Health inspection·December 2, 2022

F 0657 conference and the care conference should have occurred in September 2022. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 2 of 8 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 365287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the medical record revealed Resident #32 was admitted to the facility on [DATE]. Diagnoses included cerebral infarction, dysphagia, epilepsy, anemia, insomnia, adjustment order with anxiety, atherosclerotic heart disease, hypothyroidism, neurological neglect syndrome, mild cognitive impairment, chronic pain syndrome, encephalopathy, intracerebral hemorrhage, osteoarthritis, benign prostatic hyperplasia, neurofibromatosis, tachycardia, mild proteins calorie malnutrition, systemic inflammatory response, and hypertension. Residents Affected - Few Review of the plan of care dated 04/22/22 revealed Resident #32 had impaired ability to perform or participate in ADL care related to cerebral vascular accident, dementia, epilepsy, anemia, weakness and age-related changes. Interventions included to provide nail care and shampoo hair with showers per weekly schedules. Review of the quarterly MDS 3.0 assessment dated [DATE] revealed Resident #32 had severely impaired cognition and did not reject care. He required extensive assistance of one staff member for dressing, eating, toilet use, personal hygiene and was totally dependent of one staff member for bathing. Review of the progress notes from 09/01/22 to 11/29/22 revealed no documented evidence Resident #32 refused nail care. Observations on 11/28/22 at 9:00 A.M., on 11/29/22 at 8:40 A.M. and on 11/30/22 at 7:40 A.M., 9:40 A.M., 1:40 P.M., and 2:40 P.M. revealed Resident #32 had long dirty, jagged fingernails on both hands. On 11/30/22 at 2:15 P.M. interview with STNA #28 indicated she had never trimmed or provided nail care to Resident #32. On 11/30/22 at 2:40 P.M. interview with Licensed Practical Nurse (LPN) #6 verified Resident #32 had long dirty, jagged fingernails to both hands. On 1/30/22 at 4:15 P.M. interview with STNA #17 stated she had never attempted to trim or clean Resident #32' fingernails. Interview on 12/01/22 at 10:25 A.M. the Director of Nursing verified there was no documented evidence Resident #32 refused nail care. Based on observation, interview, and record review the facility failed to provide nail care for two dependent residents (Resident #32 and #158) and failed to provide shaving for one resident (Resident #158). This affected two (Residents #32 and #158) of five residents reviewed for activities of daily living (ADL) care. The facility census was 52. Findings include: 1. Record review for Resident #158 revealed an admission date of 06/07/22. Diagnosis included burns involving 40 - 49 percent (%) of body surface with zero to nine % third degree burns, muscle weakness, and schizoaffective disorder. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 3 of 8 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 365287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #158's long and short-term memory were intact. Resident #158 required extensive assistance of two staff for bed mobility, transfers and extensive assistance of one staff for personal hygiene. Resident #158 was always incontinent of bowel and bladder. Record review of the care plan dated 08/29/22 revealed Resident #158 had impaired ability to perform or participate in ADL. Interventions included to provide assistance with all ADL care and mobility as needed, anticipate resident needs as able. Provide nail care with showers per weekly schedule, assist with and/or shave facial hair daily as needed or per resident preference. Observation and interview on 11/28/22 at 9:41 A.M. revealed Resident #158 had a partially grown unkept beard and mustache. Resident #158 revealed staff were not washing him daily. Resident #158 revealed he wanted shaved, but staff don't shave him. Observation revealed Resident #158's fingernails were fully impacted with a thick dark brown/black substance. Resident #158 confirmed staff do not clean his nails. Resident #158 requested to be shaved and have his nails cleaned. Observation and interview on 11/30/22 at 2:17 P.M. with Registered Nurse (RN) #21 and State Tested Nursing Assistant (STNA) #19 confirmed Resident #158 had a partially grown unkept beard and mustache and severely impacted fingernails. RN #21 and STNA #19 both confirmed they were the primary caregivers for Resident #158. RN #21 and STNA #19 both confirmed neither of them offered to shave Resident #158 or clean his nails. Resident #158 confirmed to RN #21 and STNA #19 that he would like shaved and have his nails cleaned. Interview on 11/30/22 at 3:30 P.M. with RN #21 revealed she was able to shave Resident #158 and partially clean his nails but due to the embedded impaction in the nails and fungus she was unable to get all the debris from all the nails, but she updated the physician for treatment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 4 of 8 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 365287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 provide wound care for two residents (Resident #158 and #5) of two residents reviewed for non-pressure wounds. The facility census was 52. Residents Affected - Few Findings include: 1. Record review for Resident #158 revealed an admission date of 06/07/22. Diagnosis included burns involving 40 - 49 percent (%) of body surface with zero to nine % third degree burns, muscle weakness, and schizoaffective disorder. Record review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #158's long and short-term memory were intact. Resident #158 required extensive assistance of two staff for bed mobility, transfers, and extensive assistance of one staff for personal hygiene. Resident #158 was always incontinent of bowel and bladder. Resident #158 had second and third degree burns with application of ointments and non-surgical dressings. Record review of the care plan dated 06/29/22 revealed Resident #158 was at risk for skin breakdown related to impaired mobility, and old burns all over his body. Interventions included to observe and report any signs and symptoms of skin irritation such as tingling or burning feeling, discoloration, edema, excoriation, and erythema. Report to physician as needed. Observation and interview on 11/28/22 at 9:46 A.M. revealed Resident #158 was lying in bed in a hospital gown. Resident #158 was not covered. Observation revealed multiple scabbed and opened areas to Resident #158's bilateral lower legs. The tissue surrounding portions of the scabbed and opened areas were red and inflamed. No dressings were covering any of Resident #158's open wounds. Resident #158 revealed he had been burned and did not like covers on him. Observation on 11/30/22 at 2:15 P.M. revealed Resident #158 was lying in bed in a hospital gown. Resident #158 was not covered. Observation revealed the multiple scabbed and opened areas to Resident #158's bilateral lower legs were unchanged. The tissue surrounding the scabbed and opened areas remained red with portions inflamed. Resident #158 revealed there were no treatments applied to the wounds. Observation and interview on 11/30/22 at 2:17 P.M. with Registered Nurse (RN) #21 confirmed she was Resident #158's primary charge nurse. RN #21 confirmed Resident #158 had no treatment orders to any wounds on the bilateral lower extremities. Observation revealed RN #21 assessed Resident #158's wounds to his bilateral lower extremities then revealed the wounds looked bad and should have had treatments to the areas. Interview on 11/30/22 at 3:20 P.M. with Assistant Director of Nursing/Wound Care Nurse #42 revealed if wounds were to reopen, she would expect the physician, family, and herself to be notified immediately and treatment to be initiated. Assistant Director of Nursing/Wound Care Nurse #42 revealed Resident #158 had never refused treatments for her. Record review of the wound grid documentation dated 12/01/22 at 9:20 A.M. completed by Assistant Director of Nursing/Wound Care Nurse #42 revealed Resident #158 had six untreated wounds which included the left lower shin that measured 6.0 centimeters (cm) by 3.0 cm by 0.1 cm in depth. The left (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 5 of 8 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 365287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few upper shin measured 7.0 cm by 4.0 cm by 0.1 cm in depth. The left thigh measured 1.0 cm by 0.5 cm by 0.2 cm in depth. The left ankle measured 5.0 cm by 1.5 cm by 0.1 cm in depth. The right lower extremity measured 5.0 cm by 3.0 cm by 0.2 cm in depth and the right thigh measured 1.0 cm by 0.5 cm by less than 0.1 cm in depth. Interview on 12/01/22 at 12:01 P.M. with Assistant Director of Nursing/Wound Care Nurse #42 confirmed the wound measurements to Resident #158's wounds to the lower extremities and confirmed Resident #158 required treatments to the wounds. 2. Record review for Resident #5 revealed an admission date of 10/24/19. Diagnosis included cholelithiasis (gallstones) with obstruction and muscle weakness. Record review of the annual MDS 3.0 assessment dated [DATE] revealed a Brief Interview of Mental Status (BIMS) score of 15 out of 15 (cognitively intact). Resident #5 required extensive assistance of one staff for transfers, ambulation, dressing, and grooming. Record review of the progress note dated 09/26/22 at 10:47 A.M. completed by Licensed Practical Nurse (LPN) #21 revealed Resident #5 was sent to the hospital. Resident #5's speech was mumbled, and Resident #5 was lethargic. Record review of the progress note dated 09/26/22 at 6:48 P.M. revealed Resident #5 was admitted to the hospital and diagnosed with septic shock. Record review of the progress note dated 10/01/22 at 7:00 P.M. revealed Resident #5 returned from the hospital diagnosed biliary drain post gallstone surgery/removal. Record review of the physician orders for November/December 2022 revealed orders to empty the chole drain once a shift, flush the chole (biliary) drain with five to 10 milliliters (ml) of normal saline every day, and cleanse the drain site daily with soap and water and apply a drain sponge. Record review revealed there was no care plan initiated for Resident #5's chole drain or site. Interview on 11/28/22 at 10:01 A.M. with Resident #5 revealed she had been septic; she was transported to the hospital and was diagnosed with gallstones. Resident #5 revealed she now had a drain in her abdomen. Resident #5 revealed over the weekend a nurse changed the bandage covering the drain and accidentally pulled on the tubing. Resident #5 revealed there were now three sutures visible. Resident #5 revealed she reported it to her nurse this morning and her nurse assessed the area. Resident #5 denied pain to the area. Interview on 12/01/22 at 1:10 P.M. with Resident #5 confirmed nurses on each shift were assessing and completing the treatments to her chole site daily. Resident #5 revealed the sutures at her chole site were out further and she was concerned. Observation and interview on 12/01/22 at 1:19 P.M. with Assistant Director of Nursing (ADON)/ Wound Care Nurse #42 assessed Resident #5's chole site after requested by surveyor. ADON/Wound Care Nurse #42 revealed she was unsure about the sutures. Observation with ADON/Wound Care Nurse #42 revealed three sutures connected to the chole tubing located several centimeters above the insertion site. ADON/Wound Care Nurse #42 revealed the Certified Nurse Practitioner (CNP) was in the facility and ADON/Wound Care Nurse #42 left to retrieve CNP #53. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 6 of 8 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 365287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 12/01/22 at 1:40 P.M. revealed CNP #53 was sitting next to Resident #5. CNP #53 revealed this was the first she heard about the concerns with the chole tubing. CNP #53 revealed she had encouraged Resident #5 to go to the hospital immediately. Resident #5 refused to go to the hospital. CNP #53 revealed she was going to call the surgeon due to possible complications. CNP #53 revealed possible complications included infection and/or perforation of the gall bladder. CNP #53 revealed she expected to know the concern when it happened. Record review of the treatment records for Resident #5 for November 2022 revealed treatments were completed to the chole drain per the physician orders. Record review of the progress notes for Resident #5 from 11/26/22 through 11/30/22 revealed no concerns were documented regarding Resident #5's chole drain. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 7 of 8 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 365287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Altercare of Cuyahoga Falls Ctr for Rehab & Nursin 2728 Bailey Rd Cuyahoga Falls, OH 44221 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the medical record, and staff interview the facility failed to ensure Residents #27 and #44 had their physician's ordered adaptive devices for eating. This affected two residents (Residents #27 and #44) of 11 residents reviewed for nutrition. The facility census was 52. Residents Affected - Few Findings include: 1. Review of the medical record revealed Resident #27 was admitted to the facility on [DATE]. Diagnoses included congestive heart failure, chronic obstructive pulmonary disease, anemia, sciatica, diabetes, acute respiratory failure, diverticulosis, hypotension, chronic kidney disease, vascular dementia, and dysphagia. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #27 had intact cognition and required supervision of eating. Review of the nutritional assessment dated [DATE] revealed Resident #27 was to have a right curved handle spork, a divided dish, and individual (bowl) dishes. Review of the November 2022 physicians' orders revealed Resident #27 had an order for a mechanical soft regular diet with a right curved handle spork, divided dish, and individual bowls. Observation on 11/30/22 at 9:26 A.M. revealed Resident #27 received her food on a regular plate. It was verified at this time by State Tested Nursing Assistant (STNA) #18 that Resident #27 was to have a divided plate. 2. Review of the medical record revealed Resident #44 was admitted to the facility on [DATE]. Diagnoses included metabolic encephalopathy, Alzheimer's disease, moderate protein-calorie malnutrition, gastrostomy, psychosis, hypertension, dementia, cerebrovascular disease, acute kidney disease, chronic respiratory failure, osteoarthritis, lymphoedema, and transient cerebral attack. Review of the November 2022 physician's orders revealed Resident #44 had an order for divided plate for all meals. Review of the Significant Change MDS 3.0 assessment dated [DATE] revealed Resident #44 had severely impaired cognition and required extensive assistance of one staff for eating. Review of the nutritional assessment dated [DATE] revealed Resident #44 was on a regular pureed diet with a divided plate to support self-feeding. Observation on 11/30/22 at 9:28 A.M. revealed Resident #44 received her food on a regular plate. It was verified at this time by STNA #18 that Resident #44 was to have a divided plate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365287 If continuation sheet Page 8 of 8