Health inspection·June 10, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of facility policy, the facility failed to provide a safe, functional, sanitary and comfortable environment for all residents. This had the potential to affect all 89 residents residing in the facility. Findings include: Record review of the resident concern log dated May 2025 revealed on 05/02/25 Resident #4 had a concern about floors being sticky. On 05/15/25 there was a concern noted regarding room cleanliness by Resident #15. On 05/22/25 a concern was noted for cleanliness of the room by two residents (#90 and #91). On 05/26/25 another concern for room cleanliness was logged by Resident #90. Record review of the Resident Council meeting minutes dated 04/17/25 revealed a concern for housekeeping on the weekends. Record review of the Resident Council meeting minutes dated 05/27/25 revealed residents requesting rooms be cleaned more thoroughly. Observations were conducted on 06/04/25 between 10:45 A.M. and 12:40 P.M. with admission Director (AD) #267 of the general facility environment, resident rooms and resident common areas throughout the facility. AD #267 verified the following concerns at the time of the observations: • room [ROOM NUMBER] was noted to have a toilet with a broken handle, there was a large stain on the carpet and the curtains did not function properly due to being incorrectly hung. • Resident #79's room had curtains on the window that were not hung correctly so the curtain did not properly function. • Resident #82's room had a heavily stained carpet. • (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 365275 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 365275 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Vista Nursing and Rehab 1216 5th Ave Youngstown, OH 44504 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)