Health inspection·May 5, 2022

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #41 was admitted to the facility on [DATE] with diagnoses including Parkinson's disease, dysphagia, Crohn's disease, Asperger's syndrome, major recurrent depressive disorder, anxiety disorder, heart failure and chronic kidney disease. Review of the annual comprehensive assessment MDS 3.0 dated 03/31/22 indicated he was alert, oriented and independent in daily decision making ability. He displayed no behaviors including rejection of care. Resident #41 required the total dependence on two plus staff for toilet use and personal hygiene. He was always incontinent of bowel and bladder. He had physical impairment of one side of the upper and lower extremities. Review of the care plan lacked a plan for incontinence or refusal of care. Interview and observation of Resident #41 on 05/03/22 at 07:35 A.M. revealed he was not wearing a hand splint because his right palm hurt. He opened his hand as much as he could and it was red inside. He reported the brace for his leg was screwed up and did not fit, so he was not going to wear it either. On 05/03/22 at 02:00 P.M. Resident #41 was observed sitting in his wheelchair in the hallway. It appeared his incontinent brief was bulging due to being severely saturated and his clothing was noticeably wet beside his abdomen and thigh. Incontinence care was observed after the wetness was identified. The resident was found to be wearing four saturated incontinence briefs that had leaked out the sides causing his clothing to be wet. Interview with Director of Therapy #517 on 05/04/22 at 8:02 A.M. revealed Resident #41 had a custom wheelchair with a leg rest and cushion. He would tell staff when did not want to use the leg rest. An orthotic specialist talked with him the other day about wearing the orthotic but he still refused. She reported the hand splint was to be worn as tolerated but the resident would ask for it to be off at times. Interview with the assessment nurse LPN #504 on 05/03/22 at 3:00 P.M. revealed she had recently added to the aide folder that residents were to wear one brief when out of bed and no brief when in bed. She verified Resident #41's care plan did not address urinary incontinence or refusal of care. She was unaware he was using four briefs. She reported she would order size 3 X briefs for the resident. LPN #504 reported on 05/05/22 at 9:00 A.M. the resident preferred to wear four incontinence briefs. Two on him and two folded on top of his peri area. There was no evidence root cause for the use of four briefs was identified. Based on record review and interview the facility failed to ensure Resident #23, Resident #29 and Resident #41 were comprehensively assessed and care plans were developed regarding health conditions, psychotropic medication use and activities of daily living. This affected three (Residents #23, #29 and #41) of 19 residents whose care plans were reviewed. The facility census was 44. Findings include: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1. Review of the medical record for Resident #23 revealed an admission date of 03/03/22 with diagnoses including anemia, non-Hodgkin lymphoma hypertension, arthritis and corneal transplant. Review of the comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 13 indicating Resident #23 was cognitively intact. She required extensive assistance in the areas of turning and repositioning in bed, moving between surfaces such as from a bed to a chair, dressing, and toilet use and was totally dependent on staff to move about her room and throughout the facility. She was always incontinent of bowel and bladder and experienced occasional pain over five days during the review period. She rated her pain at a four out of ten and had limited activity as a result. She was at risk for pressure ulcers, had one unstageable deep tissue injury (a purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue due to pressure and/or shear) and received two days of injections and two days of anticoagulants of the seven days. Resident #23 received speech, physical and occupational therapy. The MDS assessment revealed communication, rehabilitation potential, urinary continence, falls, nutritional status, pressure ulcers and pain as triggered care areas to be addressed in the resident's care plan. Review of Resident #23's care plan dated 03/10/22 revealed the resident had a care plan to address short term rehabilitation, a discharge plan to return to the community, advanced directives, nutrition issues related to a fractured hip, decreased intake at meals, weight loss, eating slowly, dehydration and needs for healing. The care plan did not address all the care areas triggered in the MDS assessment such as communication, rehabilitation potential, urinary incontinence, pressure ulcers, falls or pain. 2. Review of the record for Resident #29 revealed an admission date of 02/21/22 with diagnoses of dysphasia, chronic obstructive pulmonary disease (COPD), fibromyalgia, generalized anxiety disorder, type two diabetes, emphysema, bipolar disorder, major depressive disorder and hyperlipidemia. Review of the MDS for Resident #29 dated 04/19/22 revealed a BIMS score of 15 indicating she was cognitively intact. She required extensive assistance with bed mobility, transfers between surfaces, moving throughout different areas of the facility, dressing, and personal hygiene. She was totally dependent on staff for toilet use, was occasionally incontinent of urine and always incontinent of bowel. She received antipsychotics, antianxiety and antidepressant medications seven of seven days for the review period and received oxygen, speech, occupational and physical therapy. The MDS assessment revealed rehabilitation potential, urinary incontinence, psycho-social well being, mood, activities, falls nutritional status, pressure ulcers and psychotropic drug use as triggered care areas to be addressed in the resident's care plan. Resident #29's care plan dated 02/24/22 revealed it addressed discharge planning, advanced directives, diabetes COPD, meal intake, food allergies, weight loss and dysphasia. The care plan did not address all the care areas triggered in the MDS assessment such as rehabilitation potential, urinary incontinence, psycho-social well being, mood, activities, falls, pressure ulcers and psychotropic drug use. On 05/04/22 at 1:01 P.M. Licensed Practical Nurse (LPN) #504 confirmed the care plans for Resident #23 and #29 did not identify and address all triggered care areas. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure timely incontinence care for residents. This affected two (Residents #30 and #11) of three residents observed for incontinence care. The facility census was 45. Findings include: 1. Review of Resident #30's medical record revealed an admission date of 08/18/21 with diagnoses that included incontinence and muscle weakness. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had impaired cognition, required extensive assistance with bed mobility, transfers, dressing and personal hygiene, and total dependence with toileting. She was incontinent of bowel and bladder. Review of the care plan dated 12/15/21 revealed self care deficits related to decreased mobility and weakness and interventions included provide a sponge bath when a full bath or shower cannot be tolerated. Resident #30 required assistance of one staff member and additional assistance as needed for increased weakness or fatigue. 2. Review of Resident #11's medical record revealed an admission date of 12/25/20 with diagnoses including malnutrition, chronic obstructive pulmonary disease (COPD) dementia, difficulty walking, muscle weakness and incontinence. Review of the MDS dated [DATE] revealed she had intact cognition and required extensive assistance with bed mobility, transfers, and personal hygiene, and total dependence with toileting and bathing. She was incontinent of bowel and bladder. Review of the care plan dated 09/09/21 revealed self care deficits related to limited mobility and muscle weakness and interventions provide a sponge bath when a full bath or shower cannot be tolerated. Resident #11 required extensive assist of one staff with personal hygiene and total assist of 1-2 staff for toileting. She was incontinent of bowel and bladder related to inability to anticipate toileting needs and, needed assist with all care related to impaired mobility. Interventions included to check every two hours and as required for incontinence. Observation of incontinence care on 05/02/22 at 9:11 A.M. for Resident #11 with State Tested Nurse Aide (STNA) #512 revealed the resident was heavily saturated with urine and was wearing two incontinence briefs. STNA #512 stated she was unaware the resident was wearing two briefs and stated she had not provided care for the resident yet. Observation of incontinence care on 05/02/22 at 9:22 A.M. for Resident #30 with STNA #512 revealed the resident was incontinent of a large amount of urine. Resident #30 was observed to have been wearing two incontinence briefs. Interview at the time of the observation with STNA #512 revealed she had not provided care to the resident yet and stated she was unaware the resident had been wearing two incontinence briefs. Interview on 05/03/22 at 3:12 P.M. with the Director of Nursing (DON) revealed she had been made (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 aware Residents #11 and #30 had been wearing two incontinence briefs. the DON stated staff should not be using two briefs on the residents unless it was the resident's preference. This deficiency substantiates Complaint Number OH00132218. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation and interview the facility failed to ensure medications were properly stored and discarded when expired. This had the potential to affect all 45 residents currently residing in the facility. Findings include: Observation on 05/02/22 at 10:37 A.M. with Licensed Practical Nurse (LPN) #502 revealed the medication cart contained a bottle of Geri-Tussin (liquid cough syrup) that had expired on 11/2021. Interview with LPN #502 at the time of the observation revealed she had not checked expiration dates prior to beginning medication administration. LPN #502 verified the Geri-Tussin should have been discarded as indicated by the expiration date. Observation on 05/02/22 at 11:06 A.M. with LPN #510 revealed various unidentifiable loose pills in different compartments of the medication cart, a bottle of Geri-Tussin with an expiration date of 11/2021, and a bottle of Docusate (liquid stool softener) with an expiration date of 04/2022. Interview with LPN #510 at the time of the observation revealed she had not checked expiration dates prior to beginning medication administration, she had not cleaned out the drawers of the medication cart recently and she was unaware of loose pills in various compartments. LPN #510 verified the expired medications should have been discarded and there should not have been loose unidentified pills in the medication cart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 and staff interview, the facility failed to ensure opened food products were dated and labeled. This had the potential to affect 43 of 45 residents receiving food from the kitchen. The facility identified Residents #21 and #30 as not receiving food by mouth. Findings include: A tour of the kitchen was completed on 05/02/22 at 8:30 A.M. through 9:00 A.M. with Dietary Manager (DM) #518. Observation of the food stored in the three door freezer in the room off the dry storage room on 05/02/22 at 8:40 A.M. revealed the following which were confirmed by DM #518: Open and undated bags of frozen hash browns, stuffed cabbage rolls, cookies, chicken tenders and fish. Observation of the two door freezer outside the dry storage room on 05/02/22 at 8:45 A.M. revealed the following which were confirmed by DM #518: An open bag of frozen spinach, not dated. Observation of the dry storage room on 05/02/22 at 8:50 A.M. revealed the following which were confirmed by DM #518: An open bag of spoons which should have been sealed per DM #518 and three open, undated bags of dry cereal. Interview with DM #518 on 05/02/22 at 10:12 A.M. revealed all residents but two (Residents #21 and #30) received food from the kitchen. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 Based on observation, interview, facility policy review, review of the Centers for Disease Control (CDC) Considerations for Preventing Spread of COVID-19, and review of the CDC COVID Tracker website the facility failed to maintain proper infection control procedures to prevent the potential spread of infection including proper COVID screening, use of Personal Protective Equipment (PPE) and hand hygiene practices. This had the potential to affect all 45 residents currently residing in the facility. Residents Affected - Few Findings include: 1. Observation on 05/02/22 at 7:35 A.M. revealed the front reception area did not have have a COVID screening questionnaire, thermometer for obtaining temperatures, or a sign in log. Interview with Licensed Practical Nurse (LPN) #504 revealed nothing was required prior to entry. A second interview with LPN #504 at 7:55 A.M. revealed a COVID questionnaire should be completed prior to entry into the facility. Observation revealed LPN #504 had a questionnaire that consisted of international travel, exposure, symptoms, cough or shortness of breath within the last 14 days and a recent COVID infection within 10 days. LPN #504 also obtained temperatures to record on the questionnaire logs. LPN #504 stated all individuals who entered should answer the questionnaire as well as obtain a temperature prior to entering. Interview on 05/02/22 at 7:57 A.M. with State Tested Nursing Assistants (STNA) #500 and #501 revealed they had not screened themselves prior to entering the facility. Interview at 8:09 A.M. with STNA #503 revealed she had not screened herself in prior to working on the floor, and further stated she had not been made aware she was required to screen prior to beginning her shift. Observation on 05/03/22 at 6:50 A.M. revealed a COVID screening log at the front desk with three unreadable names and no recorded temperatures. Interview with Registered Nurse (RN) #505 at the time of the observation revealed she was the Infection Preventionist (IP) and she was unable to identify the three names on the sign in sheet and stated all individuals were required to obtain their temperatures prior to entrance. 2. Observation on 05/02/22 at 7:57 A.M. revealed STNA #500 was in Resident #37's room providing care and STNA #501 was in Resident #36's room also providing care and neither had a face shield on. Interview with STNA #500 and #501 revealed they had not been made aware the facility had positive COVID cases and neither were aware of what PPE they should be using. Observation at 8:09 A.M. revealed STNA #503 was wearing a surgical mask but was not wearing a face shield. Interview with STNA #503 at the time of the observation revealed she had not been made aware the facility had positive COVID cases and she was not aware of the required PPE. Observation at 2:40 P.M. revealed a medication cart located outside of the COVID unit that had a disposable isolation gown partially in a trash can on the outside of the medication cart and a disposable stethoscope on top of the lid to the trash can. Interview with RN #505 at 2:50 P.M. confirmed the disposable equipment was outside of the COVID unit and RN #505 stated the isolation supplies should have been discarded on the COVID unit prior to exiting. RN #505 stated due to the facility having positive COVID cases a face shield was required to be worn while in the facility. 3. Observation of wound care on 05/03/22 at 7:00 A.M. for Resident #1 with LPN #506 revealed she cleaned the resident's left heel wound with normal saline. She then applied the ordered betadine (antiseptic solution) and a clean dressing to the wound without changing her gloves. Interview with LPN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 #506 after the completion of the wound care confirmed she should have changed her gloves and performed hand hygiene after cleaning the wound. Review of a facility memo (undated) revealed appropriate PPE must be worn at all times that included an N95 mask and face shield. Residents Affected - Few Review of the CDC guidance updated 09/10/21 titled Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes revealed Older adults living in congregate settings are at high risk of being affected by respiratory and other pathogens, such as SARS-CoV-2. A strong infection prevention and control (IPC) program is critical to protect both residents and healthcare personnel (HCP). Even as nursing homes resume normal practices, they must sustain core IPC practices and remain vigilant for SARSCoV- 2 infection among residents and HCP in order to prevent spread and protect residents and HCP from severe infections, hospitalizations, and death. In general, healthcare facilities should continue to follow the IPC recommendations for unvaccinated individuals (e.g.,use of Transmission-Based Precautions for those that have had close contact to someone with SARS-CoV-2 infection) when caring for fully vaccinated individuals with moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatments. Manage Residents with suspected or confirmed SARS-CoV-2 infection HCP caring for residents with suspected or confirmed SARS-CoV-2 infection should use full PPE (gowns, gloves, eye protection, and a NIOSH-approved N95 or equivalent or higher-level respirator). Source control and physical distancing (when physical distancing is feasible and will not interfere with provision of care) are recommended for everyone in a healthcare setting. This is particularly important for individuals, regardless of their vaccination status, who live or work in counties with substantial to high community transmission or who have: o Not been fully vaccinated; or o Suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g.,those with runny nose, cough, sneeze); or o Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection for 14 days after their exposure, including those residing or working in areas of a healthcare facility experiencing SARS-CoV-2 transmission (i.e., outbreak); or o Moderate to severe immunocompromise; or o Otherwise had source control and physical distancing recommended by public health authorities o should still consider continuing to practice physical distancing and use of source control. Implement Universal Use of Personal Protective Equipment for HCP If SARS-CoV-2 infection is not suspected in a patient presenting for care (based on symptom and exposure history), HCP working in facilities located in counties with substantial or high transmission should also use PPE as described below: NIOSH-approved N95 or equivalent or higher-level respirators should be used for: o All aerosol-generating procedures (refer to Which procedures are considered aerosol generating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 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 365731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE East Park Care Center 8 East Park Circle Brook Park, OH 44142 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 procedures in Level of Harm - Minimal harm or potential for actual harm healthcare settings) Residents Affected - Few o All surgical procedures that might pose higher risk for transmission if the patient has COVID-19 (e.g., that generate potentially infectious aerosols or involving anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, respiratory tract) o Facilities could consider use of NIOSH-approved N95 or equivalent or higher-level respirators for HCP working in other situations where multiple risk factors for transmission are present. One example might be if the patient is unvaccinated, unable to use source control, and the area is poorly ventilated. o Eye protection (i.e., goggles or a face shield that covers the front and sides of the face) should be worn during worn during all patient care encounters. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 10 of 10