Inspection·February 29, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations, interviews, and record reviews the facility failed to ensure Resident #12 and Resident #46's rooms were kept clean and sanitary environment. This affected two residents (#12 and #46) of four residents reviewed for physical environment. The facility census was 86. Findings Include: 1. Observation on 02/26/24 at 9:00 A.M. of Resident #46's room revealed food crumbs on the floor around the bed and recliner. The bathroom had feces on the floor that appeared someone had stepped in it and tracked it in bathroom, feces on the front of toilet seat, the toilet lid, and on the wall behind the toilet. Observation on 02/27/24 at 10:26 A.M. of Resident #46 room revealed all above concerns from the day before were still present. The bathroom and room had not been cleaned. Interview on 02/27/24 at 10:35 A.M. with Housekeeper (HK) #532 and HK#545 stated rooms are to be cleaned daily, which concise of sweeping, mopping, dusting, and cleaning the bathroom. HK #532 and HK #545 stated they did not work on 02/26/24. Interview on 02/27/24 at 10:41 A.M. with Housekeeping Director (HD) #504 verified Resident #46's room did not get cleaned 02/26/24, and she did not have staff to clean all the rooms. She stated they could use at least one more housekeeping staff, so all resident rooms get cleaned daily. Review of the housekeeping cleaning schedule for 02/26/24 revealed Resident #46's room was not cleaned on 02/26/24. 2. Observation on 02/26/24 at 11:40 A.M. of Resident #12's bathroom shower revealed a brownish stain on floor and two dry, dirty, white washcloths. Resident #12's family stated the dirty washcloth had been there for the past two to three weeks. Observation revealed the resident's floor was dirty, and the bed was not made. The floor had various crumbs throughout the room including around the bed and underneath the bed. Follow-up observation on 02/27/24 at 11:01 A.M. of Resident #12's room revealed the brownish stain was still on bathroom shower floor, but the two dirty washcloths were removed. The resident's room floor was still dirty with crumbs. Interview on 02/27/24 at 12:11 P.M. with HD #504 revealed resident rooms were to be cleaned daily. Observation at this time of Resident #12's with HD #504 verified the brown stain on shower floor and the various crumbs throughout the room around and under the bed. HD #504 stated she was told Resident #12's room was cleaned yesterday and stated it would be taken care of. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366491 If continuation sheet Page 2 of 7 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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 observation, interview, record review, and facility policy review, the facility failed to respond to Resident #61's change in condition. This affected one resident (#61) of 21 residents reviewed for change in condition. The facility census was 86. Residents Affected - Few Findings Include: Resident #61 was admitted to the facility on [DATE] with diagnoses including dementia without behaviors, cirrhosis of the liver, diabetes, heart disease, hypothyroidism, and high blood pressure. Review of the quarterly comprehensive Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #61 was severely cognitively impaired and required extensive care of one to two people for all personal care, including eating. Interview with Resident #61's significant other, who is the resident's Power of Attorney (POA), on 02/26/24 at 12:15 P.M. revealed the resident declined significantly over the last four days. Today was the worst he had been in those four days. The POA said he had increased congestion in his chest and had a history of pneumonia and urinary tract infections (UTIs). She comes every day at lunchtime because she is worried no one will feed him if she does not come. Observation of Resident #61 during lunch in his room on 02/26/24 at 12:15 P.M. revealed the resident was unresponsive to voice or touch. The POA attempted to give the resident some Boost (supplement), and the resident took a sip then startled awake and jumped straight up in his wheelchair, opened his eyes wide, coughed, and then returned to his unresponsive state. Unit Manager (UM) #502 brought in Resident #61's lunch tray a few minutes later. The POA then updated UM #502 with the same information she had told this surveyor. This surveyor informed UM #502 of the resident's reaction when given a sip of Boost. UM #502 left the room and returned with nectar thick juice (a thickening agent used to make liquids similar in texture to fruit nectars). UM #502 assessed Resident #61, watched the POA remove food from the resident's right cheek, and then advised the POA not to attempt to feed him anything else, including drinks. UM #502 said she would notify the nurse practitioner regarding the resident's decline. Review of the progress notes dated 02/26/24 through 02/27/24 for Resident #61 revealed no documentation from UM #502 regarding her assessment of the resident or of the information provided by the POA. No documentation was found indicating the resident's nurse practitioner or physician were notified of the resident's change in status. Social Worker (SW) #503 documented the POA wished to have a hospice consult. No documentation from 02/26/24 and 02/27/24 indicated the physician/nurse practitioner had been notified of the resident's change in status, a speech therapy referral or any new orders had been obtained since 02/26/24. Interview with the Director of Nursing (DON) on 02/29/24 at 11:30 A.M. revealed she was sure the nurse must have notified the physician/nurse practitioner and confirmed it should have been documented along with the provider's response. The DON also confirmed a speech evaluation should have been completed due to Resident #61's change of condition in swallowing. Interview with UM #502 on 02/29/24 at 2:00 P.M. revealed she must have gotten sidetracked which is why she forgot to document her assessment but would enter a late entry now. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366491 If continuation sheet Page 3 of 7 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Review of the facility's Resident Change in Condition policy, last revised 07/28/22, revealed the purpose of the policy was to ensure staff provided timely and appropriate care and services when residents experience a change in condition that has or is likely to cause serious life-threatening harm or injuries and/or adverse negative health outcomes. When a significant or acute change is identified in a resident's physical, mental, or psychosocial status the nurse will notify the attending physician regarding the change in condition once an assessment of the resident has been completed. The nurse will document any changes in the resident's medical condition or status in the resident's medical record. If a significant change in the resident's physical or mental condition occurs, a comprehensive assessment of the resident's condition will be completed. Event ID: Facility ID: 366491 If continuation sheet Page 4 of 7 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility policy review, the facility failed to ensure appropriate diagnoses for the use of psychotropic medications and failed to ensure behaviors were tracked for one resident (#61) of five residents reviewed for psychotropic medication usage. The facility census was 86. Findings Include: Resident #61 was admitted to the facility on [DATE] with diagnoses including dementia without behaviors, cirrhosis of the live, diabetes, heart disease, hypothyroidism, and high blood pressure. Review of the quarterly comprehensive Minimum Data Set 3.0 assessment, dated 01/01/24, revealed Resident #61 was severely cognitively impaired and required extensive care of one to two people for all personal care, including eating. Review of the physician's orders for Resident #61 revealed on 02/09/24 an order was written for Sertraline (an antidepressant) 25 milligrams (mg) once a day for agitation. Sertraline is prescribed for depression. On 02/12/24 an order was written for Seroquel (an antipsychotic medication used to treat dementia with behavioral disturbance) 12.5 mg orally every 12 hours as needed for 60 days for dementia without behavioral disturbance. Seroquel is ordered for dementia with behavioral disturbance. On the same date an order was written for Acetaminophen (a medication for pain/fever) 500 mg give two tablets orally three times a day for agitation. Review of the nursing documentation for Resident #61 revealed no documentation regarding why Seroquel 12.5 mg as needed was ordered on 02/12/24. There was also no documentation regarding behaviors other than the resident had a behavior, but there was no indication as to what the behavior was or what was done to redirect the behavior. Interview with the Director of Nursing (DON) on 02/29/24 at 11:30 A.M. confirmed the diagnoses the Sertraline, Acetaminophen, and the as needed Seroquel were all inappropriate diagnoses for dementia without behavioral disturbance. Review of the facility's Psychotropic Drug Use policy, last revised November 2017, revealed the resident prescribed a psychotropic medication must have a specific reason for why it is ordered. An as needed antipsychotic medication order is limited to 14 days and will not be renewed unless the prescribing physician evaluates the resident in person for the appropriateness of the medication. The policy addresses the only appropriate diagnoses that can be used for any antipsychotic and dementia without behaviors is not an approved diagnosis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366491 If continuation sheet Page 5 of 7 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 3. Resident #61 was admitted to the facility on [DATE] with diagnoses including dementia without behaviors, cirrhosis of the liver, diabetes, heart disease, hypothyroidism, and high blood pressure. Review of the quarterly comprehensive Minimum Data Set (MDS) 3.0 assessment, dated 01/01/24, Resident #61 was severely cognitively impaired and required extensive care of one to two people for all personal care, including eating. Interview with Resident #61's significant other, who is the resident's Power of Attorney (POA), on 02/26/24 at 12:15 P.M. revealed the resident had declined significantly over the last four days. This day was the worst he had been in those four days. The POA said he had increased congestion in his chest and had a history of pneumonia and urinary tract infections (UTIs). She comes every day at lunchtime because she was worried no one would feed him if she did not come. Observation of Resident #61 during lunch in his room on 02/26/24 at 12:15 P.M. revealed the resident was unresponsive to voice or touch. The POA attempted to give the resident some Boost (supplement), and the resident took a sip then startled awake and jumped straight up in his wheelchair, opened his eyes wide, coughed, and then returned to his unresponsive state. Unit Manager (UM) #502 brought in Resident #61's lunch tray a few minutes later. The POA then updated UM #502 with the same information she had told this surveyor. This surveyor informed UM #502 of the resident's reaction when given a sip of Boost. UM #502 then left the room. The POA removed the lid from the resident's lunch tray and revealed a plated filled with brown food and Brussel sprouts. Review of the meal ticket revealed the brown food was a breaded pork chop and cheesy hashbrowns. The resident's lunch also included Brussel sprouts, juice, and milk. The pork chop was pre-cut into large pieces. The POA said the facility always gives him Brussel sprouts and spinach both of which she has told DM #506 he did not like several times, yet they continue to give it to him. Review of Resident #61's menu ticket revealed the ticket was marked no Brussel sprouts. The ticket also indicated the resident was to receive double portion and to cut the food to bite size pieces. The POA said she has requested gravy be put over his potatoes and entrée as they were always very dry, but that has not happened. UM #502 entered the room with nectar thick (a thickening agent is added to the liquid to reach a fruit nectar) juice. UM #502 confirmed the meal ticket was not followed. Observation of Resident #61's lunch tray on 02/28/24 at 12:15 P.M. included ground roast beef with mashed potatoes with gravy over both, peas and carrots, and mandarin oranges. The resident did receive double portions, diet Coke and water. The POA said she requested milk and wrote it at the top of the meal ticket in blue ink as they always forget to give the resident milk. No milk was included with his lunch. Review of the meal ticket revealed milk was written in blue ink at the top of the ticket, and four ounces of milk was also checked to be added to the tray. Interview with DM #506 on 02/28/24 at 2:57 P.M. revealed he had spoken several times with Resident #61's POA about dietary preferences. They just changed his meal texture to mechanical soft with ground meat and gravy. He began working for the facility a few months earlier and he has been working with the staff to improve their service. DM #506 confirmed the staff needs improvement in matching the menu ticket to what is on the tray. Based on observation, interview, and record review the facility failed to ensure tray ticket (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366491 If continuation sheet Page 6 of 7 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 366491 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Strongsville Healthcare and Rehabilitation 18936 Pearl Road Strongsville, OH 44136 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 0803 Level of Harm - Minimal harm or potential for actual harm accuracy and preferences were followed affecting three residents (#23, #61, and #70) observed during dining observations and had the potent to affect four residents (#4, #36, #58, and #74)identified by the facility who received a pureed diet. The facility census was 86. Findings Include: Residents Affected - Some 1. Review of the medical record for Resident #23 revealed an admission date of 03/29/23. Diagnoses included dementia without behavioral disturbance, diabetes mellitus due to underlying condition with diabetic neuropathy, dysphagia (difficulty swallowing), and muscle weakness. Review of the February 2024 physician orders for Resident #23 revealed an active order dated 03/30/23 for low concentrated sweets diet, pureed texture, and thin liquids consistency. 2. Review of the medical record for Resident #70 revealed and admission date of 03/14/23. Diagnoses included type II diabetes mellitus with diabetic chronic kidney disease, dysphagia, pharyngeal phase, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, anxiety, and muscle weakness (generalized). Review of the February 2024 physician orders for Resident #70 revealed active order dated 06/29/23 for no added salt (NAS) diet, regular texture, and thin liquids consistency. All foods cut up, extra sauce and gravy for meats. Review of the menu and menu extension for lunch on 02/28/26 revealed roast beef au jus, chive mashed potatoes, peas and carrots, and bread stick. The pureed meal included pureed roast beef au jus, pureed mashed potatoes, pureed carrots, and pureed bread stick. Observation on 02/28/24 at 11:23 A.M. of tray line service, observed Dietary [NAME] (DC) #527 plate a pureed meal for Resident #23 included pureed roast beef, pureed carrots, and mashed potatoes but no pureed bread. Observed DC #527 plate Resident #70's meals with pea and carrots, mashed potatoes, and roast beef. DC #527 cut up the roast beef. Gravy was not added to any of the meal items. Resident #70's tray ticket revealed typed and circled extra gravy and sauces. At 11:24 A.M. Assisted Director of Nursing (ADON) #501 served Resident #23 and #70 their meals. Interview on 02/28/24 at 11:28 A.M. with ADON #501 verified Resident #23 did not receive a pureed bread stick and Resident #70 did not receive gravy on or with her meal. Interview on 02/28/24 at 11:32 A.M. with Dietary Manager (DM) #506 stated the pureed bread was not made but was in process of being done at this time. DM #506 stated the gravy was cooked with the beef that's why it was sent out dry, but they were now sending out bowls of gravy. Review of the order listing report dated 02/26/24 revealed four additional residents (#4, #36, #58, and #74) also received a pureed diet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366491 If continuation sheet Page 7 of 7