Health inspection·August 12, 2025

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Director of Nursing (DON) #399 on the morning of 07/17/25 that there were some maggots noted on Resident #4 but that she had not seen them and did not see the picture of the maggots until shown by the Ombudsman on 07/24/25. During the interview, the LNHA confirmed the facility had not filed a SRI until after the Ombudsman was at the facility on 07/24/25. The LNHA confirmed a witness statement was never obtained from the nurse who initially discovered and reported the maggots, Licensed Practical Nurse (LPN) #325, and that previous DON #399 failed to do a proper investigation before employment ended at the facility. Review of the nursing scheduled from 07/15/25 through 07/17/25 confirmed LPN #325 worked the 7:00 P.M. to 7:00 A.M. shift on 07/15/25, 07/16/25, 07/19/25, and 07/20/25. Further review of the nursing schedules revealed a total of two nurses, Registered Nurse (RN) #337 and LPN#325) and six Certified Nurse Aides (CNAs #302, #326, #340, #375, #379, and #383) worked nightshift on 07/16/25. Review of the SRI investigation revealed only three witness statements, including an undated statement from LPN #366 who was not on duty the night of the alleged incident but noted an unsuccessful attempt to contact LPN #325, a statement from respiratory Therapist (RT) #385, who was not on duty on 07/16/25 or 07/17/25 and had not observed or include knowledge of any maggots, and a third statement, also written by LPN #366, detailing an interview conducted with LPN #321, who was on duty for day shift on 07/17/25. There was no witness statements obtained from any staff scheduled from 7:00 P.M. on 07/16/25 to 7:00 A.M. on 07/17/25 and no notes indicating attempts were made to contact any of the scheduled staff except LPN #325 (no date, time, or details were documented). The investigation included no mention of maggots and no mention of Resident #4's room missing a screen and what facility follow-up was regarding the screen. Additionally, there was no evidence Resident #23 had a comprehensive assessment or that any other resident had been interviewed or their skin was assessed for excess moisture or the presence of maggots. Telephone interview on 08/11/25 at 5:06 P.M. with LPN #366 confirmed the investigative role involved talking with RT #385 and nurses, assisting with nursing re-education, and policy reviews. LPN #366 further confirmed the current DON performed a head-to-toe assessment on Resident #4 after the facility filed the SRI. According to LPN #366, nursing in-services that were marked as reviewed over the phone included nurses being provided copies of the policies when they returned to the facility for their shifts and did not include a return demonstration of trach care and suctioning. During the interview, LPN #366 confirmed there were other interviews she conducted, other than the one nurse (LPN #321) and RT #385. Interview on 08/11/25 at 5:40 P.M. with the LNHA confirmed the information in the folder provided to the surveyor to be reviewed on site was the complete investigation conducted by the facility, including all witness statements. During the interview, the LNHA confirmed both trach residents were checked, but the LNHA verbalized uncertainty as to whether a full assessment was completed and documented of any like residents (other resident(s) with a trach) or any other resident susceptible to altered skin integrity. Interview on 08/12/25 at 10:10 A.M. with Maintenance #362 confirmed the facility installed new windows in March 2025, and Resident #4 did not have a screen prior to the incident with the maggots around his trach on 07/17/25. Review of the purchase order for Quality Glass & Mirror, Incorporated, revealed an order was placed for two window screens measuring approximately 29.5 inches by 17 5/16 inches on 07/18/25 and a receipt for the total price charged for the two screens dated 07/28/25. Review of the undated procedure titled Incidents Requiring Immediate Notification revealed facility incident reports were crucial for documenting the event and facilitating investigations. Further review of the procedure revealed all relevant details about the incident, witnesses, and actions taken were considered essential documentation. This deficiency represents noncompliance investigated under Incident Number 2579881 and Complaint Number 2579936. Event ID: Facility ID: 365320 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 365320 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Care of Copley 2631 Copley Road Akron, OH 44321 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, review of facility policies, and review of the facility investigation of self-reported incident (SRI) number 263186, the facility failed to ensure appropriate care and services were provided to Resident #4, who had a tracheostomy. This affected one resident (Resident #4) of two residents (residents #4 and #23) who were reviewed for appropriate tracheostomy care. The facility census was 46. Review of the medical record for Resident #4 revealed an admission date of 01/10/25 with diagnoses including acute respiratory failure with hypoxia, cerebral infarction, type two diabetes mellitus, atrial fibrillation, paranoid schizophrenia, post-traumatic subdural hemorrhage, lymphangioma, sepsis, encephalopathy, gastrostomy status, and encounter for attention to tracheostomy. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment completed on 07/10/25 revealed Resident #4 had severely impaired cognition and was dependent for all activities of daily living (ADL), including, bathing, dressing, personal hygiene, oral hygiene, bed mobility, and transfers. Further review of the MDS revealed Resident #4 required oxygen therapy, suctioning, and tracheostomy (trach) care. Review of the plan of care dated 01/10/24 to 10/12/25, last reviewed 07/18/25, revealed Resident #4 had a tracheostomy secondary to encephalopathy, acute and chronic respiratory failure, subdural hygroma, and cerebrovascular accident. Interventions included ensuring the trach ties were always secured, wearing a gown and gloves when providing direct care and tracheostomy care, monitoring and documenting respiratory status per orders, and specific instructions in the event of an unplanned decannulation (trach tube out/dislodged). There were no interventions specified for routine trach care or maintenance. Review of the current physician orders revealed an order dated 07/17/25 for Resident #4 to have trach care rendered every shift and as needed (PRN). Review of the previous trach care orders revealed an order dated from 01/10/25 through 07/17/25 for trach care daily and PRN. Additional tracheostomy-related orders for Resident #4 included: Change the trach tube every month starting on 01/10/25 and continuing monthly on the 10th each month and as needed (dated 01/10/25). Change the trach ties weekly every Monday on day shift and as needed (dated 01/10/25). Suction the trach every shift as needed (dated 01/10/25). Change the inner cannula daily with trach care and as needed (dated 01/27/25).Review of the treatment administration record (TAR) for July 2025 revealed documentation that trach care was performed once daily from 07/01/25 through 07/16/25 and then every shift starting with the night shift on 07/17/25. PRN trach-related documentation included trach tie changes on 07/17/25 and on 07/21/25 and triple antibiotic ointment application to the trach as needed for redness on 07/17/25 at 6:19 A.M. There was no documentation that additional trach care was performed on an as-needed basis from 07/01/25 through 07/31/25. Review of the nurses' notes dated 07/17/25 at 6:15 A.M. revealed Resident #4 had the trach ties changed with a note indicating the site was cleansed with normal saline, dried with gauze, triple antibiotic ointment was applied to the trach site, and the area was left open to air. The note revealed no description of the trach stoma or surrounding area or reason for the additional trach tie change. Review of a follow-up note dated 07/17/25 at 8:00 A.M. revealed Physician #395 was at the facility and was notified of excoriation underneath the trach ties and an order was given for mupirocin lidocaine 2-2% ointment to be applied four times a day for 14 days and that the resident representative for Resident #4 was notified of the new order. Review of all progress notes from 06/07/25 through 08/07/25 revealed no mention of the presence of maggots around the trach ties or trach stoma or of any unusual substance noted around the trach and surrounding area. Review of the assessments titled Respiratory Assessment/Vent Check completed on 07/17/25 at 7:26 A.M., 9:00 A.M., 10:36 A.M., and 2:15 P.M. revealed no mention of any unusual assessment criteria or Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365320 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 365320 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Care of Copley 2631 Copley Road Akron, OH 44321 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few occurrences related to Resident #4's trach or surrounding area. Interview on 08/07/25 at 10:22 A.M. with Registered Nurse (RN) #396 confirmed viewing video footage of maggots crawling around the neck, the trach, and under the trach ties on both sides of the neck of Resident #4 during the night shift on 07/16/25. RN #396 further stated the video was recorded by Licensed Practical Nurse (LPN) #325 and forwarded to the previous Director of Nursing (DON) #399 and the Licensed Nursing Home Administrator (LNHA). RN #396 revealed during the interview that the maggots were able to be removed by staff on duty, new trach ties were applied after cleaning Resident #4, and the physician was notified that maggots were found around the trach and neck of Resident #4. Telephone interview on 08/07/25 at 12:59 P.M. with the Ombudsman confirmed allegations were received from two separate sources on 07/24/25 of improper care of a resident's tracheostomy (trach). The first source was anonymous and did not provide the name of the resident but included three photos which appeared to be maggots around a trach collar. The second source revealed they had been sent or shown pictures of Resident #4 with maggots around his trach ties. The Ombudsman further revealed an in-person visit was made to the facility on [DATE] where it was confirmed the facility had been informed of maggots being noted near Resident #4's trach between the night of 07/16/25 and the morning of 07/17/25 (a Wednesday night to Thursday morning shift). During the on-site visit, the Ombudsman further found that the window to Resident #4's room had no screen at the time of the incident, and staff had reported a wasp had previously been observed entering that window. Interview on 08/07/25 at 2:11 P.M. with the LNHA confirmed being alerted by the previous DON #399 on the morning of 07/17/25 that there were some maggots noted on Resident #4 but that she had not seen them and did not see the picture of the maggots until shown by the Ombudsman on 07/24/25. At the time of this interview, the LNHA confirmed the trach care orders changed for Resident #4 once discovery of the maggots was made to prevent it from happening again. Interview on 08/07/25 at 4:22 P.M. with Certified Nursing Assistant (CNA) #326 confirmed LPN #325 reported to staff during the nightshift on 07/16/25 that some small white things were seen moving around near Resident #4's neck and trach tube and had requested assistance from staff in identifying and addressing the concern. CNA #326 further confirmed observing maggots were localized around the trach and completely around Resident #4's neck. During the interview, CNA #326 stated Resident #4 was given a complete bed bath, the neck was washed thoroughly while the aide and two nurses removed the maggots, trach care was provided by LPN #325, and all the bedding and clothing was changed. Interview on 08/07/25 at 4:49 P.M. with RN #337 confirmed the presence of maggots around the trach collar of Resident #4 during nightshift on 07/16/25 and assisting LPN #325 and the aide with cleaning and removing the maggots. During the interview, RN #337 stated most of the trach care in the facility was performed by the Respiratory Therapist (RT) and night nurses typically just suctioned the trach and changed trach ties if needed. RN #337 further confirmed Resident #4 tended to drool a lot, causing the trach ties to get moist and on that night (night shift scheduled 07/16/25 to 07/17/25), Resident #4's trach ties were very moist. Observation on 08/11/25 at 8:55 A.M. revealed CNA #315 entered Resident #4's room and informed RT #385 that Resident #4 was going to be showered. During the observation, RT #385 stated she would return and do trach care after Resident #4 was out of the shower adding trach care had also been completed earlier that morning. Observation on 08/11/25 from 10:10 A.M to 10:20 A.M. of trach care for Resident #4 performed by RT #385 revealed the old trach ties were wet from the shower earlier that morning and the skin beneath was moist. During the observation, the new trach ties were applied and secured to hold the trach in place without the moist skin beneath the trach ties first being dried. Skin beneath the new trach ties appeared shiny and slightly moist. Trach care continued once the new ties were replaced with no additional concerns with the procedure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365320 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 365320 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Care of Copley 2631 Copley Road Akron, OH 44321 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with RT #385 after completion of the trach care confirmed the new trach ties were applied directly after removing the wet ones without drying the area in between steps. While in Resident #4's room for trach care, a note was observed posted next to the window requesting nobody open the window because there was no screen and a wasp had previously flown in through the window. A closer observation of the window revealed there was a screen in place on this date. At this time, RT #385 confirmed the presence and content/verbiage of the sign. A follow-up interview on 08/11/25 at 10:28 A.M. with RT #385 confirmed trach care frequency was typically conflicting as to whether it was performed one or two times a day. Per RT #385, changing of trach pads would be done as needed but opening the whole pack for trach care was usually only done once a day. During the interview, RT #385 confirmed Resident #4's order changed to twice daily after the maggots were noted because he drooled a lot and the order change was also to reiterate to the nurses that care was getting done. RT #385 also confirmed Resident #23, the other resident with a trach, still had orders for trach care once a day and as needed and his orders had not changed. Further interview confirmed trach ties were changed once weekly and as needed and the RT would often need to change the trach ties when in the facility on Mondays and Fridays due to the increased secretions or drainage around Resident #4's neck. Interview on 08/11/25 at 2:02 P.M. with CNA #340 confirmed that Resident #4 had no screen, staff sometimes opened that window, and a wasp was observed flying into the room. CNA #340 further stated she verbalized concerns that Resident #4 was unable to speak for himself or make sure insects did not land on him, so a sign was placed instructing that nobody open the window. CNA #340 also confirmed assisting to identify and help remove maggots from around the trach of Resident #4 during the night shift on 07/16/25. Interview on 08/11/25 at 3:02 P.M. with LPN #325 confirmed that the night of 07/16/25 to 07/17/25 Resident #4 was receiving oral care when it was noted the trach dressing was saturated. Upon closer inspection when preparing to change the gauze dressing, hundreds of tiny white things she had never seen before were noted moving around under the gauze, around the trach stoma, and around the neck under the trach ties. Further interview with LPN #325 confirmed she requested other facility staff to help identify the white moving items and help clean Resident #4. During the interview, LPN #325 stated the initial attempts to reach the Nurse Practitioner on-call and the DON were unsuccessful so video was taken to show the DON what the concern was so Resident #4 could get cleaned up and appropriate orders could be obtained. Interview on 08/11/25 at 4:10 P.M. with CNA #324 confirmed Resident #4 did not have a screen in the window and CNA #324 had observed the window being left open with no screen. Telephone interview on 08/11/25 at 5:06 P.M. with LPN #366 confirmed the investigative role involved talking with RT #385 and nurses, assisting with nursing re-education, and policy reviews. According to LPN #366, nursing in-services that were marked as reviewed over the phone included nurses being provided copies of the policies when they returned to the facility for their shifts and did not include a return demonstration of trach care and suctioning. Interview on 08/11/25 at 5:59 P.M. with CNA #302 confirmed she visualized the maggots around Resident #4's trach the night of 07/16/25 to 07/17/25. CNA #302 further confirmed Resident #4's trach pad (she described as the gauze around the stoma) and trach ties typically got easily saturated and nurses would change the gauze when notified of it being soiled but had not personally observed trach ties being changed during the night shifts. During the interview, CNA #302 confirmed Resident #4 did not have a screen in the window for several months and that there were occasions it was cracked open and had to be shut upon CNA #302s arrival. Interview on 08/12/25 at 10:10 A.M. with Maintenance #362 confirmed the facility installed new windows in March 2025 and Resident #4 did not have a screen prior to the incident with the maggots around his trach on 07/17/25. Interview on 08/12/25 at 10:24 A.M. with the DON confirmed Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365320 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 365320 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Care of Copley 2631 Copley Road Akron, OH 44321 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete #4 had orders changed to increase the frequency of trach care to twice a day after an incident involving maggot around his trach. During the interview, the trach care policy was reviewed and the DON confirmed that the facility policy was to provide trach care at least two times a day. The DON further confirmed that when wet or moist trach ties were removed, the skin was to be thoroughly dried prior to placing and securing new trach ties. Review of the policy titled Tracheostomy Care, dated 03/01/25, revealed trach care should be performed at least twice daily, and trach ties were to be changed whenever soiled or wet. This deficiency represents noncompliance investigated under Incident Number 2579881 and Complaint Number 2579936. Event ID: Facility ID: 365320 If continuation sheet Page 6 of 6