Health inspection·April 28, 2023

F 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to disclose requested financial information to Resident #16's Financial Power of Attorney (POA) upon request. This affected one resident (#16) of three residents reviewed for financial disclosure. The facility census was 53. Residents Affected - Few Findings include: Record review for Resident #16 revealed an admission date of 09/21/15. Diagnoses included paranoid schizophrenia, unspecified dementia, muscle weakness, abnormalities of gait and mobility, mood disorder with depressive features, delusional disorder, and anxiety disorder. Record review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was cognitively intact. Resident #16 required supervision for bed mobility, transfers, ambulation, dressing and personal hygiene. Resident #16 used a wheelchair for mobility. Record review of Resident #16's profile revealed Resident #16 had a POA over care and financial who was also the emergency contact person, Resident #16's Sister #302. Record review of the Durable Financial Power of Attorney, dated 02/09/16, revealed Resident #16's Sister #302 was granted Durable Financial Power of Attorney on 02/09/16. Record review of the care plan dated 04/25/19 revealed Resident #16 had impaired cognition function/dementia or impaired thought process related to dementia. Interventions included communicating with Resident #16 and his family regarding Resident #16 's capabilities and needs. Record review of the account statements for Resident #16 from 06/01/22 through 03/28/23 revealed quarterly statements were signed by Resident #16. On 08/16/22 Resident #16 had $3378.30 deposited into his account via personal check. On 03/14/23 $1500.00 was debited for funeral. Record review of the Resident Fund Management Service authorization and agreement to handle resident funds form revealed on 07/01/20 Resident #16 signed the form for account type: non-transferring account (no automatic transfer of deposits to pay for care cost). Resident #16 signed and dated the form 07/01/20 with a witness (not Resident #16's POA or facility staff per Administrator) dated 07/01/20. Interview on 04/20/23 at 1:10 P.M. with Resident #16 revealed he did not remember if he ever received banking statements from the facility and revealed he did not know about any money in an account. Resident #16 revealed his sister (Sister #302) paid for what he needed. Interview on 04/24/23 at 11:03 A.M. with the Administrator revealed Resident #16 's Sister #302 expressed concerns over Resident #16's trust (unsure of date). Resident #16's Sister #302 was POA of medical and financial over Resident #16. Resident #16's Sister #302 purchased Resident #16 's personal items and was reimbursed with monies available in Resident #16 's account. The Administrator revealed Resident #16 's Sister #302 was made aware (unsure of date) of the deposit made on 08/16/22 deposited into Resident #16 's account and expressed she was concerned where the money came from. The Administrator revealed the deposit on 08/16/22 was a refund from the facility due to overpayment. The overpayment was found during an audit of resident accounts due to the facility change in ownership in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 2 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few May 2022. An audit of Resident #16's accounts was completed in August 2022 after change in ownership. There was a payment of several thousand dollars that was originally from Resident #16 's ex-wife that was transferred to his trust several years ago (unsure of date but around 2015 to 2016). During the facilities change in ownership, the overpayment from Resident #16's account to the facility was found and refunded (deposited) into Resident #16's account on 08/16/22. The funds needed spent on something appropriate. Resident #16's Sister #302 had been personally prepaying for Resident #16's pre planned funeral expenses. The facility notified Resident #16's Sister #302 that the money was available (unsure of date and no documentation of the date available) and could be used for the funeral expenses. Resident #16 's Sister #302 wanted the money and was concerned she was not made aware at the time the money was deposited, where the money came from, but agreed for the money to go to Resident #16's funeral planning expenses. The Administrator confirmed Resident #16's Sister #302 never received any banking statements for Resident #16. The Administrator revealed Resident #16 received his own billing statements because he was cognitively intact according to his Brief Interview of Mental Status (BIMS). The Administrator confirmed Resident #16 had diagnoses to included paranoid schizophrenia, unspecified dementia, mood disorder with depressive features, delusional disorder, and anxiety disorder. The Administrator revealed she was unaware of when the facility overdrew monies from Resident #16's account that was reimbursed on 08/16/22, or what the money was billed for at that time because she did not have access to that information. The Administrator confirmed she was unable to tell Resident #16's Sister #302 when the facility overdrew monies from Resident #16's account of what the money was billed for because she did not know. This deficiency represents non-compliance investigated under Complaint Number OH00141159. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 3 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to timely assist Resident #12 with toileting to prevent incontinence. This affected one resident (#12) of three residents reviewed for bowel and bladder. The facility census was 53. Findings include: Record review for Resident #12 revealed an admission date of 03/29/23. Diagnoses included reduced mobility, muscle weakness, Crohn's disease with unspecified complications, and polyneuropathy. Record review of the Medicare five-day Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #12 was cognitively intact. Resident #12 was totally dependent of two persons physical assist for transfers and extensive two person assist for toileting. Resident #12 was frequently incontinent of bowel. Record review of the facility tasks from 04/11/23 through 04/24/23 revealed Resident #12 was continent of stool on 18 occasions and incontinent on five occasions. Record review of the care plan dated 02/10/23 for Resident #12 revealed Resident #12 had an activities of daily living self-care performance deficit related to impaired balance, limited mobility, and shortness of breath. Interventions included Resident #12 required extensive assistance of one staff member for toileting. Observation on 04/20/23 at 9:35 A.M. revealed Resident #12's call light had been on, and Resident #12 was sitting in her wheelchair in her doorway of her room. Resident #12 requested surveyor to please help her to the bathroom, she needed to go badly. Observation revealed Licensed Practical Nurse (LPN) #321 was at her medication cart approximately three doors down from Resident #12 passing medications. Resident #12 revealed she had already asked LPN #321 who told her staff were helping others. Resident #12 left her doorway and began propelling herself up the hall revealing she needed to find someone to assist her because she really needed to go. Observation at 9:40 A.M. revealed Resident #12 continued to propel herself back up towards her room, passing LPN #321, and revealed she could not find anyone. Resident #12 went back to sit in her doorway while waiting for assistance. Resident #12 revealed she had Crohn's disease, and it was difficult at times to wait too long. Resident #12 revealed she was incontinent when she could not wait any longer. Observation at 9:40 A.M. revealed LPN #321 was at her medication cart and completed passing medications for one resident and had initiated another resident's medications. Interview with LPN #321 verified she was aware Resident #12 needed assistance to the bathroom and revealed someone would be coming. Resident #12 sat in front of her doorway requesting someone please help. Observation at on 04/20/23 at 9:45 A.M. revealed Resident #12 was still sitting in her doorway with her call light on waiting for assistance to the bathroom. LPN #321 continued to be at her medication cart near Resident #12. Observation revealed two staff members standing near the nurse's station within view of Resident #12 and her activated call light. Observation revealed the two staff members were not assisting another resident at that time. Interview with State Tested Nurse Aide (STNA) #322, revealed she was training STNA #323 and verified she could see Resident #12 sitting in her doorway with the call light activated. STNA #322 revealed she was working the east side of the hall, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 4 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #12 was on the west. STNA #322 revealed she would be able to assist residents on the west side, but she was currently training STNA #323. Observation on 04/20/23 at 9:47 A.M. revealed STNA #318 walking up the hall towards Resident #12. STNA #318 revealed she would assist Resident #12 to the bathroom. Observation of STNA #318 transfer Resident #12 to the bathroom toilet revealed Resident #12 had been incontinent of stool. STNA #318 revealed Resident #12 was continent of stool, she just needed help to transfer to the toilet in time. Observation revealed STNA #318 assisted Resident #12 with incontinence care. Interview on 04/20/23 at 1:45 P.M. with Resident #12's sister revealed her concern Resident #12 was continent of her bowel, but she would have to wait to go to the bathroom at times and sometimes became incontinent while waiting. Interview on 04/20/23 at 1:52 P.M. with the Administrator revealed any nurse or STNA could assist any resident, they did not have to be on their assignment. Interview on 04/24/23 at 2:26 P.M. with the Acting Director of Nursing (DON) revealed if a nurse was passing medications and another resident required assistance, she would expect the nurse to stop after completing the resident she was working on and assist the resident before initiating medications for the next resident. This deficiency represents non-compliance investigated under Complaint Number OH00141599. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 5 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration. **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 timely and routinely provide fresh ice water to five residents (#32, #11, #24, #25 and #12) of 10 residents reviewed for receiving fresh water. The facility census was 53. Findings include: 1. Record review for Resident #32 revealed an admission date of 04/18/23. Diagnosis included aftercare following joint replacement surgery. Record review of the admission Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #32 was cognitively intact. Record review of the physician orders for April 2023 revealed Resident #32 was to receive regular thin fluid consistency. Record review of the care plan dated 04/20/23 included Resident #32 was at risk for altered hydration related to aspiration pneumonia, obesity, and recent surgery. Interventions included to keep water pitcher at bedside within reach filled with water and ice. Interview on 04/20/23 at 8:36 A.M. with Resident #32 revealed no one brought her water for the past two days. Resident #32 revealed the staff did not bring fresh water unless asked. Observation revealed Resident #32 had an empty water cup at her bedside. Observation on 04/20/23 at 1:00 P.M. revealed Resident #32 had an empty water cup at her bedside. Resident #32 confirmed no one had brought any water. 2. Record review for Resident #11 revealed an admission date of 03/20/23. Diagnoses included encounter for other orthopedic aftercare, muscle weakness, and muscle wasting and atrophy. Record review of the admission MDS assessment dated [DATE] revealed Resident #11 was cognitively intact. Resident #11 required extensive assistance of two persons for bed mobility, transfers, and supervision with set up help only for eating. Record review of the physician order dated 03/22/23 revealed Resident #11 received a regular diet, regular texture thin consistency. Interview on 04/20/23 at 8:59 A.M. with Resident #11 revealed she had to ask for water daily then waited for an extended amount of time, sometimes hours to get the water. Observation revealed Resident #11 had an empty cup at her bedside. No water was available for her to drink. Observation and interview on 04/20/23 at 1:22 P.M. with Resident #11 revealed she had no drinking water. The cup at her bedside remained empty. Resident #11 revealed she asked for water after breakfast, but no one had brought any yet. 3. Record review for Resident #24 revealed an admission date of 02/09/22. Diagnoses included heart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 6 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0807 failure, epilepsy, and muscle weakness. Level of Harm - Minimal harm or potential for actual harm Record review of the quarterly MDS assessment dated [DATE] revealed Resident #24 was cognitively intact. Resident #24 required extensive assistance with bed mobility, transfers, locomotion, and supervision with set up help for eating. Residents Affected - Some Record review of the physician orders for April 2023 revealed Resident #24 received regular thin fluids. Record review of the care plan for Resident #24 dated 01/30/23 Resident #24 was at risk for malnutrition and altered hydration. Interventions included to keep water pitcher at bedside within reach filled with water/ice. Interview on 04/20/23 at 8:54 A.M. with Resident #24 revealed he had not had any water. Resident #24 revealed he only got water when he asked. Observation revealed Resident #24 had an empty water cup at his bedside. Observation on 04/20/23 at 1:20 P.M. revealed Resident #24 had an empty water cup at his bedside. Resident #24 confirmed no one had brought any water. 4. Record review for Resident #25 revealed an admission date of 05/26/21. Diagnoses included moderate protein calorie malnutrition, type two diabetes mellitus, and muscle weakness. Record review of the annual MDS assessment dated [DATE] revealed Resident #25 was severely cognitively impaired. Resident #25 required supervision with set up help only for eating. Record review of the physician orders for Resident #25 for April 2023 included regular texture diet, thin consistency. Record review of the care plan dated 02/14/23 revealed Resident #25 was at risk for malnutrition and altered hydration. Interventions included to keep water pitcher at bedside within reach filled with water/ice. Interview on 04/20/23 at 9:23 A.M. with Resident #25 revealed he had no water, and he would not receive water unless he asked. Observation revealed Resident #24 had an empty water cup at his bedside. Observation on 04/20/23 at 1:40 P.M. revealed Resident #25 had an empty water cup at his bedside. Resident #25 confirmed no one had brought any water. Interview on 04/20/23 at 1:41 P.M. with State Tested Nursing Assistant (STNA) #307 confirmed Residents #11, #32, #24, and #25 did not have water. STNA #307 revealed he tried to pass water when they asked for it, but they need to ask. 5. Record review for Resident #12 revealed an admission date of 03/29/23. Diagnoses included reduced mobility, muscle weakness, Crohn's disease with unspecified complications, and polyneuropathy. Record review of the Medicare five-day MDS assessment dated [DATE] revealed Resident #12 was cognitively intact. Resident #12 required assistance with activities of daily living. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 7 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0807 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of the care plan dated 02/10/23 for Resident #12 revealed Resident #12 had an activities of daily living self-care performance deficit related to impaired balance, limited mobility, and shortness of breath. Interventions included Resident #12 required assistance with activities of daily living. Interview on 04/20/23 at 9:35 A.M. with Resident #12 revealed she had no water. Observation revealed Resident #12 had an empty water cup at her bedside. Observation and interview on 04/20/23 at 9:55 A.M. with STNA #318 confirmed Resident #12 had no drinking water. STNA #318 revealed she passed ice water only when a resident requested it. STNA #318 revealed she did not have enough time to give all residents ice water every day. Interview and observation on 04/20/23 at 1:45 P.M. with Resident #12's sister revealed she was frustrated Resident #12 still had no ice water and that happened frequently. Observation revealed Resident #12 had an empty water cup at her bedside. Interview on 04/24/23 at 10:40 A.M. with Certified Nurse Practitioner (CNP) #310 revealed when she visited residents at the facility, she has had to get residents water herself before. Interview on 04/24/23 at 2:26 P.M. with the Director of Nursing (DON) revealed residents should get water routinely and throughout the day. Review of the facility policy titled, Hydration Cart Guidelines, undated, revealed Dietary will be responsible for maintaining and filling the ice cart daily prior to each cart pass. Activities will coordinate with various departments to ensure that the cart is passed twice daily. Ice water is passed to all residents each shift by Activities unless medically contraindicated. This deficiency represents non-compliance investigated under Complaint Number OH00141599. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 8 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure closets were in functioning order for five residents (#16, #39, #24, #11, and #50) of seven residents reviewed for functioning closet doors. The facility failed to ensure Resident #20's heater had the front panel secured. This affected one resident (#20) of one resident reviewed for the heater panel. The facility failed to ensure Resident #11's nightstand was clean and in good repair. This affected one resident (#11) of one resident reviewed for functioning/clean nightstand. The facility failed to ensure soiled clothes were not left on the floor for an extended period for three residents (#16, #39, and #24) of 14 residents reviewed for soiled clothing on the floor. The facility failed to ensure soiled bed pans/urinals were not left in shared bathrooms. This affected nine residents (#16, #39, #11, #21, #4, #50, #25, #40, and #24) of 14 residents bathrooms observed. The facility census was 53. Findings include: 1. Record review for Resident #16 revealed an admission date of 09/21/15. Diagnoses included paranoid schizophrenia, unspecified dementia, muscle weakness, abnormalities of gait and mobility, mood disorder with depressive features, delusional disorder, and anxiety disorder. Record review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #16 was cognitively intact. Resident #16 required supervision for transfers, ambulation, dressing, and personal hygiene. Resident #16 was always continent of bowel and bladder. Record review of the care plan dated 04/03/23 revealed Resident #16 was at risk for falls related to being unaware of safety needs, confusion, and gait and balance problems, and a history of several falls prior to admission. Interventions included Resident #16 required a safe environment with floors free from spills and/or clutter. Observation on 04/20/23 at 8:40 A.M. revealed Resident #16 was lying in his bed. Resident #16 shared a room with Resident #39. The room Resident #16 and Resident #39 shared had a strong foul odor of urine/body odor. Inside the bathroom that Resident #16 and Resident #39 shared was a urinal hanging on the grab bar next to the toilet. The urinal had dried urine in the bottom and surrounding the opening of the urinal. Resident #16 had a basket next to his bed (on his left side of the bed) on the floor full of clothes, spilling onto the floor surrounding the basket, unfolded, and a coat lying on top the clothes. Multiple empty and partially filled cups of a dark drink were sitting on the bedside table and stand. Resident #16's closet was located on Resident #39's side of the room. The right side of the closet was Resident #16's area, and the left side was Resident #39's area. In front of the closet on the floor were multiple soiled shirts and pants in a pile and scattered. A walker and three pairs of shoes were also on the floor in front of the closet. There were two sliding doors to the closet. Both sliding doors were off the hinges and unable to be opened safely. Interview with Resident #16 revealed he was tired, didn't care, and just wanted to go back to sleep. Observation on 04/20/23 at 8:45 A.M. with Dietary Aide #305 confirmed there was a strong odor in Resident #16's room, there was dried urine on the inside and opening of the urinal in the bathroom, the room was cluttered and had clothes on the floor, and the closet doors (utilized by Resident #16 and Resident #39) were both off the hinges, partially opened on each side, and unable to be moved. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 9 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0921 Level of Harm - Minimal harm or potential for actual harm Interview on 04/20/23 at 1:55 P.M. with Housekeeper #309 revealed resident rooms were cleaned one to two times a week. Housekeeper #308 revealed he wiped off tables, cleaned bathrooms (excluding bed pans or urinals) swept, mopped, and replaced toiletry items. Housekeeper #308 revealed he just cleaned around items on floors including soiled clothes, shoes, boxes, etc. Housekeeper #308 confirmed Resident #16's room had a strong foul odor and revealed it was probably from the trash and shoes. Residents Affected - Some 2. Record review for Resident #39 revealed an admission date of 05/11/21. Diagnosis included chronic obstructive pulmonary disease (COPD), muscle weakness, and unsteady on his feet. Record review of the quarterly MDS assessment dated [DATE]revealed Resident #39 was cognitively intact. Resident #39 required supervision with one-person physical assistance for transfers, ambulation, and toilet use. Resident #39 used a walker and wheelchair for mobility and was always continent of bowel and bladder. Interview on 04/20/23 at 8:47 A.M. with Resident #39 confirmed the urinal in the shared bathroom was his. Resident #39 confirmed the left side of the closet was his and the right side was Resident #16s. Resident #39 confirmed the clothes lying on the floor near the front of the closet included multiple shirts and pants. Resident #39 revealed those were his dirty clothes. The staff did not pick them up and take them to laundry unless he asked which was usually a few times a week. Resident #39 revealed his room was cleaned usually one to two times a week. Resident #39 confirmed the doors on his closet were broken and he would not be able to open them without assistance. Resident #39 revealed he was unable to smell an odor. 3. Record review for Resident #24 revealed an admission date of 02/09/22. Diagnoses included heart failure, epilepsy, and muscle weakness. Record review of the quarterly MDS assessment dated [DATE] revealed Resident #24 was cognitively intact. Resident #24 required assistance with bed mobility, transfers, locomotion, dressing, and supervision with set up help for eating. Observation on 04/20/23 at 8:54 A.M. revealed Resident #24 was lying in his bed eating breakfast. Resident #24 had multiple clothing items piled up on his floor near the end of his bed. Resident #24 revealed those were his clothes and they were soiled. Resident #24 revealed the staff will pick them up and take them to laundry a few times a week. Observation on 04/20/23 at 8:56 A.M. with Human Resources (HR) #304 confirmed Resident #24 had multiple clothing items that were soiled piled up on his floor near the end of his bed. 4. Record review for Resident #11 revealed an admission date of 03/20/23. Diagnoses included encounter for other orthopedic aftercare, spinal stenosis, lumbar region with neurogenic claudication, muscle weakness, muscle wasting and atrophy, personality disorder, major depressive disorder, anxiety disorder, and carpal tunnel syndrome. Record review of the admission MDS assessment dated [DATE] revealed Resident #11 was cognitively intact. Resident #11 required extensive assistance of two persons for bed mobility, transfers, and extensive assistance of one person for dressing. Observation on 04/20/23 at 8:59 A.M. with Resident #11 revealed the bedside table had multiple dried spills, the top of the nightstand Resident #11 had personal items sitting on had a film of dust. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 10 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The nightstand had two drawers in the front and was pulled forward and turned at an angle within Resident#11's reach. The back particle board of the nightstand was caved in causing the drawers not to be able to close all the way. Resident #11 had a couch in her room. The couch had multiple clothing items covering the couch. The closet Resident #11 was to store her clothing had two doors. Both doors were off tract and was unable to safely open. Resident #11 had a bathroom shared by two other residents, Resident #21 and #4. Inside the bathroom were three soiled bed pans placed behind two separate handrails. None of the three bedpans had a resident name or were placed in a bag. Resident #11 revealed she used a bedpan at night. Resident #11 also revealed no one had ever wiped her bedside table or nightstand off since she was admitted to the facility. Resident #11 revealed staff cleaned her room once a week and she had to keep her clothes on the couch because the closet was broken. Observation on 04/20/23 at 9:05 A.M. with HR #304 of Resident #11's room revealed HR #304 confirmed the bedside table and the nightstand Resident #11 used were both soiled. The nightstand was broken. Resident #11's clothes were scattered and piled on her couch. The closet doors on Resident #11's closet used to store clothes were off the hinges and unable to be used. HR #304 verified there were three unmarked soiled bedpans in Resident #11's bathroom. The bathroom was shared with two other residents. HR #304 revealed the bed pans should be in a bag and placed in the drawer in the resident's room after each use. 5. Record review for Resident #21 revealed an admission date of 04/06/23. Diagnoses included acute respiratory failure with hypoxia and Alzheimer's disease. Record review of the MDS assessment dated [DATE] revealed Resident #21 had moderately impaired cognition. Resident #21 required assistant with activities of daily living including toilet use. Resident #21 was always incontinent of bowel and bladder. Interview on 04/20/23 at 9:20 A.M. with Resident #21 revealed she was unsure if staff used a bedpan for her. 6. Record review for Resident #4 revealed an admission date of 03/22/23. Diagnoses included atherosclerotic heart disease and weakness. Record review of the MDS assessment dated [DATE] revealed Resident #4 was cognitively intact. Resident #4 required extensive assistants of one person for toileting and was frequently incontinent of bowel and bladder. Interview on 04/20/23 at 9:22 A.M. with Resident #4 revealed staff used a bedpan for her at times. 7. Record review for Resident #20 revealed an admission date of 02/22/23. Diagnoses included epilepsy and epileptic syndromes with seizures, repeated falls, and muscle weakness. Record review of the Medicare five-day MDS assessment dated [DATE] revealed Resident #20 had moderately impaired cognition. Resident #20 required assistance with activities of daily living. Observation on 04/20/23 at 9:14 A.M. revealed Resident #20 was lying in bed. On Resident #20's left side of her bed, near where she was lying, was a large heater connected to the wall. The front panel of the heater that covered the inside, which had multiple wires and the heating system, was broken from the base, exposing the inside. Resident #20 revealed that had been broken as long as she had been there. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 11 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0921 Level of Harm - Minimal harm or potential for actual harm Observation and interview on 04/20/23 at 9:17 A.M. with Maintenance Director #306 revealed the heater in Resident #20's room was used to heat her room. The heater was electric. Maintenance Director #306 confirmed the front panel of the heater was broken and exposing the insides. Maintenance Director #306 confirmed he was aware of multiple residents closet doors broken and revealed they just needed new hardware the bearings. Residents Affected - Some 8. Record review for Resident #50 revealed an admission date of 01/12/21. Diagnosis included chronic obstructive pulmonary disease (COPD). Record review of the quarterly MDS assessment dated [DATE] revealed Resident #50 had severe cognitive impairment. Resident #50 required assistance with activities of daily living, including limited assistance with locomotion in his room. Record review of the care plan for Resident #50 revealed no information on use of a bed pan. Observation on 04/20/23 at 9:21 A.M. revealed Resident #50 was lying in bed resting quietly. Observation revealed Resident #50's closet doors were off the hinges and not functioning. Observation revealed Resident #50 shared a bathroom with Resident #25, #40 and #24. Observation revealed there were three bedpans placed in the grab bars in the bathroom. Two of the bedpans had visible dried stool on them. The bedpans were not in bags and had no names on them. Observation and interview on 04/20/23 at 1:32 P.M. with State Tested Nursing Assistant (STNA) #307 confirmed the broken closet doors in Resident #50's room and confirmed there were three bedpans, two with visibly soiled stool, in the bathroom shared by Residents #50, #25, #40, and #24. STNA #307 revealed he was not sure who's bedpan belonged to who or which residents used a bedpan at night. 9. Record review for #25 revealed an admission date of 05/26/21. Diagnoses included moderate protein calorie malnutrition, type two diabetes mellitus, and muscle weakness. Record review of the annual MDS assessment dated [DATE] revealed Resident #25 was severely cognitively impaired. Resident #25 required assistance with toileting and required supervision with set up help only for eating. Resident #25 was always incontinent of bowel and bladder. Record review of the care plan for Resident #25 revealed no information on use of a bed pan. 10. Record review for Resident #40 revealed an admission date of 02/22/23. Diagnoses included encephalopathy and muscle weakness. Record review of the Medicare five-day MDS assessment dated [DATE] revealed Resident #40 had moderately impaired cognition. Resident #40 required extensive assistance of one staff for toilet use and was always incontinent of bowel and bladder. Record review of the care plan for Resident #40 revealed no information on use of a bed pan. 11. Record review for Resident #24 revealed an admission date of 02/09/22. Diagnoses included acute and chronic respiratory failure and muscle weakness. Record review of the quarterly MDS assessment dated [DATE] revealed Resident #24 was cognitively intact. Resident #24 required extensive assistance for toileting and was occasionally incontinent of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 12 of 13 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 365452 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pearlview Rehab & Wellness Ctr 4426 Homestead Dr Brunswick, OH 44212 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 0921 urine and always incontinent of bowel. Level of Harm - Minimal harm or potential for actual harm Record review of the care plan for Resident #24 revealed no information on use of a bed pan. Interview on 04/20/23 at 1:32 P.M. with Resident #24 revealed he used a bedpan at night at times. Residents Affected - Some Interview on 04/24/23 at 2:12 P.M. with the Administrator revealed resident rooms were cleaned a few times a week including the bathrooms. Trash was also emptied a few times a week and all staff could pick clothes up off the floor. The Administrator revealed there was no housekeeping policy. This deficiency represents non-compliance investigated under Master Complaint Number OH00141599 and Complaint Number OH00141159. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 13 of 13