Health inspection·October 21, 2025

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and review of the facility policy, the facility failed to ensure admission paperwork was signed as required. This affected one resident (#74) of three residents reviewed for admission. The facility census was 168. Findings include:Review of the medical record revealed Resident #74 was admitted to the facility on [DATE] with diagnoses including transient cerebral ischemic attack, heart failure, atrial fibrillation, hypertension, obstructive sleep apnea, peripheral autonomic neuropathy, anxiety disorder, abnormalities of gait and mobility, dysphagia, insomnia, muscle weakness, essential tremor, foot drop. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment revealed Resident #74 had a Brief Interview of Mental Status (BIMS) score of 15 out of 15, indicating intact cognition. Interview on 10/16/25 at 11:00 A.M. with Resident #74's responsible party revealed she was concerned because the facility had called her stating they did not have Resident #74's admission paperwork, and she was told she needed to fill out the admission paperwork again. Review of the admission packet provided by the Administrator on 10/20/25 for new admission residents, revealed the admission Agreement, assignment of benefits, authorization of representative, resident personal funds, suite hold and leave of absence, authorization for professional services, special financial Power of Attorney (POA), release of information to the facility and from the facility, information consent form, photo consent form, mail authorization form, contact information form, and organizational practices. The Administrator was unable to produce a signed copy of Resident #74's admission Agreement. On 10/20/25 at 9:37 A.M. an interview with the Administrator verified Resident #74's admission paperwork was not signed and should be completed at the time of admission. The Administrator stated when the facility performed audits of admission Agreements, they discovered Resident #74 did not have a signed admission Agreement. The facility had reached out to Resident #74's responsible party inquiring if she had a copy of the admission Agreement. The Administrator stated Resident #74's admission Agreement was not lost; it was not done. Interview on 10/20/25 at 4:04 P.M. with Resident #74's responsible party revealed the facility had contacted her to sign the facility admission Agreement because the facility admissions coordinator did not generate the document for her. Review of the facility's policy titled Admissions, dated 03/24/16, revealed and admission team met periodically as needed. Completed applications were reviewed to determine if the facility could properly serve the applicant. An application was deemed completed and ready for review by the admission team when it contained the completed admission application including completed financial disclosure, a completed pre-admission physical or medical transfer and copies of applicant's social security card, Medicare card and copies of all secondary medical insurance. This deficiency represents non-compliance investigated under Complaint Number 2642861. Event ID: Facility ID: 366045 If continuation sheet Page 2 of 6 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 366045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jennings Hall 10204 Granger Road Garfield Heights, OH 44125 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and facility policy review, the facility failed to ensure staff provided Resident #74 with the appropriate level of assistance to ensure a safe transfer and bed mobility. This affected one resident (#74) of three residents reviewed or transfers and bed mobility and had the potential to affect 60 residents (#15, #109, #95, #66, #82, #157, #78, #165, #162, #153, #87, #154, #124, #123, #143, #53, #42, #116, #27, #29, #49, #69, #125, #32, #93, #47, #25, #110, #104, #155, #89, #108, #99, #40, #112, #51, #14, #16, #57, #37, #71, #128, #76, #34, #120, #161, #156, #13, #60, #94, #115, #113, #126, #160, #15, #115, #113, #126, #160, and #24) identified by the facility as dependent on staff for transfers from bed to chair and 20 residents (#66, #82, #122, #153, #157, #165, #51, #104, #156, #15, #63, #113, #115, #126, #160, #32, #125, #150, #27, and #80) residents identified by the facility as dependent on staff to roll left and right in bed. The facility census was 168. Findings include:Review of the medical record revealed Resident #74 was admitted to the facility on [DATE] with diagnoses including transient cerebral ischemic attack, heart failure, atrial fibrillation, hypertension, peripheral autonomic neuropathy, anxiety disorder, abnormalities of gait and mobility, dysphagia, insomnia, muscle weakness, tremor, and foot drop. Review of the care plan initiated on 05/15/25 revealed Resident #74 was at risk for falls related to deconditioning, gait and balance problems and tremors. Goals included Resident #74 would be free from falls, Resident #74 would be free from minor injury, and Resident #74 would not sustain serious injury. Interventions included anticipating the needs of Resident #74, Resident #74 needed prompt response to all requests for assistance, encouraging Resident #74 to participate in activities that promote exercise for physical strengthening and improved mobility, and physical therapy (PT) to evaluate and treat as ordered and as needed. Review of the health status note dated 06/07/25 at 10:50 A.M. written by Registered Nurse (RN) #308 revealed Resident #74 stated her arm was extended too far in the Hoyer (mechanical) lift last night. The care partner stated Resident #74's arm was not extended, and Resident #74 complained of pain to that left arm. RN #308 assessed Resident #74's skin, and if the pain did not get better, RN #308 would call the doctor. Review of the health status note dated 06/08/25 at 8:38 A.M. written by RN #308 revealed Resident #74 stated her shoulder hurt. RN #308 reported the pain to the nurse practitioner (NP). Review of the PT discharge summary electronically signed on 06/09/25 at 4:11 P.M., revealed the dates of service were 05/13/25 to 06/09/25. Resident #74's highest practical level was achieved. Resident #74 was baseline dependent on staff to roll from lying back to left and right and PT did not attempt to assist using log rolling techniques due to medical conditions or safety concerns. Resident #74's discharge mobility consisted of dependent on staff for chair to bed or chair transfers. PT recommendation consisted of mechanical sling lift bed to wheelchair transfers. Review of the physician visit note dated 06/12/25 written by NP #583 revealed Resident #74 was seen as a follow up for left shoulder pain. Pain was present in the left humerus. Resident #74 stated she was in pain since they Hoyered her. Pain was present for the last five days. There was no improvement with pain. The incident occurred more than two days ago, and the left shoulder was affected. The pain severity of five on a zero to ten pain scale, ten being the worst pain. The pain was moderate and had been intermittent since the injury. Resident #74 had no other injuries or history of shoulder surgery. The plan was a left humerus x-ray per order. Review of physician visit note dated 06/13/25 at 1:30 P.M. written by NP #583, revealed an x-ray was completed and unremarkable. The results were reviewed with Resident #74 and her daughter. A lidocaine patch (pain relieving patch) was ordered, and Resident #74 was given Tylenol (analgesic) for pain. Review of the occupational therapy (OT) discharge summary Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366045 If continuation sheet Page 3 of 6 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 366045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jennings Hall 10204 Granger Road Garfield Heights, OH 44125 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few electronically signed on 06/26/25 at 9:22 A.M., revealed the dates of service were 05/12/25 to 06/19/25. Resident #74's goal was met on 06/19/25 to increase ability to tolerate ceiling lift transfers with no complaints of pain or discomfort. Resident #74's baseline was trialed with various slings to increase comfort during transfers. The discharge summary revealed Resident #74 tolerated a full sling during transfers. Review of the health status note dated 08/08/25 at 1:53 P.M. written by RN #308 revealed Resident #74 reported she was smashed on the left side of the face while being turned in bed this morning. The care partner reported her glasses touched Resident #74's face, but Resident #74 now stated it felt like she was hit with a bowling ball in the face. No redness or bruising were noted. Reported to the Director of Nursing (DON) and NP. The NP assessed Resident #74 resulting in no new skin issues. (There was only one staff member in the room at the time of the incident). Review of the physician visit note dated 08/08/25 at 10:27 P.M. written by NP #583 revealed Resident #74 stated her left side of the face collided with the care partners face and glasses during her incontinence care. No injury was noticed. Resident #74 denied pain. Review of the Minimum Data Set (MDS) 3.0 quarterly assessment dated [DATE] revealed Resident #74 had a Brief Interview of Mental Status (BIMS) score of 15 out of 15, indicating intact cognition. Resident #74 was dependent on staff for feeding, toilet hygiene, and bathing, and required maximum assistance to roll left and right in bed, and transfer from bed to chair. Review of the PT evaluation dated 09/17/25 revealed Resident #74 was at baseline status and did not need continued PT. Baseline consisted of not attempting to roll left and right in bed due to medical condition or safety concern. Resident #74 was unable to complete sit to stand and stand to sit transfers with one-person maximum assistance. Resident #74 was dependent on mobility in bed and dependent on staff for chair to bed transfers. Observation on 10/16/25 at 10:30 A.M. revealed Senior Care Partner #362, Care Partner #418 and the DON were present in the room for the transfer of Resident #60's transfer from the recliner to the bed. Two staff members (Senior Care Partner #362 and Care Partner #418) performed the task together. Interview on 10/16/25 at 10:30 A.M. with Senior Care Partner #362 and Care Partner #418 revealed they always performed a ceiling lift on residents with two staff members. Interview on 10/16/25 at 11:20 A.M. with Licensed Practical Nurse (LPN) #491 revealed two staff members were to be in the room to assist with ceiling lifts for resident safety. This would prevent accidents from happening like equipment malfunction. Interview on 10/16/25 at 11:25 P.M. with Senior Care Partner #379 revealed two nurses or aides must be in the room for ceiling lifts to prevent resident falls. Interview on 10/16/25 at 11:51 A.M. with Resident #74's responsible party stated she viewed camera recordings in Resident #74's room, which revealed, on 06/06/25 in the evening an aide transferred Resident #74 from the recliner to the bed. Resident #74's arm appeared to be stretched and repeatedly stretched during the transfer, and the resident cried throughout the incident. Interview on 10/16/25 at 1:53 P.M. with the DON revealed at the previous facility Resident #74 transferred from suggested two care takers in Resident #74's room were needed for all care. The facility made sure two care givers were available for Resident #74 bathing, ceiling lifts and rolling in bed. The facility utilizes two types of slings, the hygiene sling and body sling, for use during the ceiling lift. When Resident #74's shoulder was in pain (note from 06/07/25) the aide used a hygiene lift that was too tight that caused Resident #74 pain. There was only one aide in the room during this lift. Interview on 10/16/25 at 3:15 P.M. with Care Partner #421 revealed two care takers must be present in a resident's room when the ceiling lift was used because this placed a resident at high risk for falls. Interview on 10/16/25 at 3:20 P.M. with Resident #74 revealed one staff member was present to use the ceiling lift and she hurt her shoulder (note dated 06/07/25) because the straps kept hurting her. She stated she just wanted to get out of the lift. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366045 If continuation sheet Page 4 of 6 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 366045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jennings Hall 10204 Granger Road Garfield Heights, OH 44125 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete #74 also stated an aide hit her head with her head (note dated 08/08/25) because the bed went up and down. It was horrible. Interview on 10/20/25 at 11:14 A.M. with Director or Therapy #587 revealed if a resident was dependent on staff for mobility, two staff members were needed to assist for mobility. Resident #74 was dependent on staff for chair-to-bed transfers to ensure resident and staff safety. Observation on 10/20/25 at 4:01 P.M. of Resident #74 revealed she was lying on her back in bed and was not able to turn left or right in bed. Interview on 10/21/25 at 11:30 A.M. with NP #583 revealed Resident #74 required a high level of care, and it would be best for two staff members to care for Resident #74 because Resident #74 was dependent on staff for all mobility and activities of daily living. NP #583 stated Resident #74 was injured in the sling (note dated 06/07/25), and Resident #74 complained of pain. Resident #74 also stated an aide's face collided with her face when an aide turned her (note dated 08/08/25). The previous facility had suggested two staff members for all Resident #74's care. Observation and interview on 10/21/25 at 1:00 P.M. with Administrator Resident#584, the Administrator, Chief Nursing Officer, and the DON viewed a video dated 06/06/25 at 7:05 P.M. that revealed Resident #74 was observed to be sitting in a recliner with one aide in the room that performed the ceiling lift. The aide raised the ceiling lift with straps attached to the sling and ceiling lift and resident positioned in the sling. Resident #74's right hand was over the sling in a bent position. Resident #74's left arm was observed to be extended straight up between the sling strap and the ceiling lift. Resident #74's arm extended up as the ceiling lift rose up toward the ceiling. Resident #74's left arm remained extended until the aide lowered the resident to the bed. Resident #74's face was noted to be in distress during the transfer. After the aide replaced the ceiling lift in the charger, the aide asked Resident #74, Which arm is it? the aide touched Resident #74's left arm and ask if it was this one. Resident #74 stated, yes. Resident #74 was observed to moan in pain when the sling was removed and during the lift. Resident #74 stated it was because of the Hoyer lift. The DON #stated the aide used the hygiene sling during the lift, and it was not the whole-body sling and verified both arms should be bent outside the sling, not extended. Observation and interview on 10/21/25 at 1:15 P.M. with Administrator Resident #584, the Administrator, Chief Nursing Officer and the DON revealed a video dated 08/08/25 at 6:13 A.M. revealed one aide was providing peri-care to Resident #74 alone in Resident #74's room. When the aide rolled Resident #74 to the right-side edge of the bed, the bed dropped down. The aide grabbed Resident #74's body and bumped Resident #74's head. The aide stated I'm sorry three times and asked Resident #74 if she was bleeding. The aide stated, this bed went down , I didn't want you to fall, I tried to catch you because I felt the bed going down. Resident #74 was observed to lay in bed with her hand holding her head. The DON stated two staff members should roll Resident #74 in bed because Resident #74 was dependent on care. Interview on 10/21/25 at 1:23 P.M. with Care Partner #495 revealed on 08/08/25 she was changing Resident #74 when she heard the bed click. Care Provider #495 was concerned that Resident #74 was going to fall, so she grabbed the resident; her glasses hit Resident #74 in the face. Care Provider #495 stated two staff members were needed for ceiling lifts and to turn Resident #74. (There was only one staff member in the room at the time of the incident). Review of the facility policy titled Ceiling Lifts, dated February 2006, revealed the ceiling lift would be used for any resident who displayed the functional need and met the criteria for use. The ceiling lift would be used according to product guidelines, and the appropriate number of staff members would be used. This deficiency represents non-compliance investigated under Complaint Number 2642861. Event ID: Facility ID: 366045 If continuation sheet Page 5 of 6 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 366045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jennings Hall 10204 Granger Road Garfield Heights, OH 44125 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to ensure medications were secured until consumed by residents. This affected one resident (#87) of 25 residents (#28, #42, #52, #53, #56, #64, #75, #84, #87, #114, #116, #117, #122, #124, #127, #132, #139, #142, #146, #153, #154, #162, #165, #166, and #167) residing on the Main Level [NAME] Unit. The facility census was 168. Findings include:Review of the medical record for Resident #87 revealed an admission date of 12/12/24 with diagnoses including type two diabetes mellitus, primary generalized osteoarthritis, and chronic diastolic heart failure. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #87 had intact cognition. Interview on 10/16/25 at 9:11 A.M. noted Resident #87 sitting at a table in the dining room. Interview with the resident revealed no concerns; however, further observations revealed a medication cup sitting on the table filled with 19 medications. No medications were controlled medications. Interview on 10/16/25 at 9:13 A.M., the Director of Nursing (DON) observed the medication cup filled with medications. The DON then stated, this is wrong to have the medications sitting on the table without staff. The facility was unable to provide a policy related to ensuring medications were consumed by residents. This deficiency represents non-compliance investigated under Complaint Number 2642861. Event ID: Facility ID: 366045 If continuation sheet Page 6 of 6