Inspection·August 20, 2025

F 0697 Level of Harm - Actual harm Residents Affected - Few P.M. revealed Resident #150 reported severe pain all over her body and 2 tablets of as needed (PRN) Percocet 5-325 mg tablets were administered as ordered. Review of the nursing progress note dated 07/10/25 timed at 9:02 A.M. for Resident #150 indicated two tablets of Percocet 5-325 mg oral tablet were given for severe pain. Repositioning and distraction were noted to be ineffective. A note timed at 3:19 P.M. noted an additional dose of Percocet was given to Resident #150 for severe pain in her left leg, and repositioning and distraction were noted to be ineffective. An additional note timed at 9:23 P.M. revealed two tablets of Percocet 5-325 mg oral tablet were given to Resident #150 due to severe pain. Review of the 07/11/25 nursing progress noted timed at 3:13 P.M. for Resident #150 revealed two tablets of Percocet 5-325 mg oral tablet were given for pain in her legs and repositioning and distraction were noted to be ineffective. An additional note timed at 4:08 P.M. revealed Resident #150 had a bruise on her left leg. Resident #150 was noted to squeeze the leg in the area of the bruise when in pain. Resident #150 stated she squeezes her leg to make it feel better. No further discoloration was noted. A new order for Percocet was received from the nurse practitioner. Review of the physician order dated 07/11/25 revealed a new order for Oxycodone 10 mg by mouth five times a day for pain related to encounter for orthopedic aftercare. An additional order dated 07/11/25 for Acetaminophen (an over-the-counter mild pain reliever) 500 mg by mouth five times a day for pain. The Oxycodone and Acetaminophen were scheduled to be administered at the same times. Review of the 07/11/25 nursing progress note timed at 9:00 P.M. revealed two tablets of Percocet 5-325 mg oral tablets were given to Resident #150 for reports of severe pain. Review of change of condition assessment dated [DATE] for Resident #150 revealed the resident had a bruise to her right front thigh and pain in her leg. The assessment did not include any evidence range of motion (ROM) was evaluated or that a functional assessment was performed. Review of the 07/11/25 witness statement from CNA #254 revealed she reported bruising to Registered Nurse (RN) #234 and Director of Nursing (DON) #283 which were small and yellowish in color. The CNA noted the bruises appeared to be self-inflicted from hands on right thigh. Review of the witness statement dated 07/11/25 from the previous Director of Nursing (DON) #283 revealed the CNA requested the nurse and DON #283 to look at Resident #150 in bed. DON #283 indicated a few bruises were noted when Resident #150 took her hands and placed them around her right thigh and that the bruises appeared to be self-inflicted. Review of Resident #150's Medication Administration Record (MAR) for July 2025 revealed on 07/12/25, the resident reported pain ratings of five at 6:00 A.M., three at 10:00 A.M., and five at 6:00 P.M. On 07/13/25, the resident reported pain ratings of a two at 6:00 A.M., three at 10:00 A.M., a one at 2:00 P.M., and a two at 10:00 P.M. On 07/14/25, the resident reported pain levels of a two at 6:00 A.M., three at 10:00 A.M., and four at 6:00 P.M. Review of a nursing progress note dated the 07/15/25 and timed at 4:40 P.M. revealed Resident #150 continued to show signs of pain and general discomfort with ecchymosis (bruising) noted to her right thigh and inguinal (groin) area. Review of a skin assessment dated [DATE] for Resident #150 revealed intact skin, new area identified on front of right thigh. The new area was described as a small yellow and blue colored bruise where Resident #150 placed her fingers to lift her leg. Two bruises were noted on each side of her right thigh. Review of Resident #150's MAR for July 2025 revealed on 07/15/25, the resident reported pain ratings of three at 6:00 A.M., five at 10:00 A.M., six at 2:00 P.M., two at 6:00 P.M., and a six at 10:00 P.M. Review of a nursing progress note dated 07/16/25 and timed at 5:26 P.M. revealed Resident #150 was alert and expressed pain during the shift. A large bruise was observed on the resident's right thigh. Supervisor (unnamed) was made aware and stated resident was awaiting an orthopedic follow-up appointment. Resident #150 was observed not eating much during meals this shift. A subsequent note timed at 11:54 P.M. revealed Resident #150 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365826 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365826 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Cuyahoga Falls 300 East Bath Road Cuyahoga Falls, OH 44223 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 0697 Level of Harm - Actual harm Residents Affected - Few reported excruciating pain to her right hip. The physician was notified and the nurse put in an order for x-rays to be done due to bruises to the right hip and sensitivity to the area. An x-ray was to be completed in the morning. The note did not mention if the resident's ROM had been assessed or if a functional assessment had been performed. Review of Resident #150's MAR for July 2025 revealed on 07/16/25, the resident reported pain ratings of a five at 6:00 A.M., three at 2:00 P.M., four at 6:00 P.M., and an eight at 10:00 P.M. On 07/17/25 at 6:00 A.M, Resident #150's pain was rated as a ten out of ten. Review of an x-ray examination report dated 07/17/25 revealed Resident #150 had an acute right hip fracture to the intertrochanteric ridge. Review of a change in condition note dated 07/17/25 and timed at 1:05 P.M. revealed the results of the x-ray concluded an acute right hip fracture to the intertrochanteric ridge. Orders were placed to send Resident #150 to a local emergency room. Resident #150 left the facility at 1:19 P.M. Review of the nursing progress note dated 07/17/25 and timed at 11:32 P.M. revealed Resident #150 was admitted to the local hospital with a diagnosis of a right femur fracture. Review of a facility self-reported incident (SRI) dated 07/17/25 revealed an injury of unknown origin was reported for Resident #150's hip fracture. The facility submitted their final report on 07/24/25 and concluded the injury was the result of non-witnessed mechanical trauma in the context of severe osteoporosis and prior hardware failure and determined no abuse or mistreatment occurred. Review of a hospital Discharge summary dated [DATE] revealed Resident #150 was treated at a local hospital for a diagnosis of right intertrochanteric hip fracture, dementia, and recurrent falls and noted that upon hospital discharge, hospice care was recommended. X-ray results of the right hip on 07/17/25 revealed an acute, mildly displaced right intertrochanteric fracture. The report noted the resident's family declined surgical intervention and opted for hospice care. Resident #150 did not return to the facility. Review of the facility incident log from 06/01/25 to 08/06/25 did not reveal any incidents or falls for Resident #150. Review of the witness statement dated 07/23/25 from CNA #235 revealed on 07/15/25 she helped CNA #234 change Resident #150 in bed and observed the bruising on her thigh which appeared to be yellow in color and reported it to the nurse and DON. Review of the witness statement dated 07/24/25 from Director of Rehabilitation #282 revealed therapy did seated occupational therapy with Resident #150 in July 2025 and did not do physical therapy. Interview on 08/06/25 at 10:23 A.M. with CNA #235 revealed she was helping CNA #247 change Resident #150 on 07/09/25 and when they went to roll Resident #150 over, they noticed yellow and purplish bruising. They went to tell Licensed Practical Nurse (LPN) #284 and RN #234 who stated they were already aware of the bruising. Interview on 08/06/25 at 10:31 A.M. with CNA #247 revealed she went in with CNA #235 to change Resident #150 on 07/09/25 and noticed a large bruise on her inner hip. CNA #247 went to get the nurse, and the nurse stated it was yellow and appeared to be an older bruise. When CNA #247 and CNA #235 turned Resident #150 onto her side, the back of her hip was purple, and she told the nurse she needed to go to the hospital. CNA #247 stated she reported it to LPN #284 on 07/09/25 and again the next time she worked on 07/11/25 to RN #234 and Unit Manger #218. CNA #247 stated a few days prior, she had noticed Resident #150 had not been eating or drinking well and was moaning during shift and had reported it on 07/09/25 and was told by RN #234 and Unit Manager #218 they would keep an eye on it and medicate Resident #150. Phone interview on 08/06/25 at 5:25 P.M. with Registered Nurse (RN) #234 revealed CNA #247 called her into Resident #150's room on 07/11/25 to look at bruising with DON #283. RN #234 then called the physician and got an order for scheduled pain medication. RN #234 stated the bruising appeared older and yellow. RN #234 stated Resident #150 would squeeze her thighs and the bruising appeared to be where she grabbed her thighs. Interview on 08/07/25 at 6:12 A.M. with LPN #241 revealed she was told by LPN #284 in the first few days of July about the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365826 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365826 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Cuyahoga Falls 300 East Bath Road Cuyahoga Falls, OH 44223 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 0697 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete bruising on Resident #150, but the resident was not sent out for evaluation until a couple of weeks later. LPN #241 stated when the bruising was first observed, it appeared to be smaller and did not appear to be concerning, and Resident #150 was unaware how it happened. The second time, a couple weeks later, the bruising was observed it was much larger and was yellowish, indicating an older bruise. Interview on 08/07/25 at 6:25 A.M. with CNA #228 revealed she first noticed the bruising in the middle of July, and it had already been reported. The bruising appeared small, and dark in color. Resident #150 appeared to be in pain despite the resident receiving pain medication. CNA #228 reported the bruising got worse and Resident #150 seemed more confused. On 07/16/25, prior to the x-ray, Resident #150 seemed to be in considerable pain, was moaning, and would grab her right thigh. Interview on 08/07/25 at 7:26 A.M. with CNA #234 revealed she reported Resident #150 having pain and rubbing her hip around 07/06/25 to RN #234 who talked with DON #283. A couple days later she reported Resident #150 was not eating or drinking well. When CNA #234 asked Resident #150 if she was in pain she nodded yes. CNA #234 stated when she washed her up on 07/10/25, the resident had pain, and she reported it to DON #283. The bruising appeared purple in color. Following reporting the resident's pain to DON #283, Resident #150 appeared to be in more pain and was not sent out until 07/17/25. Resident #150 was not wanting to get out of bed due to her pain and when she was being changed, she was moaning in pain. Interview on 08/07/25 at 12:25 P.M. with the Assistant Director of Nursing (ADON) revealed Resident #150 was unable to voice concerns about pain or bruising. RN #234 contacted her on 07/11/25 and they thought the bruising was from Resident #150 grabbing her thighs with her hands. On 07/16/25, when Resident #150 was having extreme pain, an x-ray was completed, and she was sent out for further evaluation of the right hip fracture. The ADON confirmed she was unable to provide evidence that the physician was notified of continued breakthrough pain between 07/11/25 and 07/16/25 when the x-ray was ordered. Telephone interview on 08/07/25 at 12:48 P.M. with RN #237 revealed after 07/11/25, Resident #150's pain medications (Oxycodone 10 mg) were scheduled. RN #237 reported Resident #150 appeared to be more confused and her quality of life seemed to be declining. RN #237 stated she had reported her concerns, but the concerns were falling on deaf ears. RN #237 stated when communicating with the previous shift nurse, they both felt the increased pain medications were causing Resident #150 to be less alert and not addressing the resident's pain. The two nurses had discussed Resident #150 and had concerns she would need to have an x-ray examination or need to be sent out (to the hospital) to address her condition change. Interview on 08/07/25 at 2:33 P.M. with the Administrator revealed they were not aware of Resident #150 sustaining any falls and proceeded to investigate Resident #150's fracture as an injury of unknown origin following the x-ray examination results obtained on 07/17/25. The Administrator reported that the facility staff believed Resident #150's bruising was not suspicious, had been caused by her squeezing her leg, the bruising appeared to be Resident #150's handprint, and they did not open a SRI until 07/17/25. Review of the facility policy titled Change in Condition Communication revised 06/2019 revealed to notify the physician of the change in medical condition. The nurse will document all assessments and changes in the resident's condition in the medical record. All attempts to notify the physician and family members will be thoroughly documented in the resident's medical record. The guidelines are not intended to substitute for good nursing judgement. If the nurse feels uncomfortable with a situation, he/she should not delay contacting the physician or call 911 if it appears to be life-threatening event. The above applies 24 hours a day, seven days a week. This deficiency represents non-compliance investigated under Complaint Number 2576681. Event ID: Facility ID: 365826 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365826 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Continuing Healthcare of Cuyahoga Falls 300 East Bath Road Cuyahoga Falls, OH 44223 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 observation, interview, record review, and facility policy review, the facility failed to ensure residents were free from significant medication errors. This affected one resident (#112) out of three residents reviewed for insulin administration. The facility identifieid ten residents who required insulin. The facility census was 50. Findings include: Review of Resident #112's medical record revealed an admission date of 02/22/21 with diagnoses including chronic kidney disease, heart failure, type two diabetes mellitus, and protein calorie malnutrition.Review of Resident #112's care plan revised on 08/16/21 revealed the resident was at risk for hypoglycemic (low blood sugar) and hyperglycemic (elevated blood sugar) episodes related to diabetes. Listed interventions included to monitor blood sugar levels as ordered, monitor for signs and symptoms of hypoglycemia and hyperglycemia, and to administer insulin as ordered. Review of Resident #112's physician orders revealed an order dated 06/18/25 for Novolog (a short acting insulin) inject 3 units subcutaneously twice daily for type two diabetes mellitus with diabetic neuropathy. Additional instructions stated to hold the dose for a blood sugar less than 110. Review of the Minimum Data Set (MDS) quarterly assessment dated [DATE] revealed Resident #112 had a Brief Interview for Mental Status (BIMS) score of 15 indicating intact cognition. Resident #115 was assessed to require minimal or supervising assistance for activities of daily living (ADLs) and hygiene needs. Resident #112 was identified to require insulin injections on seven out of seven days of the assessment reference period. Observation on 08/06/25 at 11:42 A.M. revealed Licensed Practical Nurse (LPN) #231 obtained Resident #112 ' s blood glucose level. LPN #231 cleansed her hands and the glucometer. LPN #231 proceeded to wipe Resident #112's finger with an alcohol swab, inserted the test trip into the glucometer, and used a single-use lancet to prick Resident #112's right pinky finger with the lancet. LPN #231 wiped the first drop of blood off with clean gauze and then placed the test strip over a small drop of Resident #112's blood to obtain a blood glucose result of 93. LPN #231 then retrieved the multidose vial of Resident #112's Novolog insulin from the medication cart, cleansed the top of the vial with an alcohol swab, and drew up four units of insulin using an insulin syringe. LPN #231 then performed hand hygiene and returned to Resident #112's room. LPN #231 administered the four units of insulin subcutaneously to Resident #112, injecting the insulin into the resident's right upper arm. Hand hygiene was performed after contact with the resident.Interview with the Director of Nursing (DON) on 08/06/25 at 1:30 P.M. verified the significant medication error with LPN #231 administering insulin to Resident #112 when the medication should have been held per provider order. The DON assessed Resident #112 for any signs and symptoms of hypoglycemia. Resident #112 displayed no negative effects from receiving the insulin dose. The DON documented the medication error in the electronic medical record and informed the resident and the physician of the occurrence. No new orders were obtained. Review of facility policy titled, Medication Administration and Management revised 06/2019, revealed authorized staff members administer subcutaneous injections. The nurse will review physician orders and follow the eight rights of medication administration. This deficiency represents non-compliance investigated under Complaint Number 2581097. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365826 If continuation sheet Page 5 of 5