Inspection·October 28, 2025

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, review of staff statements, medical record review, and review of facility policy, the facility failed to develop and implement a comprehensive and effective pressure ulcer program to ensure wound care was provided to prevent a decline Resident #150's wound status. Actual Harm occurred beginning on 07/24/25 when Resident #150 returned from a hospitalization and wound care orders to treat a chronic right heel wound were not transcribed into the facility's electronic health record (EHR) for implementation. Between 07/24/25 and 08/20/25, Resident #150 had no wound care orders in place and had no documented wound dressing changes recorded. Resident #150 was seen by Wound Nurse Practitioner (NP) #706 on 08/20/25 who noted the wound had deteriorated and had an increase in wound exudate. Resident #150 was hospitalized on [DATE] and required a debridement (a medical procedure to remove dead, infected, or damaged tissue from a wound) for gas gangrene (bacterial infection that destroys muscle tissue) of the right foot and osteomyelitis (infection of the bone) of the right heel. The debridement procedure resulted in significant exposure of the plantar calcaneus (bottom part of the heel). Resident #150 was admitted to the hospital for eight days and required intravenous antibiotics to treat his wound infection. On 09/07/25 staff identified the presence of maggots in Resident #150's right heel wound. The resident was transferred to the hospital for treatment of infection of the area. This affected one resident (#150) of three residents reviewed for wound care. The facility census was 50.Findings include:Review of the medical record for Resident #150 revealed an initial admission date of 02/14/24 with diagnoses including Stage IV (a full-thickness wound involving muscle, tendon, and/or bone) pressure ulcer of right heel, local infection of skin and subcutaneous tissue, chronic osteomyelitis with draining sinus of left ankle and foot, non-pressure chronic ulcer of left heel and mid foot with necrosis of bone, congestive heart failure, diabetes mellitus, myiasis (parasitic infection of fly larvae in human tissue), and epilepsy. Record review revealed Resident #150 had multiple hospitalizations while residing in the facility.Review of the plan of care initiated 02/29/24 revealed Resident #150 was at risk for pressure ulcer development related to history of pressure ulcers, decline in activities of daily living and mobility, and incontinence status. Interventions included administer treatments as ordered, monitor for effectiveness of treatments, educate on causes of skin breakdown, inform of any new areas of skin breakdown, monitor dressing to ensure it is intact, monitor nutritional status, obtain labs as ordered, and treat pain as ordered. The plan of care was cancelled on 09/01/25. An additional plan of care was initiated on 09/03/25 and revised on 09/08/25 to include the resident had an alteration to his skin to include osteomyelitis affecting bilateral heels. Listed interventions included administer treatments as ordered and monitor for effectiveness, assess, record, and monitor wound leaking as ordered, pressure reducing mattress to the bed, and assist the resident to turn and reposition as needed. The care plan did not mention any offloading of the heels or heel boots that Resident #150 should wear. Review of the census list for Resident #150 revealed the resident was hospitalized from [DATE] to 07/03/25. Review of the Braden Scale for Predicting Pressure Ulcer Risk Evaluation dated 07/04/25 revealed Resident #150 was at moderate risk for developing pressure injuries. Review of a wound assessment report dated 07/09/25 authored by Wound Nurse Practitioner (NP) #706 revealed Resident #150 had an unstageable (indicating a wound bed and depth of a wound is unable to be visualized) diabetic ulcer of the right heel measuring 5.0 centimeters (cm) in length by 5.5 cm in width with 0.1 cm depth. (This ulcer was subsequently assessed during a July 2025 hospitalization to be a pressure ulcer.) The report revealed the wound was acquired on 11/14/24. There was 90 percent (%) eschar (layer of dead tissue that forms over wound) and 10% epithelial tissue (thin layer of Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 2 of 8 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 10/28/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few new tissue). There was no exudate (fluid that leaks out of blood vessels into surrounding tissue in response to inflammation or injury) noted. The recommended wound treatment was to cleanse the right heel with normal saline, apply Betadine (antiseptic solution), and abdominal (ABD) pad, and rolled gauze, change daily and as needed. The wound was noted to be stalled. Review of a wound assessment report dated 07/16/25 authored by Wound NP #706 revealed Resident #150's right heel wound measured 5.0 cm in length, 5.5 cm in width, and 0.1 cm depth. The wound was 90% eschar and 10% epithelial tissue. There was no noted exudate. The wound remained stalled. The recommended treatment remained to cleanse with normal saline, apply Betadine, and ABD pad, and rolled gauze with frequency of daily and as needed. Review of a progress note dated 07/19/25 timed 11:15 P.M. revealed Resident #150 was having difficulty managing his blood glucose levels and the physician recommended to send the resident to the hospital for evaluation. An additional progress note dated 07/20/25 timed 4:17 A.M. revealed Resident #150 was admitted to the hospital for hyperglycemia, osteomyelitis, and anemia. The resident was hospitalized until 07/24/25. Review of a hospital Physician Consultation Report dated 07/20/25 revealed Resident #150 presented to the hospital for elevated blood glucose levels. An x-ray examination of his right foot showed soft tissue ulceration overlying the right posterior calcaneus (a bone in the foot near the heel) with underlying cortical destruction consistent with osteomyelitis. Review of a hospital skin assessment dated [DATE] revealed Resident #150's right heel measured 7.3 cm in length by 8.0 cm in width and had an undetermined depth. The wound was 90% brown eschar and 10% small area of mixed yellow and red noted caudally (towards the posterior aspect of the wound). There was moderate serosanguineous drainage which was somewhat malodorous. Iodoflex (a wound treatment designed to absorb slough, soft necrotic tissue, and exudate), ABD pad (a highly absorbent dressing, used for heavily draining wounds) and rolled gauze were applied and heel lift boots were applied. Review of hospital discharge instructions dated 07/24/25 revealed Resident #150 had diagnosis of acute osteomyelitis of the right heel. Resident #150 had an order for Vancomycin one gram intravenously every 12 hours for a duration of four weeks. There was no evidence of wound care orders noted on the hospital discharge instructions. Review of a clinical admission noted dated 07/25/25 revealed no note regarding Resident #150's right heel wound. Resident #150 was noted to have a left heel diabetic foot ulcer. Review of a skilled nursing evaluation dated 07/27/25 revealed no note regarding Resident #150's of right heel wound. The evaluation did reference Resident #150 was noted to have a left heel diabetic foot ulcer. Review of a wound assessment report dated 07/30/25 authored by Wound NP #706 revealed Resident #150's right heel wound measured 7.3 cm in length by 7.5 cm in width with 0.1 cm depth. The wound was 90% eschar and 10% epithelial. There was no noted drainage. The wound remained stalled. The recommended wound treatment remained to cleanse with normal saline, apply Betadine, and ABD pad, and rolled gauze with a frequency of daily and as needed. Review of a wound follow up note dated 08/01/25 authored by Wound NP #706 revealed Resident #150's right heel wound was stable, and debridement was considered to destabilize necrotic tissue. An addendum was added on 08/24/25 stating Resident #150's right heel diabetic wound had deteriorated and was now an unstageable pressure injury. Review of the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for July 2025 revealed no evidence of wound care orders or evidence of any wound care provided to Resident #150's right heel following his return to the facility from the hospital on [DATE]. Review of a skilled nursing evaluation dated 08/03/25 revealed no note regarding Resident #150's of right heel wound. The evaluation did reference Resident #150 was noted to have a left heel diabetic foot ulcer. Review of a wound assessment report dated 08/06/25 authored by Wound NP #706 revealed Resident #150's right heel wound measured 9.0 cm in length by 8.0 cm with 0.1 cm depth. The wound was 90% eschar (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 3 of 8 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 10/28/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few and 10% epithelial tissue. There was no noted drainage. The wound was noted to have remained stalled. The recommended wound treatment remained to cleanse with normal saline, apply Betadine, and ABD pad, and rolled gauze with frequency of daily and as needed. Review of a wound follow up note dated 08/06/25 authored by Wound NP #706 revealed Resident #150's wound was considered stable. An addendum was added on 08/24/25 stating Resident #150's right heel diabetic wound had deteriorated and was now an unstageable pressure injury. Review of skilled nursing evaluation dated 08/09/25 revealed no note regarding Resident #150's of right heel wound. The evaluation did reference Resident #150 was noted to have a left heel diabetic foot ulcer.Review of a wound assessment report dated 08/13/25 authored by Wound NP #706 revealed Resident #150's right heel wound measured 7.0 cm in length by 7.5 cm with 0.1 cm depth. The wound was 90% eschar and 10% epithelial. There was no noted drainage. The wound was noted to have remained stalled. The recommended wound treatment remained to cleanse with normal saline, apply Betadine, and ABD pad, and rolled gauze with frequency of daily and as needed. Review of skilled nursing evaluation dated 08/18/25 revealed no note regarding Resident #150's of right heel wound. The evaluation did reference Resident #150 was noted to have a left heel diabetic foot ulcer.Review of a wound follow-up note dated 08/20/25 for service on 08/13/25 authored by Wound NP #706 revealed Resident #150's wound was considered stable. Additional interventions included Prafo heel boots (pressure relief ankle foot orthosis used to always take pressure off the back of the foot) to be worn at all times. An addendum was added on 08/24/25 stating Resident #150's right heel diabetic wound had deteriorated and was now an unstageable pressure injury. Review of a wound assessment report dated 08/20/25 authored by Wound NP #706 revealed Resident #150's right heel wound measured 7.5 cm in length by 9.5 cm in width by 0.1 cm depth. The wound was 80% eschar, 10% epithelial tissue, and 10% granulation tissue. There was moderate serosanguinous drainage. The wound was noted to be deteriorating. The recommended wound treatment was changed to cleanse with normal saline, apply Medi-honey (wound ointment which helps maintain a moist wound environment, has antibacterial properties, and aids in autolytic debridement) and Calcium Alginate (wound dressing used to manage drainage and promote a moist wound environment), ABD pad, and rolled gauze with instructions to change daily and as needed. Review of progress note dated 08/20/25 timed 2:19 P.M. revealed Resident #150 was sent to the hospital for lethargy and a change in mental status. Resident #150 was noted to have blood-tinged urine, was unable to swallow at lunch, and was difficult to rouse.Review of census list for Resident #150 Resident #150 was hospitalized on [DATE]. Review of hospital paperwork from admission date of 08/20/25 to discharge date of 08/28/25 revealed Resident #150 was admitted for altered mental status. Resident #150 had a debridement procedure on 08/22/25 for gas gangrene of the right foot and osteomyelitis (bone infection) of the right heel. Cultures taken during the debridement procedure grew moderate Bacteroides fragilis group with mixed flora isolated including mixed gram-negative rods. Resident #150 was seen by podiatry on 08/25/25. The right heel wound measured 6.5 cm by 9.5 cm by 1.5 cm. Resident #150's wound was noted to probe to the bone and had large amount of serous drainage. Review of podiatry follow up on 08/26/25 revealed there was significant exposure of the plantar calcaneus observed. Wounds were dressed with Betadine and wet to dry dressing. The podiatrist noted there would likely be a need for amputation in the future however at current to continue local wound care and long-term intravenous antibiotics. Review of a NP wound follow up note dated 08/21/25 revealed Resident #150's wound had deteriorated. It was noted the dressing removed during service on 08/20/25 was not the supplies ordered for treatment. It was also noted there was no pad and protect dressing or heel boots in place. The note instructed to change dressings as ordered, only use supplies recommended for treatment, and use heel boots at all times. Review of the MAR and TAR for August 2025 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 4 of 8 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 10/28/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few revealed there was no evidence of any wound care provided to Resident #150's right heel until 08/28/25, following his return to the facility from the hospital. Starting on 08/28/25, Resident #150's right heel was cleansed with normal saline, betadine and a wet-to-dry dressing was applied daily. Additionally, there was no evidence that Resident #150 had orders for Prafo boots as recommended in Wound NP #706's wound notes. Review of Order Listing Report from 07/01/25 to 08/31/25 revealed Resident #150 had no wound care orders for treatment of the right heel wound care between 07/24/25 and 08/20/25. Review of a NP wound assessment report dated 09/03/25 revealed Resident #150's right heel wound measured 9.0 cm by 10.0 cm by 0.5 cm. The wound was 50% epithelial and 50% granulation. There was moderate serosanguinous drainage. The wound was noted to be deteriorating. The recommended wound treatment was changed to cleanse with normal saline, apply Betadine followed by wet to dry dressing, ABD pad, and rolled gauze with frequency of daily and as needed. Review of a NP wound follow up note dated 09/03/25 revealed Resident #150 had a recent hospitalization in which there was heel debridement procedure completed. It was noted there was exposure of bone and tendon to the right heel. Additional interventions noted to utilize a low air loss mattress and use Prafo heel boots at all times. The note stated not to use plastic heel boots. Review of Resident #150's plan of care initiated on 09/03/25 revealed Resident #150 had a Stage III pressure ulcer on his sacrum and osteomyelitis affecting bilateral heels. Interventions included administer treatments as ordered, assess and monitor wound healing, assist with turning and repositioning as needed, inspect skin daily during routine care, obtain labs as ordered, pressure reducing cushion to chair, and pressure reducing mattress. Review of skilled nursing evaluation noted dated 09/07/25 revealed Resident #150's bilateral heel wounds showed decline. Review of a census list for Resident #150 revealed hospitalization from 09/07/25 to 09/17/25. Review of a progress note dated 09/07/25 timed 12:38 P.M. revealed Resident #150 was receiving personal care and there were noted necrotic (dead tissue) areas, warmth, and purulent drainage to the bilateral heel wounds. It was noted that Resident #150's wounds appeared more swollen, and the resident had increased pain at the sites. The NP was notified and gave order to send to hospital for evaluation and treatment of possible infected wounds. Review of a statement dated 09/07/25 by Certified Nursing Assistant (CNA) #818 revealed while changing Resident #150 it was noted the dressing on his heel needed changed. The dressing was dated 09/05/25, was extremely discolored, and was falling apart. CNA #818 indicated she noted movement in the wound and found maggots crawling in the wound. CNA #818 informed both nurses on duty. Review of a statement dated 09/07/25 by CNA #857 revealed while performing care for Resident #150 it was noted the dressing was falling off his right foot. CNA #857 stated she picked up Resident #150's right foot and saw maggots crawling on his foot. It was also noted the dressing was dated 09/05/25. Review of a statement dated 09/07/25 by Licensed Practical Nurse (LPN) #807 revealed the aides reported during personal care for Resident #150, his dressing to his right heel fell off. The aides reported maggots were present in the right heel wound bed. LPN #807 went to room with another nurse to assess the area. There was a pungent odor noted. The two nurses observed the maggots in Resident #150's right foot wound. The other nurse began cleansing the wound. LPN #807 called 911 for emergency services due to the necrotic and foul-smelling wound. LPN #807 contacted the Director of Nursing (DON) who instructed the nurses to cleanse and re-wrap the wound. The NP was notified of the resident's change and need for emergency services. LPN #807 noted the dressing on Resident #150's right heel was dated 09/05/25. Review of fire department Prehospital Care Report Summary dated 09/07/25 revealed Resident #150 was transported by emergency medical services (EMS) to the hospital. The chief complaint was listed as maggots in a foot wound. It was noted facility staff stated as they were getting Resident #150 ready to transfer out of his bed, they noticed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 5 of 8 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 10/28/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few maggots in the pressure ulcer on the right heel. Staff stated they cleaned out the wound with sterile water prior to EMS arrival. Review of a physician consultation report dated 09/07/25 revealed Resident #150 presented to hospital from skilled nursing facility (SNF) after staff noticed maggots, malodor, and drainage from a right heel wound. There were no maggots seen in the right heel wound at time of hospital observation. Examination of Resident #150's right foot revealed an extensive wound to the posterior planter aspect of the right heel measuring 6.0 cm in length by 9.0 cm in width with depth noted to the bone. There was significant exposure of the plantar calcaneus and noted malodor and pus in the right heel wound. The treatment plan was listed as betadine with a wet-to-dry dressing. The note referenced the plan was for Resident #150 to be admitted for an infected Stage IV decubitus ulcer (a full-thickness pressure ulcer with exposed muscle, tendon, or bone) to the right heel with potential surgical intervention pending final culture reports and x-ray examinations. Review of a critical care progress note dated 09/15/25 revealed Resident #150 was sent to hospital from nursing home with complaints of generalized weakness. He was found to have larvae infestation of the wound in the right lower extremity and anemia. It was noted per podiatry there was poor outlook of the right lower extremity (RLE) and Resident #150 had previously refused a below the knee amputation (BKA) on multiple occasions. Resident #150 had debridement procedure on 09/11/25 of right heel bone cortex. Treatment for right heel was to apply Dakins solution (a solution used to clean and disinfect wounds) with gauze pads, ABD pads, kerilx (rolled gauze) wrap, and ACE (compression) wraps. During the hospital stay Resident #150 had a rapid called for altered mental status and hypothermia, with metabolic encephalopathy in the setting of sepsis (systemic infection) suspected. Review of hospital podiatry follow up note dated 09/15/25 revealed Resident #150's right heel wound measured 10.0 cm in length by 7.5 cm in width with depth to the bone. The wound bed was exclusively bone of the heel. The note referenced the resident had refused a BKA and wound care was the only option at this time to prevent further infection. The note referenced Resident #150 was stable from a podiatry perspective with a need for close outpatient follow up. Review of discharge summary report dated 09/16/25 revealed Resident #150 was to follow up with the podiatry office in one week and the right heel wound was to utilize Dakin's solution, gauze pads, ABD pads, kerlix and ACE wraps to be changed daily. Review of a NP wound assessment report dated 09/17/25 revealed Resident #150's right heel wound measured 7.0 cm in length by 8.0 cm in width and 0.5 cm in depth. The wound was 10% eschar, 10% slough, and 80% granulation. The wound was noted to be deteriorating. There was moderate serosanguinous drainage noted and there was exposed tissue to adipose, muscle/fascia, tendon/ligament, and bone level. The recommended wound treatment was changed to cleanse with normal saline, apply Dakins moistened gauze followed by ABD pad and rolled gauze with frequency of three times per day (TID) and as needed. Review of a wound follow up note dated 09/19/25 authored by Wound NP #706 revealed Resident #150's right heel had severely deteriorated and was noted to be severely deformed. Additional interventions included changing dressings as ordered, wearing heel boots at all times, and maintaining a low air loss mattress. Review of the MAR and TAR for September 2025 revealed no order or corresponding documentation of Resident #150 utilizing a low air loss mattress or Prafo boots as recommended in Wound NP #706's September 2025 wound notes. Interview on 10/21/25 at 12:13 P.M. with Assistant Director of Nursing (ADON) #829 revealed she was the wound nurse for the facility. ADON #829 reported Resident #150 had the right heel wound since before she started in February 2025. ADON #829 stated they had been treating the wound in-house, however, since September 2025 Resident #150 had been going to outside podiatry appointments for wound management. ADON #829 stated Resident #150 had history of osteomyelitis and they had to discuss the potential for amputation. ADON #829 stated she was notified staff had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 6 of 8 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 10/28/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few noted maggots in the resident's wound on 09/07/25. ADON #829 stated the wound was cleansed and Resident #150 went to the hospital. ADON #829 stated she did not observe maggots in the wound herself and was unsure how they would have infested the wound. A follow-up interview at 1:25 P.M. with ADON #829 confirmed Wound NP #706 had noted Resident #150's wound was deteriorating on or about 08/20/25. ADON #829 stated the eschar had started to come off and the wound was measuring larger. ADON #829 stated Resident #150 required extensive debridement during a recent hospitalization. Interview on 10/21/25 at 3:01 P.M. with a family member of Resident #150's revealed Resident #150 was currently in the hospital. The family member reported Resident #150 was admitted from a podiatry appointment as he was bleeding too much and was on Coumadin. The family member reported the facility was no longer allowed to care for Resident #150's wound per podiatry. The family member indicated she preferred it this way as Resident #150 had been to the hospital several times for wounds and had multiple infections due to a lack of appropriate and necessary staff treatment. The family member indicated she had once seen Resident #150 at the facility and his wound was not taken care of. The family member stated she had to get on the facility to make sure his wounds were taken care of appropriately. The family member indicated she was unaware there were concerns for maggots in the wound on 09/07/25. Interview on 10/21/25 at 3:27 P.M. with LPN #807 revealed she had cared for Resident #150 on 09/07/25. LPN #807 stated Resident #150 had very complex wounds. LPN #807 stated she was notified by the aide there were maggots in Resident #150's wound on this date. LPN #807 stated she did not believe the agency night nurse from the shift prior had provided wound care as ordered. LPN #807 stated she and Registered Nurse (RN) #800 assessed the resident's wound and cleansed the wound with normal saline. LPN #807 estimated there were approximately 20 maggots seen in the right heel wound. LPN #807 stated she notified the Director of Nursing (DON) and NP she was going to call 911. Interview on 10/21/25 at 4:06 P.M. with CNA #818 revealed she had cared for Resident #150 on 09/07/25. CNA #818 stated Resident #150 was dependent on staff for all care needs. CNA #818 stated during care it was noted Resident #150's dressing (to the right foot) was discolored and coming off. CNA #818 stated the dressing was dated 09/05/25 and was usually done by night shift. CNA #818 noted there was a pungent odor to the wound. CNA #818 stated she notified LPN #807 about the concerns with Resident #150's wound. Interview on 10/21/25 at 4:40 P.M. with Podiatrist #705 revealed Resident #150 had very complicated wounds. Podiatrist #705 stated he had discussed amputation multiple times with Resident #150. Podiatrist #705 stated Resident #150 was unable to care for his own wounds and relied on caregivers. Podiatrist #705 stated he generally does not trust nursing facilities to provide wound care in an appropriate manner and would prefer to provide the care for his patients himself. Podiatrist #705 stated he had been caring for Resident #150's dressings in office since an operation in September 2025. Podiatrist #705 stated he was consulted while Resident #150 was in the hospital on [DATE] but did not visualize any maggots in the wound at that time. Interview on 10/22/25 at 7:34 A.M. with ADON #829 confirmed she was unable to locate any evidence Resident #150 had an order for wound care between 07/24/25 to 08/20/25. ADON #829 stated the Wound NP #706 had seen Resident #150 weekly during that time but was unable to locate any evidence of additional treatments provided in Resident #150's medical record. Interview on 10/22/25 at 8:22 A.M. with the DON denied any knowledge of missing orders or declining wounds for Resident #150. The DON indicated she was notified by LPN #807 staff saw maggots in the resident's wound on 09/07/25. The DON stated she would expect staff to clean the wound if they observed something in the wound. Interview on 10/22/25 at 11:51 A.M. with CNA #857 revealed she had cared for Resident #150 on 09/07/25. CNA #857 confirmed she had observed maggots crawling out from his right foot wound. CNA #857 stated she stayed with Resident #150 while CNA #818 went to get LPN #807. CNA #857 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365731 If continuation sheet Page 7 of 8 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 10/28/2025 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 0686 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stated Resident #150 was very compliant with care and would ask caregivers for extra clean ups at times. Interview on 10/22/25 at 3:51 P.M. with former Wound NP #706 revealed she had been caring for Resident #150's wounds for approximately five months at the facility. Wound NP #706 stated Resident #150 had a stable necrotic area to right heel. Wound NP #706 stated the ulcer was a diabetic foot ulcer, and she was treating with Betadine. Wound NP #706 verified the wound then presented as a pressure injury (unable to recall date). Wound NP #706 stated she had noted some decline in his right heel. Wound NP #706 stated there were some incidents when the wrong dressing was applied or the wound was not padded and protected. Wound NP #706 stated Resident #150's wound was larger, so it was documented it was deteriorating. Wound NP #706 stated she was unable to recall any additional information as she was no longer employed with the company and did not have access to her notes for this resident. Interview on 10/22/25 at 4:01 P.M. with RN #800 revealed an aide had come to get her on 09/07/25 and stated Resident #150's wound dressing had come off. They stated there were maggots in the wound. RN #800 stated she and LPN #807 went in to assess the situation. RN #800 stated she cleansed the area as much as she could and told LPN #807 to work on getting Resident #150 sent out [to the hospital]. RN #800 stated there were approximately 20 maggots in the wound and stated it was disgusting. RN #800 stated the maggots were moving within the wound. RN #800 stated she ensured Resident #150 was sent out to the hospital and then went back to her assignment. Review of facility policy on wound care dated September 2021 revealed prior to providing wound care physician's orders should be verified. Documentation of the wound care procedure would be completed in the resident's medical record. This deficiency represents non-compliance investigated under Complaint Number 2642458 and is a recite to the complaint survey completed on 10/14/25. Event ID: Facility ID: 365731 If continuation sheet Page 8 of 8