Health inspection·December 19, 2023

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few reported by her daughter (FM #370). FM #370 reported mom (Resident #43) felt unsafe. After a nurse interview with second party present, Resident #43 stated she felt unsafe because of how staff repositioned and turned her during care. Resident #43 was educated by the nurse that she had to be turned and repositioned when her care was provided and Resident #43 was unable to assist. FM #370 stated Resident #43 had a cervical fracture and the nurse educated Resident #43 that this might contribute to why Resident #43 feels this when staff were providing care. The LNHA would continue to monitor as needed. Review of Resident #43's progress notes dated 08/14/23 at 3:01 A.M. included Resident #43 was interviewed, and FM #370 was present in the room during the interview. Resident #43 stated she felt unsafe when staff were providing personal care because she felt she's being pushed and pulled on when being changed. FM #370 stated Resident #43 had a cervical injury and LPN #328 said she was not aware of that and would look into it. The notes stated LPN #328 made the Administrator aware of the conversation. Review of Resident #43's progress notes dated 08/14/23 at 1:33 P.M. revealed this nurse (DON) and the LNHA met with Resident #43 and FM #370 due to concerns related to weekend staff. Resident #43 stated staff hurt her when they turned and repositioned her. Resident #43 stated she was in pain all the time and aide was pushing and pulling on her. Resident #43 described pain as shooting pain in her legs and she had it all the time related to neuropathy. FM #370 stated Resident #43 had pain all the time because of neuropathy and a cervical injury she obtained prior to admission to the facility. The Administrator confirmed Resident #43's pain was chronic and increased by moving and repositioning. All present in the room agreed Resident #43 would be a two person change and reposition to minimize discomfort. FM #370 requested STNA #374 not be assigned to Resident #43's care and was told the facility would do everything they could to honor the request, but it could increase call light response time, and it could take longer for care because two staff were needed. FM #370 and Resident #43 were informed STNA #374 was a regular on the nursing unit Resident #43 resided on, and they expressed understanding. Resident #43 and FM #370 were advised to make the DON and LNHA aware if they had other concerns. Review of Resident #43's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #43 was cognitively intact. Resident #43 had upper extremity impairment and lower extremity impairment on both sides. Resident #43 was always incontinent of urine and bowel. Resident #43 used oxygen. Review of Resident #43's care plan revised 10/31/23 included Resident #43 required assistance with majority of activities of daily living (ADL) due to respiratory failure, congestive heart failure (CHF), and dementia. Resident #43 was incontinent of bowel and bladder and was able to make toileting needs known the majority of the time. Resident #43 will experience no significant decline in ADL performance through the next review date. Resident #43 would present with no further decline in bowel and bladder continence through the next review date. Interventions included checking and changing every two hours for incontinence; Resident #43 required enhanced barrier isolation for CRE (carbapenem-resistant enterobacterales); Resident #43 was a two person assist for all personal care. Interview on 12/13/23 at 7:09 A.M. of FM #370 revealed LPN #328 and STNA #374 screamed at Resident #43 when they provided care for her. FM #370 stated Resident #43 was afraid of black people because she was screamed at. FM #370 stated STNA #374 pushed her mom really hard while turning her when providing care, and when Resident #43 cried out, STNA #374 stated Resident #43 was so large and she was so tiny it was hard for STNA #374 to turn Resident #43 by herself. FM #370 stated STNA #374 would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 2 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0607 Level of Harm - Minimal harm or potential for actual harm not get help to assist with turning Resident #43 so she could change her incontinence brief. FM #370 indicated on 08/12/23 and 08/13/23 Resident #43 called her and was terrified because LPN #328 and STNA #374 were assigned to care for her. FM #370 stated she contacted the DON by phone, she did not answer so she went to the facility to be with Resident #43. FM #370 indicated when she walked into the building LPN #328 screamed at her. Residents Affected - Few Interview on 12/14/23 at 2:23 P.M. of the Administrator revealed FM #370 never told her LPN #328 was verbally abusive to Resident #43. The Administrator stated on 08/2023 there was a meeting with Resident #43, FM #370, and Resident #43's hospice nurse and there was no mention in the meeting by Resident #43 or FM #370 that LPN #328 was verbally abusive to Resident #43. The Administrator stated there was an incident when STNA #374 required assistance to turn Resident #43 so she could change her incontinence brief and LPN #328 told Resident #43 she was a plus sized woman and the staff had to use proper body mechanics to turn her properly. The Administrator indicated she did not think Resident #43 liked LPN #328 saying she was a plus sized woman. The Administrator stated LPN #328 was a heavier woman and referred to herself as a plus sized woman. The Administrator stated Resident #43 could assist with turning when she was first admitted but told LPN #328, she could no longer assist. The Administrator stated she did not think she had to report this incident to the State Agency because it was mostly about turning Resident #43 for care, and Resident #43 did not say she felt afraid or unsafe. Interview on 12/19/23 at 9:31 A.M. of LPN #328 and the Administrator revealed when the incident happened, Resident #43 was talking to someone on her phone when STNA #374 entered her room to change her incontinence brief. LPN #328 stated when STNA #374 tried to turn Resident #43 to change her incontinence brief, Resident #43 pushed back against STNA #374, and STNA #374 told Resident #43 she had to assist with the turning and if she was not able to assist then STNA #374 would need to find someone to help her. LPN #328 stated when this happened, she was standing outside Resident #43's room preparing her medications for administration, and she did not hear Resident #43 say she was afraid or felt unsafe. LPN #328 stated after this happened, FM #370 came to the facility around 2:00 A.M. and told her Resident #43 felt unsafe. LPN #328 stated she called the Administrator when FM #370 told her Resident #43 felt unsafe. LPN #328 stated the Administrator asked her to interview Resident #43 to find out why she felt unsafe, and LPN #328 asked Nurse #375 to go into Resident #43's room with her. LPN #328 stated Nurse #375 talked to Resident #43, and Resident #43 did not say she felt unsafe, but FM #370 stated Resident #43 felt unsafe. LPN #328 indicated FM #370 did not want to leave the room while Resident #43 was interviewed. LPN #328 indicated Resident #43 did not say she felt unsafe, only that she was being pulled by STNA #374. LPN #328 stated she told Resident #43 and FM #370 it was not really abuse because they needed to turn Resident #43 to change her incontinence brief. LPN #328 stated up to this point Resident #43 assisted with turning when she needed changed, and after this incident happened Resident #43 became a two staff assist with ADL. LPN #328 stated at no time was Resident #43 screamed at by the staff. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation, and Misappropriation of Resident Property dated 12/2017 included facility staff should immediately report all allegations involving abuse, neglect, misappropriation of resident property, exploitation, or mistreatment, including injuries of unknown source to the Administrator and to the State Agency in accordance with the procedures in the policy. If a staff member was accused or suspected of abuse, neglect, exploitation, mistreatment, or misappropriation of resident property the facility should immediately remove that staff member from the facility and the scheduled pending the outcome of the investigation. If the event that caused the allegation involved an allegation of abuse or bodily injury, it should be reported to the State Agency immediately but not later than two hours after the allegation was made. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 3 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0607 This deficiency represents noncompliance investigated under Complaint Number OH00148618 and Complaint Number OH00148607. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 4 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and review of the facility policy the facility failed to ensure Resident #43's allegation of staff-to-resident abuse was reported to the State Agency timely. This affected one resident (#43) out of three residents reviewed for abuse. The facility census was 44. Findings include: Review of Resident #43's medical record revealed an admission date of 07/24/23 with diagnoses including chronic respiratory failure with hypoxia, heart failure, dementia, right and left lumbago with sciatica, and dependence on supplemental oxygen. Review of Resident #43's progress notes dated 08/13/23 at 9:09 P.M. included this nurse, Licensed Practical Nurse (LPN) #328, went in Resident #43's room with her aide, STNA #374, to find out why Resident #43 did not want STNA #374 to care for her. Resident #43 stated she did not want STNA #374 because she was [expletive] to her when she took care of her previously. LPN #328 told Resident #43 she was the nurse in the room when STNA #374 expressed that she needed Resident #43 to assist with turning because she was falling backwards and STNA #374 stated she would find someone to assist her to change Resident #43's incontinence brief. LPN #328 stated she assisted STNA #374 to change Resident #43's incontinence brief. LPN #328 told Resident #43 it was her right to refuse to have STNA #374 care for her, but it was not a legitimate reason for Resident #43 to refuse to have STNA #374 care for her because STNA #374 was allowed to ask Resident #43 to assist her and STNA's job was to assist as much as possible. LPN #328 told Resident #43 it was her right to refuse to have STNA #374 care for her, but she might have to wait a little longer for another aide or nurse to help her when she required assistance. STNA #374 apologized to Resident #43 if she made her feel any type of way she was trying to use proper body mechanics so she would not hurt herself or Resident #43, and each way Resident #43 complained. Review of Resident #43's progress notes dated 08/13/23 at 10:26 P.M. revealed LPN #328 informed the Director of Nursing (DON) of the conversation with Resident #43. The notes further stated Family Member (FM) #370 arrived to the facility and stayed in Resident #43's room. FM #370 did not speak to facility staff or LPN #328 about the situation. Review of a text message on 08/14/23 at 2:13 A.M. between FM #370 and the DON revealed FM #370 received a call from Resident #43 stating she was afraid to be in the facility tonight. Review of Resident #43's progress notes dated 08/14/23 at 2:42 A.M. revealed the LNHA (Licensed Nursing Home Administrator) received a call from the nurse regarding the concern with patient care reported by her daughter (FM #370). FM #370 reported mom (Resident #43) felt unsafe. After a nurse interview with second party present, Resident #43 stated she felt unsafe because of how staff repositioned and turned her during care. Resident #43 was educated by the nurse that she had to be turned and repositioned when her care was provided and Resident #43 was unable to assist. FM #370 stated Resident #43 had a cervical fracture and the nurse educated Resident #43 that this might contribute to why Resident #43 feels this when staff were providing care. The LNHA would continue to monitor as needed. Review of Resident #43's progress notes dated 08/14/23 at 3:01 A.M. included Resident #43 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 5 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few interviewed, and FM #370 was present in the room during the interview. Resident #43 stated she felt unsafe when staff were providing personal care because she felt she's being pushed and pulled on when being changed. FM #370 stated Resident #43 had a cervical injury and LPN #328 said she was not aware of that and would look into it. The notes stated LPN #328 made the Administrator aware of the conversation. Review of Resident #43's progress notes dated 08/14/23 at 1:33 P.M. revealed this nurse (DON) and the LNHA met with Resident #43 and FM #370 due to concerns related to weekend staff. Resident #43 stated staff hurt her when they turned and repositioned her. Resident #43 stated she was in pain all the time and aide was pushing and pulling on her. Resident #43 described pain as shooting pain in her legs and she had it all the time related to neuropathy. FM #370 stated Resident #43 had pain all the time because of neuropathy and a cervical injury she obtained prior to admission to the facility. The Administrator confirmed Resident #43's pain was chronic and increased by moving and repositioning. All present in the room agreed Resident #43 would be a two person change and reposition to minimize discomfort. FM #370 requested STNA #374 not be assigned to Resident #43's care and was told the facility would do everything they could to honor the request, but it could increase call light response time, and it could take longer for care because two staff were needed. FM #370 and Resident #43 were informed STNA #374 was a regular on the nursing unit Resident #43 resided on, and they expressed understanding. Resident #43 and FM #370 were advised to make the DON and LNHA aware if they had other concerns. Review of Resident #43's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #43 was cognitively intact. Resident #43 had upper extremity impairment and lower extremity impairment on both sides. Resident #43 was always incontinent of urine and bowel. Resident #43 used oxygen. Review of Resident #43's care plan revised 10/31/23 included Resident #43 required assistance with majority of activities of daily living (ADL) due to respiratory failure, congestive heart failure (CHF), and dementia. Resident #43 was incontinent of bowel and bladder and was able to make toileting needs known the majority of the time. Resident #43 will experience no significant decline in ADL performance through the next review date. Resident #43 would present with no further decline in bowel and bladder continence through the next review date. Interventions included checking and changing every two hours for incontinence; Resident #43 required enhanced barrier isolation for CRE (carbapenem-resistant enterobacterales); Resident #43 was a two person assist for all personal care. Interview on 12/13/23 at 7:09 A.M. of FM #370 revealed LPN #328 and STNA #374 screamed at Resident #43 when they provided care for her. FM #370 stated Resident #43 was afraid of black people because she was screamed at. FM #370 stated STNA #374 pushed her mom really hard while turning her when providing care, and when Resident #43 cried out, STNA #374 stated Resident #43 was so large and she was so tiny it was hard for STNA #374 to turn Resident #43 by herself. FM #370 stated STNA #374 would not get help to assist with turning Resident #43 so she could change her incontinence brief. FM #370 indicated on 08/12/23 and 08/13/23 Resident #43 called her and was terrified because LPN #328 and STNA #374 were assigned to care for her. FM #370 stated she contacted the DON by phone, she did not answer so she went to the facility to be with Resident #43. FM #370 indicated when she walked into the building LPN #328 screamed at her. Interview on 12/14/23 at 2:23 P.M. of the Administrator revealed FM #370 never told her LPN #328 was verbally abusive to Resident #43. The Administrator stated on 08/2023 there was a meeting with Resident #43, FM #370, and Resident #43's hospice nurse and there was no mention in the meeting by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 6 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #43 or FM #370 that LPN #328 was verbally abusive to Resident #43. The Administrator stated there was an incident when STNA #374 required assistance to turn Resident #43 so she could change her incontinence brief and LPN #328 told Resident #43 she was a plus sized woman and the staff had to use proper body mechanics to turn her properly. The Administrator indicated she did not think Resident #43 liked LPN #328 saying she was a plus sized woman. The Administrator stated LPN #328 was a heavier woman and referred to herself as a plus sized woman. The Administrator stated Resident #43 could assist with turning when she was first admitted but told LPN #328, she could no longer assist. The Administrator stated she did not think she had to report this incident to the State Agency because it was mostly about turning Resident #43 for care, and Resident #43 did not say she felt afraid or unsafe. Interview on 12/19/23 at 9:31 A.M. of LPN #328 and the Administrator revealed when the incident happened, Resident #43 was talking to someone on her phone when STNA #374 entered her room to change her incontinence brief. LPN #328 stated when STNA #374 tried to turn Resident #43 to change her incontinence brief, Resident #43 pushed back against STNA #374, and STNA #374 told Resident #43 she had to assist with the turning and if she was not able to assist then STNA #374 would need to find someone to help her. LPN #328 stated when this happened, she was standing outside Resident #43's room preparing her medications for administration, and she did not hear Resident #43 say she was afraid or felt unsafe. LPN #328 stated after this happened, FM #370 came to the facility around 2:00 A.M. and told her Resident #43 felt unsafe. LPN #328 stated she called the Administrator when FM #370 told her Resident #43 felt unsafe. LPN #328 stated the Administrator asked her to interview Resident #43 to find out why she felt unsafe, and LPN #328 asked Nurse #375 to go into Resident #43's room with her. LPN #328 stated Nurse #375 talked to Resident #43, and Resident #43 did not say she felt unsafe, but FM #370 stated Resident #43 felt unsafe. LPN #328 indicated FM #370 did not want to leave the room while Resident #43 was interviewed. LPN #328 indicated Resident #43 did not say she felt unsafe, only that she was being pulled by STNA #374. LPN #328 stated she told Resident #43 and FM #370 it was not really abuse because they needed to turn Resident #43 to change her incontinence brief. LPN #328 stated up to this point Resident #43 assisted with turning when she needed changed, and after this incident happened Resident #43 became a two staff assist with ADL. LPN #328 stated at no time was Resident #43 screamed at by the staff. Review of the facility policy titled Abuse, Mistreatment, Neglect, Exploitation and Misappropriation of Resident Property dated 12/2017 included facility staff should immediately report all allegations involving abuse, neglect, misappropriation of resident property, exploitation, or mistreatment, including injuries of unknown source to the Administrator and to the State Agency in accordance with the procedures in the policy. If a staff member was accused or suspected of abuse, neglect, exploitation, mistreatment, or misappropriation of resident property the facility should immediately remove that staff member from the facility and the scheduled pending the outcome of the investigation. If the event that caused the allegation involved an allegation of abuse or bodily injury, it should be reported to the State Agency immediately but not later than two hours after the allegation was made. This deficiency represents noncompliance investigated under Complaint Number OH00148618 and Complaint Number OH00148607. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 7 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 interview, record review, and review of the facility policy the facility failed to ensure Resident #43's weights were checked daily according to the physician's orders. This affected one resident (#43) out of three residents reviewed for weights. The facility census was 44. Residents Affected - Few Findings include: Review of Resident #43's medical record revealed an admission date of 07/24/23 with diagnoses including chronic respiratory failure with hypoxia, heart failure, dementia, right and left lumbago with sciatica, and dependence on supplemental oxygen. Review of Resident #43's physician's orders dated 07/25/23 revealed daily weight, one time a day for CHF (congestive heart failure). Review of Resident #43's weights dated 10/01/23 through 12/19/23 revealed there were eight daily weights (10/01/23, 10/21/23, 11/20/23, 11/23/23, 11/24/23, 11/30/23, 12/03/23 and 12/09/23) which were not documented as obtained according to the physician's orders. Review of Resident #43's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #43 was cognitively intact. Resident #43 had upper extremity impairment and lower extremity impairment on both sides. Resident #43 was always incontinent of urine and bowel. Resident #43 used oxygen. Review of Resident #43's care plan dated 08/02/23 revealed Resident #43 had edema in the bilateral lower extremities and left upper arm and was at risk for weight fluctuations with edema resolution. The goal included Resident #43 would have reduced edema and prevent recurrence through the next review date. Interventions included monitoring her weight per physician orders. Interview on 12/13/23 at 7:09 A.M. of Family Member (FM) #370 revealed Resident #43 did not get her weight checked daily as ordered by the physician. FM #370 stated it was important for Resident #43's weight to be checked because she had CHF. Interview on 12/19/23 at 3:46 P.M. of Interim Director of Nursing/Vice President of Operations (IDON/VPO) #371 confirmed Resident #43 did not have daily weights documented on 10/01/23, 10/21/23, 11/20/23, 11/23/23, 11/24/23, 11/30/23, 12/03/23, and 12/09/23. Review of the facility policy titled Resident Weights dated 11/11/19 included physician's orders for daily weights would be monitored by the IDT (interdisciplinary team) and daily weights should be recorded on the MAR (Medication Administration Record) by the licensed Registered Nurse or Licensed Practical Nurse. Daily weights should also be communicated to the IDT for proper evaluation and follow-up. This deficiency represents noncompliance investigated under Complaint Number OH00148618. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 8 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and review of the facility policy the facility failed to ensure Resident #43's physical therapy discharge recommendations were implemented. This affected one resident (#43) out of three residents reviewed for therapy recommendations. The facility census was 44. Findings include: Review of Resident #43's medical record revealed an admission date of 07/24/23 with diagnoses including chronic respiratory failure with hypoxia, heart failure, dementia, right and left lumbago with sciatica, and dependence on supplemental oxygen. Review of Resident #43's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #43 was cognitively intact. Resident #43 had upper extremity impairment and lower extremity impairment on both sides. Resident #43 was always incontinent of urine and bowel. Resident #43 used oxygen. Review of Resident #43's progress notes dated 10/25/23 at 11:14 A.M. included the goal was not met for Resident #43's restorative programs due to Resident #43 was dependent on staff for completion of active ROM (range of motion). Resident #43's restorative programs were discontinued, and therapy was notified of the decline. Resident #43 would be evaluated by therapy. Resident #43 declined to be placed on a toileting schedule. Review of Resident #43's care plan revised 10/31/23 included Resident #43 required assistance with majority of ADL (activities of daily living) due to respiratory failure, CHF (congestive heart failure), and dementia. Resident #43 was incontinent of bowel, bladder, and was able to make toileting needs known the majority of the time. The goal indicated Resident #43 would experience no significant decline in ADL performance through the next review date. Resident #43 would present with no further decline in bowel and bladder continence through the next review date. Interventions included to arrange skilled occupational therapy and physical therapy as indicated and as ordered by the physician; restorative nursing screen quarterly and programs as indicated; Resident #43 was a two person assist for all personal care. Review of Resident #43's physical therapy Discharge summary dated [DATE] through 12/04/23 included 24-hour care, non-ambulatory, Hoyer (mechanical) lift for transfers, caregivers perform ROM with Resident #43 during ADL as tolerated. Interview on 12/13/23 at 7:09 A.M. of Family Member (FM) #370 revealed Resident #43's was discharged from therapy and was supposed to be put on a restorative program, but it was never completed. Interview on 12/19/23 at 10:08 A.M. of Corporate Infection Preventionist (CPI) #373 and Registered Nurse/Unit Manager (RN/UM) #313 revealed when Resident #43 was admitted she had physical therapy services, was discharged from therapy, and on 09/22/23 was started on a restorative program. RN/UM #313 stated toward the end of 10/2023, Resident #43 was evaluated and had a decline in all areas in her level of function. RN/UM #313 stated when he evaluated her, she stated she was not able to do her exercises by herself and was not able to maintain her level of function, so he referred her back to physical therapy. RN/UM #313 stated Resident #43 received therapy services until 12/04/23. RN/UM #313 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 9 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0688 Level of Harm - Minimal harm or potential for actual harm indicated Resident #43 was not started on a restorative program on 12/04/23 because he did not receive a restorative form from Director of Rehab (DOR) #376, and he did not know why. CPI #373 stated DOR #376 was not available for interview. CPI #373 indicated Physical Therapist #377 gave DOR #376 her recommendations, and DOR #376 did not follow through and give the recommendations to RN/UM #313. CPI #373 confirmed Resident #43 did not receive restorative services from 12/04/23 through 12/19/23. Residents Affected - Few Review of the facility policy titled Restorative Programs Policy reviewed 10/10/18 included the intent of the facility was to promote optimal wellness and prevent a decline in functional status for all residents. All residents would be screened and referred to restorative for appropriate treatment. The Unit Manager would monitor all of the programs as programs were initiated and changed. This deficiency represents noncompliance investigated under Complaint Number OH00148618. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 10 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and review of the facility policy the facility failed to ensure Resident #43's incontinence care was completed timely. This affected one resident (#43) out of three residents reviewed for incontinence. The facility census was 44. Findings include: Review of Resident #43's medical record revealed an admission date of 07/24/23 with diagnoses including chronic respiratory failure with hypoxia, heart failure, dementia, right and left lumbago with sciatica, and dependence on supplemental oxygen. Review of Resident #43's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #43 was cognitively intact. Resident #43 had upper extremity impairment and lower extremity impairment on both sides. Resident #43 was always incontinent of urine and bowel. Resident #43 used oxygen. Review of Resident #43's care plan revised 10/31/23 included Resident #43 required assistance with majority of ADL (activity of daily living) due to respiratory failure, CHF (congestive heart failure), and dementia. Resident #43 was incontinent of bowel, bladder, and was able to make toileting needs known the majority of the time. Resident #43 would experience no significant decline in ADL performance through the next review date. Resident #43 would present with no further decline in bowel and bladder continence through the next review date. Interventions included checking and changing every two hours for incontinence; Resident #43 required enhanced barrier isolation for CRE (carbapenem-resistant enterobacterales); Resident #43 was a two person assist for all personal care. Observation on 12/18/23 at 7:39 A.M. of Resident #43's room revealed a Centers for Disease Control and Prevention (CDC) sign on Resident #43's door for enhanced barrier precautions and to wear a gown and gloves for the following high-contact resident care activities including changing briefs and assisting with toileting, dressing, bathing, showering, and providing hygiene. Review of Resident #43's Point of Care (POC) documentation completed by the State Tested Nurse Aides (STNAs) revealed Resident #43 was incontinent of urine and her incontinence brief was changed on 12/18/23 at 6:59 P.M. and on 12/19/23 at 5:30 A.M. There was no further documented evidence from 6:59 P.M. through 5:30 A.M. Resident #43 had her incontinence brief changed. Review of Resident #43's progress notes dated 12/18/23 through 12/19/23 did not reveal documented evidence Resident #43 was checked for incontinence or she refused to have her incontinence brief changed. Interview on 12/18/23 at 8:35 A.M. of Family Member (FM) #370 revealed she watched Resident #43's camera footage during the night shift and Resident #43 did not have her incontinence brief changed from 12/18/23 around 7:00 P.M. until 12/19/23 around 6:00 A.M. FM #370 stated twelve hours passed and Resident #43 was not changed. FM #370 stated Resident #43 told STNA #338 she needed changed, but STNA #338 did not change her incontinence brief or apply cream to her perineal area. Observation on 12/19/23 at 1:50 P.M. of Resident #43's camera footage revealed on 12/19/23 at 6:05 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 11 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A.M. Registered Nurse (RN) #300 entered Resident #43's room, was not wearing an isolation gown, and asked Resident #43 if she was weighed and had her incontinence brief changed. Resident #43 stated she was weighed but her incontinence brief needed changed. RN #300 left the room and returned at 6:07 A.M. with STNA #338. STNA #338 and RN #300 did not don an isolation gown before entering Resident #43's room and proceeded to provide Resident #43's incontinence care. After Resident #43's incontinence care was complete RN #300 and STNA #338 left the room. Interview on 12/19/23 at 1:50 P.M. of Resident #43 revealed her incontinence brief was not changed all night long. Interview on 12/19/23 at 2:43 P.M. of RN #300 revealed on 12/18/23 she was assigned to the nursing unit Resident #43 resided on and worked through the night until the morning of 12/19/23. RN #300 stated she entered Resident #43's room on 12/19/23 around 6:00 A.M. for her 6:00 A.M. BiPAP (bilevel positive airway pressure) check and asked Resident #43 if she had her weight checked and her incontinence brief changed. RN #300 stated Resident #43 told her she was weighed but she did not get her incontinence brief changed and she was wet. RN #300 stated she found STNA #338 right away and together they changed Resident #43's incontinence brief. RN #300 stated she did not know why STNA #338 did not change her when she weighed her. RN #300 indicated Resident #43 was alert and oriented and could notify staff when she needed changed. RN #300 stated Resident #43's incontinence brief was wet, but there was no evidence she was sitting in it for a while, her linens were dry and did not need changed, the color of the urine in the brief did not indicate it was there a significant amount of time. RN #300 stated she did not see STNA #338 change Resident #43 during her shift, but she did see her go in and out of the room multiple times. RN #300 stated she was in Resident #43's room several times during her shift, and Resident #43 did not tell her she needed changed. RN #300 stated she made sure Resident #43's call pendant was always within her reach. Review of the facility policy titled Urinary Incontinence-Clinical Protocol revised 09/2012 included for incontinent individuals, the nursing staff would identify, and document circumstances related to incontinence; for example frequency, nocturia, dysuria, or relationship to coughing or sneezing. This deficiency represents noncompliance investigated under Complaint Number OH00148618. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 12 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0880 Provide and implement an infection prevention and control program. 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, review of facility policy, and review of Centers for Disease Control and Prevention (CDC) guidance the facility failed to maintain and implement an effective infection prevention and control Residents Affected - Some program to prevent the transmission of CRE (carbapenem-resistant enterobacterales), including proper personal protective equipment (PPE) was worn by staff when entering Resident #43's room who was on enhanced barrier isolation for CRE and failed to ensure staff discarded and changed soiled gloves appropriately after providing Resident #43's incontinence care. This had the potential to affect 19 residents (#2, #4, #5, #8, #11, #13, #14, #17, #21, #23, #24, #27, #30, #31, #32, #35, #36, #40, #41) residing on the nursing unit. The facility census was 44. Findings include: Review of Resident #43's medical record revealed an admission date of 07/24/23 with diagnoses including chronic respiratory failure with hypoxia, heart failure, dementia, right and left lumbago with sciatica, and dependence on supplemental oxygen. Review of an email titled CP-CRE (carbapenems-producing carbapenem-resistant enterobacterales, when enterobacterales develop resistance to the group of antibiotics called carbapenems the germs are called CRE) screening and enhanced barrier precautions from the local health department to Registered Nurse/Infection Preventionist (RN/IP) #302 dated 09/19/23 revealed Resident #43 had the OXA-48 gene detected (represents the main enzymatic resistance mechanism, carbapenems gene). Review of Resident #43's physician orders dated 10/05/23 revealed enhanced barrier isolation for CRE, every day and night shift for isolation required per local health department, use gown and gloves for all hands-on care, private room or cohort with like organism. Review of Resident #43's Quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #43 was cognitively intact. Resident #43 had upper extremity impairment and lower extremity impairment on both sides. Resident #43 was always incontinent of urine and bowel. Resident #43 used oxygen. Review of Resident #43's care plan revised 10/31/23 included Resident #43 required assistance with majority of ADL (activities of daily living) due to respiratory failure, CHF (congestive heart failure), and dementia. Resident #43 was incontinent of bowel, bladder, and was able to make toileting needs known the majority of the time. Resident #43 would experience no significant decline in ADL performance through the next review date. Resident #43 would present with no further decline in bowel and bladder continence through the next review date. Interventions included checking and changing every two hours for incontinence; Resident #43 required enhanced barrier isolation for CRE; Resident #43 was a two person assist for all personal care. Observation on 12/18/23 at 7:39 A.M. of Resident #43's room revealed a CDC sign on Resident #43's door for enhanced barrier precautions, and instructions were to clean hands before entering and when leaving the room, and to wear a gown and gloves for the following high-contact resident care activities including changing briefs and assisting with toileting, dressing, bathing, showering and providing hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 13 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation on 12/18/23 at 7:39 A.M. of State Tested Nursing Assistants (STNAs) #337 and #342 revealed they donned gloves, surgical masks, and isolation gowns, entered Resident #43's room and provided incontinence care for Resident #43. During incontinence care, STNA #337 stated Resident #43 had a little bit of redness in the crease of her thighs and he would put barrier cream in those areas. Without removing his soiled gloves, STNA #337 picked up an empty tube of barrier cream from the top of Resident #43's bedside table, noticed it was empty and using his soiled gloves opened the drawer of Resident #43's bedside table and searched the drawer looking for another tube of barrier cream which he did not find. STNA #337 closed the drawer and said he would have the nurse get more barrier cream when he was finished. STNA #337 did not remove his soiled gloves and fluffed Resident #43's pillow, picked up her PRAFO (pressure relief ankle foot orthosis) boots and put them on her feet, picked up her blankets from her chair, and covered her with the blankets. STNA #337 confirmed he did not remove his soiled gloves before touching Resident #43's drawer, pillow, PRAFO boots, and blankets. Interview on 12/18/23 at 8:30 A.M. of Corporate Infection Preventionist (CPI) #373 revealed STNA #337 told her he did not remove his soiled gloves prior to touching Resident #43's drawer, pillow, PRAFO boots, and blankets. Interview on 12/18/23 at 8:35 A.M. of Family Member (FM) #370 revealed she watched Resident #43's night shift camera footage from 12/18/23 through the morning of 12/19/23 and when Resident #43 incontinence care was completed on 12/19/23 around 6:00 A.M. Registered Nurse (RN) #300 and STNA #338 did not wear isolation gowns. FM #370 stated Resident #43 was on precautions, and staff was supposed to wear a gown when they provided care for her. Observation on 12/19/23 at 1:50 P.M. of Resident #43's camera footage revealed on 12/19/23 at 6:05 A.M. RN #300 entered Resident #43's room, was not wearing an isolation gown and asked Resident #43 if she was weighed and had her incontinence brief changed. Resident #43 stated she was weighed, but her incontinence brief needed changed. RN #300 left the room and returned at 6:07 A.M. with STNA #338. STNA #338 and RN #300 did not don an isolation gown before entering Resident #43's room and proceeded to provide Resident #43's incontinence care. During Resident #43's incontinence care both RN #300 and STNA #338's clothes touched Resident #43's gown and the bed linens. After Resident #43's incontinence care was complete, RN #300 and STNA #338 left the room. Interview on 12/19/23 at 2:43 P.M. of RN #300 revealed on 12/18/23 she was assigned to the nursing unit Resident #43 resided on and worked through the night until the morning of 12/19/23. RN #300 stated she entered Resident #43's room around 6:00 A.M. for her 6:00 A.M. BiPAP (bilevel positive airway pressure) check and asked Resident #43 if she had her weight checked and her incontinence brief changed. RN #300 stated Resident #43 told her she was weighed but she did not get her incontinence brief changed, and she was wet. RN #300 stated she found STNA #338 right away, and Resident #43's incontinence brief was changed. RN #300 confirmed Resident #43 was on enhanced barrier precautions and she did not don an isolation gown, and STNA #338 did not don an isolation gown before entering Resident #43's room and providing incontinence care. Interview on 12/19/23 at 3:46 P.M. of Interim Director of Nursing/Vice President of Operations (IDON/VPO) #371 revealed she was aware RN #300 and STNA #338 did not don isolation gowns when they provided Resident #43's incontinence care on 12/19/23 at 6:07 A.M. Review of the facility policy titled Isolation-Categories of Transmission-Based Precautions updated 10/17/23 included in addition to Standard Precautions, implement Enhanced Barrier Precautions for residents known or have been infected with MDRO's (multidrug resistant organisms) that may be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 14 of 15 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 366385 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Canterbury of Twinsburg 9928 Vail Drive Twinsburg, OH 44087 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indirectly transferred from resident-to-resident during high contact care activities. Examples of MDRO that might require Enhanced Barrier Precautions included CRE, and residents with CRE would automatically be placed on Enhanced Barrier Precautions. Use gloves, gown and handwashing during high-contact resident care activities that provide opportunities for transfer of MDRO's to staff hands and clothing. MDRO's might be indirectly transferred from resident-to-resident during these high-contact care activities. Examples of high-contact resident care activities requiring gown and glove use for Enhanced Barrier Precautions included dressing, bathing, showering, providing hygiene, changing linens, changing briefs, or assisting with toileting. This deficiency represents noncompliance investigated under Complaint Number OH00148618. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366385 If continuation sheet Page 15 of 15