Inspection·September 11, 2024

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview and policy review, the facility failed to provide a clean and homelike environment. This affected five residents (#42, #52, #62, #65) and had the potential to affect 16 residents living on Hall 2A (#79, #80, #81, #82, #83, #84, #85, #86, #87, #88, #89, #90, #91, #92, #93 and #94)) and 25 residents living on Hall 3B (#52, #54, #55, #56, #57, #58, #59, #60, #61, #62, #63, #64, #65, #66, #67, #68, #69, #70, #71, #72, #73, #75, #76, #77 and #78). The facility census was 92. Findings include: On 09/09/24 at 10:25 A.M. a tour of the building revealed the shower room in Hall 2A had an overflowing sharps container with used razors. Razors were also noted sitting on top of the sharps container. The findings were verified at the time of the observation by Registered Nurse (RN) #201. At 10:50 A.M. on observation of Resident #42's room revealed built up dirt in corners of the bathroom. Resident #42 was laying in bed and appeared sleeping. On the right side of the bed on the floor was dried spit. On the wall was dried spit. On top of register there was dried spit. The aforementioned findings were verified by State Tested Nurse Aide (STNA) #136 and STNA #126 at the time of the observation. On 09/09/24 at 10:50 A.M. an observation of hall 3B revealed a built-up black substance along the baseboards. Resident #72's room had a loaf of bread and pickles on the floor. There was also clothing on hangers on the floor. Built up dirt was noted at the door thresh hold. The room of Residents #52, #62 and #65 had dried spilled coffee on the floor by a fall mat. Upon lifting the fall mat and there was a puddle of wet coffee underneath. A garbage can had garbage in it and no bag. There was resident clothing on the floor against the left-hand wall when facing the windows from the doorway. The aforementioned findings were verified by Licensed Practical Nurse (LPN) #161 at the time of the observation. LPN #161 stated floors were not done on the weekends. On 09/09/24 at 11:45 A.M. an interview with Director of Environmental Services #159 revealed resident rooms were to be cleaned daily. A review of the document titled, Park Center Daily Housekeeping Room Checklist that was undated revealed resident rooms were to have floors swept and mopped daily. A review of the document titled, Room Cleaning Policy that was undated revealed the policy was established to ensure resident rooms within the Skilled Nursing Facility were maintained in a clean, sanitary, and safe condition to promote the health and wellbeing of residents. Under the subtitle Frequency of Cleaning it indicated resident rooms would be cleaned on a regular basis according to a predetermined schedule and high touch surfaces would be cleaned and disinfected daily. Under the subtitle Cleaning Procedures it indicated the facility would follow established cleaning procedures and protocols to ensure thorough and effective cleaning of resident rooms. A review of the policy titled, Quality of Life-Homelike Environment dated August 2009 revealed residents were provided with a safe, clean, comfortable, and homelike environment. The policy also indicated the facility staff and management should maximize, to the extent possible, the characteristics of the facility that reflected a personalized, homelike setting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 2 of 3 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 09/11/2024 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 0921 This deficiency represents non-compliance investigated under Complaint Number OH00156539. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365185 If continuation sheet Page 3 of 3