Health inspection·March 14, 2024

F 0555 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some diagnosis including atherosclerotic heart disease. Review of the quarterly MDS assessment dated [DATE], for Resident #25 revealed the resident was cognitively intact. Review of the Resident Profile revealed Resident #25 was a patient of Physician #2. Interview on 02/29/24 at 2:56 P.M. with Resident #25 revealed she was asked a few days ago about changing physicians. Resident #25 revealed she never agreed to change physicians. Record review of the facility generated letter, undated and directed to residents, families and Responsible Parties revealed neither Resident #25 nor the resident's responsible party had a signed consent to switch physician's on file. Although, Physician #2 was currently listed on the resident's profile as the resident's physician. 4. Review of Resident #15's medical record revealed an admission date of 08/04/21. The resident had a diagnosis including dementia. Review of the quarterly MDS assessment dated [DATE] revealed Resident #15 was severely cognitively impaired. Review of the Resident Profile revealed Resident #15 was a patient of Physician #2. Interview on 02/29/24 at 2:59 P.M., with Resident #15 revealed she did not know anything about a physician. Record review of the facility generated letter, undated and directed to residents, families and Responsible Parties revealed neither Resident #15 nor the resident's responsible party had a signed consent to switch physician's on file. Although, Physician #2 was currently listed on the resident's profile as the resident's physician. 5. Review of Resident #13's medical record revealed an admission date of 09/29/18 with a diagnosis including cerebral palsy. Review of the quarterly MDS assessment dated [DATE] revealed Resident #13 was cognitively intact. Review of the Resident Profile revealed Resident #13 was a patient of Physician #2. Interview on 03/04/24 at 1:12 P.M., with Resident #13 revealed he was never asked if he wanted to change physicians. Resident #13 revealed they told him last Friday or Saturday (03/01/24 or 03/02/24) he had to change (physicians) and to sign a form because Physician #2 was his doctor now. Resident #13 revealed he wanted to stay with Physician #1, but stated he had no choice. 6. Review of Resident #5's medical record revealed an admission date of 06/30/23 with a diagnosis including type two diabetes mellitus. Review of the quarterly MDS assessment dated [DATE] revealed Resident #5 was cognitively intact. Review of the Resident Profile revealed Resident #5 was a patient of Physician #2. Interview on 03/04/24 at 1:17 P.M., with Resident #5 revealed she was visiting a friend one day in the Assisted Living apartments (date not provided) and she was told Physician #1 was an excellent doctor, so she asked Physician #1 to be her doctor; Physician #1 accepted, and he became her doctor Resident #5 revealed then the facility told her she was changing physicians. Resident #5 revealed she was never told who she would have (as a physician) and was never asked who she wanted to be her physician. 7. Review of Resident #41's medical record revealed an admission date of 12/11/18 with a diagnosis including major depressive disorder. Review of the annual MDS assessment dated [DATE] revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 2 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0555 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident was cognitively intact. Review of the Resident Profile revealed Resident #41 was a patient of Physician #2. Interview on 03/04/24 at 1:28 P.M., with Resident #41 revealed the facility required him to sign a paper to change doctors. Resident #41 revealed he wanted Physician #1 to be his physician, but Licensed Practical Nurse (LPN) #606, said no, he had to change, and he had to sign the paper. Interview on 02/29/24 at 4:57 P.M., with the Administrator and Director of Nursing (DON) confirmed the facility gave a letter to Physician #1 terminating his services at the facility. The Administrator revealed Physician #1 refused to sign the new facility Credentialing Form (Implemented 02/01/24), so he was no longer allowed to see residents at the facility. The Administrator revealed Physician #1's last day was 02/26/24. The new Medical Director, Physician #2 was the only physician practicing at the facility and all Physician #1's residents were now patients of Physician #2. The Administrator revealed all residents were notified and had signed a form agreeing to change from Physician #1 to Physician #2. The Administrator and DON revealed they were unable to recall the exact date residents were notified of the change. Interview on 03/04/24 at 1:31 P.M., with LPN #606 revealed she gave all residents who were former residents of Physician #1 forms to let them know Physician #1, would no longer be working at the facility. LPN #606 informed the residents Physician #526 would be their new physician and she had the residents sign the form. LPN #606 revealed she delivered the forms to the residents on either Thursday or Friday (02/29/24 or 03/01/24) of the previous week. LPN #606 confirmed the forms were not dated. Throughout the interview, LPN #606 never indicated Physician #2 would be the residents' new doctor. LPN #606 confirmed Physician #526 was another physician that came to the facility and was able to see residents. Interview on 03/04/24 at 2:50 P.M., with the Facility Ombudsman revealed she had spoken with the Administrator and Physician #1 about resident having the right to choose their own physician. The Ombudsman revealed she spoke with one resident at the facility who wanted to stay with Physician #1. The Ombudsman did not identify who the resident was or when she spoke to the resident. The Ombudsman revealed she would advocate for the residents to see any physician they wanted. Interview on 03/04/23 at 3:22 P.M., with Physician #1 revealed he reviewed the facility new credentialing contract and agreed with 98% of it. Physician #1 revealed he refused to sign the contract because of the portion indicating the administrator had the right to terminate his services with no cause. Physician #1 revealed he believed that was what the facility was trying to do and as soon as he signed the contract and the ink dried, he was done (his services would be terminated with no cause). The second reason he stated he refused to sign the contract was related to the facility wanting him to have hospital privileges to refer residents. Physician #1 indicated usually when residents were admitted to the hospital, they admit to a hospitalist. Physician #1 revealed he was in internal medicine, not very many doctors go to the hospital anymore and he did not sign the contract based on those two items. Physician #1 revealed he had been at this facility since October 2015 and was not aware of any issues or concerns expressed to him. Physician #1 revealed after he was given the termination letter, he spoke with each of his patients at the facility and none of them wanted to change physician. Physician #1 confirmed each resident voluntarily signed a form (Doctor Election), he provided for them, confirming their choice to not change physicians and to continue with his services. Review of the form titled Doctor Election revealed on 02/04/24, Resident #5, #12, #13, the Power of Attorney of Resident #15, Resident #25, #34, and #41, signed the form electing they would like to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 3 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0555 continue services with Physician #1. Level of Harm - Minimal harm or potential for actual harm Interview on 03/06/24 at 11:00 A.M., with Regional Director of Operations #523 revealed concerns Physician #1 would not sign e-scripts and would not follow facility policies. Regional Director of Operations #523 revealed he was not sure what policies were not followed but stated he would ask the Administrator. Regional Director #524 entered and revealed Physician #1 refused to sign e-scripts and that was why the facility no longer wanted him to provide services to residents in the facility. At 11:36 P.M., the DON entered the conversation and revealed additional concerns with Physician #1 that included he was not signing monthly orders timely or writing some prescriptions correctly. The DON revealed Physician #1 told her he could see residents at his office, but she did not believe he had an office, so all residents had their physician services transferred to Physician #2. Residents Affected - Some Review of the eLicense.Ohio.gov website verified Physician #1 was a Doctor of Medicine with the Medical Board and his license was active with no current restrictions on practice. There was no evidence provided Physician #1 was not qualified and properly licensed as a medical physician able to practice medicine in the State of Ohio. There was no evidence provided of any current disciplinary action taken against the physician's license preventing him from providing direct medical care to the residents of the facility. Review of an undated facility generated letter, completed by Administrator, directed to residents, family and friends of the facility revealed the facility was switching Medical Directors on 02/01/24. At the end of February 2024 (Physician #1) would no longer be rounding at the facility, contact the facility with any questions or concerns. Review of an undated facility generated letter, directed to residents, families and responsible parties revealed on 02/26/24 the (facility) implemented a physician credentialing policy/agreement, requiring that any physician seeking admitting and attending privileges at our facility agree to abide by certain policies and procedures in order to obtain such privileges. Your current attending physician, (Physician #1) has elected not to enter into the agreement. Therefore, effective immediately, (Physician #1) will no longer be following residents at (the facility). As a result, your care will be transitioned to (Physician #2), our new Medical Director. Alternatively, you may identify and select a different physician of your choice, who must then be approved via facilities credentialing process and agree to abide by the applicable policies and procedures referenced above in order to obtain attending privileges. We ask that you please sign below to acknowledge your receipt and understanding of this notification. If you have any questions, please feel free to let us know. Under the notation was an area to be signed by Resident or Responsible Party. Review of the undated policy titled, Attending Physician Credentialing, included admitting and attending privileges may be granted, maintained, suspended and or terminated at any time, in the sole discretion of Facilities Administrator, regardless of the status of any corrective action. Should privileges be suspended or terminated, the attending physician agrees to cooperate in transitioning their patients to another physician who has privileges at the facility according to the patients choice, or if the patient does not assert such a choice, then to the care of the physician designated by the Medical Director. The credentialing also included maintaining unencumbered admitting privileges at a hospital that has a current transfer agreement with the facility and inform facility immediately if their privileges are revoked or encumbered in any way. Review of the undated policy tilted Resident Rights, revealed Physician choice: The right upon request, to be assigned, within the capacity of the home to make the assignment, to the staff physician (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 4 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0555 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some of the residents choice, and the right, in accordance with rules and written policies and procedures of the home, to select as the attending physician a physician who is not on the staff of the home. It is the facilities policy to abide by all resident rights, and to communicate these rights to residents and their designated representative in a language they can understand. The policy included the facility must inform the resident if the facility determines that the physician chosen by the resident is unable or unwilling to meet the requirements specified in this part and the facility seeks alternate physician participation to assure provision of appropriate and adequate care and treatment. The facility must discuss the alternative physician participation with the resident and honor the residents preference if any among options. This deficiency represents noncompliance investigated under Complaint Number OH00150880. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 5 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation and staff interview, the facility failed to maintain complete medical records in residents medical charts. This had the potential to affect all 48 residents residing at the facility. The facility census was 48. Findings include: Observation on 03/07/24 at 2:31 P.M., with Director of Nursing (DON) revealed a large stack, several inches thick of several resident's information that included: laboratory results, physician progress notes, signed physician orders, and resident monthly summaries. The paper work had various dates from 12/12/24 through 03/05/24. Interview with the DON, at the time of observation, revealed she was unsure why the medical records person had not been filing the resident information in the medical records timely. DON confirmed there were records unfiled from 12/12/24 through 03/05/24 that potentially could affect the care and treatment of all residents. This deficiency represents noncompliance investigated under Complaint Number OH00150880. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 6 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0865 Have a plan that describes the process for conducting QAPI and QAA activities. Level of Harm - Minimal harm or potential for actual harm Based on record review and interview, the facility failed to ensure their Quality Assurance and Performance Improvement (QAPI) program committee thoroughly evaluated, identified areas in need of improvement, and corrected deficient practice. This affected three of three residents reviewed for choice of physician (#15, #42 and #24) and one (#43) of three residents reviewed for accuracy of documentation. The facility census was 49. Residents Affected - Some Findings include: Review of the facility's survey tracking history revealed the facility had a complaint survey completed on 03/14/24 which resulted in concerns residents were not provided with their physician of choice, and inaccuracy of the medical record in relation to the wound care documentation. Interview on 04/16/24 at 3:16 P.M. with Resident #15 revealed he was previously a patient of Physician #1. He further stated they booted out his previous physician and he was referred to some doctor [Physician #2] who I don't know. During this interview, Resident #15 voiced that his opinion didn't matter because the facility would not allow Physician #1 in the facility, and he did not think Physician #1 had anywhere outside the facility to keep seeing him. Throughout the interview, Resident #15 was alert, oriented to person and place, demonstrated an organized thought pattern, and made his wishes clear he preferred to maintain Physician #1 as his attending physician. Interview on 04/16/24 at 3:45 P.M. with Resident #42 revealed he had a different physician (Physician #2), but if he had the option, he would have preferred to continue seeing Physician #1. Resident #42 further revealed he was not given other options from which to choose a new physician, stating no, they gave him to me. He also stated it was his belief, based on conversation with facility staff, there was no office where he could go to see Physician #1. Interview on 04/16/24 at 4:50 P.M. with Resident #24 revealed facility staff informed her Physician #1 could no longer come to the facility and that the facility assigned her to a different doctor that was supposed to be the new medical director, Physician #2. Resident #24 then stated she informed the facility she preferred that if Physician #1 was not allowed to see her anymore she would like to see if Physician #4 because he reminded her of Physician #1. During the interview, Resident #24 confirmed she never received a definitive response regarding the possibility of Physician #4 taking over as her attending, just that Physician #2 was now the physician for the facility. At the time of the interview, Resident #24 expressed she must not have had a choice, other than to use their doctor. Interview on 04/17/24 at 1:30 P.M. with the Administrator revealed he typed and signed an attestation indicating residents were offered their choice of physicians on 03/21/24, but he was not the person who spoke to the listed residents and was unable to confirm how the questions or options were presented. The administrator said the social worker spoke to the residents on 03/21/24. Interview on 04/17/24 at 1:52 P.M. with Social Services Designee (SSD) #366 revealed she asked residents if they wanted to use Physician #2 in the facility, informed them Physician #1 did not have an office to see patients outside the facility, and told them if they were dissatisfied with Physician #2, she could help them make arrangements to find another primary care provider (PCP) in the community, if they had someone in mind. During the interview, SSD #366 confirmed she did not provide residents with names or contact information for any other physicians from which to choose. She further confirmed she was uncertain of the date she had these conversations; and she had no formal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 7 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0865 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some documentation of specifics from the conversations. During the interview, SSD #366 presented a small piece of notebook paper she used to take notes. Review of this notebook paper revealed it contained a list of five resident names, including Resident #15, and whether they received a letter. The notebook paper did not specify dates, times, exactly who she spoke with, or full content of the conversations. Upon receipt of a requested copy of this notebook paper at approximately 2:10 P.M. on 04/17/24 there was a hand-written notation with new information indicating - Residents asked if they want [Physician #2] or help w/ new PCP or setting up rides to PCP/ [Physician #1] in comm.? Interviewed on 03/21/24 was also added near the bottom of this notebook paper. Interview on 04/17/24 at 4:19 P.M. with Physician #1 revealed he was a nursing home doctor and worked in facilities. He confirmed he did not have his own office but rented space from Physician #3, which was located approximately five to six miles from the facility. Physician #1 explained he did not typically see patients at this rented space because for most residents residing in nursing homes it was impractical for the residents to make many office visits. However, he said he could make arrangement to see residents at this rented space if needed, but believed the facility staff shared with the residents he did not have an office. Interview on 04/18/24 at 1:08 P.M. with Physician #3 confirmed Physician #1 leased space within his medical practice. During this interview, Physician #3 confirmed Physician #1 saw patients in that office space a couple times a year and could continue to make arrangements for patient appointments in his office as needed. Review of the eLicense.Ohio.gov website verified Physician #1 was a Doctor of Medicine with the Medical Board and his license was active with no current restrictions on practice. There was no evidence provided Physician #1 was not qualified and properly licensed as a medical physician able to practice medicine in the State of Ohio Interview with the Administrator on 04/18/24 at 12:35 P.M. revealed the facility held monthly QAPI meetings and the medical director was expected to attend quarterly. The Administrator confirmed the last meeting was held on 03/29/24 with the interdisciplinary team and the medical director was not in attendance for that meeting. During this interview, the Administrator confirmed the team reviewed the facility's progress with audits related to open surveys exited on 01/30/24 and 03/14/24. Regarding audits, the Administrator stated he uploaded the audits to the Information Dissemination Collection (EIDC) system but her did not review them. The Administrator confirmed no problems with the execution of their approved plan of correction were identified and the committee did not identify potential ongoing non-compliance during the QAPI meeting held on 03/29/24. Review of the QAPI meeting notes from 03/29/24 revealed no indication any concerns were identified regarding the facility's execution of the written plan of correction or ongoing non-compliance. Review of the State Operations Manual (SOM), chapter seven, section §7317 titled Acceptable Plan of Correction effective 11-16-18 revealed the facility must develop a plan to monitor their ongoing performance toward compliance and ensure solutions put into place are sustained. Section §7317 also revealed when a plan of correction is approved, it is the facility who is ultimately accountable for managing their own compliance. 2. Review of Resident #43's Medication Administration Record (MAR) and the Treatment Administration Record (TAR) for February 2024 revealed there was no documentation of the following wound care treatments for the following wounds on the following dates: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 8 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0865 Right upper buttock- missing documentation for ordered treatments on 02/02/24, 02/15/24, 02/16/24, 02/17/24, 02/22/24, 02/23/24 (morning treatments), and 02/29/24 (both treatments). Level of Harm - Minimal harm or potential for actual harm Right knee- missing documentation for ordered treatment on 02/02/24. Residents Affected - Some Right posterior scalp- missing documentation for ordered treatment on 02/08/24. Left toes and left heel- missing documentation for ordered treatments on 02/02/24, 02/15/24, 02/16/24, 02/17/24, 02/22/24, and 02/23/24. Left first toe- missing documentation for ordered treatment on 02/29/24. Coccyx- missing documentation for ordered treatments scheduled the mornings of 02/15/24, 02/15/24, 02/16/24, 02/22/24, 02/23/24, and 02/29/24, and the scheduled evening treatment on 02/29/24. Review of the progress notes revealed no documentation on 02/02/24, 02/08/24, 02/15/24, 02/16/24, 02/17/24, 02/22/24, 02/23/24, or 02/29/24 regarding Resident #43's wound care. Review of the MAR and the TAR for March 2024 revealed there was no documentation of the following wound care treatments for the following wounds on the following dates: Right upper buttock- missing documentation for ordered treatment on 03/30/24. Right posterior scalp- missing documentation for ordered treatment on 03/01/24, 03/04/24, and 03/05/24. Left great toe- missing documentation for ordered treatment on 03/03/24. Left heel- missing documentation for ordered treatment on 03/11/24. Review of the progress notes revealed no documentation on 03/01/24, 03/03/24, 03/04/24, 03/05/24, 03/11/24, or 03/30/24 regarding Resident #43's wound care. Review of Resident #43's MAR and TAR for March 2024 revealed there was no documentation of the following wound care treatments for the following wounds on the following dates: Right upper buttock- missing documentation for ordered treatments on 04/05/24 and 04/09/24. Right posterior scalp- missing documentation for ordered treatments on 04/01/24, 04/05/24, 04/08/24, 04/09/24, 04/12/24, and 04/13/24. Left great toe- missing documentation for ordered treatments on 04/01/24, 04/05/24, 04/08/24, 04/12/24, and 04/13/24. Left heel- missing documentation for ordered treatment on 04/01/24, 04/04/24, 04/05/24, 04/08/24, 04/09/24, 04/12/24, and 04/13/24. Review of the progress notes revealed no documentation on 04/01/24, 04/04/24, 04/05/24, 04/08/24, 04/09/24, 04/12/24, or 04/13/24 regarding Resident #43's wound care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 9 of 10 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 365859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Merriman 209 Merriman Rd Akron, OH 44303 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 0865 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 04/17/24 at 9:45 A.M. with Licensed Practical Nurse (LPN) #304 revealed nurses who completed wound care and treatments were to sign-off the care and treatments were completed on the MAR or TAR. Resident refusal of wound care was to be documented on the MAR or TAR and in the progress notes. Interview on 04/17/24 at 1:25 P.M. with the Director of Nursing (DON) confirmed completed wound care should be documented on the MAR or TAR and nurses should document if the resident refused medications or treatments. Interview on 04/18/24 at 12:25 P.M. with the DON revealed wound audits were conducted by LPN #304 so she could not speak to how the audits were conducted. Interview with the Administrator on 04/18/24 at 12:35 P.M. revealed the facility held monthly QAPI meetings and the medical director was expected to attend quarterly. The Administrator confirmed the last meeting was held on 03/29/24 with the interdisciplinary team and the medical director was not in attendance for that meeting. During this interview, the Administrator confirmed the team reviewed the facility's progress with audits related to open surveys exited on 01/30/24 and 03/14/24. Regarding audits, the Administrator stated he uploaded the audits to the Information Dissemination Collection (EIDC) system but he did not review them. The Administrator indicated the QAPI committee did not identify problems with the execution of their approved POC or potential ongoing non-compliance during the QAPI meeting held on 03/29/24. Interview on 04/18/24 at 1:20 P.M. with LPN #304 revealed the wound audits completed for the facility's plan of correction did not capture missing documentation on the MAR or the TAR during week two and week four audits of Resident #43's wound care. Review of the policy last reviewed in August 2023 titled Wound Care revealed treatments were to be documented in the medical record. Refusals and the reason for refusal were also to be documented. Review of the QAPI meeting notes from 03/29/24 revealed no indication any concerns were identified regarding the facility's execution of the written POC or potential ongoing compliance Review of the State Operations Manual (SOM), chapter seven, section §7317 titled Acceptable Plan of Correction effective 11-16-18 revealed the facility must develop a plan to monitor their ongoing performance toward compliance and ensure solutions put into place are sustained. Section §7317 also revealed when a plan of correction is approved, it is the facility who is ultimately accountable for managing their own compliance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365859 If continuation sheet Page 10 of 10