Inspection·October 22, 2025

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few they (#1 and #93) were both sitting in the common area and talking. Resident #93 stated they were joking around but he never touched her. Resident #93 stated he was told she was telling people he pulled her pants down. Resident #93 denied the allegation and revealed there were no staff or other residents in the area at that time. The facility's investigation did not have any staff statements and did not identify what staff members supervised smoke breaks on 10/05/25, did not include staff statements to identify who assisted with smoke breaks on 10/05/25, and did not identify who worked with Residents #1 and #93 to investigate if anyone staff members heard or witnessed the incident. The investigation did not have Resident #2's statement who reported it to Resident #1's husband. Interview and observation on 10/22/25 at 10:22 A.M. revealed Resident #1 was well groomed and sitting on the edge of her bed. Resident #1 revealed there was a man who pulled her pants down, he would go out to smoke with the smoking group. Resident #1 revealed he did not touch her private area and stated, He just came up from behind me and pulled them down. Resident #1 demonstrated while stating that he grabbed the sides of her pants and pulled them down to her lower thighs. Resident #1 stated she told him (#93), You're an idiot pulled her pants up and went directly to her room. Resident #1 confirmed she was upset and when she returned to her room, her roommate (Resident #2) was present and discussed why she was so upset. Resident #1 stated she forgets things but not that. Resident #1 stated he (Resident #93) was just joking or something. Interview on 10/22/25 at 10:39 A.M. with Resident #2 stated her roommate (Resident #1) was sexually assaulted on 10/05/25 and she came up to their room upset. Resident #2 stated Resident #1 came from smoking, she was crying, she said she was grabbed by the waist, he (Resident #93) pulled her (Resident #1) pants down and grabbed her 'private'. Resident #2 revealed Resident #1's husband came the following morning. Interview on 10/22/25 at 11:32 A.M. with the Administrator revealed Resident #2 reported the allegation to Resident #1's husband via telephone. An SRI was initiated, and the allegation was investigated. The SRI was unsubstantiated. Resident #1 refused to go to the hospital for an evaluation. The Administrator revealed the incident occurred where residents wait to go outside to smoke according to Resident #1. Resident #93 denied he pulled her pants down and said there were no witnesses. The Administrator stated Resident #1 said 'someone' pulled her pants down, and Resident #1 could not remember who did it. Resident said the resident was joking. Interview on 10/22/25 at 1:31 P.M. with the DON revealed she interviewed Resident #1 with her husband and the Administrator. The DON stated she asked Resident #1 what happened and Resident #1 said after the smoke break, her and a guy (#93) were sitting in the common area near where the residents go out to smoke. Resident #1 said he (#93) pulled her pants down. She asked if he touched her inappropriately (in her private area), she stated no. The DON told Resident #1 the facility would send her to the hospital for an evaluation. Resident #1 refused and said no one touched her, they were joking around. The DON confirmed Resident #1 told her that he pulled her pants down but did not touch her private area. The DON confirmed there were no staff interviewed regarding the incident or for potential like behaviors from Resident #93 with other residents. The DON stated Resident #1 had never made up stories in the past while residing at the facility. The DON confirmed the facility's investigation did not have any staff interviews and confirmed no staff were interviewed regarding the incident or any potential like incidents. The DON confirmed the facility did not interview the residents and staff who went on the same smoke break as Resident #1 and #93. The DON confirmed the police was not called regarding the incident. Observation on 10/22/25 at 1:44 P.M. revealed a small room near the exit to the smoking area. Observation revealed eight residents were outside smoking. Resident #1 and #93 were present but not near each other. Activities Assistant #395 was also present and assisted residents' back into the facility from the smoking break. Resident #93 ambulated with a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365388 If continuation sheet Page 2 of 3 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 365388 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Plaza Extended Care 3600 Franklin Boulevard Cleveland, OH 44113 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 FORM CMS-2567 (02/99) Previous Versions Obsolete steady gait while using a walker without staff assistance. Review of the facility policy titled Abuse, Neglect, Exploitation and Misappropriation of Resident Property dated 01/06/25 revealed it is the facility's policy to investigate all alleged violations involving abuse, neglect, misappropriation of resident property, exploitation or mistreatment including injuries of unknown source. Facility staff should immediately report all such allegations to the Ohio Department of Health (ODH). In cases where a crime is suspected, the Administrator will report the same to local law enforcement. Sexual Abuse included non-consensual sexual contact of any type with a resident. The investigation protocol included to interview the resident, the accused and all witnesses. Witnesses generally include anyone who: witnessed or heard the incident; came in close contact with the resident the day of the incident (including other residents, family members), and employees who worked closely with the accused employees and or alleged victim the day of the incident. If there are no direct witnesses, then the interviews may be expanded. For example, you may wish to interview all employees on the shift or the unit, as appropriate, as well as other residents on the unit. This deficiency represents non-compliance investigated under Complaint Number 2647625. Event ID: Facility ID: 365388 If continuation sheet Page 3 of 3