Inspection·October 24, 2022

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bathroom. Resident #53's room was cluttered with personal items and medical equipment and only a very small path was available to walk to the bathroom for both Resident #53 and his roommate (Resident #11). An interview with Resident #53 on 01/17/22 at 1:47 P.M. indicated he had fallen and fractured his right leg which caused him pain when attempting to participate during therapy sessions. Resident #53 indicated he was attempting to walk from the bathroom to his bed and tripped over personal items on his way from the bathroom when he fell and fractured his leg while attempting to put on his shoes. An interview with Director of Nursing (DON) on 10/19/22 at 11:00 A.M. verified the above findings. 2. Resident #11 was admitted on [DATE] and re-admitted to the facility on [DATE] with diagnoses including epilepsy, convulsions, cerebral vascular accident (stroke) with hemiparesis (weakness of one entire side of the body) and hemiplegia (complete paralysis of half of the body), homonymous field defect (a field loss deficit in the same halves of the visual field of each eye, often resulting from cerebrovascular injury or tumor), apraxia (brain is unable to make and deliver correct movement instructions to the body.), aphasia (disorder that affects how you communicate) and unsteadiness on feet. Review of Resident #11's plan of care initiated on 08/06/21 revealed he had a risk for falls and potential injury related to stoke, weakness, impaired balance and impaired cognition. The goal of the plan of care was to minimize potential risk factors related to falls. Interventions on the plan of care included to provide an anti-rollback wheelchair for mobility with a nonskid pad on the seat of the wheelchair, remove the wheelchair from the bedside, provide a commode/urinal at the bedside and commonly used articles in reach and provide a visual reminder to use the call light and wait for assistance Additional interventions included to use a mechanical lift for transfers and to maintain a clear pathway. Resident #11's clinical record indicated he had sustained multiple falls from 07/01/22 to 10/18/22. Three falls occurred in Resident #11's room on 08/29/22, 08/20/22, 07/28/22 while trying to self transfer out of bed to his wheelchair with no injury sustained from the falls. Review of Resident #11's MDS assessment dated [DATE] revealed Resident #11 was minimally verbal due to aphasia diagnosis and needed extensive assistance of one person for transfers and supervision while us a ing a wheelchair for mobility. Review of Resident #11's fall assessment dated [DATE] revealed he had a high risk for falls due to Resident #11 exhibited loss of balance while standing, was confined to a chair, sometimes had memory problems and was receiving antiseizure medication. An observation of Resident #11's room on 10/17/22 at 1:30 P.M. revealed he shared a room with another resident and both residents had multiple personal items and designated medical equipment within reach in their room. There was a very small path from the door to Resident #11's bed with his roommate's wheelchair partially blocking the path to the door. Resident #11's bed was close to the privacy curtain and was difficult to navigate the path to enter and exit his bed and travel to the bathroom or exit the room with a wheelchair. An interview with DON on 11/19/22 at 11:00 A.M. verified the above findings and indicated she was aware of the problem with the clutter in Resident #11's room. DON indicated this was an ongoing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 2 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 0558 problem due to both residents in the room were at risk for falls. 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: 365707 If continuation sheet Page 3 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and medical record review, the the facility failed to properly treat Resident #21's constipation. This affected one resident (Resident #21) out of one resident reviewed for constipation. Residents Affected - Few Findings include: Review of Resident #21's medical record revealed an admission date of 11/16/20 with diagnoses including acute kidney failure, muscle weakness, morbid obesity, and acquired absence of right leg above the knee. Review of Resident #21's Care Plan dated 07/01/22 revealed the resident was at risk for constipation due to decreased mobility and medications. Interventions included for the facility to follow their bowel protocol for bowel management and record bowel movement patterns each day. Review of Resident #21's October 2022 physicians orders revealed the resident had orders for MiraLax Packet with instructions to give 17 grams by mouth every 24 hours as needed for constipation and Bisacodyl Suppository with instructions to insert one suppository rectally every 24 hours as needed for constipation. Additionally the resident was noted to be on several medications that can cause constipation including Tramadol, Klonopin, and Zoloft. Review of Resident #21's bowel record from 09/19/22 through 10/16/22 revealed the resident did not have a recorded bowel movement on 09/23/22, 09/24/22, 09/25/22, 09/26/22, 10/01/22, 10/02/22, 10/03/22, 10/04/22, 10/11/22, 10/12/22, 10/13/22, 10/14/22, 10/15/22, and 10/16/22. Review of Resident #21's Medication Administration Record for September and October 2022 revealed she did not receive any of her as needed medications for constipation which included MiraLax or a Bisacodyl Suppository. Interview on 10/17/22 at 12:02 P.M. with Resident #21 revealed she has frequent constipation. Interview on 10/19/22 at 10:00 A.M. with Director of Nursing confirmed the facility did not initiate their bowel protocol for Resident #21 after she went over 72 hours without a bowel movement several times. Review of the facility's policy, Bowel Program, dated 11/13/19, revealed if the resident did not have a bowel movement in 72 hours the following actions would be taken: assess bowel sounds, assess nutritional status, initiate standing orders for constipation, or notify the the physician for an order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 4 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure Resident #24's pressure ulcer treatment was completed as ordered. This affected one resident (Resident #24) out of one resident reviewed for pressure ulcers. Residents Affected - Few Findings include: Review of resident #24's medical record revealed an admission date of 10/18/22 with diagnoses including major depressive disorder, diabetes mellitus, and an unstageable pressure ulcer to right great toe. Review of Resident #24's Care Plan, dated 05/23/22, revealed the resident was at risk for impaired skin integrity due to anemia, vitamin D deficiency, diabetes, and osteomyelitis. Intervention included to complete medications and treatments as ordered. Review of Resident #24's October 2022 physicians orders revealed an order to clean the resident's right great toe stump with wound cleaner, apply skin prep, cover with an abdominal pad, and wrap with gauze every day shift and as needed. Observation on 10/18/22 at 11:00 A.M. revealed Assistant Director of Nursing (ADON) #242 complete the pressure dressing change for Resident #24 right great toe. During the dressing change ADON #242 removed a boarder dressing from Resident #24's great toe which was dated 10/16/22. Interview on 10/18/22 at 11:18 A.M. with ADON #242 revealed Resident #24's dressing was dated for two days prior when it was scheduled to be changed daily. She also confirmed the correct dressing was not used. She confirmed the dressing should have been an abdominal pad and the stump was to be wrapped with Kerlix. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 5 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation record review and interview the facility failed to maintain Resident #30's right hand splint to prevent contracture. This affected one out of four residents reviewed for limited range of motion. The facility census was 57. Findings include: Resident #30 was admitted on [DATE] with diagnoses including stoke, kidney stone, high blood pressure, aortic aneurysm, congestive heart failure and hyperlipidemia. A review of Resident #30's occupational therapy discharge note indicated he received occupational therapy services from 08/10/22 to 09/22/22. The occupational therapy recommended a restorative program for a restorative splint and brace program. Resident #30 was to wear a right hand splint to decrease further contracture as tolerated. Resident #30's physician order dated 09/14/21 indicated to apply a right hand splint daily as tolerated. There was no documentation in Resident #30's clinical record of Resident #30 refusing to wear the splint or removing the splint after the staff applied the splint. Resident #30's plan of care had no interventions regarding the application of the right hand splint. An interview with Resident #30 on 10/17/22 at 5:22 P.M. indicated he had therapy in the past and was supposed to wear a splint on his right hand due to he was flaccid on the right side from a stoke. Resident #30 indicated the staff did not routinely assist him with applying his splint and he was not assisted with wearing the splint during his morning care on the day of the interview. An observation and interview with Resident #30 on 10/18/22 at 2:00 P.M. indicated the staff did not apply his splint in the morning. There was no splint observed on Resident #30's right wrist. Resident #30's right wrist/hand were contracted and he was unable to voluntarily move the right wrist joint or fingers. An interview with Physical Therapist Assistant (PTA) on 10/18/22 at 1:31 P.M. indicated Resident #30 had received occupational therapy for his right hand contracture and were working on strengthening, passive range of motion and right hand splinting. The restorative program recommended by occupational therapy upon discharge of the therapy sessions on 09/22/22 indicated a right hand splint to be worn daily as tolerated to prevent further contracture. On 10/18/22 at 1:56 P.M. and interview with Licensed Practical Nurse (LPN) #233 verified Resident #30 was not wearing a splint and indicated she couldn't recall if she assisted him with applying the splint earlier in the day. An interview with Director of Nursing (DON) on 10/19/22 at 11:00 A.M. verified the above findings and indicated the staff should have assisted him with application of his right hand splint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 6 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interview, the facility failed to ensure care planned interventions were in place to prevent falls for Resident #11, Resident #53, Resident #37 and Resident #20. Actual harm occurred when Resident #11 and Resident #53 suffered a fall with a fracture nose and right femur respectively and were admitted to the hospital. This affected four residents (Resident #11, Resident #20, Resident #37, and Resident #53) out of six residents reviewed for falls. The facility census was 57. Findings include: 1. Resident #53 was admitted on [DATE] with diagnoses including malnutrition, chronic obstructive pulmonary disease, dementia with behaviors, delusional disturbances, iron deficiency anemia, constipation, aortic valve stenosis, congestive heart failure, fracture of the right femur, asthma, unsteadiness, difficulty walking and muscle weakness. Review of Resident #53's Minimum Data Set (MDS) assessment dated [DATE] revealed he needed extensive assistance of two staff members for bed mobility and transfers. Review of Resident #53's fall assessment dated [DATE] indicated he had a moderate risk for falls. Review of Resident #53's plan of care revealed he was at risk for falls related to unstable mood/medical condition, congestive heart failure, debilitation, weakness, dementia, impaired balance and required assistance for activities of daily living and toileting. An intervention on the plan of care was initiated on 01/22/22 to maintain a clear pathway in his room. Resident #53's nursing progress note dated 08/28/22 at 3:21 A.M. indicated the staff at the desk heard a loud noise and heard Resident #53 yell, help, I fell!. Resident #53 was found lying on the floor on his back next to his bed near the door of his room. When asked what happened Resident #53 stated, I fell getting back into the bed when returning from the bathroom, I hit my head on the door, I hit my knee. Resident #53's knee was noticeably swollen and unable to move or bend his right leg. The note indicated the staff called 9-1-1 and Resident #53 was transported to the hospital. The nursing progress note on 08/28/22 at 8:29 A.M. indicated Resident #53 was admitted to the hospital with a fracture of the right femur and was seen by an orthopedic specialist. Resident #53's fall investigation dated 08/28/22 indicated Resident #53 had sustained a fall in his room and was sent to the hospital for an evaluation. The investigation indicated Resident #53 was attempting to remove his shoes and transfer back to bed and his walker was out of reach. The investigation indicated the nurse found the room cluttered and blocking the path to the bathroom. An observation of Resident #53's room on 10/17/22 at 11:26 A.M. and 1:30 P.M. and on 10/18/22 at 4:10 P.M. revealed oxygen equipment, a wheelchair and other personal items blocking the path to the bathroom. Resident #53's room was cluttered with personal items and medical equipment and only a very small path was available to walk to the bathroom for both Resident #53 and his roommate (Resident #11). An interview with Resident #53 on 01/17/22 at 1:47 P.M. revealed he had fallen and fractured his right leg which caused him pain when attempting to participate during therapy sessions. Resident #53 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 7 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 indicated he was attempting to walk from the bathroom to his bed and tripped over personal items on his way from the bathroom when he fell and fractured his leg while attempting to put on his shoes. Level of Harm - Actual harm An interview with Director of Nursing (DON) on 10/19/22 at 11:00 A.M. verified the above findings. Residents Affected - Few 2. Resident #11 was admitted on [DATE] and re-admitted to the facility on [DATE] with diagnoses including epilepsy, convulsions, cerebral vascular accident (stroke) with hemiparesis (weakness of one entire side of the body) and hemiplegia (complete paralysis of half of the body), homonymous field defect (a field loss deficit in the same halves of the visual field of each eye, often resulting from cerebrovascular injury or tumor.), apraxia (brain is unable to make and deliver correct movement instructions to the body), aphasia (a disorder that affects how you communicate) and unsteadiness on feet. Resident #11's plan of care initiated on 08/06/21 revealed he had a risk for falls and potential injury related to stroke, weakness, impaired balance and impaired cognition. The goal of the plan of care was to minimize potential risk factors related to falls. Interventions on the plan of care included to provide an anti-rollback wheelchair for mobility with a nonskid pad on the seat of the wheelchair, remove the wheelchair from the bedside, provide a commode/urinal at the bedside and commonly used articles in reach and provide a visual reminder to use the call light and wait for assistance. Additional interventions included to use a mechanical lift for transfers and to maintain a clear pathway. Resident #11's smoking evaluation dated 08/25/21 indicated he was a smoker, had cognition loss, dexterity problems and needed supervision while smoking. Resident #11's MDS assessment dated [DATE] revealed Resident #11 was minimally verbal due to aphasia diagnosis and needed extensive assistance of one person for transfers and supervision while using a wheelchair for mobility. Review of Resident #11's fall assessment dated [DATE] revealed he had a high risk for falls due to Resident #11 exhibited loss of balance while standing, was confined to a chair, sometimes had memory problems and was receiving antiseizure medication. Resident #11's clinical record indicated he had sustained multiple falls from 07/01/22 to 10/18/22. Three falls occurred in Resident #11's room on 08/29/22, 08/20/22, 07/28/22 while trying to self-transfer out of bed to his wheelchair with no injury sustained from the falls. Review of Resident #11's nursing progress note dated 07/15/22 at 11:07 A.M. revealed when Resident #11 was outside smoking another resident reported he appeared to have a seizure and fell out of his wheelchair. Resident #11 hit his face and was bleeding profusely. The staff called 9-1-1 and Resident #11 was sent to the hospital for evaluation of his injuries. The nursing note dated 07/15/22 at 11:59 P.M. indicated the nurse called the hospital for a report on Resident #11's condition and was informed the hospital admitted Resident #11 with breakthrough seizure. Resident #11's fall investigation dated 07/15/22 revealed he was outside smoking with other residents and appeared to have a seizure and fell out of his wheelchair and hit his head on the ground. There were no staff supervising Resident #11 and the eyewitness account of the fall was provided by another resident (Former Resident #58) who no longer resided in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 8 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 - Actual harm Residents Affected - Few Review of Resident #11's nurse practitioner progress note dated 07/21/22 upon re-admission assessment revealed he had sustained nasal fractures following a fall after having a seizure. The nurse practitioner note indicated Resident #11 had no further seizure activity and to follow-up with neurology. An observation of Resident #11's room on 10/17/22 at 1:30 P.M. revealed he shared a room with another resident and both residents had multiple personal items and designated medical equipment within reach in their room. There was a very small path from the door to Resident #11's bed with his roommate's wheelchair partially blocking the path to the door. Resident #11's bed was close to the privacy curtain and was difficult to navigate the path to enter and exit his bed and travel to the bathroom or exit the room win a wheelchair. An interview with DON on 11/19/22 at 11:00 A.M. verified the above findings and indicated she was aware of the problem with the clutter in Resident #11's room. DON indicated this was an ongoing problem due to both residents in the room were at risk for falls. 3. Resident #20 was admitted on [DATE] and re-admitted to the facility with diagnoses including psychosis, sacroiliitis (an inflammation of one or both of the immovable joints formed by the bones of the pelvis), epilepsy, Todd's paralysis (a seizure is followed by a brief period of temporary paralysis), bipolar disorder and anemia and unsteady gait. Review of Resident #20's MDS assessment dated [DATE] revealed she needed assistance with transfers, ambulation, use of the toilet and bathing. Review of Resident #20's Fall assessment dated [DATE] revealed she had a moderate risk of falls due to a history of multiple falls, use of a mobility assistance device, and use of antiseizure medications. Review of Resident #20's plan of care revised on 06/12/22, revealed Resident #20 was at risk for falls/injury due to seizure disorder, depression, osteoarthritis, activity of daily living functional status, psychotropic/antidepressant medication use, muscle weakness, anxiety, reoccurring cystitis, sacroiliitis, overactive bladder, currently experiencing uncontrolled seizure activity and need for glasses due to impaired vision. Interventions on the plan of care included to provide two staff members for assistance, use of a gait belt for transfers, and Resident #20 to wear tennis shoes when transferring. Review of Resident #20's clinical record revealed she sustained five falls from 09/01/22 to 10/18/22. A review of Resident #20's fall investigation dated 09/27/22 revealed Activities Assistant (AA) #400 went to the nurse and informed her they needed her in Resident #20's room. The nurse observed Resident #20 on her buttocks in front of her recliner. Resident #20 only had socks on and the call light was in reach. AA #20 entered Resident #20's room and asked if she wanted to attend an activity to play a game. AA #20 placed Resident #20's wheelchair close to Resident #20 and informed Resident #20 she was not able to assist her with transferring from the recliner to her wheelchair. Resident #20 attempted to self-transfer to the wheelchair. Resident #20's leg became weak, and she fell to the floor. An interview on 10/20/22 at 10:15 A.M. with AA #400 indicated she rounded on the residents to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 9 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 - Actual harm Residents Affected - Few ensure they had an activity calendar and invited them to attend activities. AA #400 stated she assisted the residents by pushing them in a wheelchair to the activity room to participate in the activity programs. AA #400 stated she would notify the state tested nursing assistant assigned to care for residents needing assistance with transferring to a wheelchair. Once the resident was assisted to their wheelchair AA #400 would proceed to push them in their wheelchair to the activity room. AA #400 stated on 09/27/22 when she entered Resident #20's room to invite her to participate in the activity she was seated in her recliner. AA #400 thought Resident #20 was independent with transfers and informed her she could not assist her to her wheelchair. AA #400 indicated Resident #20 attempted to self-transfer to her wheelchair and her leg became weak and she fell to the floor. An interview with DON on 10/20/22 at 11:20 A.M. verified the above findings. A review of the facility policy and procedure titled, Falls Clinical Protocol, revised 07/25/21 indicated the initial assessment would attempt to identify residents at risk for falls. Staff would evaluate and document falls that occur in the facility and indicate where the fall occurred, how the fall happened and if the fall was witnessed or unwitnessed. After a fall occurred, the facility would attempt to find the root cause of the fall and initiate interventions to prevent future falls. Based on the assessments of the resident a plan of care would be initiated, revised as needed and implement pertinent interventions to attempt to prevent subsequent falls. 4. Review of the medical record for Resident #37 revealed admission date of 11/18/16 and diagnoses included Alzheimer's disease, anxiety disorder, insomnia, dementia with behavioral disturbance, and polyosteoarthritis. Review of Care Plan dated 06/27/22 revealed Resident #37 was at risk for falls with intervention of the bed in lowest position. Review of Nursing Post Fall Review assessment dated [DATE] revealed Resident #37 was found to have fallen out of bed and was found by staff on knees with arm and face laying on bed still. Resident #37 had noted facial bruising after fall. Interventions implemented were to move bed into lowest position when occupied. Review of Physician's Order dated 10/09/22 revealed bed in lowest position when occupied. Review of MDS quarterly assessment dated [DATE] revealed Resident #37 had impaired cognition, disorganized thinking, and behavioral concerns. Resident #37 required total two staff assistance for transfers. Observation on 10/18/22 at 3:34 P.M. revealed Resident #37 was resting comfortably in bed. Resident #37's bed was not observed to be in lowest position. Interview on 10/18/22 at 3:37 P.M. with State Tested Nursing Assistant (STNA) #212 revealed she was aware Resident #37 had recent fall and was unsure what interventions were added. Follow up observation on 10/18/22 at 3:43 P.M. with STNA #212 verified Resident #37's bed was not in lowest position. STNA #212 adjusted Resident #37's bed to lowest position. Interview on 10/18/22 at 3:47 P.M. with Director of Nursing (DON) and Chief Clinical Officer (CCO) #247 confirmed Resident #37's bed should have been in lowest position as implemented from the fall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 10 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 on 10/08/22. Level of Harm - Actual harm Review of facility policy titled, Falls Clinical Protocol, dated 07/25/21 revealed based on falls assessment staff and physician would identify interventions to prevent falls. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 11 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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, record review, and policy review, the facility failed to ensure Resident #37 and #43 had nutritional interventions implemented timely. This affected two residents (Resident #37 and Resident #43) out of four residents reviewed for nutrition. Residents Affected - Few Findings include: 1. Review of Resident #43's medical record revealed an admission date of 10/16/19 with diagnoses including dementia, hypertension, anemia and GERD. Review of Resident #43's Minimum Data Set 3.0 assessment, dated 09/17/22, revealed the resident had intact cognition and required supervision and set help for eating. Review of Resident #43's weight record revealed a 04/01/22 weight of 138.6 pounds and a 08/27/22 weight of 131.4 pounds. Review of Resident #43's 08/11/22 nutrition note by Dietitian #272 stated a weight loss notification was triggered for the resident. The resident's body mass index revealed underweight status at 17.9. The resident exhibited clinical signs of malnutrition. Added interventions included eight ounces of Boost Breeze twice a day, add the resident to weekly weight list for monitoring, and add double protein portions to diet regimen. Review of Resident #43's September 2022 physician orders revealed the intervention for Boost Breeze and weekly weights were not ordered until 09/22/22. The resident was never order the recommended double protein. Interview on 10/19/22 at 10:22 A.M. with Dietitian #272 revealed she notified the facility on 08/11/22 of the recommend interventions for Resident #43 which included double protein, boost breeze twice a day, and weekly weights. She confirmed it is her expectation that the interventions would be implemented timely. Interview on 10/18/22 at 1:56 P.M. the Director of Nursing (DON) verified Resident #43's dietary interventions for weekly weights and boost breeze were not timely implemented and confirmed the intervention to add double protein to the residents diet was not implemented at all. Review of the facility's undated, weight protocol, revealed residents who experience unplanned significant weight loss or gradual weight loss shall be weighed weekly until stable. A report indicating significant weight variances shall be copied and distributed to the Administrator, DON, Nutrition Professional, Director of Food and Nutrition Services and other interdisciplinary team members per facility policy. 2. Review of the medical record for Resident #37 revealed admission date of 11/18/16 and diagnoses included Alzheimer's disease, vitamin deficiency, and dementia with behavioral disturbance. Review of Medicare Minimum Data Set (MDS) 3.0 Quarterly assessment dated [DATE] revealed Resident #37 had impaired cognition, disorganized thinking, and behavioral concerns. Resident #37 required extensive one staff assistance for eating. The assessment indicated Resident #37 had no swallowing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 12 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 difficulties, no significant weight changes and was on mechanically altered diet. Level of Harm - Minimal harm or potential for actual harm Review of Weight Documentation for Resident #37 revealed 04/01/22 weight of 174.4 pounds (#), 04/14/22 weight 173.3#, 08/01/22 weight 174.6#, 09/29/22 weight 169.7#, ,and 10/01/22 weight of 156.4 #. There were no additional weights for review from April 2022 to October 2022. Resident #37 had a 8.50 percent (%) weight loss in less than one month and 11.51% weight loss over six months. Residents Affected - Few Review of facility assessment Nutrition Evaluation dated 06/09/22 revealed Resident #37 was on regular diet with puree textures. Resident #37 was ordered four ounces of house supplement four times per day. Resident #37 did not have significant weight loss. Resident #37 required extensive assistance for feeding and was consuming 25 to 50% of meals. Review of care plan dated 07/14/22 revealed Resident #37 was at nutritional risk related to history of significant weight loss. Interventions included monitor need for increased nutritional intervention, monitor weights, and diet/supplements as ordered. Review of Dietary Progress Note dated 09/08/22 revealed Resident #37 remained on puree diet and staff reported consuming 51 to 100% of meals. Resident #37 received 8 ounces Ensure Plus three times per day and 2 ounces of ProStat daily. Review of facility assessments from October 2022 revealed no additional evaluations or interventions for the significant weight loss identified on 10/01/22. Review of Progress Notes from October 2022 revealed no additional evaluations or interventions for significant weight loss identified on 10/01/22. Interview on 10/20/22 at 9:39 A.M. with Dietitian #272 confirmed Resident #37 had triggered for weight loss on 10/01/22 however had not yet completed assessment of weight loss. Dietitian #272 indicated Resident #37 was on her list for visit for 10/20/22. Follow up interview on 10/20/22 at 10:12 A.M. with Dietitian #272 indicated they had requested a reweigh for Resident #37 however it had not yet been completed. Dietitian #272 confirmed there had been no additional interventions implemented for weight loss on 10/01/22. Review of facility policy titled, Weight Protocol, undated, revealed residents who have experiences unplanned, significant weight loss shall be weighed weekly until stable. Review of facility policy titled, Weight Monitoring, dated 11/13/19, revealed Dietitian would assess weights and initiate appropriate interventions and reweights will be obtained within 48 hours if at least five pound deviation was noted. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 13 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, record review, and facility policy and procedure review, the facility failed to maintain a medication error rate of less than five (5) percent (%). The medication error rate was calculated to be 6.9% and included two medication errors of 29 medication administration opportunities. This affected two residents (#11 and #26) of six residents observed during medication administration. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #11 revealed an admission date of 05/11/21 with diagnoses including anxiety disorder, hypertension, major depressive disorder, and epilepsy. Review of the October 2022 physician's orders revealed Resident #11 had an order to receive Hydralazine HCL 25 milligrams (mg) by mouth twice daily for hypertension. Observation on 10/19/22 at 8:25 A.M. revealed Licensed Practical Nurse (LPN) #233 administered Resident #11 Hydralazine HCL 50 mg. Interview on 10/19/22 at 8:38 A.M. with LPN #233 confirmed she administered Resident #11 Hydralazine HCL 50 mg when he was ordered to receive Hydralazine 25 mg. Review of the facility policy titled, Guidelines for Medication Administration dated 08/2020, revealed at a minimum the five rights, which include, right resident, right drug, right dose, right route, and right times should be applied to all medications administered and reviewed at three steps in the process of preparation. 2. Review of Resident #26's medical record revealed an admission date of 05/04/22 with diagnoses including diabetes mellitus, hypertension and dementia. Review of Resident #26 October 2022 physician's order revealed an order for Insulin Lispro 100 units/milliliter insulin pen with instructions to inject 10 units subcutaneously with meals for diabetes mellitus. Observation on 10/19/22 at 7:52 A.M. revealed LPN #215 administered medications to Resident #26. The LPN obtained the insulin pen and administered 10 units to Resident #26 without first priming the needle with two units of insulin prior to administration to ensure the correct dose of the medication was administered. Interview on 10/19/22 at 7:59 A.M. with LPN #215 confirmed she did not prime Resident #26's insulin pen before administering it to the resident Interview on 10/19/22 at 10:00 A.M. Chief Clinical Officer #247 revealed that insulin pens should be primed before use. Review of the insulin pen manufacturer instructions for use revealed the insulin pen needed to be primed before injection. Priming meant removing the air from the needle and cartridge that might collect during normal use. It was important to prime the pen before each injection so that it would work correctly. If the pen was not primed before each injection, it may cause you to get too much or too (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 14 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 little insulin. 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: 365707 If continuation sheet Page 15 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure a clean and sanitary kitchen area and ensure appropriate glove usage. This had the potential to affect all 57 of 57 residents receiving meals from kitchen, as the facility identified no residents with nothing by mouth diet orders. Findings include: Observations on 10/17/22 from 11:30 A.M. to 12:15 P.M. of facility kitchen revealed significant dried food debris and dark grease build up on floors, under equipment, and in corners of kitchen. The floor left a sticky substance on shoes throughout kitchen. Observation of juice machine revealed dried juice spray on wall next to the machine. Observed cleaning cloths and food wrappers on ground stuck between prep table holding microwave and wall. Observation of large food preparation table in middle of kitchen revealed storage drawer handles were sticky and had crumbs within drawers, there was dried food splatter and debris on lower shelving of tables and legs, and an open undated container of liquid margarine on lower-level shelf. Observation of oven revealed dark grease buildup running down front observation windows. There was food splatter and crumbs on front and sides of oven. Observation of deep fryer revealed dark grease with food floating. The bottom of the fryer was not visible through cooking grease. There was significant dark grease build up on back and sides of fryer. The deep fryer control unit was coated with cooking grease overspray. Observation of kitchen mixer revealed to be covered however had dried food debris on base of mixer. Observation of steam table revealed food splatter was dripping down front and sides. The lower-level shelf revealed dripping water from steam table caused significant rust build up. Observation of stove range revealed rust build up on grates. Observation of dish washing area revealed significant food debris and wrappers under equipment including dish machine and sinks. Observation of storage for cleaning supplies revealed two brooms and mop with bucket on floor in front of hand washing sink and significant food debris on floor. Observation of dry food storage revealed chemical rack with large spill of unknown red substance underneath. Observation of walk-in cooler revealed food debris and liquid red substance dripped on floor below metal racks. Observation of walk-in freezer revealed French fries and other food debris on floor. Observation on 10/17/22 at 12:00 P.M. of Dietary #267 was serving lunch meal. Dietary #267 was observed wearing pair of gloves while serving. Dietary #267 pushed the door to kitchen open and gave plate to dietary aide delivering cart. Dietary #267 returned to kitchen wearing same gloves and adjusted pants with gloved hands. Dietary #267 then walked over to rack holding bread and gathered items to prepare burger for resident. Dietary #267 prepared burger using same gloved hands then continued to serve rest of tray line without changing gloves. Interview on 10/17/22 at 12:15 P.M. with Food Service Supervisor (FSS) #226 confirmed findings with cleanliness and glove use. FSS #226 indicated there has been an issue with cleanliness and there are no current formal cleaning schedules in place. FSS #226 indicated equipment is cleaned as needed. Interview on 10/20/22 at 9:39 A.M. with Dietitian #272 revealed there was a monthly sanitation audit completed. Dietitian #272 indicated there had been concerns with kitchen cleanliness and concerns were addressed with FSS #226. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 16 of 17 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 365707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Phoenix of Fairlawn 120 Brookmont Rd Akron, OH 44333 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of facility policy titled, Department Cleaning Schedule, undated, revealed a schedule outlining cleaning assignments would be posted and completed to maintain sanitation of the Food and Nutrition Services Department. The Director of Food and Nutrition Services shall be responsible for assuring the cleaning schedule is maintained at all times. Review of facility policy Refrigerated Storage undated revealed refrigerated food shall be stored in a manner that optimizes food safety. Review of facility policy Floors undated revealed all kitchen floors shall be cleaned after each meal and as needed. Review of facility policy Disposable Gloves undated revealed disposable gloves shall be used for only one task and shall be discarded when damaged, soiled, or when interruptions occur in operation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365707 If continuation sheet Page 17 of 17