Inspection·September 17, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY. Residents Affected - Few Based of observation, interview, record review,Self-Reported Incident (SRI) , and facility policy review, the facility failed to ensure all staff followed Mechanical lift protocol. This affected one (Resident #135) of three residents reviewed for safe transfer with Mechanical lift. This had the potential to affect 33 residents that required the use of a mechanical lift for transfers (Resident #1, #3, #9, #10, #18, #27, #37, #38, #39, #44, #48, #49, #51, #54, #56, #57, #64, #68, #70, #71, #78, #81, #85, #88, #89, #94, #110, #114, #115, #122, #123 and #135). The facility census was 122. Findings include: Review of the closed medical record for Resident #135 revealed an admission date of 02/01/24 and discharged on 08/22/24. Diagnoses included diabetes, chronic kidney disease, morbid obesity, spinal stenosis and osteoarthritis. Resident #135 had intact cognition. Resident #135 was dependent on transfers and used a mechanical lift (Hoyer) for transfers. Review of the progress note dated 08/19/24 at 1:28 P.M. revealed the Unit Manager Licensed Practical Nurse (LPN) #309 reported to the Director of Nursing (DON) that resident had fallen from the Hoyer lift. LPN #309 was approached by the State Tested Nurses Aide (STNA) #310 which stated the Hoyer lift scale detached from the Hoyer and Resident #135 dropped into her wheelchair. The Hoyer scale hit resident in the forehead. Resident did not fall at any time during the transfer. Emergency Medical Service (EMS) arrived and took resident to ER with paperwork in hand. Interview on 09/16/24 at 9:45 A.M. with LPN #309 stated she was the unit manager on when Resident #135 was transferred with one assist and the Hoyer broke, and she was put down in wheelchair hard by STNA #312. LPN #309 stated she tried to assess Resident #135 but, she refused. She asked Resident #135 if she was hurting and stated no, she had a cut on her forehead with a little blood, but it was not bleeding at that time. She was told the Hoyer arm dropped fast and she dropped into her wheelchair. LPN #309 stated the son called 911 and they took her to the nearest hospital. Resident #135 did not return to the facility. Interview on 09/16/24 at 11:06 A.M. with Maintenance Assistant #311 stated he checks all mechanical lifts monthly to ensure they are working properly. On 08/19/24 he was told Hoyer #4 broke. He stated when STNA #312 was lowering Resident #135 the weight scale had to of got caught on something and the Hoyer bar was still being lowered but could not lower and when the weight box finally bent and broke the Hoyer bar dropped until it reached were the hydraulic was lowered too. (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 3 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 09/17/2024 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)