Health inspection·June 23, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few staff members loudly complaining about their work assignment and had felt the interaction was not appropriate. Interview on 06/18/25 at 8:46 A.M. with the Administrator revealed she had not been made aware of the incident and stated the only requirement needed to work at the facility was to be nice. The Administrator stated she would inservice the staff members on appropriate customer service and stated the interaction was not appropriate. Review of the facility's undated customer service statement provided to employees upon hire, undated revealed staff were to maintain a friendly cheerful disposition and keep their tones even and be courteous and respectful. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review and staff interview, the facility failed to ensure a Preadmission Screening and Resident Review (PASRR) Level I screen was completed after a resident remained in the facility longer than 30 days as required. This affected four residents (#6, #16, #30 and #35) of four residents reviewed for PASRR. The facility census was 40. Residents Affected - Some Findings include: 1. Review of the medical record revealed Resident #6 was admitted to the facility on [DATE] with diagnoses that included fracture of the left leg, schizophrenia and dementia. Review of the most recent Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #6 was severely cognitively impaired and required assistance of one staff person for completing his activities of daily living (ADLs). Review of census records for Resident #6 revealed Resident #6 was admitted to the facility on a hospital exemption indicating Resident #6's expected length of stay at the facility was less then 30 days and Resident #6 was exempt from the completion of a full PASRR screen for 30 days. Review of both the electronic and hard charts revealed no PASRR was completed after Resident #6's 30th day at the facility as required. Interview on 06/18/25 at 10:10 A.M. with Marketer #300 verified Resident #6 had no completed PASRR screen completed after their 30th day at the facility as required. 2. Review of the medical record revealed Resident #16 was admitted to the facility on [DATE] with diagnoses that included epileptic syndrome, urinary tract infection, type two diabetes and heart failure. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #16 was severely cognitively impaired and required assistance of one staff person for completing his ADL's. Review of census records for Resident #16 revealed Resident #16 was admitted to the facility on a hospital exemption indicating Resident #16's expected length of stay at the facility was less then 30 days and Resident #16 was exempt from the completion of a full PASRR screen for 30 days. Review of both the electronic and hard charts revealed no PASRR was completed after Resident #16's 30th day at the facility as required. Interview on 06/18/25 at 10:10 A.M. with Marketer #300 verified Resident #16 had no completed PASRR screen completed after their 30th day at the facility as required. 3. Review of the medical record revealed Resident #30 was admitted to the facility on [DATE] with diagnoses that included age related osteoporosis, urinary tract infection, elevated white blood cell count and dementia. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #30 was severely (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 0645 cognitively impaired and required assistance of one staff person for completing her ADL's. Level of Harm - Minimal harm or potential for actual harm Review of census records for Resident #30 revealed Resident #30 was admitted to the facility on a hospital exemption indicating Resident #30's expected length of stay at the facility was less then 30 days and Resident #30 was exempt from the completion of a full PASRR screen for 30 days. Residents Affected - Some Review of both the electronic and hard charts revealed no PASRR was completed after Resident #30's 30th day at the facility as required. Interview on 06/18/25 at 10:10 A.M. with Marketer #300 verified Resident #30 had no completed PASRR screen completed after their 30th day at the facility as required. 4. Review of the medical record revealed Resident #35 was admitted to the facility on [DATE] with diagnoses that included sepsis, chronic kidney disease, disorientation and unspecified convulsion. Review of the most recent MDS 3.0 assessment dated [DATE] revealed Resident #35 was cognitively intact and required assistance of one staff person for completing her activities of daily living (ADLs). Resident #35 discharged to the community on 06/16/25. Review of census records for Resident #35 revealed Resident #35 was admitted to the facility on a hospital exemption indicating Resident #35's expected length of stay at the facility was less then 30 days and Resident #35 was exempt from the completion of a full PASRR screen for 30 days. Review of both the electronic and hard charts revealed no PASRR was completed after Resident #35's 30th day at the facility as required. Interview on 06/18/25 at 10:10 A.M. with Marketer #300 verified Resident #35 had no completed PASRR screen completed after their 30th day at the facility as required. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 staff interview, the facility failed to ensure timely care and assistance was provided to Resident #146 who experienced a change in condition. This affected one resident (#146) of two reviewed for changes in condition. The facility census was 40. Residents Affected - Few Findings include: Review of Resident #146's medical records revealed an admission date of 06/06/25. Diagnoses included Parkinson's Disease. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #146 had intact cognition. Review of progress note dated 06/09/25 timed 2:22 P.M., authored by Registered Nurse (RN) #508, revealed Resident #146 had called nine-one-one (911) to summon emergency services herself because she was short of breath and no one had answered her call light. The progress note further stated RN #508 was on a break and did not get a chance to transfer Resident #146. Review of progress note dated 06/12/25 timed 7:37 P.M. authored by RN #239 revealed Resident #246 was readmitted to the facility with a diagnoses of pneumonia. Interview on 06/17/25 at 10:36 A.M. with Resident #146 revealed she had feelings of shortness of breath, a cough, and was nauseous and stated she had told anyone and everyone that walked by her door. Resident #146 stated no one had responded to her call light being on either and stated her call light was on for over an hour. Resident #146 stated due to no staff responding to her she had called 911 herself and was transported to the hospital and was diagnosed with pneumonia. Interview on 06/18/25 at 11:32 A.M. with Certified Nursing Assistant (CNA) #308 revealed she worked the day Resident #146 went to the hospital. CNA #308 stated she recalled Resident #146 telling her she didn't feel well and stated she had observed Resident #146 appeared to be having difficulty breathing. CNA #308 stated she had immediately informed the nurse (could not provide name and stated it may have been an agency nurse) and stated later that day she had been made aware Resident #146 had called 911 herself and was taken to the hospital. Review of facility policy titled Change in Patient Condition undated revealed the charge nurse/supervisor was to be made aware of a change in a residents condition and will record relevant information in the resident medical records. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 facility policy review, the facility failed to timely implement pressure ulcer treatment and interventions. This affected one resident (#152) of two residents reviewed for wounds. The facility census was 40. Residents Affected - Few Findings include: Review of hospital paperwork dated 05/29/25, prior to Resident #152's admission to the facility, revealed Resident #152 presented to the emergency department due to pain in the buttocks secondary to stage two decubitus ulcers (partial thickness loss of skin bedsores). Measurements were not included in the hospital paperwork. Resident #152 had recently been placed on antibiotics by her primary care physician related to the bedsores. Review of Resident #152's medical records revealed the resident was admitted to the facility on [DATE] with diagnoses including stage two pressure ulcer to the left buttock. Review of facility admission skin grid dated 06/03/25, unable to determine author of assessment revealed Resident #152 had a discolored area to her buttocks. Skin grid did not include any further information. Review of dietary assessment dated [DATE] authored by Dietician #503 revealed Resident #152 required increased nutrition related to pressure injury of left buttock. Review of physician orders for June 2025 revealed to assist Resident #152 with turning every two hours, air mattress and ointment to bilateral buttocks every shift and Doxycycline (antibiotic) 100 milligrams twice a day for wound infection from 06/03/25 to 06/08/25. Review of wound care physician notes from 06/05/25 to 06/11/25 revealed no documentation related to buttocks for Resident #152. Review of Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #152 had intact cognition. Resident #152 required substantial assistance with bed mobility and toileting and was incontinent of bowel and bladder. MDS assessment had not included a stage two pressure ulcer to the buttock. Review of care plan dated 06/12/25 revealed Resident #152 had actual impaired skin integrity related to incontinence dermatitis (pressure ulcer to the buttocks was not included). Interventions included apply barrier ointment every shift and as needed, encourage repositioning at least every two hours, monitor for increased redness, measure wound area at least weekly to monitor response to treatment and request supplements and increased protein to monitor healing. Observation of incontinence care on 06/16/25 at 10:55 A.M. with Certified Nursing Assistant (CNA) #229 and Agency CNA #504 revealed Resident #152 was incontinent of a large amount of liquid stool that had covered her entire body from the top of her back to her lower extremities. CNA #229 stated she had not provided Resident #152 with incontinence care since the start of their shift at approximately 6:00 A.M. Continued observation of incontinence care being provided revealed during incontinence care Resident #152 yelled out that her buttocks were burning. Resident #152 was observed to have had an open area to her left buttock that was approximately 2 inches in length and 2 inches in width (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that was reddened and bleeding. Interview with CNA #229 at time of observation revealed she was not aware of Resident #152's open area and stated she would report the area to Resident #152's assigned nurse. Interview on 06/16/25 at 11:48 A.M. with Agency Registered Nurse (RN) #505 revealed she was not aware Resident #152 had a wound to her buttocks and stated staff had not reported the area to her. Interview on 06/16/25 at 3:12 P.M. with CNA #307 revealed Resident #152 had a buttock wound since she had been at the facility. CNA #307 stated she was not aware of what treatments were in place, however she had applied ointment to Resident #152's buttock after she had provided her with incontinence care and stated she had not observed a dressing to the area when she had previously cared for Resident #152. Interview on 06/17/25 at 1:15 P.M. with RN #255 revealed she was the facility's wound nurse and stated wound rounds were performed every Wednesday with the visiting wound physician. RN #255 stated she had not completed wound rounds the previous Wednesday (06/11/25) because she had been in a meeting. RN #255 stated she had not been made aware Resident #152 had a wound to her buttock. Observation and interview with RN #255 of Resident #152's buttock wound revealed the resident had an opened, red wound to her left buttock that was bleeding at the time of observation. RN #255 stated she would implement a treatment and inform the wound physician who would see the resident on 06/18/25. Review of a physician order dated 06/17/25 revealed an order to cleanse Resident #152's left buttock with normal saline, apply medihoney (a wound ointment), cover with calcium alginate (absorbent wound dressing), and cover with a silicone dressing daily and as needed. Interview on 06/18/25 at 9:42 A.M. with Dietician #503 regarding Resident #152's nutrition assessment dated [DATE] revealed she had likely received the information of Resident #152's pressure ulcer from her prior-to-admission hospital paperwork. Dietician #503 stated she was unaware of any concerns related to Resident #152's wound or care and stated she had placed orders for nutritional supplements to promote wound healing. Telephone interview on 06/18/25 at 11:13 A.M. with Wound Physician (WP) #506 revealed she had not been made aware Resident #152 had an area to her buttocks. WP #506 stated she had been following Resident #152 for a wound to her left heel and an area to her perineal area and had not been made aware to assess any areas to Resident #152's buttocks. WP #506 stated she would be seeing Resident #152 in the afternoon and would assess her buttocks then. A follow up interview on 06/18/25 at 4:46 P.M. with WP #506 revealed Resident #152 had a stage two pressure ulcer to her left buttock and her right thigh. WP #506 provided new treatment orders to facility staff to cover the wounds with calcium alginate and a foam dressing to be changed daily. Review of facility policy titled Pressure Ulcer Prevention undated revealed residents were to receive care consistent with professional standards to prevent pressure ulcers and a resident with pressure ulcers were to receive treatment and services to promote healing and Physician will be contacted to initiate appropriate treatment orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 facility policy review, the facility failed to ensure timely incontinence care was provided. This affected two residents (#150 and #152) of two residents observed for incontinence care. The facility census was 40. Findings include: 1. Review of Resident #150's medical records revealed an admission date of 06/09/25. Diagnoses included Alzheimer's, dementia and urinary tract infections. Review of the baseline care plan dated 06/09/25 revealed Resident #150 was incontinent of bowel and bladder. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #150 had impaired cognition. Resident #150 was incontinent of bowel and bladder. Review of physician orders for June 2025 revealed to toilet resident upon rising, before and after meal, at bedtime and as needed. Interview on 06/16/25 at 9:33 A.M. with Resident #150's private companion revealed Resident #150 had not received incontinence care since approximately 2:00 A.M. Observation of incontinence care at time of interview with Certified Nursing Assistant (CNA) #229 revealed Resident #150 was saturated with urine up her head that had soaked through her incontinence brief, mattress pad and also her mattress. A large dried urine ring was also observed on Resident #150's mattress pad. CNA #229 confirmed she had not provided Resident #150 with incontinence care since the start of her shift at 6:00 A.M. and was unable to state when Resident #150 had last received incontinence care. Resident #150 was not interviewable. 2. Review of Resident #152's medical records revealed an admission date of 06/03/25. Diagnoses included pressure ulcer of the left buttock, chronic obstructive pulmonary disease (COPD) and diabetes. Review of MDS assessment dated [DATE] revealed Resident #152 had intact cognition. Resident #152 required substantial assistance with toileting and was incontinent of bowel and bladder. Review of care plan dated 06/12/25 revealed Resident #152 was incontinent of bowel and bladder. Interventions included provide incontinence care as needed. Review of physician orders for June 2025 revealed to toilet resident upon rising, before and after meal, at bedtime and as needed. Interview on 06/16/25 at 10:00 A.M. with Resident #152 revealed she had last received incontinence care sometime around 3:00 A.M. and required incontinence care at time of interview. Observation of incontinence care on 06/16/25 at 10:55 A.M. with CNA #229 and CNA #504 revealed Resident #152 was covered in a large amount of liquid stool that extended from the middle of her back to her feet. Interview with CNA #229 at time of observation revealed she had not provided Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 #152 with incontinence care since the start of her shift at 6:00 A.M. and was unable to state when Resident #152 had last received incontinence care. CNA #229 stated resident should be provided with incontinence care at least every two hours and as needed. Review of facility policy titled Incontinence Care undated revealed residents were to receive incontinence care after each incontinence episode. Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 0692 Provide enough food/fluids to maintain a resident's health. 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 facility policy review, the facility failed to ensure residents were provided with water as requested and required. This affected one resident (#22) of three residents reviewed for hydration. The facility census was 40. Residents Affected - Few Findings include: Review of Resident #22's medical records revealed an admission date of 05/27/25. Diagnoses included right arm fracture, diabetes, and history of falls. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #22 required supervision with eating. Interview on 06/16/25 at 9:17 A.M. with Resident #22 revealed she had not been receiving ice water daily and stated she usually did not even receive it once a day, even if she requested. Observation at time of interview revealed an empty water pitcher on Resident #22's sink. Interview on 06/17/25 at 10:41 A.M. with Resident #22 revealed she had still not received any ice water and stated she had been asking for a few days, and stated she had obtained water from the sink in her room. Interview on 06/17/25 at 10:43 A.M. with Certified Nursing Assistant (CNA) #229 revealed the night shift was responsible for providing ice water prior to the end of their shift and stated during her shift from 6:00 A.M. to 2:00 P.M. she was responsible to pass water as needed and also at the end of her shift. CNA #229 stated she had not been aware Resident #22 had requested ice water or had not received water for a few days. Review of facility policy titled Fluids at the Bedside undated revealed residents were to be provided with a fresh supply of water at the bedside at least daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 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 366458 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahc of Landerhaven LLC 2108 Lander Road Mayfield Heights, OH 44124 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 and record review the facility failed to ensure appropriate infection control techniques were used for a resident on enhanced barrier precautions. This affected one resident (#152) of two observed for infection control precautions. The facility census was 40. Residents Affected - Few Findings include: Review of Resident #152's medical records revealed an admission date of 06/03/25. Diagnoses included stage two pressure ulcer to the left buttock. Review of Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #152 had intact cognition. Resident #152 required substantial assistance with toileting and was incontinent of bowel and bladder. Review of current physician orders for June 2025 revealed Resident #152 was on Enhanced Barrier Precautions (EBP) due to pressure ulcer. Observation on 06/16/25 at 10:00 A.M. revealed a sign posted outside of Resident #152's room that stated EBP and the use of gown and gloves was required prior to entering. Observation of incontinence care on 06/16/25 at 10:55 A.M. revealed Certified Nursing Assistant (CNA) #229 and #504 had entered Resident #152's room and had not donned personal protective equipment (PPE). CNA #229 and #504 had proceeded to provide Resident #152 with incontinence care that included Resident #152 being incontinent of a large amount of liquid stool and urine. After completion of incontinence care interview with CNA #229 revealed she was not aware Resident #152 was on EBP and confirmed she was not aware of having to don PPE prior to providing care. Interview on 06/16/25 at 11:48 A.M. with Registered Nurse (RN) #505 revealed she was not aware of what EBP precautions had meant and further indicated she was not aware of Resident #152 being on any type of precautions. Review of facility policy titled Enhanced Barrier Precautions undated revealed resident were to be placed on EBP for residents who had wounds that included pressure ulcers and staff were to donn PPE during high contact activities that included personal hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366458 If continuation sheet Page 11 of 11