Health inspection·October 6, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few haste in providing care resulted in Resident #33 hitting her head.Review of the progress notes in Resident #33's medical record revealed no progress note related to the alleged incident.Review of the mandatory training for all staff revealed the facility educated staff on sensitivity and dementia care dated 06/16/25, 07/14/25, and 08/11/25. Subsequently implemented approximately three months after the alleged incident, which occurred in March 2025.Review of the facility document titled New Hire Orientation dated 09/25/25 revealed the staff were educated on abuse policy and protocols and dementia care related to trauma, behaviors, and substance.Review of the staff education revealed staff were educated on trauma-informed care 02/01/25, challenging behaviors for dementia residents 03/02/25, and abuse, neglect, and exploitation 09/01/25.Review of the personnel file for RN #717 revealed a hire date of 08/06/21 and education received for the abuse, neglect and misappropriation policy on 08/06/21 and 08/09/21.Review of the job termination notice dated 03/25/25 revealed RN #717 was terminated after the incident on 03/23/25 because of violating the facility's conduct and behavior policy. Review of the termination notice revealed RN #717 was observed on video footage reacting firmly and abruptly to Resident #33, who struck her during care. Review of the notice revealed RN #717 actions were loud, reactive, and lacked the calm, professional demeanor expected of quality resident care. RN #717, rather than deescalating the situation was observed on video raising her voice and holding Resident #33 hands in a manner to prevent striking, but it did not align with best practices for dealing with combative behaviors.An interview with RN #717 and CNA #720 was attempted throughout the survey period. However, attempts were unsuccessful as their employment was terminated with the facility and numbers provided were no longer in working order.Interview on 09/25/25 at 8:30 A.M. with the Administrator and the Director of Nursing (DON) revealed Resident #33's son forwarded a video from Resident 33's room camera which showed RN #717 and CNA #720 providing care in bed. RN #717 was struck in the face by Resident #33 and as a result, RN #717 grabbed Resident #33's hands and stated, You will not do that and finished helping CNA #720 provide care. Resident #33's family felt RN #717's behavior was rough and scolding. The Administrator and DON confirmed and verified the above findings at the time of the interview.Interview on 09/25/25 at 9:32 A.M. with [NAME] President of Council (VPC) #730 revealed RN #717 was terminated due to not meeting the standards of the facility related to their conduct and behavior policy. VPC #730 confirmed and verified the above findings at the time of the interview.2. Review of the medical record for Resident #48 revealed an admission date of 03/03/25 with diagnoses including Alzheimer's disease, hypertension, osteoarthritis of the left knee, and right artificial hip joint.Review of the MDS assessment dated [DATE] revealed Resident #48 had a Brief Interview for Mental Status (BIMS) score of three which indicated severe cognitive impairment and the resident was dependent on staff for toileting, lower body dressing and hygiene.Review of the physician orders dated 03/03/25 revealed an order to assist Resident #48 with turning and repositioning during routine rounds and as needed.Review of the progress note dated 03/04/25 at 4:44 P.M. revealed Resident #48 was admitted to the facility after a fall which resulted in a right hip fracture with repair.Review of the concern log for March 2025 revealed Resident #48's son contacted the Administrator on 03/24/25 to express concerns regarding the conduct of an agency aide, CNA #718, who was assigned to Resident #48. Out of abundance of caution, CNA #718 was immediately removed from duty pending a full investigation, and after a thorough review of the incident, it was determined CNA #718 would not return to the facility.Review of the facility folder titled Soft File for Resident #48 dated 03/23/25 revealed an incident timeline and analysis. Review of the timeline revealed on 03/23/25 at 8:36 P.M., the Administrator missed a call from an unknown number and at 8:37 P.M. Resident #48's son sent a text message to the Administrator requesting a callback regarding the situation. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 2 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Administrator returned the call at 8:38 P.M. and was informed the aide on duty (CNA #718) was unprofessional during care as observed via the room camera. Resident #48's son stated CNA #718 mocked Resident #48 and sent a video clip to the Administrator. At 8:46 P.M. Assistant Director of Nursing (ADON) #862 notified the Director of Nursing (DON) and the Administrator that she had also received a call to report Resident #48's family was upset. ADON #862 revealed Resident #48's family alleged CNA #718 was rough while turning Resident #48 during care and mocked him. ADON #862 confirmed Licensed Practical Nurse (LPN) #894 was present at the time of care being provided.At 8:52 P.M. the Administrator instructed ADON #862 to send CNA #718 home.At 9:12 P.M. the Administrator contacted Resident #48's son and daughter and informed them CNA #718 was sent home due to the family's concern and for failing to uphold the professionalism expected at the facility. As a result, the facility initiated a Do-Not-Return (DNR) order for CNA #718.Further review of the soft file revealed the provided video of the alleged incident was reviewed by the Administrator and DON which showed CNA #718 assisted Resident #48 with changing clothes and transferred him to bed using a Hoyer lift with the assistance of LPN #894. As Resident #48 was transferred, he made moaning noises, in which CNA #718 paused and asked if she was doing something wrong or if Resident #48 was in pain. CNA #718 was then heard mimicking the noise Resident #48 made. As CNA #718 walked toward the bathroom, she then repeated the mimicked noise from Resident #48's indication of pain.Interview on 09/24/25 at 3:21 P.M. with LPN #894 was attempted via phone. However, contact was unsuccessful as the number was disconnected.Interview on 09/24/25 at 4:12 P.M. with the Administrator revealed Resident #48's son contacted her on a weekend in March of the current year regarding an agency aide's (CNA #718) conduct, in which she had a soft file pertaining to the incident.Interview on 09/25/25 at 8:01 A.M. with the Administrator and the DON revealed Resident #48 had a fall prior to being admitted to the facility, and the family wanted a camera installed in the room. Resident #48's son reported CNA #718 was unprofessional and mocked the resident and sent a video clip of the incident in question. The Administrator revealed prior to reviewing the video clip, CNA #718 was sent home, and subsequently, after watching the video clip, CNA #718 was placed on the DNR list. The video clip revealed Resident #48 was in process of being transferred into bed by CNA #718 and LPN #894 via Hoyer lift when Resident #48 made a moaning noise indicating pain. CNA #718 asked Resident #48 if she was doing something wrong and mimicked the noise made by Resident #48. Once Resident #48 was in bed, CNA #718 walked towards the bathroom while mimicking Resident #48's moaning noise.Review of additional video clips with the Administrator and DON present, revealed CNA #718 provided incontinence care to Resident #48 while in bed. The resident was heard yelling out in pain and CNA #718 stated, You have to help me and stop resisting. CNA #718 was then observed with both hands placed on Resident #48's right hip and pushed him onto his left side as he yelled out in pain. LPN #894 then entered the resident's room and asked him to verify and confirm his name. CNA #718 continued to attempt to turn Resident #48 on his left side while he yelled out in pain. LPN #894 then placed both hands on Resident #48's right side to hold him in place on his left side, while CNA #718 continued to provide care. LPN #894 was heard asking Resident #48 if he was in pain and then stated, I just gave you Tylenol. CNA #718 was then heard telling Resident #48 to turn towards her. Resident #48 was observed not to be moving towards CNA #718, when CNA #718 was then observed placing both hands on Resident #48 left side of his body and pulling him all the way over onto his right side and holding him in place. Resident #48 continued to yell out in pain while CNA #718 asked What's the matter? After completing Resident #48 care, CNA #718 was then seen pushing Resident #48 bed using her upper legs against the wall.Interview on 09/25/25 at 8:01 A.M. with the Administrator revealed there was no longer a video to be reviewed regarding the Hoyer transfer due to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 3 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete receiving a new phone and the incident of alleged abuse was not reported to the State Survey Agency. The Administrator also revealed CNA #718 and LPN #894 no longer were employed by the facility. The Administrator confirmed and verified the above findings at the time of the interview.Review of the mandatory training for all staff revealed the facility educated staff on sensitivity care on 06/16/25, 07/14/25, and 08/11/25 approximately three months after the incident.Review of the facility document titled New Hire Orientation dated 09/25/25 revealed the staff were educated on abuse policy and protocols.Review of the staff education revealed staff were educated on abuse, neglect, and exploitation on 09/01/25.Review of the facility document titled Abuse, Neglect, Misappropriation, and Exploitation Policy revised 11/28/16, revealed the facility had a policy in place that all residents had a right to be free from abuse, neglect, misappropriation of resident property, and exploitation, including but not limited to, corporal punishment, involuntary seclusion, and any physical or chemical restraint not required to treat the resident's medical symptoms. Further review of the policy revealed alleged violations would be reported to the State Survey Agency. Review of the document revealed the facility did not implement the policy in regard to the allegation.This deficiency represents noncompliance investigated under Complaint Number 1374287 (OH00164161). Event ID: Facility ID: 365759 If continuation sheet Page 4 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 resident record review, staff interviews, review of Self-Reported Incidents (SRIs), review of facility soft file investigation, and facility policy review, the facility failed to report an incident of alleged abuse to the State Agency. This affected one (Resident #48) of two residents reviewed for abuse. The facility census was 82.Findings include:Review of the medical record for Resident #48 revealed an admission date of 03/03/25 with diagnoses including Alzheimer's disease, hypertension, osteoarthritis of the left knee, and right artificial hip joint. Review of the MDS assessment dated [DATE] revealed Resident #48 had a Brief Interview for Mental Status (BIMS) score of three which indicated severe cognitive impairment and the resident was dependent on staff for toileting, lower body dressing and hygiene. Review of the physician orders dated 03/03/25 revealed an order to assist Resident #48 with turning and repositioning during routine rounds and as needed. Review of the progress note dated 03/04/25 at 4:44 P.M. revealed Resident #48 was admitted to the facility after a fall which resulted in a right hip fracture with repair. Review of the concern log for March 2025 revealed Resident #48's son contacted the Administrator on 03/24/25 to express concerns regarding the conduct of an agency aide, CNA #718, who was assigned to Resident #48. Out of abundance of caution, CNA #718 was immediately removed from duty pending a full investigation, and after a thorough review of the incident, it was determined CNA #718 would not return to the facility. Review of the facility folder titled Soft File for Resident #48 dated 03/23/25 revealed an incident timeline and analysis. Review of the timeline revealed on 03/23/25 at 8:36 P.M., the Administrator missed a call from an unknown number and at 8:37 P.M. Resident #48's son sent a text message to the Administrator requesting a callback regarding the situation. The Administrator returned the call at 8:38 P.M. and was informed the aide on duty (CNA #718) was unprofessional during care as observed via the room camera. Resident #48's son stated CNA #718 mocked Resident #48 and sent a video clip to the Administrator. At 8:46 P.M. Assistant Director of Nursing (ADON) #862 notified the Director of Nursing (DON) and the Administrator that she had also received a call to report Resident #48's family was upset. ADON #862 revealed Resident #48's family alleged CNA #718 was rough while turning Resident #48 during care and mocked him. ADON #862 confirmed Licensed Practical Nurse (LPN) #894 was present at the time of care being provided. At 8:52 P.M. the Administrator instructed ADON #862 to send CNA #718 home. At 9:12 P.M. the Administrator contacted Resident #48's son and daughter and informed them CNA #718 was sent home due to the family's concern and for failing to uphold the professionalism expected at the facility. As a result, the facility initiated a Do-Not-Return (DNR) order for CNA #718. Further review of the soft file revealed the provided video of the alleged incident was reviewed by the Administrator and DON which showed CNA #718 assisted Resident #48 with changing clothes and transferred him to bed using a Hoyer lift with the assistance of LPN #894. As Resident #48 was transferred, he made moaning noises, in which CNA #718 paused and asked if she was doing something wrong or if Resident #48 was in pain. CNA #718 was then heard mimicking the noise Resident #48 made. As CNA #718 walked toward the bathroom, she then repeated the mimicked noise from Resident #48's indication of pain. Interview on 09/24/25 at 3:21 P.M. with LPN #894 was attempted via phone. However, contact was unsuccessful as the number was disconnected. Interview on 09/24/25 at 4:12 P.M. with the Administrator revealed Resident #48's son contacted her on a weekend in March of the current year regarding an agency aide's (CNA #718) conduct, in which she had a soft file pertaining to the incident. Interview on 09/25/25 at 8:01 A.M. with the Administrator and the DON revealed Resident #48 had a fall prior to being admitted to the facility, and the family wanted a camera installed in the room. Resident #48's son reported CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 5 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 #718 was unprofessional and mocked the resident and sent a video clip of the incident in question. The Administrator revealed prior to reviewing the video clip, CNA #718 was sent home, and subsequently, after watching the video clip, CNA #718 was placed on the DNR list. The video clip revealed Resident #48 was in process of being transferred into bed by CNA #718 and LPN #894 via Hoyer lift when Resident #48 made a moaning noise indicating pain. CNA #718 asked Resident #48 if she was doing something wrong and mimicked the noise made by Resident #48. Once Resident #48 was in bed, CNA #718 walked towards the bathroom while mimicking Resident #48's moaning noise. Review of additional video clips with the Administrator and DON present, revealed CNA #718 provided incontinence care to Resident #48 while in bed. The resident was heard yelling out in pain and CNA #718 stated, You have to help me and stop resisting. CNA #718 was then observed with both hands placed on Resident #48's right hip and pushed him onto his left side as he yelled out in pain. LPN #894 then entered the resident's room and asked him to verify and confirm his name. CNA #718 continued to attempt to turn Resident #48 on his left side while he yelled out in pain. LPN #894 then placed both hands on Resident #48's right side to hold him in place on his left side, while CNA #718 continued to provide care. LPN #894 was heard asking Resident #48 if he was in pain and then stated, I just gave you Tylenol. CNA #718 was then heard telling Resident #48 to turn towards her. Resident #48 was observed not to be moving towards CNA #718, when CNA #718 was then observed placing both hands on Resident #48 left side of his body and pulling him all the way over onto his right side and holding him in place. Resident #48 continued to yell out in pain while CNA #718 asked What's the matter? After completing Resident #48 care, CNA #718 was then seen pushing Resident #48 bed using her upper legs against the wall. Review of the SRI tracking system located within the Ohio Department of Health (ODH) for certification and licensing website revealed no incidents regarding Resident #48. Interview on 09/25/25 at 8:01 A.M. with the Administrator revealed the incident of alleged abuse was not reported to the State Survey Agency. The Administrator confirmed and verified the above findings at the time of the interview. Review of the facility document titled Abuse, Neglect, Misappropriation, and Exploitation Policy revised 11/28/16, revealed the facility had a policy in place that all residents had a right to be free from abuse, neglect, misappropriation of resident property, and exploitation, including but not limited to, corporal punishment, involuntary seclusion, and any physical or chemical restraint not required to treat the resident's medical symptoms. Further review of the policy revealed alleged violations would be reported to the State Survey Agency. Review of the document revealed the facility did not implement the policy in regard to the allegation. This deficiency represents noncompliance investigated under Complaint Number 1374287 (OH00164161). Event ID: Facility ID: 365759 If continuation sheet Page 6 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observations, staff interviews, and facility policy review, the facility failed to provide accommodation for a dependent resident's needs. This affected one (Resident #38) of three residents reviewed for nutrition. The facility census was 82. Findings include:Review of the medical record for Resident #38 revealed an admission date of 01/30/22 with diagnoses including dementia, major depressive disorder, and carpal tunnel syndrome of the right upper limb. Resident #38 received hospice care services. Review of the physician order dated 07/06/23 revealed an order for Resident #38 to reside in the memory support unit. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #38 had severe cognitive impairment and required assistance from staff for activities of daily living (ADL). Review of the care plan dated 08/18/25 revealed Resident #38 had an altered nutritional status related to dementia with a contributing history of decreased meal acceptance and weight loss. Interventions included limiting weight loss, providing set-up for meals, cutting up meats, reminders to complete meals, and beverages in a Kennedy cup (a spill-proof cup designed for people with difficulty drinking). Review of the progress note dated 08/18/25 at 9:39 A.M. revealed Resident #38 had a regular diet that required cut up meats, a Kennedy cup and reminders and cueing for meal completion. Resident #38 required use of a Kennedy cup for ease in self-feeding due to history of prior beverage spilling with oversight and encouragement while dining in the memory care unit dining room. Review of the physician order effective September 2025 revealed an order for a regular diet, regular texture, and regular consistency. Review of the hospice note dated 09/04/25 at 5:21 P.M. revealed Resident #38 was a setup for meals, required more prompting with meals and was observed to frequently play in food. Review of the Interdisciplinary Team (IDT) Care Conference assessment dated [DATE] revealed Resident #38 had severely impaired cognition, had a history of weight loss and malnutrition, required meats to be cut up, a Kennedy cup, and meals in the memory care unit for oversight and self-fed. Review of the hospice note dated 09/24/25 at 3:23 P.M. revealed Resident #38 required hand feeding during meals upon visit. Observation on 09/24/25 at 8:39 A.M. revealed Resident #38 was seated alone at a table in the memory care unit dining room with a Kennedy cup in her right hand and a fork in her left hand. The resident took a bite of her breakfast meal frequently nodding off. At the time, Certified Nurse Assistants (CNAs) #820 and #849 were observed seated at an adjacent table assisting four other unknown residents. Observation on 09/24/25 at 8:43 A.M. revealed the Director of Nursing (DON) talking to Resident #38 inquiring if Resident #38 wanted some coffee with cream. The DON was then observed requesting Resident #38 be given a cup of coffee. Resident #38 was then given a cup of hot coffee in a Styrofoam cup without a lid with steam visibly seen coming from the top of the cup. Observation and interview on 09/24/25 at 8:45 A.M., revealed CNA #820 sat in a chair next to Resident #38's left hand side and handed Resident #38 the cup of coffee. Resident #38 was then observed grabbing the cup of coffee, visibly shaking the cup, struggling to lift it and bring it to her mouth almost spilling the hot liquid. CNA #820 was then observed grabbing the cup of coffee and stated, Oh it's still hot, you almost spilled it. CNA #820 revealed she was unaware if all Resident #38's drinks were to be in a Kennedy cup and stated the resident fell asleep all the time, so she required assistance with meals including reminders and cueing. CNA #820 confirmed and verified Resident #38 was seated at the table alone with no staff assisting or providing reminders and cueing during the consumption of her meal. Interview on 09/24/25 at 10:40 A.M. with Registered Nurse (RN) #868 revealed Resident #38 required assistance during meals with encouragement and cues. Interview on 09/24/25 at 10:58 A.M. with Registered Dietician (RD) #976 revealed Resident #38 utilized a Kennedy cup due to Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 7 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete spilling liquids all over herself and tablemates and required oversight having had recent episodes of mixing or playing with her food. RD #976 confirmed and verified Resident #38 was a good eater with staff oversight and keeping an eye on her. Review of the facility document titled Activities of Daily Living undated, revealed the facility had a policy in place to ensure the care and services provided was person-centered, and honored and supported each resident's preferences, choices, values and beliefs. Review of the policy revealed the facility would provide the necessary care and services to ensure a resident's abilities in activities of daily living would not diminish including but not limited to, dining and/or eating, setting up meals and assisting with meals. Review of the document revealed the facility did not implement the policy. Event ID: Facility ID: 365759 If continuation sheet Page 8 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, hospital record review and interview, the facility failed to develop and implement a comprehensive and individualized fall prevention program/fall interventions to decrease Resident #2's risk of falls including falls with injury. This affected one resident (#2) of one resident reviewed for falls. The facility census was 82.Actual Harm occurred on 12/09/24 when Resident #2, who was at risk for falls and had a history of falls, sustained a left hip fracture without evidence the facility had implemented individualized and effective interventions to prevent the fall with fracture. The resident had sustained falls on 11/29/24 and 12/08/24 with the only intervention listed post fall was to remind the resident to call for assistance. Actual Harm continued on 02/10/25 when Resident #2, who remained at risk for falls and continued to sustain falls, was assessed to have a right hip fracture as a result of a fall when Certified Nursing Assistant (CNA) #899 failed to maintain hands-on contact assistance during a resident transfer which resulted in the fall. Resident #2 had severe pain and decreased range of motion to the right hip, was transported to the hospital and subsequently diagnosed with a closed fracture of the right hip (superior and inferior pubic rami). Findings include:Review of the medical record for Resident #2 revealed an admission date of 11/22/24 and diagnoses including diabetes mellitus, abnormalities of gait and mobility, osteopenia, osteoarthritis, anemia, lymphedema, repeated falls, and generalized muscle weakness. Review of the hospital paperwork for admission dated 11/19/24 revealed Resident #2 had previously fallen at home and sustained a nondisplaced periprosthetic fracture of the femoral component and a chronic subdural hematoma . Review of the Fall Risk Evaluation dated 11/22/24 revealed Resident #2 was at risk for falls.Review of the care plan initiated 11/23/24 revealed Resident #2 was at risk for falls. Initial interventions included for staff assistance with ambulation and transfers, and to utilize therapy recommendations Review of a Brief Interview for Mental Status (BIMS) score dated 11/29/24 revealed a score of 13 (out of 15) indicating Resident #2 had intact cognition. Review of a fall investigation report dated 11/29/24 revealed Resident #2 had an unwitnessed fall in the bedroom due to an attempted self-transfer but had no injury. Staff intervention included educating Resident #2 to call for assistance. Review of a fall investigation report dated 12/08/24 revealed Resident #2 had an unwitnessed fall in the bedroom due to an attempted self-transfer but had no injury. Staff intervention was educating Resident #2 to call for assistance (the same intervention initiated after the unwitnessed fall on 11/29/24). Review of a fall investigation report dated 12/09/24 revealed Resident #2 had an unwitnessed fall in the doorway into the hall, and the resident was unable to report what happened. Blood was observed on multiple areas of both legs and was then transferred to the hospital. A staff intervention following the incident was to bring Resident #2 into the common area for increased supervision.Review of hospital paperwork dated 12/09/24 revealed Resident #2 had fallen and complained of left hip pain. Resident #2's left leg was shortened and externally rotated. There was a left hip (peri trochanteric femur) fracture. No surgical interventions were taken. Review of admission summary note dated 12/13/24 revealed Resident #2 returned from the hospital with a left hip fracture and was non-weight bearing to the left side. Review of the Fall Risk Evaluation dated 12/13/24 revealed Resident #2 was at risk for falls. Review of the daily note dated 01/07/25 revealed Resident #2 was transferring unassisted and required education on waiting for assistance. Review of an order note dated 01/10/25 revealed Resident #2 received new therapy orders for transfers to graduate from a mechanical lift to transfer with a slide board.Review of the Medicare Minimum Data Set (MDS) five-day assessment dated [DATE] revealed Resident #2 had a (BIMS) score of 12 (out of 15) which indicated the resident had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 9 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 moderate cognitive impairment. The assessment revealed the resident required partial/moderate (staff) assistance for transfers and was independent for bed mobility and wheelchair use. Review of the physician's orders dated 02/10/25 revealed Resident #2 required one staff assistance with transfers, bilateral enabler bars for turning and repositioning, and weight bearing as tolerated. Review of a fall investigation report dated 02/10/25 revealed Resident #2 had a witnessed fall while being assisted by CNA #899 to transfer from the chair scale to the wheelchair. During the transfer while Resident #2 was standing, CNA #899 swapped the two chairs while not holding on to the resident. Resident #2 lost balance and fell backwards, then complained of pain to the right hip and had decreased range of motion. The resident was sent to the hospital. Following the incident, CNA #899 received education on safe transfers and was reminded of Resident #2 requiring hands-on assistance for standing and transfers. Review of the incident note dated 02/10/25 revealed Resident #2 was yelling out in pain and complained of severe pain to the right hip. Review of hospital paperwork dated 02/10/25 revealed Resident #2 had fallen and complained of right hip and shoulder (scapula) pain. Resident #2 had transferred from a chair scale to a wheelchair, then fell onto the buttocks. Resident #2 sustained a closed fracture of the right hip (superior and inferior pubic rami). Review of a fall investigation report dated 02/16/25 revealed Resident #2 had an unwitnessed fall out of bed. Record review revealed no information as to what interventions were in place at the time of the fall and/or why they were ineffective. At the time of the fall, Resident #2 was bleeding from the nose and mouth. The resident was transferred to the hospital. Review of corresponding hospital paperwork revealed Resident #2 had fallen and complained of right hip pain. There were no new fractures noted; however, the right hip fracture of the right pubic rami remained from the previous fall. Staff intervention following the incident included a body pillow to the open side of the resident's bed. Review of an Inservice Record Sheet dated 02/26/25 revealed CNA #899 was educated by Former Director of Therapy #716 on transfers. It was noted CNA #899's hands should always be on the resident during transfers, CNA #899 should call for assistance if needing to move away from a standing resident, and the resident should be seated if unable to physically assist. Review of the Fall Risk Evaluation dated 03/01/25 revealed Resident #2 was at risk for falls. Review of the behavior note dated 03/05/25 revealed Resident #2 had transferred unassisted from the wheelchair to the bed. Staff re-educated Resident #2 to call for assistance. There was no evidence of any additional/individualized and/or effective interventions initiated at this time to decrease the resident's risk of falls. Review of a fall investigation report dated 03/11/25 revealed Resident #2 had an unwitnessed fall in the bathroom due to self-transferring onto the toilet. Staff intervention was to encourage Resident #2 to call for assistance. There was no evidence of any additional/individualized and/or effective interventions initiated at this time to decrease the resident's risk of falls. Review of daily note dated 03/14/25 revealed Resident #2 was transferring unassisted throughout the shift. The resident was educated several times. There was no evidence of any additional/individualized and/or effective interventions initiated at this time to decrease the resident's risk of falls.Review of daily note dated 04/08/25 revealed Resident #2 was transferring unassisted throughout the shift. The resident was re-educated multiple times on call light use. There was no evidence of any additional/individualized and/or effective interventions initiated at this time to decrease the resident's risk of falls. Review of the Fall Risk Evaluation dated 06/07/25 revealed Resident #2 was at risk for falls. Review of a fall investigation report dated 07/29/25 revealed Resident #2 had an unwitnessed fall in the room due to self-transferring. There were no injuries. Staff interventions were to educate Resident #2 to call for help and wear non-skid socks.Review of the Fall Risk Evaluation dated 08/05/25 revealed Resident #2 was at risk for falls. Review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 10 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 of a fall investigation report dated 08/13/25 revealed Resident #2 had an unwitnessed fall in the room due to self-transferring. There were no injuries. Staff intervention as to educate Resident #2 to call for assistance. There was no evidence of any additional/individualized and/or effective interventions initiated at this time to decrease the resident's risk of falls.Review of a fall investigation report dated 08/26/25 revealed Resident #2 had an unwitnessed fall in the room. Resident #2 had fallen asleep in the wheelchair and then slid out. There were no injuries. Staff intervention was to encourage sitting in the recliner or bed to watch television. Review of daily note dated 09/03/25 revealed Resident #2 was observed by activities staff sitting on the floor of the room. Resident #2 voiced fixing something on the bed. There was no evidence of any additional/individualized and/or effective interventions initiated at this time to decrease the resident's risk of falls. Review of the plan of care revised 09/04/25 revealed Resident #2 was at risk for falls related to impaired mobility, non-compliance with recommendations, poor safety awareness, and impulsiveness. Interventions included enabler bar to bed, administer medications as ordered, assess for pain every shift, keep call light within reach and encourage use of call light, Dycem (non-slip surface) to the recliner chair, encourage to be in common area when out of bed, encourage participation, anti-roll backs to the wheelchair, keep items within reach, one staff assistance for transfers, monitor labs as ordered, therapy evaluation and treatment as needed, and ensure wearing appropriate footwear.Review of a fall investigation report dated 09/11/25 revealed Resident #2 had an unwitnessed fall in the bathroom due to self-transferring and not locking the wheelchair brakes. There were no injuries. Staff interventions were to apply anti-roll backs to the wheelchair and educate on locking the wheelchair brakes. Review of plan of care note, first dated 09/12/25 revealed Resident #2 was non-compliant with transfer assistance, and the resident had a long history of forgetfulness. Interventions included for staff to administer medications as ordered, approach and speak in a calm manner, assess for physical factors that may foster behavior, consult psychiatric services, divert attention from stimulus, monitor for changes, provide education, redirect resident as needed, use distraction, and help the resident to understand why the behavior was inappropriate. This care plan note did not address the resident's non-compliance as it pertained to fall risk/safety needs. On 09/24/25 at 10:35 A.M. Resident #2 was observed sitting in his wheelchair in his room. The resident was not noted to be in a common area at this time. An attempted interview with the resident at the time of the observation revealed the resident was unable to recall having any falls.Interview on 09/24/25 at 1:44 P.M. with CNA #899 revealed being the primary caregiver for Resident #2 who required one staff assistance for transfers. CNA #899 indicated on 02/10/25 she obtained Resident #2's weight using the scale chair. CNA #899 then stood the resident up from the wheelchair and went to get the wheelchair. CNA #899 described moving the scale chair and while attempting to move the wheelchair behind Resident #2, the resident fell straight backwards onto the buttocks. CNA #899 stated Registered Nurse (RN) #952 came to help and while trying to move the resident, he grabbed his leg and stated a belief it was broken. CNA #899 indicated emergency medical services (EMS) were called and got Resident #2 off the floor. Interview on 09/24/25 at 3:41 P.M. with RN #952 revealed being the assigned nurse for Resident #2 on 02/10/25. RN #952 stated CNA #899 was getting Resident #2's weight. CNA #899 had stood up Resident #2 and then went to get the wheelchair. RN #952 stated CNA #899 trusted Resident #2 too much and should have kept hands on Resident #2. RN #952 confirmed she educated CNA #899 on transfers following the incident. RN #952 stated Resident #2 complained of pain, was sent to hospital, and ended up with a fracture.Interview on 09/25/25 at 7:48 A.M. with Director of Nursing (DON) revealed Resident #2 was impulsive, non-compliant and did not slow down enough to allow time for safety. The DON indicated Resident #2 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 11 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 often educated following falls and was encouraged to use the call light (however, these interventions were noted to be ineffective). The DON indicated she believed education was an adequate intervention for Resident #2 to prevent falls as the resident was resistive to changes in care and it maintained his independence without restricting him. The DON confirmed Resident #2 sustained a fracture following the fall which occurred on 02/10/25 while being assisted by CNA #899 to transfer when the CNA failed to ensure adequate hands-on assistance was being provided to the resident. Interview on 09/25/25 at 9:45 A.M. with Physical Therapy Assistant (PTA) #989 and Occupational Therapist (OT) #991 revealed Resident #2 required one staff assistance for transfers with contact guard assist (CGA) at the time of the fall on 02/10/25. It was noted Resident #2 was inconsistent with recommendations to call for assistance and had a history of poor follow-through. Review of the facility policy, Falls Policy, dated August 2024 revealed all residents would receive adequate supervision, assistance, and devices to aide in prevention of falls. This deficiency represents non-compliance investigated under Complaint Number 1374286 (OH00161744). Event ID: Facility ID: 365759 If continuation sheet Page 12 of 13 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 365759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Health Center at the Renaissance 26376 John Rd Olmsted Twp, OH 44138 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on record review, observation, interview and facility policy review, the facility failed to ensure medications were given according to physician's orders, creating a medication error rate of 16.0 percent (%). This affected two residents (#29 and #32) of three residents observed for medication administration. The facility census was 82. Findings include:1. Review of the medical record for Resident #29 revealed an admission date of 09/08/25 and diagnoses including metabolic encephalopathy, ventricular tachycardia, and stage four chronic kidney disease. A physician's order dated 09/18/25 was for 12.5 milligrams (mg) of spironolactone (a diuretic) to be given daily, with no other current orders for this medication. Another physician's order dated 09/08/25 was for a senna-docusate 8.6-50 mg (laxative and stool softener) combination medication to be given twice daily, and no current order for any senna-only pills to be given. Observation of a medication administration procedure for Resident #29 on 09/24/25 at 8:29 A.M. by Registered Nurse (RN) #868 revealed the nurse drew out two doses of spironolactone from different containers, each being a 25 mg pill split in half for a dose of 12.5 mg each. Both half-pills were placed in a medication cup along with the resident's other pills. Additionally, the nurse drew out and administered one senna (a stool softener) 8.6 mg pill and did not draw or administer any senna-docusate combination pills. Interview with RN #868 on 09/24/25 at 8:49 A.M. verified the nurse was ready to administer the spironolactone at which time the surveyor intervened to identify the two spironolactone doses in Resident #29's cup. RN #868 then looked at the resident record, confirmed the resident was to receive only one 12.5 mg pill of spironolactone, and discarded the other spironolactone pill. Interview with RN #868 on 09/24/25 at 10:05 A.M. confirmed Resident #29 was administered the incorrect type of senna medication and had to be stopped before administering two doses of spironolactone to the resident. 2. Review of the medical record for Resident #32 revealed an admission date of 09/10/25 and diagnoses including hypertension, repeated falls, and fracture of right femur. A physician's order dated 09/10/25 was for a 500 mg chewable calcium carbonate tablet (medication for heartburn and indigestion) daily in the morning, and no active orders for a calcium-vitamin D combination tablet. Another physician's order dated 09/10/25 was for a senna-docusate 8.6-50 mg combination medication to be given twice daily, and no current order for any senna-only pills to be given. Observation of a medication administration procedure for Resident #32 on 09/24/25 at 9:09 A.M. by Licensed Practical Nurse (LPN) #893 revealed the nurse drew out and administered one senna 8.6 mg pill and did not draw or administer any senna-docusate combination pills. The nurse also drew and administered one combination oyster shell calcium 500 mg and vitamin D 5 microgram (mcg) pill and did not give any other calcium supplement. Interview with LPN #893 on 09/25/25 at 10:10 A.M. confirmed the above findings. The above findings identified four errors out of 25 observed medication administration opportunities, creating a total medication error rate of 16.0%. Review of the facility's undated medication administration policy revealed medications were administered according to orders, and staff were to verify the right medication and dosage before giving the medication. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365759 If continuation sheet Page 13 of 13