Health inspection·January 12, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, and facility policy review the facility failed to ensure Resident #48's care plan included communication and/or sensory deficits. This affected one resident (#48) of one resident reviewed for care planning. The facility census was 78. Findings include: Review of the medical record revealed Resident #48 was admitted to the facility on [DATE] with diagnoses including dementia, severe, with other behavioral disturbance, type two diabetes mellitus without complications, and sensorineural hearing loss, bilateral. Review of the Minimum Data Set 3.0 (MDS) 3.0 assessment dated [DATE] revealed Resident #48 was alert and oriented with some cognitive impairment. Review of Section B of the MDS assessment revealed Resident #48 had moderate difficulty with hearing with a hearing aid device. Review of the Nursing admission and/or re-admission assessment dated [DATE] revealed Resident #48 had moderate difficulty with hearing and utilized a hearing aid in his right ear. Review of the progress note dated 10/20/22 at 3:45 P.M. revealed Resident #48 was hard of hearing and had one hearing aid. Review of the care plan initiated on 10/25/22 revealed Resident #48 had no communication plan of care initiated related to being hard of hearing. Review of the facility document titled Inventory of Personal Effects, dated 10/20/22, revealed Resident #48 was admitted to the facility with one right ear hearing aid that was not working. Review of the document revealed the hearing aid was over [AGE] years old. Interview on 01/11/23 at 3:48 P.M. with Social Service Director (SSD) #8 revealed she was unaware of Resident #48's hearing aid needs. Interview on 01/12/23 at 10:24 A.M. with the Director of Nursing (DON) revealed resident impairments were to be care planned. Interview on 01/12/23 at 12:40 P.M. with MDS Coordinator #41 revealed she had just initiated Resident #48's communication problem related to being hard of hearing in the care plan and confirmed the findings. Review of the facility document titled Care Plans-Baseline, revised March 2022, revealed the facility had a policy in place that a baseline care plan would be developed to meet the resident immediate health and safety needs. Review of the document revealed the facility did not implement the policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366179 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 366179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solon Pointe at Emerald Ridge 5625 Emerald Ridge Parkway Solon, OH 44139 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 - Many 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. Based on observation, staff interview, and policy review the facility failed to ensure that all drugs and biologicals used in the facility were accurately labeled in accordance with professional standards to facilitate safe medication administration. This had the potential to affect all residents who reside in the facility. The facility census was 78. Findings include: Observation with the Director of Nursing (DON) on 01/10/23 at 12:05 P.M., of the medication storage room located on Rust unit, revealed the refrigerator contained one opened Novolog (insulin) flex pen mixed with other resident insulin pens, and without a resident identifier or date opened. Interview with the DON immediately following the observation, revealed the DON was unable to accurately identify the prescribed resident or date opened. The DON verified the medication was not labeled for safe medication administration per the facility policy. Observation with the DON on 01/10/23 at 12:35 P.M., of the medication storage room located on Maple unit, revealed the refrigerator contained a single one milliliter (ml) syringe that was filled with 0.1 ml of an unknown solution and placed in a plastic bin under resident vials of insulin. The syringe was not labeled with medication name, resident identifier, or date opened. Interview with the DON immediately following the observation, revealed the DON was unable to identify the medication solution or date the medication was drawn. The DON verified the medication was not labeled for safe medication administration per the facility policy. Interview on 01/12/23 at 10:28 A.M., The DON revealed all residents who reside at the facility require medication administration from staff. Review of the facility policy titled Storage of Medications, dated 04/2019, revealed the facility will store all drugs and biologicals in a safe, secure, and orderly manner. Review of the policy procedures revealed discontinued, outdated, or deteriorated drugs or biologicals are to be returned to the dispensing pharmacy or destroyed; Resident medications are stored separately from each other to prevent the possibility of mixing medications between residents; Medications requiring refrigeration are stored in a refrigerator or other secured location and are labeled accordingly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366179 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 366179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solon Pointe at Emerald Ridge 5625 Emerald Ridge Parkway Solon, OH 44139 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, staff interview, and facility policy review the facility failed to ensure the dumpster area was maintained in a clean and sanitary condition. This had the potential to affect all residents. The facility census was 78. Residents Affected - Many Findings include: Observation of the dumpster area on 01/11/23 at 2:15 P.M. revealed one dumpster did not have a door to keep closed. The dumpsters were noted to be open exposing the following: • Multiple used gloves, surgical masks, incontinence briefs and pads • Multiple empty brown cardboard boxes, plastic cups, bottles of cleansing liquid • Multiple food scraps, empty potato chips bags and pop bottles Interview on 01/11/23 at 2:15 P.M. with Dietary [NAME] (DC) #46 confirmed the above findings. Review of the facility document titled Waste Disposal, revised January 2012, revealed the facility had a policy in place that all infectious and regulated waste would be handled and disposed of in a safe and appropriate manner. Review of the document revealed the facility did not implement the policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366179 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 366179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solon Pointe at Emerald Ridge 5625 Emerald Ridge Parkway Solon, OH 44139 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation and staff interview the facility failed to maintain a clean and sanitary environment. This had the potential to affect all 78 residents residing in the facility. Residents Affected - Many Findings include: An environmental tour was conducted with Housekeeping Supervisor (HSK) #99 on 01/10/22 between 2:00 P.M. and 2:36 P.M. The following concerns were identified and verified at the time of discovery: • The tube feed pole used by Resident #20 had significant dried residual tube on the base of the pole. • The 700 and 800 halls had mold in the shower rooms. • The rooms occupied by Residents #25, #45 and #55 had tile flooring that was broken. • The hallway air conditioner/heating unit cover on the 700 hall was off and the air conditioner was dirty. • The room occupied by Resident #31 had a dirty and stained privacy curtain. • The toilet paper roll in Resident #229's room was off the wall, and the toilet paper was touching the bathroom floor. • The air vent on the 700 hall was rusted. • The 800-hall dining room had numerous water-stained ceiling tiles. • The bathroom walls in Resident #35's room were scuffed and had areas of paint peeling of the walls. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366179 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 366179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solon Pointe at Emerald Ridge 5625 Emerald Ridge Parkway Solon, OH 44139 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 0921 • Level of Harm - Minimal harm or potential for actual harm The bathroom door in Resident #65 room was broken. • Residents Affected - Many The 500-hall had stained carpeting. • The bathroom curtain used as a bathroom door in Resident #4 and #283's room was stained and torn. • The walls in Resident #7's room had significant areas of scuff and paint chipping • Multiple light fixtures in the ceiling throughout the facility had dead bugs in them. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366179 If continuation sheet Page 6 of 6