Inspection·September 14, 2023

F 0569 Level of Harm - Minimal harm or potential for actual harm provided quarterly-spend down letters and confirmed no spend-down letters from April 2023 or May 2023 were available for review for Resident #13. 3. Review of Resident #93's medical record revealed an admission date of 06/07/19 and diagnoses including heart failure, depression, paranoid schizophrenia and chronic obstructive pulmonary disease. Residents Affected - Few Review of nurses' notes from 04/25/23 to 09/12/23 revealed no notes indicating the need to spend-down funds. Review of Resident #93's quarterly resident funds statement revealed balances of $4956.23 on 05/01/23 and $6756.96 on 06/01/23. Review of supporting resident funds documentation revealed a spend-down letter was issued on 07/18/23. Interview on 09/13/23 at 11:24 A.M. with SBOM #360 and the Administrator revealed the facility provided quarterly-spend down letters and confirmed no spend-down letters from May 2023 were available for review for Resident #93. Review of the facility policy, Crown Healthcare Best Practice Guideline Resident Fund Management Service (RFMS) Concepts, dated 09/20/18 revealed every month the Business Office Manager will run the $200.00 notification summary report in resident funds management system to obtain a list of residents who are more than a specified funds amount. The list will provide which residents to send an overage letter informing the resident, power of attorney and/or guardian notification to spend-down resources based on Medicaid eligibility regulations. The Business Office Manager will send the letter to the designated responsibility party for those residents who are the funds requirement for Medicaid eligibility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 2 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review and facility policy review, the facility failed to ensure advanced directives were consistent across electronic and paper medical records. This affected two residents (Resident #23 and Resident #105) of two residents reviewed for advanced directives. The facility census was 116 residents. Findings include: 1. Review of Resident #23's medical record revealed an admission date of 03/18/22 with diagnoses including senile degeneration of brain, dysphagia, muscle weakness, falls, hypertension and chronic kidney disease stage three. Review of Resident #23's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #23 had a memory problem and received hospice care. Review of Resident #23's paper chart revealed no advanced directive information was available. Review of Resident #23's electronic medical record (EMR) revealed a code status of Do Not Resuscitate Comfort Care (DNR-CC) on the gray bar below Resident #23's photo. Review of a physician's order dated 03/27/23 revealed Resident #23 had an advanced directive of DNR-CC. Interview on 09/12/23 at 7:48 A.M. with the Director of Nursing (DON) confirmed no advanced directive was found in Resident #23's paper chart and this did not match the code status of DNR-CC listed in the EMR. 2. Review of Resident #105's medical record revealed an admission date of 06/16/23 and diagnoses including senile degeneration of the brain, unspecified protein-calorie malnutrition, type two diabetes, anxiety, dementia without behaviors, urinary retention and major depressive disorder. Review of Resident #105's significant change MDS 3.0 assessment dated [DATE] revealed Resident #105 was cognitively impaired and received hospice services. Review of Resident #105's paper chart revealed his advanced directive was a full code. Review of Resident #105's electronic medical record revealed a code status of DNR-CC on the gray bar below Resident #105's photo. Review of a physician's order dated 06/23/23 revealed Resident #105 had an advanced directive of DNR-CC. Interview on 09/12/23 at 7:48 A.M. with the DON confirmed the full code advanced directive from Resident #105's paper chart did not match the code status of DNR-CC listed in the EMR. Review of the facility policy, Advanced Directives, dated 09/01/21 revealed during the care planning process the facility will identify, clarify and review with the resident or the legal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 3 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0578 representative whether they desire to make any changes related to the Advanced Directive. The policy did not address to where advanced directives were kept in the electronic and paper medical records. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 4 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0623 Level of Harm - Potential for minimal harm Residents Affected - Some Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and facility policy review, the facility failed to provide written notice of transfer to the resident and/or representative(s) upon hospital transfer/discharge. This affected three residents (Residents #2, #57 and #123) of four residents reviewed for discharges/transfers with hospitalizations. The facility census was 116. Findings include: 1. Medical record review revealed Resident #57 was admitted to the facility on [DATE] with diagnoses of Schizoaffective disorder, chronic pancreatitis, anxiety disorder, and generalized muscle weakness. Review of the comprehensive assessment dated [DATE] revealed the resident was cognitively intact. Continued review of Resident #57's medical record revealed the resident was discharged to the hospital on [DATE] and was re-admitted to the facility on [DATE], and then discharged back to the hospital on [DATE] and returned on 09/09/23. There was no documentation in the medical record Resident #57 and/or her power of attorney (POA) received a written transfer notice at either hospitalization. Interview on 09/13/23 at 3:41 P.M. with the Director of Social Service #448 confirmed no written transfer notices were given for the hospitalizations. Interview on 09/13/23 at 05:05 P.M. with the Administrator confirmed no written transfer notices were given for the hospitalizations. 2. Medical record review revealed Resident #2 was admitted from the hospital to the facility on [DATE] with diagnoses of end stage renal disease, severe fluid overload, chronic congestive heart failure, and hypotension. Review of the comprehensive assessment dated [DATE] revealed the resident was cognitively intact. Continued review of Resident #2's medical record revealed the resident was discharged to the hospital on [DATE] and was re-admitted to the facility on [DATE]. Resident #2 was discharged back to the hospital on [DATE] and returned on 09/07/23. There was no documentation in the medical record Resident #2 and/or her POA received a written transfer notice at either hospitalization. Interview on 09/13/23 at 3:41 P.M. with the Director of Social Service #448 confirmed no written transfer notices were given for the hospitalizations. Interview on 09/13/23 at 05:05 P.M. with the Administrator confirmed no written transfer notices were given for the hospitalizations. The Facility policy titled Transfer or Discharge Notice, dated September 2021, stated the facility shall provide a resident or the representative with a (thirty 30-day) written notice of an impeding transfer or discharge. The notices will be given as soon as it is practicable, an immediate transfer or discharge that is required by an residents needs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 5 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0623 Level of Harm - Potential for minimal harm Residents Affected - Some 3. Review of the medical record for Resident #123 revealed an admission date of 07/10/23. Diagnoses included dementia with behavioral disturbance, major depressive disorder, and hypertension. Review of the discharge Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #123 had severe cognitive impairment with a memory problem. Resident #123 required extensive assistance of one staff member for bed mobility, transfers, dressing, toilet use, and personal hygiene; and supervision of one person for eating. Review of the nursing progress note dated 07/23/23 revealed Resident #123 was sent out to the psychiatric department at the hospital due to excessive combative and aggressive behavior. Review of the nursing progress noted dated 08/21/23 revealed Resident #123 arrived back to the facility from the hospital with a diagnosis of delirium and dementia. Interview on 09/14/23 at 11:30 A.M. with the Administrator confirmed there was no evidence of transfer notice sent for Resident #123. Review of facility policy titled transfer or discharge notice, dated September 2021 revealed the facility shall provide a resident and/or representative (sponsor) with a thirty-day written notice of an impending transfer or discharge. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 6 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0625 Level of Harm - Potential for minimal harm Residents Affected - Some Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, staff interview, and facility policy review, the facility failed to provide written notice of bed hold duration to the resident and/or representative(s) at the time of discharge/transfer to the hospital. This affected three residents (Residents #57, #2 and #123) of four residents reviewed for discharges with hospitalizations. The facility census was 116. Findings include: 1. Medical record review revealed Resident #57 was admitted to the facility on [DATE] with diagnoses of Schizoaffective disorder, chronic pancreatitis, anxiety disorder, and generalized muscle weakness. Review of the comprehensive assessment dated [DATE] revealed the resident was cognitively intact. Continued review of Resident #57's medical record revealed the resident was discharged to the hospital on [DATE] and was re-admitted to the facility on [DATE], and then discharged back to the hospital on [DATE] and returned on 09/09/23. There was no evidence in the medical record Resident #57 and/or her power of attorney (POA) received a bed notice at either hospitalization. Interview on 09/13/23 at 3:41 P.M. with the Director of Social Service #448 confirmed no bed hold notices were given for the hospitalizations. Interview on 09/13/23 at 05:05 P.M. the Administrator confirmed no bed holds notices were given for the hospitalizations. 2. Medical record review revealed Resident #2 was admitted from the hospital to the facility on [DATE] with diagnoses of end stage renal disease, severe fluid overload, chronic congestive heart failure, and hypotension. Review of the comprehensive assessment dated [DATE] revealed the resident was cognitively intact. Continued review of Resident #2's medical record revealed the resident was discharged to the hospital on [DATE] and was re-admitted to the facility on [DATE]. Resident #2 was discharged back to the hospital on [DATE] and returned on 09/07/23. There was no evidence in the medical record Resident #2 and/or her POA received a bed hold policy at either hospitalization discharge. Interview on 09/13/23 at 3:41 P.M. with the Director of Social Service #448 confirmed no bed hold notices were given for the hospitalizations. Interview on 09/13/23 at 05:05 P.M. with the Administrator confirmed no bed holds notices were given for the hospitalizations. 3. Review of the medical record for Resident #123 revealed an admission date of 07/10/23. Diagnoses included dementia with behavioral disturbance, major depressive disorder, and hypertension. Review of the discharge Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #123 had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 7 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0625 Level of Harm - Potential for minimal harm Residents Affected - Some severe cognitive impairment with a memory problem. Resident #123 required extensive assistance of one staff member for bed mobility, transfers, dressing, toilet use, and personal hygiene; and supervision of one person for eating. Review of the nursing progress note dated 07/23/23 revealed Resident #123 was sent out to the psychiatric department at the hospital due to excessive combative and aggressive behavior. Review of the nursing progress noted dated 08/21/23 revealed Resident #123 arrived back to the facility from the hospital with a diagnosis of delirium and dementia. Interview on 09/14/23 at 11:30 A.M. with the Administrator confirmed there was no evidence of bed hold notice was sent for Resident #123. Review of the facility bed hold and return policy, dated September 2021, revealed prior to transfers and therapeutic leaves, residents or resident representatives will be informed of the bed hold and return policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 8 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide timely incontinence care to Resident #22. This affected one resident (Resident #22) of three residents reviewed for incontinence care. The facility census was 116. Residents Affected - Few Findings include: Review of the medical record for Resident #22 revealed an admission date of 12/24/21. Diagnoses included morbid obesity, type two diabetes mellitus, and polyneuropathy. Review of the facility care plan for Resident #22 dated 08/08/23 revealed she had episodes of bowel and bladder incontinence related to depression, diabetes, and obesity. Interventions included to assist her with toileting needs and to provide peri care after each incontinent episode. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #22 revealed she had intact cognition. Resident #22 required extensive two-person assistance for bed mobility; total dependence of two persons for transfers; extensive assistance of one person for dressing, toilet use, and personal hygiene; and supervision with set up help only for eating. Resident #22 was frequently incontinent of urine and bowel. Interview on 09/11/23 at 9:18 A.M. with Resident #22 revealed she had been waiting since 8:15 A.M. that day to be cleaned up after an incontinent episode. She reported the staff informed her they would be back after linens were delivered to the unit because staff did not have any clean linens on the unit. Observation on 09/11/23 at 9:21 A.M. of the linen cart for the 100 north halls revealed only four large bath towels on it. Interview during the observation with Licensed Practical Nurse (LPN) #393 confirmed the linen cart only had four large bath towels on it. Interview on 09/11/23 at 9:33 A.M. with State Tested Nursing Assistant (STNA) #363 confirmed there were no clean linens on the unit. She reported she did inform Resident #22 she would have to wait until the unit received clean linens to be cleaned up. STNA #363 also reported the facility is often out of clean linens. Observation and interview on 09/11/23 at 9:40 A.M. with the laundry staff and the laundry room revealed four large bins of dirty linens. The clean linen cart only had six towels on it. Laundry Aides #343 and #352 were working on laundry. Interview during the observation with Laundry Aides #343 and #352 confirmed there were four large bins of dirty linen. They also just stocked the second floor of the facility that is why the clean linen cart was empty. They reported they were currently working to get the first floor stocked. Interview on 09/11/23 at 10:28 A.M. with Resident #22 confirmed she had not been cleaned up yet. Observation during the interview revealed Resident #22 was in the exact same position she had been in since the last observation and interview with her. Interview on 09/11/23 at 11:23 A.M. with Resident #22 reported she had just had her call light on, and an aide was going to clean her up. Resident #22 was observed in the same position. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 9 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0677 Level of Harm - Minimal harm or potential for actual harm Observation on 09/11/23 at 11:45 A.M. revealed incontinence care was finally provided to Resident #22 by STNA #363. STNA #363 reported linens had been delivered to the floor about twenty minutes ago. She confirmed Resident #22 had been waiting because they did not have enough linen to clean Resident #22 up. Observation during the incontinence care revealed Resident #22 had been incontinent of urine. A slight smell of urine was observed in the room. Residents Affected - Few Review of the facility policy titled, Perineal Care, dated 09/01/21 revealed perineal care will be provided as needed to keep the resident, clean, free of infection, and odor free. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 10 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and facility policy review, the facility failed to ensure consistent safe storage of smoking materials. This affected two residents (Resident #4 and #52) of two residents reviewed for smoking with the potential to affect all 16 Residents who are independent smokers (Residents #4, #12, #31, #35, #52, #82, #89, #90, #96, #99, #104, #112, #116, #118, #141 and #277). The facility census was 116. Findings include: 1. Review of the medical record for Resident #52 revealed an admission date of 01/30/20 and a readmission date of 09/18/23. Diagnoses included hemiplegia and hemiparesis following a cerebral infarction affecting left non-dominant side, interstitial pulmonary disease, and type two diabetes mellitus. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #52 had intact cognition. Resident #52 required extensive two-person physical assistance for mobility; total dependence of two-persons for transfer, locomotion on and off the unit, and toilet use; extensive one-person assistance for dressing; and limited one-person assistance for eating. Review of the smoking evaluation dated 08/09/23 for Resident #52 revealed she was an unsupervised smoker. Review of the facility care plan for Resident #52 dated 08/09/23 revealed she was a smoker. Interventions included she can smoke independently, and she will be informed of the facility's smoking rules, designated smoking areas, and storage of smoking materials. Interview and observation of Resident #52 on 09/11/23 at 10:35 A.M. revealed her outside smoking with a smoking apron on. She reported staff must bring her out to smoke. Resident #52 had a small purse hanging from her neck. The smoking area included a wall of lockers with locks on them. Interview and observation on 09/13/23 at 10:30 A.M. with Resident #52 revealed she was on the second-floor common area with her purse hanging from her neck. Resident #52 reported she did not currently have any cigarettes because she was out, but she had her lighter in her purse. Resident #52 pulled a lighter out of her purse. Interview on 09/13/23 at 9:13 A.M. with State Tested Nursing Assistant (STNA) #421 reported residents must keep their smoking materials at the front desk and ask the receptionist for them before they go to smoke. Interview on 09/13/23 at 11:00 A.M. with the Administrator revealed all smokers who are independent are educated to keep their smoking materials in a locker outside in the smoking area. He confirmed the staff assign a locker to each resident and they are given a lock and educated to always keep their smoking materials in it. The Administrator confirmed there was not a staff member assigned to ensure independent smokers were using their lockers to keep their smoking materials secured. Interview on 09/13/23 at 2:48 A.M. with Social Worker #448 revealed the facility has no supervised (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 11 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some smokers at the time. She reported when smokers are admitted , and they are identified as independent smokers they are educated on using a locker to keep their smoking materials in there. They are then assigned a locker and given a lock. She reported the smoking policy was updated in January 2023, but the new policy did not have a date. Social Worker #448 confirmed the dated policy stated facility staff will distribute smoking materials to each resident. Social Worker #448 also confirmed there was no formal process to supervise smokers using their lockers and not bringing smoking materials to their room. Review of facility smoking policy, revised September 2022 revealed resident smoking materials will be retained and distributed by the facility staff to residents during their designated smoking times and/or when the independent residents choose to smoke. Review of the facility policy on smoking, undated, revealed residents are not permitted to have smoking materials on their person or in their rooms, smoking materials must be stored in an area designated by the facility. 2. Review of Resident #4's medical record revealed an admission date of 02/04/23 and diagnoses including end-stage renal disease, depression, hypertension, sleep apnea, opioid abuse, anemia in chronic kidney disease and unspecified protein-calorie malnutrition. Review of a quarterly minimum data set (MDS) 3.0 assessment dated [DATE] revealed Resident #4 was cognitively intact and did not reject care. Review of a quarterly smoking evaluation dated 08/28/23 revealed Resident #4 was an unsupervised smoker and did not need any adaptive equipment relative to smoking. Interview on 09/11/23 at 4:07 P.M. with Resident #4 revealed he kept his own smoking materials on his person or in his space and could go out to smoke whenever he wanted. Interview on 09/13/23 at 11:03 A.M. with the Administrator revealed residents utilized lockers outside to store their own smoking materials. The Administrator indicated residents were not to have smoking materials on their person. Interviews on 09/13/23 at 2:45 P.M. and 3:00 P.M. with Director of Social Services (DOSS) #448 revealed the facility currently did not have any unsupervised smokers or set smoking times. All residents who smoke would be assigned a locker outside and a lock from maintenance to store their smoking materials. Residents would also sign a smoking consent. DOSS #448 verified the consent served as the most recent policy as of January 2023 and acknowledged the consent was not dated. DOSS #448 also verified residents should not be observed with smoking materials on their person or in their rooms inside the facility. Staff were to remove the materials when observed and remind the resident to put smoking materials back in their lockers before coming back inside the facility. DOSS #448 confirmed there was no documentation to show staff specifically observed the smoking area on a routine basis to ensure smoking materials were being stored appropriately. Interview on 09/13/23 at 4:18 P.M. with State Tested Nursing Assistant (STNA) #363 revealed she did not know where resident smoking materials were kept. Follow-up interview on 09/14/23 at 7:54 A.M. with Resident #4 revealed his smoking materials were in his backpack and observation during the interview revealed Resident #4 had a lighter and three (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 12 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cigarettes in his hand. The Administrator approached Resident #4 during the interview and told Resident #4 he could not keep the lighter and cigarettes on him as he had signed the facility smoking agreement. Resident #4 voiced he did not have a locker outside for his smoking materials to which the Administrator told Resident #4 he did have a locker for use outside. Review of a list of independent smokers identified by the facility revealed Residents #4, #12, #31, #35, #52, #82, #89, #90, #96, #99, #104, #112, #116, #118, #141 and #277 smoked independently. Review of an undated document, The Heights Smoking Policy, revealed all residents who smoke must sign a Smoking Agreement outlining all smoking policies. Residents are not permitted to have smoking materials on their person or stored in their room; smoking materials are to be kept in a designated area chosen by the facility. Resident #4 signed this document but no date was located with his signature. The document lacked information regarding how safe smoking storage would be enforced by staff. Review of a facility smoking policy dated September 2022 revealed for those who are deemed safe to smoke independently per smoking assessment they may smoke at any time resident chooses in the designated smoking areas. Resident smoking materials will be retained and distributed by the facility staff to the residents during the designated smoking times and/or when independent resident chooses to smoke. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 13 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 provide catheter care in a manner to prevent infection. This affected one (Resident #44) of two residents reviewed for catheters. The facility census was 116. Findings include: Review of the medical record for Resident #44 revealed an admission date of 03/08/23. Diagnoses included non-displaced fracture of the right tibial tuberosity, hemiplegia affecting right dominant side, and neuromuscular dysfunction of the bladder. Review of the physician's order dated 01/05/23 for Resident #44 revealed orders to clean his suprapubic catheter with soap and water, pat dry, and cover with gauze every shift. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] for Resident #44 revealed he had intact cognition. Resident #44 required extensive two-person physical assistance for bed mobility and toilet use; total dependence of two-persons for transfers; extensive one-person physical assistance for dressing and personal hygiene; and independent with set up help only for eating. Resident #44 had an indwelling catheter for urine and was frequently incontinent of bowel. Review of facility care plan dated 07/25/23 for Resident #44 revealed he required an indwelling catheter for urine related to neurogenic bladder. Interventions included to provide catheter care every shift and as needed and to irrigate foley catheter as indicated. Interview on 09/12/23 at 8:20 A.M. with Resident #44 revealed they only clean his catheter site every now and then. Observation on 09/13/23 at 4:10 P.M. of catheter care for Resident #44 with Licensed Practical Nurse (LPN) #396 revealed LPN #396 entered Resident #44's room, set up resident privacy, washed her hands, and set up a clean area to hold her supplies. LPN #396 then applied gloves and began cleaning Resident #44's suprapubic catheter site. LPN #396 then dried the area and immediately grabbed the gauze to cover the insertion site, opened the package, and applied the clean dressing to his suprapubic catheter insertion site. LPN #396 then cleaned up her supplies, washed her hands and exited the room. Interview on 09/13/23 at 4:20 P.M. with LPN #396 confirmed she did not remove her gloves, wash her hands, and apply clean gloves before applying the clean gauze dressing over the insertion site. Interview on 09/14/23 at 10:25 A.M. with the Director of Nursing (DON) confirmed she has educated her staff that during any procedure they are to wash their hands and change gloves a minimum of three times during any procedure. She reported she instructs them to wash before, during, and after the procedure is completed. Review of the facility policy titled, Catheter Care, Urinary, dated September 2023, revealed follow aseptic insertion of the urinary catheter, and maintain a closed drainage system. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 14 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide nutritional juice supplement to Resident #79 that was ordered due to a significant weight loss. This affected one resident (Resident #79) of eight residents reviewed for nutrition. Residents Affected - Few Findings include: Review of the medical record for Resident #79 revealed an admission date of 08/06/21. Diagnoses included hyperlipidemia, atrial fibrillation, and major depressive disorder. Review of physician's order dated 08/06/21 for Resident #79 revealed an order for a regular diet with regular texture and thin consistency. Resident #79 was also to receive double potions. Review of Resident #79's recorded weights dated 02/07/23 revealed he weighed 165 pounds. Resident #79 weighed 152 pounds on 06/05/23 and 146 pounds on 09/03/23. Review of dietary note dated 07/07/23 for Resident #79 revealed during the annual nutritional assessment he had a history of weight loss and fluctuations. Resident #79 was ordered to receive orange nutritional drink three times a day with meals as a meal supplement. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #79 had mild cognitive impairment. Resident #79 required extensive one-person physical assistance for bed mobility, transfers, and toileting; supervision with set-up help only for eating and dressing; and limited one-person physical assistance for personal hygiene. Review of the facility care plan for Resident #79 dated 07/30/23 revealed he was at risk for altered nutritional status related to atherosclerosis, weakness, and anxiety. Interventions included to provide nutritional supplements as ordered and provide meals, snacks, and fluids based on resident food preferences. Review of dietary note dated 08/28/23 for Resident #79 revealed he triggered for a significant weight loss over 180 days of 12.5%. Resident #79 had a history of disliking the food. Resident #79's diet had been supplemented with orange nutritional drink three times a day with meals and had a good acceptance per the nursing logs. Observation on 09/14/23 at 12:47 P.M. revealed a lunch tray was delivered to Resident #79's room. Interview and observation of the meal tray for Resident #79 on 09/14/23 at 12:50 P.M. revealed no orange nutritional drink was found on his tray. Interview during the observation with Resident #79 revealed he did not get his drink at breakfast that morning either. Review of the meal ticket on his tray confirmed Resident #79 was to receive an orange nutritional drink on his tray. Interview on 09/14/23 at 12:53 P.M. with Licensed Practical Nurse (LPN) #696 confirmed there was no orange nutritional drink on Resident #79's tray. Interview on 09/14/23 at 1:57 P.M. with the Administrator confirmed there was no orange nutritional drink on Resident #79's tray. He reported Resident #79 was offered an alternative, but he refused. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 15 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0692 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy titled, Weight Assessment and Intervention, dated September 2021, revealed the multidisciplinary team will strive to prevent, monitor, and intervene for undesirable weight loss for our residents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 16 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation and interview, the facility failed to ensure pureed foods were prepared to the appropriate consistency. This affected eight residents (Residents #11, #29, #55, #58, #59, #60, #84 and #105) receiving a pureed diet. The facility census was 116 residents. Findings include: Review of the diet spreadsheet for week three, day 17 corresponding to 09/12/23 revealed a meal consisting of pork tips in gravy, steamed rice, broccoli, dinner roll and melon cubes. Beef tips were substituted for the pork tips at the lunch meal. Observation on 09/12/23 starting at 12:00 P.M. with [NAME] #328 revealed a pan of beef tips were ready to be pureed. [NAME] #328 indicated she needed nine portions and used a #8-scoop and placed five scoops into the food processor. The food was blended and tasted by [NAME] #328, Dietary Manager (DM) #325 and the surveyor at 12:05 P.M. and the mixture was not smooth with pieces of meat still palpable on the tongue. [NAME] #328 continued to blend and taste the mixture at 12:15 P.M., 12:22 P.M. and 12:29 P.M., adding five ounces of beef broth to the mixture in total. At 12:35 P.M. tray line was winding down and [NAME] #328 was asked about the status of the beef puree. The beef puree was then tasted by Registered Dietitian (RD) #359, [NAME] #328, DM #325 and the surveyor and strings of beef were still palpable on the tongue; the mixture was not smooth. RD #359, [NAME] #328 and DM #325 verified the puree was not smooth as it should have been at the time of observation and tasting. Interviews on 09/12/23 starting at 11:28 A.M. with [NAME] #328 revealed during meal preparation they let the food processor run for an unspecified amount of time as it was not as strong or fast as a Robot Coupe (commercial food processor) which had been on backorder. [NAME] #328 stated they previously had a Robot Coupe but it broke three months ago. Review of a diet roster dated 09/12/23 revealed eight residents (Residents #11, #29, #55, #58, #59, #60, #84 and #105) received a pureed diet consistency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 17 of 18 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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, maintenance log review, and staff interview the facility failed to maintain resident rooms in a safe and functional condition. This affected four residents (Resident #11, #23, #42, #55) of 116 residents observed for environment. Findings include: A tour of the facility was conducted on 09/11/19 from 9:10 A.M. to 4:36 P.M. and the following environmental conditions were identified: 1. The room walls next to Resident #11, #23, and #55 had damage from peeled paint with dry wall showing. 2. The back wall was filled with white spackles on top of colored paint. Resident #42 stated it has been like that for three months. 3. Resident #55 room had a cracked electrical outlet plate with wires exposed on the wall next to resident bed while resident #55 was in bed. Review of the facility maintenance log revealed the above environmental concerns were not in the log. Interview of Licensed Practical Nurse (LPN) #389 on 09/11/23 at 10:24 A.M. confirmed the electric outlet plate was cracked next to resident #55's bed and stated I don't think it is safe, I will have maintenance come. Interview of Director of Maintenance #356 on 09/14/23 at 10:49 A.M. verified the damaged walls with drywall showing. Director of Maintenance #356 stated the walls were painted on a rotating bases. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 18 of 18