Health inspection·July 29, 2025

F 0689 Level of Harm - Actual harm Residents Affected - Few the care plan stated the resident required two staff assistance for the Hoyer, and only one staff was in the room at the time of the fall). Review of the (hospital) MyChart record dated 06/05/25 revealed Resident #116 received a computed tomography scan (CT) cervical spine without contrast, CT of the head without contrast, CT of T-spine/L-spine without contrast, x-rays of the left ankle, right ankle, right elbow, right femur, left foot, right foot, right hip, right humerus, right knee, left tibia and right tibia. Wound care notes in the record included a right elbow abrasion measuring one centimeter by one centimeter, a left ankle skin tear measuring 1.5 centimeters by 1.9 centimeter and a right ankle abrasion measuring three centimeters by one centimeter. Review of the witness statement taken over the phone by the DON on 06/05/15 for CNA # 540 revealed she and another aide were in the room when she was transferring Resident #116 back into bed. CNA #540 stated that when the Hoyer lift was lifting Resident #116 off of his power chair, the straps broke. CNA #540 then went and got the LPN #499, while the other aide stayed with Resident #116. Review of the undated witness statement from LPN #499 revealed around 5:30 P.M. she was passing medications, and the CNA came to her and told her Resident #116 was on the floor. She immediately went into the room to find Resident #116 was lying on the floor partially on the legs of the Hoyer. Both aides stated that the Hoyer strap broke, and Resident #116 fell. LPN #499 stated Resident #116 was assessed and sent to hospital for evaluation. Resident #116 had right foot pain. Review of the fall review dated 06/05/25 at 6:33 P.M. revealed Resident #116 was confined to chair, unable to stand without physical assistance, right foot and ankle pain. Fall details revealed the nurse was called to Resident #116's room when he had a fall while being transferred into bed with the Hoyer lift. It appeared both bottom straps broke during the transfer, and Resident #116 fell to the floor. Resident #116 complained of right foot and hip pain. Resident #116's right foot was bruised and swollen; he had abrasions to the right ankle and right elbow and a skin tear to the left ankle. Interview on 07/22/25 at 10:23 A.M. with Resident #116 revealed he fell out of the Hoyer lift when the lift pad straps broke. During the interview, Resident #116 stated there was only one aide transferring him when he fell. Resident #116 stated the aide had the wrong pad for the Hoyer, and the stitching on the straps broke and he fell to the floor. He stated he was about four feet off the floor when he fell. Resident #116 stated the pad that was used was a lift pad, used to reposition residents in bed or assist with moving them to a cot. The aide did not use the Hoyer pad that was supposed to be used with the Hoyer lift. Resident #116 stated he was in a lot of pain after the fall, and his whole right side had bruises all over it and some abrasions. Also, his left foot and ankle were bruised, and he had a skin tear. Resident #116 stated he was in a lot of pain as a result of the fall and requested to go to the hospital to be checked out.Interview on 07/22/25 at 11:58 A.M. with LPN #499 revealed she was the nurse on duty when Resident #116 fell from the Hoyer lift. LPN #499 stated the aide came to her and told her Resident #116 fell from the Hoyer when he was being transferred back to bed. LPN #499 stated there were two aides in the room when she went in to assess Resident #116. Both aides stated the straps on the pad broke, and he fell. LPN #499 stated she did not know the difference between the lift pad and a Hoyer pad and did not recall which pad was being used, but stated it was a pad with handles. LPN #499 stated Resident #116 fell from at least bed height. Interview on 07/23/25 at 10:45 A.M. with the Administrator revealed during the fall investigation it was identified that CNA #540 was the only aide in the room when Resident #116 fell from the Hoyer lift. The fall was reported to the unit nurse; she went into Resident #116's room to complete an assessment. CNA #540 was in the room at the time of the fall, the other aides working stated they were not in the room during the Hoyer transfer. CNA #540 was sent home while the investigation was being completed. During the investigation of the fall, it was also identified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 2 of 5 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 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broadview Multi Care Center 5520 Broadview Rd Parma, OH 44134 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete that a Hoyer pad was not used during the transfer, the wrong pad was used; a lift pad used for repositioning was used. The Administrator verified the lift pad was not made to sustain lifting a resident with the Hoyer lift, and that CNA #540 did not follow appropriate procedures for transferring a resident with a mechanical lift. All Hoyer lift transfers were to be completed with two assists. The deficient practice was corrected on 06/06/25 when the facility implemented the following corrective actions: On 06/05/25 Resident #116 was assessed for injuries and transferred to the emergency room for evaluation. On 06/05/25 CNA #540 was suspended pending a facility investigation. On 06/05/25 Resident #116's family, Medical Director and Physician were notified of the fall by the DON. On 06/05/25 Maintenance Director #362 performed a visual inspection of the Hoyer lift in use. On 06/05/25 all lift pads were removed from all units by Central Supply #539. On 06/05/25 an audit of the mechanical lift pads was completed to ensure there were no frays, rips, or tears with no concerns noted by Central Supply #539. Beginning on 06/05/25 education by the DON/designee was completed on mechanical lift with mechanical lift pad and two assist with return demonstration to all CNAs and nurses. All education was completed by 06/07/25. Beginning on 06/06/25 audits of staff use of mechanical lift and mechanical lift policy and procedures will be completed by the DON/designee of five residents' weekly times four weeks then three residents weekly for eight weeks. On 06/06/25 audits of all Hoyer lift pads were completed by Central Supply #539 and thereafter will be completed once a week for four weeks and then as needed. Beginning on 06/06/25, Quality Assurance and Performance Improvement (QAPI) will be held weekly times four weeks and then monthly times two to review the findings of the above audits. This deficiency represents non-compliance investigated under Complaint Number 1276734 (OH00166418), 1276731 (OH00164835) and 1276730 (OH00164488). Event ID: Facility ID: 365757 If continuation sheet Page 3 of 5 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 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broadview Multi Care Center 5520 Broadview Rd Parma, OH 44134 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 FORM CMS-2567 (02/99) Previous Versions Obsolete 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, observations, staff and resident interviews, the facility failed to ensure incontinent care needs were met in a timely manner for Resident #6. This affected one (Resident #6) of three residents reviewed for incontinence care. The facility census was 154. Findings include: Review of the medical record for Resident #6 revealed an admission date 01/05/24. Diagnoses included type II diabetes, convulsions, chronic diastolic congestive heart failure, hypertension, presence of a cardiac pacemaker, and peripheral vascular disease. Review of the plan of care dated 01/09/24 revealed Resident #6 had bowel incontinence related to impaired mobility, physical limitations, no control and unformed stool. Interventions included checking if Resident #6 was continent, offer assistance with toileting, if incontinent, remove wet or soiled clothing, briefs, provide incontinent care, and apply protective barrier after each incontinent episode. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #6 had cognitive impairment and was dependent on staff for toileting. Resident #6 was always incontinent of bowel and had an indwelling suprapubic catheter (a soft tube placed through the lower abdomen directly into the bladder to drain urine) for urine output. Observation on 07/21/25 at 11:15 A.M. revealed Resident #6's call light was on. The call light was continuously monitored to see when staff were going to respond. Observation of multiply staff going down the hall, but no one entered Resident #6's room until 11:54 A.M. Licensed Practical Nurse (LPN) #395 entered the room to give Resident #6 medication. Interview on 07/21/25 at 11:56 A.M. with Resident #6 revealed the nurse came in to give medications and when he asked to be changed because he had waited all morning, the nurse stated she would go get his aide. Resident #6 stated he felt like she thought she was too good to change him. Resident #6 stated he had been waiting all morning for incontinence care. Observation on 07/21/25 at 11:58 A.M. revealed the interim Director of Nursing (DON) brought clean towels and washcloths to provide incontinence care to Resident #6. The interim DON and LPN #395 completed incontinence care. Interview on 07/21/25 at 12:07 P.M. with Certified Nurse Assistance (CNA) #514 stated she was the aide for Resident #6, and she was assisting other residents that had to get up for dialysis and was told that Resident #6 needed changed, but she had not gotten there yet. CNA #514 did not feel they were short staffed, just busy. CNA #514 stated call lights should be answered within ten minutes. Interview on 07/21/25 at 12:21 P.M. with LPN #395 verified call lights should be answered within ten minutes and that 40 minutes was too long. LPN #395 stated she assisted with cleaning Resident #6, and he had had a small bowel movement. Interview on 07/21/25 at 12:25 P.M. with the interim DON verified call lights should be answered within as soon as possible, it may take ten minutes if staff were busy. The interim DON stated any staff member could answer a call light, to see if they can assist the residents at that time. Staff were to work together to answer call lights timely. This deficiency represents non-compliance investigated under Complaint Number 1276733 (OH00167219) and 1276730 (OH00164488). Event ID: Facility ID: 365757 If continuation sheet Page 4 of 5 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 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Broadview Multi Care Center 5520 Broadview Rd Parma, OH 44134 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to provide the appropriate assistive device to enable residents to eat or drink independently. This affected two (Residents #19 and #25) of three residents reviewed for assistive devices and 19 residents reviewed for needing assistance with meals. This had the potential to affect three additional (Residents #64, #104, and #122) identified by the facility as also requiring adaptive equipment for eating and drinking. The facility census was 152. Findings include: 1. Review of the medical record for Resident #19 revealed an admission date of 06/21/22. Diagnoses included hemiplegia and hemiparesis, vascular dementia, dysphagia, and impulse disorder. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #19 was severely cognitively impaired and was dependent on staff for eating and drinking. Review of the physician's orders for Resident #19 revealed the resident was on a pureed texture, nectar thickened liquids, with double portion proteins, ordered 11/08/24. A Magic Cup (supplement) three times a day for dietary supplement to be provided with meals, with total assistance was ordered 02/10/25. Adaptive equipment required included a sippy cup with lid/spout and a divided plate. Review of the quarterly nutrition assessment completed on 07/11/25 revealed Resident #19 required a spouted cup with lid and handle at all meals to promote independence with beverages. Total assistance was to be provided at meals at this time with spouted cup. Observation of meal trays and assistance on 07/22/25 at 12:45 P.M. revealed Resident #19's tray ticket stated sippy cup with lid/spout and a divided plate. The resident did not have the sippy cup with lid/spout. The observation was verified with Certified Nursing Assistant (CNA) #430 and CNA #536. 2. Review of the medical record for Resident #25 revealed an admission date of 03/15/25. Diagnoses included drug induced Parkinson's, Alzheimer's, convulsions, and dementia with other behavioral disturbances. Review of the significant change MDS 3.0 assessment dated [DATE] revealed Resident #25 was severely cognitively impaired and was dependent on staff for eating and drinking. Review of the physician's orders for revealed Resident #25 was on a pureed diet with double portion of protein and vegetable, ordered 03/15/25. Adaptive equipment: scoop plate, built-up utensil(s), and a two handled sippy cup. Review of the nutrition assessment dated [DATE] at 4:24 P.M, revealed Resident #25 revealed a pureed diet, double portions were in place and tolerated well. Resident #25 needed extensive-to-total assistance to complete the meal. Preferences and alternative menu were reviewed with his wife who provided preferences. Observation of meal trays and assistance on 07/22/25 at 12:44 P.M. revealed Resident #25's tray ticket listed a 2-handle sippy cup, built-up utensils and scoop plates. The resident did not have the 2-handle sippy cup. Staff were assisting residents. The observation was verified with CNA #430 and CNA #536. This deficiency was an incidental finding identified during the complaint investigation. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 5 of 5