Health inspection·October 17, 2023

F 0585 happening since her admission, 08/30/23. Level of Harm - Minimal harm or potential for actual harm Interview on 10/16/23 at 1:38 P.M. and 10/17/23 at 7:48 A.M. with RN #608 revealed she had received several complaints over the last month from residents, including Resident #29, and staff that night shift had not been providing timely incontinence care including at times going the entire shift. She revealed first shift staff also brought it to her attention that when they came on duty several residents had not been changed as their incontinence products were saturated in urine, and they required complete linen changes due to urine soaked through their incontinence products to the linen. She revealed she had notified the Acting DON #600 several times of the residents, including Resident #29, and staff's concerns. She revealed she had gone to the Acting DON #600 again as the concerns continued and told her that she was going to start marking the resident's incontinence products to track if the residents were being changed. She revealed on 10/11/23 at approximately 11:00 P.M. she had State Tested Nursing Assistant (STNA) #615 mark a few residents' incontinence products, including Resident #29. She revealed on 10/12/23 at appropriately 8:30 A.M. she checked on Resident #29 to see if she received proper incontinence care, but she still had the same marked incontinence product that had been applied on 10/11/23 and it was evident she had not been changed all night shift as her incontinent product was saturated in brown urine, her sheets were saturated with brown dried rings, her buttocks were red and excoriated, and she could smell a strong urine smell from the hallway and in her room. She revealed she had Acting DON #600 come to Resident #29's room and showed her that she was still wearing the same marked incontinence product applied on 10/11/23 and was saturated in urine. She revealed it was frustrating as the issue continued to happen regarding night shift staff not changing the residents properly including, Resident #29, and that she felt her hands were tied as despite reporting the continued issue to the Acting DON #600, she did not feel that the issue had been addressed as she felt nothing had been done about it. Residents Affected - Few Interview on 10/17/23 at 8:29 A.M. with Scheduler/ Human Resources (HR) #611 revealed she maintained the employee personnel files and had not received any disciplinary actions and/or education that staff had received from 10/01/23 to 10/17/23 for not providing timely incontinence care. Interview on 10/17/23 at 9:15 A.M. with Acting DON #600 verified last week RN #608 came and got her to show her Resident #29's incontinence product and concern that she had not been changed by the previous shift (night shift). She verified her incontinence product was saturated in urine. She verified Resident #29 was cognitively intact, and Resident #29 stated that she had not been changed on night shift, 10/11/23. She revealed that she did not know off hand which aide was assigned to Resident #29 on 10/11/23 through 10/12/23 night shift. She revealed she had no evidence that the staff involved was educated and/or received disciplinary action for not changing Resident #29 all night. She revealed that she had no documented evidence that she had investigated the concern voiced by Resident #29 and/or that she had gotten back to Resident #29 regarding how she had addressed the concern, and/or that she had checked with Resident #29 if the concern was resolved. Interview on 10/17/23 at 10:03 A.M. with STNA #612 revealed she worked on first shift and frequently when she came on duty several of the residents, including Resident #29, had not been properly changed by the previous shift as their incontinence products were saturated in urine and/or bowel movement, required complete bed changes and/or had dried brown urine rings on their sheets. She revealed she had reported the issue to the nurses and Acting DON #600 several times regarding the residents' lack of timely incontinence care. Review of the grievance log dated 09/01/23 to 10/16/23 revealed the facility had no grievances including Resident #29's complaint voiced on 10/12/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366011 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 366011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Ridge Health and Rehabilitation 9901 Johnnycake Ridge Rd Mentor, OH 44060 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the undated facility policy labeled, Resident Grievance revealed all complaints and grievances would be investigated and the result of the investigation shall be reported back to the individual registering the concern within a reasonable time. The policy revealed individuals may express complaints to staff or administration verbally or in writing at any time. The policy revealed a complaint was defined as an expression of dissatisfaction with a committed or omitted action. The policy revealed a response was to be given in a timely manner as follow up and would be documented and logged as part of the Quality Assurance Program. The policy revealed if the complainant was not satisfied with the response a formal written grievance may be submitted to the grievance committee. This deficiency represents non-compliance investigated under Master Complaint Number OH00147275 and Complaint Number OH00146748. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366011 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 366011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Ridge Health and Rehabilitation 9901 Johnnycake Ridge Rd Mentor, OH 44060 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 the interview, record review and review of facility policy, the facility did not ensure Resident #29 received timely incontinence care. This affected one resident (Resident #29) out of six residents ( Resident #13, #20, #28, #29, #47, and #72) reviewed for timely incontinence care and had the potential to affect 59 residents (Resident #1, #2, #3, #6, #7, #8, #9, #11, #13, #14, #15, #17, #18, #19, #20,#21, #22, #23, #27, #28, #29, #31, #32, #33, #34, #35, #36, #37, #38, #40, #43, #44, #45, #46, #47, #48, #49, #50, #51, #52, #54, #55, #56, #59, #60, #61, #62, #63, #65, #68, #69, 70, #71, #72, #74, #75, #78, #80, #82) who were identified as incontinent of bowel and/ or urine. Residents Affected - Few Findings included: Review of medical record for Resident #29 revealed an admission date of 08/30/23 and her diagnoses included multiple sclerosis, diabetes, need for assistance with personal care, and morbid obesity. Review of nursing notes dated from 08/30/23 to 10/17/23 revealed no concerns documented in her medical record regarding refusal of incontinence care. Review of care plan dated 09/11/23 revealed Resident #29 had urinary incontinence and was at risk for altered dignity, skin breakdown, and urinary tract infections. Interventions included checking and providing incontinence care as needed, applying barrier cream after each incontinent episode, and observing and reporting redness, excoriation and/ or open areas with incontinence care. Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #29 had intact cognition. She required extensive assist of two staff with bed mobility and toileting. She was unable to ambulate. She was frequently incontinent of bowel and bladder. Review of assessment labeled, Bladder Observation dated 10/10/23 and completed by Registered Nurse (RN) #614 revealed Resident #29 was incontinent of urine due to impaired mobility. The assessment revealed she had incontinence without sensation of urine loss. Interview on 10/16/23 at 1:28 P.M. and 10/17/23 at 12:35 P.M. with Resident #29 revealed she had notified several nurses including RN #608 that night shift had not been providing timely incontinence care and at times she had gone the whole shift not being changed and laid in urine. She revealed the nurses including RN #608 had continued to report that they had notified Acting DON #600 but that nothing happened as night shift continued to frequently not change her. She revealed on 10/11/23 from 11:00 P.M. to approximately 8:30 A.M. she was not provided incontinence care and that her skin was burning from not being changed. She revealed RN #608 came into her room to check on her, turned her over and seen that she was lying in a puddle of urine. She revealed RN #608 had notified the Acting DON #600 and had her come to her room to show her the incontinence product and how she had not been changed for over nine hours. Resident #29 revealed Acting DON #600 stated she would check into it but that she never got back to her regarding the complaint and/ or how the complaint would be resolved. She revealed she felt that she would continue not to be changed timely especially on night shift despite making the nurses and Acting DON #600 aware of her concern as it had been happening since her admission, 08/30/23. Interview on 10/16/23 at 1:38 P.M. and 10/17/23 at 7:48 A.M. with RN #608 revealed she had received several complaints over the last month from residents including Resident #29 and staff that night (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366011 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 366011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Ridge Health and Rehabilitation 9901 Johnnycake Ridge Rd Mentor, OH 44060 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 shift had not been providing timely incontinence care. She revealed first shift staff also brought it to her attention that when they came on duty several residents had not been changed as their incontinence products were saturated in urine, and they required complete linen changes due to urine soaked through their incontinence products to the linen. She revealed she had notified the Acting Director of Nursing (DON) #600 several times of the residents including Resident #29 and staff's concerns. She revealed she had gone to the Acting DON #600 again as the concerns continued and told her that she was going to start marking the resident's incontinence products to track if the residents were being changed. She revealed on 10/11/23 at approximately 11:00 P.M. she had State Tested Nursing Assistant (STNA) #615 mark a few residents the incontinence products including Resident #29. She revealed on 10/12/23 at appropriately 8:30 A.M. she checked on Resident #29 to see if she received proper incontinence care but she still had the same marked incontinence product that had been applied on 10/11/23 and it was evident she had not been changed all night shift as her incontinent product was saturated in brown urine, her sheets were saturated with brown dried rings, her buttocks was red and excoriated and that she could smell a strong urine smell from the hallway and in her room. She revealed she had Acting DON #600 come to Resident #29's room and showed her that she was still wearing the same marked incontinence product applied on 10/11/23 and was saturated in urine. She revealed it was frustrating as the issue continued to happen regarding night shift staff not changing the residents properly including Resident #29 and that she felt her hands were tied as despite reporting the continued issue to the Acting DON #600 she did not feel that the issue had been addressed as she felt nothing had been done about it. Interview on 10/17/23 at 8:29 A.M. with Scheduler/ Human Resources (HR) #611 revealed she maintained the employee personnel files and had not received any disciplinary actions and/ or education that staff had received from 10/01/23 to 10/17/23 for not providing timely incontinence care. Interview on 10/17/23 at 9:15 A.M. with Acting DON #600 verified last week RN #608 had come and got her to show her Resident #29's incontinence product and concern that she had not been changed by the previous shift (night shift). She verified her incontinence product was saturated in urine. She verified Resident #29 was cognitively intact and that Resident #29 had stated that she had not been changed on night shift, 10/11/23. She revealed that she did not know off hand which aide was assigned to Resident #29 on 10/11/23 through 10/12/23 night shift. She revealed she had no evidence that the staff involved was educated and/ or received disciplinary action for not changing Resident #29 all shift or had an investigation regarding the incident. Interview on 10/17/23 at 10:03 A.M. with State Tested Nursing Assistant (STNA) #612 revealed she worked on first shift and frequently when she came on duty several of the residents including Resident #29 had not been properly changed by the previous shift as their incontinence products were saturated in urine and/ or bowel movement, required complete bed changes and/ or had dried brown urine rings on their sheets. She revealed she had reported the issue to the nurses and Acting DON #600 several times regarding the residents' lack of timely incontinence care. Review of facility policy labeled, Perineal Care dated November 2019 revealed it was the facility's responsibility to provide cleanliness and comfort to the resident, prevent infections, and skin irritation. The policy revealed if resident refused the staff was to notify the supervisor if the resident refused perineal care. The policy did not reveal anything about how often incontinence care should be provided. This deficiency represents non-compliance investigated under Master Complaint Number OH00147275 and COMPLAINT NUMBER OH00146748. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366011 If continuation sheet Page 5 of 5