Inspection·November 19, 2024

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Actual harm Based on observation, medical record review, and interview, the facility failed to develop and implement comprehensive, effective and individualized pain management programs for all residents. The facility failed to ensure Resident #104 received pain medication as ordered and the facility failed to ensure Resident #60 was re-assessed timely following complaints of severe pain to determine if changes were needed to his medication regimen. This affected two residents (#60 and #104) of six residents reviewed for pain. Residents Affected - Few Actual harm occurred on 11/14/24 when Resident #104, who had a diagnosis of metastatic (cancer cells have spread to areas other than the original tumor) lung cancer did not receive routine/scheduled pain medication as ordered to achieve effective pain relief/pain management and prevent shortness of breath resulting in complaints of increased pain which included facial grimacing and shortness of breath with pursed lip breathing. Findings include: 1. Review of Resident #104's medical record revealed the resident had diagnoses including malignant neoplasm of the lungs and chronic obstructive pulmonary disease. On 11/13/24 (at 8:00 P.M.) a new order was written for the administration of Morphine Sulfate (an opiate (narcotic) analgesic) 15 milligrams (mg) every four hours for metastatic lung cancer. Review of the medication administration record (MAR) revealed the 8:00 P.M. dose on 11/13/24 was not administered because Resident #104 was sleeping. In addition, the 12:00 A.M. and 4:00 A.M. doses of Morphine were not administered on 11/14/24 with a code to see nursing notes. However, the notes were devoid of a reason the medication was not administered. On 11/14/24 at 8:50 A.M., Resident #104's call light was observed on. The length of time it had been on was unknown at that time. At 8:55 A.M., Resident #104 ambulated to his doorway and spoke to Licensed Practical Nurse (LPN) #240 about getting pain medication. LPN #240 stated she was told Resident #104 did not receive pain medication over night or his morning doses because he was sleeping which Resident #104 denied. LPN #240 stated she would be with Resident #104 when she was done (preparing medication for another resident). At 8:57 A.M., Resident #104 had returned to his room and was sitting on the side of his bed. An interview with Resident #104 at the time of the observation revealed concerns he was having trouble getting his Morphine, stating he was supposed to get it every four hours. Resident #104 stated he had received no Morphine since 9:00 P.M. on 11/13/24. Pursed lip breathing, shortness of breath and facial grimacing were noted. Resident #104 stated the night nurse told him the facility was out of the Morphine. LPN #240 administered Resident #104's medication at 9:05 A.M. including the Morphine 15 mg. (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 4 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 11/19/2024 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)