Inspection·April 24, 2024

F 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to ensure Resident #135 received appropriate discharge instructions. This finding affected one resident (#135) of three residents reviewed for discharge instructions. Residents Affected - Few Findings include: Review of the medical record revealed Resident #135 was admitted on [DATE] and discharged on 03/29/24 with diagnoses including diabetes, essential hypertension, and muscle weakness. Review of Resident #135's Report and Decision of the Hearing Officer form dated 02/22/24 revealed the resident won the appeal, and the facility may not discharge and transfer the resident based on non-payment. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #135 exhibited intact cognition. Review of the Notice of Discharge and Transfer form dated 02/28/24 revealed Resident #135 was being discharged for an unpaid balance of $11,520.00. The resident did not appeal the second notice. Review of the progress note dated 03/19/24 at 10:22 A.M. indicated Resident #135 was encouraged to come talk with Licensed Social Worker (LSW) #808 about the discharge. The resident reported that he would come later. Review of an email dated 03/21/24 at 2:09 P.M. from Regional Director of Finance #813 to LSW #808 revealed the email was a follow-up to make sure there were solid plans in place for Resident #135's discharge before the end of the month. The resident's last covered day was on 01/25/24. Review of an email dated 03/22/24 at 9:32 A.M. from LSW #808 to Regional Director of Finance #813 indicated Resident #135 was introduced to a group home owner yesterday, and he was unwilling to have a conversation with him. Review of Resident #135's progress note dated 03/25/24 at 1:54 P.M. indicated the durable medical equipment (DME) would be delivered to the facility on [DATE]. Review of the progress note dated 03/29/24 at 4:08 P.M. indicated Resident #135 was discharged home with all belongings, prescriptions, and medications. Review of Resident #135's billing statement revealed the resident owed the facility $20,480.00. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 365192 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 04/24/2024 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)