Health inspection·February 27, 2024

F 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, resident interview, staff interview, and review of the policy, the facility failed to provide a phone for residents to use that would be located in a private area to allow for private conversations. This affected one (#37) and had the potential to affect all residents except (Resident #34, #6, #10, #60, #25, #9, #23, and #11) who did not use the facility phones. The facility census was 40. Residents Affected - Some Findings include: Review of Resident #37's medical record revealed an admission date of 08/21/23. Diagnoses included obstructive uropathy and depression. Review of the quarterly minimum data set (MDS) assessment revealed Resident #37 was cognitively intact. Observation on 02/20/24 at 4:17 P.M., revealed Resident #37 was standing in front of the nurses station talking on the phone. Observation revealed residents and staff near the area. Resident #37's conversation could be heard clearly by anyone near the area. Interview on 02/20/24 at 4:24 P.M., with Resident #37 revealed he was talking with a family member. Resident #37 revealed this was the only phone he could use; he would rather have a private conversation, but he had no choice. Interview on 02/20/24 at 4:25 P.M., with Director of Nursing (DON) confirmed the residents were only allowed access to the phone in front of the nurses station. DON confirmed the conversations were not private and could be heard by anyone near the area. Review of the undated policy titled, Resident Rights, revealed the resident has the right to have reasonable access to the use of a telephone and a place in the facility where calls cannot be overheard. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 2 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of the policy, the facility failed to timely notify a resident's Guardian, after a fall. This affected one (#1) of three residents reviewed for notification to the responsible party after a fall. The facility census was 20. Findings include: Review of Resident #1's medical record revealed an admission date of 05/07/15. Diagnosis included unspecified dementia. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #1 was moderately cognitively impaired. Review of the resident profile revealed Resident #1 had a Guardian of Person. The Guardian of Person was the primary contact person and Resident #1's legal Guardian. Review of the progress note dated 01/23/24 at 11:00 A.M., completed by Licensed Practical Nurse (LPN) #259 revealed, This nurse was alerted by activities that this resident had fell. This nurse went to the lounge where this resident was found sitting on his behind. This nurse assessed the patient. Resident stated, I tripped over my cane but I'm alright. Resident was able to pick himself up off the floor. Resident complained of generalized pain. Resident was given PRN (as needed) pain medication for discomfort. Review of the progress note dated 01/24/24 at 11:40 A.M., completed by Registered Nurse (RN) #292 revealed, Notified by (Nurse Practitioner) NP that resident was complaining of head pain behind his ear and is to be sent to emergency room (ER) via 911 due to the fall on 01/23/24 and hitting his head at time of fall and receiving Xarelto. Emergency 911 called, and a call was placed to guardian. Message left for guardian to call facility. Resident transported to ER via 911. Interview on 02/26/24 at 2:00 P.M., with previous Director of Nursing (DON) #291 revealed she would notify the family of a resident of fall as soon as possible, within 15 minutes of the fall occurring. Previous DON #291 revealed she was aware LPN #259 did not contact the guardian at any time after his fall on 01/23/24. Previous DON #291 revealed there was no excuse, she, or someone should have notified the Guardian Resident #1 had the fall as soon as possible on 01/23/24. Review of the policy titled, Change in Condition Monitoring, dated 05/01/22, included our facility shall promptly notify the resident, his or her attending physician, and Family/ POA/Guardian of changes in the residents medical/mental condition and or status. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 3 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interview, record review, and review of the policy, the facility failed to provide a clean, comfortable homelike environment for residents. This affected four (#1, #2, #8, and #26) of 22 resident rooms observed. The facility census was 40. Findings include: 1. Review of Resident #8's medical record revealed an admission date of 07/26/17. Diagnoses included chronic obstructive pulmonary disease, myopia, psychosis, morbid severe obesity, polyosteoarthritis, and need for assistants with personal care. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #8 was moderately cognitively impaired. Resident #8 required substantial maximum assistants with toileting and lower body dressing. Resident #8 was occasionally incontinent of urine. Review of the care plan for Resident #8 dated 02/15/24 revealed Resident #8 experiences frequent bladder incontinence and is at risk for episodes of bowel incontinence related to activity intolerance, limited mobility, morbid obesity, mental illness, and low motivation. Interventions included prefers bedside commode at the bedside, monitoring for incontinence, assist as needed with incontinence care. Assist to change clothing after each incontinent episode. Observation on 02/20/24 at 10:00 A.M., revealed Resident #8 was sitting up in her wheelchair sleeping. At the end of Resident #8's bed, against the wall was a bedside commode. The bedside commode was between half and three fourths full of urine and stool. To the side of the bedside commode, on the floor were two pairs of urine soiled pants. In front of and under the bedside commode was a large puddle of urine. The room had a strong foul odor. Observed on the floor throughout the room was trash products, food reminisces, and a buildup of dirt and grime in the creases and cracks of the floor. The bathroom entrance also had a large buildup of dirt and grime on the floor and the lower door frame on the left side to the entrance to the bathroom had multiple pieces missing and broken. Observation on 02/20/24 at 1:32 P.M., revealed Resident #8 was sitting up in her chair. The bedside commode was still between half and three fourths full of urine and stool. To the side of the bedside commode, on the floor were two pairs of urine soiled pants. In front of and under the bedside commode was a large puddle of partially dried urine. The room had a strong foul odor. Observed throughout the floor was trash products, food reminiscences, and a buildup of dirt and grime in the creases and cracks of the floor. Resident #8's lunch tray was still sitting on the table. Interview with Resident #8, at the time of the observation, the resident stated, Of course I want my room cleaned, they just don't always do it. Observation on 02/20/24 at 2:30 P.M., with Maintenance Director/Housekeeping Supervisor #263 of Resident #8's room, confirmed at the end of Resident #8's bed, against the wall was a bedside commode. The bedside commode was three fourths full of urine and stool. To the side of the bedside commode, on the floor were two pairs of urine soiled pants (the same two pair from the morning and afternoon observation). In front of and under the bedside commode was a large puddle of dried urine. The room had a strong foul odor. Throughout the floor was trash products, food reminisces, and a buildup of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 4 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dirt and grime in the creases and cracks of the floor. The bathroom entrance also had a large buildup of dirt and grime on the floor and the lower door frame on the left side to the entrance to the bathroom had multiple pieces missing and broken. Maintenance Director/Housekeeping Supervisor #263 stated each room should be cleaned daily. 2. Review of Resident #1's medical record revealed an admission date of 05/07/15. Diagnoses included diabetes mellitus and chronic pain. Review of the quarterly MDS assessment dated [DATE] resident was moderately cognitively impaired. Observation on 02/20/24 at 1:47 P.M., revealed Resident #1's room was very cluttered. There was a large stack of clothes next to the bed overflowing in a box onto the floor. The floor was dirty with a buildup of dirt and grime. The bedside table had old food wrappers and partially cups of liquids. In Resident #1's bathroom was a large buildup of dirt and grime. The roll of toilet paper was sitting on the floor. The holder on the wall was missing the roll holder. Interview with Resident #1, at the time of the observation, revealed there was nowhere to put the toilet paper because the roll holder was missing. Resident #1 revealed the staff cleaned when they wanted to. Observation on 02/20/24 at 2:30 P.M., with Maintenance Director/Housekeeping Supervisor #263 of Resident #1's room confirmed Resident #1's room was very cluttered. There was a large stack of clothes next to the bed overflowing in a box onto the floor. The floor was dirty with a buildup of dirt and grime. The bedside table had old food wrappers and partially cups of liquids. In Resident #1's bathroom was a large buildup of dirt and grime. The roll of toilet paper was sitting on the floor. The holder on the wall was missing the roll holder. 3. Review of Resident #2's medical record revealed an admission date of 11/20/18. Diagnoses included chronic obstructive pulmonary disease, traumatic brain injury, personal history of traumatic fracture, and presence of right artificial hip joint. Review of the quarterly MDS assessment dated [DATE] revealed the resident was cognitively intact. Resident #2 received as needed pain medication for frequent pain. Observation on 02/20/24 at 1:49 P.M. revealed Resident #2 shared the bathroom with Resident #1. Resident #2's room also had a large buildup of dirt and grime throughout the floor, in all corners and in the bathroom shared with Resident #1. Observation on 02/20/24 at 2:32 P.M., with Maintenance Director/Housekeeping Supervisor #263 of Resident #2's room confirmed Resident #2's room also had a large buildup of dirt and grime throughout the floor, in all corners an in the bathroom shared with Resident #1. 4. Review of Resident #26's medical record revealed an admission date of 08/01/16. Diagnoses included unspecified convulsions and recurrent depression. Review of the annual MDS assessment dated [DATE] revealed Resident #26 was cognitively intact. Resident #26 was independent with toileting, personal hygiene, and ambulation. Observation on 02/20/24 at 2:10 P.M., with Maintenance Director/Housekeeping Supervisor #263 of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 5 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #26's room revealed seven of the ceiling tiles were stained brown from dried water and two large tiles were bowed out from the ceiling. Maintenance Director/Housekeeping Supervisor #263 revealed the facility had a leaky roof a few months ago and confirmed the tiles were not replaced. Observation revealed the bathroom floor was still wet, Maintenance Director/Housekeeping Supervisor #263 confirmed the housekeepers just finished cleaning Resident #26's room and bathroom. Observation revealed the toilet in the bathroom had dried urine dripping and small hair particles on the rim of the toilet. The bowl had a large brown ring inside the bowl. The top of the toilet and toilet paper holder had a thick buildup of dust. Surrounding the toilet on the floor was a large buildup of dirt and grime. Maintenance Director/Housekeeping Supervisor #263 confirmed the toilet had not been cleaned and the floor had a large buildup of dirt and grime. The sink used for Resident #26 to wash in was located in the bedroom. The handle for the hot water was missing. Inside the sink was a large ring of scum buildup. Maintenance Director/Housekeeping Supervisor #263 verified the missing hot water handle and verified there was no way for Resident #26 to use his hot water in the sink. Maintenance Director/Housekeeping Supervisor #263 revealed Housekeeper #212 and #265 just finished cleaning Resident #26's room. Interview and observation on 02/20/24 at 2:16 P.M., with Maintenance Director/Housekeeping Supervisor #263, Housekeeper #212 and #265 confirmed Housekeeper #212 and #265 finished cleaning Resident #26's room [ROOM NUMBER] to 30 minutes ago. Housekeepers #212 and #265 stated they forgot to clean the toilet rim, seat, bowl, and top. They also forgot to clean the sink. Interview on 02/20/24 at 2:20 P.M., with Resident #26 revealed he would like his room to be clean, but it was not. Resident #26 revealed he didn't say anything because it doesn't do any good. Resident #26 revealed he had been telling them about the missing handle on the hot water for over a year. It doesn't do any good, they never fixed it, so he just got tired of telling them. Review of the policy titled, Homelike Environment, dated 05/01/22, revealed the facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflect a personal homelike environment. The characteristics include a clean, sanitary, and orderly environment. This deficiency represents an incidental finding investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 6 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of resident council minutes, review of staff schedules, review of Self-Reported Incidents (SRI), staff interview and review of the policy, the facility failed to report an allegation of staff being rough to one resident (#8) and personal items being stolen from one resident (#32). This affected two (#8 and #32) of six residents reviewed for Abuse, Neglect and Misappropriation. The facility census was 40. Findings include: 1. Review for Resident #8's medical record revealed an admission date of 07/26/17. Diagnoses included chronic obstructive pulmonary disease, myopia, morbid severe obesity and need for assistants with personal care. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #8 was moderately cognitively impaired. Resident #8 required assistants with activities of daily living. 2. Review for Resident #32's medical record revealed an admission date of 01/27/23. Diagnoses included cerebral infarction, memory deficit following cerebral infarction, and acquired absence of left leg below the knee. Review of the annual MDS dated [DATE] revealed Resident #32 was moderately cognitively impaired. Resident #32 used a wheelchair for mobility. Resident #32 required substantial/maximum assistants with transfers and wheelchair mobility. Review of the Resident Council minutes dated 12/12/23, unsigned, revealed State Tested Nursing Assistant (STNA) (#220) night shift is not the best; STNA #242-night shift is rough; residents wished nurses would take residents more seriously; and agency night nurses aren't good. Under the section in the Resident Council minutes titled: Concerns Not Covered included stuff being stolen from rooms. Interview on 02/22/24 at 11:36 A.M., with Registered Nurse (RN) Corporate MDS Nurse/Previous Director of Nursing (DON) #291 revealed she was the Acting DON at the facility up until three weeks ago. Previous DON #291 revealed she attended the Resident Council meeting on 12/12/23. Previous DON #291 revealed she heard Resident #8 say the word mean not rough and they were two different words. Previous DON #291 revealed if she would have heard rough, she would have investigated the concern because that to her would mean hands on rough, mean meant something more verbal. Previous DON #291 revealed she spoke with Resident #8 after the meeting, and she asked Resident #8 what happened. Resident #8 said, they were mean, they kept telling her to go back to bed. Previous DON #291 revealed Resident #8 did not specify what happened, Resident #8 changed the subject and went on to say she did not receive her medication either. Previous DON #291 revealed she did not discuss the concern any further with Resident #8 about the staff being mean or rough or not receiving her medications. Previous DON #291 confirmed there was no reporting or SRI completed regarding Resident #8's concern with staff being mean or rough, she did not question any other residents to see if they had concerns with staff, and she never spoke with either STNA or any other staff to discuss the concern of staff being mean or rough. Previous DON #291 revealed both STNA's continued to work their regular schedule, neither was suspended or talked to about the situation with staff being mean or rough. Previous DON #291 confirmed the statement from the residents regarding stuff being stolen from rooms was also not investigated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 7 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0609 Level of Harm - Minimal harm or potential for actual harm Previous DON #291 revealed there was a resident who would go in three other residents rooms and take stuff and either put it in his room or throw it on the roof. Previous DON #291 revealed she thought they (the residents in resident council) just made a funny remark about it and confirmed there was no reporting or SRI completed for either concern. Previous DON #291 confirmed Resident #28 would take things from Resident #32's room because he did not like him. Residents Affected - Few Interview on 02/22/24 at 11:50 A.M., with Activities Director #287 revealed she attended the Resident Council meeting on 12/12/23 and typed the minutes. Activities Director #287 revealed Resident #8 expressed the concern of STNA #220 and #242 on night shift and used the word rough. Activities Director #287 revealed Resident #8 did not explain how or what the STNA's did and confirmed Previous DON #291 was present. Activities Director #287 confirmed residents also reported in the meeting they were concerned with stuff being stolen from their rooms. Resident #28 would take things from Resident #32's room because he did not like him. Interview on 02/22/24 at 11:59 A.M., with Administrator, revealed she was employed at the facility for less than two weeks. The administrator revealed if a resident made the statement of staff being rough or mean, she would do a reporting and submit an SRI immediately. Administrator confirmed no SRI or reporting was completed for the concerns from Resident Council on 12/12/23 and STNA #242 was never interviewed or suspended for any reporting and was still employed at the facility. Review of the staff file and scheduled time worked for STNA #242 revealed STNA #242 worked night shift on 12/04/23, 12/05/23, 12/06/23, 12/10/23, 12/13/23, 12/14/23, 12/18/23, 12/19/23, 12/20/23, 12/24/23, 12/27/23, 12/28/23, 01/02/24, 01/07/24, 01/10/24, 01/11/24, 01/14/24, 01/15/24, 01/17/24, 01/21/24, 01/24/24, 01/25/24, 01/29/24, 01/31/24, 02/04/24, 02/07/24, 02/11/24, 02/14/24, 02/17/24, and 02/18/24. Review of the Enhanced Information Dissemination and Collection (EIDC) system for SRI reporting revealed no evidence of the two allegations being reported. Review of the policy titled, Abuse Prevention dated 08/20/21, included the facility will not tolerate Abuse, Neglect, Exploitation of its residents or Misappropriation of Resident Property. It is the facility's policy to investigate all alleged violations involving Abuse, Neglect, Exploitation of its residents or Misappropriation of Resident Property. Facility staff should immediately report all such allegations to the Administrator and to the State Department of Health. This deficiency represents an incidental finding investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 8 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, review of resident council minutes, staff interview and review of the policy, the facility failed to investigate an allegation of staff being rough to one resident (#8) and personal items being stolen from one resident (#32). This affected two (#8 and #32) of six residents reviewed for Abuse, Neglect and Misappropriation. The facility census was 40. Residents Affected - Few Findings include: 1. Review for Resident #8's medical record revealed an admission date of 07/26/17. Diagnoses included chronic obstructive pulmonary disease, myopia, morbid severe obesity and need for assistants with personal care. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #8 was moderately cognitively impaired. Resident #8 required assistants with activities of daily living. 2. Review for Resident #32's medical record revealed an admission date of 01/27/23. Diagnoses included cerebral infarction, memory deficit following cerebral infarction, and acquired absence of left leg below the knee. Review of the annual MDS dated [DATE] revealed Resident #32 was moderately cognitively impaired. Resident #32 used a wheelchair for mobility. Resident #32 required substantial/maximum assistants with transfers and wheelchair mobility. Review of the Resident Council minutes dated 12/12/23, unsigned, revealed State Tested Nursing Assistant (STNA) (#220) night shift is not the best; STNA #242-night shift is rough; residents wished nurses would take residents more seriously; and agency night nurses aren't good. Under the section in the Resident Council minutes titled: Concerns Not Covered included stuff being stolen from rooms. Interview on 02/22/24 at 11:36 A.M., with Registered Nurse (RN) Corporate MDS Nurse/Previous Director of Nursing (DON) #291 revealed she was the Acting DON at the facility up until three weeks ago. Previous DON #291 revealed she attended the Resident Council meeting on 12/12/23. Previous DON #291 revealed she heard Resident #8 say the word mean not rough and they were two different words. Previous DON #291 revealed if she would have heard rough, she would have investigated the concern because that to her would mean hands on rough, mean meant something more verbal. Previous DON #291 revealed she spoke with Resident #8 after the meeting, and she asked Resident #8 what happened. Resident #8 said, they were mean, they kept telling her to go back to bed. Previous DON #291 revealed Resident #8 did not specify what happened, Resident #8 changed the subject and went on to say she did not receive her medication either. Previous DON #291 revealed she did not discuss the concern any further with Resident #8 about the staff being mean or rough or not receiving her medications. Previous DON #291 confirmed there was no investigation completed regarding Resident #8's concern with staff being mean or rough, she did not question any other residents to see if they had concerns with staff, and she never spoke with either STNA or any other staff to discuss the concern of staff being mean or rough. Previous DON #291 revealed both STNA's continued to work their regular schedule, neither was suspended or talked to about the situation with staff being mean or rough. Previous DON #291 confirmed the statement from the residents regarding stuff being stolen from rooms was also not investigated. Previous DON #291 revealed there was a resident who would go in three other residents rooms and take stuff and either put it in his room or throw it on the roof. Previous DON #291 revealed she thought (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 9 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few they (the residents in resident council) just made a funny remark about it and confirmed there was no investigation completed for either concern. Previous DON #291 confirmed Resident #28 would take things from Resident #32's room because he did not like him. Interview on 02/22/24 at 11:50 A.M., with Activities Director #287 revealed she attended the Resident Council meeting on 12/12/23 and typed the minutes. Activities Director #287 revealed Resident #8 expressed the concern of STNA #220 and #242 on night shift and used the word rough. Activities Director #287 revealed Resident #8 did not explain how or what the STNA's did and confirmed Previous DON #291 was present. Activities Director #287 confirmed residents also reported in the meeting they were concerned with stuff being stolen from their rooms. Resident #28 would take things from Resident #32's room because he did not like him. Interview on 02/22/24 at 11:59 A.M., with Administrator, revealed she was employed at the facility for less than two weeks. The administrator revealed if a resident made a statement of staff being rough or mean, she would do an investigation immediately. Administrator confirmed no investigation was completed for the concerns from Resident Council on 12/12/23 and STNA #242 was never interviewed or suspended for any investigation and was still employed at the facility. Review of the policy titled, Abuse Prevention dated 08/20/21, included the facility will not tolerate Abuse, Neglect, Exploitation of its residents or Misappropriation of Resident Property. It is the facility's policy to investigate all alleged violations involving Abuse, Neglect, Exploitation of its residents or Misappropriation of Resident Property. Facility staff should immediately report all such allegations to the Administrator and to the State Department of Health. This deficiency represents an incidental finding investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 10 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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** Based on observation, medical record review, and staff interview, the facility did not provide or offer resident showers or baths as care planned. This affected one (#9) of three residents reviewed for showers/bathing. The facility census was 20. Residents Affected - Few Findings include: Observation on 02/20/22 at 1:40 P.M., revealed Resident #9 was sitting up in her wheelchair. Resident #9 was not answering questions. Resident #9's hair was disheveled and had a body odor. Record review for Resident #9 revealed an admission date of 03/30/21. Diagnoses included muscle weakness, aphasia following cerebral infarction, muscle weakness and need for assistants with personal care. Resident #9 received Hospice services effective 01/26/24. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #9 was unable to complete the interview. Resident #9 required substantial/maximum assist with bathing. Review of the care plan dated 12/28/23 revealed Resident #9 had a self-care performance deficit and required extensive/total assist with showering. Record review of the shower schedule revealed Resident #9 had a scheduled shower every Wednesday and Saturday. Record review of the shower sheets on 02/21/24 for February 2024 for Resident #9 revealed Resident #9 received a shower on 02/07/24 and 02/14/24. Interview on 02/22/24 at 3:42 P.M., with Director of Nursing (DON) revealed each resident was offered two showers a week and as needed. The facility staff documented on the shower sheets when residents received or refused a shower. DON confirmed Resident #9 was only offered two showers by the facility staff from 02/01/24 through 02/22/24. Resident #9 received hospice services and the Hospice services also completes showers in addition to the two offered by the facility. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 11 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, activity calendar review, resident interview and staff interview, the facility failed to prove structured meaningful group activities for residents residing in the Memory Care Unit. This affected three (#7, #17, and #92) and had the potential to affect all 11 residents (#6, #7, #13, #17, #18, #20, #24, #28, #34, #90 and #92) residing in the Memory Care Unit. The facility census was 40. Residents Affected - Some Findings include: 1. Review for Resident #17's medical record revealed an admission date of 01/19/24. Diagnoses included malignant neoplasm of the brain and diabetes mellitus. Resident #17 resided in the Memory Care (MC) Unit. Review of the admission minimum data set (MDS) assessment revealed Resident #17 was severely cognitively impaired. Resident #17 required set up or clean up assistants with activities of daily living. Residents were independent with transfers and ambulation. Review of the Activity Calendar posted in the Memory Care Unit for 02/21/24 revealed 10:00 A.M. Bingo; 11:00 A.M. Memory Care corner; and 2:00 P.M. Games. The activity calendar included activities daily for the month of February 2024 from 10:00 A.M. until 2:00 P.M., with the exception of Sundays when there were AA meetings scheduled at 6:00 P.M. Observation on 02/21/24 at 10:00 A.M., revealed there were no activities (Memory Care Corner) going on in the memory care unit. Residents were observed wandering, sleeping, or sitting in a chair doing nothing. There was no music playing or staff interaction observed. Interview at the time of the observation, with Central Supply/State Tested Nursing Assistant (STNA) #204 confirmed there were no activities at this time in the MC unit, but it was posted on the Activity Calendar. Observation on 02/21/24 at 10:19 A.M., revealed Activity Director #287 was sitting in her office filling out blank activity forms for the entire month of February 2024 for Residents. Activity Director #287 confirmed the activity forms for the Residents in Memory Care were all blank for the entire month of February 2024 and she was trying to get caught up and get them filled in. Activity Director #287 revealed she had no training on activities, no certifications, she was the only staff member doing activities and she was also the Licensed Social Worker Designee for the facility. There was no other Licensed Social Worker or Licensed Social Worker Designee, so she had to do both jobs. Activity Director #287 confirmed there was no activity in the MC unit as scheduled at 10:00 A.M. because she had to catch up on her other work. Activity Director #287 revealed there were no actual group activities that ever occurred in the MC unit, she would do 1:1 every day, each resident in the MC unit would get 1:1 time talking, watching TV, or doing something two times a week. Activity Director #287 confirmed there were no structured group activities that occurred in the MC unit. Interview on 02/21/24 at 10:50 A.M., with Licensed Practical Nurse (LPN) #222 revealed she never seen activities for the residents in the MC Unit. LPN #222 revealed sometimes Resident #90, #20, and #13 goes out of the MC Unit when other activities are going on like Bingo, but no other residents leave. LPN #222 revealed the residents in the MC Unit would benefit from structured activities and they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 12 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some would all be able to participate, if they had more to do, they would do more, they have nothing to do back here but watch TV. Observation and interview on 02/21/24 at 10:55 A.M., revealed Resident #17 was lying in his bed staring at the ceiling. Resident #17 revealed he would like more things to do, he was bored and there was nothing to do. 2. Review for Resident #92's medical record revealed an admission date of 08/05/22. Diagnoses included vascular dementia. Review of the quarterly MDS revealed residents had a short term and long-term memory problem. Resident #92 resided in the Memory Care Unit. Review of the care plan dated 12/28/23 revealed Resident #92 was dependent on staff for activities, cognitive stimulation, and social interaction. Interventions included inviting residents. Observation and interview on 02/21/24 at 10:57 A.M., of Resident #92 revealed Resident #92 was sitting in his chair. Resident #92 revealed he would like more things to do. 3. Review of Resident #7's medical record revealed an admission date of 06/22/15. Diagnoses included unspecified dementia, restlessness, agitation, and wandering. Resident #7 resided in the Memory Care Unit. Review of the quarterly MDS dated [DATE] revealed Resident #7 was severely cognitively impaired. Resident #7 was independent with ambulation. Review of the care plan for Resident #7 included to explain to Resident #7 the importance of social interaction, leisure activity time and encourage Resident #7's participation. Observation and interview on 02/21/24 at 11:00 A.M., with Resident #7 revealed Resident #7 was sitting in his chair. Resident #7 revealed he would like to sing in a quartet, play cards, draw pictures, Resident #7 revealed they don't do none of that here. Interview on 02/21/24 at 11:07 A.M., with State Tested Nurse Aide (STNA) #246 revealed there were no activities in the MC Unit because those residents were not able to focus. Interview on 02/21/24 at 11:23 A.M., with Office Personnel #281 revealed she was the Administrator Assistant. Office Personnel #281 revealed she held the activities license because she was certified in activities, but Activity Director #287 was the Activity Director. Office Personnel #281 revealed she was told the facility had to have someone certified in activities, so she kept her certification up, but she never worked in activities since 2020. Office Personnel #281 confirmed she did not complete or review the activities schedule; she did not participate or perform in any activities, and she did not oversee the program. Interview on 02/21/24 at 11:35 A.M., with Administrator confirmed Office Personnel #281 did not participate or oversee any activities for residents residing in the facility. The administrator confirmed the MC Unit did not have any group activities or programming except for 1:1 two days a week. The administrator revealed the MC Unit should have programming specific for those residents. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 13 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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, record review, staff interview, and policy review, the facility failed to implement a physician order timely for treatment to a wound for a resident and complete wound treatments as ordered. This affected two (#9 and #16) of five residents reviewed for wound treatments. The facility census was 40. Residents Affected - Few Findings include: 1. Review of Resident #9's medical record revealed an admission date of 03/30/21. Diagnoses included blister to the right thigh, muscle weakness, age related nuclear cataract bilateral, contracture of the left hand, need for assistants with personal care, and nicotine dependence, cigarettes. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #9 was unable to complete the interview. Resident #9 required assistants with activities of daily living. Review of the progress note dated 11/21/23 at 12:59 A.M., completed by Certified Nurse Practitioner CNP #290 revealed Chief Complaint/Reason for this visit was the facility requested visit for wound to right thigh. Staff were assisting Resident (#9) with bathroom/hygiene care, and they noticed a blister on the right thigh. Staff also noticed a hole burned in the same location of her sweatpants. Resident had returned from smoke break recently. Treatment to the right thigh blister - apply bacitracin or stock topical antibacterial ointment and dry dressing to the right thigh wound daily until healed. Review of the Treatment Administration Record (TAR) for Resident #9 for November and December 2023 revealed there was no treatment completed for Resident #9's burn to the right thigh. Review of the physician orders revealed the order for the wound care was put into the electronic medical record on 11/21/24 for Resident #9 but was not scheduled a time for the nurse to implement and complete the daily treatment. Review of the January 2024 TAR revealed the treatment for Resident #9's wound to the right thigh was initiated on 01/05/24. Interview on 02/22/24 at 3:42 P.M., with Director of Nursing (DON) verified Resident #9 had a cigarette burn to her right thigh that occurred on 11/21/23. DON verified there was no treatment initiated to the burn on the right thigh until 01/05/24. Observation on 02/22/24 at 3:44 P.M., with DON of Resident #9's right thigh revealed a small circular scar to the thigh. DON confirmed that was where the cigarette burns healed. Interview on 02/26/24 at 10:12 A.M., with Previous DON #291 verified the order for Resident #9's wound care to the right thigh was put in the electronic medical record but did not carry over anywhere to where the nurses could see or complete it. The wound care to the right thigh was ordered 11/21/23 and not initiated until 01/05/24. 2. Review of Resident #16's medical record revealed an admission date of 03/19/20. Diagnosis included unspecified dementia, dysphagia following cerebral infarction, and need for assistants with personal care. Review of the quarterly Minimum Data Set, dated [DATE] revealed Resident #16 was moderately cognitively impaired. Resident #16 required substantial/maximum assistants with personal hygiene. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 14 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 had a feeding tube. Level of Harm - Minimal harm or potential for actual harm Review of the care plan dated 12/18/23 revealed Resident #16 required a tube feeding related to a history of dysphagia. Interventions included treatment of feeding tube insertion site as ordered. Monitor the area of signs and symptoms of infection when completing the treatment. Residents Affected - Few Review of the physician orders revealed on 10/20/22, Resident #16 received a physician order to cleanse the peg site with normal saline, apply xeroform and cover with drain sponge. Change daily. Review of the physician orders revealed Resident #16 received a physician order on 01/05/24, gently wash peg tube site with soap and warm water, pat dry, sprinkle nystatin powder and cover with drain sponge daily and as needed. Review of the TAR for February 2024 revealed both orders for Resident #16 for peg tube site care were present and signed daily by the same nurse. Observation on 02/20/24 at 4:03 P.M., with Licensed Practical Nurse (LPN) #259 complete the treatment for Resident #16's peg tube site revealed LPN #259 removed the undated dressing to Resident #16's peg tube site. The insertion site was deep red and crusty dry drainage was on the old dressing and the insertion site along with a moderate amount of thick yellow drainage. There was a foul odor from the site. LPN #259 verified the drainage and odor. After removing the old dressing, LPN #259 removed her gloves, did not wash hands, then left the room and returned with gauze. LPN #259 again did not wash her hands, cleansed the peg tube site with normal saline, put a clean drain sponge over the site, taped and dated the dressing. LPN #259 then left the room and returned to her medication cart without washing her hands. Interview at the time of the observation, revealed LPN #259 verified she cleansed the site with normal saline, nothing was applied but the drain sponge. Interview on 02/26/24 at 10:30 A.M., with Registered Nurse (RN) Corporate MDS Nurse/Previous DON #291 revealed when the new order for the treatment for Resident #16's peg tube site was written on 01/05/24, they should have discontinued the old order written 10/20/22. Interview on 02/27/24 at 8:00 A.M., with Registered Nurse (RN) #215 confirmed when she completed Resident #16's dressing change to the peg tube site, she would put nystatin on the site then the xeroform, she would combine both orders then sign both orders. Review of the policy titled, Wound Care dated 05/01/22 included it is the policy of this facility to ensure that all residents skin conditions are properly tracked and cared for. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 15 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, record review, and review of policy, the facility failed to ensure fall prevention interventions were in place and ensure a resident was provided a smoking apron intervention to prevent burns. This affected six (#3, #9, #14, #27, #32, and #34) of seven residents reviewed for incidents and accidents. The facility census was 40. Findings include: 1. Review of Resident #32's medical record revealed an admission date of 01/27/23. Diagnoses included cerebral infarction, memory deficit following cerebral infarction, and acquired absence of left leg below the knee. Review of the annual Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #32 was moderately cognitively impaired. Resident #32 used a wheelchair for mobility. Resident #32 required substantial/maximum assistants with transfers and wheelchair mobility. Review of the care plan for Resident #32 dated 12/28/23, revealed Resident #32 was at risk for falls related to gait/balance problems, impaired communication/comprehension, impaired safety awareness and impulsivity. The care plan did not include the intervention for dycem. Review of the physician orders for Resident #32 dated 04/24/23 revealed an order for dycem to the wheelchair seat. Observation on 02/20/24 at 3:26 P.M., revealed Resident #32 was sitting up in his wheelchair. Resident #32 revealed he did not have dycem in his chair. Resident #32 revealed he wasn't sure what that was, but staff never put anything under him to sit on. Observation and interview 02/20/24 at 3:27 P.M., with State Tested Nursing Assistant (STNA) #219 confirmed Resident #32 did not have dycem in his wheelchair. Observation in Resident #32's room revealed there was no dycem in Resident #32's room. STNA #219 revealed she was unsure where dycem was kept. Interview on 02/20/24 at 3:32 P.M., with STNA #256 revealed she worked with Resident #32 all the time and Resident #32 never had dycem to his wheelchair. 2. Review of Resident #27's medical record revealed an admission date of 01/25/17. Diagnoses included cerebrovascular disease, dementia, and repeated falls. Review of the quarterly MDS dated [DATE] revealed Resident #27 was severely cog impaired and required substantial maximum assist with bed mobility, transfers, and wheelchair mobility. Record review of the care plan dated 12/28/23 revealed Resident #27 was at risk for falls related to weakness, immobility, impulsiveness, impaired decision making and safety awareness. Interventions included dycem to wheelchair seat. Record review of the physician orders for Resident #27 revealed an order dated 05/05/22 for dycem (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 16 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0689 to the wheelchair. Level of Harm - Minimal harm or potential for actual harm Observation on 02/20/24 at 3:30 P.M., with STNA #219 and #246 confirmed Resident #27 was sitting up in his wheelchair. Resident #27 did not have dycem in his chair. Residents Affected - Some Interview on 02/20/24 at 3:32 P.M., with STNA #256 revealed she worked with Resident #27 all the time and Resident #27 never had dycem to his wheelchair. 3. Review of Resident #34's medical record revealed an admission date of 01/26/16. Diagnoses included Alzheimer's disease with early onset, hemiplegia and hemiparesis following cerebral infarction, spastic hemiplegia affecting left dominant side, Parkinson's disease, muscle weakness, unsteady on feet, and need for assistants with personal care. Review of the quarterly MDS dated [DATE] revealed Resident #34 had a short- and long-term memory problem. Resident #34 used a wheelchair and was dependent for a chair to bed transfer and required substantial to max assist with wheelchair mobility. Review of the care plan dated 01/28/24 revealed Resident #34 was at risk for falls related to incontinence, weakness, impaired safety awareness, impaired cognition, left hemiparesis, and impaired decision making. Interventions included antiroll back brakes and anti-tippers to the wheelchair and applying dycem to the wheelchair seat. Review of the physician orders for Resident #34 included dycem to wheelchair at all times dated 05/19/20 and anti-tippers and anti-rollback to the wheelchair dated 01/29/18. Observation on 02/21/23 at 10:50 A.M., revealed Resident #34 was sitting up in his wheelchair in the hall. Observation and interview with Licensed Practical Nurse (LPN) #222 confirmed Resident #34 did not have anti-tippers or anti-rollback to the wheelchair. LPN #222 also confirmed Resident #34 did not have dycem. LPN #222 revealed she was unsure when Resident #34 last had anti-tippers or anti-rollback to the wheelchair, but it must have been a long time ago. 4. Review of Resident #3's medical record revealed an admission date of 04/14/21. Diagnoses included Wernicke's encephalopathy, Parkinson's disease, degeneration of the nervous system, muscle weakness and history of falling. Review of the quarterly MDS assessment dated [DATE] revealed Resident #3 was cognitively intact. Resident #3 used a walker, required partial/ moderate assistants to stand and to ambulate. Review of the care plan for Resident #3 revealed is at risk for falls related to a history of falls, psychoactive medications, syncope. Resident is impulsive- paces much of the day. Interventions included to encourage use of hipster padded undergarments to reduce risk of serious injury. Observation and interview on 02/21/24 at 4:30 P.M., with STNA #283 and #213 of Resident #3 confirmed Resident #3 was not wearing hipsters and had none were available in his room. STNA #213 revealed she believed Resident #3 was supposed to wear hipsters, but none was available. Resident #3 revealed he would wear hipsters if he had them. Interview on 02/27/24 at 10:40 A.M., with DON confirmed Resident #3 had no hipsters available in the facility. Observation of the laundry storage area with DON confirmed the facility had one small (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 17 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some pair of hipsters, no other hipsters were available. DON confirmed Resident #3 wore a large. DON revealed staff were not offering or applying the hipsters. 5. Review of Resident #9's medical record revealed an admission date of 03/30/21. Diagnoses included anxiety disorder, muscle weakness, age related nuclear cataract bilateral, unspecified convulsions, contracture of the left hand, need for assistants with personal care, and nicotine dependence, cigarettes. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #9 was unable to complete the interview. Resident #9 required assistants with activities of daily living. Review of the care plan dated 04/08/21 revealed Resident #9 had potential for injury due to smoking habit. Resident #9 required supervision/monitoring for assistants while smoking. Interventions included Resident #9 was to utilize a smoking apron and a cigarette holder device while smoking. Review of the progress note dated 11/21/23 at 12:59 A.M. completed by Certified Nurse Practitioner CNP #290 revealed Chief Complaint/Reason for this visit was the facility requested visit for wound to right thigh. Staff were assisting (Resident #9) with bathroom/hygiene care, and they noticed a blister on the right thigh. Staff also noticed a hole burned in the same location of her sweatpants. Resident had returned from smoke break recently. She wears fire resistant bib when out on smoke breaks. Resident was a current smoker every day. A treatment was ordered to the right thigh blister. Staff to ensure proper placement of fire resistance bib when out smoking. Interview on 02/22/24 at 3:42 P.M., with DON verified Resident #9 had a cigarette burn to her right thigh that occurred on 11/21/23. DON revealed on the day Resident #9 obtained the burn to the right thigh, the cherry of the cigarette fell on her thigh. DON revealed staff was with Resident #9 on that day but did not have her smoking apron on. DON revealed after the burn occurred, staff were verbally in serviced to assure they placed the smoking apron on Resident #9 while smoking but nothing was in writing. Observation on 02/22/24 at 3:44 P.M., with DON of Resident #9's right thigh revealed a small circular scar to the thigh. DON confirmed that was where the cigarette burns healed. 6. Review of Resident #14's medical record revealed an admission date of 02/25/21. Diagnoses included Tourette's syndrome, intervertebral disc degeneration, unspecified dementia, scoliosis, and repeated falls. Review of the quarterly MDS dated [DATE] revealed Resident #14 was severely cognitively impaired. Resident #14 was independent with sit to stand, transfers and ambulation. Review of the care plan dated 12/28/23 revealed Resident #14 was at risk for falls related to significant cognitive impairment, diminished safety awareness, wandering, and forgetting to use assistive devices. Interventions included to encourage resident to wear hipsters at all times. Review of the physician orders for Resident #14 dated 12/28/21 revealed encourage hipsters to be worn when out of bed as tolerated. May remove for personal care. Observation on 02/21/24 at 10:00 A.M., with STNA #219 confirmed Resident #14 was not wearing hipsters. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 18 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of the Treatment Administration Record (TAR) for Resident #14 for February 2024 revealed the hipsters were signed for each shift. Interview on 02/27/24 at 10:40 A.M., with DON confirmed the TAR for Resident #14 was being signed by nurses and revealed the hipsters were offered. DON confirmed Resident #14 wore a size medium hipster and there was none available in the facility to offer. DON revealed she was aware nurses were signing the TAR without reading or completing the task they signed for. Review of the policy titled, Fall and Incident Investigation dated 07/22/22, included in compliance with federal and state regulations, all resident occurrences, whether falls or incidents will be documented and investigated to ascertain root cause and have a plan developed to prevent reoccurrence. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 19 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, and record review, the facility failed to provide nutritional supplements per physician orders. This affected one (#9) of three residents reviewed for supplements. The facility census was 40. Residents Affected - Few Findings include: Review of Resident #9's medical record revealed an admission date of 03/30/21. Diagnoses included aphasia, dysphagia, and protein calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) for Resident #9 revealed the resident was unable to complete the cognitive status interview. Resident had weight loss not on prescribed weight loss regimen. Review of the care plan dated 12/28/23 revealed Resident #9 had a nutritional problem related to disease process per nutritional assessment with a history of difficulty with chewing and swallowing. Interventions included providing supplements per order and provide and serve diet as ordered. Review of the physician orders for February 2024 included Resident #9 was to receive a mechanical soft diet with thin liquids and a magic cup two times a day. Observation on 02/20/24 at 4:30 P.M., revealed Dietary Manager #282 was serving resident trays. Dietary Manager #282 revealed the kitchen staff provided magic cups (frozen nutritional treat) on residents meal trays. Dietary Manager #282 revealed there were times the facility ran out of supplements. Observation on 02/20/24 at 4:40 P.M., revealed Resident #9 was sitting in the dining room eating her dinner. Resident #9's meal ticket had (frozen nutritional treat) on the ticket. Resident #9 did not have the magic cup (frozen nutritional treat) on her tray. Interview with Licensed Practical Nurse #259, at the time of the observation, verified Resident #9 did not receive her magic cup (frozen nutritional treat) as ordered by the physician. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 20 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure a resident was free from a significant medication error when medications were not administered per the physicians order. This affected one (#37) of three residents reviewed for medication administration. The facility census was 40. Residents Affected - Few Findings include: Review for Resident #37's medical record revealed an admission date of 08/21/23. Diagnoses included unspecified psychosis and dementia. Review of the progress note dated 12/29/23 at 12:52 P.M., completed by Licensed Practical Nurse (LPN) #201 included the nurse was notified by the physician that Resident #37 was hard to arouse and diaphoretic. The physician ordered a stat (immediate) laboratory test (labs). Review of the physician orders revealed on 12/29/23 an order for Resident #37 was received for STAT Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC) with differential (Diff) and a Urinalysis (UA) culture and sensitivity (C&S). Review of the progress note for Resident #37 dated 01/01/24 at 6:10 P.M., completed by Registered Nurse (RN) #292, revealed the lab results were received for Resident #37 and the potassium level was 5.8; (Certified Nurse Practitioner) CNP was notified, and new orders were received. Review of the untimed physician order for Resident #37 dated 01/01/24 revealed an order for Lokelma oral packet 10 grams one packet two times a day for three administrations for hyperkalemia. Review of the Medication Administration Record (MAR) for Resident #37 revealed Lokelma was not administered on 01/01/24 due to not being available. Review of the MAR revealed on 01/02/24 one dose of Lokelma was administered at 9:00 A.M.; further review of the MAR revealed no further doses of Lokelma was administered. Review of the progress notes and medication administration notes for Resident #37 revealed no documentation was completed to determine why Lokelma was not administered for the three doses. Interview on 02/22/24 at 3:01 P.M., with CNP #290 revealed a high and low potassium levels could cause cardiac arrhythmia's and if the potassium level got critically high, it could cause cardiac arrest. CNP #290 confirmed after she was made aware of the high potassium level, she ordered Lokelma 10 grams for three doses, (decreases the potassium level). CNP #290 confirmed she was not made aware Resident #37 only received one of the three doses ordered. Interview on 02/22/24 at 4:43 P.M., with Director of Nursing (DON) confirmed Resident #37 only received one of the three doses of Lokelma ordered. DON also confirmed the physician nor CNP were notified of the missed doses of Lokelma for Resident #37. DON revealed she was not sure what happened, either the pharmacy did not deliver the medication, or the medication was input into the Electronic medical record incorrectly. DON revealed she would have expected the nurse to notify CNP/MD immediately if the medication was not available. DON confirmed the resident did not have any significant side effects from not receiving the medication as ordered. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 21 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy, the facility failed to ensure medications were stored in a secure manner. This affected one (#7) and had the potential to affect 10 (#6, #13, #17, #18, #20, #24, #28, #34, #90 and #92) additional residents residing in the Memory Care Unit. The facility census was 40. Findings include: 1. Review of Resident #7 revealed an admission date of 06/22/15. Diagnoses included unspecified dementia moderate with psychotic disturbance, restlessness and agitation, delirium, noncompliance with other medical treatment, and wandering. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #7 was severely cognitively impaired. Resident #7 had no impairment to upper or lower extremities and was independent with ambulation. Review of the care plan for Resident #7 dated 01/12/24 revealed Resident #7 had a behavior problem of refusing medication. Interventions included anticipating and meeting the resident's needs. Review of the Medication Administration Record (MAR) revealed Resident #7 received cetirizine HCL 10 milligrams (mg), Depakote sprinkles 250 mg, fluphenazine hcl concentrate five mg, tamsulosin 0.4 mg capsule, and Zoloft 50 mg, during the morning medication pass on 02/20/24. Orders also included may put medicine in food/drinks every shift. Interview on 02/20/24 at 10:18 A.M., with Licensed Practical Nurse (LPN) #225 revealed LPN #225 was at her medication cart located in the hall in the Memory Care Unit. LPN #225 revealed Resident #7 had an order to put his medication in his drink or food. LPN #225 revealed Resident #7 liked coffee so the nurses put his medication in his coffee. LPN #225 revealed she already put all Resident #7's morning medication in his coffee (confirmed listed as above), and he was in the activity room drinking it. LPN #225 confirmed she left the coffee with the medications in it with Resident #7 to drink and confirmed she was unable to see Resident #7 to confirm he was consuming all his medication. Observation on 02/20/24 at 10:21 A.M., with LPN #225 revealed Resident #7 was sitting in the activity room of the Memory Care Unit with Resident #6. No staff were in the area. Resident #7 had a Styrofoam cup sitting in front of him with a lid. Observation revealed there was no more coffee in the cup. In the bottom of the cup and along the sides were reminiscences of crushed medications that did not dissolve. LPN #225 stated most of the medication was the tamsulosin because it does not dissolve but she would leave it with him until he took it all. LPN #225 verified she routinely left Resident #7's coffee and medications with him unsupervised. Review of the census revealed there were 10 additional residents (#6, #13, #17, #18, #20, #24, #28, #34, #90 and #92) residing on the Memory Care unit. 2. Observation on 02/20/24 at 1:00 P.M. revealed State Tested Nursing Assistant (STNA) #204 pushed the code on the door to the nurses station in the memory care unit and entered the nurses station. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 22 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation revealed inside the nurses station was two large plastic bags sitting on the counter behind the nurses station. LPN #225 revealed the bags had medications inside. LPN #225 verified the medications on the counter were to be returned to pharmacy and confirmed a medication refrigerator was present that did not have a lock on it. Observation revealed inside the refrigerator were four unopened vials of insulin and one partial bottle of tuberculin. Interview at the time of the observation, with LPN #225 confirmed all STNA's had the code to the door to enter the nurses station and confirmed they would have access to the unsecured medications behind the nurses station. Observation and interview on 02/20/24 at 1:05 P.M., LPN #225 then left the nurses station, no staff were present in the nurses station, LPN #225 walked up the hall turning the corner to the next hall when the surveyor requested her to return. Observation revealed when LPN #225 exited the nurses station, she closed the door, but the door did not latch allowing the residents residing in the memory care unit access to enter the nurses station where medications were not secured, and staff were not present. LPN #225 returned to the nurses station and verified the door was not secured revealing sometimes it does that. Observation revealed Resident #7 was ambulating near the nurses station. LPN #225 confirmed there were 11 residents residing in the Memory Care Unit who would have the ability to enter the area (Resident #6, #7, #13, #17, #18, #20, #24, #28, #34, #90 and #92). Interview on 02/20/24 at 1:25 P.M., with Director of Nursing (DON) confirmed medications unsecured in the Memory Care Units nurses station were one full bottle of phenytoin oral suspension, one full bottle of lactulose, buspirone hcl tablets and one fluticasone propionate nasal spray. DON confirmed STNA's knew the code to the nurses station and had access to unsecured medications. Review of the policy titled, Medication Storage dated 05/01/22, included the facility shall store all drugs and biologicals in a safe, secure, and orderly manner. Medications requiring refrigeration must be stored in a refrigerator located in the drug room at the nurses station or other secured location. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 23 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. Based on record review, staff interview, and review of the policy, the facility failed to notify the physician/Certified Nurse Practitioner (CNP) timely of a high potassium level (lab value) for one resident. This affected one (#37) of three residents reviewed for physician notification of lab results. The facility census was 40. Findings include: Review for Resident #37's medical record revealed an admission date of 08/21/23. Diagnoses included unspecified psychosis and dementia. Review of the progress note dated 12/29/23 at 12:52 P.M., completed by Licensed Practical Nurse (LPN) #201 included the nurse was notified by the physician that Resident #37 was hard to arouse and diaphoretic. The physician ordered a stat (immediate) laboratory test (labs). Review of the physician orders revealed on 12/29/23 an order for Resident #37 was received for STAT Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC) with differential (Diff) and a Urinalysis (UA) culture and sensitivity (C&S). Record review of the progress note dated 12/29/23 at 8:50 P.M. completed by LPN #274, Resident #37 refused the lab draw and a STAT lab work to be called in first thing in am for re-attempt. Review of the resulting lab report for Resident #37 revealed the blood work was collected 12/30/23 at 1:20 P.M. The results were faxed to the nurse at the facility on 12/31/23 at 6:13 P.M. Results included the potassium level was 5.8 (High) normal range was 3.5 to 5.1 Review of the progress note for Resident #37 dated 01/01/24 at 6:10 P.M., completed by Registered Nurse (RN) #292 revealed the lab results were received for Resident #37 and the potassium level was 5.8; (Certified Nurse Practitioner) CNP was notified and new orders were received. Review of the physician order for Resident #37 dated 01/01/24 revealed an order for Lokelma oral packet 10 grams one packet two times a day for hyperkalemia. Interview on 02/22/24 at 3:01 P.M. with CNP #290 confirmed she, nor the physician, was notified of the high potassium level for Resident #37 until 01/01/24. CNP #290 revealed a high and low potassium levels could cause cardiac arrhythmia's and if the potassium level got critically high, it could cause cardiac arrest. CNP #290 confirmed after she was made aware of the high potassium level, she ordered Lokelma 10 grams for three doses, (decreases the potassium level). Interview on 02/22/24 at 4:43 P.M., with Director of Nursing (DON) revealed she would have expected the nurse to notify CNP/MD immediately after receiving the lab result at the facility on 12/31/23 at 6:13 P.M. Review of the policy titled, Change in Condition Monitoring dated 05/01/22, included our facility shell promptly notify the resident, his or her attending physician, and Family/ POA/Guardian of changes in the residents medical/mental condition and or status. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 24 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0773 This deficiency represents non-compliance investigated under Complaint Number OH00150668. 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: 365370 If continuation sheet Page 25 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, staff interview, and review of the policy, the facility failed to consistently document three residents controlled drug administration on their Medication Administration Record (MAR). This affected three (#1, #2 and #3) of four residents reviewed for accuracy of documentation on the medication administration record. The facility census was 40. Findings include: 1. Review of Resident #1's medical record revealed an admission date of 05/07/15. Diagnoses included lumbago with sciatica, low back pain and dementia. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #1 was moderately cognitively impaired. Record review of the physician orders for February 2024 revealed resident had an order to receive oxycodone hcl tablet five mg by mouth every six hours as needed for pain. Record review of the Controlled Drug Record compared to Resident #1's Medication Administration Record (MAR) for February 2024 revealed Resident #1 received oxycodone hcl tablet five mg by mouth on 02/02/24 at 9:00 P.M., 02/03/24 at 1:00 A.M., 02/03/24 at 8:11 A.M., 02/08/24 at 2:00 P.M. and 10:00 P.M., 02/09/24 at 9:00 A.M., 02/13/24 at 2:30 P.M., 02/15/24 at 9:00 A.M., and 02/17/24 at 10:00 P.M. that was not documented in Resident #1's MAR. 2. Review for Resident #2's medical record revealed an admission date of 11/20/18. Diagnoses included traumatic brain injury, personal history of traumatic fracture, and presence of right artificial hip joint. Review of the quarterly MDS dated [DATE] revealed Resident #2 was cognitively intact. Resident received as needed pain medication for frequent pain. Record review of the physician orders dated 09/11/23 revealed Resident #2 was to receive oxycodone hcl oral tablet five mg one tablet by mouth every 12 hours as needed for moderate to severe pain. Record review of the Controlled Drug Record compared to Resident #2's MAR for February 2024 revealed Resident #2 received oxycodone hcl oral tablet five mg one tablet by mouth on 02/01/24 9:00 A.M., 02/02/24 9:00 A.M., 02/03/24 t 5:00 A.M., 02/06/24 at 1045 P.M., 02/07/24 at 10:40 A.M. and 9:00 P.M., 02/08/24 at 9:00 A.M., 02/09/24 t 9:00 A.M., 02/10/24 at 9:00 P.M., 02/11/24 at 10:40 P.M., 02/12/24 at 9:00 A.M., 02/13/24 at 9:30 A.M. and 9:00 P.M., 02/15/24 at 10:00 A.M., 02/20/24 at 12:40 P.M., and 02/21/24 at 2:00 P.M. that was not documented in Resident #2's MAR. 3. Review for Resident #3's medical record revealed an admission date of 04/14/21. Diagnoses included Alzheimer's disease and anxiety disorder. Record review of the quarterly MDS dated [DATE] revealed Resident #3 received medication for anxiety. Record review of the physician orders dated 02/07/24 revealed Resident #3 received ativan one mg by mouth every six hours as needed for anxiety. Record review of the Controlled Drug Record compared to Resident #3's MAR for February 2024 revealed Resident #3 received the Ativan one mg on 02/02/24 at 12:40 P.M., 02/08/24 at 7:00 A.M., 02/09/24 at 10:00 A.M. and 10:00 P.M., 02/13/24 at 9:00 A.M. and 8:00 P.M., 02/16/24 and 02/20/24 at 6:17 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 26 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0842 P.M. that was not documented in Resident #3's MAR. Level of Harm - Minimal harm or potential for actual harm Interview on 02/22/24 at 2:28 P.M., with Director of Nursing (DON) confirmed nurses documented on the Controlled Drug Record when the pulled a controlled drug for a resident. The nurse then was required to document on the Resident's MAR when the resident received the medication for accuracy of administration. DON confirmed Resident #1, #2, and #3 did not have accurate documentation of controlled medications on the MAR. Residents Affected - Few Review of the policy titled, Medication Administration dated 05/01/22, included the individual administering the medication must initial the resident's MAR on the appropriate line after giving each medication and before administering the next one. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 27 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, resident interview, staff interviews, record review and review of the policies, the facility failed to maintain infection control practices of hand washing and during oxygen therapy. This affected four (#2, #6, #16 and #17) of six residents reviewed for infection control. The facility census was 40. Residents Affected - Some Findings include: 1. Review of Resident #17's medical record revealed an admission date of 01/19/24. Diagnosis included diabetes mellitus. Record review of the admission Minimum Data Set (MDS) revealed Resident #17 was severely cognitively impaired. Record review of the physician order dated 01/09/24. for Resident #17 revealed an order for accu checks (blood sugar checks) before meals and at bedtime for diabetes. Observation on 02/20/24 at 10:18 A.M., of Licensed Practical Nurse (LPN) #225 assess Resident #17's blood sugar using a glucometer revealed LPN #225 removed the glucometer from the medication cart drawer. LPN #225 took the glucometer in Resident #17's room, sat the glucometer directly on Resident #17's nightstand and put on a pair of disposable gloves. LPN #225 did not clean the area on the nightstand or use a barrier. LPN #225 then assessed Resident #17's blood sugar using a lancet and the glucometer. LPN #225 then left Resident #17's room (did not remove the gloves or wash her hands), returned to the medication cart, removed her gloves, put the glucometer back in the medication cart (did not clean the glucometer before putting it away), then documented the blood sugar value in the electronic medical record. LPN #225 then reviewed orders for Resident #6. 2. Review of #6's medical record revealed an admission date of 11/30/23. Diagnosis included diabetes mellitus. Record review of the physician order for Resident #6 revealed an order for check blood sugar twice a day and as needed for signs of hypoglycemia or hyperglycemia. Observation on 02/20/24 at 10:34 A.M. of LPN #225 assesses Resident #6's blood sugar using a glucometer revealed LPN #225 removed the glucometer (the same glucometer used for Resident #17) from the medication cart drawer. LPN#225 took the glucometer in Resident #6's room, sat the glucometer directly on Resident #6's table and put on a pair of disposable gloves. LPN #225 did not clean the area on the table or use a barrier. LPN #225 then assessed Resident #6's blood sugar using a lancet and the glucometer. LPN #225 then left Resident #6's room (did not remove the gloves or wash her hands), returned to the medication cart, removed her gloves, put the glucometer back in the medication cart (did not clean the glucometer before putting it away), documented the blood sugar value in the electronic medical record). Interview on 02/20/24 at 10:38 A.M., with LPN #225 verified she did not wash her hands or use hand sanitizer at any point before, during or after assessing Resident #17's blood sugar, she did not wash her hands or use hand sanitizer prior to or after assessing Resident #6's blood sugar. LPN #225 verified she did not clean the area or place a barrier in Resident #17's or #6's room prior to setting the glucometer down and verified she did not clean the glucometer after using the glucometer on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 28 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0880 Level of Harm - Minimal harm or potential for actual harm Resident #17 and before using the glucometer on Resident #6 and before putting the glucometer back in the medication cart after assessing Resident #6's blood sugar. 3. Review of Resident #16's medical record revealed an admission date of 03/19/20. Diagnoses included unspecified dementia, dysphagia following cerebral infarction, and need for assistants with personal care. Residents Affected - Some Review of the quarterly Minimum Data Set, dated [DATE] revealed Resident 16 was moderately cognitively impaired. Resident required substantial/maximum assistants with personal hygiene. Review of the physician orders revealed Resident #16 received a physician order on 01/05/24 gently wash peg tube site with soap and warm water, pat dry, sprinkle nystatin powder and cover with drain sponge daily and as needed. Observation on 02/20/24 at 4:03 P.M., of Licensed Practical Nurse (LPN) #259 complete the dressing change to Resident #16's peg tube site revealed LPN #259 removed the old dressing which was undated at Resident #16's peg tube site. The site was deep red and had a moderate amount of thick yellow drainage at the site. LPN #259 removed the dressing then removed her gloves, did not wash hands, then left the room and returned with gauze. LPN #259 again did not wash her hands, cleansed the site with normal saline, did not wash her hands after cleansing the site, applied the clean dressing and tape. LPN #259 then disposed of the old dressing supplies and left the room (without washing her hands). LPN #259 then went back to her medication cart and opened the drawer of the cart. LPN #259 verified she never washed her hands or used hand sanitizer at any time during or after Resident #16's dressing change to her peg tube site. 4. Review of Resident #2's medical record revealed an admission date of 11/20/18. Diagnoses included chronic obstructive pulmonary disease, traumatic brain injury, pulmonary hypertension, and presence of right artificial hip joint. Review of the quarterly MDS dated [DATE] revealed Resident #2 was cognitively intact. Record review of the physician orders for Resident #2 included: 1. Ipratropium-Albuterol Inhalation Solution 0.5-2.5 milligrams (mg) per milliliter (ml) give one dose inhale orally via nebulizer four times a day for shortness of breath dated 11/04/23. 2. Oxygen at four liters to maintain (pulse oximetry) SPO2 above 92% every shift dated 04/28/22. 3. Change all oxygen tubing on Sunday night shift, date time and initial all tubing, place in clear bag with date, time, and initials on it when not in use. Change if soiled, includes concentrator and aerosol machine tubing and mask/inhalation tubing, dated 01/08/23. Observation on 02/20/24 at 1:49 P.M. revealed Resident #2 was not in his room. Observation revealed an oxygen e-tank was sitting next to the bed. The oxygen tubing and nasal cannula for the e-tank were lying on the floor. The nasal cannula tips of the tubing were both dark brown. The tubing was undated. Further observation revealed the nasal cannula tubing connected to the concentrator was also lying on the floor. The nasal cannula tips of the tubing were both dark brown. The tubing was undated. Observation of the aerosol mask revealed the mask and tubing were both lying on the floor. Observation revealed the mask or tubing was not dated. There were no bags for storage of the oxygen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 29 of 30 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 365370 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Momentous Health at Richfield 4360 Brecksville Rd Richfield, OH 44286 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 0880 supplies visibly present. Level of Harm - Minimal harm or potential for actual harm Observation on 02/21/24 at 8:35 A.M., of Resident #2 revealed Resident #2 was lying in his bed watching TV. Resident #2 had his oxygen on using the nasal cannula from the concentrator. Resident #2 revealed he did not know if the facility changed his oxygen tubing but when he removed the tubing it would often fall from the bed onto the floor. Residents Affected - Some Observation on 02/21/24 at 9:10 A.M., with Corporate Nurse Registered Nurse (RN) #291 confirmed Resident #2's oxygen e-tank was sitting next to the bed. The oxygen tubing and nasal cannula for the e-tank were lying on the floor. The nasal cannula tips of the tubing were both dark brown. The tubing was undated. Further observation revealed the nasal cannula tubing connected to the concentrator was also lying on the floor. The nasal cannula tips of the tubing were both dark brown. The tubing was undated. Observation of the aerosol mask revealed the mask and tubing were both lying on the floor. Observation revealed the mask or tubing was not dated. There were no bags for storage of the oxygen supplies visibly present. Further observation revealed the floor was very dirty, unkept. Corporate Nurse Registered Nurse (RN) #291 confirmed these were the tubing's Resident #6 routinely used daily for oxygen needs and aerosol treatments. Corporate Nurse Registered Nurse (RN) #291 confirmed the tubing's should be stored in bags when not in use and dated. The visibly soiled cannula's should have been replaced before further use. Review of the policy titled, Oxygen Administration dated 05/01/22, revealed oxygen tubing should be changed weekly, nasal cannula tubing may need to be changed more frequently. Review of the policy titled, Infection Control Overview dated 05/01/22, included employees must wash their hands for 20 seconds using soap and water under the following conditions: after contact with blood or other body fluids, after removing gloves, after removing items potentially contaminated with blood or body fluids or secretions. In most situations, the preferred method of hand hygiene is with an alcohol based handrub for the following situations: Before or after direct contact with a resident, before performing any non-surgical invasive procedure, before handling clean or soiled dressing, gauze, pad, etc; before moving from a contaminated body site to a clean body site, after handling used dressings and after removing gloves. This deficiency represents non-compliance investigated under Complaint Number OH00150668. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365370 If continuation sheet Page 30 of 30