Health inspection·November 25, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mobility limitations and had sufficient strength to lift herself up from a chair and move independently in the bed and the chair (The admission MDS listed a mobility impairment and the need for moderate assistance). The assessment notes did not account for the presence of the reddened area that was assessed this same date on Resident #58's right buttock.Review of all assessments completed between 05/19/25 and 07/29/25 revealed no non-pressure skin grid assessments or pressure skin grid assessments were completed throughout the duration of Resident #58's time at the facility, despite the reddened area to the right buttock being identified upon admission. There was no indication of ongoing assessment or resolution of the altered skin integrity. Review of the Weekly Skin Check assessment revealed only one weekly skin assessment was completed, dated 07/21/25, in which no new skin problems were identified. The medical record contained no skin assessments, other than the admission assessment completed on 05/19/25. There were no ongoing assessments to show the reddened area was reassessed, tracked, or treated. Additionally, there were no skin assessments to indicate the necessity for use of antifungal, antimicrobial, or corticosteroid creams, lotions, powders, or shampoos as ordered. Review of the care plan from 05/20/25 through 09/14/25 revealed Resident #58 had actual impairment of skin integrity related to the right buttocks being reddened. Interventions included administration of treatments as ordered, adding a pressure-reducing device to the mattress and the chair, and follow facility protocols for treatment of skin injury. The care plan for actual skin integrity impairment was not resolved at any time during the duration of Resident #58's facility stay. Further review of the care plan revealed the facility initiated a care plan focus for antifungal therapy related to a yeast infection on 07/23/25 and resolved this focus on 07/24/25 (Resident #58 had orders for twice daily Nystatin powder for antifungal treatment from 05/19/25 through 07/29/25 and for Ketoconazole shampoo from 06/16/25 through 07/29/25). Review of the progress notes dated 05/19/25 revealed an admission note at 3:28 P.M. which indicated Resident #58 had a red area on the right buttock with no pain and a note at 11:15 P.M. which indicated Resident #58 had a reddened area to the center of the right buttock by the intergluteal cleft and a reference to see a new order for Triad Cream. Further review of the progress notes revealed a note dated 06/11/25 at 2:00 P.M. that Resident #58 had returned from an appointment with a dermatologist with new orders for ketoconazole and metrogel. There were no notes related to the reason for the appointment or reason for the new topical medications. Review of the Medication Administration Records (MARs) and Treatment Administration Records (TARs) from May 2025, June 2025, and July 20205 revealed no documentation of weekly skin assessments being completed. Interview on 11/24/25 at 10:08 P.M. with the Director of Nursing (DON) confirmed that any completed weekly skin assessments should be found in the electronic medical record (EMR) under weekly skin checks. Interview on 11/24/25 at 3:10 P.M. with Registered Nurse (RN) #327 confirmed skin assessments were to be completed once a week by the nurses and that the order should pop up on the MAR or the TAR weekly to remind the nurse to complete the assessment. Interview on 11/25/25 at 3:35 P.M. with Licensed Practical Nurse (LPN) Unit Manager (UM) #346 revealed initial skin assessments were to be performed by the admitting floor nurse and then weekly thereafter by the floor nurse, and she was not certain of the process for notifying the wound nurse when residents were found to have altered skin integrity. LPN UM #346 further explained that the nurses should be prompted within the electronic medical record (EMR) to do a complete skin assessment, found under the clinical assessments tab. During the interview, LPN UM #346 confirmed being the wound care nurse for the facility since August 2025 and verbalized not always knowing when a resident developed a new skin concern, adding that she was uncertain as to whether the nursing staff had ever been instructed to pass the information along to the wound nurse. A follow-up interview with the DON on 11/25/25 between 4:00 P.M. and 4:30 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 2 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few P.M. confirmed the presence of the order dated 05/19/25 for a Braden scale assessment to be completed for Resident #58 on admission and then weekly for three weeks and confirmed that only Braden scale assessment one was completed, dated 05/19/25. During the interview, the DON also confirmed only one weekly skin assessment had been performed, dated 07/21/25, and that the red area reported on admission, as well as any other skin alteration, should have been assessed at least weekly, and there was no evidence the assessments were completed by nursing staff. 2. Review of the medical record for Resident #61 revealed an initial admission date of 03/07/25 and a discharge date of 11/12/25. Review of the Clinical Census revealed Resident #61 was out of the facility for greater than 24 hours, beginning on 10/13/25, with re-entry listed as 10/15/25. Pertinent diagnoses included multiple sclerosis, chronic obstructive pulmonary disease (COPD), neuromuscular dysfunction of the bladder, type two diabetes mellitus, hypertensive heart and chronic kidney disease with heart failure, Stage three chronic kidney disease, anxiety disorder, major depressive disorder, post laminectomy syndrome, and primary osteoarthritis of the right knee.Review of the care plan dated 03/11/25 revealed Resident #61 had an actual impairment of skin integrity of the coccyx. Interventions included encouragement of good nutrition and hydration, medication as ordered, monitoring skin integrity, documentation of the location, size, and treatment of the skin injury, reporting abnormalities, incontinence care as needed, and turning and repositioning as tolerated. Further review of the care plan revealed no care plan was put into place related to Resident #61 being at risk for impaired skin integrity secondary to mobility issues, MS, and bowel and bladder incontinence, just actual skin impairments noted during Resident #61's facility stay. Review of the Discharge Return Anticipated Minimum Data Set (MDS) 3.0 assessment completed on 10/13/25 revealed Resident #61 had moderate cognitive impairment and was dependent for transfers and required maximum assistance with toileting hygiene, bathing, and rolling left and right in bed. Further review of the MDS revealed Resident #61 had one unstageable pressure injury which presented as a deep tissue injury that was not present on admission.Review of the Skin: Pressure Ulcer/Wound Record Area #1 dated 09/30/25 revealed documentation that a new skin area on Resident #61's coccyx was first observed on 09/30/25. The assessment further revealed the pressure ulcer was unstageable and measured five centimeters (cm) by 3.7 cm by 0.1 cm. Wound care consisted of cleansing with normal saline solution, patting dry, and application of triad paste while leaving open to air. Further review of the assessment revealed that the wound reassessment frequency was to be every shift by the floor nurse and weekly by the wound Nurse Practitioner (NP). Review of all Weekly Skin Check - V 2 assessments from 03/07/25 (admission) to 09/30/25 (the date the new unstageable pressure ulcer was identified) revealed only two assessments, dated 07/22/25 and 09/19/25, had been completed. Review of the progress notes revealed a dietary note dated 09/30/25 at 1:19 P.M. indicating staff reported Resident #61 had a new deep tissue injury (DTI) on the right buttock. There were no nursing progress notes related to the new altered skin integrity identified on 09/30/25. Review of the orders revealed an order dated 10/16/25 for a Braden skin assessment to be completed on admission and every week for three weeks. Review of the Braden scale assessments revealed no Braden skin assessments were completed, as ordered, after re-entry on 10/15/25.Interview on 11/24/25 at 10:08 P.M. with the DON confirmed completed weekly skin assessments were kept in the electronic medical record (EMR) under weekly skin checks. During the interview, the DON confirmed that there were only two weekly assessments in the EMR completed for Resident #61, dated 07/22/25 and 09/19/25. Review of the policy titled Pressure Ulcer Prevention and Interventions, last revised January 2023, revealed all residents were to have skin assessed on a routine basis, which included a daily skin inspection, especially over bony prominences, for residents who had non-blanchable erythema (reddening of the skin), and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 3 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 documentation of findings no less frequently than weekly. This deficiency represents non-compliance investigated under Complaint Number 1401318. 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: 366471 If continuation sheet Page 4 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 Based on record review, interview, and facility policy review, the facility failed to ensure physician orders for weights were completed as ordered for one resident (#58). This had the potential to affect all residents residing in the facility. The facility census was 57. Findings include: Review of the closed medical record for Resident #58 revealed an admission date of 05/19/25 and a discharge date of 07/29/25. Diagnoses included but were not limited to acute respiratory failure with hypoxia, severe persistent asthma, type II diabetes with hyperglycemia, long term use of insulin, congestive heart failure, hypertensive heart disease and schizoaffective disorder, and post bariatric surgery status. Review of the 07/29/25 discharge Minimum Data Set (MDS) 3.0 for Resident #58 revealed a Brief Interview of Mental Status (BIMS) of 15 which indicated intact cognition. Review of the activities of daily living (ADLs) revealed Resident #58 was independent for meals. No weight was recorded on the MDS.Review of Resident #58's care plan last reviewed on 05/20/25 revealed potential for altered nutrition and hydration related to diagnosis of acute hypoxic respiratory failure, type II diabetes mellitus and history of bariatric surgery. Resident #58 also had physician-directed weight loss through the use of diuretics. A listed intervention included to monitor and record weights as physician ordered.Review of Resident #58's physician orders revealed an order dated 05/23/25 for daily weights to be obtained. Review of the Medication Administration Record (MAR) for July 2025 revealed staff were signing of Resident #58's daily weights on the MAR as being complete with the exception of 07/11/25 which was blank and 07/26/25 where it noted the resident refused. There were no actual weights recorded on the MAR. Review of Resident #58's weights under the weights tab in the electronic medical record revealed the last recorded weight was 05/27/25 which listed Resident #58's weight at 260.2 pounds.Interview on 11/19/25 at 2:30 P.M. with Registered Dietitian #369 confirmed the actual daily weights were not recorded on the resident's MAR, rather they were just checked off as complete. Registered Dietician #369 stated the weights should have been completed and recorded daily. Interview on 11/19/25 at 2:45 P.M. with the Director of Nursing (DON) confirmed daily weights were signed off but no weights were recorded in Resident #58's medical record as ordered by the physician. Review of the October 2024 revised facility policy called; Weight Policy and Procedure revealed residents will be weight monthly unless ordered otherwise by a physician. Weights will be recorded in the resident's medical record. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 5 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview, review of the medical record, and review of facility policy, the facility failed to ensure resident drug regimens did not include the unnecessary use of opioids. This affected one resident (#13) of four residents reviewed for appropriate pain management. The facility census was 57. Findings include:Review of the medical record for Resident #13 revealed an admission date of 02/17/24. Pertinent diagnoses included nontraumatic subarachnoid hemorrhage, nontraumatic intracerebral hemorrhage in the cortical hemisphere, dysphagia, aphasia, epilepsy, chronic obstructive pulmonary disease (COPD), chronic respiratory failure with hypoxia, and type two diabetes mellitus. Review of the quarterly Minimum Data Set (MDS) assessment completed on 08/26/25 revealed Resident #13 had severe cognitive impairment but was usually able to make herself understood and usually understood others. Further review of the MDS revealed Resident #13 was on a scheduled pain regimen, received as needed analgesics (pain medications), and reported pain occurred almost constantly but rarely affected sleep or day-to-day activities. The MDS indicated that Resident #13 received medications from high-risk categories, including antidepressant, anticoagulant, antibiotic, anticonvulsant, and opioid. Review of the orders revealed Resident #13 had one routine order for control of neuropathy that included an order dated 01/21/25 for Gabapentin, 300 milligrams (mg), one capsule by mouth three times a day for neuropathic pain. The orders also included two PRN (as needed) analgesics (pain-relief medications): 1) orders dated 02/28/25 to 10/09/25 and 10/09/25 for acetaminophen oral tablet, 325 mg, give two tablets (650 mg) by mouth every six hours as needed for pain, and 2) orders dated 12/17/24 to 10/09/25 and 10/09/25 for oxycodone hydrochloride (an opioid typically prescribed to treat moderate to severe pain), five milligram tablet, give 5 mg by mouth every eight hours as needed for pain. Further review of the orders revealed consecutive orders, dated 02/17/24 to 10/09/25 and 10/09/25 through current, for staff to assess Resident #61 for pain every shift. The order specified that if pain was present, documentation was required and non-pharmacological interventions were to be attempted prior to administration of analgesics. Review of the care plan from 02/18/24 to 12/14/25 revealed Resident #13 was at risk for pain. Interventions included anticipating need for pain relief and responding immediately to any complaints of pain, documenting non-pharmacological intervention attempts prior to administration of pharmacological intervention, documenting probable cause of pain and removing or limiting causes where possible. The interventions further specify that non-pharmacological techniques to offer prior to administration of analgesics included relaxation techniques, meditation, guided imagery, soft music, dim lights, repositioning for comfort, offering a back rub, providing a quiet atmosphere, and instructing in deep breathing exercises.Review of the Medication Administration Record (MAR) from July 2025 revealed Resident #13 was administered oxycodone on 07/03/25 at 7:36 A.M. and 5:06 P.M., on 07/09/25 at 3:28 P.M., on 07/15/25 at 8:31 A.M. and 4:46 P.M., on 07/19/25 at 9:49 P.M. and on 07/20/25 at 5:51 A.M. with a pain assessment documented with the oxycodone administration as NA. No non-pharmacological interventions were noted on the MAR as being attempted prior to the administration of oxycodone during the corresponding shifts on 07/03/25, 07/09/25, 07/15/25, and 07/19/25 to 07/20/25 and the overall pain rating for the shifts was documented as zero for each of the corresponding shifts. Furthermore, Resident #13 did not receive acetaminophen, a non-opioid analgesic, prior to receiving acetaminophen. Review of the MAR also revealed that only two (07/13/25 at 11:23 P.M. and 07/26/25 at 9:36 P.M.) of the total 22 doses of oxycodone administered to Resident #13 in July 2022 had documentation of attempted non-pharmacological interventions prior to medication administration. Review of the linked electronic MAR (eMAR) progress notes dated 07/03/25 at 7:36 A.M., 07/09/25 at 3:28 P.M., 07/15/25 at 8:31 A.M. and at 4:46 P.M., 07/19/25 at 9:49 P.M., and 07/20/25 at 5:51 A.M. revealed Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 6 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few no assessments that indicated Resident #13 experienced moderate to severe pain or requested to receive oxycodone. Further review of the notes revealed no non-pharmacological intervention attempts were made prior to medication administration. Review of the MAR from August 2025 revealed Resident #13 was administered 5 mg of oxycodone by mouth on 08/11/125 at 7:35 P.M., on 08/12/25 at 11:12 A.M., and on 08/26/25 at 1:18 P.M. with the corresponding pain scale rated as NA. No non-pharmacological interventions were noted on the MAR as being attempted prior to the administration of oxycodone during the corresponding shifts on 08/11/25, 08/12/25, or 08/26/25 with an overall pain assessment for the shift rated as zero on 08/11/25 and 08/12/25 and as NA on 08/26/25. Further review of the MAR revealed that out of the total of 13 doses of oxycodone administered to Resident #13 in August 2025, only three doses, the doses administered on 08/01/25 at 7:07 A.M. and 7:17 P.M., and on 08/09/25 at 8:09 P.M., had corresponding documentation of non-pharmacological intervention attempts prior to medication administration.Review of the linked eMAR progress notes dated 08/11/125 at 7:35 P.M., on 08/12/25 at 11:12 A.M., and on 08/26/25 at 1:18 P.M. revealed no indication that non-pharmacological interventions were attempted prior to medication administration or that Resident #13 experienced moderate to severe pain during care that did not subside after completion of personal care. Review of the MAR from September 2025 revealed Resident #13 was administered 5 mg of oxycodone by mouth on 09/06/25 at 7:46 P.M., on 09/09/25 at 8:00 A.M., and on 09/14/25 at 7:50 A.M. with pain rated as NA at the time of the medication administration. There were no pain interventions documented on the correlating shifts prior to the administration of the oxycodone. Further review of the MAR also revealed that no interventions were documented prior to the administration of oxycodone that was administered on 09/15/25 at 11:47 A.M. or on 09/18/25 at 10:15 P.M.Review of the linked eMAR progress notes dated 09/06/25 at 7:46 A.M., on 09/09/25 at 8:00 A.M., and on 09/14/25 at 7:50 A.M. revealed no indications Resident #13 experienced moderate to severe pain that did not subside with repositioning or completion of personal care or that any non-pharmacological interventions were attempted prior to administering Resident #13 oxycodone. Review of the MAR from October 2025 revealed Resident #13 was administered 5 mg of oxycodone by mouth on 10/05/25 at 9:29 P.M. and on 10/15/25 at 12:07 P.M. for pain rated between an five and six on a numerical pain rating scale (indicating moderate pain); however, there was no documentation that non-pharmacological interventions were attempted before medication administration and the corresponding eMAR progress notes contained no documentation of non-pharmacological intervention attempts. Review of the MAR from November 2025 revealed Resident #13 was administered 5 mg of oxycodone by mouth on 11/05/25 at 7:19 P.M. for a pain rated a one out of ten on the numerical pain rating scale (indicating mild discomfort) with no documented non-pharmacological interventions, no administration of acetaminophen for discomfort, and no progress note identifying that Resident #13 had uncontrolled pain which required administration of an opioid analgesic. Observation on 11/19/25 at 11:15 A.M. revealed Resident #13 resting soundly with no signs of discomfort and no stirring to verbal stimuli. Interview with Resident #13 on 11/20/25 from 9:37 A.M. to 9:47 A.M. revealed no report of pain and a history of neuropathy, for which Gabapentin was administered three times a day. During the interview, Resident #13 confirmed feeling pain during the provision of personal care by facility staff when they do not take their time or follow the resident's instructions. Resident #13 further stated that the staff who listen and take their time do not cause her to experience pain and that when pain does occur, the pain ceases once the care is completed or will, on occasion, last for a few minutes afterward but then settles without intervention or medication. Resident #13 verbalized that the intervention that most helps with pain is for staff to take their time during personal care and render care in the manner directed by Resident #13. During the interview, Resident #13 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 7 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete confirmed the use of oxycodone was not a preferred intervention. Interview on 11/25/25 at 1:24 P.M. with Certified Nurse Aide (CNA) #356 denied knowledge of Resident #13 requiring opioids for pain control, adding that Resident #13 does not experience much pain when care is performed properly and that the pain subsides once care is completed. Interview on 11/25/25 at 2:05 P.M. with CNA #322 confirmed that Resident #13 was able to make her needs known to staff well, when staff are patient and take their time. Further interview with CNA #322 revealed the only time Resident #13 complains of pain is during personal care and repositioning and that the pain subsides when care is completed. CNA #322 also stated Resident #13 likes her legs to be rubbed and does not like her feet touching the footboard, and if staff pull Resident #13 up in bed when needed and take the time to ease anxiety during care, there were no longer any signs or verbalization of discomfort. Interview on 11/25/25 at 2:27 P.M. with CNA #306 confirmed Resident #13 understood others and was easy to understand when staff took the time to listen. During the interview, CNA #306 stated that Resident #13 seemed to experience anxiety, versus pain, during personal care, and that the anxiety and signs of discomfort go away once care is completed. Interview on 11/25/25 at 2:34 P.M. with CNA #357 confirmed Resident #13 was able to make her needs known to staff and that it was anxiety, not pain, exhibited by Resident #13 during care. During the interview, CNA #357 further revealed Resident #13 typically exhibits no signs of pain once care is completed and Resident #13 is repositioned as she specified to staff. Interview on 11/25/25 at 4:00 P.M. with the Director of Nursing (DON) confirmed NA meant not applicable and was not an approved method of documenting a pain assessment. The DON further revealed a pain assessment should be conducted to assess and understand the level of pain experienced by the resident prior to administering pain medication and then confirmed, regarding NA on the MAR, that she was seeing that all over the place on the pain assessments. During the interview, the DON confirmed the MAR reflected the lack of consistent pain assessments prior to administration of an opioid analgesic and the lack of intervention attempts documented prior to pain medication administration to Resident #13. Further interview revealed Resident #13 was capable of making her needs known to staff and that the DON was aware that Resident #13 did not like the use of controlled substances. Review of the policy titled Pain Management last updated February 2023 revealed if a resident was assessed to have pain, the nurse was to explore both pharmacological and non-pharmacological interventions and implement the interventions listed in the resident's comprehensive care plan and professional standards of practice. The policy further specified that pain relief strategies should be appropriate for the type of pain or pain related symptoms. This deficiency represents non-compliance identified while investigating Complaint Number 1401319. Event ID: Facility ID: 366471 If continuation sheet Page 8 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, medical record review, and review of facility policy, the facility failed to ensure a medication error rate of less than five percent (%). This affected two residents (Residents #12 and #39) of five residents (Residents #5, #12, #13, #30, and #39) observed during medication administration when the observation resulted in an error rate of 8.33%. The facility census was 57.1. Review of the medical record for Resident #12 revealed an admission date of 12/06/23 with pertinent diagnoses including spinal stenosis, depression, type two diabetes mellitus, repeated falls, polyarthritis, nonexudative age-related macular degeneration, hyperlipidemia, obstructive reflux uropathy, essential (primary) hypertension, benign prostatic hyperplasia without lower urinary tract symptoms and gastro-esophageal reflux disease. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment completed on 09/02/25 revealed Resident #12 had intact cognition with no observed behaviors. Further review of the MDS revealed Resident #12 required setup or clean-up assistance for eating, oral care, and personal hygiene. High-risk medications included drugs from the antibiotic category. Review of the care plan dated 09/16/25 revealed Resident #12 had the potential for impaired skin integrity. Interventions included administration of medications and treatments as ordered. Further review of the care plan revealed Resident #12 had impaired cognitive function and impaired visual function with interventions including administration of medications as ordered and monitoring for side effects of medications. Review of the medication orders revealed the following medications were to be administered to Resident #12 in the mornings:- Acidophilus oral capsule, give one capsule by mouth two times daily for supplement, dated 02/10/25, scheduled for 7:00 A.M. to be administered by a clinician- Cipro 500 milligram (mg) oral tablet, give one tablet by mouth two times daily for seven days for urinary tract infection (UTI), dated 11/16/25 and scheduled for administration by a clinician in the mornings between 7:00 A.M. and 11:00 A.M.- PreserVision AREDS2 oral capsule, give one capsule by mouth two times a day related to macular degeneration, dated 07/10/24, scheduled for morning administration by a clinician, which included tome span between 7:00 A.M. and 11:00 A.M.- Oyster calcium with vitamin D3 tablet, 500 mg - five micrograms (mcg), give one tablet by mouth in the morning for supplement, dated 07/10/24, to be administered by a clinician between 7:00 A.M. and 11:00 A.M. - Atenolol 25 mg oral tablet, give one tablet by mouth each morning for hypertension, dated 07/10/24, to be clinician-administered between 7:00 A.M. and 11:00 A.M. - Senna 8.6 mg tablet, give one tablet by mouth in the morning for constipation, dated 08/28/25, to be clinician-administered between 7:00 A.M. and 11:00 A.M.- Lac-Hydrin five external lotion five percent (%) to be applied topically to bilateral lower extremities twice a day for dry skin, dated 04/18/25 in the morning at 8:00 A.M. by the clinician- Multivitamin with minerals oral tablet, give one tablet by mouth in the morning for supplement, dated 07/20/24 to be administered daily at 8:00 A.M. by the clinician- Vitamin D3 tablet 1,000 units, give one tablet by mouth in the morning for health maintenance, dated 07/16/24, scheduled for 8:00 A.M. for clinician administrationFish oil 1,000 mg oral capsule by mouth two times a day for supplement, dated 06/27/25, scheduled for clinician administration at 8:00 A.M. Observation on 11/20/25 of Licensed Practical Nurse (LPN) #303 preparing and administering medications for Resident #12 revealed, after checking Resident #12's blood pressure and pulse, LPN #303 dispensed the following medications into a clear plastic medicine cup between 9:03 A.M. and 9:08 A.M.:- Acidophilus 1billion units, one capsule- Multivitamin with minerals, one tablet- Atenolol 25 mg, one tablet- Vitamin D, 25 micrograms (mcg) (1,000 units), one tablet- Ciprofloxacin 500mg, one tablet- ProSight with zinc (the facility substitute for PresserVision AREDS2), one capsuleOystershell 500-5mg plus D, one tabletInterview on 11/20/25 at 9:08 A.M. with LPN #303 revealed the ordered Senna, 8.6 mg, was not in the medication cart. Observation Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 9 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few at this time revealed LPN #303 locking the prepared medication in the cart and leaving the unit at 9:09 A.M until returning at 9:15 A.M. Continued observation at that time revealed the new bottle of Senna was opened, dated, then one tablet was dispensed into the same medicine cup as the other seven pills. At 9:18 A.M., LPN #303 confirmed a total of eight pills were in the medication cup. Continued observation on 11/20/25 at 9:18 A.M. revealed LPN #303 entered the room of Resident #12, handed Resident #12 the medicine cup with the eight pills, verified Resident #12 had water, then left the room. Interview on 11/20/25 at 12:51 P.M. with Resident #12 revealed only pills were given at the time of the observation (at 9:19 A.M.) and Resident #12 was usure if lotion was applied to the legs that morning, stating I really can't remember getting it put on this morning.Interview on 11/20/25 at 3:29 P.M. with LPN #303 confirmed that Resident #12 had an order for Fish Oil that was supposed to be given twice daily, at 8:00 A.M. and at 8:00 P.M. Review of the progress note dated 11/20 25 at 3:57 P.M. revealed LPN #303 had identified the missed morning dose of fish oil and notified the Nurse Practitioner. Review of the Medication Administration Audit Report (MAAR) for Resident #12 for the morning medication administration pass on 11/20/25 revealed LPN #303 documented at 9:08 A.M. that all medications that were scheduled at 7:00 A.M. and 8:00 A.M., except Senna 8.6 mg fish oil 1,000 mg, were administered between 9:05 A.M. and 9:06 A.M. (these medications were observed being handed to Resident #12 at 9:19 A.M.). The documentation indicated Lac-Hydrin 5% lotion was administered to Resident #12's bilateral lower legs at 9:06 A.M., at the same time the oral medications were listed as administered. The MAAR further contained documentation that Senna 8.6 mg was administered to Resident #12 at 9:16 A.M. (documentation entered at 9:18 A.M.). There was no entry on the MAAR that fish oil 1,000 mg (scheduled for 8:00 A.M.) was administered the morning of 11/20/25. Review of the policy titled Medication Administration - General Guidelines last revised August 2014 revealed medications were to be administered as prescribed, the medication order should be verified against the medication label, and the person giving the medication was to ensure the right medication was given to the right resident, adhering to the right dose, right route, and right time. Further review of the policy revealed medications were to be administered within 60 minutes of the scheduled time, unless otherwise specified by the prescriber. The policy specified that the person administering the medications was to record medication administration on the MAR directly after the medications was administered.2. Review of the medical record for Resident #39 revealed an admission date of 12/20/24 with diagnoses including ossification of muscle, multiple sites (abnormal formation of bone within muscle tissue), subsequent encounter for closed fracture with routine healing of part of the neck of the right femur, paraplegia, neuromuscular dysfunction of the bladder, anemia, major depressive disorder, unspecified injury of the thoracic spinal cord from thoracic vertebrae seven through ten, and chronic pain due to trauma. Review of the annual Minimum Data Set (MDS) 3.0 assessment completed on 11/04/25 revealed Resident #39 had intact cognition. Further review of the MDS revealed Resident #39 required setup or cleanup for eating and received medications from high-risk categories, including antidepressant, opioid, antiplatelet, and anticonvulsant. Review of the orders revealed an order dated 12/20/24 for aspirin, 81 milligram (mg) capsules, give Resident #39 one capsule by mouth in the mornings for mild pain. Review of the care plan dated 11/23/25 revealed Resident #39 was at risk for pain related to paraplegia, neuropathy, spinal cord injury, right femoral neck fracture, ossification of the hip, and gout. Interventions included responding appropriately and timely to complaints of pain and assessing pain relief measures. Further review of the care plan revealed Resident #39 had an alteration in musculoskeletal status and interventions included providing analgesics as ordered by the physician. Observation on 11/20/25 from 8:15 A.M. to 8:25 A.M. of Resident #39's morning medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 10 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete administration by Registered Nurse (RN) #361 revealed that when the ordered aspirin, 81 mg oral capsule, was prepared for administration, the aspirin was dispensed from a bottled labeled aspirin 81 mg chewable tablet and placed in the same medication cup as the other morning medications in oral tablet and oral capsule forms. Further observation revealed Resident #39 poured the cupful of pills in his mouth, including the chewable aspirin, and swallowed the pills together with a gulp of water. Interview on 11/20/25 at 8:45 A.M. with RN #361 confirmed the aspirin was dispensed from a bottle indicating it was a chewable tablet and that the aspirin was placed in the same medication cup as the other oral tablets and capsules. Further interview confirmed that Resident #39 swallowed the aspirin, instead of chewing the aspirin. During the interview, RN #361 also confirmed the order was for an oral capsule and not chewable tablet and added that the facility did not carry the low dose aspirin in capsule form, just the enteric coated aspirin and the chewable tablets.Review of the policy titled Medication Administration - General Guidelines last revised August 2014 revealed medications were to be administered as prescribed, the medication order should be verified against the medication label, and the person giving the medication was to ensure the right medication was given to the right resident, adhering to the right dose, right route, and right time. This deficiency represents non-compliance investigated under Complaint #1401318. Event ID: Facility ID: 366471 If continuation sheet Page 11 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, medical record review, and review of facility policy, the facility failed to ensure medications were not left with a resident to take independently who was not approved to safely store or self-administer medications. This affected one resident (#12) of five residents observed and reviewed for medication administration. The facility census was 57.Findings include: Review of the medical record for Resident #12 revealed an admission date of 12/06/23 with pertinent diagnoses including spinal stenosis, depression, type two diabetes mellitus, repeated falls, polyarthritis, nonexudative age-related macular degeneration, hyperlipidemia, obstructive reflux uropathy, essential (primary) hypertension, benign prostatic hyperplasia without lower urinary tract symptoms and gastro-esophageal reflux disease.Review of the assessments revealed a Nursing: Self-Administration of Medications evaluation completed on 01/26/25 indicated Resident #12 could not safely administer all medications but could safely administer Pantoprazole and Synthroid only. The assessment did not indicate the ability to safely store medications at the bedside. Further review of the assessments revealed no follow-up evaluation was completed with the quarterly assessments.Review of the quarterly Minimum Data Set (MDS) 3.0 assessment completed on 09/02/25 revealed Resident #12 had intact cognition with no observed behaviors. Further review of the MDS revealed Resident #12 required setup or clean-up assistance for eating, oral care, and personal hygiene. High-risk medications included drugs from the antibiotic category. Review of the active medication orders revealed the following medications were to be administered to Resident #12 by a clinician with the morning medication pass:- Acidophilus oral capsule, give one capsule by mouth two times daily for supplement, dated 02/10/25, scheduled for 7:00 A.M. to be administered by a clinician- Cipro 500 milligram (mg) oral tablet, give one tablet by mouth two times daily for seven days for urinary tract infection (UTI), dated 11/16/25 and scheduled for administration by a clinician in the mornings between 7:00 A.M. and 11:00 A.M.- Preservision AREDS2 oral capsule, give one capsule by mouth two times a day related to macular degeneration, dated 07/10/24, scheduled for morning administration by a clinician, which included tome span between 7:00 A.M. and 11:00 A.M.- Oyster calcium with vitamin D3 tablet, 500 mg - five micrograms (mcg), give one tablet by mouth in the morning for supplement, dated 07/10/24, to be administered by a clinician between 7:00 A.M. and 11:00 A.M.- Atenolol 25 mg oral tablet, give one tablet by mouth each morning for hypertension, dated 07/10/24, to be clinician-administered between 7:00 A.M. and 11:00 A.M.Senna 8.6 mg tablet, give one tablet by mouth in the morning for constipation, dated 08/28/25, to be clinician-administered between 7:00 A.M. and 11:00 A.M.- Lac-Hydrin five external lotion five percent (%) to be applied topically to bilateral lower extremities twice a day for dry skin, dated 04/18/25 in the morning at 8:00 A.M. by the clinician- Multivitamin with minerals oral tablet, give one tablet by mouth in the morning for supplement, dated 07/20/24 to be administered daily at 8:00 A.M. by the clinician- Vitamin D3 tablet 1,000 units, give one tablet by mouth in the morning for health maintenance, dated 07/16/24, scheduled for 8:00 A.M. for clinician administration- Fish oil 1,000 mg oral capsule by mouth two times a day for supplement, dated 06/27/25, scheduled for clinician administration at 8:00 A.M.Observation on 11/20/25 from 9:03 A.M. to 9:18 A.M. of Licensed Practical Nurse (LPN) #303 preparing and administering medications for Resident #12 revealed the following medications were placed in a clear plastic medication cup: Acidophilus 1 billion units, one capsule; multivitamin with minerals, one tablet; Atenolol 25 mg, one tablet; vitamin D, 25 micrograms (mcg) or 1,000 units, one tablet; Ciprofloxacin 500 mg, one tablet; ProSight with zinc (the facility substitute for Preservision AREDS2), one capsule; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 12 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and Oystershell 500-5 mg plus D, one tablet. Interview with LPN #303 at the time of observation confirmed a total of eight pills were in the medicine cup for Resident #12. Observation on 11/20/25 between 9:18 A.M. and 9:19 A.M. revealed LPN #303 entered the room of Resident #12, handed Resident #12 the medicine cup containing eight pills, verified Resident #12 had water, and then left the room as Resident #12 was picking up the first pill from the medicine cup and placing it into his mouth. Continued observation revealed LPN #303 returned to the medication cart and began preparing medications for another resident in the hallway, with no view of Resident #12, from 9:19 A.M. to 9:20 A.M. LPN #303 then locked the medications cart and left the unit, stating a needed medication was not on the cart and needed picked up from the pharmacy. As LPN #303 was observed walking away from the unit at 9:20 A.M., Resident #12 was observed continuing to independently take the medications handed to him, one by one, until the last one was swallowed at 9:22 A.M. (LPN #303 was not on the unit at that time). Interview on 11/20/25 at 9:23 A.M. with Resident #12 confirmed the medicine cup with pills is sometimes left in the room for him and reported that some nurses did that because they know they can count on me and then added, I just took them all, referring to the pills. Interview on 11/20/25 at 9:35 A.M. with LPN #303 confirmed Resident #12 liked to take time to look at each pill, one by one, and let his wife know what each pill was that he received. During the interview, LPN #303 confirmed handing the medication cup with pills to Resident #12, verifying a drink was available to help swallow the pills, and leaving after he began taking the pills, though LPN #303 also denied that the medication was left at the bedside or that the medications were not considered nurse-administered, reasoning that the pills were handed directly to Resident #12 in the medication cup, after already being dispensed by the nurse from the containers. Further interview confirmed LPN #303 did leave the unit just after leaving the medications with Resident #12.Review of the list of residents the facility identified as able to self-administer medications did not include Resident #12. Review of the policy titled Self-Administration of Medications last revised August 2014 revealed the ability to self-administer medications was to be reassessed on a quarterly basis and with a significant change in condition.This deficiency represents non-compliance investigated under Complaint Number 1401318. Event ID: Facility ID: 366471 If continuation sheet Page 13 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview, and facility policy review, the facility failed to ensure a resident's admission was timely completed and failed to ensure routine assessments were completed as required. This affected three residents (#60, #2, and #61) of six residents reviewed for accuracy of medical records. The facility census was 57. Findings include: 1. Review of the closed medical record for Resident #60 revealed an admission date of 07/12/25 and a discharge date of 07/24/25. Diagnoses included but were not limited to rhabdomyolysis, sepsis, hydronephrosis, dysfunction of bladder, and elevated white blood cell count. Review of the hospital discharge instructions dated 07/11/25 for Resident #60 revealed medication orders for Albuterol 90 micrograms (mcg) inhaler as needed, Amlodipine 5 milligram (mg) oral tablet to be taken by mouth twice a day, Ceftriaxone 500 mg oral tablet to be given by mouth twice daily for ten days. Doxazosin 2 mg oral tablet to be given by mouth twice daily, finasteride 5 mg oral tablet to be given by mouth daily, Metoprolol tartrate 50 mg oral tablet to be given by mouth twice daily, multivitamin one tablet by mouth once daily, Protonix 40 mg delayed release tablet to be given by mouth daily, Xarelto 20 mg tablet by mouth daily with evening meal, Zocor 40 mg tablet to be given by mouth at bedtime, Spironolactone 50 mg oral tablet to be given by mouth at breakfast, tamsulosin 0.4 mg oral capsule to be given by mouth twice daily, and Spiriva Respimat 60 mcg per inhalation aerosol two puffs to be given daily as needed for shortness of breath. Review of the admission assessment dated [DATE] timed at 10:07 A.M. opened by Licensed Practical Nurse (LPN) #319 for Resident #60 revealed the assessment was not complete. The information contained in the assessment was populated from a previous admission in 2023 and did not contain current information. Review of the physician orders for Resident #60 revealed an order dated 07/12/25 timed at 7:09 P.M. had been entered for Amlodipine Besylate tablet 10 mg by mouth one time a day for hypertension, Pantoprazole sodium tablet delayed release 40 mg by mouth one time a day for acid reflux, Simvastatin tablet 40 mg tablet by mouth at bedtime for hyperlipidemia, and Tamsulosin hydrochloride capsule 0.4 mg by mouth one time a day for benign prostatic hyperplasia (BPH). Review of the physician orders for Resident #60 revealed an order dated 07/12/25 timed at 7:29 P.M. entered for Doxazosin Mesylate 4 mg oral tablet by mouth two times a day for blood pressure. Review of the physician order for Resident #60 revealed an order dated 07/12/25 timed at 7:31 P.M. for Finasteride 5 mg oral tablet by mouth in the evening for BPH. Review of the physician order for Resident #60 revealed an order dated 07/12/25 timed at 7:41 P.M. for Rivaroxaban 20 mg oral tablet by mouth in the evening for anticoagulation. Review of the nursing progress note dated 07/12/25 timed at 8:08 P.M. written by LPN #319 for Resident #60 revealed he was admitted to the facility at 10:00 A.M. Vitals and a head-to-toe assessment were noted to be completed and documented. Review of the nursing progress noted dated 07/13/25 timed at 8:40 A.M. revealed Licensed Practical Nurse (LPN) #371 assisted LPN #372 with Resident #60 who was found to be sideways wedged between the two head rails and there was noted blood on the floor. Resident #60 was able to be repositioned in the bed and was noted to have a dent on the top of his head with a small lump on the side of the dent. Resident #60 stated he had been hallucinating. LPN #371 called the physician and received an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 14 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0842 order to send Resident #60 out to a local hospital for evaluation. Level of Harm - Minimal harm or potential for actual harm Review of the nursing progress note dated 07/13/25 timed at 10:38 A.M. revealed LPN #371 spoke with the emergency room physician who stated Resident #60 was sent to the hospital without paperwork. LPN #371 updated the physician on Resident #60's status. Residents Affected - Few Review of the July 2025 Medication Administration Record (MAR) for Resident #60 revealed only three of the physician-ordered medications with a start date of 07/12/25 were listed. Two Amlodipine Besylate oral tablet 2.5 mg oral tablets were noted as being given at 8:00 P.M. on 07/12/25, Doxazosin Mesylate oral tablet 4 mg by mouth was noted as not being given and to see nurses notes, and Tamsulosin HCl oral capsule 0.4 mg was given at 8:00 P.M. Review of Resident #60's care plan revealed it was initiated on 07/12/25 but not completed. Review of the 07/18/25 admission Minimum Data Set (MDS) 3.0 for Resident #60 revealed he had intact cognition. Resident #60 was noted to require maximum assistance from staff for toileting, bathing, dressing and transfers and was also noted to have an indwelling catheter. Telephone interview on 11/24/25 at 11:10 A.M. with LPN #371 revealed on the night of 07/12/25, she was working on another unit and was approached by two other nurses for help. When she entered Resident #60's room, there was blood on the floor, Resident #60 was sideways in the bed with his head wedged against the bed rail and his feet pushing against the other bed rail. They were able to get Resident #60 turned in the bed and noticed an indentation on his head from being wedged against the bed rail. The blood was noted to be from his intravenous (IV) access site. LPN #371 stated she attempted to review the physician orders, but they were in the queue and not completed or activated. LPN #371 called the physician and received orders to send Resident #60 out for evaluation. LPN #371 told LPN #372 to call for transport. LPN #371 also confirmed she received a phone call from Resident #60's hospital physician later the same day stating he was sent without any paperwork and asked for information as to what had happened prior to being sent to the hospital. Telephone interview on 11/24/25 at 12:25 P.M. with LPN #372 revealed she worked on the night of 07/12/25, it was her first day at the facility and she was having difficulty with her computer access for medical records and had notified management. LPN #372 had flushed Resident #60's IV as ordered and left his room to assist another resident. An aide, whom she did not recall their name, stated she needed help. When she entered Resident #60's room, he had turned himself sideways in the bed and was wedged between the railings near the top of the bed and he was pushing with his feet which pushed his head further against the other railing. Resident #60 had torn his IV site cap off and it bled onto the floor. LPN #372 stated she called 911 due to him being confused, pulling out the IV cap, and due to the indentation on his head from being wedged in the bed railings. LPN #372 stated she tried to find his initial nursing assessment but was unable to and confirmed no paperwork was sent with Resident #60 when he was transported to the local hospital. Telephone interview on 11/24/25 at 1:45 P.M. with LPN #319 confirmed when a resident is admitted they do a head-to-toe assessment, obtain vital signs, complete the admission assessment, and make a documentation note in the electronic medical record. LPN #319 confirmed the admission assessment should be completed within an hour of a resident's admission to the facility. LPN #319 did not recall Resident #60 and did not recall if admission paperwork or an assessment was completed. Interview on 11/24/25 at 2:02 P.M. with the Director of Nursing (DON) confirmed the admission (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 15 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assessment for Resident #60 was not completed and also confirmed physician orders for medications were not entered until at least 10 hours after admission and not all ordered medications were entered. Interview on 11/24/25 at 4:06 P.M. with Regional Director of Clinical #373 confirmed the admission assessment for Resident #60 was not completed and only had information from his previous admission in 2023. Regional Director of Clinical #373 also confirmed the admission assessment should have been completed within a couple hours of admission, medications should have been entered sooner than 10 hours after admission, and paperwork should have been sent with Resident #60 when he was sent to the hospital. Review of the November 2022 revised facility policy called; Admission, Discharge and Transfer revealed the facility will provide for a safe and appropriate admission, transfer and discharge as needed. Review of the December 2022 facility policy called; EHR Records and Documentation revealed the medical record shall reflect a resident's progress toward achieving their person-centered plan of care objectives and goals and the improvement and maintenance of their clinical, functional, mental and psychosocial status. The licensed nurse will document on all new admissions by documenting in the admission UDA (PCC) within 24 hours. The medical record should provide sufficient information for staff to respond to the changing status and needs of the resident. 2. Resident #2 was admitted on [DATE] and had a re-entry date of 12/11/24. Diagnoses included chronic obstructive pulmonary disease (COPD), respiratory failure, obstructive sleep apnea, anxiety disorder, cirrhosis of the liver, asthma, anemia, essential (primary) hypertension, personal history of neoplasm of the bladder, centrilobular emphysema, dependence on supplemental oxygen, gastrostomy status, and chronic pain syndrome. Review of the facility incident logs revealed Resident #2 had an unwitnessed fall on 07/05/25. Review of the clinical assessment history revealed the Nursing: Fall Risk Assessment - V 1 was completed on 09/22/24, 12/08/24, and 07/05/25 (Resident #2 was discharged and readmitted to the facility on [DATE]). There was no evidence that the fall risk assessment had been completed upon facility readmission or quarterly for Resident #2 for the current facility stay, until the fall that occurred on 07/05/25. Review of the quarterly MDS 3.0 assessment completed on 11/04/25 revealed Resident #2 had intact cognition, used a wheelchair for locomotion, and required moderate assistance with transfers. Further review of the MDS revealed Resident #2 had no history of falls since admission, re-entry, or completion of the previous comprehensive assessment. Interview on 11/24/25 from 9:00 A.M. to 9:15 A.M. with the DON revealed uncertainty as to the frequency that the fall risk assessments were to be completed, but would be checking the policy to make that determination. A follow-up interview on 11/25/25 between 4:20 P.M. and 4:30 P.M. with the DON confirmed no admission or quarterly fall risk assessments had been completed since Resident #2's rea-entry date of 12/11/24 and that the only assessment completed since re-entry was on 07/05/25, after Resident #2's fall. 3. Review of the medical record for Resident #61 revealed an initial admission date of 03/07/25 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 16 of 17 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 366471 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avenue at Broadview Heights 1201 Akins Road Broadview Heights, OH 44147 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a discharge date of 11/12/25. Review of the Clinical Census revealed Resident #61 was out of the facility for greater than 24 hours, beginning on 10/13/25, with re-entry listed as 10/15/25. Pertinent diagnoses included multiple sclerosis, chronic obstructive pulmonary disease (COPD), neuromuscular dysfunction of the bladder, type two diabetes mellitus, hypertensive heart and chronic kidney disease with heart failure, Stage three chronic kidney disease, anxiety disorder, major depressive disorder, post laminectomy syndrome, and primary osteoarthritis of the right knee. Review of the incident logs revealed Resident #61 had an unwitnessed fall on 09/20/25. Review of the clinical assessment history revealed Resident #61 had a Nursing: Fall Risk Assessment - V 1 completed on 03/11/25 for the initial admission and did not have another fall risk assessment completed until 09/20/25 after sustaining an unwitnessed fall. There was no record of quarterly fall risk assessments or a fall risk assessment being completed with readmission on [DATE]. Review of the Discharge with Return Anticipated Minimum Data Set (MDS) 3.0 assessment completed on 10/13/25 revealed Resident #61 had moderate cognitive impairment and was dependent for transfers. Further review of the MDS revealed Resident #61 had one fall with injury since admission, re-entry or the last assessment. Interview on 11/25/25 between 4:20 P.M. and 4:30 P.M. with the DON confirmed there had been no quarterly or readmission fall risk assessments completed between Resident #61's initial admission date and the date of the fall (09/20/25). Review of the policy titled Fall Management last updated December 2022 revealed a licensed nurse was to assess each resident for fall risk through the Fall Risk Assessment on admission, quarterly, and with significant changes. This deficiency represents non-compliance investigated under Complaint Numbers 2560788 and 1401316. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366471 If continuation sheet Page 17 of 17