Health inspection·May 30, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the employee handbook, revised August 2012, revealed respect toward residents was mandatory. Review of the undated facility provided handbook titled, Federal & Ohio Resident Rights & Facility Responsibilities, revealed a facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. Review of the facility policy titled, Resident Rights, revised October 2017, revealed the purpose of the policy was to assure the resident's personal dignity, well-being and self-determination was maintained to assure residents were knowledgeable to their rights and responsibilities in this regard. This deficiency represents non-compliance investigated under Complaint Number OH00142721. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 2 of 17 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 05/30/2023 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 0552 Ensure that residents are fully informed and understand their health status, care and treatments. 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, resident interview, and staff interview, the facility failed to ensure residents were informed of changes in treatments and healthcare. This affected one (#38) of three residents reviewed for participation in treatment and healthcare changes. The facility census was 44. Residents Affected - Few Findings include: Review of Resident #38's medical record identified admission to the facility occurred on 04/12/23 with medical diagnoses including cellulitis of bilateral legs, major depression, high blood pressure, morbid obesity, anxiety, and diabetes. Review of Resident #38's admission assessment dated [DATE] revealed Resident #38 was cognitively intact, was able to walk with supervision, and was occasionally incontinent of bowel and bladder. Review of Resident #38's physician progress notes revealed an in-person visit occurred on 05/17/23 at which time the physician ordered the antibiotic ciprofloxacin (Cipro) 500 milligrams (mg) twice a day for 30 days for cellulitis. Further review of the medical record identified on 05/18/23 a physician order to discontinue the Cipro was noted; however, with no documentation as to the reason. Interview with Resident #38 on 05/30/23 at 8:02 A.M. stated she was never given the Cipro her physician ordered and she had no idea why it was not given to her. Resident #38 confirmed she had cellulitis in both legs and believed she needed the medication. Resident #38 stated she also had her urine checked for an infection, but never heard anything back regarding the results. Resident #38 confirmed she tried to keep up with her medical conditions. Interview with Licensed Practical Nurse (LPN) #214 on 05/30/23 at 10:41 A.M., while LPN #214 reviewed Resident #38's medical record, and stated she thought the reason Resident #38's antibiotic was not started was because of an elevated blood urea nitrogen (BUN) laboratory value that returned on 05/19/23. The interview confirmed Resident #38's urinalysis that was completed on 05/19/23 was negative; however, there was no evidence Resident #38 was notified of the laboratory results. The interview confirmed there was no written evidence of any discussions with Resident #38 regarding her healthcare and or changes in treatment which included why she was not started on the antibiotic medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 3 of 17 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 05/30/2023 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 0678 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interviews, and review of facility policies, the facility failed to ensure basic life support items were immediately accessible to all staff on the emergency cart. The facility also failed to ensure all staff were trained in cardiopulmonary resuscitation (CPR). This had the potential to affect 11 (#9, #11, #16, #18, #20, #21, #24, #34, #35, #36 and #39) of 11 residents who the facility identified had orders in place for initiation of CPR in the event of cardiac or pulmonary arrest. The facility census was 44. Findings include: Interview with Registered Nurse (RN) #207 on [DATE] at 7:27 A.M. stated, in the event a resident with full code orders (full life saving measures, including CPR, for a person with cardiac or respiratory arrest) experienced cardiac or respiratory arrest she would find the emergency cart and see if the supplies needed were inside. Observation on [DATE] at 7:27 A.M., during interview with RN #207, revealed RN #207 approached the emergency cart which was located in the general sitting area on the second floor. RN #207 attempted to open the cart; however, it was secured shut with a plastic zip-tie. The tie was not breakable and RN #207 identified she would have to find scissors to get it open. Interview with RN #207 at that time verified the emergency cart was not readily accessible in an emergency situation. Further observation on [DATE] at 7:46 A.M. revealed RN #207 and Licensed Practical Nurse (LPN) #214 were able to obtain a pair of scissors and open the emergency cart. Interview with the facility Director of Nursing (DON) on [DATE] at 9:47 A.M. stated she was new to the facility and started approximately one month ago. DON stated she could not locate any emergency procedures in the facility for the facility emergency cart. DON confirmed the emergency cart was secured with a plastic zip-tie that was not the break away type, and DON confirmed staff would have to have something to cut open the cart to see what supplies are located in the emergency cart. Interview with DON on [DATE] at 10:03 A.M. stated she was sending a maintenance staff member to buy some break away plastic locks to place on the crash cart as there were none in the facility. Interview with Human Resources Manager (HRM) #254 on [DATE] at 9:55 A.M. confirmed not all direct care staff members were trained and certified related to CPR. The HRM #254 provided a listed of facility direct care staff who do not have CPR certification which included Registered Nurse (RN) #202, RN #205 and RN #208); Licensed Practical Nurse (LPN) #211, LPN #214, LPN #215, LPN #217, LPN #218, LPN #219 and LPN #220. Review of the facility emergency crash cart and automated external defibrillators (AED) policy, dated 2022, revealed the facility will ensure they maintain at least one emergency cart per nursing care floor with additional carts as deemed necessary. The purpose of the policy was to ensure that all supplies critical to basic life support are readily available on the emergency cart. The policy identified the emergency cart is checked every 24 hours and after every use. AED use is authorized from personnel certified in CPR and use of the AED. Nursing staff should be familiar with the content located on and within the emergency crash cart. The policy did not have documented evidence the cart (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 4 of 17 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 05/30/2023 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 0678 would be locked. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 5 of 17 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 05/30/2023 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, and staff interview, the facility failed to ensure nutritional tube feedings were administered as ordered. This affected one (#42) of two residents reviewed for tube feedings. The facility census was 44. Findings include: Review of Resident #42's medical record revealed an admission date of 01/24/23 with medical diagnoses including motor vehicle accident (MVA), acute and chronic respiratory failure, dysphagia, multiple fractures, and tracheostomy status. Review of the quarterly assessment dated [DATE] revealed Resident #42 had impaired cognition and was totally dependant on staff for care. Review of Resident #42's written plan of care for nutrition revealed the plan identified Resident #42 received nothing by mouth and received tube feeding as ordered by the physician. Review of the physician orders revealed Resident #42 was ordered the nutritional intervention of Isosource 1.5 Cal at 65 cubic centimeters per hour (cc/hr) for nutrition. Review of the medication administration record dated 05/23/23 revealed an unidentified night nurse shift documented Resident #42 received Isosource 1.5 Cal at 65 cc/hr. Observation of Resident #42 on 05/24/23 at 7:27 A.M. revealed Resident #42 was located in bed, near the window and had a gastrostomy tube (g-tube) for feeding. Further observation revealed Resident #42 had a feeding tube pump and a bag of Fibersource HN 1.2 Cal running at 65 cc/hr. Observation and interview with the facility Director of Nursing (DON) on 05/24/23 at 9:47 A.M. confirmed Resident #42's tube feeding that was currently being administered was not the correct nutritional supplement. This deficiency represents non-compliance investigated under Master Complaint Number OH00143129. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 6 of 17 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 05/30/2023 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, staff interview, review of manufacture instructions, and review of a facility policy, the facility failed to provide adequate care and services to maintain a tracheostomy in a safe manner. This affected two (#16 and #42) of two residents reviewed with a tracheostomy. The facility identified Resident #16 and Resident #42 as the only residents in the facility with a tracheostomy. The facility census was 44. Residents Affected - Few Findings include: 1. Review of Resident #42's medical record revealed admission to the facility on [DATE] with medical diagnoses including motor vehicle accident (MVA), acute and chronic respiratory failure, dysphagia, multiple fractures, and tracheostomy status. Review of the quarterly assessment dated [DATE] revealed Resident #42 had impaired cognition and was totally dependant on staff for care. Review of Resident #42's physician orders revealed an order for tracheostomy (a surgically created hole in the trachea that provides and alternate airway for breathing) care every shift twice a day and as needed with a disposable #6 Shiley inner cannula. Resident #42 had physician orders to suction as needed as well. Observation of Registered Nurse (RN) #207, Licensed Practical Nurse (LPN) #214, and the facility Director of Nursing (DON) on 05/24/23 at 2:20 P.M. revealed RN #207 noted she was new at the facility and was going to have LPN #214 and the DON assist her to perform tracheostomy care and suctioning for Resident #42. LPN #214 obtained a sealed tracheostomy care kit which contained a plastic compartment tray, vinyl gloves; a water proof drape, one trachea dressing, two gauze pads, one tracheostomy brush, two pipe cleaners, two cotton tip applicators, and one pop-up basin. LPN #214 was on the left side of the bed with RN #207 on the right side of the bed and the DON was located at the foot of the bed during the observation. Continued observation on 05/24/23 at 2:27 P.M., revealed LPN #214 obtained a pair of clean gloves, donned them, and then obtained a sealed tracheostomy suction tube. LPN #214 opened the package and pulled the suction tube out of the sterile package with the clean gloves. LPN #214 then leaned over to Resident #42 and determined he needed repositioned. LPN #214 touched the suctioning catheter, including the tip, on Resident #42's gown and bedding. LPN #214 and RN #207 repositioned Resident #42. LPN #214 then set the suction catheter outside of the package onto Resident #42's bedside stand while turning on the suction machine. LPN #214 attached the suction catheter to the machine and proceeded to suction Resident #42 all while wearing the non-sterile gloves and using the same catheter that had touched multiple items. Interview on 05/24/23 at approximately 2:30 P.M. with LPN #214, following completion of suctioning for Resident #42, confirmed she should have maintained a sterile procedure during the entire suctioning event. RN #207 and the DON confirmed they did not stop and or intervene during the procedure and all confirmed the procedure should be done sterile. The interviews confirmed the staff did not feel comfortable and confident in performing suctioning of Resident #42. Observation on 05/24/23 at 2:33 P.M. revealed LPN #214, RN #207 and DON were observed with LPN #214 on the left side and RN #207 on the right side of Resident #42. The DON was at the foot of the bed during the observation. LPN #214 indicated she was getting ready to perform tracheostomy care for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 7 of 17 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 05/30/2023 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #42. LPN #214 had a sealed disposable trachea care kit and opened the kit in sterile fashion. LPN #42 donned non-sterile gloves and removed the old tracheostomy dressing. LPN #214 and RN #207 then began removing Resident #42's tracheostomy tie (which holds the tube in place). Resident #42's tracheostomy tie was completely loose on the left side and no nurse was holding onto the tracheostomy. The surveyor intervened immediately and requested the nurse to hold onto the tracheostomy tube. Interview at that time with all staff members present in Resident #42's room stated there were unsure why they were removing Resident #42's tracheostomy tie as they did not have a new one at the bedside to replace it, and the tracheostomy tie was reattached. The staff then removed the disposable inner cannula and began cleaning it. LPN #214 then re-inserted the disposable inner cannula back into Resident #42's tracheostomy. LPN #214, RN #207, and the facility DON could not locate any disposable inner cannulas in Resident #42's room. Interview with LPN #214, RN #207 and the DON on 05/24/23 at 2:47 P.M. following the procedure confirmed they did not throw the inner cannula away and replace it with a new one. The interview identified they did not know the inner cannula was disposable. The interview confirmed the facility did not have procedures in place to follow to perform tracheostomy care with the disposable inner cannulas. The interview confirmed Resident #42's physician orders are for a #6 Shiley disposable inner cannula to be changed twice a day. Interview with LPN #214, RN #207, and the DON confirmed they all need training on the proper procedures for suctioning and tracheostomy care. Review of the undated manufacture instructions for the disposable Shiley inner cannula revealed the instructions were located in each box of cannulas provided to the facility. The instructions revealed these are single use only with instructions to remove the inner cannula disposable (DIC) from the tracheostomy tube by squeezing the tabs on the 15 millimeter (mm) connector until both snap-locks clear the ridge lock on the outer cannula, withdraw slowly, dispose of the removed DIC, the new DIC may be moistened with water soluble lubricant to facilitate insertion, insert the DIC with the 15 mm snap-lock connector and lock into position, to lock the DIC in place, push the connector until both snap-locks clear the ridge lock on the outer cannula, and the patient's respirations and vital signs should be routinely evaluated after locking the DIC in the tube. Review of the facility policy titled, Tracheostomy Care-Suctioning, dated 2022, revealed the policy identified tracheal suctioning is performed by licensed nurse to clean the throat and upper respiratory tract of secretions that may block the airway. The policy identified using sterile technique, open the suction catheter kit, and put on the sterile gloves. Consider the glove on your dominant hand sterile and the non-dominant hand clean. Using the clean hand, pour sterile normal saline into the disposable sterile solution container. Remove the suction catheter from it wrapper with the sterile hand, coiling it to keep from touching non-sterile objects. Attach the suction catheter to the tubing, using clean hand and turn on the suction machine. Suction a small amount of solution through the catheter by occluding the suction control valve with the thumb of the clean hand. Insert the catheter into the tracheostomy tube opening gently during the inspiration until resistance is felt. DO NOT apply suction while inserting. Apply suctioning intermittently by removing and replacing the thumb of the clean hand over the suction control valve. Simultaneously withdraw the catheter rolling it into your dominant hand. This should take approximately 10 to 15 seconds. 2. Review of Resident #16's medical record revealed admission to the facility on [DATE] with medical diagnoses including acute respiratory failure, tracheostomy status, Barrett's esophagus without dysplasia, cellulitis of the neck, muscle weakness, depression, and unspecified mood disorder. Review of Resident #16's current physician orders revealed an order for staff to provide routine tracheostomy care with a #6 Shiley DIC. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 8 of 17 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 05/30/2023 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #16's nursing progress notes dated 04/07/23 at 7:07 P.M. revealed a note which indicated the facility did not have Resident #16's type of inner cannula and a supplier was notified to bring in tracheostomy supplies so care could be provided. Interview with Resident #16 on 05/24/23 at 1:42 P.M. stated she had her tracheostomy for more than 10 years, and confirmed the nursing staff perform her tracheostomy care. Resident #16 stated sometimes the staff re-use the inner cannula and sometimes throw them away. Resident #16 confirmed there was currently no #6 Shiley DIC in her room and verified it occurred often. Observation and interview with the facility DON on 05/24/23 at 3:12 P.M. confirmed there were no #6 Shiley DICs located in Resident #16's room at that time. The interview confirmed Resident #16's physician order was for tracheostomy care with DIC to be completed twice a day. This deficiency represents non-compliance investigated under Complaint Number OH00142721. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 9 of 17 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 05/30/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident and staff interview, review of manufacture instructions, review of a facility policy, the facility failed to ensure all licensed nursing staff were competent to provide care and services residents with a tracheostomy. This affected two (#16 and #42) of two residents reviewed with a tracheostomy. The facility identified Resident #16 and Resident #42 as the only residents in the facility with a tracheostomy. The facility census was 44. Findings include: 1. Review of Resident #42's medical record revealed admission to the facility on [DATE] with medical diagnoses including motor vehicle accident (MVA), acute and chronic respiratory failure, dysphagia, multiple fractures, and tracheostomy status. Review of the quarterly assessment dated [DATE] revealed Resident #42 had impaired cognition and was totally dependant on staff for care. Review of Resident #42's physician orders revealed an order for tracheostomy (a surgically created hole in the trachea that provides and alternate airway for breathing) care every shift twice a day and as needed with a disposable #6 Shiley inner cannula. Resident #42 had physician orders to suction as needed as well. Observation of Registered Nurse (RN) #207, Licensed Practical Nurse (LPN) #214, and the facility Director of Nursing (DON) on 05/24/23 at 2:20 P.M. revealed RN #207 noted she was new at the facility and was going to have LPN #214 and the DON assist her to perform tracheostomy care and suctioning for Resident #42. LPN #214 obtained a sealed tracheostomy care kit which contained a plastic compartment tray, vinyl gloves; a water proof drape, one trachea dressing, two gauze pads, one tracheostomy brush, two pipe cleaners, two cotton tip applicators, and one pop-up basin. LPN #214 was on the left side of the bed with RN #207 on the right side of the bed and the DON was located at the foot of the bed during the observation. Continued observation on 05/24/23 at 2:27 P.M., revealed LPN #214 obtained a pair of clean gloves, donned them, and then obtained a sealed tracheostomy suction tube. LPN #214 opened the package and pulled the suction tube out of the sterile package with the clean gloves. LPN #214 then leaned over to Resident #42 and determined he needed repositioned. LPN #214 touched the suctioning catheter, including the tip, on Resident #42's gown and bedding. LPN #214 and RN #207 repositioned Resident #42. LPN #214 then set the suction catheter outside of the package onto Resident #42's bedside stand while turning on the suction machine. LPN #214 attached the suction catheter to the machine and proceeded to suction Resident #42 all while wearing the non-sterile gloves and using the same catheter that had touched multiple items. Interview on 05/24/23 at approximately 2:30 P.M. with LPN #214, following completion of suctioning for Resident #42, confirmed she should have maintained a sterile procedure during the entire suctioning event. RN #207 and the DON confirmed they did not stop and or intervene during the procedure and all confirmed the procedure should be done sterile. The interviews confirmed the staff did not feel comfortable and confident in performing suctioning of Resident #42. Observation on 05/24/23 at 2:33 P.M. revealed LPN #214, RN #207 and DON were observed with LPN #214 on the left side and RN #207 on the right side of Resident #42. The DON was at the foot of the bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 10 of 17 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 05/30/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few during the observation. LPN #214 indicated she was getting ready to perform tracheostomy care for Resident #42. LPN #214 had a sealed disposable trachea care kit and opened the kit in sterile fashion. LPN #42 donned non-sterile gloves and removed the old tracheostomy dressing. LPN #214 and RN #207 then began removing Resident #42's tracheostomy tie (which holds the tube in place). Resident #42's tracheostomy tie was completely loose on the left side and no nurse was holding onto the tracheostomy. The surveyor intervened immediately and requested the nurse to hold onto the tracheostomy tube. Interview at that time with all staff members present in Resident #42's room stated there were unsure why they were removing Resident #42's tracheostomy tie as they did not have a new one at the bedside to replace it, and the tracheostomy tie was reattached. The staff then removed the disposable inner cannula and began cleaning it. LPN #214 then re-inserted the disposable inner cannula back into Resident #42's tracheostomy. LPN #214, RN #207, and the facility DON could not locate any disposable inner cannulas in Resident #42's room. Interview with LPN #214, RN #207 and the DON on 05/24/23 at 2:47 P.M. following the procedure confirmed they did not throw the inner cannula away and replace it with a new one. The interview identified they did not know the inner cannula was disposable. The interview confirmed the facility did not have procedures in place to follow to perform tracheostomy care with the disposable inner cannulas. The interview confirmed Resident #42's physician orders are for a #6 Shiley disposable inner cannula to be changed twice a day. Interview with LPN #214, RN #207, and the DON confirmed they all need training on the proper procedures for suctioning and tracheostomy care. Review of the undated manufacture instruction for the disposable Shiley inner cannula revealed the instructions were located in each box of cannulas provided to the facility. The instructions revealed these are single use only with instructions to remove the inner cannula disposable (DIC) from the tracheostomy tube by squeezing the tabs on the 15 millimeter (mm) connector until both snap-locks clear the ridge lock on the outer cannula, withdraw slowly, dispose of the removed DIC, the new DIC may be moistened with water soluble lubricant to facilitate insertion, insert the DIC with the 15 mm snap-lock connector and lock into position, to lock the DIC in place, push the connector until both snap-locks clear the ridge lock on the outer cannula, and the patient's respirations and vital signs should be routinely evaluated after locking the DIC in the tube. Review of the facility policy titled, Tracheostomy Care-Suctioning, dated 2022, revealed the policy identified tracheal suctioning is performed by licensed nurse to clean the throat and upper respiratory tract of secretions that may block the airway. The policy identified using sterile technique, open the suction catheter kit, and put on the sterile gloves. Consider the glove on your dominant hand sterile and the non-dominant hand clean. Using the clean hand, pour sterile normal saline into the disposable sterile solution container. Remove the suction catheter from it wrapper with the sterile hand, coiling it to keep from touching non-sterile objects. Attach the suction catheter to the tubing, using clean hand and turn on the suction machine. Suction a small amount of solution through the catheter by occluding the suction control valve with the thumb of the clean hand. Insert the catheter into the tracheostomy tube opening gently during the inspiration until resistance is felt. DO NOT apply suction while inserting. Apply suctioning intermittently by removing and replacing the thumb of the clean hand over the suction control valve. Simultaneously withdraw the catheter rolling it into your dominant hand. This should take approximately 10 to 15 seconds. 2. Review of Resident #16's medical record revealed admission to the facility on [DATE] with medical diagnoses including acute respiratory failure, tracheostomy status, Barrett's esophagus without dysplasia, cellulitis of the neck, muscle weakness, depression, and unspecified mood disorder. Review of Resident #16's current physician orders revealed an order for staff to provide routine (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 11 of 17 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 05/30/2023 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 0726 tracheostomy care with a #6 Shiley DIC. Level of Harm - Minimal harm or potential for actual harm Review of Resident #16's nursing progress notes dated 04/07/23 at 7:07 P.M. revealed a note which indicated the facility did not have Resident #16's type of inner cannula and a supplier was notified to bring in tracheostomy supplies so care could be provided. Residents Affected - Few Interview with Resident #16 on 05/24/23 at 1:42 P.M. stated she had her tracheostomy for more than 10 years, and confirmed the nursing staff perform her tracheostomy care. Resident #16 stated sometimes the staff re-use the inner cannula and sometimes throw them away. Resident #16 confirmed there was currently no #6 Shiley DIC in her room and verified it occurred often. Observation and interview with the facility DON on 05/24/23 at 3:12 P.M. confirmed there were no #6 Shiley DICs located in Resident #16's room at that time. The interview confirmed Resident #16's physician order was for tracheostomy care with DIC to be completed twice a day. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 12 of 17 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 05/30/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, resident and staff interview, review of manufacture recommendations, and policy review, the facility failed to follow medication instructions for use of inhaled medications and failed to administered medications as ordered. This affected two (#4 and #5) of three residents reviewed for medications. The census was 44. Findings include: 1. Observation of medication administration with Registered Nurse (RN) #207 for Resident #5 on 05/24/23 at 8:14 A.M. revealed RN #207 gathered a total of eight pills, an inhaler, two liquid medications, and Humalog insulin 11 units subcutaneously via insulin pen. RN #207 provided Resident #5 with the inhaler and Resident #5 inhaled one puff as ordered. RN #207 was observed to not offer Resident #5 to rinse her mouth and spit after taking the inhaled medication. Interview with Resident #5 and RN #207 on 05/24/23 at 8:31 A.M. confirmed Resident #5 was not provided the opportunity to rinse and spit following the inhaler. Review of Resident #5's physician orders and medication administration record (MAR) revealed an order for Resident #5 to received the medication for chronic obstructive pulmonary disease Breo inhaler one oral inhalation with instructions to rinse and expectorate after use. Review of the manufacture instructions for the Breo inhaler revealed under the area titled, Warnings and Precautions, candida albicans infection of the mouth and pharynx may occur and it was advised for patients to rinse mouth with water without swallowing after inhalation to help reduce the risk. 2. Review of Resident #4's medical record revealed an admission date of 03/22/23 with medical diagnoses including stroke, bipolar disorder, anxiety, chronic kidney disease, and COVID-19. Review of the medical record revealed Resident #4 was in the hospital from [DATE] through 03/22/23 prior to her admission to the facility. Further review of the hospital notes revealed Resident #4 arrived at the emergency room with weakness, had not been taking her medications, and was not eating or drinking for the past five to seven days. The hospital psychiatry notes dated 03/18/23 revealed Resident #4 was in a mental health hospital two weeks ago for four days with increased depression. The notes identified Resident #4 was discharged from the mental health hospital on the mood stabilizer Depakote 500 milligrams (mg) and the anti-psychotic medication Zyprexa five (5) mg. Review of Resident #4's discharge medication list dated 03/22/23 revealed instructions to start Depakote extended release (ER) 500 mg two tablets at bedtime and instructions to stop Zyprexa Zydis 20 mg disintegrating tablet. Review of Resident #4's progress notes dated 05/17/23 revealed Certified Nurse Practitioner (CNP) #645, who was an outside the facility provider, called the facility and wanted to initiate orders for Zyprexa 5 mg by mouth at bedtime and decrease Depakote to 500 mg at bedtime after seeing Resident #4. The note indicated the facility wanted to contact their in house Psychiatrist (#725) before proceeding with the orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 13 of 17 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 05/30/2023 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review a facility late entry progress note dated 05/30/23 at 12:18 P.M. revealed on 05/22/23 at 12:14 P.M. in house Psychiatrist #725 was contacted regarding CNP #645's orders. The note revealed in-house Psychiatrist #725 indicated he would not longer see Resident #4 and all orders should then go through the primary physician. Interview with the facility Director of Nursing on 05/30/23 at 11:54 A.M. confirmed Resident #4 was never started on the Zyprexa 5 mg at bedtime and the Depakote decreased to 500 mg at bedtime in accordance with the CNP #645's orders dated 05/17/23. Review of the facility medication administration policy, dated 2022, revealed medications are administered by licensed nurses as ordered by the physician and in accordance with professional standards of practice. This deficiency represents non-compliance investigated under Master Complaint Number OH00143129, Complaint OH00143013, and Complaint Number OH00142721. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 14 of 17 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 05/30/2023 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, staff interview, and review of a facility policy, the facility failed to administered medications according to physician orders resulting in a medication error rate greater than five percent. There were two medication errors out of 25 opportunities for error observed for an medication error rate of eight percent. This affected one (#5) of three residents observed for medication administration. The facility census was 44. Residents Affected - Few Findings include: Observation of medication administration with Registered Nurse (RN) #207 for Resident #5 on 05/24/23 at 8:14 A.M. RN #207 gathered a total of eight pills, an inhaler, two liquid oral medications, and Humalog insulin 11 units subcutaneously (SQ) via insulin pen. RN #207 provided the pills, liquid medications, and 11 units of insulin without issues. Resident #5 was not administered long acting insulin or a nasal spray during this observation. Review of Resident #5's physician orders and medication administration record (MAR) revealed Resident #5 should have received Basaglar Kwik Pen insulin (long acting) 26 units (SQ) scheduled twice daily, and Nasacort nasal spray with directions for one puff in each nostril. Interview with RN #207 on 05/24/223 at 9:05 A.M., confirmed she forgot to give the long acting insulin and only gave short acting insulin. RN #207 confirmed she additionally forgot to administered Resident #5's nasal spray. Review of the facility medication administration policy, dated 2022, revealed medications are administered by licensed nurses as ordered by the physician and in accordance with professional standards of practice. This deficiency represents non-compliance investigated under Master Complaint Number OH00143129, Complaint OH00143013, and Complaint Number OH00142721. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 15 of 17 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 05/30/2023 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm Based on observation, medical record review, staff interview, and review of a facility policy, the facility failed to administered medications according to physician orders resulting in a significant medication error. This affected one (#5) of three residents observed for medication administration. The facility census was 44. Residents Affected - Few Findings include: Observation of medication administration with Registered Nurse (RN) #207 for Resident #5 on 05/24/23 at 8:14 A.M. RN #207 gathered a total of eight pills, an inhaler, two liquid oral medications, and Humalog insulin 11 units subcutaneously (SQ) via insulin pen. RN #207 provided the pills, liquid medications, and 11 units of insulin without issues. Resident #5 was not administered long acting insulin during this observation. Review of Resident #5's physician orders and medication administration record (MAR) revealed Resident #5 should have received Basaglar Kwik Pen insulin (long acting) 26 units (SQ) scheduled twice daily. Interview with RN #207 on 05/24/223 at 9:05 A.M., confirmed she forgot to give the long acting insulin and only gave short acting insulin. Review of the facility medication administration policy, dated 2022, revealed medications are administered by licensed nurses as ordered by the physician and in accordance with professional standards of practice. This deficiency represents non-compliance investigated under Master Complaint Number OH00143129, Complaint OH00143013, and Complaint Number OH00142721. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 16 of 17 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 05/30/2023 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 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. Based on observation, staff interview, and facility policy review, the facility failed to ensure a medication cart was maintained in a safe and secure manner on the second floor. This had the potential to affect all residents residing in the facility with the exception of five (#11, #20, #26, #36, and #43) residents who resided on the first floor of the facility. The facility census was 44. Findings include: Observation of the second floor of the facility on 05/24/23 at 7:47 A.M. revealed the east medication cart was observed unlocked with two drawers open in the hallway outside of a resident room. The medication cart was against the wall next to the room, with the open drawers facing the hallway. There was no licensed nursing staff was within eyesight of the cart at the time of the observation. Registered Nurse (RN) #207 was located inside the resident room, and returned to the medication cart, at 7:51 A.M., placed a blood sugar testing machine on top of the cart, and then re-entered the resident room with the medication cart remaining unlocked and two drawers open. RN #207 then returned to the medication cart at 7:59 A.M. Interview on 05/24/23 at 7:59 A.M. with RN #207 confirmed she left the medication cart unlocked and unattended. RN #207 identified she was new to the building and used to work at a hospital; however, confirmed she should not be leaving medication carts unlocked and unattended providing access to medications. Review of a medication storage policy, dated 2022, revealed it is the facility policy to ensure all medications housed on the premises will be stored to ensure security. The policy revealed during a medication pass, medication must be under the direct observation of the person administering medications or locked in the medication storage cart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365452 If continuation sheet Page 17 of 17