Inspection·October 1, 2024

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. 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 the facility policy the facility failed to ensure Resident #48, who had an order to self-medicate, kept his medications stored appropriately. This affected one resident (#48) who the facility identified as the only resident in the facility that self-medicated. The facility census was 92. Residents Affected - Few Findings include: Review of the medical record for Resident #48 revealed an admission date of 06/12/24. Diagnoses included type two diabetes mellitus, hypertension, and schizophrenia. Review of the physician's order dated 06/12/24 revealed that Resident #48 may keep his medications at his bedside and administer his medications to himself. Review of the self-administration of medication assessment dated [DATE] revealed that Resident #48 demonstrated secure storage for medication in his room. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed that Resident #38 had intact cognition. Resident #48 required minimal assistance with all activities of daily living. Review of the care plan dated 09/18/24 revealed Resident #48 prefers to administer his own medication. Interventions included assist Resident #48 in securing his medication after administration, and to educate him on proper storage of the medications to prevent unauthorized access. Interview on 09/25/24 at 9:50 A.M. with Resident #48 revealed he had no concerns with his medications because he administered them to himself. He reported he gets his medications prefilled from a local pharmacy and he keeps them in his room and gives them to himself. Resident #48 reported he does not have a lock box for his medications because he does not need one. Observation during the interview revealed a cardboard box sitting in a paper bag next to his bed with Resident #48's information on it full of prefilled packets for administration. The outside of the box listed the medications inside and they included: • Coreg 3.125 milligrams (mg) (medication to treat high blood pressure) • (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 5 Event ID: 365853 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 365853 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Center 8064 South Avenue Boardman, OH 44512 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)