Health inspection·March 25, 2024

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few when he his hair was shampooed but it had been early in the month. Resident #60 stated this past Tuesday, 03/19/24 an aide he had not seen before shampooed his hair. Resident #60 stated his hair had been shampooed twice since he had been at the facility. Interview on 03/21/24 at 10:46 A.M. with Licensed Practical Nurse (LPN) #219 stated a lot of times he had to help Resident #60 get up and dressed because he didn't always get the assistance in a timely manner. LPN #219 stated he was not sure if the aides washed Resident #60's on shower days or if it was getting done per physician order. Review of the MAR for March 2024 with LPN #219 verified he had signed off on 03/04/24 and 03/18/24 that Resident #60 hair was shampooed per physician order. LPN #219 stated he assumed the aides shampooed the resident's hair. Interview on 03/21/24 at 10:56 A.M. with Registered Nurse (RN) #300 stated Resident #60's hair could be shampooed during bed baths and when given a shower. RN #300 stated technically since the shampoo was a medication, the nurse should be doing it or making sure it was on the resident's hair and the aides could rinse it out. Review of the MAR for March 2024 with RN #300 verified she signed off on the order as completed on 03/11/24 and then stated she did not recall. Review of the facility policy titled Activities of Daily Living, revised 08/12/20, revealed provision of ADL (activities of daily living) care will include but not limited to staff to provide care in the following areas: this shall include, but not be limited to, eating, toileting, ambulation, bathing, dressing, and transferring. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 2 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **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 #85's neuro checks were completed as scheduled after a fall. This affected one resident (#85) out of four residents reviewed for falls. The facility census was 88. Findings include: Review of Resident #85's medical record revealed an admission date of [DATE] and diagnoses included malignant neoplasm of the prostate and end stage renal disease. Resident #85 passed away at the facility on [DATE]. Review of Resident #85's progress notes dated [DATE] at 3:33 P.M. included Resident #85 was alert and oriented. Resident #85's advance directive was a full code, and Resident #85 was on peritoneal dialysis. Resident #85 required a mechanical lift for transfers and required assistance with toileting, bathing, and bed mobility. Review of Resident #85's progress notes dated [DATE] at 10:53 P.M. revealed Resident #85 was observed lying in the prone position on the floor in his room close to his bed. A neuro check assessment was completed and were within normal limits, blood pressure was 98/62, heart rate 68, temperature 97.6, oxygen saturation 97 percent, and respirations were 18 per minute on room air. Resident #85 denied complaints of pain and denied hitting his head. Resident #85 was assisted back to bed with a mechanical lift and three staff members. Resident #85's wife, his Certified Nurse Practitioner, and the Director of Nursing (DON) were notified. Neuro checks were initiated, and Resident #85 was educated to use his call bell for help. Staff would continue to monitor the resident closely. Review of Resident #85's neuro checks revealed neuro checks were initiated on [DATE] and were completed every 15 minutes times four and were completed every 30 minutes times four. Further review revealed neuro checks were to be completed every one-hour times four. Neuro checks were documented on [DATE] at 2:15 A.M. and on [DATE] at 3:15 A.M. and revealed Resident #85 was awake, alert, able to verbalize needs, moved extremities equally and pupils were equal and reactive. Resident #85 was scheduled to have neuro checks completed on [DATE] at 4:15 A.M., but there was no evidence the neuro checks were completed, and further review revealed no further neuro checks were completed until Resident #85 was found on [DATE] at 5:00 A.M. and was cold to touch with the absence of vital signs and pupil response. Review of Resident #85's progress notes dated [DATE] at 6:30 A.M. included an unidentified State Tested Nursing Assistant (STNA) and nurse reported to Licensed Practical Nurse (LPN) #236 at 5:00 A.M. that Resident #85 was cold to touch with the absence of vital signs and pupil response. Upon entering Resident #85's room, LPN #85 initiated a code. CPR (cardiopulmonary resuscitation) was started and 911 was called. EMS (Emergency Medical Services) arrived at 5:15 A.M. and paramedics pronounced Resident #85 DOA (dead on arrival) at 5:20 A.M. Review of Resident #85's care plan dated [DATE] included Resident #85 was at risk for falls characterized by a history of falls, injury. Resident #85 would minimize risks for falls, minimize injuries related to falls through the next review target date on [DATE]. Interventions included implementing preventative fall interventions, devices; maintaining the call bell within reach; and maintaining (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 3 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 0689 the resident's needed items within reach. Level of Harm - Minimal harm or potential for actual harm Review of Resident #85's Certificate of Death dated [DATE] included the immediate cause of death was End Stage Renal Disease, the manner of death was natural causes, and there was no autopsy performed. Residents Affected - Few Interview on [DATE] at 3:00 P.M. of Regional Director of Clinical Services (RDCS) #286 and the Director of Nursing (DON) confirmed Resident #85 had a fall on [DATE] and Resident #85's neuro checks were scheduled to be completed on [DATE] at 4:15 A.M. and there was no documented evidence the neuro checks were done. RDCS #286 confirmed no further neuro checks were completed on [DATE] after 3:15 A.M. until Resident #85 was found on [DATE] at 5:00 A.M. cold to touch with the absence of vital signs and pupil response. RDCS #286 stated Resident #85 was a very sick man and was admitted to the facility from the hospital on [DATE]. Review of the facility policy titled Neurological Checks Policy, revised [DATE], included neurological checks were indicated to monitor for potential irregularities in neurological status in the event of known or unknown head trauma as the result of a resident event, change in resident condition or physician's order. An initial neurological check would be performed by a licensed clinician for all residents who have sustained a witnessed, unwitnessed, alleged, reported, or suspected head trauma following an unusual occurrence or change in resident neurological condition. Upon initiation of the schedule or as triggered by a qualifying event, the neurological check assessment in the electronic health record or on paper would be initiated to conduct periodic checks and to document the results of the neurological checks. Unless otherwise ordered by the physician, the frequency of neurological assessments would be every 15 minutes times four, then every 30 minutes times four, then every one-hour times three, then every four hours times two, then every eight hours times two. Elements to be assessed included level of consciousness, mental status, vital signs including blood pressure, pulse, respirations, and movement, coordination. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 4 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 policy and procedure review, the facility failed to ensure timely incontinence care. This affected one resident (#13) of one resident reviewed for bowel and bladder incontinence. The facility census was 88. Findings include: Review of the medical record for Resident #13 revealed an admission date of 01/18/23. Diagnoses included hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, ulcerative colitis, heart failure, and chronic pain syndrome. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #13 had intact cognition, no behaviors, and was always incontinent of bowel and bladder. Review of the care plan dated 01/19/23 revealed Resident #13 had an activities of daily living (ADL) self-care deficit related to hemiplegia and hemiparesis following cerebral infarction affecting right dominant side. Interventions included assisting with activities of daily living, dressing, grooming, toileting, feeding, oral care. Resident #13 required assistance of one staff with toileting. Interview on 03/19/24 at 9:40 A.M. with Resident #13 stated she had a bowel movement (BM) and had been waiting 15 minutes so far for staff to change her. Follow-up interview on 03/19/24 at 9:51 A.M. with Resident #13 revealed she had initially used her call light to inform the staff she needed to be changed and had been waiting. The odor of BM was present through the N95 facemask while in resident's room. Staff were observed in the hall. Observation on 03/19/24 at 9:53 A.M. observed State Tested Nurse Aide (STNA) #202 enter Resident #13's room and leave. Observation on 03/19/24 at 10:00 A.M. observed Resident #13's call light turned on and at 10:01 A.M. observed staff answered call light then left out of room turning call light off. Observation on 03/19/24 10:15 A.M. observed Resident #13's call light turned back on and at 10:16 A.M. a nurse entered the room and exited Resident #13's room turning off the call light. Observation on 03/19/24 at 10:19 A.M. STNA #301 and another staff member enter Resident #13's room and at 10:22 A.M. both staff exited the resident's room. Observation on 03/19/24 at 10:30 A.M. STNA #301 and another staff member entered Resident #13's room with towels and closed the door. Interview on 03/19/24 at 11:00 A.M. with STNA #202 stated when she entered Resident #13's room at 9:53 A.M., Resident #13 told her she needed to be changed. STNA #202 stated she then told Resident #202's aide, STNA #301, that Resident #13 needed to be changed and that she would assist her. Interview on 03/19/24 at 12:08 P.M. with STNA #301 stated it was her first day at the facility and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 5 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 she had been running around doing patient care. STNA #301 stated when she entered Resident #13's room she told her she wanted a shower. STNA #301 stated when she changed Resident #13's brief, she had a little, liquidy BM in her brief. Review of the facility policy titled Incontinent Resident Care, revised January 2014, revealed incontinent residents will be cared for by nursing personnel to ensure adequate skin care, control odor and provide personnel hygiene. Event ID: Facility ID: 366440 If continuation sheet Page 6 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, record review, and policy and procedure review, the facility failed to maintain a clean and sanitary kitchen and nursing unit areas, failed to ensure staff wore hairnets while in the kitchen, and failed to ensure scoops were not stored in the containers with the food items. This had the potential to affect all residents except three residents (#48, #66, and #69) who received nothing by mouth. The facility census was 88. Findings include: Observation on 03/18/24 from 6:15 P.M. through 6:27 P.M. during the brief kitchen tour revealed three dietary staff observed in the kitchen cleaning without wearing hair restraints. Attempt to wash hands at the hand washing sink across from the dry storage area revealed the hot water was not working. Attempt to wash hands at the handwashing sink near the dish machine, and the hot water was also not working. Observed small white Styrofoam bowls stored in the bulk cereal containers for the cheerios, fruit loops, and rice Krispies. Observed in the bulk flour was a large plastic cup with measurements that was stored in the container with the flour. The clear lids of the bulk sugar, flour, and breadcrumbs had various food crumbs, food debris, and appeared sticky. Interview on 03/18/24 between 6:15 P.M. and 6:27 P.M. with Dietary [NAME] (DC) #212 verified the above findings. DC #212 stated the sink near the dry storage was leaking so maintenance shut the hot water valve off and must have turned the hot water valve off at the sink near the dish machine as well. DC #212 stated they would use the other sinks to wash their hands that were not indicated as handwashing sinks. DC #212 stated they weren't wearing hairnets because they were able to take them off after meal service to clean. Observation on 03/20/24 at 3:27 P.M. of the nursing unit refrigerators with Regional Registered Dietitian (RRD) #302. RRD #302 stated the servery on the 400/500 hall was closed. Observation of the 400/500 hall servery revealed the refrigerator empty and within normal temperature but had dried spillage on the bottom portion of the inside of the refrigerator. RRD #302 verified the observation. Observation on 03/20/24 at 3:30 P.M. of the 300-hall nursing unit servery revealed a dried spillage on the inside bottom of the refrigerator and a moderate amount of dried food debris/spillage on the grills of the shelves. Observation of the freezer revealed various spillage, a cup of slushy with no name or label, turned on its side and an open Twix candy bar. Observation of the microwave revealed minimal dried spillage and food debris inside of the microwave, but the silver shelf that the microwave sat on had a large dried black/brownish substance with food debris. Interview at this time with RRD #302 verified the observation. Observation on 03/20/24 at 4:35 P.M. of tray line temperatures revealed the food was observed on the steamtable. Observed a large, black fan on and blowing toward the food on the steam table that was dirty with dust. Interview at this time with RRD #302 verified the observation. Review of the list of residents with their diet orders provided by the facility revealed three residents (#48, #66, and #69) who received nothing by mouth. Review of the facility policy titled Food Preparation Area Policy, revised 06/07/21, revealed the community facility will maintain a clean, sanitary, and safe food preparation area. Food preparation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 7 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete staff must use hand washing facilities, which will be available and will include hot and cold water with a soap dispenser, disposable towel rack, and trash can with step to open lid. Hand washing sinks will be separate from ware washing sinks and will be located near food preparation and clean dish areas. Hand washing sinks will not be used for food preparation. Review of the facility policy titled Storage of Dry Food Policy, revised 03/09/24, revealed bulk food scoops are not to be stored in bins but are kept covered and protected near containers. Scoops are to be washed, sanitized, and dried on a routine basis. Event ID: Facility ID: 366440 If continuation sheet Page 8 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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, and review of the facility policy the facility failed to ensure hand hygiene was completed during medication administration for Resident's #9, #57 and #64 and failed to ensure Resident #31's soiled linens and soiled incontinence brief was not placed on the floor during incontinence care. This affected three residents (#9, #57 and #64) out of seven reviewed for medication administration and one resident (#31) of three residents reviewed for incontinence care. The census was 88. Residents Affected - Some Findings include: 1. Review of Resident #57's medical record revealed an admission date of 07/26/23 with diagnoses including severe protein-calorie malnutrition, pain in the right and left knees, and hypertension. Observation on 03/21/24 at 8:56 A.M. of Registered Nurse (RN) #285 revealed she was standing at the medication cart preparing Resident #57's medications for administration. RN #285 finished preparing Resident #57's medications, placed them in a small plastic cup and walked in Resident #57's room. RN #285 took Resident #57's blood pressure then administered the medications. After administering Resident #57's medications, RN #285 walked out of the room and back to the medication cart. RN #285 did not wash her hands or use hand sanitizer before leaving Resident #57's room or after she returned to the medication cart. 2. Review of Resident #9's medical record revealed an admission date of 11/17/22 with diagnoses including atherosclerotic heart disease, hypertension, and gastro-esophageal reflux disease. Observation on 03/21/24 at 9:09 A.M. of RN #285 revealed she was standing at the medication cart preparing Resident #9's medications for administration. RN #285 finished preparing Resident #9's medications, placed them in a small plastic cup and walked into Resident #9's room without using hand sanitizer or washing her hands. RN #285 administered Resident #9's medications and walked out of the room and back to the medication cart without using hand sanitizer or washing her hands. 3. Review of Resident #64's medical record revealed an admission date of 02/28/22 with diagnoses including unspecified dementia, chronic kidney disease, stage three, and hypertension. Observation on 03/21/24 at 9:14 A.M. of RN #285 at 9:14 A.M. revealed she walked into Resident #64's room without using hand sanitizer or washing her hands. RN #285 took Resident #64's blood pressure and left the room without using hand sanitizer or washing her hands. Interview on 03/21/24 at 9:14 A.M. of RN #285 confirmed she did not use hand sanitizer or wash her hands during medication administration to Resident's #57 and #9 and did not use hand sanitizer or wash her hands before or after taking Resident #64's blood pressure. RN #285 stated you got me. 4. Review of Resident #31's medical record revealed an admission date of 01/16/24 with diagnoses including dementia, anxiety, and hypertension. Review of Resident #31's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #31 had severe cognitive impairment. Resident #31 was occasionally incontinent of urine and always incontinent of bowel. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 9 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 03/21/24 at 8:34 A.M. of Licensed Practical Nurse (LPN) #216 revealed he was working in the role of a State Tested Nursing Assistant and was preparing to provide incontinence care for Resident #31. LPN #216 stated Resident #31 had a bowel movement, needed her incontinence brief changed, and she needed to be dressed and assisted to the chair in her room so she could eat breakfast. Observation of Resident #31 revealed she was lying in bed on her left side and a pungent odor of bowel movement was noted. LPN #31 provided Resident #31's incontinence care and when her incontinence brief was removed a large brown bowel movement could be seen. Further observation revealed LPN #216 placed the soiled incontinence brief with a large amount of feces in it on the floor and placed the soiled washcloth and towel used during incontinence care on the floor beside the incontinence brief. LPN #216 stated he would clean it up later. LPN #216 did not remove the soiled gloves used for incontinence care and picked up Resident #31's clean pants and shirt and placed them on a chair in the room. Observation revealed LPN #216 took his soiled gloves off, did not wash his hands or use hand sanitizer and donned clean disposable gloves. LPN #216 proceeded to dress Resident #31 in a clean shirt and pants and assisted her to a chair. LPN #216 did not remove his gloves, use hand sanitizer, or wash his hands, picked up Resident #31's breakfast tray, placed it on a table in front of her and removed the lids from her breakfast items. LPN #216 removed his gloves, washed his hands, then returned to Resident #31, and finished assisting her with her meal tray. There was a pungent odor of bowel movement noted in the room, and when asked about the soiled incontinence brief and washcloth lying on the floor, LPN #216 stated he would clean them up after Resident #31 ate her breakfast. Review of the facility policy titled Incontinent Resident Care, revised 01/2014, included incontinent residents would be cared for by nursing personnel to ensure adequate skin care, control odor and provide personal hygiene. Further review included to remove soiled clothing and do not put linen on the floor, dispose of linen per exposure control policy and to wash hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 10 of 11 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 366440 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Pointe Health & Rehab Center 402 Golf View Lane Highland Heights, OH 44143 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 Residents Affected - Many 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 did not ensure the laundry room was maintained in a clean and sanitary manner. This had the potential to affect all residents residing in the facility. The facility census was 88. Findings include: Observation on 03/19/24 at 4:14 P.M. revealed accumulated lint under each of the three dryers. There was a substantial amount of lint coating the surfaces in the room behind the dryers. The eye wash station sink was coated with white substance. The washing machines were coated in a white fuzzy substance that adhered to the surface. The wall behind the washing machines was cracked open along the baseboard. Interview on 03/19/24 at 4:19 P.M. with Regional Director of Clinical Services #286 verified these findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366440 If continuation sheet Page 11 of 11