Health inspection·September 26, 2024

F 0684 her to see what Resident #70's blood pressures were prior to administration of hydralazine. Level of Harm - Minimal harm or potential for actual harm Interview on 09/25/24 at 4:30 P.M. with the Director of Nursing confirmed when Resident #70 was administered hydralazine there was no associated blood pressure documented to ensure residents blood pressure was above the parameter set by the nurse practitioner. Residents Affected - Few Review of the facility policy Medication Administration - General Guidelines, dated 11/21, revealed medications are administered in accordance with written orders of the prescriber. This deficiency represents non-compliance investigated under Master Complaint Number OH00157568 and Complaint Number OH00157321. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366419 If continuation sheet Page 2 of 4 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 09/26/2024 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 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, review of the medical record and facility policy the facility failed to ensure timely incontinence care was provided for Resident #70. This affected one resident (#70) of three residents reviewed for incontinence care. The facility census was 71. Findings include: Review of the medical record for Resident #70 revealed an admission date of 06/21/23. Medical diagnoses included chronic obstructive pulmonary disease, paraplegia, anxiety, major depressive disease, essential hypertension, neuromuscular dysfunction of bladder, and personal history of urinary tract infection. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #70 was cognitively intact. Resident #70 required setup or clean-up assistance with eating and oral hygiene, partial to moderate assistance with toileting, upper body dressing, and personal hygiene, substantial to maximal assistance with shower/bathing and lower body dressing and was dependent on staff for putting on/taking off footwear. Resident #70 was frequently incontinent of bladder and always incontinent of bowel. Review of the care plan dated 6/22/23 revealed Resident #70 was incontinent of bowel related to paraplegia. Interventions included to check resident to see if continent, offer to assist with toileting, and provide incontinence care after each episode. Further review of care plan revealed Resident #70 had bladder incontinence related to neuromuscular dysfunction of bladder and limited mobility with interventions that included to assess bladder continence quarterly and as needed and provide incontinence care after each episode. Interview on 09/25/24 at 9:52 A.M. with Resident #70 stated she was not sure when she was last changed, and she had asked a state tested nurse aide (STNA) to be changed earlier and was told that they would be back after they got people up for the day. Observation on 09/25/24 at 10:10 A.M. with STNA #367 and STNA #362 of Resident #70's incontinence care revealed after STNA #362 uncovered Resident #70, the draw sheet under the resident was soaked with urine and had a large dried brown ring, and the resident's incontinence brief was also filled with urine and bowel movement. Interview on 09/25/24 at 11:51 A.M. with STNA #362 confirmed Resident #70's brief and draw sheet under her was soaked with urine when incontinence care was provided during observation and stated that Resident #70 had not been provided timely incontinence care. Interview on 09/25/24 at 11:20 A.M. with STNA #333 confirmed Resident #70 was on their assignment had had not checked to see if Resident #70 needed changed yet for the day due to midnight shift reported all the residents in their assignment had been changed and dry at the start of their shift. STNA #333 stated his shift started at 7:00 A.M. and by 10:10 A.M. he had not provided incontinence care. STNA #333 stated that Resident #70 had asked to be changed when he went around to collect breakfast trays, and he told the resident that they would be back after they finished collecting breakfast trays. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366419 If continuation sheet Page 3 of 4 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 09/26/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the facility policy titled Incontinence Care, dated 11/30/23, revealed the purpose of incontinence care was to keep residents' skin clean, dry and free from irritation and odor and to prevent skin breakdown and prevent infection. This deficiency represents non-compliance investigated under Master Complaint Number OH00157568 and Complaint Number OH00157321. Event ID: Facility ID: 366419 If continuation sheet Page 4 of 4