Health inspection·February 15, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to ensure the resident's call light was within reach. This affected one (Resident #8) of five residents reviewed for call lights. The facility census was 94. Residents Affected - Few Findings include: Review of the medical record for Resident #8 revealed an admission date of 10/25/22 with diagnoses including hemiplegia (paralysis) to the left side and dementia. Review of Resident #8's care plan dated 10/26/22 stated she required assistance with activities of daily living related to balance problems, impaired cognition, safety awareness and weakness. The staff were to place her call light within reach so she could call for assistance. Review of Resident #8's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed she had impaired cognition and was dependent on staff for activities of daily living. Observation on 02/13/24 at 8:44 A.M. of Resident #8 revealed her call light cord to be wrapped around the side rail but the call button dangling on the floor. Resident #8 stated she had a headache and was cold. Interview on 02/13/24 at 8:49 A.M. with Licensed Practical Nurse (LPN) #246 verified Resident #8's call light was not within reach. LPN #246 stated Resident #8 was able to utilize her call light. Observation on 02/14/24 at 8:40 A.M. of Resident #8 revealed her call light cord to be wrapped around the side rail but the call button dangling on the floor. Resident #8 was observed to be sleeping. Interview on 02/14/24 at 8:40 A.M. with State Tested Nurse Aide (STNA) #250 verified Resident #8's call light was not within reach. Observation on 02/15/24 at 8:31 A.M. of Resident #8 revealed her call light cord to be wrapped around the side rail but the call button dangling on the floor. Interview on 02/15/24 at 8:32 A.M. with STNA #208 verified Resident #8's call light was not within reach. Page 1 of 15 365853 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 showers were completed as scheduled. This finding affected two residents (Residents #54 and #350) of five residents reviewed for activities of daily living (ADLs). The facility census was 94. Residents Affected - Few Findings include: 1. Review of Resident #350's medical record revealed the resident was admitted on [DATE] with diagnoses including difficulty in walking, radiculopathy and pain in the right hip. Review of Resident #350's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited intact cognition and required substantial/maximal assistance with shower/bathing. Review of Resident #350's shower documentation revealed the resident was scheduled for showers on Tuesday, Thursday and Saturday on nightshift and he had received a bed bath on 02/06/24, refused on 02/09/24 and received a bed bath on 02/10/24. Interview on 02/12/24 at 7:33 P.M. with Resident #350 confirmed he was admitted for approximately two weeks and staff had not offered him a shower. Interview on 02/14/24 at 2:24 P.M. with Licensed Practical Nurse (LPN) #202 confirmed the documentation did not reveal evidence Resident #350 was offered a shower. LPN #202 stated she stopped by and interviewed Resident #350 who reported that he was not offered a shower at any point. She stated she would put the resident on the shower schedule. 2. Review of Resident #54's medical record revealed an admission date of 06/29/18 and diagnoses including legal blindness, schizoaffective disorder, glaucoma, anxiety, epilepsy, adjustment disorder with depressed mood and obesity. Review of a quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #54 was cognitively intact and was dependent on staff for bathing and hygiene care. Review of a facility shower schedule as of 02/14/24 revealed Resident #54 was to receive showers on Tuesdays, Thursdays and Saturdays. Review of Resident #54's shower data revealed showers and/or bed baths were recorded for the last 60 days on 12/13/23 (Wednesday), 12/14/24 (Thursday), not applicable was marked on 12/16/24 (Saturday), a refusal was noted on 12/19/23 (Tuesday), not applicable was marked on 12/21/23 (Thursday), 12/23/23 (Saturday), not applicable was marked on 12/26/23 (Tuesday), 12/29/23 (Friday), 12/31/23 (Sunday), 01/02/24 (Tuesday), 01/05/24 (Friday), not applicable was marked on 01/06/24 (Saturday), a refusal was noted on 01/16/24 (Tuesday), 01/18/24 (Thursday), 01/20/24 (Saturday), 01/24/24 (Wednesday), 01/31/24 (Wednesday), a refusal was noted on 02/01/24 (Thursday), 02/04/24 (Sunday), 02/07/24 (Wednesday), not applicable was marked on 02/10/24 (Saturday), and 02/13/24 (Tuesday). No data was available for 12/16/23 (Saturday), 12/21/23 (Thursday), 12/26/23 (Tuesday), 12/28/23 (Thursday), 12/30/23 (Saturday), 01/04/24 (Thursday), 01/09/24 (Tuesday), 01/11/24 (Thursday), 01/13/24 (Saturday), 01/23/24 (Tuesday), 01/25/24 (Thursday), 01/27/24 (Saturday), 01/30/24 (Tuesday), 02/03/24 (Saturday), 365853 Page 2 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0677 02/06/24 (Tuesday) and 02/08/24 (Thursday). Level of Harm - Minimal harm or potential for actual harm Review of Resident #54's nurses' notes covering 12/23/23 to 02/08/24 did not illustrate any showers or bed baths given or refused on 12/16/23 (Saturday), 12/21/23 (Thursday), 12/26/23 (Tuesday), 12/28/23 (Thursday), 12/30/23 (Saturday), 01/04/24 (Thursday), 01/09/24 (Tuesday), 01/11/24 (Thursday), 01/13/24 (Saturday), 01/23/24 (Tuesday), 01/25/24 (Thursday), 01/27/24 (Saturday), 01/30/24 (Tuesday), 02/03/24 (Saturday), 02/06/24 (Tuesday) and 02/08/24 (Thursday). Residents Affected - Few Interview on 02/12/24 at 8:04 P.M. with Resident #54 revealed her care including bathing was often interrupted by staff and not completed. Resident #54 stated at times she had to have a shower canceled since they only had one staff on the unit. Resident #54 stated she was not getting even two showers or bed baths a week. Interview on 02/14/24 at 10:57 A.M. with Licensed Practical Nurse (LPN) #212 revealed Resident #54 did not refuse care including showers. Interview on 02/14/24 at 11:06 A.M. with State Tested Nursing Assistant (STNA) #256 confirmed Resident #54 was not getting her showers and likely was getting one shower every two weeks. STNA #256 stated there was a new sheet for showers that now had the times 7:00 A.M. to 7:00 P.M. but used to split between 7:00 A.M. to 3:00 P.M. and 3:00 P.M. to 11:00 P.M. STNA #256 stated the 3:00 P.M. to 11:00 P.M. staff were not completing their charting or showers so the sheet changed and more showers got bumped to day shift. STNA #256 explained often times there would be one staff member from 3:00 P.M. to 7:00 P.M. and they could not complete bathing for both the 300 and the 400 halls. STNA #256 also shared not applicable on the charting meant a shower or bed bath was not given. Interview on 02/14/24 at 11:18 A.M. with STNA #284 revealed Resident #54 did not refuse care including showers. Review of a policy, Routine Resident Care, no date revealed the facility would promote resident-centered care by attending to the total medical, nursing, physical, emotional, mental, social and spiritual needs and honor resident lifestyle preferences while in the care of this facility. Routine care by a nursing assistant includes personal care including bathing. 365853 Page 3 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

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, record review and interview, the facility failed failed to ensure Resident #347's intravenous (IV) fluids were discontinued after use and Resident #26's right foot dressing was completed as ordered. This finding affected one (Resident #347) of one resident reviewed for IV therapy and one (Resident #26) of three residents reviewed for general skin conditions. The facility census was 94. Residents Affected - Few Findings include: 1. Review of Resident #347's medical record revealed the resident was admitted on [DATE] with diagnoses including encounter for surgical aftercare following surgery on the genitourinary system, unspecified intestinal obstruction and essential hypertension. Review of Resident #347's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment. Review of Resident #347's physician orders revealed an order dated 02/09/24 for dextrose-sodium chloride intravenous solution 5-0.45% (percent), use 75 ml (milliliters) per hour intravenously every shift for an ileus for two days. Review of Resident #347's IV team form dated 02/10/24 at 12:45 P.M. revealed a new peripheral IV line was started in the resident's left forearm. Review of Resident #347's medication administration records (MARS) from 02/01/24 to 02/14/24 revealed the IV fluids were administered as ordered. Review of Resident #347's progress note with the effective date of 02/12/24 at 4:30 P.M. created on 02/14/24 at 11:29 A.M. authored by Registered Nurse (RN) Clinical Manager #258 revealed a new bag of fluids were hung per the order. The IV site infiltrated over the weekend and the nurse clamped the IV to check the orders. The IV fluids were completed. Observation on 02/12/24 at 7:05 P.M. with RN #320 revealed Resident #347 was lying in bed with IV tubing attached to left the peripheral IV access site on the resident's left wrist and the tubing was attached to a bag of D5-0.45% IV fluids which was observed hanging on a pole by the resident's bed. Observation of Resident #347's left forearm revealed the IV fluids and tubing were clamped at the resident's wrist area with a white clamp and the fluids were not infusing. Interview on 02/14/24 at 11:13 A.M. with RN Clinical Manager #258 confirmed she had clamped Resident #347's IV fluids on 02/12/24 around 4:30 P.M. to 5:00 P.M. and she forgot to tell the nurse prior to going home. She confirmed the discontinued IV fluids were hanging on the IV pole with clamped tubing on Resident #347's left wrist for approximately two hours when the fluids should have been discontinued immediately after the resident had received the IV fluids for two days as ordered. Review of the Obtaining and Transmitting Infusion Therapy Orders dated 12/2019 indicated all orders written for infusion therapies must be complete and promptly communicated to pharmacy staff to assure safe and appropriate care of the patient. 2. Review of Resident #26's medical record revealed the resident was readmitted on [DATE] with 365853 Page 4 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0684 diagnoses including atherosclerotic heart disease, low back pain and cardiomegaly. Level of Harm - Minimal harm or potential for actual harm Review of Resident #26's physician orders revealed an order dated 06/27/23 to apply a dry dressing between the right great toe and 2nd toe to protect every night shift. Residents Affected - Few Review of Resident #26's treatment administration records (TARS) from 01/01/24 to 02/14/24 revealed the wound care to the right great toe was completed as ordered. Observation on 02/14/24 at 9:39 A.M. with State Tested Nursing Assistant (STNA) #313 of Resident #26's right foot revealed a reddened blister on the inner aspect of the right great toe which was reddened. No dressing was observed on the right great toe as ordered. Interview on 02/14/24 at 9:42 A.M. with Resident #347 revealed the staff did not complete the dressing to her right great toe as ordered. Interview on 02/14/24 at 9:45 A.M. with Registered Nurse (RN) Clinical Manager #258 confirmed Resident #347's right great toe dressing was not completed as ordered. Review of the undated Skin Care and Wound Management Overview policy revealed the facility staff strive to prevent resident/patient skin impairment and to promote the healing of existing wounds. 365853 Page 5 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and facility policy review, the facility failed to ensure resident smoking materials were maintained by the facility staff. This affected four (Residents #15, #64, #77 and #346) of four residents reviewed for smoking. The facility census was 94. Findings include: 1. Review of the medical record for Resident #15 revealed an admission date of 03/09/20 with diagnoses including spinal cord disease, paraplegia (paralysis to his legs), chronic obstructive pulmonary disease and nicotine dependence. Review of the Smoking Acknowledgement form revised on 03/30/16, revealed smoking materials could present a safety hazard and the facility had adopted a safety policy and procedure to provide a safe smoking area. Resident #15 signed this form on 06/13/23. Review of the quarterly smoking assessment dated [DATE] revealed Resident #15 was an independent smoker. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #15 had impaired cognition. Observation and interview on 02/13/24 at 4:26 P.M. revealed Resident #15 had smoking materials in his room which including dried tobacco and cigarette papers. Resident #15 verified he was able to keep the smoking materials in his room. He stated he also had a lighter in his room but did not smoke in the building. Interview on 02/14/24 at 9:55 A.M. with Director of Admissions #262 verified residents were provided with the Smoking Acknowledgement form and the facility smoking policy upon admission. She verified the smoking materials were to be maintained by the facility staff per the policy. Observation and interview on 02/14/24 at 10:24 A.M. revealed Resident #15 to have five large bags of dried tobacco and ten cartons of cigarettes in his room on the left side of his bed on his floor. There were two cigarette butts laying on the resident's floor. Director of Plant Maintenance #270 was by the doorway of his room and verified smoking materials in Resident #15's room. Review of the facility policy titled, Resident/Patient Smoking, dated 03/25/16, revealed smoking safety instructions for all smokers included that all smoking materials would be maintained by the facility staff and provided to the resident/patient on request. 2. Review of the medical record for Resident #64 revealed an admission date of 10/05/20 with diagnoses including chronic obstructive pulmonary disease and nicotine dependence. Review of the Smoking Acknowledgement form revised on 03/30/16, revealed smoking materials may present a safety hazard and the facility had adopted a safety policy and procedure to provide a safe smoking area. Resident #64 signed this form on 10/06/20. 365853 Page 6 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0689 Level of Harm - Minimal harm or potential for actual harm Review of the quarterly smoking assessment dated [DATE] revealed Resident #64 was an independent smoker. Review of the quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #64 had impaired cognition. Residents Affected - Some Observation and interview on 02/14/24 at 9:11 A.M. revealed Resident #64 had smoking materials including cigarettes on his wheelchair that he was pushing back to his room. He stated he had been outside smoking. Resident #64 stated he kept his cigarettes and lighter in his room. Interview on 02/14/24 at 9:55 A.M. with Director of Admissions #262 verified residents were provided with the Smoking Acknowledgement form and the facility smoking policy upon admission. She verified the smoking materials were to be maintained by the facility staff per the policy. Review of the facility policy titled, Resident/Patient Smoking, dated 03/25/16, revealed smoking safety instructions for all smokers included that all smoking materials would be maintained by the facility staff and provided to the resident/patient on request. 3. Review of the medical record for Resident #77 revealed an admission date of 01/18/24 with diagnoses including chronic obstructive pulmonary disease and nicotine dependence. Review of the Smoking Acknowledgement form revised on 10/17/19, revealed smoking materials may present a safety hazard and the facility had adopted a safety policy and procedure to provide a safe smoking area. Residents were not to keep or store their smoking materials themselves and they had to be given to staff to be placed in a locked secured area. Resident #77 signed this form on 01/19/24. Review of the admission smoking assessment dated [DATE] revealed Resident #77 was an independent smoker. Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #77 had impaired cognition. Interview on 02/14/24 at 9:55 A.M. with Director of Admissions #262 verified residents were provided with the Smoking Acknowledgement form and the facility smoking policy upon admission. She verified the smoking materials were to be maintained by the facility staff per the policy. Interview on 02/14/24 at 10:52 A.M. with Registered Nurse (RN) #318 revealed Resident #77 kept his own cigarettes and lighter in his room. He stated the only time the staff will manage the smoking materials is if a resident attempts to smoke in their room. Review of the facility policy titled, Resident/Patient Smoking, dated 03/25/16, revealed smoking safety instructions for all smokers included that all smoking materials would be maintained by the facility staff and provided to the resident/patient on request. 4. Review of the medical record for Resident #346 revealed an admission date of 01/18/24 with diagnoses including chronic obstructive pulmonary disease and nicotine dependence. Review of the Smoking Acknowledgement form revised on 10/17/19, revealed smoking materials may present a safety hazard and the facility had adopted a safety policy and procedure to provide a safe 365853 Page 7 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0689 Level of Harm - Minimal harm or potential for actual harm smoking area. Residents were not to keep or store their smoking materials themselves and they had to be given to staff to be placed in a locked secured area. Resident #346 signed this form on 01/18/24. Review of the admission smoking assessment dated [DATE] revealed Resident #346 was an independent smoker. Residents Affected - Some Review of the admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed Resident #346 had intact cognition. Interview on 02/14/24 at 9:55 A.M. with Director of Admissions #262 verified residents were provided with the Smoking Acknowledgement form and the facility smoking policy upon admission. She verified the smoking materials were to be maintained by the facility staff per the policy. Interview on 02/14/24 at 10:49 A.M. with Medication Technician #237 verified Resident #346 kept her own cigarettes and lighter in her room. Interview on 02/14/24 at 10:52 A.M. with Registered Nurse (RN) #318 revealed residents kept their own cigarettes and lighters in their rooms. He stated the only time the staff will manage the smoking materials is if a resident attempts to smoke in their room. Review of the facility policy titled, Resident/Patient Smoking, dated 03/25/16, revealed smoking safety instructions for all smokers included that all smoking materials would be maintained by the facility staff and provided to the resident/patient on request. 365853 Page 8 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0694 Provide for the safe, appropriate administration of IV fluids 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, record review and interview, the facility failed failed to ensure Resident #347's intravenous (IV) fluids were discontinued after use. This finding affected one (Resident #347) of one resident reviewed for IV therapy. Residents Affected - Few Findings include: Review of Resident #347's medical record revealed the resident was admitted on [DATE] with diagnoses including encounter for surgical aftercare following surgery on the genitourinary system, unspecified intestinal obstruction and essential hypertension. Review of Resident #347's admission Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed the resident exhibited moderate cognitive impairment. Review of Resident #347's physician orders revealed an order dated 02/09/24 for dextrose-sodium chloride intravenous solution 5-0.45% (percent), use 75 ml (milliliters) per hour intravenously every shift for an ileus for two days. Review of Resident #347's IV team form dated 02/10/24 at 12:45 P.M. revealed a new peripheral IV line was started in the resident's left forearm. Review of Resident #347's medication administration records (MARS) from 02/01/24 to 02/14/24 revealed the IV fluids were administered as ordered. Review of Resident #347's progress note with the effective date of 02/12/24 at 4:30 P.M. created on 02/14/24 at 11:29 A.M. authored by Registered Nurse (RN) Clinical Manager #258 revealed a new bag of fluids were hung per the order. The IV site infiltrated over the weekend and the nurse clamped the IV to check the orders. The IV fluids were completed. Observation on 02/12/24 at 7:05 P.M. with RN #320 revealed Resident #347 was lying in bed with IV tubing attached to left the peripheral IV access site on the resident's left wrist and the tubing was attached to a bag of D5-0.45% IV fluids which was observed hanging on a pole by the resident's bed. Observation of Resident #347's left forearm revealed the IV fluids and tubing were clamped at the resident's wrist area with a white clamp and the fluids were not infusing. Interview on 02/14/24 at 11:13 A.M. with RN Clinical Manager #258 confirmed she had clamped Resident #347's IV fluids on 02/12/24 around 4:30 P.M. to 5:00 P.M. and she forgot to tell the nurse prior to going home. She confirmed the discontinued IV fluids were hanging on the IV pole with clamped tubing on Resident #347's left wrist for approximately two hours when the fluids should have been discontinued immediately after the resident had received the IV fluids for two days as ordered. Review of the Obtaining and Transmitting Infusion Therapy Orders dated 12/2019 indicated all orders written for infusion therapies must be complete and promptly communicated to pharmacy staff to assure safe and appropriate care of the patient. 365853 Page 9 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

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, interview, menu spreadsheet review and policy review the facility failed to serve palatable meals at appetizing temperatures. This affected 91 residents receiving meals from the kitchen as three residents (Residents #23, #86 and #296) were ordered nothing-by-mouth (NPO). The facility census was 94. Residents Affected - Some Findings include: Review of a menu for Day 17 Week Three Tuesday corresponding to 02/13/24 revealed the following for the dinner meal: Rancher's Chicken Thigh, country style tomatoes, oven browned potatoes, cornbread and peanut butter cookie. Interview on 02/12/24 at 7:56 P.M. with Resident #56 revealed food was really cold. Interview on 02/12/24 at 8:01 P.M. with Resident #54 revealed the food was cold more often that not and you would not want to eat it. Interview on 02/12/24 at 8:12 P.M. with Resident #25 revealed the food was sometimes cold. Interview on 02/12/24 at 8:22 P.M. with Resident #31 revealed the food was cold because his room was at the very end of the facility. Interview on 02/13/24 at 8:58 A.M. with Resident #32 revealed the food at dinner was cold. Observation of the dinner meal on 02/13/24 starting at 5:13 P.M. revealed District Manager (DM) #321 took temperatures of the foods to be served with the facility's self-calibrating electronic thermometer as follows: potatoes, 171 degrees Fahrenheit (F); stewed tomatoes, 170 degrees F; and chicken thigh, 183 degrees F. Tray service began at 5:20 P.M. A test tray was requested for the Providence cart which started at 5:38 P.M. and some additional dining room trays were made during this time. A test tray was made at 5:53 P.M., the tray was on the cart at 5:54 P.M., the cart left the kitchen at 5:55 P.M., and the cart was on the unit at 5:57 P.M. Tray pass started at 5:57 P.M. The test tray was sampled at 6:03 P.M. with DM #321 and Culinary Supervisor (CS) #274 and temperatures of the foods to be sampled were as follows: tomatoes, 145 degrees F; chicken, 129 degrees F then continued downward to 116 degrees F and did not rise back up again; and potatoes, 101 degrees F. The Administrator entered the observation during the test tray. The chicken was lukewarm and did not taste palatable at this temperature. The potatoes were cold and were not palatable. DM #321 stated at the time of observation minimum temperatures of the food to be served on tray line was 135 degrees F but did not elaborate further regarding a food temperature at time of tray delivery. DM #321, DS #274 and the Administrator were made aware during the test tray observation that the potatoes and chicken were cold and not palatable and they did not disagree. Review of the facility list of resident diets revealed Residents #23, #86 and #296 were NPO. Review of a policy, Food: Preparation, dated February 2023 revealed all foods would be held at appropriate temperatures greater than 135 degrees F for hot holding. The policy did not specify a minimum temperature at point of service such as when the meal tray was delivered. Review of a policy, Food: Quality and Palatability, dated February 2023 revealed food should be at 365853 Page 10 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0804 Level of Harm - Minimal harm or potential for actual harm the appropriate temperature as determined by the type of food to ensure residents' satisfaction and to minimize the risk for scalding and burns. An attachment for resident tray assessment indicated hot foods were to temp at 120 degrees F or higher. Residents Affected - Some 365853 Page 11 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and policy review, the facility failed to ensure foods were labeled, dated and not retained when expired. This had the potential to affect 91 residents receiving food from the facility's kitchen as three residents (Residents #23, #86 and #296) were ordered nothing-by-mouth (NPO). The facility census was 94. Findings include: Observation of the facility's nourishment refrigerators on 02/12/24 starting at 7:24 P.M. with Culinary Supervisor (CS) #274 revealed the following areas of concern: • On the Providence unit, there was a food container with Resident #347's room number and no date. • On the Lifestyles unit, in the freezer there was a freezerburnt container of ground beef dated 10/13/23. In the refrigerator, there was a container of ice cream with Resident #61's name on it dated 06/14, a peanut butter and jelly sandwich dated 02/03/23, two peanut butter and jelly sandwiches without dates, an additional half of a peanut butter and jelly sandwich that was hard to touch and lacked a date, a clear container with a staff member's name on it with half of a sandwich inside with no date and an expired bottle of nutritional supplement dated 02/04/24. • On the Regency unit, there was expired milk dated 02/02/24, there were 2.5 peanut butter and jelly sandwiches that were not dated, there was a meat and cheese sandwich dated 02/02/24, there was a meat and cheese sandwich dated 02/03/24 and there were three pudding cups dated 02/05/24. Interviews with CS #274 verified the above areas of concern at the time of observation. CS #274 stated items should be discarded six days after the date marked on the item and stated dietary staff were to check the dates on the food items in these refrigerators daily and throw out expired food. CS #274 also verified all food items needed to be labeled and dated and nurses would label residents' foods before placing them in the refrigerator. Interview on 02/13/24 at 10:12 A.M. with District Manager (DM) #321 revealed there was no documentation available showing that staff went through these refrigerators to check for expired foods since staff just had to document they delivered snacks. Review of the facility list of resident diets revealed Residents #23, #86 and #296 were NPO. Review of the document, Label and Date In-service, dated 12/15/16 revealed standard dating for prepared foods, puddings, sauces, leftovers, etc. is seven days. All products should be marked with a made on and use by date. Any other items with a clearly marked expiration date such as milk, yogurt or thickened liquids should use that clearly labeled expiration date after opening. 365853 Page 12 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0812 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy, Refrigerator Maintenance and Temperature, reviewed 02/25/22, revealed the policy was applicable for all refrigerators wherever they were located. Cleaning referred to discarding outdated produce or products, foods, or liquids suspected of spoilage. Dietary refrigerators will be cleaned and disinfected by dietary staff on a regular schedule. Residents Affected - Some 365853 Page 13 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on record review and staff interviews, the facility failed to ensure complete and accurate documentation for Residents #15 and #62. This affected one of three residents reviewed for restorative care (#62) and one of one record reviewed for transmission-based precautions (#15). The facility census was 94. Findings Include: 1. Review of medical records for Resident #15 revealed an admission date of 10/07/20. Resident #15 was diagnosed with MRSA (Methicillin Resistant Staphylococcus Aureus) in the urine on 06/13/23 and was subsequently placed on transmission-based precautions (contact precautions). Contact Precautions were not discontinued after completion of the appropriate antibiotic therapy. Review of Resident #15's medical records revealed the order for contact precautions was discontinued on 02/14/24. Review of the Medication Administration Record (MAR) indicated Resident #15 remained on contact precautions from 06/13/23 through 02/13/24. Nursing staff was documenting on the MAR daily the resident was currently on contact precautions. Observation on 02/14/24 at 12:13 PM revealed no signage on the door indicating Resident #15 was on contact precautions. Interview on 02/14/24 at 2:14 PM with Registered Nurse (RN) #322 indicated Resident #15 had been removed from contact precautions following the completion of antibiotic therapy. RN #322 confirmed the order for contact precautions remained on the MAR from 06/20/23 through 02/14/24 and was being signed daily by nursing staff. 2. Review of the medical record for Resident #62 revealed an admission date of 01/05/23 with a history of cerebral infarction (stroke) and right side hemiplegia (paralysis on the right side of the body), muscle weakness, lack of coordination, contracture of the right hand, and cognitive communication deficit. Resident #62 had an order to receive restorative nursing, that included passive ROM (range of motion) for 15 minutes every day. Review of Resident #62's care plan, dated 04/18/23, revealed the nurses and nursing assistants were responsible for restorative nursing services. Review of the Restorative Task Form from 01/16/24-02/13/24 revealed no documentation of nursing staff providing Passive ROM for the dates of 01/21/24, 01/24/24, 01/27/24, 01/30/24, 02/09/24, and 02/10/24. Interviews with State Tested Nursing Assistant (STNA) #311 and STNA #313 on 02/14/24 revealed that Passive ROM was performed daily with Resident #62 during daily activities when getting dressed and ambulating. However, documentation was sometimes not done due to time constraints. 365853 Page 14 of 15 365853 02/15/2024 Greenbriar Center 8064 South Avenue Boardman, OH 44512

F 0842 Interview with Licensed Practical Nurse (LPN) #202 verified the lack of documentation on the Restorative Nursing Form and stated they have been working to improve documentation. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 365853 Page 15 of 15