Inspection·November 17, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some correct.Review of the interview record (witness statement) authored by Assistant Business Office Manager (ABOM) #122 as the interviewee and the Administrator as the interviewer dated 09/02/25 revealed, .I don ' t know how items are decided upon for R [residents]. When R packages arrive, they are in [BOM #120 ' s] name and she opens them and tells me where they go. I have never opened a package without being asked that was addressed to [BOM #120] or opened a package unwitnessed. Sometimes I think the dollar amount of items purchased are excessive. I have never observed any jewelry. I questioned [BOM #120] and [Receptionist #128] on the cost of the items (fans specifically - [NAME] fans). I did not mention my thoughts to [previous Administrator] .Review of the interview record (witness statement) authored by Receptionist #128 as the interviewee and RDO #124 as the interviewer dated 09/02/25 revealed, Have lots of boxes come to the office in [BOM #120 ' s] name? We used to get a lot but not as many now. Did you open the boxes? Only the ones she told me to open. When she has you open them, what is the process? I label the items and take them to resident rooms .Review of the interview record (witness statement) authored by former Activities Director #127 as the interviewee and the Administrator as the interviewer dated 09/02/25 revealed, .Why did activities stop buying items for residents? I told [the former Administrator] I was done because there were too many hands in the pot. I felt like [BOM #120] was buying [NAME] and inappropriate items for residents. What kind of items? Play Station 5, gold watch, expensive items that these residents don ' t use. Did you report this? Yes, I reported it to [former Administrator]. Also, the resident did not want the Play Station 5 so [BOM #120] wanted to donate it to the facility activities department. At this time, I said, absolutely not that it was not appropriate.Review of the interview record (witness statement) authored by BOM #120 as the interviewee and the Administrator as the interviewer dated 09/02/25 revealed, What is your process for resident spend downs? I write checks to my name, deposit in my account, place orders online and use my card to purchase items. Was anyone aware you were writing checks to yourself? Yes, [former Administrator] knew. How did you decide what to buy for residents? I talk to the guardians to get permission. Did you document these conversations with the guardians and families? No - I just called them. What do you do with the receipts from the purchases? Everything is in the month end book. Did anyone tell you they did not want the items bought? No - except two recliners that the guardians told me to donate to the facility. I drafted a letter to the guardians, but I did not send it. Do you process petty cash checks? Yes, all the time. Did you write a check to [name of family member of BOM #120]? Yes. Who is [name of family member of BOM #120]? My dad. Why would you write a check to your dad? Because I didn ' t have a license and the bank wouldn ' t cash the check, so my dad cashed it for me.Review of the police incident report dated 09/05/25 authored by Patrol Officer #133 revealed, On Friday, September 5, 2025, at 2:39 P.M., I was dispatched to [facility address] for a theft report. Upon arrival, I met with the complainant, [Regional Director of Operations (RDO) #124]. [RDO #124 ' s name], the Regional Director of Operations of the [facility], stated that she conducted an audit of all employees. She discovered that [BOM #120], an employee, had written herself a check from the company ' s checking account which was intended for patient spending. This account was described as one that the company keeps updated with available funds for whenever a patient wants cash or personal items. After the patient received their cash or items, it is withdrawn from their [the facility] spending accounts, where all their Medicare money is deposited. All purchased items for patients should have receipts attached to the transaction in their records. Furthermore, all checks for items purchased should be made payable to the vendor where the purchase took place. [RDO #124] said a company check should never be made out to an individual employee. Also, [RDO #124] informed me that any withdrawal of funds was not in [BOM #120 ' s] job description as a business office (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 2 of 11 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 11/17/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some manager. A detailed investigation showed [BOM #120] wrote herself checks multiple times since February 2025. [The facility] suspended [BOM #120] on September 2nd while the investigation continued. During the investigation, [RDO #120] discovered [BOM #120] wrote as many as 14 checks to herself from [the facility] patient spending accounts, totaling $19,981.04. Please note that [BOM #120] also issued one check to her father, [BOM #120 ' s father name], who was not employed at the company. Many of these patients are in the memory care unit where family consent is required for any financial transactions. [RDO #124] could not provider receipts for several purchases. However, some checks [BOM #120] wrote to herself had receipts scanned into he system, but the items purchased were not found in the patient ' s rooms. These items included a laptop, a tablet, jewelry, and women ' s clothing bought for a male patient. [BOM #120] was officially terminated on September 5th based on internal findings. I contacted [BOM #120], and she provided her account. [BOM #120] claimed she followed her job responsibilities and did not violate any rules. All items purchased for patients were ordered by her and delivered to the facility. Once they arrived there, it was not longer her responsibility to ensure the items reached the patient ' s rooms. [BOM #120] said all checks written to herself where for replenishing the [facility] bank account, from which the facility withdrew money when patient ' s requested funds. Please note that during the conversation, it seemed like [BOM #120] talked in circles, and her story did not make any sense. [BOM #120] mentioned she would be willing to come to [the police department] to fill out a statement once she is no longer COVID-positive. As of September 11th, [BOM #120] has not submitted a written statement to [the police department]. On September 11th, I contacted some families of the patient ' s involved in the memory care unit. I spoke to [Resident #97 ' s son], who is the son and power of attorney for the patient, [Resident #97]. I also talked to [Resident #9 ' s guardian], who is the legal guardian for patient [Resident #9]. Both confirmed that they were not made aware of any of the transactions. They were advised that the [facility] replenished the patient spending accounts of all the parties harmed. [RDO #124] provided me with a binder of paperwork, which included: copies of the checks, company policy regarding patient transactions, scanned receipts, and copies of the internal investigation. This binder will be stored in [the police department] evidence locker .An arrest warrant will be issued for [BOM #120] on the following charge: ORC 2913.02(A)[3] Theft (F4).Interview on 09/09/25 at 11:40 A.M. with Assistant Business Officer Manager (ABOM) #122 revealed ABOM #122 noticed BOM #120 would do resident spends down on her own credit card and reimburse herself (BOM #120). At the time, it was not apparent BOM #120 was misappropriating funds because BOM #120 would have receipts for purchases. Interview on 09/09/25 at 12:10 P.M. with Regional Business Office Manager (RBOM) #123 revealed RBOM #123 was covering at the facility for BOM #120 on 08/26/25, 08/27/25 and 08/28/25, which RBOM #123 had discovered a check BOM #120 had written to herself from the Resident Fund Management Service (RFMS) petty cash account. RBOM #120 verified it was not a normal practice for a BOM to write a check to themselves. RBOM #120 immediately notified the Administrator and Regional Director of Operations (RDO) #123.Interview on 09/09/25 at 2:15 P.M. with RDO #123 verified the misappropriation of resident funds occurred for 13 residents (#6, #8, #9, #12, #32, #43, #57, #67, #83, #87, #97, #105, and #107). Interview on 09/09/25 at 4:10 P.M. with the Administrator revealed BOM #120 had been suspended for a prior incident that occurred on 08/23/25 so RBOM #123 was covering the facility and found BOM #120 had written a check to herself (BOM #120) from the RFMS account. The Administrator asked RDO #124 if RDO #124 approved BOM #120 to write checks to herself out of the RFMS account. RDO #124 stated, Absolutely not. RBOM #123 then began to audit all the checks written out of the RFMS account. The Administrator verified misappropriation of resident funds did occur.Interview on 09/15/25 at 1:35 P.M. with Former Administrator #128 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 3 of 11 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 11/17/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some revealed he was not aware that BOM #120 was writing facility checks to herself and he was not told by any residents or staff that BOM #120 was purchasing [NAME] or inappropriate items for the residents.A follow-up interview on 09/15/25 at 5:00 P.M. with the Administrator revealed the Chief Operating Officer for the facility had signed all the checks by an automatic signature for the facility checks prior to this incident.Review of the personnel record for BOM #120 revealed a hire date of 12/16/24. Review of the Business Office Manager job description dated January 2020 revealed an essential function was to process and record accounts payable invoices for the facility; BOM #120 signed the job description form on 12/16/24. BOM #120 acknowledged she was educated on Abuse, Neglect and Misappropriation and Exploitation on 12/16/24. Review of the Disciplinary Action form dated 09/05/25 revealed after a completed internal investigation following BOM #120 ' s suspension on 09/02/25, it was determined that BOM #120 participated in misappropriation of resident funds. The violation resulted in immediate termination of employment.Review of the facility ' s Best Practice Guideline RFMS Concepts dated 09/20/18 revealed when a resident requests cash, the designated assistant/receptionist would review the resident ' s account to ensure he/she had sufficient funds for transactions. The BOM would process the withdraw record debiting the funds from the resident ' s account. If the resident requested a check, the BOM would complete the withdraw transaction. The designated assistant/receptionist would print the check. The receptionist/designated BOM assistant maintained the RFMS checks and printed the checks.Review of the facility ' s Abuse Prevention Program policy dated September 2021 revealed our residents had the right to be free from abuse, neglect, misappropriation of resident property and exploitation. 1. Review of the medical record for Resident #97 revealed an admission date of 01/30/20 with diagnoses that included dementia, cognitive communication deficit, anxiety disorder, and psychosis. Review of the Minimum Data Set (MDS) 3.0 significant change assessment dated [DATE] revealed Resident #97 was severely cognitively impaired and wandered one to three days during the assessment. Resident #97 resided on the secured memory care unit. Review of the Resident Management Funds Service (RMFS) Resident Statement Landscape from January 2025 to September 2025 for Resident #97 revealed the following:a. On 07/22/25, $1,268.90 was debited for bedding with BOM #120 as the payee.b. On 07/24/25, $5,695.91 was debited for personal needs items with BOM #120 as the payee.Review of the undated (approximately on 07/21/25) Amazon receipt revealed the following items were addressed to BOM #120 at the facility address which included: 14-carat diamond cut hoop earrings for $149.99, 14-carat gold hoop earrings for $114.99 and a Samsung Galaxy tablet for $219.99.Review of the RFMS Withdrawal Record dated 07/21/25 revealed the petty cash account was credited a total of $1,475.00 which included $1,268.90 for Resident #97 ' s bedding; BOM #120 was the vendor. It also included items for Resident #43 though deficient practice was not identified for that specific item identified. Review of Check #1958 dated 07/21/25 revealed the check of $1,475.00 was paid to the order of BOM #120 for resident spend downs. Review of the undated (approximately on 07/23/25) Amazon receipt revealed the following items were addressed to BOM #120 at the facility address which included: Sony wireless noise cancelling headphones for $449.99, [NAME] purifier for $499.00, 18-carat white gold rose [NAME] necklace for $219.99, 0.10 carat round lab grown 18-carat solid white gold diamond earrings for $221.87, 14-carat gold hoop earrings for $259.95, and a Samsung Galaxy tablet for $1,399.99. Review of the RFMS Withdrawal Record dated 07/23/25 revealed the petty check account was credited a total of $31,235.80 which included $5,695.91 for Resident #97 ' s personal need items; BOM #120 was the vendor. The remaining amount of $25,539.89 was accounted for.Review of Check #1959 dated 07/23/25 revealed $5,695.91 was paid to the order of BOM #120 for resident spend downs.Review of the interview record (witness statement) authored by BOM #120 as the interviewee and the Administrator as the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 4 of 11 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 11/17/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some interviewer dated 09/02/25 revealed, .Have you spoken to [Resident #97 ' s] family members re: purchases? Yes, she received a very large check from OPERS [Ohio Public Employees Retirement System] that needed to be spent. Family wanted funeral arrangements made. I spent $25,000 on funeral arrangements .They also said they wanted her to look nicer, so I purchased her clothes and jewelry. Did you buy her a tablet? Yes. Did you find that to be appropriate for someone in the dementia unit? I thought the aides would help her with it. Was this authorized from the family? Yes, it was collaborative.Review of the interview record (witness statement) authored by Resident #97 ' s son as the interviewee and the Administrator as the interviewer dated 09/02/25 revealed, I am aware that [BOM #120] purchased funeral arrangements for my mom. She received a large check from OPERS and [BOM #120] advised that the best way to spend down her funds was to prepay for funeral expenses. I did give permission for [BOM #120] to spend that money on my mom ' s behalf. I am unaware of any jewelry or electronics being purchased and would not have authorized any of these items as my mom is on the dementia unit and those items would not be appropriate.Review of the undated witness statement authored by LSW #133 revealed, on 08/29/25, [Quality Assurance (QA) #125] and I contacted [Resident #97 ' s son] and left a message to return our call. QA and myself then contacted resident ' s sister, [Resident #97 ' s sister name], and asked her if she or anyone in the family purchased or gave permission to purchase earrings and a necklace. [Resident #97 ' s sister] stated that they would never purchase or request to purchase jewelry for [Resident #97].Interview on 09/09/25 at 2:15 P.M. RDO #124 (RBOM #123 present) revealed Check #1959 dated 07/23/25 was written to BOM #120 which had receipts for gold earrings, a gold pendent, computer, tablet, [NAME] fan, noise cancelling headphones, multiple sets of bedding, shoes and clothes however Resident #97 ' s family did not authorize the purchases for Resident #97. RDO #124 verified Resident #97 would be reimbursed $6,235.96.2. Review of the closed medical record for Resident #105 revealed an admission date of 04/07/25 with diagnoses which included chronic obstructive pulmonary disease, major depressive disorder, hypertension, atrial fibrillation, and anxiety disorder. Review of the MDS 3.0 quarterly assessment dated [DATE] revealed Resident #105 was cognitively intact. Resident #105 discharged to another skilled nursing facility (SNF) on 07/11/25.Review of the RMFS Resident Statement Landscape from January 2025 to September 2025 for Resident #105 revealed the following:a. On 02/05/25, $50.00 was debited for personnel needs items with BOM #120 ' s father as the payee.b. On 07/01/25, $1,175.92 was debited for clothing with BOM #120 as the payee. c. On 07/02/25, $376.73 was debited for nicotine pods/food.d. On 07/09/25, $761.92 was debited for an electronic tablet with BOM #120 as the payee. Review of the undated (approximately on 06/30/25) Amazon receipt revealed the following items were addressed to BOM #120 at the facility address which included: 55-ounces of Frosted Flakes cereal for $13.24 and 42-ounces Raisin Bran Crunch cereal for $12.00.Review of the RFMS Withdrawal Record dated 06/30/25 revealed the petty cash account was credited for a total of $1,175.92 for Resident #105 ' s clothing; BOM #120 was the vendor.Review of Check #1947 dated 07/01/25 revealed $1,502.65 was paid to the order of BOM #120 for resident spend downs. This was $326.73 more than what was spent on the resident. Review of the undated (approximately on 07/08/25) Amazon receipt revealed the following items were addressed to BOM #120 at the facility address: Samsung Galaxy tablet S10 13.1-inch for $679.99 and Seymac tablet case for Samsung tablet for $25.49.Review of the email from Quality Assistant (QA) #125 to admission Director #130 (at the SNF Resident #105 resided) dated 09/10/25 revealed QA #125 requested the receipts for Resident #105 ' s tablet and case.Review of the email from QA #125 to Admissions Director dated 09/15/25 revealed QA #125 delivered a check on Saturday (09/13/25) for Resident #105.Review of the email from Social Services Director #131 to Admissions Director #130 dated 09/15/25 revealed the facility was still (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 5 of 11 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 11/17/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some investigating everything for Resident #105.Interview on 09/09/25 at 8:30 A.M. and 9:25 A.M. with Admissions Director (AD) #130 revealed the tablet that was ordered for Resident #105 [by BOM #120] was a different model than the tablet Resident #105 received; an approximately $600 difference in price.Interview on 09/09/25 at 2:15 P.M. RDO #124 (with RBOM #123 present) revealed the day Resident #105 discharged to another SNF, the resident was supposed to have an electronic tablet. BOM #120 told RDO #124 that the tablet had arrived broken, so BOM #120 returned/sent back the tablet then BOM #120 reordered a tablet and sent the tablet directly to the other SNF where Resident #105 resided. RDO #124 was previously unaware that the electronic tablet BOM #120 ordered for Resident #105 was a different model and price than the electronic tablet that Resident #105 received. Interview on 09/15/25 at 9:30 A.M. with the Administrator revealed Resident #105 was reimbursed an additional $592.53 on 09/11/25 for the difference of the tablet that was ordered versus the tablet the resident received.Interview on 09/15/25 at 2:25 P.M. with Resident #105 revealed she did not authorize $700 to be spent on a tablet and stated the tablet she received cost $200. Resident #105 also stated she did not authorize the purchases of cereals. Resident #105 stated the unauthorized use of her money made her angry [and she] could be a lot nastier.Interview on 09/15/25 at 3:45 P.M. with RBOM #123 revealed Resident #105 was reimbursed $326.73 for the nicotine pods since the facility could not locate a receipt for the transaction. 3. Review of the medical record for Resident #6 revealed an admission date of 03/27/25 with diagnoses which included bipolar disorder, alcohol abuse, encephalopathy, acute respiratory failure, anxiety disorder, and disorientation. Review of the MDS 3.0 significant change assessment dated [DATE] revealed Resident #6 was moderately cognitively impaired. Resident #6 had a legally appointed guardian.Review of the RFMS Resident Statement Landscape from January 2025 to September 2025 for Resident #6 revealed the following:a. On 02/03/25, $50.00 was debited for personal need items with BOM #120 ' s father as the payee.b. On 04/15/25, $565.23 was debited for clothing with BOM #120 as the payee.c. On 05/08/25, $323.21 was debited for phone tablet request with BOM #120 as the payee.d. On 06/20/25, $255.89 was debited for clothing with BOM #120 as the payee.e. On 07/09/25, $564.29 was debited for an air purifier with BOM #120 as the payee.Review of the RFMS Withdrawal Record for Check #1884 dated 02/11/25 revealed BOM #120 received payment for a total of $3,417.37 for resident spend downs which included $335.98 for Resident #6 ' s clothing, $513.50 for Resident #6 ' s bedding, and $50.00 for Resident #6 ' s personnel need items; BOM #120 was the vendor.Review of Check #1884 dated 02/11/25 revealed $3,417.37 was paid to the order of BOM #120 for resident spend downs. This amount was a combination of items for Resident #6, #12, and #107. Review of the RFMS Withdrawal Record for Check #1903 dated 04/15/25 revealed BOM #120 received payment totaling $5,233.50 for resident spend downs which included $565.23 for Resident #6 ' s clothing; BOM #120 was the vendor.Review of Check #1903 dated 04/15/25 revealed $5,233.50 was paid to the order of BOM #120 for resident spend downs. This amount was a combination of items for Resident #6, #8, #12, #32 and #57. Interview on 09/09/25 at 2:15 P.M. with RDO #124 (RBOM #123 present) revealed receipts could not be located for purchases of Resident #6 ' s clothing, bedding and personal need items from Check #1884 dated 02/11/25. RDO #124 revealed Resident #6 would be reimbursed $1,464.71.Interview on 09/15/25 at 8:15 A.M. with Resident #6 ' s guardian verified the guardian did not authorize the facility to purchase clothing, bedding and personal items for Resident #6.4. Review of the medical record for former Resident #107 revealed an admission date of 08/02/22 with diagnoses which included dementia with agitation, chronic obstructive pulmonary disease, diabetes, cognitive communication deficit, and end stage renal disease. Review of the MDS 3.0 quarterly assessment dated [DATE] revealed Resident #107 was moderately cognitively intact. Resident #107 was discharged to the hospital on [DATE] and did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 6 of 11 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 11/17/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some return.Review of the RFMS Resident Statement Landscape from January 2025 to May 2025 for Resident #107 revealed the following: a. On 02/12/25, $243.92 was debited for clothing.b. On 02/12/25, $475.56 was debited for bedding.c. On 02/12/25, $106.17 was debited for personal need items.Review of the RFMS Withdrawal Record for Check #1884 dated 02/11/25 revealed BOM #120 received payment for a total of $3417.37 for resident spend downs which included $243.92 for Resident #107 ' s clothing, $475.56 for Resident #107 ' s bedding, and $106.17 for Resident #107 ' s personnel need items; BOM #120 was the vendor.Review of Check #1884 dated 02/11/25 revealed $3,417.37 was paid to the order of BOM #120 for resident spend downs. This amount was a combination of items for Resident #6, #12, and #107. Interview on 09/09/25 at 2:15 P.M. with RDO #124 (RBOM #123 present) revealed receipts could not be located for purchases for Resident #107 ' s clothing, bedding and personal items from Check #1884 dated 02/11/25. RDO #124 revealed Resident #107 would be reimbursed $825.65. 5. Review of the medical record for Resident #32 revealed an admission date of 06/27/23 with diagnoses which included Parkinsonism, diabetes, mobility, generalized anxiety disorder, restlessness and agitation, convulsions, and metabolic encephalopathy. Review of the MDS 3.0 quarterly assessment dated [DATE] revealed Resident #32 was moderately cognitively impaired. Resident #32 had a legally appointed guardian.Review of the RFMS Resident Statement Landscape from January 2025 to September 2025 for Resident #32 revealed the following:a. On 03/18/25, $500.00 was debited for clothing with BOM #120 as the payee.b. On 04/15/25, $280.79 was debited for clothing with BOM #120 as the payee.c. On 04/28/25, $161.98 was debited for a recliner with BOM #120 as the payee.d. On 05/08/25, $177.00 was debited for snack bar with BOM #120 as the payee.Review of the RFMS Withdrawal Record for Check #1903 dated 04/15/25 revealed the petty cash account was credited $5,233.50 which included $280.79 for Resident #32 ' s clothing; BOM #120 was the vendor.Review of Check #1903 dated 04/15/25 revealed $5,233.50 was paid to the order of BOM #120 for resident spend downs. This amount was a combination of items for Resident #6, #8, #12, #32 and #57. Interview on 09/09/25 at 2:15 P.M. with RDO #124 (RBOM #123 present) revealed the facility could not locate a receipt for Check #1903 dated 04/15/25 for Resident #32 ' s clothing. RDO #124 stated Resident #32 would be reimbursed for $280.79.Interview on 09/15/25 at 9:02 A.M. with Resident #32 ' s guardian revealed the guardian had already completed a spend down for the resident by purchasing clothing and shoes. The police reached out to the guardian and the guardian wanted to press charges against BOM #120 so BOM #120 couldn ' t do this again at another facility. 6. Review of the medical record for Resident #43 revealed an admission date of 06/15/24 with diagnoses which included Parkinson ' s disease, tremor, sleep disorder and diverticulosis. Review of the MDS 3.0 annual assessment dated [DATE] revealed Resident #43 was cognitively intact.Review of the RFMS Statement Landscape from January 2025 to September 2025 for Resident #43 revealed the following:a. On 02/07/25, $50.00 was debited for personal need items with Resident #120 ' s father as the payee.b. On 03/27/25, $61.59 was debited for phone case and headphones with BOM #120 as the payee.c. On 07/22/25, $206.10 was debited for telephone charges with BOM #120 as the payee.Review of the RFMS Withdrawal Record dated 03/27/25 revealed the petty cash account was credited $61.59 for Resident #43 ' s phone case and headphones; BOM #120 was the vendor.Review of Check #1896 dated 03/28/25 revealed $61.59 was paid to the order of BOM #120 for resident spend downs. Interview on 09/09/25 at 2:15 P.M. with RDO #124 (with RBOM #123 present) revealed the facility could not locate a receipt from Check #1896 from 03/28/25 for Resident #43 ' s phone case. RDO #124 stated Resident #43 would be reimbursed for $61.59. Observation on 09/16/25 at 10:10 A.M. revealed Resident #43 was sitting in the second-floor dining room wearing headphones connected by a wire to his cell phone. Interview, during the observation, with Resident #43 revealed the headphones he was wearing were from his family. Resident #43 stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 7 of 11 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 11/17/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete BOM did not give him headphones. 7. Review of the medical record for Resident #67 revealed an admission date of 01/08/24 with diagnoses which included dementia, diabetes, symptoms and signs involving cognitive functions and awareness, restlessness and agitation, mental disorder, encephalopathy, and systolic congestive heart failure. Review of the MDS 3.0 quarterly assessment dated [DATE] revealed Resident #67 was moderately cognitively impaired. Resident #67 had a legally appointed guardian.Review of the RFMS Statement Landscape from January 2025 to September 2025 for Resident #67 revealed the following:a. On 03/18/25, $1,830.00 was debited for personal need items with BOM #120 as the payee.b. On 04/17/25, $2,359.09 was debited for a computer with BOM #120 as the payee.c. on 04/28/25, $324.68 was debited for furniture with BOM #120 as the payee.Review of the undated Amazon receipt revealed the following item was addressed to BOM #120 at the facility address: a Samsung Galaxy book 3 Pro laptop for $2,359.09.Review of the RFMS Withdrawal Record dated 04/16/25 revealed the petty cash account was credited $2,359.09 for Resident #67 ' s computer; BOM #120 was the vendor.Review of Check #1909 dated 04/17/25 revealed $2359.09 was paid to the order of BOM #120 for resident spend downs. Review of the RFMS Withdrawal Record dated 05/15/25 revealed the petty cash account was credited a total of $2,222.19 which included $1,624.93 for Resident #67 ' s clothing; BOM #120 was the vendor. This amount was a combination of items for Resident #9 and #67. Review of Check #1923 dated 05/16/25 revealed $2,421.52 was paid to order of BOM #120 for resident spend downs. Interview on 09/09/25 at 2:15 P.M. with RDO #124 (RBOM #123 present) revealed Resident #67 stated he did not receive a computer, and a computer was not located in the resident ' s room for Check #1909 dated 04/17/25. RDO #124 stated receipts were located for women ' s clothing for Resident #67 (a male resident) for Check #1923 dated 05/16/25. RDO #124 revealed Resident #67 would be reimbursed for $2359.09 and $597.26.Interview on 09/15/25 at 9:02 A.M. with Resident #67 ' s guardian revealed she did not authorize the purchase of a computer and women ' s clothing for Resident #67. The police reached out to the guardian and the guardian wanted to press charges against BOM #120 so BOM #120 couldn ' t do this again in another facility.8. Review of the medical record for Resident #9 revealed an admission date of 02/01/24 with diagnoses which included Alzheimer ' s disease, repeated falls, dementia with agitation, need for assistance with personal care, delusional disorder, psychosis, hallucination Event ID: Facility ID: 365661 If continuation sheet Page 8 of 11 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 11/17/2025 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review, nursing staff schedule review, disciplinary action review, policy review and interview, the facility failed to implement a person-center care plan to support the behavioral health care needs of Resident #1. This affected one (Resident #1) of three residents reviewed for behavioral health. The census was 102.Findings include: Review of the medical record for Resident #1 revealed an admission date of 04/22/25 with diagnoses which included borderline personality disorder, post-traumatic stress disorder, generalized anxiety disorder, hereditary and idiopathic neuropathy, severe morbid obesity due to excess calories, arthritis, pain in left hip and fibromyalgia. Review of the potential for pain care plan revised on 04/26/25 revealed Resident #1 had potential for pain related to fibromyalgia, neuropathy, osteoarthritis and left hip pain with interventions which included: administer medications per physician orders, notify physician or nurse practitioner if current pain medication was ineffective, and encourage resident to request pain medication before the pain became too intense.Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #1 was cognitively intact, had verbal behaviors one to three days during the assessment, had other behavioral symptoms four to six days during the assessment, used a wheelchair for mobility, was independent with bed mobility and transferring from the bed to chair. Review of the behavior care plan revised on 08/07/25 revealed Resident #1 had behaviors resistant to care which included she did not want to be disturbed while sleeping and demanded her medications be administered at midnight with interventions which included: administer medications per physician order, attempt to redirect resident when exhibiting behaviors; reapproach when resident has deescalated, encourage the resident to ask for staff assistance when feeling frustrated with others and two care providers at all times.Review of the aggressive behaviors care plan revised on 08/28/25 revealed Resident #1 had aggressive behaviors related to being verbally aggressive towards staff, utilizing inappropriate language towards staff, swearing and yelling at staff, and being physically aggressive toward staff/alternate residents with interventions which included administer medications per physician orders and allow resident to verbalize frustrations, and provide emotional support and reassurance. Review of the psychiatric/mood care plan revised on 09/03/25 revealed Resident #1 had an impaired psychiatric/mood status related to depression, anxiety, bipolar and post-traumatic stress disorder (PTSD). PTSD triggers included: staff waking her up and any physical touch of her person or belongings. Interventions included: administer medications and treatments as indicated by physician orders, encourage participation from the resident to make her own decisions, provide a calm environment when the patient was emotional or frustrated and allow time to voice feelings and staff to knock on door and announce their presence if needing to wake resident. Review of the September 2025 physician orders revealed Resident #1 was ordered the following medications: Diclofenac sodium tablet delayed release 75 mg with instructions to give one tablet by mouth at bedtime for inflammation/left hip pain at 12:00 A.M., Naproxen oral tablet 500 mg with instructions to give one tablet by mouth at bedtime related to fibromyalgia at 12:00 A.M., Hydroxyzine pamoate (an antihistamine used to treat anxiety) capsule 50 mg with instructions to give one capsule by mouth three times a day related to generalized anxiety disorder from 7:00 A.M. to 11:00 A.M., 4:00 P.M. to 6:00 P.M. and 7:00 P.M. to 11:00 P.M., Acetaminophen oral tablet 500 mg with instructions to give two tablets by mouth every six hours as needed by mild/moderate pain, Diclofenac Sodium external gel 1% with instructions to apply to lower back topically every 12 hours as needed for pain, Ibuprofen tablet 800 mg with instructions to give one tablet by mouth every eight hours as needed for pain, and Tramadol HCl tablet 50 mg with instructions to give (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 9 of 11 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 11/17/2025 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few one tablet by mouth as needed for mild/moderate pain (pain on scale six to eight [out of 10]).Review of the nurses note dated 09/09/25 timed 4:34 A.M. authored by Registered Nurse (RN) #126 revealed Resident #1 was scheduled for routine medication at 12:00 A.M. The resident requested medication at 4:00 A.M. while this nurse was on lunch break. Upon return at 4:30 A.M., this nurse was in a room when she overheard resident at the nurses' station upset and hostile talking about this nurse to an aide, making derogatory remarks yelling, that [expletive] ain't nowhere but in that room. She also stated that [expletive] been on break all shift, I'll drag her [expletive] all over the internet. I already have footage of her being a [expletive] nurse. The resident appeared agitated and uncooperative. For staff safety, medications were not administered at this time. The behavior was reported to management for awareness, further direction, and follow up. There was no evidence that RN #126 attempted any interventions or asked another nurse in the facility to attempt to administer Resident #1's medication and there was no evidence that RN #126 notified the physician or nurse practitioner of the resident requesting her scheduled medications late. Review of the nurses note dated 09/09/25 timed 6:25 A.M. authored by RN #126 revealed at approximately 6:25 A.M., the aide approached this nurse stating, resident began cursing and yelling at her as the aide was putting soiled linen in the hamper. The resident was yelling loudly to the point another resident had to ask the aide, who is that yelling?. Management was notified. Review of the September 2025 Medication Administration Record (MAR) revealed the following as needed medications were administered: Acetaminophen oral tablet 500 mg two tablets were last administered on 09/09/25 at 10:04 A.M. and Tramadol HCl tablet 50mg two tablets had last been administered on 09/09/25 at 10:04 A.M. The residents Diclofenac sodium external gel 1% hadn't been administered and Ibuprofen tablet 800 mg one tablet had been last administered on 09/07/25 at 7:44 P.M.Review of the nursing staff schedule from 09/08/25 revealed RN #126, LPN #144 and LPN #145 worked from 09/08/25 at 7:00 P.M. to 09/09/25 at 7:00 A.M. and LPN #146 worked from 09/08/25 at 11:00 P.M. to 09/09/25 at 7:00 A.M. Observation on 09/09/25 at 1:50 P.M. revealed Resident #1 was sitting in a power wheelchair in the parking lot smoking a cigarette. Interview, during the observation, with Resident #1 revealed the resident notified ADON #136 this day regarding the resident's interaction with certified nurse aide (CNA) #129 and RN #126 last night (09/08/25 into 09/09/25). Resident #1 stated she asked for her medications at 4:00 A.M. however she did not receive her medications until 8:30 A.M. on 09/09/25. Resident #1 stated she experienced a lot of pain when she requested her medications at 4:30 A.M. Interview on 09/09/25 at 4:20 P.M. with Quality Assistant #125 verified there were other nurses working during the nightshift who could have approached Resident #1 to administer medications. Interview on 09/09/25 at 4:50 P.M. and 6:00 P.M. with RN #126 revealed Resident #1 had a history of hostile behaviors such as throwing items at staff and calling staff names. Resident #1 had scheduled medications at midnight (12:00 A.M.) however the resident never pushed the call light or exited her room to request her midnight medications per the care plan. At 4:00 A.M., Resident #1 asked for her medications and RN #126 was on break. At 4:30 A.M., when RN #126 returned from break, CNA #129 notified RN #126 that the resident was requesting her medications. RN #126 was in a room and RN #126 could hear Resident #1 talking, cursing and laughing about RN #126. RN #126 stated she was scared to address her because the resident had thrown a dinner tray at a CNA before. RN #126 immediately text messaged the DON and ADON #134 to ask if RN #126 should give the resident her medication, however RN #126 did not receive a text message back until 6:00 A.M. At approximately 5:00 A.M., RN #126 began passing medications on the secured memory care unit and Resident #1 had left the nurses station. RN #126 stated management had told her (RN #126) that nurses from other units were not obligated to come upstairs to pass Resident #1 her medications. RN #126 stated there were two (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365661 If continuation sheet Page 10 of 11 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 11/17/2025 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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete other nurses working on the first floor during night shift last night. When asked if RN #126 had notified the resident's physician or nurse practitioner of Resident #1 requesting her medications late, RN #126 stated that she had reached out to the DON via text message on how to proceed. Interview on 09/09/25 at 5:10 P.M. with the DON revealed Resident #1 tended to single-out one person and it happened to be RN #126 and there always was an issue with Resident #1 and RN #126. Resident #1 had care-planned interventions regarding medication administration. The DON stated that Resident #1's medications were due at midnight, and RN #126 was following the care plan to not wake Resident #1. At 4:30 A.M., Resident #1 began yelling and calling the nurse derogatory names. The DON verified another nurse in the facility could have approached Resident #1 to administer medications. She further confirmed that the RN refusing to administer Resident #1's medications, further elevated her behaviors.A follow-up interview on 09/15/25 at 8:00 A.M. with RN #126 revealed RN #126 verified it was her duty to administer medications and Resident #1 usually received her as needed medications with her scheduled medications. A follow-up interview on 09/15/25 at 12:05 P.M. with the DON verified RN #126 did not call Resident #1's physician or nurse practitioner to inquire about administering the resident's midnight medications late and verified Resident #1 could have been administered as needed pain medication. Interview on 09/15/25 at 3:20 P.M. with CNA #129 revealed Resident #1 pushed her call light around 4:00 A.M. and was very demanding and rude asking for her medications. RN #126 was on lunch at the time, so CNA #129 notified RN #126 when RN #126 returned from lunch. Review of the Disciplinary Action form dated 09/09/25 revealed RN #126 failed to administer scheduled medications causing a delay in care. It stated RN #126 failed to comply with standard nursing practices or facility policy and procedures. RN #126 was terminated from employment on 09/11/25. Review of the facility's undated Administering Medications policy revealed medications must be administered in accordance with the orders, including any required time frames. Review of the facility's Intervention and Monitoring Behavioral assessment dated [DATE] revealed the interdisciplinary team would evaluate behavioral symptoms in residents to determine the degree of severity, distress, and potential safety risk to the resident and develop a plan of care accordingly. Interventions would be individualized and part of an overall care environment that supported physical, functional and psychosocial needs, and strived to understand, prevent and relieve the resident's distress or loss of abilities. This deficiency represents non-compliance investigated under Complaint Number 2618274. Event ID: Facility ID: 365661 If continuation sheet Page 11 of 11