 4:00 P.M. on 10/03/23. On 10/03/2023 at approximately 1:50pm facility staffing agencies were notified by LNHA #900 of necessary education required prior to next shift. Education will be available to all agency staff to be educated prior to shift. On 10/03/23 at 4:00 P.M. HR #352 and the DON terminated LPN #315's employment by phone. On 10/03/23 a Quality Assurance Performance Improvement (QAPI) meeting (with LNHA #900, the DON, AD #396, LPN/UM #301 and #300, RN #320, HS #380, SC #355, HR #352 and SSD #354 in attendance) was held, and subsequent meetings scheduled for 10/10/23, 10/17/23, 10/24/23 and 10/31/23. On 10/04/23 at 7:00 A.M. the DON will begin education audits on the Abuse and Unmanageable Resident policy. Audits will be completed on eight staff members weekly for four weeks, then twice monthly for two months and randomly thereafter. The Ohio Board of Nursing to be contacted 10/4/2023 by end of business (5:00pm) by the DON. Beginning the week of 10/08/23, the Administrator or Designee will conduct 10 resident interviews weekly for four weeks using the QIS abuse questionnaire then monthly times three, then randomly thereafter to ensure resident safety. Residents will be randomly selected from the entire population to ensure all residents are feeling safe in their home. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 2 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 All Audits and Facility Processes will be reported to and reviewed by the QAPI team weekly times 4 weeks. Level of Harm - Immediate jeopardy to resident health or safety Although the Immediate Jeopardy was removed on 10/03/23, the deficiency remained at Severity level two (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility was in the process of implementing their corrective action plan and were monitoring to ensure on-going compliance. Residents Affected - Few Findings include: Review of medical record for Resident #72 revealed an admission date of 04/03/19 with diagnoses including unspecified dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, anxiety disorder unspecified, cervical disc disorder unspecified cervical region, major depressive disorder, suicidal ideations, anoxic brain damage, need for assistance with personal care and schizoaffective disorder bipolar type. Review of Resident #72's Minimum Data Set (MDS) 3.0 assessment, dated 09/29/23, revealed Resident #72 was assessed as severe cognitive impairment with a Brief Interview for Mental Status (BIMS) of 04 out of 15, and was assessed as having physical and verbal behavioral symptoms directed towards others. Review of the comprehensive care plan, start date 07/13/23, documented Resident #72 was at risk for verbal and physical agitation aggression related to cognitive impairment. Resident #72 was verbally and physically abusive toward staff and will yell and scream when she does not get her way. Further review documented a goal Resident #72 will not harm self or others, will not verbally abuse others , will not strike others. Interventions included administration of medication per physician orders, allow patient time to respond to directions or requests, gain patient's attention before speaking or touching, give patient clear and concise explanation of anything about to occur, if behavioral intervention strategies are not working then leave if safe to do so and reapproach later, and psych consult as needed. Review of a nursing note dated 09/27/23 written by Licensed Practical Nurse ( LPN) #315 revealed Resident #72 was given night medication. Resident #72 became verbally abusive toward this nurse. Nurse #315 attempted to redirect unsuccessfully. Resident #72 continued verbal assaults, threatened to physically harm this nurse then actually punched this nurse. LPN #315 documented she tried to restrain Resident #72 who continued to punch her and knocked her glasses off. LPN #315 documented Resident #72 was held where she could no longer do harm to this nurse. STNA came to assist and spent 20 minutes with the resident. Review of the facility SRI investigation, dated 09/27/23, revealed Resident #72 had a verbal exchange with LPN #315. Resident #72 began to yell at LPN #315 then Resident #72 hit LPN #315 knocking her glasses off. STNA #330 witnessed LPN #315 grab Resident #72 by the neck/throat and shoved the resident up against the wall and choked the resident until STNA #330 intervened and separated them. STNA #330 took Resident #72 to her room. STNA #330 then located the supervisor to report the incident. Education was given to staff about Abuse policy and Handling Difficult Residents. Review of STNA #330's witness statement, dated 09/27/23 revealed Resident #72 swung at Nurse #315 and nurse #315 pushed Resident #72 into a door and grabbed the resident by her neck and was choking the resident to the point Resident #72 stated she could not breath. STNA #330 brought Resident #72 to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 3 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 her room to calm the resident down. Resident #72 neck was bright red and resident was crying. Level of Harm - Immediate jeopardy to resident health or safety Review of STNA #341 witness statement, dated ( not date on the statement) revealed Resident #72 punched LPN #315. LPN #315 restrained Resident #72 until STNA #330 broke them up. Residents Affected - Few Review of Resident #92's witness statement, dated 09/27/23 revealed LPN #315 pushed Resident #72 head against a metal door then pushed Resident #72 into a corner and choked the resident. Resident #72 mumbled she could not breath and her face was red. Resident #92 stated she was afraid Resident #72 was going to die. Review of Resident #68 witness statement dated 09/27/23 revealed Resident #72 hit LPN #315 and LPN #315 held her forearm against Resident #72 to stop the resident. Review of LPN #315 witness statement, ( no date on report) revealed Resident #72 hit her and she restrained the resident until the STNA came. Review of the local police department report for Incident #23B016570, dated 09/28/23, revealed officers were sent to Park Center for an assault/patient abuse report following an altercation in the hallway between patient and nurse that occurred on 09/27/23 at about 9:00 P.M. Resident #92 was the reportee and witnessed the altercation. Resident #92 stated Resident #72 swung at Nurse #315 first because she did not want to take her medication and stated Resident #72 was choked. Resident #92 states she observed LPN #315 aggressively push Resident #72's head up against the metal door frame very hard, then LPN #315 grabbed Resident #72 by her throat and pushed her up against the wall with her hands choking the resident. Resident #92 stated she heard Resident #72 say I can't breathe and her face turned red. Resident #92 returned to her room because she was upset and called the police. Another State tested nurse aid ( STNA) #330 stated she saw Resident #72 swing at LPN #315 then observed LPN #315 push Resident #72 into the door frame and grabbed her by the neck and had resident up against the door. STNA #330 stated he separated the resident and nurse. STNA #330 stated he witnessed LPN #315 intentionally slam Resident #72's head against the door and choke her to the point her face was red and heard Resident #72 gasping for air and said she could not breath. LPN #315 stated she restrained Resident #72 against the wall by using her forearm. Another resident ( Resident #68) stated he was in the hallway and witnessed LPN #315 restrain Resident #72 up against the wall using her forearm to resident's chest to keep her there until another employee arrived. STNA #341 stated she observed Resident #72 hit LPN #315. LPN #315 then restrained Resident #72 up against the wall until STNA #330 arrived and broke them up. Police Report further stated Resident #72 had several fresh red marks and slight swelling around her neck area and Resident #72 complained of difficulty swallowing. Resident #72 was transported to the hospital. Review of the hospital emergency room (ER) documentation dated 09/27/23 at 11:32 P.M. revealed Resident #72 was sent to the ER after strangulation type injury. admission physical exam revealed vague erythema (superficial reddening of the skin, usually as a result of injury or irritation causing dilatation of the blood capillaries) noted to the anterior bilateral neck. There was some concern for arterial injury, esophageal injury, and soft tissue injury therefore a Computed Axial Tomography ( CAT ) scan was ordered. Radiology preliminary results of the CAT scan showed no evidence of soft tissue injury or soft tissue hematoma in neck and was released to be discharged back to the Park Center on 09/28/23 at 5:38 A.M. with a diagnosis of reported assault and anterior neck pain in stable condition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 4 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of LPN #315's employee file revealed a date of hire of 01/25/23. There was a verbal warning dated 02/28/23 for not completing learning assignments by assigned dates which consisted of Ethics in Health care Part 3: Boundaries and Boundary violation, Abuse and Neglect in Healthcare. Interview on 09/29/23 at 8:33 A.M. with the Director of Nursing (DON) revealed there was conflicting evidence of what happened the night of 09/27/23 so the police did not arrest LPN #315 the night of the incident. The DON suspended LPN #315 pending results of the incident investigation and local police department detective investigation. Staff education had been started and Resident #72 was seen by a psychiatrist and was willing to attend counseling services. Interview on 09/29/23 at 9:42 A.M. with Resident #92 by phone revealed she witnessed Resident #72 hit LPN #315 and stated LPN #315 took the resident by her throat and hit her head against the wall and proceeded to choke Resident #72 . STNA #330 was in the hallway. She stated the police came around 9:30 P.M. Interview on 09/29/23 at 10:19 A.M. with STNA #341 on 09/29/23 verified Resident #72 was restrained up against the wall and STNA #330 broke up the fight. Interview on 09/29/23 at 11:24 A.M. with LNHA #901 via telephone revealed the abuse allegation was still under investigation. LNHA #901 stated LPN #315 was with the facility for a while. The facility has reeducated staff on the abuse policy and dealing with difficult residents. He stated the Human Resources department ran an entire audit on all staff in the abuse registry. A quality assurance performance plan was started on abuse with a root cause analysis. Interview on 09/29/23 at 11:20 A.M. with Resident #68 revealed he witnessed LPN #315 had one arm against Resident #72 trying to stop Resident #72 from hitting her. Resident #68 verified Resident #72 hit her head on the wall. Interview on 09/29/23 at 2:30 P.M. with Specified Resident ( SR) #72 revealed she was choked by LPN #315 . Resident #72 stated she choked me hard and verified by name LPN #315 put her hands around her neck. Resident #72 stated LPN #315 wanted to give her medication and she did not want it. Resident #72 stated she punched LPN #315 because she made her mad. After she punched LPN #315 the nurse choked her. She stated she was still a little scared and needed a sleeping pill to sleep at night. Interview on 09/29/23 at 10:04 P.M. by phone , revealed STNA #330 verified he was sitting in the lounge on the night of 09/27/23 and heard yelling escalating in the hallway of 3B. When STNA #330 went to the hallway he observed Resident #72 swing her right arm and hit LPN #315 causing her glasses to fall off her face. LPN #315 grabbed Resident #72 by the neck and choked the resident. STNA #330 broke up the fight and took Resident #72 to her room for safety. STNA #330 stated Resident #72 neck was very red, and her face was red. STNA #330 felt he had to save Resident #72. Interview on 10/02/23 at 9:30 A.M. with Nurse Practitioner (NP) #402 revealed she did evaluate Resident #72 the next day and the resident did have some bruising to her neck and neck pain. NP #402 stated Resident #72 stated she swung at LPN #315 because the nurse was not listening to her. Interview was conducted on 10/03/23 at approximately 9:20 A.M. with the DON who described Resident #72 as having good mentation and able to give a reliable recollection regarding what LPN #315 did to her the evening on 09/27/23. The DON stated she believed physical abuse occurred towards Resident #72 from LPN #315. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 5 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Interview on 10/02/23 at 10:00 AM. with Psychiatrist #403 verified Resident #72 was fearful the incident would happen again and did not sleep well at night. Psychiatrist #403 stated the resident clearly stated a nurse hit her and tried to strangle her and had clear memories for the incident. Interview on 10/02/23 at 12:34 P.M. with LPN #315 verified she was passing night medication when Resident #72 started screaming at her. LPN #315 stated she told Resident #72 to go back in her room. LPN #315 continued to pass medication when Resident #72 punched her in the face and knocked her glasses off. LPN #315 stated she moved Resident #72 to the wall and held the resident's arm with one hand and her forearm across the chest with her other hand. Finally, somebody came and assisted LPN #315 and placed Resident #72 back in her room. LPN #315 stated she knows Resident #72 could have behavior problems but did not know any care plan intervention for Resident #72's aggression. LPN #315 stated she did not assault Resident #72 , but she was the one assaulted and moved Resident #72's body to the wall. Review of the facility policy titled Abuse, Neglect, and Exploitation of Residents dated 2003, documented the definition of physical abuse as the inappropriate physical contact with a resident which harms or is likely to harm the resident. It is the policy of the facility that acts of physical, verbal, mental and financial abuse directed against a resident are absolutely prohibited. Based on medical record review, review of a facility self-reported incident (SRI) and investigation, review of a police report, review of the facility Abuse policy and resident and staff interviews, the facility failed to ensure Resident #72 was free from physical and emotional/psychosocial abuse. This resulted in Immediate Jeopardy and actual physical harm with serious psychosocial harm on 09/27/23 at approximately 9:30 P.M. when Licensed Practical Nurse (LPN) #315 abused Resident #72 by pushing the resident's head into a wall and physically restraining the resident with her hands around Resident #72's throat/neck. Resident #72 was observed by witnesses gasping for air and attempting to verbalize she could not breath. The resident was assessed to have erythema (redness) and bruising to her neck, voiced fear for her safety in the facility and suffered subsequent sleep disturbance requiring the prescription of a hypnotic sleep medication and psychological counseling because of the incident. This affected one resident (#72) of eight residents reviewed for abuse. The facility census was 90. On 10/03/23 at 12:20 P.M. Licensed Nursing Home Administrator (LNHA) #900 and the Director of Nursing (DON) were notified Immediate Jeopardy began on 09/27/23 at approximately 9:30 P.M. when State Tested Nursing Assistant (STNA) #330 and Resident #92 witnessed LPN #315 using aggressive force against Resident # 72. LPN #315 was observed grabbing Resident #72 around the throat, pushed the resident's head into the wall and began choking her with her hands. Resident #72 struggled to say she could not breath and her face was turning red. STNA #330 broke up the altercation, the police were called, and Resident #72 was taken to the hospital where she was found to have erythema (redness) present on her neck and complained of pain. The Immediate Jeopardy was removed on 10/03/23 when the facility implemented the following corrective actions: • On 09/27/23 at approximately 9:00 P.M. STNA #330, immediately separated Resident #72 and LPN #315 to ensure resident safety. STNA #330 remained with Resident #72 until law enforcement arrived. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 6 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 • Level of Harm - Immediate jeopardy to resident health or safety On 09/27/23 Resident #72 was sent to the emergency room for evaluation/assessment following the report given to law enforcement. • Residents Affected - Few On 09/27/23 LPN #315 was immediately placed on suspension pending investigation and removed from facility after police took her statement on 9/27/2023. • On 09/27/23 at approximately 10:00 P.M. Resident #72's guardian and the medical director were notified by LPN #306 of the incident and Resident #72's transfer to the emergency room. • On 09/27/23 at approximately 10:00 P.M. the DON started a full investigation of the incident. • On 09/28/23 at 12:30 A.M. the DON filed a self-reported incident with the Ohio Department of Health. • On 09/28/23 at approximately 9:30 A.M. the DON initiated interviews with alert and oriented residents with Brief Interview for Mental Status (BIMS) greater than or equal to 12 to ensure they had no concerns and initiated education on abuse and behavioral residents with staff. • On 09/28/23 Resident #72 returned to facility from the hospital emergency room. • On 09/28/23 Resident #72 was seen by Psychiatrist #403 to follow for any psychological effects. A new order for sleep aid was obtained for Resident #72. • On 10/03/23 from 1:00 P.M. to 4:00 P.M., RN #320, LPN/Unit Manager (UM) #301 and LPN/UM #300 completed full body assessments on 90 of 90 residents with no negative findings on the skin assessments. • On 10/03/23 at approximately 1:00 P.M. LNHA #900 began education on the facility Abuse/Neglect/Misappropriation Policy as well as the Unmanageable Resident Policy on how to manage residents with behaviors with the management team including Social Service Director (SSD) #354, Staffing Coordinator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 7 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 Level of Harm - Immediate jeopardy to resident health or safety (SC) #355, Human Resources (HR)#352, Physical Therapist (PT)#371, Housekeeping Supervisor (HS) #380 and Dietary Supervisor (DS) #389. The management team then proceeded to educate all staff working in the facility in each department. The DON also assisted with the education beginning at 1:50 P.M. with facility staff present in the facility and by phone. A plan for education to be completed for all 102 of 102 staff members by 10/03/23 at 11:59 P.M. was implemented. Residents Affected - Few • On 10/03/23 at approximately 1:15 P.M. LNHA #900 and Activity Director (AD) #396 initiated Quality Indicator Survey (QIS) Abuse Questionnaires to ensure 90 of 90 residents felt safe in the facility. The questionnaires were completed by 4:00 P.M. on 10/03/23. • On 10/03/2023 at approximately 1:50 P.M. facility staffing agencies were notified by LNHA #900 of necessary education required prior to next shift. Education would be available to all agency staff to be educated prior to shift. • On 10/03/23 at 4:00 P.M. HR #352 and the DON terminated LPN #315's employment by phone. • On 10/03/23 a Quality Assurance Performance Improvement (QAPI) meeting (with LNHA #900, the DON, AD #396, LPN/UM #301 and #300, RN #320, HS #380, SC #355, HR #352 and SSD #354 in attendance) was held to discuss the issue with subsequent meetings scheduled for 10/10/23, 10/17/23, 10/24/23 and 10/31/23. • On 10/04/23 at 7:00 A.M. the DON began education audits on the Abuse and Unmanageable Resident policy. Audits would be completed on eight staff members weekly for four weeks, then twice monthly for two months and randomly thereafter. • The facility indicated the Ohio Board of Nursing would be notified of the incident involving LPN #315 on 10/4/2023 by end of business (5:00 P.M.) by the DON. • Beginning the week of 10/08/23, the Administrator or Designee would conduct 10 resident interviews weekly for four weeks using the QIS abuse questionnaire then monthly times three, then randomly thereafter to ensure resident safety. Residents would be randomly selected from the entire population to ensure all residents felt safe in their home. • (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 8 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few The facility implemented a plan for all audits and facility processes to be reported to and reviewed by the QAPI team weekly for four weeks. Although the Immediate Jeopardy was removed on 10/03/23, the deficiency remained at Severity level two (no actual harm with potential for more than minimal harm that is not Immediate Jeopardy) as the facility was in the process of implementing their corrective action plan and were monitoring to ensure on-going compliance. Findings include: Review of medical record for Resident #72 revealed an admission date of 04/03/19 with diagnoses including unspecified dementia unspecified severity without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, anxiety disorder unspecified, cervical disc disorder unspecified cervical region, major depressive disorder, suicidal ideations, anoxic brain damage, need for assistance with personal care and schizoaffective disorder bipolar type. Review of the comprehensive care plan, with a start date of 07/13/23 revealed Resident #72 was at risk for verbal and physical agitation/aggression related to cognitive impairment. Resident #72 was verbally and physically abusive toward staff and would yell and scream when she does not get her way. Further review documented a goal for Resident #72 to not harm self or others, not verbally abuse others and not strike others. Interventions included administration of medication per physician orders, allow patient time to respond to directions or requests, gain patient's attention before speaking or touching, give patient clear and concise explanation of anything about to occur, if behavioral intervention strategies are not working then leave if safe to do so and reapproach later, and psych consult as needed. Review of a nursing note dated 09/27/23 written by Licensed Practical Nurse (LPN) #315 revealed Resident #72 was given night medication. Resident #72 became verbally abusive toward this nurse. Nurse #315 attempted to redirect unsuccessfully. Resident #72 continued verbal assaults, threatened to physically harm this nurse then actually punched this nurse. LPN #315 documented she tried to restrain Resident #72 who continued to punch her and knocked her glasses off. LPN #315 documented Resident #72 was held where she could no longer do harm to this nurse. STNA came to assist and spent 20 minutes with the resident. Review of a facility SRI investigation, dated 09/27/23, revealed Resident #72 had a verbal exchange with LPN #315. Resident #72 began to yell at LPN #315 then Resident #72 hit LPN #315 knocking her glasses off. STNA #330 witnessed LPN #315 grab Resident #72 by the neck/throat and shoved the resident up against the wall and choked the resident until STNA #330 intervened and separated them. STNA #330 took Resident #72 to her room. STNA #330 then located the supervisor to report the incident. Resident #72 complained of neck/throat pain and difficulty swallowing. Resident #72 was very upset and difficult to calm down. Resident #72 had redness with some swelling around her neck with no other apparent injuries. The local police department was notified of the incident at 10:00 P.M. Review of STNA #330's witness statement, dated 09/27/23, revealed Resident #72 swung at LPN #315 and LPN #315 pushed Resident #72 into a door and grabbed the resident by her neck and was choking the resident to the point Resident #72 stated she could not breath. STNA #330 brought Resident #72 to her room to calm the resident down. Resident #72's neck was bright red, and the resident was crying. Review of STNA #341 undated witness statement revealed Resident #72 punched LPN #315. LPN #315 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 9 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365185 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Center Healthcare and Rehabilitation 5665 South Ave Youngstown, OH 44512 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 0600 restrained Resident #72 until STNA #330 broke them up. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #92's witness statement, dated 09/27/23, revealed LPN #315 pushed Resident #72's head against a metal door then pushed Resident #72 into a corner and choked the resident. Resident #72 mumbled she could not breathe, and her face was red. Resident #92 stated she was afraid Resident #72 was going to die. Residents Affected - Few Review of Resident #68's witness statement, dated 09/27/23, revealed Resident #72 hit LPN #315 and LPN #315 held her forearm against Resident #72 to stop the resident from hitting her. Review of LPN #315 undated witness statement, revealed Resident #72 hit her and she restrained the resident until the STNA came to assist. Review of the local police department report for Incident #23B016570, dated 09/28/23, revealed officers were sent to Park Center for an assault/patient abuse report following an altercation in the hallway between patient and nurse that occurred on 09/27/23 at about 9:00 P.M. Resident #92 was the reportee and witnessed the altercation. Resident #92 stated Resident #72 swung at LPN #315 first because she did not want to take her medication and stated Resident #72 was choked. Resident #92 stated she observed LPN #315 aggressively push Resident #72's head up against the metal door frame very hard, then LPN #315 grabbed Resident #72 by her throat and pushed her up against the wall with her hands choking the resident. Resident #92 stated she heard Resident #72 say I can't breathe and her face turned red. Resident #92 returned to her room because she was upset and called the police. STNA #330 stated he saw Resident #72 swing at LPN #315 then observed LPN #315 push Resident #72 into the door frame and grabbed her by the neck and had resident up against the door. STNA #330 stated he separated the resident and nurse. STNA #330 stated he witnessed LPN #315 intentionally slam Resident #72's head against the door and choke her to the point her face was red and heard Resident #72 gasping for air and said she could not breath. LPN #315 stated she restrained Resident #72 against the wall by using her forearm. Another resident ( Resident #68) stated he was in the hallway and witnessed LPN #315 restrain Resident #72 up against the wall using her forearm to resident's chest to keep her there until another employee arrived. STNA #341 stated she observed Resident #72 hit LPN #315. LPN #315 then restrained Resident[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 10 of 10