Health inspection·September 18, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few BIMS assessment result is or if they consent. (as included in updated facility abuse policy deeming this act abuse).When a police report was made, staff would follow up with the police to determine if any charges would be pursued. Thorough Investigations: A thorough investigation must be completed for all investigations. A thorough investigation should include interviewing the resident, the accused, and all witnesses. Witnesses generally include anyone who: witnessed or heard the incident; came in close contact with the resident on the day of the incident (including other residents, family members); and employees who worked closely with the accused employee(s) and/or alleged victim the day of the incident. On 09/16/25 at 5:15 P.M. the [NAME] President of Clinical Services updated the facility Abuse Policy to include staff to resident relations. Specifically in the policy training section the facility added:Training would also include education on staff to resident relationships: At no time could staff develop, participate and/or engage in an emotional or physical intimate relationship with a resident. This would include, but not limited to, communication (text, phone calls, social media) and/or in person as this was abuse. On 09/16/25 at 5:20 P.M. the facility re-opened the SRI related to Resident #50. The police were updated that Resident #50 wanted to re-speak with them again. On 09/16/25 at 5:30 P.M. the RDO #201 and Regional Director of Clinical Services educated the Administrator and DON on the following:BIMs assessment and scoring.Staff to Resident Relation (as included in updated facility abuse policy deeming this act abuse): At no time can staff develop, participate and/or engage in an emotional or physical intimate relationship with a resident. This would include, but not limited to, communication (text, phone calls, social media) and/or in person regardless of what resident BIMS assessment result is or if they consent. (as included in updated facility abuse policy deeming this act abuse).When a police report was made, staff would follow up with the police to determine if any charges would be pursued. Thorough Investigations: A thorough investigation must be completed for all investigations. A thorough investigation should include interviewing the resident, the accused, and all witnesses. Witnesses generally include anyone who: witnessed or heard the incident; came in close contact with the resident on the day of the incident (including other residents, family members); and employees who worked closely with the accused employee(s) and/or alleged victim the day of the incident. On 09/16/25 at 5:30 P.M. the Administrator and DON educated the following staff members: Activities Director, Human Resources Director, Unit Manager, Wound Nurse, Maintenance Director, Social Services Director, Central Supply Clerk and Housekeeping Supervisor on the following:BIMs assessment and scoring.Staff to Resident Relation (as included in updated facility abuse policy deeming this act abuse): At no time can staff develop, participate and/or engage in an emotional or physical intimate relationship with a resident. This would include, but not limited to, communication (text, phone calls, social media) and/or in person regardless of what resident BIMS assessment result is or if they consent. (as included in updated facility abuse policy deeming this act abuse).When a police report was made, staff would follow up with the police to determine if any charges would be pursued. Thorough Investigations: A thorough investigation must be completed for all investigations. A thorough investigation should include interviewing the resident, the accused, and all witnesses. Witnesses generally include anyone who: witnessed or heard the incident; came in close contact with the resident on the day of the incident (including other residents, family members); and employees who worked closely with the accused employee(s) and/or alleged victim the day of the incident. On 09/16/25 at 6:00 P.M. the facility held an Ad Hoc Quality Assurance Performance Improvement (QAPI) meeting to review the incident involving HK #208 and Resident #50, the investigation and the facility abuse policy not outlining physical and emotional contact between staff and resident. The facility identified the root cause of the incident included that the facility policy did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365316 If continuation sheet Page 2 of 6 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 365316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Square Nursing and Rehabilitation 1211 W Market St Akron, OH 44313 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 outline physical or emotional contact between staff and resident or that Resident #50 was cognitively impaired. Staff in attendance included the Medical Director via phone, the Administrator, Director of Nursing (DON), Activities Director, Human Resources Director, Unit Manager, Wound Nurse, Maintenance Director, Social Services Director, Central Supply Clerk and Housekeeping Supervisor. On 09/16/25 at 8:15 P.M. the facility completed a Brief Interview for Mental Status (BIMs) Assessment on all residents. All care plans were reviewed regarding cognitive status after the BIMS assessments were updated. This was completed by the clinical management staff, Social Services Designee and Activity Director. On 09/16/25 at 7:00 P.M. the facility wound nurse completed skin assessments on all residents who had a BIMS of 12 or below. On 09/16/25 at 7:30 P.M. the facility Social Services Designee, Activity Director and the clinical management staff completed resident abuse questionnaires for residents with a BIMs score of 13 or above. On 09/16/25 at 7:45 P.M. all staff were educated on the following:BIMs assessment and scoring.Staff to Resident Relation (as included in updated facility abuse policy deeming this act abuse): At no time can staff develop, participate and/or engage in an emotional or physical intimate relationship with a resident. This would include, but not limited to, communication (text, phone calls, social media) and/or in person regardless of what resident BIMS assessment result is or if they consent. (as included in updated facility abuse policy deeming this act abuse).When a police report was made, staff would follow up with the police to determine if any charges would be pursued. Thorough Investigations: A thorough investigation must be completed for all investigations. A thorough investigation should include interviewing the resident, the accused, and all witnesses. Witnesses generally include anyone who: witnessed or heard the incident; came in close contact with the resident on the day of the incident (including other residents, family members); and employees who worked closely with the accused employee(s) and/or alleged victim the day of the incident. On 09/17/25 at 12:11 P.M. the facility notified the police department regarding the abuse allegation, re-opening of the facility investigation for sexual abuse and provided the alleged perpetrator's information. Beginning on 09/17/25 the facility implemented a plan to complete head-to-toe assessments on five random residents who had a BIMs score of 12 or less to assess for signs and symptoms of abuses, five times a week for four weeks then five residents weekly for four weeks. Beginning on 09/17/25 the facility would interview five random residents five times for four weeks and then five random residents weekly for four weeks with abuse questionnaires for residents with a BIMs of 13 or higher. Beginning on 09/17/25 the facility would complete five random staff questionnaires on new abuse policy five times a week for four weeks and then five random staff weekly for four weeks. Beginning on 09/17/25 RDO #201 and the Regional Director of Clinical Services would audit facility SRIs for a thorough and proper investigation. Beginning on 09/17/25 RDO #201 and the Regional Director of Clinical Services would audit SRIs for police notification.All discrepancies would be submitted to the QAPI Committee and revised as needed for three months. Although the Immediate Jeopardy was removed on 09/17/25 the deficiency remained at Severity Level 2 (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 monitoring to ensure continued compliance. Findings include: Review of the medical record for Resident #50 revealed an admission date of 09/19/24 with diagnoses including diffuse traumatic brain injury with loss of consciousness of 31 minutes to 59 minutes, hemiplegia affecting right dominant side and depression. The resident was noted to have a guardian. Review of the care plan dated 01/10/25 for Resident #50 revealed she had impaired cognitive function and thought process related to a traumatic brain injury related to a gun shot wound and skull fracture with impaired decision making and memory loss. Interventions included to communicate with the resident, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365316 If continuation sheet Page 3 of 6 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 365316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Square Nursing and Rehabilitation 1211 W Market St Akron, OH 44313 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 family and caregivers regarding resident's capabilities and needs. Review of a Durable Power of Attorney and Guardianship document dated 05/09/25 for Resident #50 revealed she had a guardian in place. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #50 revealed she had an impaired cognition, scoring a nine out of 15 on the BIMs assessment. Review of text messages dated 08/15/25 and 08/16/25 revealed HK #208 sent Resident #50 his picture on 08/15/25. On 08/16/25 at 4:40 A.M. HK #208 asked Resident #50 to ensure her phone was locked as he did not want her to get caught with his picture on it. On 08/16/25 at 7:20 A.M. HK #208 stated he was working all day and asked if he could get these balls licked and see you jack that cat off. Resident #50 never responded. On 08/16/25 at 4:18 P.M. HK #208 sent another text asking if he could see her before he got off work. Resident #50 responded she had a boyfriend. Review of a facility SRI, tracking number 264268 dated 08/19/25 revealed Resident #50's friend notified the police, the facility compliance hotline and an attorney that Resident #50 had a sexual relationship with HK #208. When interviewed, Resident #50 stated she and HK #208 had begun communicating approximately two weeks prior but couldn't provide the exact dates. Resident #50 stated the conversations progressed to sexual topics and she performed oral sex on HK #208 twice, first on 08/15/25 and then on 08/16/25. Information included in the facility SRI revealed Resident #50 stated she had willingly participated during an interview with Activities Director #200. The facility conducted their investigation and concluded that Resident #50 willingly consented to a relationship with the staff member and the staff member did not try or have intent to cause harm to the resident. Review of police report #2025-00098017 completed by Patrolman #210 revealed on 08/19/25 at 9:34 P.M. the reporting officer arrived at the facility after being called for force of threat of rape to Resident #50. There report identified an unknown black male suspect. The narrative stated the victim was sexually assaulted by the suspect. Review of a facility investigation revealed a statement dated 08/19/25 at 9:15 P.M. by Licensed Practical Nurse (LPN) #209. The statement included the LPN interviewed Resident #50 related to the allegation of sexual abuse. Resident #50 stated the housekeeper came into her room on two separate occasions within the previous week and made her perform oral sex on him. She stated she did the sex acts out of fear. Resident #50 also stated that she had text (messages) on her phone from the staff member asking for sexual favors from her. Review of a BIMs assessment performed on 08/20/25 revealed Resident #50 scored 12 out of 15 which reflected the resident exhibited moderately impaired cognition. Review of a typed statement by Activities Director #200 on 08/20/25 for Resident #50 revealed Resident #50 was educated on the term of consensual and non-consensual sexual actions. She stated understanding of the definitions. Resident #50 stated that inappropriate communication with HK #208 had begun two weeks prior. She stated she had done it two times but did not profit. When asked what she meant regarding the statement Resident #50 stated I gave him head and he did not cum. Resident #50 stated she was not raped and was a willing participant. She stated on 08/15/25 she pulled out his penis from his clothing and put it into her mouth. She stated on 08/16/25 HK #208 pulled his penis out and put it into her mouth. Resident #50 stated she did not plan to give him head that day, but she did not tell him no. She stated when he attempted to contact her again, she told him she had a new boyfriend. Resident #50 signed the statement. Review of Resident #50's medical record revealed there was no further follow up with additional interventions to address the 08/15/25 and 08/16/25 incidents of sexual abuse. Interview on 09/16/25 at 8:37 A.M. with the Administrator revealed he believed that both the resident and the housekeeper were consenting to the sexual activity, and the facility abuse policy did not state staff and residents could not be intimate with each other. He stated the police did not open a case because both the resident and HK #208 consented to the relationship. During an interview on 09/16/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365316 If continuation sheet Page 4 of 6 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 365316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Square Nursing and Rehabilitation 1211 W Market St Akron, OH 44313 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 8:47 A.M. with Resident #50 the resident stated she did consent to oral sex with HK #208 one time. She stated she performed oral sex on HK #208 the second time because she felt scared. Upon further conversation, the resident was unable to state what she was fearful of with HK #208. She then presented her cellphone and reviewed texts she had received from HK #208. Interview on 09/16/25 at 9:30 A.M. with Activities Director (AD) #200 revealed Resident #50 had told her she never refused to have oral sex with Housekeeper #208 and based on this, AD #200 stated she felt the interaction was consensual. Interview on 09/16/25 at 10:14 A.M. with RDO #201 revealed the RDO felt Resident #50 understood was consent meant and she ensured she cognitively understood what was being asked during the investigation. She stated in addition, to her knowledge the resident's guardian had no concerns with the incidents that had occurred. RDO #201 also stated the police were called and had no further concerns. Interview on 09/16/25 at 11:16 A.M. with RDO #201 revealed she suspended HK #208 on 08/20/25. The employee refused to give a statement but stated he denied the allegation of sexual abuse. RDO #201 stated HK #208 never returned to the facility to provide a statement and quit by voicemail. The facility had been unable to reach HK #208 since that time. Interview on 09/16/25 at 1:18 P.M. with the Administrator revealed Resident #50 and her friend spoke to the police in regard to the incidents with HK #208. He stated Resident #50's friend, who was another resident, had called the police to report an allegation of sexual abuse. The Administrator was unaware if anyone from the facility spoke to police while they were at the facility on 08/19/25. He verified the police report did not have HK #208 listed as the suspect. The Administrator also verified the facility had not updated the police department once they were made aware of the staff member (HK #208) involved. The Administrator revealed he believed the police would follow with the facility if there was a concern. The Administrator verified reviewing Resident #50's statement dated 08/19/25 with LPN #209 (which indicated the resident performed the act out of fear). Interview on 09/16/25 at 3:01 P.M. with Resident #50's guardian revealed she was contacted by the facility and Resident #50 that the resident had oral sex with HK #208 on two occasions. She stated she was told the first occasion Resident #50 had consented to and on the second she had not but performed oral sex out of fear. Resident #50's guardian stated she was concerned men would pray on Resident #50 due to her desperation and age. Interview on 09/17/25 at 10:39 A.M. with LPN #209 revealed Resident #50 had come to her to speak about a sexual abuse allegation on 08/19/25. She stated Resident #50's friend, another resident, stated he had called the police. She stated during her interview with Resident #50 she took her to a private location without any other staff or residents. She stated Resident #50 stated HK #208 had texted her sexually inappropriate statements and she had provided him oral sex on two occasions. She stated Resident #50 stated she had performed oral sex to HK #208 the first time willingly but did not want to the second time. LPN #209 stated Resident #50 told her she only performed oral sex the second occasion due to fear. She stated when the police arrived, they asked her where the resident's room was and then she had no further discussions with them. She stated when Resident #50 showed her the texts on her phone she was able to identify the picture as HK #208 and she updated the Administrator and RDO #201 with the information. She stated Resident #50 had a name saved in her phone that was not HK #208's name but was able to verify it was his picture. Attempted interview on 09/17/25 at 2:23 P.M. with Detective #211 with the police department major crimes unit was unsuccessful. Interview on 09/17/25 at 5:02 P.M. with Patrolman #210 revealed when he arrived at the facility he spoke to a couple of staff members inquiring on who the alleged perpetrator was. He stated the employees were unable to verify the suspect. He stated he had no contact with the facility staff after he left the building on 08/19/25. Review of the facility policy titled, Abuse, Neglect, Exploitation and Misappropriation of Resident Property, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365316 If continuation sheet Page 5 of 6 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 365316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Square Nursing and Rehabilitation 1211 W Market St Akron, OH 44313 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 dated 10/27/17, revealed sexual abuse was defined as the non-consensual contact of any type with a resident. It also defined exploitation as taking advantage of a resident for personal gain through manipulation, intimidation, threats or coercion. The policy did not address staff to resident sexual relations as abuse situations despite a residents' cognition or willingness to consent. This deficiency represents non-compliance investigated under Complaint Number 2605456. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365316 If continuation sheet Page 6 of 6