Inspection·August 25, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she refused to participate in the investigation. ADON/RN #609 sent CNA #612 home. The SRI revealed Resident #127 already cancelled her bank cards with replacements ordered. Staff interviews were conducted and identified that Former CNA #612 had Hispanic food but did not confirm the allegation. The police department was notified and was onsite. The SRI revealed at this time the facility suspects the incident occurred but was not able to confirm. The facility unsubstantiated the SRI based on the evidence was inconclusive. Resident #127 was reimbursed and an ongoing investigation with the police department continued. Former CNA #612 was removed from the facility. Additional residents were also named in the SRI as victims: Resident #156, Former Residents #165, and #167. Review of the undated SRI investigation statement completed by the Administrator revealed he met with Resident #127 following the allegation of misappropriation and Resident #127 stated she thought one staff member, Former CNA #612, was responsible for the misuse of her credit card. She stated she did not witness Former CNA #612 using the card. ADON/RN #609 was investigating, and Resident #127 replaced her debit card and felt safe having it in her room. Review of the nursing note dated 07/30/25 at 9:52 A.M. and completed by the Administrator revealed he met with Resident #127 who had no additional concerns, and all her items were secured. Review of the Check Authorization Form dated 08/04/25 and completed by the Administrator revealed a check request for $104.00 was requested for the reimbursement to Resident #127 for staff usage of resident card without her consent. Review of receipt dated 08/04/25 revealed Resident #127 signed that she received the reimbursement check for $104.00. Review of the undated additional facility investigation revealed face sheets for Residents #26, #156, Former Residents #165, #167, and #168. There was an undated notebook paper that identified other potentially affected residents on the top of the paper dates and last four digits of credit card numbers for each resident. There were no other witness statements, interviews and/ or any other facility investigation including details for the other named resident victims. Review of the Termination Report dated 07/29/25 revealed Former CNA #612 was terminated from the facility on 07/29/25 for violation of company policy and was not eligible for rehire. Interview on 08/20/25 at 10:48 A.M. with ADON/RN #609 revealed on 07/28/25 at approximately 11:00 A.M. Former CNA #612 told Resident #127 to tell her that someone used her credit card on 07/26/25. She revealed she went outside with Resident #127, and she showed her two text messages from her bank on her phone for a DoorDash purchase from Empanadas and an online purchase from [NAME] Secrets. ADON/RN #609 revealed Resident #127 stated she had not given anyone permission to use her credit card. ADON/RN #609 revealed she called CNA #620 who had worked on 07/26/25 to ask if she was eating food from Empanadas and she had denied but stated Former CNA #612 was. Former CNA #612 was on duty and had her come to her office. She asked if she received DoorDash from Empanadas at the facility on 07/26/25, and she stated she had. ADON/RN #609 revealed she asked Former CNA #612 for the DoorDash receipt which she showed her, and it matched the same amount and last four-digit numbers of Resident #127's credit card that Resident #127 had shown her on her phone. Former CNA #612 would not confirm or deny that she used Resident #127's credit card for the purchase. She immediately had Former CNA #612 punch out and go home. She notified the Administrator on 07/28/25 at approximately 11:15 A.M. and informed him of the allegation and investigation. She believed a week later they found Resident #127's credit card in the laundry. Interview on 08/20/25 at 11:08 A.M. with Administrator verified the alleged allegation of misappropriation was made by Resident #127 to ADON/RN #609 on 07/28/25 at approximately 11:00 A.M. and she notified him regarding the incident and investigation. Interview on 08/20/25 at 11:33 A.M. with Resident #127 revealed she heard Former CNA #612 in the hallway complaining that she did not have gas for her vehicle and was going through a rough time. She loaned her ten dollars using her credit card by using the Cash App (a mobile payment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 2 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some system). Two days later, she received notification on her phone that her credit card was used for DoorDash and [NAME] Secrets that she did not give anyone authorization to use. She did not report it right away, but a few days later she had told, ADON/RN #609. She revealed she had shown ADON/RN #609 her phone which had messages from her bank of the charges. ADON/RN #609 investigated and found out Former CNA #612 was eating the food that she bought on her credit card that day at the facility. She stated, I am nervous in here, I do not know who will take something next. She revealed then a girl in laundry found her card in the dryer which she stated, was messed up as I said she did not want to get mixed up in this. She verified the facility reimbursed her but she wanted Former CNA #612 prosecuted as it was not right for her to use her credit card without her consent. 2. Review of the closed medical record of Former Resident #165 revealed an admission date of 07/04/25. She was discharged home on [DATE]. Her diagnoses included diabetes, osteomyelitis, and chronic renal disease requiring dialysis. There was nothing in her medical record regarding misappropriation. Phone interview on 08/21/25 at 10:27 A.M. with Former Resident #165 revealed she had several credit cards that were used without her permission while at the facility. She revealed her Discover card was charged $208.00 and currently she was attempting to have the charges removed. Her bank card was charged $198.00 and she was reimbursed from her bank. There were a total of six or seven DoorDash charges on her credit cards that totaled approximately $300.00. She had no idea how a staff member could have gotten her card as she slept with her purse. 3. Review of the medical record for Resident #156 revealed an admission date of 06/26/25 with diagnoses including heart failure, chronic obstructive pulmonary disease (COPD), and atrial fibrillation. There was nothing in his medical record regarding misappropriation. Review of the admission MDS assessment dated [DATE] revealed Resident #156 had impaired cognition. Interview on 08/21/25 at 9:26 A.M. with Resident #156 revealed yesterday, 08/20/26, they told him about his credit card being misused by someone and some man at the facility had his card currently. He had not used his credit card recently and stated, this is wrong as he became upset. 4. Review of the medical record for Former Resident #168 revealed an admission date of 01/21/25 with diagnoses including major depression and bipolar disorder. There was nothing in his medical record regarding misappropriation. Review of the Medicare Five-Day MDS assessment dated [DATE] revealed Resident #168 had intact cognition. 5. Review of the medical record for Resident #26 revealed an admission date of 07/13/25 with diagnoses including diabetes, hypertension, and adult failure to thrive. There was nothing in his medical record regarding misappropriation. Review of the admission MDS assessment dated [DATE] revealed Resident #26 had intact cognition. Interview on 08/21/25 at 9:20 A.M. with Resident #26 revealed he had a wallet with one-hundred-dollar bill, two twenty-dollar bill and a Visa credit card that came up missing after it was sitting on his over the bed table. He revealed this happened two to three months ago, and he reported the incident, and a police report was filed. Interview on 08/21/25 at 9:40 A.M. with the Administrator revealed Resident #26 was just recently admitted and was not at the facility two or three months ago. Resident #26 had never reported that his wallet, money, or credit card was missing. He revealed the facility had never contacted the police to file a report on his missing wallet, money or credit cards. 6. Review of the closed medical record for Former Resident #167 revealed an admission date of 07/19/25. She was discharged on 08/02/25. Her diagnoses included diabetes, chronic kidney disease, and congestive heart failure. There was nothing in his medical record regarding misappropriation. Review of the admission MDS assessment dated [DATE] revealed Former Resident #167 had intact cognition. Interview on 08/21/25 at 8:14 A.M., 10:45 A.M., and 11:06 A.M. with the Administrator revealed Healthcare Investigator Specialist through Abuse, Neglect, and Misappropriation (ANM) unit #611 notified him (unsure of exact date) that when he checked with [NAME] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 3 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Secrets records he had found other residents at the facility were potentially affected including Residents #26, #156, Former Residents #165, #167, and #168 as they all had either charges or attempted charges on their credit cards. He revealed he had not filed additional SRI's as he stated he was told by Healthcare Investigator Specialist through ANM unit #611 not to as he would add to the current SRI #263396 the victims (residents) names. He verified he had not completed any additional investigations for the other residents besides Resident #127 despite being aware there were additional victims (residents) on 08/13/25 or 08/14/25. He revealed Healthcare Investigator Specialist through ANM unit #611 was completing the investigation as well as the police department. He revealed he had just spoken to Resident #156's daughter on 08/20/25 who lived out of state who stated a few months ago, Residents #156's credit card had been misused, and she did not know who to contact. He revealed last night, 08/20/25, he received permission from Resident #156 to take his card to keep it safe. Former Resident #168 had cognitive impairment and no longer resided at the facility. He revealed it appeared the [NAME] Secret transaction went through and Healthcare Investigator Specialist through ANM unit #611 was still working on the amount of the transaction. Healthcare Investigator Specialist through ANM unit #611 stated Resident #26 had a [NAME] Secret transaction but on interview last night, 08/20/25 Resident #26 stated he did not have any credit cards. He revealed that Former Resident #165's credit card was misused but that she had disputed the charges with her credit card company and the charges got removed from the cards. Former Resident #167 had progressive dementia, and her bank card was used for a purchase at [NAME] Secrets. He revealed he sent a memo to the residents last night, 08/20/25, informing them that there was an event of unconsented use of credit cards and asked the residents to report if they had any issues. He also revealed that starting today, 08/21/25, his receptionist and nurse managers would be contacting families regarding the misappropriation of credit card use to see if any other residents were affected. He unsubstantiated the SRI because the police report was still open and the facility had reimbursed Resident #127 her money. He verified it appeared there was misappropriation but until Former CNA #612 was formally charged, and in his opinion, the SRI was inconclusive. Interview on 08/21/25 at 9:49 A.M. with Healthcare Investigator Specialist through ANM unit #611 revealed he became aware of the incident of misappropriation through the SRI #263396 involving Resident #127 and Former CNA #612 that was filed by the facility. On 08/12/25 he was at the facility and started his investigation. On 08/13/25 he spoke with Former CNA #612 who denied the incident. He submitted a request from [NAME] Secrets on 08/13/25 and discovered there were more victims (residents) that had resided at the facility or currently still did reside at the facility. On 08/13/25 or 08/14/25 he let the facility administrator know there were more victims and the details of his investigation. He revealed he told the administrator he would add the victims (residents) names to SRI #263396 but never told the administrator to not investigate the additional residents affected. He revealed misappropriation potentially involving Former CNA #612 using resident's credit cards occurred from 06/25/25 to 07/26/25. He revealed that Former Resident #168's credit card was charged on 06/25/25 $84.24 and it appeared he was the first victim. The transaction included a known email address with Former CNA #612 nickname on it. Resident #26's credit card was used on 07/16/25 for a charge of $187.70 and on 07/19/25 for a charge of $56.16. Former Resident #165 had three credit cards with multiple charges on each card without her knowledge/consent. Former Resident #167 credit card was also used. Attempted interview on 08/21/25 at 10:17 A.M. with Former CNA #612 revealed the phone number was unable to take the call and unable to leave a voicemail. Review of the personnel file for Former CNA #612 revealed a date of hire of 09/27/24. She had references prior to hire, was on the background check log without any concerns, had an active CNA certification that was in good (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 4 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0602 Level of Harm - Minimal harm or potential for actual harm standing and had training on abuse including misappropriation on hire. Review of the facility policy labeled, Abuse, Neglect, Exploitation, and Misappropriation of Resident Property, dated 06/08/22, revealed residents had the right to be free from abuse, neglect, exploitation, and misappropriation of resident property. This deficiency represents non-compliance investigated under Master Complaint Number 2594162. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 5 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, review of a facility self-reported incident (SRI), interview and review of facility policy, the facility failed to ensure an allegation of misappropriation was timely reported to the state agency. This affected one (Resident #127) out of seven residents reviewed for misappropriation. The facility census was 160. Findings include:Review of the medical record for Resident #127 revealed an admission date of 05/22/25 and diagnoses included chronic renal disease requiring dialysis, diabetes, respiratory failure and hypertension. Review of the quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #127 had impaired cognition. Review of the screenshot of Resident #127's phone dated 07/26/25 revealed on 07/26/25 at 12:10 P.M. her credit card was used at 12:10 P.M. for a DoorDash purchase from a restaurant named, Empanadas for $24.39. The screenshot also revealed on 07/26/25 at 12:37 P.M. her credit card was used for an online purchase at [NAME] Secret.com for $79.34. The screenshot revealed the last four digits of the credit card were [####]. Review of the DoorDash receipt (provided by Former Certified Nursing Assistant (CNA) #612) from Empanadas dated 07/26/25 at 1:10 P.M. revealed there was a purchase of one combo meal of chicken stew, white rice, and beans as well as a drink. The amount on the receipt was $24.39 and the last four digits of the credit card were [####], the same amount and last four digit on Resident #127's phone screenshot. Review of the Employee Time Entry Report for CNA #612 revealed she worked at the facility on 07/26/25 from 7:00 A.M. to 6:30 P.M., the date Resident #127 revealed her card was used for DoorDash. Former CNA #612 worked 07/28/25, the date Resident #127 reported the incident, from 7:00 A.M. to 11:00 A.M, the time Assistant Director of Nursing (ADON)/Registered Nurse (RN) #609 had her leave the facility. Review of the email dated 07/28/25 at 12:43 P.M. from ADON/RN #609 to the Administrator revealed the morning of 07/28/25 ADON/RN #609 was sitting in the nursing station when Resident #127 returned from her appointment. Former CNA #612 told Resident #127 that she should tell ADON/RN #609 about someone using her bank card on 07/26/25. Resident #127 then showed ADON/RN #609 a text message alert from the bank that someone had ordered Empanadas using her card. Resident #127 reported to ADON/RN #609 that CNA #620 was eating Hispanic food that day at the facility. ADON/RN #609 called CNA #620, and she denied eating Hispanic food, but stated Former CNA #612 was eating Hispanic food. ADON/RN #609 then had Former CNA #612 come into the office and asked if she ordered Hispanic food from Empanadas and she verified she had. ADON/RN #609 then asked her for the receipt from DoorDash which she provided, and it had the same amount and last four digits of Resident #127's credit card (same as the screenshot). ADON/RN #609 then had Former CNA #612 leave the facility and told her not to return until she heard from someone at the facility. Review of SRI tracking #263396 created on 07/29/25 at 5:07 P.M. by the Administrator revealed facility ADON/RN #609 informed the Administrator of Resident #127's allegation of misappropriation. Resident #127 alleged Former CNA #612 used her bank card without her knowledge. ADON/RN #609 interviewed Former CNA #612 as she was present in the facility, but she refused to participate in the investigation. ADON/RN #609 sent CNA #612 home. The SRI revealed Resident #127 already cancelled her bank cards with replacements ordered. Staff interviews were conducted and identified that Former CNA #612 had Hispanic food but did not confirm the allegation. The police department was notified and was onsite. The SRI revealed at this time the facility suspects the incident occurred but was not able to confirm. The facility unsubstantiated the SRI based on the evidence was inconclusive. Resident #127 was reimbursed and an ongoing investigation with the police department continued. Former CNA #612 was removed from the facility. Additional residents were also named in the SRI as victims: Resident #156, Former Residents #165, and #167. Interview on 08/20/25 at 10:48 A.M. with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 6 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete ADON/RN #609 revealed on 07/28/25 at approximately 11:00 A.M. Former CNA #612 told Resident #127 to tell her that someone used her credit card on 07/26/25. She revealed she went outside with Resident #127, and she showed her two text messages from her bank on her phone for a DoorDash purchase from Empanadas and an online purchase from [NAME] Secrets. ADON/RN #609 revealed Resident #127 stated she had not given anyone permission to use her credit card. ADON/RN #609 revealed she called CNA #620 who had worked on 07/26/25 to ask if she was eating food from Empanadas and she had denied but stated Former CNA #612 was. Former CNA #612 was on duty and had her come to her office. She asked if she received DoorDash from Empanadas at the facility on 07/26/25, and she stated she had. ADON/RN #609 revealed she asked Former CNA #612 for the DoorDash receipt which she showed her, and it matched the same amount and last four-digit numbers of Resident #127's credit card that Resident #127 had shown her on her phone. Former CNA #612 would not confirm or deny that she used Resident #127's credit card for the purchase. She immediately had Former CNA #612 punch out and go home. She notified the Administrator on 07/28/25 at approximately 11:15 A.M. and informed him of the allegation and investigation. She believed a week later they found Resident #127's credit card in the laundry. Interview on 08/20/25 at 11:08 A.M. with Administrator verified the alleged allegation of misappropriation was made by Resident #127 to ADON/RN #609 on 07/28/25 at approximately 11:00 A.M. and she notified him regarding the incident and investigation. He verified he did not report the SRI until 07/29/25 at 5:07 P.M. to the state agency. He verified he did not report the incident within 24 hours. Interview on 08/20/25 at 11:33 A.M. with Resident #127 revealed she heard Former CNA #612 in the hallway complaining that she did not have gas for her vehicle and was going through a rough time. She loaned her ten dollars using her credit card by using the Cash App (a mobile payment system). Two days later, she received notification on her phone that her credit card was used for DoorDash and [NAME] Secrets that she did not give anyone authorization to use. She did not report it right away, but a few days later she had told, ADON/RN #609. She revealed she had shown ADON/RN #609 her phone which had messages from her bank of the charges. Review of the facility policy labeled, Abuse, Neglect, Exploitation, and Misappropriation of Resident Property, dated 06/08/22, revealed the administrator or designee would notify the state agency of all alleged violations involving mistreatment, neglect, abuse, exploitation, and misappropriation of resident property as soon as possible but no later than 24 hours from the time of the incident and/or allegation. This deficiency represents non-compliance investigated under Master Complaint Number 2594162. Event ID: Facility ID: 365757 If continuation sheet Page 7 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews, review of a facility self-reported incident (SRI), interviews and review of the facility policy, the facility failed to ensure alleged incidents of misappropriation were thoroughly investigated. This affected five (Residents #26, #156, #165, #167, and #168) out of seven residents reviewed for misappropriation. The facility census was 160. Findings include:1. Review of the medical record for Resident #127 revealed an admission date of 05/22/25 with diagnoses including chronic renal disease requiring dialysis, diabetes, respiratory failure and hypertension. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #127 had impaired cognition. Review of the screenshot of Resident #127's phone dated 07/26/25 revealed on 07/26/25 at 12:10 P.M. her credit card was used at 12:10 P.M. for a DoorDash purchase from a restaurant named, Empanadas for $24.39. The screenshot also revealed on 07/26/25 at 12:37 P.M. her credit card was used for an online purchase at [NAME] Secret.com for $79.34. The screenshot revealed the last four digits of the credit card were [####]. Review of the DoorDash receipt (provided by Former Certified Nursing Assistant (CNA) #612) from Empanadas dated 07/26/25 at 1:10 P.M. revealed there was a purchase of one combo meal of chicken stew, white rice, and beans as well as a drink. The amount on the receipt was $24.39 and the last four digits of the credit card were [####], the same amount and last four digit on Resident #127's phone screenshot. Review of the email dated 07/28/25 at 12:43 P.M. from ADON/RN #609 to the Administrator revealed the morning of 07/28/25 ADON/RN #609 was sitting in the nursing station when Resident #127 returned from her appointment. Former CNA #612 told Resident #127 that she should tell ADON/RN #609 about someone using her bank card on 07/26/25. Resident #127 then showed ADON/RN #609 a text message alert from the bank that someone had ordered Empanadas using her card. Resident #127 reported to ADON/RN #609 that CNA #620 was eating Hispanic food that day at the facility. ADON/RN #609 called CNA #620, and she denied eating Hispanic food, but stated Former CNA #612 was eating Hispanic food. ADON/RN #609 then had Former CNA #612 come into the office and asked if she ordered Hispanic food from Empanadas and she verified she had. ADON/RN #609 then asked her for the receipt from DoorDash which she provided, and it had the same amount and last four digits of Resident #127's credit card (same as the screenshot). ADON/RN #609 then had Former CNA #612 leave the facility and told her not to return until she heard from someone at the facility. Review of SRI tracking #263396 created on 07/29/25 at 5:07 P.M. by the Administrator revealed facility ADON/RN #609 informed the Administrator of Resident #127's allegation of misappropriation. Resident #127 alleged Former CNA #612 used her bank card without her knowledge. ADON/RN #609 interviewed Former CNA #612 as she was present in the facility, but she refused to participate in the investigation. ADON/RN #609 sent CNA #612 home. The SRI revealed Resident #127 already cancelled her bank cards with replacements ordered. Staff interviews were conducted and identified that Former CNA #612 had Hispanic food but did not confirm the allegation. The police department was notified and was onsite. The SRI revealed at this time the facility suspects the incident occurred but was not able to confirm. The facility unsubstantiated the SRI based on the evidence was inconclusive. Resident #127 was reimbursed and an ongoing investigation with the police department continued. Former CNA #612 was removed from the facility. Additional residents were also named in the SRI as victims: Resident #156, Former Residents #165, and #167. Review of the undated SRI investigation statement completed by the Administrator revealed he met with Resident #127 following the allegation of misappropriation and Resident #127 stated she thought one staff member, Former CNA #612, was responsible for the misuse of her credit card. She stated she did not witness Former CNA #612 using the card. ADON/RN #609 was investigating, and Resident #127 replaced her debit card and felt safe having it in her room. Review of Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 8 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the Check Authorization Form dated 08/04/25 and completed by the Administrator revealed a check request for $104.00 was requested for the reimbursement to Resident #127 for staff usage of resident card without her consent. Review of receipt dated 08/04/25 revealed Resident #127 signed that she received the reimbursement check for $104.00. Review of the undated additional facility investigation revealed face sheets for Residents #26, #156, Former Residents #165, #167, and #168. There was an undated notebook paper that identified other potentially affected residents on the top of the paper dates and last four digits of credit card numbers for each resident. There were no other witness statements, interviews and/ or any other facility investigation including details for the other named resident victims. Review of the Employee Time Entry Report for CNA #612 revealed she worked at the facility on 07/26/25 from 7:00 A.M. to 6:30 P.M., the date Resident #127 revealed her card was used for DoorDash. Former CNA #612 worked 07/28/25, the date Resident #127 reported the incident, from 7:00 A.M. to 11:00 A.M. Review of the Termination Report dated 07/29/25 revealed Former CNA #612 was terminated from the facility on 07/29/25 for violation of company policy and was not eligible for rehire. Interview on 08/20/25 at 10:48 A.M. with ADON/RN #609 revealed on 07/28/25 at approximately 11:00 A.M. Former CNA #612 told Resident #127 to tell her that someone used her credit card on 07/26/25. She revealed she went outside with Resident #127, and she showed her two text messages from her bank on her phone for a DoorDash purchase from Empanadas and an online purchase from [NAME] Secrets. ADON/RN #609 revealed Resident #127 stated she had not given anyone permission to use her credit card. ADON/RN #609 revealed she called CNA #620 who had worked on 07/26/25 to ask if she was eating food from Empanadas and she had denied but stated Former CNA #612 was. Former CNA #612 was on duty and had her come to her office. She asked if she received DoorDash from Empanadas at the facility on 07/26/25, and she stated she had. ADON/RN #609 revealed she asked Former CNA #612 for the DoorDash receipt which she showed her, and it matched the same amount and last four-digit numbers of Resident #127's credit card that Resident #127 had shown her on her phone. Former CNA #612 would not confirm or deny that she used Resident #127's credit card for the purchase. She immediately had Former CNA #612 punch out and go home. She notified the Administrator on 07/28/25 at approximately 11:15 A.M. and informed him of the allegation and investigation. She believed a week later they found Resident #127's credit card in the laundry. Interview on 08/20/25 at 11:33 A.M. with Resident #127 revealed she heard Former CNA #612 in the hallway complaining that she did not have gas for her vehicle and was going through a rough time. She loaned her ten dollars using her credit card by using the Cash App (a mobile payment system). Two days later, she received notification on her phone that her credit card was used for DoorDash and [NAME] Secrets that she did not give anyone authorization to use. She did not report it right away, but a few days later she had told, ADON/RN #609. She revealed she had shown ADON/RN #609 her phone which had messages from her bank of the charges. ADON/RN #609 investigated and found out Former CNA #612 was eating the food that she bought on her credit card that day at the facility. She stated, I am nervous in here, I do not know who will take something next. She revealed then a girl in laundry found her card in the dryer which she stated, was messed up as I said she did not want to get mixed up in this. She verified the facility reimbursed her but she wanted Former CNA #612 prosecuted as it was not right for her to use her credit card without her consent. 2. Review of the closed medical record of Former Resident #165 revealed an admission date of 07/04/25. She was discharged home on [DATE]. Her diagnoses included diabetes, osteomyelitis, and chronic renal disease requiring dialysis. There was nothing in her medical record regarding misappropriation. Phone interview on 08/21/25 at 10:27 A.M. with Former Resident #165 revealed she had several credit cards that were used without her permission while at the facility. She revealed her Discover card was charged (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 9 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some $208.00 and currently she was attempting to have the charges removed. Her bank card was charged $198.00 and she was reimbursed from her bank. There were a total of six or seven DoorDash charges on her credit cards that totaled approximately $300.00. She had no idea how a staff member could have gotten her card as she slept with her purse.3. Review of the medical record for Resident #156 revealed an admission date of 06/26/25 with diagnoses including heart failure, chronic obstructive pulmonary disease (COPD), and atrial fibrillation. There was nothing in his medical record regarding misappropriation. Review of the admission MDS assessment dated [DATE] revealed Resident #156 had impaired cognition. Interview on 08/21/25 at 9:26 A.M. with Resident #156 revealed yesterday, 08/20/26, they told him about his credit card being misused by someone and some man at the facility had his card currently. He had not used his credit card recently and stated, this is wrong as he became upset. 4. Review of the medical record for Former Resident #168 revealed an admission date of 01/21/25 with diagnoses including major depression and bipolar disorder. There was nothing in his medical record regarding misappropriation. Review of the Medicare Five-Day MDS assessment dated [DATE] revealed Resident #168 had intact cognition. 5. Review of the medical record for Resident #26 revealed an admission date of 07/13/25 with diagnoses including diabetes, hypertension, and adult failure to thrive. There was nothing in his medical record regarding misappropriation. Review of the admission MDS assessment dated [DATE] revealed Resident #26 had intact cognition. Interview on 08/21/25 at 9:20 A.M. with Resident #26 revealed he had a wallet with one-hundred-dollar bill, two twenty-dollar bill and a Visa credit card that came up missing after it was sitting on his over the bed table. He revealed this happened two to three months ago, and he reported the incident, and a police report was filed. Interview on 08/21/25 at 9:40 A.M. with the Administrator revealed Resident #26 was just recently admitted and was not at the facility two or three months ago. Resident #26 had never reported that his wallet, money, or credit card was missing. He revealed the facility had never contacted the police to file a report on his missing wallet, money or credit cards. 6. Review of the closed medical record for Former Resident #167 revealed an admission date of 07/19/25 and she was discharged on 08/02/25. Her diagnoses included diabetes, chronic kidney disease, and congestive heart failure. There was nothing in his medical record regarding misappropriation. Review of her admission MDS dated [DATE] revealed Former Resident #167 had intact cognition. Interview on 08/21/25 at 8:14 A.M., 10:45 A.M., and 11:06 A.M. with the Administrator revealed Healthcare Investigator Specialist through Abuse, Neglect, and Misappropriation (ANM) unit #611 notified him (unsure of exact date) that when he checked with [NAME] Secrets records he had found other residents at the facility were potentially affected including Residents #26, #156, Former Residents #165, #167, and #168 as they all had either charges or attempted charges on their credit cards. He revealed he had not filed additional SRI's as he stated he was told by Healthcare Investigator Specialist through ANM unit #611 not to as he would add to the current SRI #263396 the victims (residents) names. He verified he had not completed any additional investigations for the other residents besides Resident #127 despite being aware there were additional victims (residents) on 08/13/25 or 08/14/25. He revealed Healthcare Investigator Specialist through ANM unit #611 was completing the investigation as well as the police department. He revealed he had just spoken to Resident #156's daughter on 08/20/25 who lived out of state who stated a few months ago, Residents #156's credit card had been misused, and she did not know who to contact. He revealed last night, 08/20/25, he received permission from Resident #156 to take his card to keep it safe. Former Resident #168 had cognitive impairment and no longer resided at the facility. He revealed it appeared the [NAME] Secret transaction went through and Healthcare Investigator Specialist through ANM unit #611 was still working on the amount of the transaction. Healthcare Investigator Specialist (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 10 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete through ANM unit #611 stated Resident #26 had a [NAME] Secret transaction but on interview last night, 08/20/25 Resident #26 stated he did not have any credit cards. He revealed that Former Resident #165's credit card was misused but that she had disputed the charges with her credit card company and the charges got removed from the cards. Former Resident #167 had progressive dementia, and her bank card was used for a purchase at [NAME] Secrets. He revealed he sent a memo to the residents last night, 08/20/25, informing them that there was an event of unconsented use of credit cards and asked the residents to report if they had any issues. He also revealed that starting today, 08/21/25, his receptionist and nurse managers would be contacting families regarding the misappropriation of credit card use to see if any other residents were affected. He unsubstantiated the SRI because the police report was still open and the facility had reimbursed Resident #127 her money. He verified it appeared there was misappropriation but until Former CNA #612 was formally charged, and in his opinion, the SRI was inconclusive. Interview on 08/21/25 at 9:49 A.M. with Healthcare Investigator Specialist through ANM unit #611 revealed he became aware of the incident of misappropriation through the SRI #263396 involving Resident #127 and Former CNA #612 that was filed by the facility. On 08/12/25 he was at the facility and started his investigation. On 08/13/25 he spoke with Former CNA #612 who denied the incident. He submitted a request from [NAME] Secrets on 08/13/25 and discovered there were more victims (residents) that had resided at the facility or currently still did reside at the facility. On 08/13/25 or 08/14/25 he let the facility administrator know there were more victims and the details of his investigation. He revealed he told the administrator he would add the victims (residents) names to SRI #263396 but never told the administrator to not investigate the additional residents affected. He revealed misappropriation potentially involving Former CNA #612 using resident's credit cards occurred from 06/25/25 to 07/26/25. He revealed that Former Resident #168's credit card was charged on 06/25/25 $84.24 and it appeared he was the first victim. The transaction included a known email address with Former CNA #612 nickname on it. Resident #26's credit card was used on 07/16/25 for a charge of $187.70 and on 07/19/25 for a charge of $56.16. Former Resident #165 had three credit cards with multiple charges on each card without her knowledge/consent. Former Resident #167 credit card was also used. Attempted interview on 08/21/25 at 10:17 A.M. with Former CNA #612 revealed the phone number was unable to take the call and unable to leave a voicemail. Review of the personnel file for Former CNA #612 revealed a date of hire of 09/27/24. She had references prior to hire, was on the background check log without any concerns, had an active CNA certification that was in good standing and had training on abuse including misappropriation on hire. Review of the facility policy labeled, Abuse, Neglect, Exploitation, and Misappropriation of Resident Property, dated 06/08/22, revealed once the administrator was notified an investigation of the alleged violation would be conducted. The investigation must be completed within five working days. The person investigating the incident should take the following actions: interview the resident, accused and all witnesses, obtain a statement from the resident, accused and each witness, review each resident's record, and document evidence of the investigation. The policy revealed follow up to the investigation would ensure involved residents plan of care was reviewed and revised if needed, determine modifications to exiting policies and procedures, and staff training if appropriate. This deficiency represents non-compliance investigated under Master Complaint Number 2594162. Event ID: Facility ID: 365757 If continuation sheet Page 11 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0760 Ensure that residents are free from significant medication errors. 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, interview, review of the incident accident log, review of manufacture's guidelines, review of the Medication Omission report, review of the Notice of Corrective Action form, review of the Wrong Dose report, review of the National Library of Medicine and review of the facility policy, the facility failed to ensure residents were free of significant medication errors. This affected three (Residents #29, #34, and #169) out of 11 residents observed or reviewed for medication administration. The facility census was 160. Findings include:1. Review of Resident #29's medical record revealed an admission date of 06/04/24 with diagnoses including schizoaffective disorder, chronic respiratory failure, anemia, human immunodeficiency virus (HIV), gastroesophageal reflux disease (GERD), and end stage renal disease (ERSD) requiring dialysis. Review of the care plan dated 06/13/24 revealed Resident #29 had ESRD with dialysis. Interventions included administering medication as ordered, and monitoring lab work as indicated. Review of the care plan dated 06/13/24 revealed Resident #29 had the potential for gastrointestinal distress related to GERD. Interventions included giving medications as ordered, monitoring for abdominal distention, pain, nausea, vomiting heartburn, or indigestion. Review of the August 2025 physician orders revealed Resident #29's orders included: ferrous sulfate oral solution 300 milligram (mg) per five milliliter (ml) (iron supplement) give 5 ml by mouth two times a day as a supplement, midodrine oral 10 mg tablet (medication to treat orthostatic hypotension) give one tablet by mouth one time a day every Monday, Wednesday and Friday, renal multivitamin (supplement) give one tablet by mouth one time a day due to ESRD, and darunavir-cobicistat oral tablet 800-150 mg (medication to treat HIV) give one tablet by mouth one time a day for HIV. There was no order to crush his medications. Observation of the medication administration on 08/20/25 at 7:59 A.M. completed by Licensed Practical Nurse (LPN) #608 revealed she prepared the following medications for Resident #29: Ferrous sulfate 325 milligram (mg) one tablet, darunavir-cobicistat 800-150mg one tablet, [NAME]-Vite one tablet, and midodrine 10 mg one tablet. She then proceeded to crush the medications and mixed in applesauce. Interview on 08/20/25 at 8:22 A.M. and 08/21/25 at 8:53 A.M. with LPN #608 verified she crushed all Resident #29's medications including the ferrous sulfate tablet, darunavir-cobicistat, [NAME]-Vite, and midodrine. She verified Resident #29 did not have an order to crush his medications and verified the above medications should not have been crushed. She stated, I thought he always got them crushed because when she started at the facility that was what she was told. She verified Resident #29 had an order for ferrous sulfate oral solution 300 mg per five ml give 5 ml by mouth and she administered ferrous sulfate 325 mg one tablet instead. Interview on 08/20/25 at 8:26 A.M. with Registered Nurse (RN)/Assistant Director of Nursing (ADON) #609 revealed Resident #29 did not have an order to crush his medications, and he takes his medications whole. Interview on 08/20/25 at 12:25 P.M. with Facility Pharmacist #615 revealed Resident #29 had an order for ferrous sulfate oral solution 300 milligram per five ml give 5 ml by mouth two times a day and not ferrous sulfate 325 mg tablet. She revealed the ferrous sulfate 325 mg tablet should not be crushed as it was coated and would alter the medication release mechanism that could cause gastrointestinal issues. She revealed per recommendations darunavir-cobicistat 800-150 mg tablet should not be crushed. Also, she revealed the [NAME]-Vite was also coated and should not be crushed per recommendations. She revealed the Midodrine 10 mg she was unsure as in her system it did not list if can and/or cannot but would refer to the manufacturer guidelines. Interview on 08/20/25 at 1:04 P.M. with Director of Nursing (DON) verified Resident #29 did not have an order to crush his medications and stated LPN #608 should not have crushed his medications including the darunavir-cobicistat 800-150mg tablet, [NAME]-Vite, and Midodrine 10 mg. He Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 12 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few verified Resident #29 had an order for ferrous sulfate oral solution 300 mg per five ml give 5 ml by mouth and not ferrous sulfate 325 mg one tablet as well as ferrous sulfate tablets should not be crushed. Review of the Symtuza, dated 2025, manufacture guidelines for darunavir-cobicistat 800-150 mg tablet revealed the medication had the option to split the pill into two pieces and after splitting the entire dose should be consumed immediately after splitting. There was nothing in the guidelines regarding crushing of the tablet. Review of the National Library of Medicine, dated 10/30/24, revealed ferrous sulfate tablet should not be crushed or chewed. Review of the [NAME]-Vite RX- Uses, Side effects and More, dated 2025, package guidelines revealed do not crush or chew extended-release capsules or tablets as doing so can release all the drug at once increasing the risk of side effects. Review of the Well Wisp, dated 2025, guidelines revealed crushing midodrine was not recommended as it can alter the medication's effectiveness and safety profile. The tablets were designed to release the active ingredient gradually into the blood stream which was crucial to maintain a stable blood pressure throughout the day. Crushing these tablets could disrupt this controlled release feature and lead to rapid absorption causing adverse effects. 2. Review of the medical record for Resident #34 revealed an admission date of 01/11/24 with diagnoses including schizoaffective disorder, bipolar disorder, and dementia with agitation. Review of the care plan dated 09/25/24 revealed Resident #34 required use of psychotropic medications with potential adverse reactions related to insomnia, poor appetite, and schizophrenia. Interventions included administering medications per physician order, monitoring resident's behaviors, monitoring, documenting and reporting any adverse effects to the physician. Review of the nursing notes dated from 03/24/25 to 08/21/25 revealed no signs of adverse effects from Resident #34 not receiving her Haloperidol Decanoate intramuscular (IM) injection (antipsychotic) as ordered on 03/24/25, 04/21/25, and 05/19/25. Review of the March 2025 Medication Administration Record (MAR) revealed on 03/24/25, Resident #34 refused her Haloperidol Decanoate IM injection. Review of the nursing notes dated 03/24/25 revealed there was no documented evidence Resident #34's Primary Care Physician (PCP) #618 was notified she had refused her Haloperidol Decanoate IM injection. Review of the April 2025 MAR revealed on 04/21/25 Resident #34 was scheduled for her Haloperidol Decanoate IM injection but the MAR was blank indicating she did not receive the injection. Review of the May 2025 MAR revealed on 05/19/25 Resident #34 was scheduled to receive her Haloperidol Decanoate IM injection and LPN #617 documented OT. (clarification with Administrator revealed OT meant when refused or the medication not provided for some reason). Review of the nursing note dated 05/19/25 revealed there was no documented evidence PCP #618 was notified that Resident #34's Haloperidol Decanoate IM injection was not administered as ordered. Review of the nursing note dated 06/05/25 at 12:44 P.M. and completed by the DON revealed the Administrator and he met with Resident #34's guardian regarding the recent incident. The facility provided support and at this time the concerns had been addressed. Review of the June 2025 MAR revealed on 06/09/25 Resident #34 received her Haloperidol IM injection. Review of the June 2025 physician orders revealed Resident #34 had an order dated 11/27/24 for Haloperidol Decanoate IM solution 50 mg per ml inject one ml IM one time a day every 28 days for bipolar disorder. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #34 had intact cognition and no behaviors. Review of the Medication Omission report, dated 06/05/25, and completed by RN #613 revealed during chart review, Resident #34 missed multiple doses of her IM Haldol medication. Resident #34 was immediately assessed for injuries and none were noted. The report revealed Resident #34 was at baseline, vital signs were stable, and no negative findings were noted. Resident #34's guardian and Nurse Practitioner (NP) #616 were notified, and a new order was received to start medication on 06/09/25. Review of the Notice of Corrective Action, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 13 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dated 06/05/25, revealed LPN #617 received corrective action due to poor work performance that involved a medication error. She was educated on the five medication rights before giving a medication. Interview on 08/21/25 at 1:35 PM and 3:27 P.M. with the DON revealed the facility was conducting a medication audit and discovered Resident #34 had missed several doses of her Haloperidol Decanoate IM injection. He verified on 03/24/25 that the nurse had documented Resident #34 had refused her Haloperidol Decanoate IM injection, and he did not have documented evidence Resident #34's PCP #618 was notified. He also verified on 04/21/25 Resident #34 was scheduled to receive her Haloperidol Decanoate IM injection, but the MAR was blank indicating she did not receive it. Also, he verified on 05/19/25 she was scheduled to receive the Haloperidol Decanoate IM injection, but the nurse documented that it was on order and Resident #34 did not receive it. He revealed on 06/05/25 during the medication audit the facility discovered Resident #36 had not received her Haloperidol Decanoate IM injection that was scheduled to be given every 28 days since 02/24/25. Resident #36 was assessed and had no adverse effects from the omitted doses. He verified she was administered her Haloperidol Decanoate IM injection on 06/09/25. Interview on 08/21/25 at 3:35 P.M. with Resident #34 revealed she was aware she missed her Haloperidol Decanoate IM injections for several months and felt she did not have any adverse effects from the missed doses. She revealed she did not feel she needed the Haloperidol Decanoate IM injection and revealed recently they had taken her off the Haloperidol Decanoate IM injection as now she received the pill form. She revealed she felt happy as she did not like taking IM injections. 3. Review of the closed medical record Resident #169 revealed an admission date of 04/18/25 and he was discharged on 08/17/25. His diagnoses included lymphedema, peripheral vascular disease, diabetes and chronic pain. Review of the May 2025 physician orders revealed Resident #169 had the following orders: Oxycodone 15 mg (opioid pain medication) give one tablet by mouth every six hours for chronic pain and Oxycodone 10 mg (opioid pain medication) give one tablet by mouth every eight hours as needed for breakthrough pain. Review of the Wrong Dose report dated 05/20/25 at 12:45 A.M. and completed by RN #600 revealed Resident #169 had requested his as needed Oxycodone 10 mg dose and RN #600 gave Oxycodone 15 mg dose in error. Resident #169 was notified of wrong dose given and expressed understanding. The report revealed NP #619 was notified and ordered to hold his 6:00 A.M. dose of Oxycodone 15 mg and give his as needed Oxycodone 10 mg. He had no adverse effects from the medication error. Review of the nursing notes dated 05/20/25 to 08/17/25 revealed no adverse effects from the wrong dose of medications given to Resident #169 on 05/20/25. Review of the nursing note dated 05/20/25 at 1:32 A.M. and completed by RN #600 revealed she contacted NP #619, and a medication review was done. RN #600 received a new order to hold Resident #169's 6:00 A.M. dose of routine Oxycodone 15 mg and give him his 10 mg as needed dose instead at 6:00 A.M. Review of NP #619's note dated 05/20/25 at 1:32 A.M. revealed Resident #169 was given his Oxycodone 15 mg dose instead of his 10 mg dose. The note revealed the plan would be to hold his 6:00 A.M. dose. Review of the Notice of Corrective Action dated 05/20/25 revealed RN #600 was given corrective action due to poor work performance regarding medication error. Review of the care plan dated 08/07/25 revealed Resident #169 was at risk for pain and discomfort related to cellulitis, arthritis, and depression. Interventions included administering pain medications as ordered, monitoring and documenting side effects of pain medication, and assessing for pain. Interview on 08/21/25 at 1:35 P.M. with the DON revealed on 05/20/25 Resident #169 had requested his as needed Oxycodone 10 mg dose and RN #600 gave his routine Oxycodone 15 mg dose in error. He revealed NP #619 was notified and ordered to hold his 6:00 A.M. dose of Oxycodone 15 mg and give his as needed Oxycodone 10 mg instead. He revealed Resident #169 did not have any adverse effects from the medication error. Review of the incident accident log dated from 05/01/25 to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 14 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 08/19/25 revealed the facility had two medication errors as on 05/20/25 Resident #169 received the wrong dose of medication, and on 06/05/25 Resident #34's medication was omitted. Review of the facility policy labeled, Medication Administration- General Guidelines, dated 2006, revealed medications were to be administered as prescribed and in accordance with good nursing principles and practices. Th policy revealed the nurse must ensure the five rights (right resident, right drug, right dose, right route, and right time were applied for each medication being administered). The policy revealed crushing of medications may require a physician's order and if safe to do so. The policy revealed an individual approach should be used when crushing in working with the pharmacist and physician to determine the most appropriate method and consider each resident safety. Long- acting and enteric coated dosages should not be crushed. The policy revealed medication refusals must be reported to the physician after three doses or per facility protocol and there must be documentation of the notification. The policy revealed if a dose was withheld, refused or was not available the space provided on the MAR needed to be initialed and circled. This deficiency represents non-compliance investigated under Complaint Number 2583042. Event ID: Facility ID: 365757 If continuation sheet Page 15 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on record review, observation and interview, the facility failed to ensure Resident #29's room was maintained in a clean and sanitary manner. This affected one (Resident #29) out of six residents reviewed for physical environment. The facility census was 160. Findings include:Review of Resident #29's medical record revealed an admission date of 06/04/24 with diagnoses including schizoaffective disorder, chronic respiratory failure, and end stage renal disease requiring dialysis. Review of the care plan dated 06/11/24 revealed Resident #29 was alert and oriented and able to make his needs known. Interventions included encouraging the resident to make a routine, daily decisions, and coach through process if decisions were not forthcoming. There was nothing in his comprehensive care plan regarding hoarding and/or concerns related to not allowing staff to clean/maintain his room in a sanitary manner. Observation during medication administration on 08/20/25 at 7:59 A.M. revealed Licensed Practical Nurse (LPN) #608 entered Resident #29's room and multiple gnats were flying, landing, and/or crawling on his breakfast tray, drink cups, and the straws in his cups that were located on his bedside table next to Resident #29. Also, there were gnats flying around his room, on his bed and on Resident #29. Attempted interview on 08/20/25 at 8:20 A.M. with Resident #29 but he just looked at this surveyor when questions were asked regarding the gnats. Interview on 08/20/25 at 8:22 A.M. with LPN #608 verified there were multiple gnats on his food, cups, and straws as well as flying in his room and on Resident #29. She revealed the gnats were always in Resident #29's room and verified, there were most likely over 40 gnats. She revealed she did not know what the facility was doing regarding the gnats. Interview on 08/20/25 at 8:26 A.M. with Registered Nurse (RN)/Assistant Director of Nursing (ADON) #609 verified there were multiple gnats in Resident #29's room on his food, cups, straws, as well as on Resident #29. She revealed the gnats were always in his room as Resident #29 hoards items, but she would let housekeeping know. Observation on 08/21/25 at 8:53 A.M. of Resident #29's room revealed his breakfast tray was on his bedside table with three drinks with straws in each drink. There were multiple gnats climbing all over the leftover food on his tray, up his straws, and on his cups. Gnats were also observed flying throughout the room and on his bed, including on his pillow. On the corner of Resident #29's bedside table, there were five Nutren 2.0 (supplement drink) containers that had multiple gnats crawling on all the containers, especially on the lid area. Interview on 08/21/25 at 9:00 A.M. with LPN #608, who was administering medications in the hallway, revealed Resident #29 had left for dialysis. She verified gnats continued to be in Resident #29's room including on his leftover food, straws, cups, supplement drink containers, and bed. She again stated, they always in there. When asked what the plans were to resolve the concern, she shrugged her shoulders and, in a motion, took her hands and clapped them together as she revealed that was how she tried to get rid of the gnats. She verified there was over 50 gnats in his room. Interview on 08/21/25 at 9:02 A.M. with the Director of Nursing (DON) verified the gnats in Resident #29's room including on his leftover food, straws, cups, and bed. He revealed he was unsure what the facility was doing about the gnats in his room. Interview on 08/21/25 at 9:04 A.M. with Maintenance Director #614 verified the gnats in Resident #29's room and revealed there were most likely over 50 gnats including on his leftover food, drinks, straws, and bed. He was not aware there were gnats in his room. He was not notified on 08/20/25 regarding the gnats observed in Resident #29's room. He stated that staff were to notify him of any pests, and he then addressed any concern. Interview on 08/21/25 at 10:20 A.M. with Housekeeping #607 revealed she sometimes worked on Resident #29's unit and she verified she had routinely seen gnats in his room. She revealed Resident #29 kept food in his room including putting it in his drawers or other spots, but that she had a good rapport with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 16 of 17 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365757 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/25/2025 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 0921 Level of Harm - Minimal harm or potential for actual harm Resident #29 and just had to remind him his room needed cleaned. She revealed Resident #29 never refused to have his room cleaned to her knowledge. Interview on 08/21/25 at 10:45 A.M. with the Administrator revealed the facility did not have an actual pest control policy. This deficiency represents non-compliance investigated under Complaint Number 2583042. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365757 If continuation sheet Page 17 of 17