Health inspection·November 14, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few had complained she was not provided incontinence care during the night. Resident #8 was educated on using her call light to alert the staff of need for incontinence care. The nursing progress note indicated the staff were educated on the need to check and change Resident #8 every two hours due to increased episodes of incontinence. Review of Resident #8's plan of care initiated on 10/18/23 indicated Resident #8 had episodes of bladder / bowel incontinence related to decreased sensation to void, depression, and generalized weakness. Interventions on the plan of care included to assist resident with toileting needs, check at regular intervals and change as needed, observe peri/rectal-area for redness, irritation, skin excoriation/breakdown, provide disposable incontinence products and provide peri-care after each incontinent episode; apply house barrier cream after incontinence care. A review of Resident Council Minutes dated 09/28/23 indicated Resident #8 had informed the facility of two State Tested Nursing Assistants (STNA #79 and STNA #80) who often were not answering call lights and taking breaks together and leaving the nursing unit without a stna to answer the call lights. An interview with Resident #8 on 11/16/23 at 7:15 A.M. revealed the staff did not always answer the call lights or provide incontinence care in a timely manner. Resident #8 stated she had informed the Director of Nursing and Nurse Practitioner regarding the need to to have incontinence care in a timely manner to a prevent a urinary tract infection. Resident #8 stated the facility had not resolved the issue to her satisfaction. Resident #8 stated she was worried she would get a urinary tract infection due to laying in an incontinence brief soaked in urine for an extended period of time. An interview with Licensed Practical Nurse (LPN) #81 on 11/16/23 at 7:29 A.M. revealed she was informed of Resident #8's concern with untimely incontinence care by Resident #8. LPN #81 stated she talked to both STNA #79 and STNA #80 who informed her they had not checked on Resident #8 because she did not press her call light. LPN #81 informed both STNA #79 and STNA #80 of the need for staff to check Resident #8 every two hours even if she did not alert them by pressing her call light of the need to have incontinence care. LPN #81 stated she had informed the Director of nursing the following morning of Resident #8's concern with incontinence care. An interview with Director of Nursing on 11/16/23 at 7:50 A.M. revealed she was aware of Resident #8's concern regarding incontinence care and had followed up with Resident #8 on 11/13/23. The Director of Nursing stated she had not addressed the concern with STNA #79 or STNA #80 until 11/16/23. The Director of Nursing verified the above findings during the interview. The Director of Nursing was unable to provide documentation of when she had addressed Resident #8's concern. This deficiency represents non-compliance investigated under Complaint Number OH00147691. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 2 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 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** THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Based on record review, interviews with staff, review of the facility's fall investigation and facility policy and procedure the facility failed to prevent Resident #53's fall. This affected one out of three residents reviewed for falls. The facility census was 67. Actual Harm occurred on 06/25/23 when Hospitality Aide (HA) #75 was pushing Resident #53, who was dependent on staff for transfer, had impairment on one side of the upper body and impairment on both sides of the lower extremities and used a wheelchair for mobility outside in her wheelchair while talking on her phone. Resident #63's wheelchair slipped off the sidewalk, tipping the wheelchair and Resident #53 fell to the ground. Resident #53 sustained a fractured left humerus because of the fall. Findings include: Resident #53 was admitted on [DATE] with diagnoses including nontraumatic subarachnoid hemorrhage, Alzheimer's dementia, fractured left humerus, bone density disorder, osteoarthritis, intervertebral disc degeneration, spondylosis, presbyopia, peripheral vascular disease, obesity, atrial fibrillation, cerebral vascular disease, high blood pressure, right and left ankle contracture, right and left knee contracture, anemia, depression, and a history of venous thrombosis. Resident #53 had medical conditions including muscle weakness, need for assistance with personal care, and dependence on a wheelchair for mobility. Review of Resident #53's Minimum Data Set (MDS) assessment dated [DATE] indicated Resident #53 was dependent on staff for transfer, impairment on one side of the upper body and impairment on both sides of the lower extremities and used a wheelchair for mobility. The MDS assessment indicated she had a risk for falls and a plan of care was initiated to prevent falls. Review of Resident #53's plan of care revised on 08/18/23 indicated a risk for falls related to cerebral vascular accident, agitation, bladder incontinence, decrease strength and endurance, functional problems, opioid/antipsychotic medication use, recent fracture of the humerus. Resident #53 was dependent on staff for all transfers using a mechanical lift. Interventions in the plan of care included applying anti-tippers to the back of the wheelchair. Review of Resident #53's nursing progress note dated 06/25/23 indicated staff assisted Resident #23 in her wheelchair to go outside for a smoking break. While staff was pushing Resident #53 in her wheelchair the front wheel of the wheelchair slipped off the sidewalk causing the wheelchair to tip and Resident #53 fell out of the wheelchair onto her stomach. Resident #53 was assessed and found abrasions on both knees and Resident #53 complained of left shoulder pain and had redness noted on the right side of her forehead. Resident #53 was sent to the hospital for an evaluation. Staff were educated to stay towards the center of the sidewalk when assisting a resident outdoors in a wheelchair. Resident #53 returned to the facility from the emergency room on [DATE] with her left arm mobilized in a sling. Review of the fall investigation dated 06/25/23 indicated while HA #75 was pushing Resident #53 in her wheelchair the front wheel slid off the sidewalk, tipped and Resident #53 fell to the ground on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 3 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 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 her stomach. The staff used a mechanical lift pad to lift Resident #53 back to the wheelchair. Level of Harm - Actual harm An interview with Resident #53 on 11/15/23 at 9:40 A.M. revealed she was assisted by an aide (unnamed) in her wheelchair to go outside for her smoking break. Resident #53 stated the aide was talking on her phone and was distracted. Resident #53 stated the aide was pushing her outside on the sidewalk and the front wheel of the wheelchair slipped off the edge of sidewalk causing the wheelchair to tip, and she fell to the ground. Resident #53 stated she was transported to the hospital and an x-ray was performed on her left shoulder. Resident #53 stated the x-ray results revealed she had fractured her left arm. The hospital staff applied a sling to immobilize her shoulder and she returned to the facility the next day. Residents Affected - Few Interviews with Resident #3 and Resident #5 on 11/15/23 at 9:47 A.M revealed they witnessed Resident #53's fall on 06/25/34. Both residents stated HA #75 was talking on her phone while pushing Resident #53 in her wheelchair outside the facility on the sidewalk and the front wheel of the wheelchair slipped off the sidewalk causing the wheelchair to tip and Resident #53 to fall out of the wheelchair to the ground. Both residents stated they reported they had witnessed the fall to staff (unnamed). An interview with HA #76 on 11/15/23 at 2:52 P.M. revealed she was pushing a resident in a wheelchair following behind Resident #53 and HA #75 on 06/25/23 for the residents' smoking break. HA #76 stated she witnessed the fall and stated HA #75 was talking on her phone and was distracted when Resident #53's wheelchair went off the sidewalk and Resident #53 fell to the ground. HA #76 stated HA #75 was not paying attention and had one hand on Resident #53's wheelchair while pushing Resident #53's wheelchair to guide the wheelchair down the sidewalk when the fall occurred. An interview with the Director of Nursing on 11/15/23 at 3:00 P.M. verified the above information. The facility policy and procedure titled Fall Prevention Program revised on 10/25/23 indicated each resident would be assessed for the risks of falling and would receive care and services in accordance with the level of risk to minimize the likelihood of falls. The policy and compliance guidelines included: 1. The facility utilized a standardized risk assessment for determining a resident's fall risk. 2. Upon admission, the nurse would complete a fall risk assessment along with the admission assessment to determine the resident's level of fall risk. 3. The nurse would indicate the resident's fall risk and initiate interventions on the resident's care plan, in accordance with the resident's level of risk. 4. When a resident who did not have a history of falling experienced a fall, the resident would be placed on the facility's Fall Prevention Program. 5. Each resident's risk factors, and environmental hazards would be evaluated when developing the comprehensive plan of care. The deficient practice was corrected on 06/30/23 when the facility implemented the following corrective actions: • (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 4 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 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 On 06/26/23 all staff responsible for assisting with smoking breaks were provided education by the Director of Nursing (DON) and Licensed Practical Nurse (LPN) #82 to ensure residents who needed assistance with mobility were kept in the middle of the pathway. Residents Affected - Few • On 06/26/23 the facility conducted an ad hoc Quality Assurance and Performance Improvement (QAPI) meeting to review the findings of the investigation. • On 06/28/23 all staff and cognitively intact residents were educated regarding wheelchairs having the right of way on the sidewalk by the DON. • On 06/30/23 the edges of the facility sidewalk were highlighted by the Maintenance Director to clearly identify the sidewalk edge parameters. • On 06/30/23 a new smoking area was identified by Maintenance Director in the dementia courtyard for residents residing in the dementia unit. Residents residing on the secured dementia unit would start their smoking break after the non-secured nursing unit residents until the dementia smoking area was completed. • All newly admitted residents who smoke will be educated on the smoking break times and residents in wheelchairs have the right of way while using the sidewalk. • The DON to audit smoking breaks five times a week for four weeks of using both hands to maneuver the wheelchair while assisting residents for their smoking break, residents moving in and out of the facility using the sidewalk in single file, and the ensure the sidewalk was clearly marked. • Results of the audits would be reviewed in the QAPI Committee meeting after one month with revision to the plan and changes in monitoring as deemed by the QAPI committee. • On 07/06/23 and 07/13/23 the facility conducted additional ad hoc QAPI meeting and reviewed the occurrence. This deficiency represents non-compliance investigated under Complaint Number OH00147691. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 5 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and resident/staff interview the facility failed to ensure Resident #8 received assistance with incontinence care in a timely manner. This affected one out of three residents reviewed for incontinence care. The facility census was 67. Findings include: Resident #8 was admitted on [DATE] with diagnoses including rheumatoid polyneuropathy with rheumatoid arthritis, gastrointestinal reflux disease, thyroid disorder, arthritis, depression, [NAME]-Danlos syndrome (connective tissue disease), high blood pressure, and constipation. Resident #8's clinical record indicated a urinary tract infection diagnosis was confirmed on 11/16/23. Review of Resident #8's Minimum Data Set (MDS) assessment dated [DATE] indicated she was always incontinent of urine and frequently incontinent of bowel. The MDS assessment indicated she was not a candidate for a toileting program. A review of Resident #8's nursing progress note dated 11/06/23 at 6:56 A.M. indicated Resident #8 had complained she was not provided incontinence care during the night. Resident #8 was educated on using her call light to alert the staff of need for incontinence care. The nursing progress note indicated the staff were educated on the need to check and change Resident #8 every two hours due to increased episodes of incontinence. The nursing note indicated a note was placed in the physician's binder to see Resident #8 in the morning for a possible urinary tract infection. Review of Resident #8's plan of care initiated on 10/18/23 indicated Resident #8 had episodes of bladder/bowel incontinence related to decreased sensation to void, depression, and generalized weakness. Interventions on the plan of care included to assist resident with toileting needs, check at regular intervals and change as needed, observe peri/rectal-area for redness, irritation, skin excoriation/breakdown, provide disposable incontinence products and provide peri-care after each incontinent episode; apply house barrier cream after incontinence care. An interview with Resident #8 on 11/16/23 at 7:15 A.M. revealed the staff did not always answer the call lights or provide incontinence care in a timely manner. Resident #8 stated she had informed the Director of Nursing and Nurse Practitioner regarding the need to to have incontinence care in a timely manner to a prevent a urinary tract infection. Resident #8 stated the facility had not resolved the issue to her satisfaction. Resident #8 stated she was worried she would get a urinary tract infection due to laying in an incontinence brief soaked in urine for an extended period of time. An interview with Licensed Practical Nurse (LPN) #81 on 11/16/23 at 7:29 A.M. revealed she was informed of Resident #8's concern with untimely incontinence care by Resident #8. LPN #81 stated she talked to both STNA #79 and STNA #80 who informed her they had not checked on Resident #8 because she did not press her call light. LPN #81 informed both STNA #79 and STNA #80 of the need for staff to check Resident #8 every two hours even if she did not alert them by pressing her call light of the need to have incontinence care. LPN #81 stated she had informed the Director of nursing the following morning of Resident #8's concern with incontinence care. An interview with Director of Nursing on 11/16/23 at 7:50 A.M. revealed she was aware of Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 6 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #8's concern regarding incontinence care on 11/13/23 and had not addressed the concern with STNA #79 or STNA #80 until 11/16/23. The Director of Nursing verified the above findings during the interview. The facility policy titled Incontinence revised on 10/26/23 indicated the policy was based on the resident's comprehensive assessment, all residents that were incontinent would receive appropriate treatment and services. The Policy Explanation and Compliance Guidelines indicated: • The facility must ensure that residents who are continent of bladder and bowel upon admission receive appropriate treatment, services, and assistance to maintain continence unless his or her clinical condition is or becomes such that continence is not possible to maintain. • For residents with urinary incontinence, the facility will ensure that residents are not catheterized unless the residentâ Euros (Trademark) clinical condition demonstrates that catheterization was necessary. • Residents that enter the facility with an indwelling catheter, or receives one while in the facility, will be assessed for removal of the catheter as soon as possible, unless the residentâ Euros (Trademark) clinical condition demonstrates that catheterization was necessary. • Residents that are incontinent of bladder or bowel will receive appropriate treatment to prevent infections and to restore continence to the extent possible. This deficiency represents non-compliance investigated under Complaint Number OH00147691. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 7 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure staff washed their hands to prevent possible cross contamination of germs during Resident #40's medication administration and Resident #27's incontinence care. This affected one out of five residents observed during medication administration and one out of three residents reviewed for incontinence care. The facility census was 67. Residents Affected - Few Findings include: 1. Resident #40 was admitted on [DATE] with diagnoses including deep vein thrombosis, high blood pressure, hemiplegia, dementia, depression, schizophrenia, psychotic disorder, asthma, and diabetes mellitus. An observation on 11/15/23 at 8:15 A.M. of Registered Nurse (RN) #77 administer medications to Resident #40 revealed concerns with hand hygiene. RN #77 was finishing administering medications to Resident #19 and left Resident #19's room and did not wash/sanitize her hands prior to removing and dispensing Resident #40's oral medications in a medication cup. RN #77 removed nine medications (amlodipine, aspirin, vitamin D, citalopram, furosemide, gabapentin, losartan, memantine, metformin) from the medication cart to administer to Resident #40 and proceeded to enter Resident #40's room and handed the cup of medication to Resident #40. Resident #40 consumed the medications and RN #77 exited Resident #40's room and did not wash/sanitize her hands. RN #77 proceeded to remove Resident #62's medications from the medication cart when she was asked to stop the medication administration task and wash/sanitize her hands. An interview with RN #77 on 11/15/23 at 8:25 A.M. verified she should have washed her hands after administering the medication to Resident #19 before administering medications to Resident #40 and after administering medications to Resident #40 before administering medications to Resident #62. 2. Resident #27 was admitted on [DATE] with diagnoses including stroke, obstructive uropathy, hemiplegia, depression, and high blood pressure. Resident #27's Minimum Data Set (MDS) assessment dated [DATE] indicated he was always incontinent of bowel and bladder. An observation of State Tested Nursing Assistant (STNA) #78 on 11/16/23 at 6:30 A.M. check residents for incontinence revealed a concern with hand hygiene. STNA #78 entered Resident #33's room and donned a pair if disposable gloves and rolled Resident #33 to check the incontinence brief for incontinence. STNA #78 removed the gloves and donned a second pair of disposable gloves without washing/sanitizing her hands and entered Resident #27's room to check his incontinence brief and found the incontinence brief soaked with urine. STNA #78 left Resident #27's room and with the same gloved hands and entered the clean linen storage closet and obtained linens to perform Resident #27's incontinence care. STNA #78 proceeded to remove her gloves and donned a third pair of disposable gloves without washing/sanitizing her hands and performed Resident #27's incontinence care. STNA #78 completed the incontinence care for Resident #27 and using the same gloved hands assisted Resident #27 with repositioning in the bed touching the bed remote, pulling the light cord and repositioned Resident #27's bedside table close to the bed without removing the soiled gloves or washing/sanitizing her hands. An interview with STNA #78 on 11/16/23 at 6:45 A.M. verified the above findings and agreed she should have washed her hands between glove changes, after checking Resident #33 for incontinence, and before touching the various items in Resident #27's room after performing incontinence care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 8 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility policy and procedure titled Hand Hygiene revised on 01/01/22 indicated all staff would perform proper hand hygiene procedure to prevent the spread of infection to other personnel, residents and visitors. This applied to all staff working in all locations within the facility with the exception of food prep areas. Hand hygiene was the general term for cleaning hands by handwashing with soap and water or use of an aseptic hand rub, also known as alcohol-based hand rub. Hand hygiene was indicated and would be performed under conditions listed below: Wash hands with soap and water: -When hand are visibly dirty. - When hands are visibly soiled with blood or body fluids. - Before and after eating. - After use of the restroom. - Exposure to Bacillus anthracis is suspected or proven. - Exposure to Clostridium difficile is suspected or likely. - After caring for a person with known of suspected infectious diarrhea. Clean hands with soap and water or alcohol based hand rub: - When coming on duty. - Between resident contacts. - After handling contaminated objects. - Before performing invasive procedures. - Before applying and upon removing personal protective equipment. - Before preparing and handling medications. - Before and after handling clean or soiled dressings and/or linen. - Before performing resident care procedures. - Before and after providing resident care procedures. - Before and after caring for residents in isolation precautions. - After handling items potentially contaminated with blood or body fluids, secretions, excretions. - When moving from contaminated body site to clean body sit during resident care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 9 of 10 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 365718 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arbors at Streetsboro 1645 Maplewood Dr Streetsboro, OH 44241 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 - After assistance with personal bodily functions. Level of Harm - Minimal harm or potential for actual harm - After sneezing, coughing, and/or blowing or wiping nose. - Before going off duty. Residents Affected - Few - When in doubt. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365718 If continuation sheet Page 10 of 10