Inspection·June 10, 2024

F 0760 Review of Resident #50's Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition. Level of Harm - Actual harm Residents Affected - Few Review of Resident #50's undated Quality Improvement Tool for Review of Acute Care Transfers form dated 05/17/24 revealed the resident had a change in condition with complaints of increased epigastric pain. The nurse medicated the resident for pain but (the resident) insisted on going to the hospital. The physician was notified. Review of Resident #50's emergency medical service (EMS) squad report dated 05/17/24 revealed at 5:03 A.M. the squad was called to dispatch to the facility, and they arrived at 5:10 A.M. The report revealed Resident #50 had a hard time breathing. Upon squad arrival, the resident was in his room sitting up and could not breathe. The resident stated that the place was trying to kill him. The resident stated the concern had been going on for over an hour. The staff stated the resident had a breathing treatment and it did absolutely nothing for him. The report included the resident's room was 80 degrees, and he was over 600 pounds. The resident was placed on a CPAP machine and transferred to the hospital. Interview on 06/07/24 at 4:37 P.M. with RN #812 revealed Resident #50 was stable when she cared for him on 05/16/24. She stated she did not have medications to give the resident as they were ordered from pharmacy. She stated she removed what she could from the Pyxis starter system but was not able to administer his Torsemide because it was not available. Telephone interview on 06/07/24 at 6:40 P.M. with NP #811 revealed she was aware the resident's medications were on order from the pharmacy, including his Torsemide. Interview on 06/07/24 at 6:45 P.M. with RN #813 revealed she sent Resident #50 to the hospital on [DATE] around 1:00 A.M. to 1:30 A.M. for increased complaints of pain. She stated she had completed Resident #50's leg dressing around 12:00 A.M. and mediated the resident for pain with Oxycodone narcotic pain medication at that time. She stated the resident denied complaints of chest pain or shortness of breath. Telephone interview on 06/10/24 at 8:06 A.M. with Resident #50's insurance representative revealed they received a call from the resident's family member who reported the resident went two days without his prescription medication, being told the facility had not received the medication yet. On 05/18/24 the resident was having difficulty breathing, lost consciousness, and was sent to the emergency department. The resident was treated for having fluid on his lungs and was hospitalized . The insurance representative reached out to Resident #50 who further reported not receiving his prescription medication including Torsemide (following his admission to the nursing facility). Resident #50 indicated he would remain at the hospital until a bed became available at a different skilled rehabilitation facility. Telephone interview on 06/10/24 at 9:33 A.M. with Fire Department #815 revealed they were called to the facility for a male resident with complaints of the resident having a hard time breathing. Staff stated a breathing treatment was implemented. The resident's room was approximately 80 degrees. A CPAP was placed on the resident and the resident's oxygen level was at 100%. The resident was transported to the hospital. Review of the Medication Administration policy dated 11/2021 revealed medications should be administered as prescribed in accordance with good nursing principles and practices and only by persons (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366419 If continuation sheet Page 2 of 3 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 366419 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twinsburg Post Acute 8551 Darrow Road 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 0760 legally authorized to do so. Level of Harm - Actual harm This deficiency represents non-compliance investigated under Master Complaint Number OH00154196 and Complaint Number OH00154137. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366419 If continuation sheet Page 3 of 3