Inspection·February 26, 2024

F 0550 like it. Level of Harm - Minimal harm or potential for actual harm 3. Review of the medical record for Resident #109 revealed an admission date of 02/13/24 with diagnoses that included type two diabetes, alcoholic cirrhosis of the liver without ascites, and other postprocedural endocrine and metabolic complications and disorders. Residents Affected - Some Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #109 had a Brief Interview Mental Status (BIMS) score of nine that indicated he had cognitive impairment. The assessment also revealed Resident #109 was independent for activities of daily living (ADLs). Review of the care plan dated 01/20/24 revealed Resident #109 had a behavior problem with interventions that included to approach and speak to in a calm manner. Observation on 02/20/24 at 9:35 A.M. revealed Resident #109 entering the courtyard designated for resident smoke breaks. STNA #834 was observed following behind Resident #109, opening the door to the courtyard and yelling Did you get a breakfast tray! Resident #109 appeared pleasant and was observed smiling in response to STNA #834's inquiry while saying No. STNA #834 was then observed yelling at Resident #109 in a blunt and abrupt tone Why are you laughing? I am being dead serious as she stormed off. Observation revealed Licensed Practical Nurse (LPN) #898 staring at STNA #834 with her mouth ajar. Interview on 02/20/24 at 9:40 A.M. with LPN #898 confirmed the interaction between STNA #834 and Resident #109. LPN #898 said she watched the entire encounter between STNA #834 and Resident #109. LPN #898 revealed she could not believe what she had just witnessed and found it strange that STNA #834 acted that way. Interview on 02/20/24 at 9:43 A.M. with Resident #109 confirmed STNA #834 yelled at him regarding his breakfast tray. 4. Review of the medical record for Resident #9 revealed an admission date of 09/26/23 with diagnoses that included Crohn's disease of both the small and large intestine, Crohn's disease of the large intestine with fistula, and moderate protein-calorie malnutrition. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #9 had a Brief Interview Mental Status (BIMS) score of 15 that indicated she was alert and oriented to person, place, and time. Review of the care plan dated 01/03/24 revealed Resident #9 required assistance with activities of daily living (ADLs) and had a behavior problem with interventions that included approaching and speaking to in a calm manner. Interview on 02/20/24 at 10:14 A.M. with Resident #9 revealed the previous week, Activities Aide (AA) #954 was talking with another resident. Resident #9 heard AA #954 say that snake over there as she was pointing at her. Resident #9 asked what that meant and AA #954 would not answer her. Resident #9 became upset and told Human Resource (HR) #876 and Activities Director (AD) #859. Resident #9 observed AA #954 being escorted out of the building a little while later. Interview on 02/20/24 at 10:28 A.M. with HR #876 revealed she had been made aware of what Resident #9 said happened and informed the Administrator and subsequently AA #954 was suspended. HR #876 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 2 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0550 revealed the investigation related to Resident #9's allegation was ongoing. Level of Harm - Minimal harm or potential for actual harm 5. Interview on 02/20/24 at 1:44 P.M. with Licensed Practical Nurse (LPN) #898 revealed she had been aware of resident complaints regarding Registered Nurse (RN) #831 being rude, not answering call lights and being on her phone most times. Residents Affected - Some Review of RN #831's personnel file revealed she was reprimanded for poor attitude and had 10 unidentified residents complaints about her customer service. Review of the facility document titled Resident Rights effective 08/11/17, revealed the policy indicated staff would provide care in a safe and respectful manner, that included but not limited to speaking respectfully to residents. This deficiency represents non-compliance investigated under Complaint Number OH00151242, OH00150858 and OH00150571. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 3 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0551 Give the resident's representative the ability to exercise the resident's rights. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident record review, observation and staff interview, the facility failed to ensure reasonable requests made by a resident's guardian were honored. This affected one (#1) of one resident reviewed for reasonable requests made by a guardian. The facility census was 131. Residents Affected - Few Findings include: Review of the medical record for Resident #1 revealed an admission date of 11/27/23 with diagnoses that included quadriplegia, acute and chronic respiratory failure with hypoxia, tracheostomy status, traumatic subdural hemorrhage with loss of consciousness of unspecified duration and contractures of the left and right hip and left and right knee. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #1 was severely impaired for task of daily life and was dependent on staff for activities of daily living (ADLs). Review of the care plan dated 01/31/24 revealed Resident #1 required assistance with ADLs related to quadriplegia and a traumatic brain injury. Review of the progress note dated 01/11/24 timed 9:51 A.M. revealed a care conference was held on 01/09/24 with Resident #1's appointed guardian. Review of the progress note revealed Resident #1's guardian requested Resident #1 be up in his chair for a couple of hours per day. Review of the progress note dated 02/09/24 timed 10:02 A.M. revealed Resident #1's guardian requested Resident #1 be out of bed daily with his helmet on when out of bed. Observation on 02/14/24 at 7:30 A.M., 8:00 A.M., 10:45 A.M., and 2:45 P.M. revealed Resident #1 was in bed. Interview on 02/14/24 at 4:10 P.M. with Registered Nurse (RN) #828 confirmed Resident #1 remained in bed and had not been gotten out of bed and into his chair. Interview on 02/16/24 at 10:00 A.M. with Licensed Practical Nurse (LPN) #804 revealed Resident #1's guardian requested, during his care conference, to have him up in his chair. Review of the facility document titled Resident Rights effective 08/11/17, revealed that a legal guardian had the right to make important decisions on the resident's behalf and take part in care planning. This deficiency represents non-compliance investigated under Complaint Number OH00150571. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 4 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 observation, resident interviews, staff interviews, and facility policy review, the facility failed to maintain a clean and sanitary environment. This affected seven (#17, #89, #90, #110, #111, #112, #113, and #115) residents and had the potential to affect all residents. The facility census was 131. Findings include: Observation on 02/14/24 at 5:24 A.M. revealed a food cart with multiple dirty dinner dishes located on the second floor. Interview on 02/14/24 at 5:31 A.M. with State Tested Nurse Assistant (STNA) #941 confirmed the dirty dishes in the hall and stated she was not aware of who was supposed to take them down to the kitchen. STNA #941 believed the dishes should have been taken down to the kitchen on the previous shift because dinner was done by the time she arrived for her shift. Observation of Resident #115's room on 02/14/24 at 5:37 A.M. revealed the wall underneath the air conditioning (AC) unit had a large amount of chipped paint. Interview with STNA #941 at the time of the observation confirmed the chipped paint. Observation of Resident #17's room on 02/14/24 at 8:25 A.M. revealed a packet of jelly and butter smashed into the floor. Observation of Resident #17's room on 02/15/24 at 5:19 A.M. revealed the same jelly packet was on the floor as the previous day's observation. Interview with STNA #924 confirmed the finding at the time of the observation. Observation of the first floor dining room, located near the designated smoking area, on 02/15/24 at 5:45 A.M. revealed four carts on wheels with old meal trays stacked on each shelf. Interview on 02/15/24 at 6:05 A.M. with Licensed Practical Nurse (LPN) #955 revealed the kitchen doors were locked at night and there was no way to access the kitchen. The STNAs collected the meal trays at night and left them in the first floor dining room until kitchen staff arrived in the morning. Observation on 02/15/24 at 7:05 A.M. revealed Resident #111 was in his room urinating on the floor next to his bed. Resident #111 resident was not interviewable. Interview on 02/15/24 at 10:45 A.M. with Resident #112 revealed his room was dirty and he cleaned his bathroom himself. Resident #112 said his bathroom door and entry door to his room were never cleaned and had multiple hand and fingerprints on them. Observation, at the time of the interview, revealed the bathroom door and entry door to Resident #112's room had multiple white colored smudges and what appeared to be hand and fingerprints on the doors. Interview on 02/15/24 at 10:55 A.M. with STNA #834 confirmed Resident #112's bathroom and entry room doors had smudges and hand/fingerprints on them. Interview on 02/15/24 at 11:00 A.M. with Housekeeper (HSKP) #958 revealed she cleaned resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 5 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some rooms, common areas, and high contact surfaces daily. HSKP #958 revealed she had already cleaned the second floor units where the rooms of Residents #112, #113, #110 and #111 were located. HSKP #958 said she had swept and mopped all floors, changed the garbage, and dusted all needed areas. Tour of the second floor units with HSKP #958, at the time of the interview, revealed the bathroom and entry doors to Resident #112 and #113's room were not cleaned. Observation of Resident #110 and #111's room revealed surgical gloves, crumbled paper, a small plastic bag, other unidentifiable debris and trash on the floor and the floor had a dried sticky substance on it where Resident #111 had urinated. HSKP #958 confirmed the observations. On 02/20/24 at 8:16 A.M. a strong urine odor was noted outside of Residents #89 and #90's room. Observation at this time revealed Resident #89 was not present in the room but a large, dried, yellow stain was present on Resident #89's blanket and sheets. Observation of Resident #80 and 90's room on 02/20/24 at 8:24 A.M. with Unit Manager (UM) #804 revealed, Resident #89 was present in the room. UM #804 asked Resident #89 if her sheets were dirty and she stated yes. UM #804 asked Resident #89 what happened and Resident #89 stated oh you know and requested new sheets. UM #804 confirmed Resident #89's blanket and sheets had dried yellow stains and the room had a urine odor. Review of the facility document titled HCSG Cleaning Procedures 5 & 7 Step and Isolation Room Cleaning undated, revealed the facility had a cleaning procedure in place to ensure the resident environment was cleaned and sanitized properly. Review of the document revealed housekeeping staff were to collect trash, sweep, mop, and to spot clean all vertical surfaces including doors, handles and knobs. Review of the document revealed the facility did not implement the policy in regard to the allegation. This deficiency represents non-compliance investigated under Complaint Number OH00150858 and OH00150571. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 6 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 Based on observation, interview, record review, and personnel file review, the facility failed to ensure medications were administered according to accepted standards of practice. This affected one resident (#10) identified during a random observation. The facility also failed to ensure pain medications were administered as ordered by the physician and requested by the resident. This affected two of 14 sampled residents (#21 and #22). The facility census was 131. Residents Affected - Few Findings include: 1. Observation on 02/14/24 at 9:09 A.M. revealed Unit Manger/Licensed Practical Nurse (LPN) #848 at a medication cart preparing medications for administration. LPN #848 was observed popping pills out of medication cards into a medication cup. LPN #848 handed the medication cup to Registered Nurse (RN) #828, who took the medications into Resident #10's room. Interview with LPN #848 at time observation revealed she was helping RN #828 with her medication pass. Interview on 02/14/24 at 10:31 A.M. with RN #828 revealed she administered the medications given to her by LPN #848 to Resident #10. RN #828 explained she was running behind on her medication pass and LPN #848 was helping her. RN #828 did not verify the medications that were given to her and did not sign them off as administered in the computer. Review of facility's undated Medication Administration policy revealed staff were not to administer medications prepared by others. 2. Interview on 02/20/24 at 11:06 A.M. with Resident #21 revealed Registered Nurse (RN) #831 did not administer his medication a few nights ago. Resident #21 requested oxycodone (used to treat moderate to severe pain) and RN #831 said the medication was unavailable. Resident #21 did not report this to facility staff. Review of Resident #21's Medication Administration Record (MAR) for February 2024 revealed his 02/18/24 evening medications were scheduled to be given at 9:00 P.M. The evening medications were documented by RN #831 as administered at 1:39 A.M. on 02/19/24 and there was no documentation the oxycodone was administered. Review of RN #831's personnel file revealed a write up dated 03/06/23 indicating the facility investigated resident complaints of not receiving their medications timely. 3. Interview on 02/20/24 at 1:44 P.M. with Licensed Practical Nurse (LPN) #898 revealed she had been told by some residents Registered Nurse (RN) #831 did not always administer their medications as scheduled/ordered. Resident #22 often complained of pain related to her diagnoses. Resident #22 was upset a few days ago and stated RN #831 did not administer her pain medication, Dilaudid (used to treat moderate to severe pain). LPN #898 had checked the Medication Administration Record (MAR) and RN #831 had not signed off as having administered Dilaudid to Resident #22. Review of Resident #22's MAR for February 2024 revealed evening medications on 02/18/24 were scheduled at 9:00 P.M. and were documented by RN #831 as given on 02/19/24 at 12:02 A.M. and 1:53 A.M. The was no documentation the Dilaudid was administered. Review of RN #831's personnel file revealed a write up dated 03/06/23 indicating the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 7 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 investigated resident complaints of not receiving their medications timely. Level of Harm - Minimal harm or potential for actual harm This deficiency represents non-compliance investigated under Complaint Number OH00151242 and OH00150571. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 8 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 - Some 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** 5. Review of the closed medical record for Resident #136 revealed she was admitted to the facility on [DATE] and discharged on 12/16/23. Resident #136 had diagnoses that included traumatic subdural hemorrhage without loss of consciousness, type two diabetes mellitus and chronic kidney disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #136 had a Brief Interview for Mental Status (BIMS) score of four indicating severe cognitive impairment. Review of the care plan dated 02/22/21 revealed Resident #136 was incontinent of urine with interventions that included to observe for signs and symptoms of urinary tract infection (UTI) such as pain, burning, urine cloudiness, fever, altered mental status, foul smelling urine and to report to medical provider if identified. Review of the progress note dated 12/06/23 timed 1:00 A.M. revealed Resident #136 was seen by the physician and an urinalysis was ordered to rule out a UTI related to increased confusion. Review of the physician orders dated 12/06/23 revealed an order to obtain a urinalysis for Resident #136 due to increased confusion and possible UTI. Review of the progress note dated 12/07/23 timed 6:56 P.M. revealed staff were not able to obtain a urine sample from Resident #136 and the order was reentered into the electronic medical record (point click care). Review of the progress note dated 12/08/23 timed 6:35 A.M. revealed Resident #136's order to collect a urine sample for possible UTI was to be discontinued once collected. Review of the progress note dated 12/08/23 timed 12:06 P.M. revealed the lab had already been at the facility and Resident #136's urine sample would have to be collected on Sunday (12/10/23) for Monday (12/11/23) pick up. Review of the progress note dated 12/11/23 timed 6:27 A.M. revealed a urine sample had not been obtained for Resident #136. Review of the progress note dated 12/11/23 timed 7:13 P.M. revealed Resident #136 missed the the specimen hat for urine collection and the amount collected was not enough to send out for analysis. Review of the progress note dated 12/12/23 timed 6:23 A.M. revealed Resident #136's order to collect a urine sample for possible UTI was to be discontinued once collected. Review of the progress note dated 12/12/23 timed 6:51 P.M. revealed a urine sample could not be collected and an order was obtained to collect a sample using a straight catheter. Review of the progress note dated 12/15/23 timed 6:46 P.M. revealed Resident #136's urinalysis results were reported to the physician. Review of Resident #136 urinalysis lab results dated 12/15/23 revealed the urine was positive for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 9 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 klebsiella pneumoniae. Further review of the lab results revealed a collection date of 12/13/23. Level of Harm - Minimal harm or potential for actual harm Review of the progress note dated 12/16/23 timed 5:00 A.M. revealed the facility was awaiting pending results of urine culture. Residents Affected - Some Review of the infection control log dated December 2023 revealed no listing for Resident #136 having a UTI. Review of the Infection Control Surveillance Criteria Report assessment dated [DATE] revealed no information related to Resident #136 having a UTI. Interview on 02/21/24 at 2:44 P.M. with the Director of Nursing (DON) revealed she could not speak to why Resident #136's UTI was not followed-up on and why the UTI was not included on the infection control logs for the month of December 2023. The DON revealed staff were to complete infection control surveillance assessments in point click care but Resident #136 did not have an infection control surveillance assessment in place. The DON confirmed all the aforementioned findings at the time of the interview. This deficiency represents non-compliance investigated under Complaint Number OH00150858 and OH00150571. Based on observation, interview and record review, the facility failed to ensure ongoing monitoring and timely intervention for residents with symptoms of urinary tract infections and failed to provide timely and appropriate incontinence care and toileting assistance. This affected one (#115) of two residents reviewed for urinary catheters, and four (#15, #17, #117 and #136) of four residents reviewed for incontinence. The facility census was 131. Findings include: 1. Review of Resident #115's medical records revealed an admission date of 09/16/22. Diagnoses included obstructive uropathy (a disorder of the urinary tract that occurs due to obstructed urinary flow). Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #115 had intact cognition, had a urinary catheter and was incontinent of bowel. Review of the care plan dated 01/16/24 revealed Resident #115 had a urinary catheter. Interventions included report signs and symptoms that included foul smelling urine to the physician. Review of an urinalysis report for Resident #115 revealed a collection date of 02/07/24 and a reported date of 02/07/24. The urinalysis report showed signs of a urinary tract infection (UTI) and indicated the sample was possibly contaminated. Review of current physician orders for February 2024 revealed no order for a repeat urinalysis or antibiotics. Observation of incontinence care on 02/14/24 at 5:31 A.M. for Resident #115 with State Tested Nurse Aide (STNA) #941 revealed when STNA #941 opened Resident #115's urinary catheter drainage bag to empty it a strong, pungent foul odor was immediately detected. STNA #941 confirmed the odor and stated she was not sure what was causing the odor. At the time of the observation Resident #115 stated he had a UTI but was not receiving antibiotics. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 10 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 - Some Observation of Resident #115 on 02/20/24 at 8:24 A.M. with unit manager/Licensed Practical Nurse (LPN) #804 confirmed the strong, foul, pungent odor from Resident #115's urinary catheter drainage bag. LPN #804 stated Resident #115 was warm to the touch and his eyes appeared to be sunken in. LPN #804 obtained a set of vital signs. Resident #115's heart rate was 136 (normal range between 60-100) and temperature was 99.1 degrees Fahrenheit (F) (normal 98.6 degrees F). Review of the urinalysis report with LPN #804 confirmed the results indicated signs of a UTI and possible contamination. LPN #804 indicated a repeat specimen should have been obtained and sent for analysis. 2. Review of Resident #15's medical records revealed an admission date of 02/03/24. Diagnoses included difficulty walking and anxiety. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #15 had intact cognition, was dependent for toileting and incontinent of bowel and bladder. Review of the care plan dated 02/14/24 revealed Resident #15 required two of more staff for toileting. Observation on 02/15/23 at 12:03 P.M. revealed a call light on outside of Resident #15's room and Resident #15 was noted to be groaning. During interview with Resident #15, at the time of observation, the resident stated I'm so uncomfortable, it feels like something is under my back. Resident #15 asked if someone could assist her with repositioning. Upon exiting Resident #15's room STNA #910 was observed sitting in a common area outside of Resident #15's room. Interview with STNA #910 revealed she was aware Resident #15 had complaints of pain and had informed the nurse. STNA #910 stated she had repositioned Resident #15 approximately an hour ago. STNA #910 entered Resident #15's room with STNA #948 and began to assist Resident #15 with repositioning and while reposition the resident, STNA #910 noted Resident #15 was on a bed pan. Both STNA #910 and #948 denied they had placed Resident #15 on the bed pan. STNA #910 removed the bed pan and further observation revealed Resident #15 was wearing an incontinence brief. STNA #910 stated she sometimes placed residents on bedpans without removing their incontinence briefs in order to avoid the residents making a mess in their beds; however, STNA #910 had not placed Resident #15 on the bedpan without removing the incontinence brief, another staff must have. STNA #910 proceeded to remove the incontinence brief which contained stool. Interview with Resident #15 at time of observation revealed she had been placed on the bed pan approximately two hours ago. Resident #15 refused to provide the name of the staff member who had placed her on the bed pan; she stated I'm not a snitch. 3. Review of Resident #117's medical records revealed an admission date of 02/09/22. Diagnoses included left sided paralysis, dementia and muscle weakness. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #117 had impaired cognition and was incontinent of bowel and bladder. Review of the care plan dated 12/11/23 revealed Resident #117 had bowel and bladder incontinence. Interventions included provide assistance with toileting as needed and provide peri-care after each incontinence episode. Observation of incontinence care on 02/15/24 at 7:58 A.M. with STNA #838 for Resident #117 revealed Resident #117 was incontinent of a large amount of stool that was dried in some areas. STNA #838 stated she had not provided incontinence care for Resident #117 since the beginning of her shift at 7:00 A.M. and STNA #838 did not know when incontinence care was last provided. Resident #117 was combative during care and refused interview. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 11 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 - Some 4. Review of Resident #17's medical records revealed an admission date of 11/09/23. Diagnoses included right femur fracture and tracheostomy. Review of Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 had impaired cognition and was incontinent of bowel and bladder. Review of the care plan dated 01/31/24 revealed Resident #17 was incontinent of bowel and bladder. Interventions included check resident for incontinence. Interview on 02/14/24 at 6:07 A.M. with State Tested Nursing Assistant (STNA) #869 revealed while working her shifts she observed numerous residents who were heavily soiled with urine. STNA #869 sent an email to Human Resources (HR) #876 to inform her of her concerns but received no response. Review of the email with STNA #869 revealed an email dated 01/18/24 timed 1:08 A.M. which was sent to HR #876 indicating all of the residents on STNA #869 's assignment needed bed changes and bed baths and they were nasty. Interview on 02/14/24 at 11:46 A.M. with HR #869 revealed she had not received an email regarding concerns of resident care not being completed. Observation on 02/15/24 at 5:19 A.M. revealed a call light was on outside of Resident #17's room. Interview with Resident #17 at time of observation revealed he needed bathroom assistance. At the time of interview STNA #924 entered Resident #17's room and STNA #924 began assisting Resident #17. Further observation revealed Resident #17 had been incontinent of urine and the urine had saturated through his incontinence brief onto his sheets. STNA #924 stated she was not aware Resident #17 had been incontinent and stated Resident #17 usually used his call light for assistance. STNA #924 was not sure when Resident #17 had last been changed or toileted because another STNA also provided care for Resident #17. Interview on 02/15/24 at 6:10 A.M. with STNA #869 revealed she had changed Resident #17's incontinence brief and bed linens at approximately 8:00 P.M. the previous evening because Resident #17's bedding was soaked with urine. STNA #869 stated she assisted Licensed Practical Nurse (LPN) #875 with Resident #17's tracheostomy care at approximately 4:00 A.M. but had not provided Resident #17 with incontinence care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 12 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and policy review, the facility failed to appropriately care for a Percutaneous Endoscopic Gastrostomy (PEG) tube site to identify, lessen or resolve possible skin irritation and local infection. This affected one (#115) of two residents reviewed for PEG tubes. The facility census was 131. Findings include: Review of Resident #115's medical records revealed an admission date of 09/16/22. Diagnoses included gastrostomy (artificial opening in the abdomen for nutrition). Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #115 had intact cognition and required extensive assistance with activities of daily living (ADL). Review of the care plan dated 01/1/6/24 revealed Resident #1 had a PEG tube. Interventions included provide insertion site care per orders. Observation of Resident #115 on 02/14/24 at 5:37 A.M. with State Tested Nursing Assistant (STNA) #941 revealed Resident #115 had a PEG tube. Observation of the PEG tube insertion site revealed there was not a dressing and a large amount of dried brown debris was noted around the tube insertion site. STNA #941 confirmed the observation and stated she did not perform care of PEG tube sites and she would inform the nurse. Observation of Resident #115 on 02/20/24 at 8:24 A.M. with unit manager/Licensed Practical Nurse (LPN) #804 revealed a gauze dressing around Resident #115's PEG tube insertion site. LPN #804 removed the gauze dressing and a large amount of dried brown debris was observed. Interview with Resident #115 at the time of observation revealed a nurse had come in that morning and put the dressing on the site without cleaning around the tube site. This observation was confirmed with LPN #804 who stated PEG tube sites were to be cleaned daily and as needed. Review of facility's undated policy titled Care of the Enteral Tube Site revealed direction to change dressing daily or more frequently if soiled. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 13 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 respiratory care equipment was at the resident's bedside for immediate access. This affected two (#1 and #17) of two residents reviewed for tracheostomy care. The facility census was 131. Residents Affected - Few Findings include: 1. Review of Resident #17's medical records revealed an admission date of 11/09/23. Diagnoses include tracheostomy and dysphasia (difficulty swallowing). Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 had impaired cognition. Review of the care plan dated 01/31/24 revealed Resident #17 had a tracheostomy. Interventions included keep an extra trach at the bedside and provide suctioning per orders. Review of current physician orders for February 2024 revealed to suction resident every shift and as needed. Observation on 02/14/24 at 8:38 A.M. revealed Resident #17 was exhibiting signs of inability to clear his airway. At the time of observation Licensed Practical Nurse (LPN) #866 was present and confirmed Resident #17 was having difficulty clearing his airway. During the observation unit manager/LPN #848 entered Resident #17's room and stated Registered Nurse (RN) #828 was on her way to the room. Resident #17 continued to show signs of inability to clear his airway. LPN #848 stated she could not locate a suctioning kit in the room, exited the room and returned without a suctioning kit. Continued observation revealed an unknown staff member knocking on the door and handing three suctioning kits to LPN #848. At 8:45 A.M., RN #828 entered Resident #17's room and Resident #17 was suctioned. The suctioning procedure removed a large amount of secretions from Resident #17's airway. Upon completion of the suctioning procedure Resident #17 refused an interview. Interview with LPN #848 revealed residents with tracheotomies were to have a suctioning kit available in their rooms. 2. Review of Resident #1's medical records revealed an admission date of 11/27/23. Diagnoses included tracheostomy,quadriplegia and respiratory failure. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 was rarely understood. Review of the care plan dated 01/31/24 revealed Resident #1 had a tracheostomy. Interventions included provide trach care and suctioning per orders. Review of current physician orders for February 2024 revealed an order to suction Resident #1 every shift and as needed. Observation on 02/14/24 at 9:09 A.M. with Licensed Practical Nurse (LPN) #848 revealed Resident #1 had a tracheostomy and was non verbal. Further observation revealed LPN #848 could not locate a suctioning kit in the resident's room. LPN #848 stated Resident #1 should have a suctioning kit available in his room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 14 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 and policy review, the facility failed to ensure medications were not left unattended in resident rooms. This affected one (#72) of three residents whose rooms were randomly observed for unsecured medications. The facility census was 131. Findings include: Observation on 02/14/24 at 7:28 A.M. revealed Resident #72 was sleeping in bed, with a cup of medications on his bedside table that contained three pills. Observation of the medication cup in Resident #72's room on 02/14/24 at 7:31 A.M. with Unit Manager/Licensed Practical Nurse (LPN) #804 confirmed there were three pills in the medication cup. LPN #804 identified two of the pills being Resident #71's thyroid medication but was unable to identify the third pill. LPN #804 stated she had educated the nursing staff on not leaving medications at the residents' bedside previously. Review of facility's undated policy titled Medication Administration revealed medications should not be left unattended. This deficiency represents non-compliance investigated under Complaint Number OH00151242. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 15 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews, and menu review, the facility failed to serve hot, palatable, and visibly pleasing foods. This affected Residents #17, #19, #20, #28, #34, #108, and had the potential to affect all residents, except Residents #23, #25, #63, #100, and #115 who were identified as not consuming food by mouth (NPO). The facility census was 131. Residents Affected - Many Findings include: Interview with Resident #28 on 02/14/24 at 6:18 A.M. revealed the facility's food had no flavor and he wouldn't feed it to a dog. Interview with Resident #19 on 02/15/24 at 7:40 A.M. revealed the facility's food was terrible. Interview with Resident #17 on 02/15/24 at 7:57 A.M. revealed the facility's food was cold and not hot enough. Observation on 02/15/24 at 10:00 A.M. with State Tested Nursing Assistant (STNA) #948 revealed she was using the first floor unit microwave behind the nursing station adjacent to Resident #17's room. Interview with STNA #948, at the time of the observation, revealed Resident #20's food was cold and Resident #20 requested that it to be warmed up. Review of the facility menu for the week of 02/11/24 to 02/17/24 revealed the lunch meal for 02/15/24 consisted of crispy baked chicken, cheese quiche, macaroni and cheese, sauteed spinach, sliced parsley carrots, dinner rolls and/or bread, and pumpkin pie. Observation of kitchen tray line on 02/15/24 at 1:17 P.M. revealed a pan of crispy baked chicken with the pieces of chicken ranging in sizes from small to large. The breading was falling off the chicken and the pieces were flimsy. Dietary [NAME] (DC) #957 was grimacing and shaking her head as she plated the lunch meal. Interview with DC #957, at the time of the observation, revealed she did not know why the chicken looked the way it did or why the chicken sizes varied. DC #957 continued to plate the meals placing various sized pieces of chicken on the plates as the chicken was falling apart. After the last resident meal was plated there was no macaroni and cheese or sauteed spinach left; therefore, macaroni and cheese and sauteed spinach could not be tested for flavor or palatability. In addition there was no macaroni and cheese or sauteed spinach available if second helpings were requested. Completion of a test tray with Dietary Manager (DM) #812 on 02/15/24 at 1:30 P.M. revealed the tray consisted of mashed potatoes, Brussel sprouts, and crispy baked chicken. The mashed potatoes, Brussel sprouts and crispy baked chicken had little to no seasoning, was bland, and without flavor. The Brussel sprouts measured an internal temperature of 124 degrees Fahrenheit, and the crispy baked chicken measured an internal temperature of 115 degrees Fahrenheit, and both tasted cold. DM #812 verified the findings of the test tray at the time the test tray was completed. Interview on 02/20/24 at 8:08 A.M. with Resident #34 revealed he took a picture of his food on 02/16/24 because he was given two pieces of raw bacon. Resident #34 said he reported it to everyone including the Administrator, Director of Nursing (DON) and the staff nurses. Interview on 02/20/24 at 8:20 A.M. with Resident #108 revealed he could not identify a food item on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 16 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0804 Level of Harm - Minimal harm or potential for actual harm his breakfast tray. Observation at the time of the interview revealed a brownish colored formed substance that looked like sawdust and the edges of the food item appeared dry. Resident #108 picked up the item and was unable to tear it in half. Observation of Resident #108's meal ticket revealed the meal consisted of scrambled eggs with cheese and a turkey sausage patty. Resident #108 said he would not eat it because he did not know what it was. Residents Affected - Many Observation and interview on 02/20/24 at 8:24 A.M. with Unit Manager (UM) #804 verified the observation of the unknown food item on Resident #108's tray. UM #804 said she would call the kitchen and have them send Resident #108 a new tray without the item on it. Review of a list provided by the facility revealed Residents #23, #25, #63, #100, and #115 were identified as not consuming food by mouth (NPO). This deficiency represents non-compliance investigated under Complaint Number OH00150571. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 17 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, resident record review, printed meal ticket review, and policy review, the facility failed to ensure food was prepared in the correct form to meet resident needs. This affected one (#17) of one resident reviewed for appropriate diet texture. The facility census was 131. Findings include: Review of the medical record for Resident #17 revealed an admission date of 11/09/23 with diagnoses that included fracture of right femur, tracheostomy status, and dysphagia (difficulty swallowing) oropharyngeal stage. Review of the Diet History Food Preferences assessment dated [DATE] revealed Resident #17 had issues with swallowing and was on a pureed diet. Review of the physician orders dated 11/20/23 revealed Resident #17 had a current order for a regular diet, dysphagia pureed texture with nectar thick liquids consistency for nutrition. Review of the Dietary Nutritional assessment dated [DATE] revealed Resident #17 was on a pureed diet with a history of chewing and swallowing issues. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #17 had memory impairment, was dependent on staff for activities of daily living (ADLs), was moderately impaired for decisions regarding tasks of daily life and was on a mechanically altered diet. Review of the care plan dated 01/31/24 revealed Resident #17 was on a mechanically altered diet that consisted of dysphagia puree and nectar liquids with interventions to provide meals per diet order. Observation and interview on 02/14/24 at 8:25 A.M. revealed Resident #17 sitting in his room eating his breakfast. Resident #17's breakfast included scrambled eggs in a soft mechanical texture. Resident #17 was observed to have a continuous cough while having difficulty clearing his airway. Licensed Practical Nurse (LPN) #866 was informed Resident #17 was having difficulty clearing his airway. LPN #866 entered the room and indicated Resident #17 needed suctioned. Interview and observation on 02/14/24 at 8:42 A.M. with Unit Manager (UM) #848 revealed Resident #17 had an upcoming appointment to have his tracheostomy capped. UM #848 confirmed the scrambled eggs served to Resident #17 for breakfast were a soft mechanical texture. UM #848 said Resident #17 received the appropriate diet and could have scrambled eggs. Interview on 02/15/24 at 7:35 A.M. with LPN #846 revealed Resident #17 was on a mechanical soft diet. Interview on 02/15/24 at 7:36 A.M. with LPN #928 revealed Resident #17 was on a pureed texture, nectar thick diet. Observation and interview on 02/15/24 at 7:50 A.M. with State Tested Nurse Aide (STNA) #903 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 18 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed Resident #17's breakfast tray arrived and consisted of mechanical chopped soft pancakes, pureed sausage with gravy, pureed cream of wheat and nectar thick orange juice. Review of the facility printed meal ticket on Resident #17's meal tray revealed Resident #17 was to receive a regular diet, dysphagia pureed textured and nectar thick liquids. The meal ticket indicated Resident #17's breakfast tray should have consisted of pureed buttermilk pancakes, pureed sausage patty with brown gravy, pureed oatmeal cereal, nectar thick milk, orange juice, coffee, or hot tea. STNA #903 verified Resident #17's breakfast tray and meal ticket did not match. Interview on 02/15/24 at 7:53 A.M. with UM #848 confirmed Resident #17's breakfast tray consisted of mechanical pancakes and did not match his meal ticket. Interview on 02/15/24 at 11:28 A.M. with Speech Therapist (ST) #901 revealed Resident #17 had multiple barium swallow trials with inconsistent results and a history of hospitalizations due aspiration pneumonia and insufficient oral motors due to surgeries. Resident #17 was high risk for aspiration and was recommended no food by mouth (NPO); however, after his last hospitalization, he received a physician order for the least restricted diet which consisted of a puree and nectar thick diet. ST #901 did not currently work with Resident #17 due to his risk of aspiration. Interview on 02/15/24 at 12:00 P.M. with Dietary Manager (DM) #812 revealed all resident meal tickets were printed and were followed and tracked for accuracy. Review of the facility document titled Meal Distribution revised February 2023, revealed all meals would be assembled in accordance with the individualized diet order, plan of care, and preferences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 19 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0810 Provide special eating equipment and utensils for residents who need them and appropriate assistance. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident record review, observations, and staff interviews, the facility failed to ensure assistive devices were in place for meals. This affected three (#97, #125 and #126) of three residents reviewed for assistive devices during meals. The facility census was 131. Residents Affected - Some Findings include: Observation of the lunch meal tray line on 02/15/24 at 1:17 P.M. with Kitchen [NAME] (KC) #957 revealed the meal tickets of three residents (#97, #125, and #126) were set to the side. The meal tickets indicated the assistive devices each resident required with meals. Continued observation revealed KC #957 looking throughout the kitchen for the required assistive devices. Interview with KC #957, at the time of the observation, revealed Residents #97 and #126 required a scoop plate and Resident #125 required a divided plate and they had already used the assistive plates that were available, there were no more assistive plates. Observation and interview on 02/15/24 at 1:23 P.M. with the Administrator, who was assisting with tray line, revealed she told KC #957 to use regular plates for Residents #97, #125, and #126. The Administrator revealed the kitchen ran out of assistive plates and needed to order more. Observation revealed lunch meal trays for Residents #97, #125, and #126 were plated on regular plates, placed on the meal cart, and exited the kitchen. The Administrator confirmed the above findings at the time of the observation. Review of the medical record for Resident #97 revealed she admitted to the facility on [DATE] with diagnoses that included hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left nondominant side, chronic obstructive pulmonary disease and dysphagia oropharyngeal phase. Review of the physician orders dated 09/01/22 revealed Resident #97 had an order in place to receive a regular textured diet, thin consistency with a scoop plate for meals. Review of the Dietary Nutritional assessment dated [DATE] revealed Resident #97 was able to eat independently with setup of required adaptive equipment of a scoop plate. Review of the annual Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #97 had a Brief Interview for Mental Status (BIMS) score of 15 that indicated she was alert and oriented to person, place, and time. The MDS assessment revealed Resident #97 required setup and cleanup assistance with eating. Review of the care plan dated 01/27/24 revealed Resident #97 was at risk for malnutrition related to dysphagia with interventions that included the need for adaptive equipment, scoop plate, and to provide meals per diet order. Review of the medical record for Resident #125 revealed he was admitted to the facility on [DATE] with diagnoses that included disorder of the brain, epilepsy, and dysphagia oral phase. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #125 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 20 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 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 0810 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some alert and oriented with some cognition impairment, required setup for eating and was on a mechanically altered diet. Review of the physician orders dated 01/25/24 revealed a current order to use divider plates for all meals. Review of the Dietary Nutritional assessment dated [DATE] revealed Resident #125 was able to eat independently with setup and required a divided plate in place for all meals. Review of the care plan dated 02/13/24 revealed Resident #125 was at risk for malnutrition with interventions that included a need for a mechanically altered diet, meals provided per diet orders, and a divider plate for all meals. Review of the medical record for Resident #126 revealed he was admitted to the facility on [DATE] with diagnoses that included type two diabetes mellitus, encephalopathy, and chronic kidney disease. Review of the physician orders dated 09/13/23 revealed an order for Resident #126 to utilize a scoop plate and two handled mugs with lids for all meals to improve independence with feeding. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #126 had a Brief Interview Mental Status score of six that indicated cognitive impairment and was on therapeutic diet. Review of the care plan dated 01/21/24 revealed Resident #126 was at risk for malnutrition with interventions that included provide assistance with meals, provide meals per diet order, and provide adaptive equipment as needed. Review of the Dietary Nutritional assessment dated [DATE] revealed Resident #126 required a scoop plate for all meals. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 21 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and staff interview, the facility failed to ensure staff wore hair coverning when in the kitchen. This had the potential to affect all residents, except Residents #23, #25, #63, #100, and #115 who were identified as not consuming food by mouth (NPO). The facility census was 131. Findings include: Observation and interview on 02/15/24 at 1:00 P.M. revealed Kitchen Aide (KA) #814 entering the kitchen from the door located near the first floor dining room and walking from one side of the kitchen to the opposite side entrance, near the front entrance of the facility, without a hairnet in place. Interview with KA #814 revealed she went to get something to drink and did not want to walk all the way around to reenter the kitchen. Interview on 02/21/24 at 9:40 A.M. with Corporate Dietary Manager (CDM) #959 revealed there were no hairnets for kitchen staff use located at the entry to the kitchen from the first floor dining room. Review of the facility provided list revealed Residents #23, #25, #63, #100, and #115 were identified as not consuming food by mouth (NPO). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 22 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review and review of personnel file, the facility failed to ensure staff who clocked in for work with symptoms of Covid-19 were immediately tested and or sent home. This had the potential to affect all residents. The facility also failed to ensure urinary catheter drainage bags were not placed on the floor. This affected one (#85) of two residents reviewed for urinary catheters. The facility census was 131. Residents Affected - Many Findings include: 1. Review of Resident #85's medical records revealed an admission date of 12/15/23. Diagnoses included stroke with left sided weakness, and muscle weakness. Review of the Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #85 had impaired cognition, had an indwelling urinary catheter and was incontinent of bowel. Review of the care plan dated 12/22/23 revealed Resident #85 had an indwelling urinary catheter related to obstructive uropathy (disorder of the urinary tract that occurs due to obstructed urinary flow). Interventions included position catheter bag below the level of the bladder. Observation on 02/15/24 at 7:52 A.M. revealed Resident #85 was sleeping in bed and his urinary catheter was on the floor under his bed. This observation was confirmed with Licensed Practical Nurse (LPN) #892 who stated the catheter should not have been placed on the floor. LPN #892 picked up Resident #85's urinary catheter and hung it on the resident's bed rail. Review of facility policy titled Catheter Care undated, revealed to check that collection bag is not on the floor. 2. Interview on 02/20/24 at 10:28 A.M. with Human Resources (HR) #876 revealed Receptionist #954 was written up due to a Covid situation. Receptionist #954 came to work with symptoms of Covid and worked her entire shift after being told she needed to test for Covid. Receptionist #954 did not test until the end of her shift and reported the results were positive. Interview on 02/21/24 at 1:36 P.M. with the Director of Nursing (DON) and the infection preventionist, Licensed Practical Nurse (LPN) #848 revealed Receptionist #954 presented to work with symptoms of Covid in December 2023. The DON stated staff were not to report to work if they had Covid symptoms. The DON was not present on the date Receptionist #954 worked with symptoms of Covid but did sign Receptionist #954's disciplinary write up. The DON stated the Administrator informed Receptionist #954 to test but Receptionist #954 did not follow the directive and did not test. The DON stated according to the write up Receptionist #954 worked the entire shift then completed the Covid test which was positive. LPN #848 stated she was present at the facility on the date Receptionist #954 worked with Covid symptoms but was not notified of the situation. LPN #848 did not see Receptionist #954 at anytime during the shift. Interview on 02/21/24 at 3:10 P.M. with the Administrator revealed she was present the day Receptionist #954 came to work with symptoms of Covid; however, the Administrator did not see Receptionist #954 at any time that day. Review of Receptionist #954's write up dated 12/26/23 with the Administrator revealed it was the first time she had seen the write up and the Administrator was not aware of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 23 of 24 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 365192 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Health Center 6455 Pearl Rd Parma Heights, OH 44130 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many who told Receptionist #954 to test during the shift. The Administrator indicated she did not receive a phone call from Receptionist #954 but someone did call (could not recall who) to inform her Receptionist #954 had tested positive for Covid. Once the Administrator was aware Receptionist #954 was positive for Covid she advised that Receptionist #954 should leave the facility immediately. Review of Receptionist #954's personnel file revealed a write up dated 12/26/23 that indicated at the beginning of the shift on 12/18/23 at 8:00 A.M. Receptionist #954 was told to test for Covid due to being symptomatic. Receptionist #954 was told again in the afternoon to test for Covid and still did not. At 4:30 P.M., Receptionist #954 was told by HR #876 to test and again did not but went outside for a smoke break. The write up further indicated Receptionist #954 called the Administrator at 6:17 P.M. and stated she was positive and the Administrator told her to leave immediately. The Administrator received a phone call at 6:46 P.M. from the therapy director indicating Receptionist #954 remained at the facility and was observed walking the halls with her mask down below her chin. Review of the facility policy titled Criteria for Covid-19 Requirements revised 05/11/23 revealed all who entered and had any signs or symptoms of Covid, a positive test or had close contact with an individual diagnosed with Covid was to report to the clinical leader or charge nurse This deficiency represents non-compliance investigated under Complaint Number OH00150571. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365192 If continuation sheet Page 24 of 24