Inspection·June 26, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A second observation on 06/24/25 at 9:37 A.M. with Maintenance Director #816 of Resident #113's room revealed the air conditioning unit was blowing slight air into the resident's room. Interview on 06/24/25 at 9:37 A.M. with Maintenance Director #816 revealed the facility was not aware of Resident #113's air conditioning unit not functioning appropriately. Maintenance Director #816 revealed the air conditioning unit was leaking due to condensation or sweating. Maintenance Director #816 did not know why the front of the air conditioning unit was removed and lying beside the wall. Interview on 06/24/25 at 9:38 A.M. with Registered Nurse (RN) #815 revealed she had worked on 06/23/25 and Resident #113's room was hot. RN #815 confirmed the resident was sweating but she did not know the temperature in the resident's room. RN #815 also confirmed she had previously reported the leaking air conditioner to the maintenance department and the maintenance staff had placed blankets underneath the air conditioning unit. Interview on 06/25/25 at 7:46 A.M. with Licensed Social Worker (LSW) #818 indicated Resident #113's family had come in at some point over the weekend (06/21/25 or 06/22/25) and reported environmental concerns including the hot temperature of the resident's room. Review of the temperature Logbook Documentation forms revealed Resident #113's room temperature was last obtained on 06/20/25 with a result of 72 degrees Farenheit (F). Review of the Resident/Family Concern/Grievance Form dated 06/23/25 revealed Resident #113's family had reported environmental concerns related to the room and the facility provided a fan for the room (and a portable air conditioner on 06/24/25). 2. Review of Resident #20's medical record revealed the resident was initially admitted on [DATE] and readmitted on [DATE] with diagnoses including respiratory failure, tracheostomy status and neuromuscular dysfunction of the bladder. Review of Resident #20's MDS 3.0 assessment dated [DATE] revealed the resident had a memory problem. Interview on 06/24/25 at 11:07 A.M. with Resident #20's daughter revealed the resident's air conditioning unit was not working appropriately and it was hot in the resident's room. Observation on 06/24/25 at 11:15 A.M. with Maintenance Assistant #814 of Resident #20's resident room revealed the ambient temperature using a hydrometer was 81.4 degrees Fahrenheit. Observation of the air conditioning unit with Maintenance Assistant #814 of the air conditioning unit revealed the unit was set to automatic and felt cold when touched but was only slightly blowing cold air into the room. Two fans were noted in the resident's room. Observation and subsequent interview on 06/24/25 at 12:07 P.M. with the Administrator of Resident #20's room revealed the air conditioning unit was set at the automatic setting and was slightly blowing cold air into the resident's room. The Administrator revealed he would talk to the maintenance department about the air conditioning unit. A blanket was noted underneath the air conditioning unit. Review of the Facility Temperature Policy dated 09/2021 revealed the purpose of the policy was to provide a comfortable and safe temperature for the residents in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 2 of 4 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 06/26/2025 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 0584 This deficiency represents non-compliance investigated under Complaint Numbers OH00166906 and OH00164339. 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 3 of 4 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 06/26/2025 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure visibly soiled bedding was changed in a timely manner affecting Resident #76. The facility also failed to ensure the south wing shower room wall was maintained in good repair. This had the potential to affect 35 residents (#5, #9, #21, #24, #27, #30, #31, #37, #38, #41, #44, #48, #49, #52, #56, #65, #66, #68, 69, #71, #72, #74, #82, #84, #92, #95, #97, #99, #100, #101, #102, #104, #108, 109, and #114) of 38 residents that use the south wing shower room. The facility census was 115. Findings include: 1. Review of the medical record for Resident #76 revealed an initial admission date of 12/03/24. Diagnoses included quadriplegia, tracheostomy status, dependence on respirator (ventilator), gastrostomy (feeding tube). Review of the comprehensive minimum data set (MDS) assessment dated [DATE] revealed Resident #76 had intact cognition and was dependent on staff for all activities of daily living (ADLs). Observation on 06/24/25 at 11:32 A.M. of Resident #76's bedding revealed a dried, brownish stain approximately 2 ½ inches on his sheet near where his right wrist was laying but did not observe any open areas. Interview at this time with Resident #76 revealed he wasn't sure what the stain was. Observation on 06/24/25 at 11:38 A.M. with Registered Nurse (RN) #815 of Resident #76's bedding verified the dried brown stain and stated she believed it was blood that came from a small scabbed over area on top of the right arm near the wrist area. RN #815 stated it was warm in the room so it could have dried fast but will make sure when the aides come into his room for care that they change his sheets. Interview on 06/25/25 at 10:47 A.M. with the Director of Nursing (DON) stated she thinks the blood was from the blood draw and provided lab results report for Resident #76. Review of the lab results revealed a collection date of 06/23/25 at 6:35 A.M. DON verified the lab draw was from the day before the observation of the dried, brown stain on 06/24/25. DON stated she was just trying to figure where the blood could have possibly come from. DON stated linens should be changed when visibly soiled. 2. Observation on 06/24/25 at 1:47 P.M. of the south wing shower room with Certified Nursing Assistant (CNA) #808 revealed the lower part of the wall between the shower and the bathroom and under the hand sanitizer was a hole with broken tiles, basketball sized, broken inward. Interview at this time with CNA #808 verified the observation and stated he was not sure how long the wall had been that way and was his first time seeing it. Review of the list provided by the facility indicated 35 residents (#5, #9, #21, #24, #27, #30, #31, #37, #38, #41, #44, #48, #49, #52, #56, #65, #66, #68, 69, #71, #72, #74, #82, #84, #92, #95, #97, #99, #100, #101, #102, #104, #108, 109, and #114) of 38 residents used the south wing shower room. This deficiency represents non-compliance investigated under Complaint Number OH00165647. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 4 of 4