Inspection·November 17, 2025

F 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete administered to Resident #85 after reporting severe pain on 11/17/25 at 8:53 A.M. and at 9:01 A.M. Observation on 11/17/25 from 9:00 A.M. to 9:07 A.M. revealed Licensed Practical Nurse (LPN) #313 obtained vital signs from Resident #85, prepared scheduled morning medications, and administered the prepared medications to Resident #85. At 9:01 A.M., Resident #85 was heard telling LPN #313 that her right leg hurt a lot and she then rated the pain level as an eight on a one to 10 numerical rating scale. Further observation revealed Tylenol was not included in the medication cup that was prepared and handed to Resident #85, although LPN #313 informed Resident #85 that there was a little something for her leg pain with the medications that were handed to Resident #85. At the time of the medication observation, two staff from the therapy department were in the room and waiting to take Resident #85 for prescribed therapy.Interview on 11/17/25 at 9:07 A.M. with LPN #313 confirmed that when telling Resident #85 that there was something for her leg pain in the medicine cup, LPN #313 was referring to the meloxicam 15 mg that was ordered daily for arthritis. During the interview, LPN #313 also stated that Resident #85 also had on a patch for pain that was not yet due to be removed (review of the medication orders and the MAR revealed Resident #85 had no orders for, or applications of, topical analgesics or pain patches). Interview on 11/17/25 at 11:48 A.M. with Resident #85 confirmed she usually took Tylenol to help with her right leg pain. During the interview, Resident #85 was uncertain whether she received the Tylenol with her morning medications because there were so many pills and she did not know what all was in the medicine cup, but she thought the nurse told her she gave her something extra for pain. At the time of the interview, Resident #85 stated that her pain was worse than earlier and wanted to see if it was time for more Tylenol. During a follow-up interview on 11/17/25 at 12:08 P.M. with LPN #313, LPN #313 was informed that Resident #85 stated the pain in the right leg was worse. During the interview, LPN #85 was observed looking in Resident #85's medical record before stating that all Resident #85 had for pain was a Tylenol order. Follow-up review of the medical record for Resident #85 at 4:57 P.M., including review of the orders, progress notes, pain assessments, and MAR, revealed no additional pain assessment was completed for Resident #85, and no Tylenol was administered to Resident #85 since the last dose given on 11/16/25 at 11:59 P.M. There were no notes to indicate any non-pharmacological interventions were offered, such as ice (as indicated in the Pain Tool assessments), that Resident #85 was offered and declined Tylenol, or that the medical provider was notified that Resident #85's assessment the morning of 11/17/25 revealed an increase in pain since admission to the facility. Review of the undated policy titled Medication Administration revealed medications were to be given timely, as prescribed, as determined by resident need and benefit. This deficiency represents non-compliance investigated under Complaint Number 2663659. Event ID: Facility ID: 365654 If continuation sheet Page 2 of 7 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 365654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austinwoods Rehab Health Care 4780 Kirk Rd Austintown, OH 44515 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 record reviews, observations, interviews and review of the facility policy, the facility failed to ensure a medication error rate of less than five percent (%) during medication administration on 11/17/25 with four errors of 25 medication administration opportunities resulted in a 16% medication error rate. This affected two residents (Residents #85 and #86) of four residents observed during medication administration. The facility census was 83.Findings include:1. Review of the medical record for Resident #85 revealed an admission date of 11/13/25 with diagnoses including unspecified dislocation of the right hip, unspecified complication of internal orthopedic prosthetic device, implant, and graft, gastroesophageal reflux disease (GERD), hyperlipidemia, primary hypertension, and unspecified glaucoma. Review of the Brief Interview for Mental Status (BIMS) summary score completed on 11/14/25 revealed Resident #85 had moderately impaired cognition. Review of the Skilled Charting dated 11/14/25 revealed Resident #85 was alert to person, place, time, and situation. The assessment further revealed Resident #85 was admitted to the facility for post-surgical services, including physical therapy (PT) and occupational therapy (OT), and that medication orders had been received. Review of the physician orders revealed Resident #85 had one medication scheduled for administration at 8:00 A.M. and a total of twelve medications scheduled for administration at 9:00 A.M. These medications included:1) Cefadroxil oral capsule, 500 milligrams (mg), (antibiotic) give one capsule by mouth two times a day for prophylaxis for seven days, dated 11/14/25, with the morning dose scheduled for 8:00 A.M.2) Amlodipine besylate oral tablet, five milligrams, give one tablet by mouth one time a day for primary hypertension, dated 11/13/25, scheduled at 9:00 A.M.3) Aspirin 81 mg oral delayed release (DR) tablet, give one tablet by mouth two times a day for deep vein thrombosis (DVT) prophylaxis, dated 11/13/25, with the morning dose scheduled at 9:00 A.M.4) Biotin oral tablet, 10,000 mcg, give one tablet by mouth one time a day for supplementation, ordered 11/13/25, scheduled at 9:00 A.M.5) Vitamin D oral tablet 50 micrograms (mcg), give one tablet by mouth once daily for supplement, dated 11/13/25, scheduled at 9:00 A.M.6) Valsartan oral tablet 320 mg, five one tablet by mouth one time a day for hypertension, dated 11/13/25, scheduled at 9:00 A.M.7) Niacin oral tablet, 100 mg, give one tablet by mouth one time a day for anemia, dated 11/13/25, scheduled at 9:00 A.M.8) Meloxicam 15 mg tablet, give one tablet by mouth one time a day for arthritis, dated 11/13/25, scheduled at 9:00 A.M.9) Folic acid 1 mg tablet, give one tablet by mouth one time a day for anemia, dated 11/13/25, scheduled at 9:00 A.M.10) Vitamin E 15 mg oral tablet, one tablet once daily as a supplement, dated 11/14/25, scheduled at 9:00 A.M.11) Culturelle Immunity Support 15B Cell capsule, give one capsule by mouth one time a day for supplement, ordered 11/14/25, scheduled at 9:00 A.M.12) Cranberry juice powder capsule, 425 mg, give one capsule by mouth one time a day for supplementation, dated 11/14/25, scheduled at 9:00 A.M.13) Prevagen oral capsule, 10 mg, give 10 mg my mouth one time a day for supplement, dated 11/14/25, scheduled at 9:00 A.M.Observation on 11/17/25 from 9:00 A.M. to 9:07 A.M. revealed Licensed Practical Nurse (LPN) #313 obtained vital signs from Resident #85, prepared morning medications, and administered the prepared medications to Resident #85. During the observation, LPN #313 confirmed there were nine pills in the medication cup, which included a 5 mg amlodipine tablet, an 81 mg aspirin tablet, a 425 mg cranberry juice powder capsule, a 1,000-mcg folic acid tablet, a 10,000-mcg biotin tablet, a 10 mg prevagen capsule, a 320 mg valsartan tablet, a 50-mcg vitamin D tablet, and a 50 mg meloxicam tablet. During medication preparation, LPN #313 confirmed that there was no Vitamin E available to give to Resident #85 because it was on order. Continued observation revealed Resident #85 took the nine pills that were provided in the medication cup at 9:05 A.M.After the medication administration observation, at 9:49 A.M., review of the medication administration record (MAR) revealed Resident #85 had Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365654 If continuation sheet Page 3 of 7 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 365654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austinwoods Rehab Health Care 4780 Kirk Rd Austintown, OH 44515 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 11 of the 13 morning medications signed as given by LPN #313 and one morning medication (Vitamin E, 15 mg) signed by LPN #313 with the MAR code 3 for Hold/See Progress Notes (only nine medications were observed as administered. Medications signed as given that were not prepared and administered during the observation included Culturelle Immunity Support 15B Cell capsule (scheduled to be given at 9:00 A.M.), Niacin 100 mg oral tablet (scheduled to be given at 9:00 A.M.), and cefadroxil 500 mg oral capsule (scheduled to be given at 8:00 A.M.). Review of the Medication Administration Audit Report (MAAR) revealed LPN #313 documented administration of the 100 mg of Niacin and 500 mg of cefadroxil at the same time as signing for the nine medications that were observed as administered (between 9:06 A.M. and 9:07 A.M.), directly after the medication was observed being administered to Resident #85. Interview on 11/17/25 at 12:08 P.M. with LPN #313 confirmed the ordered Vitamin E was not given because it was not available. At the time of the interview, LPN #313 pulled out the box of Culturelle Immunity, and reported that she found and gave the ordered Culturelle dose to Resident #85 just after the surveyor left the unit, when it popped up on the MAR as unsigned. When asked about the ordered Niacin and cefadroxil, LPN #313 stated it didn't pop up for me [on the MAR]. Observation at the time of the interview revealed the medication cart contained one blister packet dated 11/14/25 that originally contained seven tablets and one blister packet for the morning medication administration of cefadroxil dated 11/14/25 which originally was dispensed containing seven tablets. Interview with LPN #313 at the time of the observation confirmed there were five of the seven pills left in both packets, with two niacin and two cefadroxil appearing to have been dispensed (the foil backing was torn, and the pills were gone). Another review of the MAR revealed three doses of 100 mg niacin and three doses of the morning 500 mg cefadroxil were signed off, one dose each on 11/15/25, 11/16/25, and 11/17/25, though only two pills (not three) were observed missing from each pharmacy supplied blister packet. Review of the undated policy titled Medication Administration revealed medications were to be administered according to prescriber orders, including within any required timeframes. 2. Review of the medical record for Resident #86 revealed an admission date of 10/22/25 and a re-entry date of 11/03/25. Diagnoses included acute respiratory failure with hypoxia, transfusion-related acute lung injury, anemia, peripheral vascular disease, end stage renal disease, dependence on renal dialysis, and type two diabetes mellitus.Review of the admission Minimum Data Set (MDS) 3.0 assessment completed on 10/27/25 revealed Resident #86 had moderately impaired cognition had no behaviors or rejection of care, and received insulin injections, antidepressant, antiplatelet, anticonvulsant, and hypoglycemic medications. The MDS further revealed Resident #86 had complex medical conditions which included diabetes mellitus, and Resident #86 received dialysis.Review of the medication orders revealed an order dated 11/16/25 for sevelamer carbonate oral tablet, 800 mg, (non-absorbable, calcium and metal-free phosphate binder used to treat high phosphate levels) give Resident #86 six tablets by mouth before meals for dialysis. Further review of the order revealed the ordered scheduled administration times were 6:30 A.M., 11:30 A.M., and 4:30 P.M. with an order note changing morning administration to 8:00 A.M. due to resident refusal to take at 6:30 A.M.Review of the MAR revealed the Sevelamer was listed as scheduled to be given at 8:00 A.M., 11:30 A.M., and 4:30 P.M. Further review of the MAR revealed all previous sevelamer orders were listed on the MAR to be given as per the ordered times, which included 6:30 A.M., 11:30 A.M., and 4:30 P.M., with an accompanying electronic MAR (eMAR) note dated 11/16/25 that Resident #86 refused the 6:30 A.M. because it was not to be taken on an empty stomach. Observation on 11/17/25 from 9:10 A.M. to 9:25 A.M. of morning medication preparation and administration for Resident #86 by LPN #313 revealed the ordered oral medications, including sevelamer 800 mg, was administered to Resident #86 at 9:20 A.M. Interview on 11/17/25 at 9:23 A.M. with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365654 If continuation sheet Page 4 of 7 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 365654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austinwoods Rehab Health Care 4780 Kirk Rd Austintown, OH 44515 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #86 confirmed he had already eaten breakfast without having the ordered morning medication and that it had been a while since breakfast was served.Interview with LPN #313 on 11/17/25 at 9:25 A.M. confirmed the sevelamer popped up on the MAR for 8:00 A.M. administration and most medications could be given one hour before or one hour after the time it was timed for on the MAR. Further interview with LPN #313 confirmed that the order specified the sevelamer was to be given before meals, it had been more than 30 minutes since residents on the unit ate breakfast, and that the medication was administered more than one hour after the time that was listed on the MAR. Review of the undated policy titled Medication Administration revealed medications were to be administered according to prescriber orders, including within any required timeframes, and that medications were to be administered within one hour of the prescribed time, or in accordance with the specified time within the order, such as before or after meal orders. The policy further revealed that medications times were to be determined by what was best for resident outcome and not staff convenience, such as times that enhanced the optimum therapeutic benefit of the medications and have the least potential negative consequences or interaction with other medications or foods.This deficiency represents non-compliance investigated under Complaint Number 2663659. Event ID: Facility ID: 365654 If continuation sheet Page 5 of 7 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 365654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austinwoods Rehab Health Care 4780 Kirk Rd Austintown, OH 44515 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on record reviews, observations, interviews, review of facility policies, and review of manufacturer instructions for the facility's blood glucose meter, the facility failed to ensure the blood glucose meter was properly cleaned after use with Resident #86. This affected one (Resident#86) and had the potential to affect three additional (Residents #70 #73, and #81) identified by the facility as having blood sugar level checked with a glucometer. In addition, the facility did not ensure enhanced barrier precautions (EBP) were maintained during medication administration through an enteral feeding tube, affecting Resident #67. The facility identified nine residents who had enteral feeding tubes (Residents #6, #26, #45, #64, #66, #67, #69, #77, and #83). The facility census was 83.Findings include:1. Review of the medical record for Resident #86 revealed an admission date of 10/22/25 and a re-entry date of 11/03/25. Diagnoses included acute respiratory failure with hypoxia, transfusion-related acute lung injury, anemia, peripheral vascular disease, end stage renal disease, dependence on renal dialysis, and type two diabetes mellitus. Review of the admission Minimum Data Set (MDS) 3.0 assessment completed on 10/27/25 revealed Resident #86 had moderately impaired cognition and received insulin injections, antidepressant, antiplatelet, anticonvulsant, and hypoglycemic medications. Further review of the MDS revealed Resident #86 had complex medical conditions which included diabetes mellitus and dependence on renal dialysis.Review of the physician's orders revealed an order dated 11/14/25 for Resident #86 to have a blood sugar level checked twice a day. Further review of the order revealed the blood sugar checks were scheduled for 6:00 A.M. and 4:00 P.M.Observation on 11/17/25 from 9:10 A.M. to 9:13 A.M. revealed Licensed Practical Nurse (LPN) #313 used a hand-held, multi-use, blood glucose meter (BGM) to check the blood sugar of Resident #86. Further observation revealed LPN #313 removed the soiled gloves, disposed of the lancet and soiled gloves into the sharps container and trash receptacle on the medication cart, respectively, then removed one standard sized alcohol wipe from the top drawer of the medication cart, opened the wipe, and used the wipe to briskly wipe down the front of the BGM before placing the BGM back into the top drawer of the medication cart and performing hand hygiene. At the end of the observation, LPN #313 stated Resident #87 did not get insulin per sliding scale and did not need the additional fingerstick for blood sugar monitoring that was just performed, but LPN #313 expressed it was her process to check all resident's blood sugars if they were on insulin. Interview on 11/17/25 at 9:25 A.M. with LPN #313 revealed a lack of knowledge of the facility's specific policy for cleaning BGM's between resident use and confirmed the use of one standard alcohol swab to clean the BGM before placing it back into the drawer of the medication cart. Interview on 11/17/25 at 10:05 A.M. with the Director of Nursing (DON) confirmed that use of an alcohol swab to wipe the front of the BGM was not the correct procedure to ensure the device was properly cleaned and disinfected. During the interview, the DON confirmed that the facility used Sani-Cloth Disposable Wipes to clean and disinfect the BGM. During a follow-up interview on 11/17/25 at 10:20 A.M., the DON confirmed the Sani-Cloth Disposable Wipes required a two-minute dry time before the BGM would be considered properly disinfected before drying and placing the BGM back into the drawer of the medication cart.Review of the undated policy titled Performing a Blood Glucose Test revealed the facility was to always ensure that the blood glucose monitoring device was cleaned and disinfected between resident use following manufacturer's instructions.Review of the Assure Prism Multi Blood Glucose Monitoring System Manufacturer's Instructions revealed the device was required to be cleaned prior to disinfection and then disinfected using only specified products with approved Environmental Protection Agency (EPA) registration numbers, which included the following products: Clorox Germicidal Wipes, Super Sani-Cloth Germicidal Disposable Wipes, Dispatch Hospital Cleaner Disinfectant Towels with Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365654 If continuation sheet Page 6 of 7 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 365654 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Austinwoods Rehab Health Care 4780 Kirk Rd Austintown, OH 44515 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Bleach, and CaviWipes1. The instructions further revealed two of the approved wipes were required, one to clean, and one to disinfect the device. Further review of the manufacturer's instructions revealed the device was to remain wet for the specified amount of time per the wipe manufacturer's instructions in order to be considered properly disinfected. 2. Review of the medical record for Resident #67 revealed an admission date of 04/08/25 and a re-entry date of 09/16/25. Pertinent diagnoses included acute and chronic respiratory failure, spastic quadriplegic cerebral palsy, dysphagia, neuromuscular dysfunction of the bladder, seizures, attention to tracheostomy, dependence on respirator (ventilator) status, tracheostomy status, pressure ulcer of the sacral region, and gastrostomy status. Review of the quarterly MDS 3.0 assessment completed on 10/29/25 revealed Resident #67 had severely impaired cognition. Further review of the MDS revealed Resident #67 had a feeding tube and received more than 51 percent (%) of daily required calories through a feeding tube. Review of the physician's orders revealed an order which specified Resident #67 was to be on EBP per CDC (Centers for Disease Control and Prevention) guidelines.Review of the care plan last reviewed 11/06/25 revealed Resident #67 was on EBP due to having a Foley (an indwelling urinary catheter), a tracheostomy tube (trach), an enteral feeding tube, and wounds. Interventions included keeping gloves and gowns available and using appropriate personal protective equipment (PPE) during direct personal care, including bathing, dressing, transferring, changing bed linen, changing briefs, and any wound care or device use. Observation on 11/17/25 from 11:58 A.M. to 12:02 P.M. revealed Resident #67 received medication through an enteral feeding tube, which was administered by LPN #387. During the observation, LPN #387 did not wear a gown for the medication administration which required close handling of the feeding tube, such as lifting the gown and readjusting the brief to observe the insertion site, leaning in to auscultate feeding tube placement, closing the port to the enteral formula that was hanging on the feeding pump, opening and closing the medication port to attach and detach a syringe for pre and post medication flushes and medication administration, reopening the enteral feeding line port, and readjusting the residents gown and linen once the medication administration was completed. Interview on 11/17/25 at 12:05 P.M. with LPN #387 confirmed Resident #67 was in EBP, and a gown was to be worn during wound care, Foley care, trach care, and probably during administration of medications through Resident #67's feeding tube, but she did not put one on.Interview on 11/17/25 at 3:50 P.M. with the DON confirmed that residents that had enteral feeding tubes were supposed to be in EBP, which required nurses to wear a gown and gloves during medication administration through the feeding tube.Review of the policy titled Enhanced Barrier Precautions (EBP) dated April 2024, revealed EBP was to be implemented for residents with medical devices, including enteral feeding tubes. The facility EBP procedure specified that EBP was to be used consistently throughout the facility and included the use of gowns and gloves during use or care of enteral feeding tubes. This deficiency was an incidental finding identified during the complaint investigation. Event ID: Facility ID: 365654 If continuation sheet Page 7 of 7