Health inspection·June 5, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, staff interview, review of the dishwashing machine temperature logs and review of the facility policy, the facility failed to maintain appropriate dishwasher temperatures to ensure clean and sanitary dishware. This had the potential to affect all 59 residents who received food from the kitchen. The facility census was 59. Findings include: Review of the low-temperature dishwashing machine logs from 03/01/25 through 06/03/25 revealed wash temperatures were not to be below 120 degrees Fahrenheit (F) and were to be checked once per shift. During the time period reviewed, wash temperatures were documented to be below 120 degrees F on 83 occasions. During an observation on 06/04/25 at approximately 1:35 P.M. with Dietary Supervisor (DS) #471 revealed the last load of dishes following the lunch meal was in the process of being washed using the low-temperature, chemical-sanitation dishwashing machine. The dishwashing machine reached a maximum temperature of 112 degrees F for both the wash and the rinse cycles. The dishwashing machine was run numerous times and there was no increase in the temperature. Concurrent interview with DS #471 verified the dishwashing machine did not reach the appropriate temperature for the wash or the rinse cycle. DS #471 reported the machine was supposed to reach at least 120 degrees F for each cycle. DS #471 stated sometimes the machine reached 120 degrees F and sometimes it did not. Review of the facility policy titled, Dish Machine Temperatures, undated, revealed chemical sanitizing machines, which were low-temperature, were to have a wash and a rinse temperature between 120 and 140 degrees F. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365550 If continuation sheet Page 2 of 5 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 365550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hills Nursing Center 3650 Beavercrest Drive Lorain, OH 44053 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and staff interview, the facility failed to ensure garbage and refuse was disposed of properly. This had the potential to affect all 59 residents residing in the facility. The census was 59. Residents Affected - Many Findings include: Observation on 06/02/25 at approximately 8:50 A.M. with Dietary Supervisor (DS) #471 revealed two exterior dumpsters with trash laying around the dumpsters. The trash included an empty cheese wrapper, disposable gloves, an aluminum can, disposable plastic lids, clear plastic bags, empty bread bags, an empty salad dressing bottle, crumbled aluminum foil, an empty nutritional shake bottle, empty sugar packets, empty Styrofoam cups, plastic eating utensils, and more than 50 cigarette butts on the ground. Further observation revealed more than 10 clear-plastic garbage bags filled with trash including briefs and gloves. Concurrent interview with DS #471 verified the debris on the ground around the dumpster and further stated the facility had various animals in the area. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365550 If continuation sheet Page 3 of 5 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 365550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hills Nursing Center 3650 Beavercrest Drive Lorain, OH 44053 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. Based on observation, staff interviews and resident interviews the facility failed to ensure the facility was maintained in good repair. This affected six (#1, #7, #19, #41, #52 and #56) of nine residents reviewed for environment. The facility census was 59. Findings included: 1. Observation on 06/03/25 at 8:18 A.M. of Resident #7's room revealed the wall to the right of the air conditioning unit had an unknown black substance and the drywall was crumbling. Additionally, there were brown stains on the wall above the air conditioning unit. Interview on 06/05/25 at 10:22 A.M. with Director of Maintenance (DOM) #428 verified the wall around the air conditioning was crumbling and a black mold-like substance was present. DOM #428 confirmed the brown stains on the wall above the air conditioning unit and stated the brown stains were the result of a water leak. 2. Observation on 06/02/25 at 9:19 A.M. of Resident #52's bathroom revealed four tiles on the wall were missing and the sink was pulled away from the wall by approximately 1.5 inches. Interview on 06/05/25 at 10:18 A.M. with DOM #428 verified the missing wall tiles and the sink was pulling away from the wall in Resident #52's bathroom. 3. Observation on 06/02/25 at 10:00 A.M. of Resident #19's room revealed deep gouges in the wall and the base molding was coming off the wall near the bathroom door. Interview on 06/05/25 at 10:36 A.M. with DOM #428 verified the deep gouges in the wall and the base molding was coming off the wall near the bathroom. DOM #428 stated it needed to be repaired. 4. Observation on 06/02/25 at 10:30 A.M. of Resident #41's room revealed an area approximately four by four feet in size of a glue-like substance on the wall behind the bed. Interview on 06/05/25 at 10:32 A.M. with DOM #428 revealed there used to be a plastic protective board on the wall behind Resident #41's bed, but the resident pulled it off the wall. DOM #428 verified he was aware the plastic board had been removed and further confirmed the adhesive had not been cleaned up. 5. Observation on 06/02/25 at 10:50 A.M. of Resident #1's room revealed deep gouges in the wall and the base molding was coming off the wall by the bathroom door. Interview on 06/05/25 at 10:44 A.M. with DOM #428 verified the wall had deep gouges and the base molding was coming off the wall. 6. Observation on 06/02/25 at 11:38 A.M. of Resident #56's room revealed the rubber base molding by the bathroom door was coming off, with an unknown black substance, and the drywall was crumbling. Inside the bathroom, there was one missing wall tile with an unknown black substance on the wall. Interview on 06/05/25 at 10:15 A.M. with DOM #428 verified the base molding was coming off the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365550 If continuation sheet Page 4 of 5 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 365550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Hills Nursing Center 3650 Beavercrest Drive Lorain, OH 44053 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 wall, missing tile and the bathroom, and confirmed the black substance was mold. Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled, Preventative Maintenance Program dated 03/01/25, revealed a preventative maintenance program would be developed and implemented to ensure the provision of a safe, functional, sanitary and comfortable environment for residents, staff and the public. Residents Affected - Some This deficiency represents non-compliance investigated under Complaint Number OH00164448. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365550 If continuation sheet Page 5 of 5