Inspection·July 2, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete of the document titled; Employee Investigation Packet that had the name of CNA #323 on it revealed CNA #323 was suspended on 06/02/25. The document further revealed CNA #323 was terminated on 06/17/25 for theft of resident property. Review of an undated document titled; Employee Corrective Action Form revealed CNA #323 was terminated. The reason was listed as Other: Theft.On 06/26/25 at 10:34 A.M. an interview with BPD #317 revealed based on video footage and witness statements reviewed there was enough evidence to prosecute CNA #323. BPD #317 stated a warrant was issued for a misdemeanor first degree theft against CNA #323.On 06/26/25 at 11:00 A.M. an interview with the LNHA verified the contents of the investigation regarding SRI tracking number 261140. The LNHA stated a warrant was issued for the arrest of CNA #323. The LNHA further stated CNA #323 was suspended pending investigation into the event effective 06/02/25 and terminated from employment 06/17/25. On 06/26/25 at 11:05 A.M. an interview with Resident #61 revealed she had been talked to by LNHA and [NAME] police regarding missing money. Resident #61 stated she always keeps her purse with her but on that day, it slipped her mind. Resident #61 stated she counted her money that morning before her shower and had over 700 dollars. Resident #61 stated when she counted her money later that day, she was missing 400 dollars. Resident #61 stated she then reported it. On 06/26/25 at 12:07 P.M. an interview with CNA #290 revealed she was the aide who showered Resident #61 on 06/02/25. CNA #290 stated Resident #61 was incontinent prior to going to shower room so she changed her and remade the bed. CNA #290 further stated she was accompanied by Physical Therapy Assistant (PTA) #243 as therapy was working on transfers with Resident #61. CNA #290 stated she was unaware of any money missing until later that night when CNA #323 contacted her via phone stating she was suspended. CNA #290 stated she asked CNA #323 what she was doing in the room, and CNA #323 stated she was making the bed. CNA #290 further stated she thought that was odd as she had already made the bed. CNA #290 stated CNA #323 also asked her about surveillance cameras.Review of the undated policy titled; Ohio Abuse, Neglect and Misappropriation defined misappropriation as the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of residence belongings or money without the resident's consent. The document further stated it is the policy of the facility to provide resident centered care that meets the psychosocial, physical and emotional needs and concern of the residents. The policy further stated it is the intent of the facility to prevent the abuse, mistreatment, or neglect of residents or the misappropriation of their property.This deficiency was an incidental finding identified during the complaint investigation. Event ID: Facility ID: 365853 If continuation sheet Page 2 of 12 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 07/02/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and facility policy review, the facility failed to ensure Resident #106 was safely discharged to another skilled nursing facility. This affected one (Resident #106) of the five residents reviewed for discharge. The facility census was 102. Findings include:Review of the closed medical record revealed Resident #106 was admitted to the facility 05/03/24 with diagnoses of sequelae of cerebral infarction, epilepsy, systemic lupus erythema and autoimmune hepatitis. Resident #106 was cognitively intact and required maximal assistance with toileting hygiene, showers, and dressing along with moderate assistance with personal hygiene and transfers. Review of the progress note dated 03/20/25 at 2:34 P.M. revealed Resident #106 requested to have a referral sent to facilities closer to Akron, Ohio. [NAME] Care in [NAME], Ohio reached out and accepted the referral. All pertinent information requested was sent over for review and the facility accepted. All resident items were packed up by staff. Review of the progress note dated 03/21/25 at 10:08 P.M. revealed Resident #106 had not been transported to the new facility as of yet and all her belongings were gone, and Resident #106 was upset. A call was made to [NAME] Care to check if they had arranged transportation and was informed it was arranged by Greenbriar. Multiple calls were made to local transport companies and transportation was arranged with Emergency Medical Services (EMS) Transport for 03/22/25 with pick-up time between 1:30 P.M. and 3:30 P.M. A call was placed to [NAME] Care to notify them of the date and time of transport. Review of progress note dated 03/22/25 at 10:47 A.M. revealed Social Services confirmed with Admissions Director #239 that transportation had been set up and notified Resident #106. Interview on 06/23/25 at 11:38 A.M. with Social Service Designee (SSD) #211 revealed Resident #106 requested to discharge to a facility closer to where she originally lived which was in Akron, Ohio. On 03/20/25 SSD #211 received a call from [NAME] Care in [NAME], Ohio reporting they set up transportation and would pick up Resident #106 at 2:15 P.M. At 2:07 P.M. SSD #211 was notified there was a pending authorization. At 2:25 P.M. SSD #211 asked if transportation was still coming. After no response was received, SSD #211 sent a follow-up email at 3:29 P.M. to [NAME] Care admission Director #320. At 3:42 P.M. SSD #211 received an email response that said pending. SSD #211 asked if transportation would be pushed back to the following day and on 03/21/25 at 1:19 P.M., [NAME] Care admission Director #320 replied that the authorization was still pending, and transportation was on standby. At 3:25 P.M. SSD #211 asked again if authorization had been received and at 3:27 P.M. [NAME] Care admission Director #320 replied, no. At 3:29 P.M. SSD #211 emailed [NAME] Care admission Director #320 and provided her personal phone number and requested she be contacted if an authorization was received over the weekend. On 03/22/25 Resident #106 complained about not having left yet and Greenbriar Admissions Director #239 contacted [NAME] Care to find out what the holdup was and one of [NAME] Care's nurses read Greenbriar Admissions Director #239 a progress note that stated they were waiting for Greenbriar to set up transportation. Afterwards, Greenbriar admission Director #239 called and set up transportation. On 03/22 at 9:04 A.M. [NAME] Care admission Director #320 emailed SSD #211 at 9:04 A.M. to notify her authorization was still pending. SSD #211reported she did not have remote access to her email so the email from [NAME] Care admission Director #320 was not received until 03/24/25. On 03/24/25 at 3:24 P.M. SSD #211 replied to [NAME] Care admission Director #320 that she was unaware there was no authorization and reported a nurse at [NAME] Care read [NAME] Briar admission Director a progress note that [NAME] was waiting for Greenbriar to arrange transportation. SSD #211 explained she found out a week later that Resident #106 was not admitted to [NAME] Care and was diverted to a hospital where she remained in the emergency department for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 3 of 12 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 07/02/2025 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)

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few approximately one week. SSD #211 reported she later found out that [NAME] Care was out of network for Resident #106 and because of that they needed five denials before they could accept her. The Administrator spoke with Resident #106 and offered to allow her to return to Greenbriar, which she declined. SSD #211 stated it was a bad discharge.Review of the email conversation between SSD #211 and [NAME] Care admission Director #320 on 03/20/25 revealed the following: At 2:07 P.M. [NAME] Care admission Director #320 notified SSD #211 that there was a pending authorization from her Managed Care Organization (MCO) which was United Healthcare. At 2:25 P.M. SSD #211 asked if transportation was still coming. At 3:29 P.M. SSD #211 sent a follow-up email asking for an update. At 3:42 P.M. [NAME] Care admission Director #320 responded pending. At 4:08 P.M. SSD #211 asked if transportation would be pushed back to 03/21/25. At 4:15 P.M. [NAME] Care admission Director #320 responded unfortunately. Review of the email conversation between SSD #211 and [NAME] Care admission Director #320 on 03/21/25 revealed the following: At 1:19 P.M. [NAME] Care admission Director #320 reported authorization was still pending and transportation was on standby once approved. At 3:25 P.M. SSD #211 asked if the authorization was received. At 3:27 P.M. [NAME] Care admission Director #320 responded not yet, sorry. At 3:29 P.M. SSD #211 Provided her personal cell phone number and asked [NAME] Care admission Director #320 to give her a call if the authorization came back and she would notify the facility. Review of the email conversation between SSD #211 and [NAME] Care admission Director #320 on 03/22/25 revealed the following: At 9:04 A.M. [NAME] Care admission Director #320 reported the authorization was still pending and she would follow up with SSD #211 on 03/24/25. At 4:20 P.M. [NAME] Care admission Director #320 stated Hello, I got a call from my building that Resident #106 is being transported. We do not have authorization at this time. Review of the email conversation between SSD #211 and [NAME] Care admission Director #320 on 03/24/25 revealed the following: At 9:12 A.M. SSD #211 stated Hello, I wasn't aware that our admissions had set up transportation for her. Our admissions had called your building and was read a note that stated there was transportation issues which is why she hadn't been picked up yet, so she set it up. So, I do apologize for this miscommunication. I truly wasn't aware there was transport set. At 1:41 P.M. [NAME] Care admission Director #320 responded we are trying to work it out with the hospital she was diverted to. Interview on 06/23/25 at 12:35 P.M. with Greenbriar Admissions Director #239 confirmed her involvement in Resident #106's discharge and that a call was made to [NAME] Care to talk to the facility about admissions coming. Resident #106 's room was emptied as her fiance took her items to Akron. Resident #106 was to have also left, became upset, and started crying while waiting for transport. Greenbriar Admissions Director #239 called the accepting facility and spoke to a staff member who stated they were waiting for Resident #106 so a transport company was contacted and transportation arranged for the next day. Five days passed and she found out accepting facility denied Resident #106 and she was at the emergency department. SSD #211 and the administrator took it from there. Interview on 06/30/25 at 9:12 A.M. with [NAME] Care admission Director #320 confirmed Resident #106 arrived at the facility around 10:00 P.M. and that the authorization was still pending at that time. She further explained she had previously asked SSD #211 not to send Resident #106 until the authorization was received. Upon arriving at [NAME] Care Resident #106 was diverted to the hospital because there was no authorization received, and admissions did not receive the Preadmission Screening and Resident Review (PASRR) results stating Resident #106 was appropriate for a skilled nursing facility. Review of the email conversation between SSD #211 and [NAME] Care admission Director #320 confirmed the email communications were identical to those provided by SSD #211. Review of the undated Transfer and Discharge Policy revealed orientation for transfer or discharge must be provided and documented to ensure safe and orderly transfer or discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 4 of 12 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 07/02/2025 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)

F 0627 from the facility. This deficiency represents non-compliance investigated under Complaint Numbers OH00166058 (1272224) and OH00164151 (1272217). Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 5 of 12 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 07/02/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident interviews, staff interviews, observation and facility policy review, the facility failed to ensure sufficient staff to meet the needs of the residents. This affected four (Residents #83, #49, #42, and #95) interviewed regarding staffing concerns and had the potential to affect all 102 residents residing in the facility. Findings include:Interview on 06/23/25 at 9:33 A.M. with Resident #83 revealed there was only one nurse, and one aide scheduled daily.Interview on 06/23/25 at 9:56 A.M. with Resident #49 revealed the unit was understaffed, and the call light response was poor. Interview on 06/23/25 at 10:28 A.M. with Resident #42 revealed the Certified Nursing Assistants (CNAs) were lazy and would stand in the hallway talking while call lights were sounding which resulted in lengthy call light responses. Interview on 06/23/25 at 10:45 A.M. with Resident #90 revealed there was never enough staff and usually only one nurse and one aide working.Interview on 06/24/25 at 2:25 P.M. with Resident #95 revealed there was a day when there was one aide for 45 residents. Interview on 06/23/25 at 1:36 P.M. with CNA #253 she was scheduled on the Providence unit from 7:00 A.M. to 3:00 P.M. but was moved to the Lifestyle II unit due to there were no CNAs there that morning, which was likely due to call offs or staff running late. CNA #253 reported that inadequate staffing interfered with residents receiving proper care.Interview on 06/23/25 at 2:10 P.M. with CNA #311 revealed staffing levels were always short, CNA's felt overworked at times, and care, such as showers, were not always provided as a result. Interview on 06/23/25 at 10:59 A.M. with Staff Scheduler #211 revealed staffing levels were based on facility census and then staffed by each hallway. For Lifestyle II unit the census was 26. Staff Scheduler #211 reported that the facility was overstaffed.Interview on 06/23/25 at 10:25 A.M. with Licensed Practical Nurse (LPN) #214 revealed there was not enough staff. LPN #214 stated there was only one aide on her unit from 7:00 A.M. until 10:00 A.M. LPN #214 stated she called her supervisor and the scheduler and received no help until 10:00 A.M. LPN #214 was tearful during the interview and stated the residents deserved better. LPN #214 stated this is a frequent occurrence. Interview on 06/24/25 at 11:10 A.M. with LPN #208 revealed she was behind with her medication pass, which was related to not having enough staff. LPN #208 stated there were only two aides on the 100-unit that day and she had to assist with patient care. Interview on 06/25/25 at 10:15 A.M. with CNA #290 revealed staffing was an issue in the facility. CNA #290 reported the 200-unit operated best with four aides, but there were only three that day. CNA #290 reported she barely got her work completed as a result. While incontinence care was always completed, sometimes showers must wait until the next day. CNA #290 also reported Administration was not responsive to resident care needs based on census.Interview on 06/25/25 at 10:35 AM interview with LPN #208 revealed she worked the afternoon shift from 3:00 P.M. to 11:00 P.M. the previous evening with only two CNAs most of shift and made repeated attempts to contact the scheduler. On 06/25/25 at 10:40 A.M. an interview with CNA #212 revealed they often work short staffed due to report offs and tardiness. CNA #212 stated it took hours to get help in and reported most nurses do not help with get ups and call lights. Interview on 06/25/25 at 10:55 A.M. with CNA #211 who was also the scheduler verified there were two aides on the 200-unit on 06/24/25 for 1.5 hours at the beginning of the shift. CNA #211 stated there were three aides on 200-unit from 4:30 P.M. to 5:30 P.M. then two aides again until 7:00 P.M. CNA #211 stated there were three aides for the remainder of the shift. On 06/26/25 at 12:30 P.M. an interview with Physical Therapy Assistant (PTA) #243 revealed staffing was an issue and reported she assisted with answering call lights and had brought staffing issues to the Administrator and Director of Nursing (DON); however, the issues were not addressed. On 06/26/25 at 12:55 P.M. an interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 6 of 12 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 07/02/2025 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)

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many with Occupational Therapist (OT) #321 revealed there was an issue with staff showing up on time; however, staffing issues were addressed in management meetings. Observation on 06/26/25 at 7:19 A.M. revealed only one nurse was present on the Lifestyle II unit. Interview at the time of the observation with LPN #293 confirmed she was the only one on the unit and that no CNAs arrived at 7:00 A.M. as scheduled. LPN #293 did not have a schedule and was unsure which staff were scheduled.Observation on 06/26/25 between 7:19 A.M. and 7:30 A.M. Activity Director #257 and Registered Nurse (RN) #233 were observed asking LPN #293 if there were any CNAs on the unit to which LPN #293 responded, no. Interview on 06/26/25 at 9:32 A.M. with LPN #293 revealed multiple complaints related to inadequate staffing on the Lifestyle II unit were made to Unit Manager #314 and the DON in writing but unattendance and tardiness continued. LPN #293 kept copies of the written staffing complaints and provided them. LPN #293 also confirmed the night shift left promptly at 7:00 A.M., and no one stayed over to assist. LPN #293 also reported multiple staffing complaints were made in writing.Review of the staffing complaints provided to Unit Manager #314 and the DON in writing included the following: Review of a staffing complaint dated 03/01/25 by LPN #293 revealed CNA #256 failed to complete any of documentation for the entire shift and instead, talked on the phone and did schoolwork which was a frequent occurrence which was addressed with CNA #256 multiple times. Review of a staffing complaint dated 04/24/25 by LPN #293 revealed a nurse from another unit called LPN #293 to say she only had one aide and needed another. LPN #293 went to assist as her medication pass, and documentation was completed. Review of a staffing complaint dated 06/08/25 by LPN #293 revealed on 06/08/25 at approximately 7:50 A.M. LPN #293 asked Social Service Designee (SSD) #211 if CNA #256 had called off or reported she was going to be late. LPN #293 and CNA #297 provided care and hoped that CNA #256 would show up by 10 A.M. At 10:45 A.M. LPN #293 reached out to SSD #211 for an update on CNA #256. SSD #211 reported attempts were made to contact CNA #256 but were unsuccessful. At approximately 11:00 A.M. LPN #293 went to another unit and asked CNA #288 if she would assist. At 12:00 P.M. it was still only LPN #293 and CNA #297.The punch detail for 06/15/25 3:00 P.M. to 11:00 P.M. shift for the Providence unit revealed CNA #203 worked 2:59 P.M. to 10:59 P.M.; CNA #292 worked 2:57 P.M. to 10:58 P.M.; CNA #230 worked 3:00 P.M. to 8:00 P.M.; and CNA #281 worked 10:00 P.M. to 11:00 P.M. The punch times reflected there were only two aides from 8:00 P.M. to 10:00 P.M.Interview on 06/26/25 at 9:44 A.M. with Staff Scheduler #211 confirmed there were no CNAs on Lifestyle II unit as scheduled, and she was notified at 7:07 A.M. by RN #233 that no CNAs showed up. Staff Scheduler #211 reported she had not received any call-offs or notifications staff would be [NAME]. Review of the schedules for the nurses and CNAs for 06/15/25 and 06/22/25 to 06/28/25 did not reveal any concerns with staffing levels for the facility. However, review of the punch detail for 06/15/25 (Lifestyle II unit afternoon shift) and 06/26/25 (Lifestyle II unit day shift) revealed inadequate staffing levels on both shifts. The punch detail for 06/26/25 Lifestyle II unit day shift showed CNA #297's start time of 7:09 A.M.; however, she reported to the Regency unit upon arrival instead of Lifestyle II. CNA #297 did not report to the Lifestyle II unit until instructed to do so by Unit Manager #314 at approximately 7:30 A.M. The punch detail for CNA #311 revealed a start time of 8:19 A.M. and reported to Lifestyle II unit upon her arrival. Review of the Facility Assessment revealed Lifestyle II unit day shift was to have one nurse and two to three CNAs. Review of the Providence unit afternoon shift revealed it was to be staffed with two nurses and three to four CNAs. Staffing levels per the Facility Assessment were inadequate for 06/15/25 and 06/26/25. Review of the undated Nurse Staffing Information Policy revealed the facility would provide the sufficient number of staff to care for the resident population. Daily nurse staffing requirements would vary based upon resident census, acuity, and safety needs. This deficiency (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 7 of 12 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 07/02/2025 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)

F 0725 represents non-compliance investigated under Complaint Numbers OH00166996 (1272220), OH00163755 (1272216), OH00165292 (1272223), OH00164858 (1272218), and OH00164711 (1272222). Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 8 of 12 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 07/02/2025 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview and contract review, the facility failed to ensure medications were administered as ordered in a timely fashion after admission for Resident #111. This affected one (Resident #111) of eight residents who were reviewed for medication administration. The facility census was 102. Findings include:Review of the medical record for Resident #111 revealed an admission date of 06/29/25 at 6:50 P.M. with diagnoses including vesicointestinal fistula, peritoneal abscess, encounter for surgical aftercare following surgery on the digestive system, acute diastolic heart failure, hypothyroidism, arteriosclerotic heart disease, hypertension, and gastroesophageal reflux. Review of the admission assessment dated [DATE] revealed Resident #11 was alert and oriented.Review of the care plan dated 06/29/25 revealed Resident #111 had an infection. Interventions included administering antibiotics per medical providers orders. The care plan also revealed Resident #111 utilizes antidepressant medication. Interventions included administering medications as ordered.Review of the physician's orders included assessing Resident #111's pain level every shift. With each new medication order, the medication may be held until it arrives from the pharmacy, fluoxetine (an antidepressant) 40 milligrams, give two capsules by mouth in the morning for depression, amoxicillin (an antibiotic) 875 milligrams give one tablet by mouth every 12 hours four bacterial infection for five days dated 06/29/25, omeprazole (a medication that reduces stomach acid) 40 milligrams one capsule by mouth in the morning for reflux, metoprolol (a blood pressure medication) 25 milligrams one tablet by mouth daily for hypertension, loratadine (an antihistamine) 10 milligrams one tablet daily for allergies, isosorbide (a medication for coronary artery disease) extended release tablet 60 milligrams one tablet by mouth in the morning for coronary artery disease, levothyroxine (a medication for thyroid gland function) 100 micrograms give one and a half tablets daily for hypothyroidism, diazepam (an antianxiety medication) two milligrams give one tablet by mouth every eight hours as needed for anxiety dated 06/30/25, and oxycodone (a narcotic pain medication) five milligrams give one tablet by mouth every six hours as needed for seven days dated 06/30/25. Review of the medication administration record (MAR) dated 06/01/25-06/30/25 revealed fluoxetine 40 milligrams with a start date of 06/30/25 at 7:00 A.M. was not administered as ordered, isosorbide 60 milligrams with a start date of 06/30/25 at 5:00 A.M. was not administered as ordered, levothyroxine 100 micrograms with a start date 06/30/25 at 5:00 A.M. was not administered, metoprolol 25 milligrams with a start date of 06/30/25 at 7:00 A.M. was not administered, omeprazole 40 milligrams with a start date of 06/30/25 at 5:00 A.M. was not administered and amoxicillin 875 milligrams with a start date of 06/29/25 at 9:00 P.M. was not administered. Review of the facility stock medication list revealed the following medications were available in the facility starter kit (a house stock of medications to be utilized until medications can be delivered from the pharmacy): isosorbide, levothyroxine, metoprolol, omeprazole, and amoxicillin and could have been administered. On 07/02/25 at 8:48 A.M. an interview with Registered Nurses (RNs) #258 and #314 revealed there was an issue starting 06/27/25 with the facility computer system communicating with the pharmacy system regarding new medications. On 07/02/25 at 10:00 A.M. an interview with Resident #111 revealed she did not start getting medications until the evening of 07/01/25. On 07/02/25 at 1:00 P.M. an interview with Corporate Compliance RN #325 verified the house stock medication list, and the medications that could have been started for Resident #111.A review of a document titled; Pharmacy Services Agreement, signed on 05/01/25, revealed the pharmacy will deliver to the facility any prescriptions and supplies at least daily Monday through Sunday. Exhibit A of the document revealed the pharmacy will supply medications to the facility and its residents in a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 9 of 12 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 07/02/2025 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)

F 0755 Level of Harm - Minimal harm or potential for actual harm prompt and timely manner, provide house stock of medications to the facility, provide 24 hour seven days a week emergency pharmaceutical services via an on-call pharmacist and provide the facility with a medication administration system. This deficiency represents non-compliance investigated under Master Complaint Number OH00167150 (1272221) and Complaint Numbers OH00166373 (1272215), Complaint Numbers OH00163755 (1272216), and OH00164858 (1272218). Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 10 of 12 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 07/02/2025 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, interview and facility policy review, the facility failed to store insulin (a medication used to stabilize blood sugars) in a proper manner to ensure efficacy. This affected six (Residents #27, #61, #76, #90, #99, and #109) of 23 (Residents #3, #12, #27, #30, #31, #35, #40, #41, #49, #50, #52, #55, #61, #73, #75, #76, #78, #87, #90, #94, #95, #99, and #109) who were identified as utilizing insulin. The facility census was 102.Findings include: 1. Review of the medical record for Resident #27 revealed an admission date of 02/10/23 with diagnosis including type two diabetes mellitus with diabetic chronic kidney disease, and long-term use of insulin. Significant orders included Fiasp FlexTouch (a fast-acting insulin)100 units per milliliter solution pen-injector: Inject five units subcutaneously before meals for diabetes mellitus. hold for blood sugar less than 130, dated 3/5/25. Review of the quarterly Minimum Data Set Assessment (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 14 out of 15, indicating Resident #27 was cognitively intact. Review of the care plan dated 06/02/25 revealed Resident #27 had diabetes. Interventions included administering insulin injections per order. On 06/23/25 at 10:25 A.M. an observation of the medication cart for the 400 unit revealed an aspart insulin pen (generic brand of Fiasp) for Resident #27 that was opened and undated. Licensed Practical Nurse (LPN) # 214 verified the aspart insulin pen for Resident #27 was opened and not dated at the time of the observation. 2. Review of the medical record for Resident #90 revealed an admission date of 02/11/23 with diagnosis including type two diabetes mellitus with hyperglycemia, and long-term use of insulin. Significant orders included Insulin Lispro (1 Unit Dial) Subcutaneous Solution Pen-injector 100 Unit/Milliliter (Insulin Lispro) Inject as per sliding scale: if blood sugar is 0 - 150 = 0 units Give 6 units with meals plus mod dose 2 units for every 50 above 150; 151 - 200 = 2 units; 201 - 250 = 4units; 251 - 300 = 6units. If blood sugar is greater than 300 give 8 units, subcutaneously with meals, dated 04/15/25. Review of the quarterly MDS assessment dated [DATE] revealed a BIMS of 15 oout of 15, indicating Resident #90 was cognitively intact.Review of the care plan dated 04/25/25 revealed Resident #90 had diabetes. Interventions included administering insulin injections per order. On 06/23/25 at 10:25 A.M. an observation of the medication cart for the 400 unit revealed a Humalog insulin pen (name brand for lispro) for Resident #90 that was opened and undated. LPN # 214 verified the Humalog insulin pen for Resident #90 was opened and not dated at the time of the observation. 3. Review of the medical record for Resident #99 revealed an admission date of 10/07/20 with diagnosis including type two diabetes mellitus with diabetic polyneuropathy. Significant orders included Fiasp FlexTouch Subcutaneous Solution Pen-injector 100 Unit/Milliliter, Inject eight units subcutaneously before meals for diabetes mellitus. Review of the quarterly MDS assessment dated [DATE] revealed a BIMS of 15 out of 15, indicating Resident #99 was cognitively intact. Review of the care plan dated 04/16/25 revealed Resident #99 had diabetes. Interventions included administering medications per medical provider ordersOn 06/23/25 at 10:25 A.M. an observation of the medication cart for the 400 unit revealed a Fiasp insulin pen for Resident #99 that was opened and undated. LPN # 214 verified the Fiasp insulin pen for Resident #99 was opened and not dated at the time of the observation. 4. Review of the medical records for Resident #61 revealed an admission date of 02/13/25 with diagnoses including type two diabetes mellitus with hyperglycemia. Significant orders included Insulin Lispro Injection Solution 100 Unit/Milliliter, inject as per sliding scale: if blood sugar is 0 - 150 = 0 units; 151 - 200 = 2 units; 201 - 250 = 4 units; 251 - 300 = 6 units; 301 - 399 = 8 units; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 11 of 12 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 07/02/2025 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)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 400 - 600 = 8 units and call medical doctor for further orders, dated 06/20/25.Review of the quarterly MDS assessment dated [DATE] revealed a BIMS of 15 out of 15, indicating Resident #61 was cognitively intact. Review of the care plan dated 05/15/25 revealed Resident #61 had diabetes. Interventions included administering medication per medical providers orders.On 06/23/25 at 11:00 A.M. an observation of the medication cart on the 200-hall revealed lispro insulin pen for Resident #61 opened and not dated. Registered Nurse (RN) #314 verified the lispro insulin pen for Resident #61 was opened and not dated at the time of the observation. 5. Review of the medical record for Resident #76 revealed an admission date of 01/10/25 with diagnoses including type two diabetes mellitus with diabetic polyneuropathy. Significant orders included glargine insulin subcutaneous solution pen injector 100 Units/Milliliter, inject 25 units subcutaneously two times a day for diabetes, dated 01/10/25.Review of the significant change MDS assessment dated [DATE] revealed a BIMS of 15 out of 15, indicating Resident #76 was cognitively intact. Review of the care plan dated 06/13/25 revealed Resident #76 had diabetes with neuropathy. Interventions included administering medications per medical provider's orders. On 06/23/25 at 11:00 A.M. an observation of the medication cart on the 200-hall revealed a Lantus (brand name for glargine insulin) insulin pen for Resident #76 opened and not dated. RN #314 verified the Lantus insulin pen for Resident #67 was opened and not dated at the time of the observation. 6. Review of the medical record for Resident #109 revealed an admission date of 05/15/25. Resident #109 was discharged on 06/20/25. Significant diagnosis included type two diabetes mellitus without complications. Significant orders included Insulin Lispro (1 Unit Dial) Subcutaneous Solution Pen-injector 100 Unit/Milliliter, inject as per sliding scale: if blood sugar 200 - 249 = 2 units; 250 - 300 = 4 units; 301 - 350 = 6 units if above 350 or below 60 call doctor, subcutaneously at bedtime for diabetes mellitus. Review of the five-day MDS assessment dated [DATE] revealed a BIMS of 15 out of 15, indicating Resident #109 was cognitively intact.Review of the care plan dated 5/15/25 revealed Resident #109 had diabetes. Interventions included administering insulin injections per order.On 06/23/25 at 11:00 A.M. an observation of the medication cart on the 200-hall revealed a Humalog (brand name for lispro insulin) insulin pen for Resident #109 opened and not dated. RN #314 verified the Humalog insulin pen for Resident #109 was opened and not dated at the time of the observation. Review of the facility policy titled; Storage of Medications, dated 08/2020, revealed medications and biologicals are to be stored safely securely and properly. Under Section 3 titled; Expiration Dating sub point #3 revealed certain medications or package types such as IV solutions multiple dose injectable vials, ophthalmic, nitroglycerin tablets and blood sugar testing solutions and strips require an expiration date shorter than the manufacturers' expiration date once opened to ensure medication purity and potency. Sub point #5 revealed when the original seal of a manufacturer's container or vial is initially broken the container or vial will be dated. The nurse shall place a date open sticker on the medication and record the date opened and the new date of expiration. The expiration date of the vial or container will be 30 days from opening, unless the manufacturer recommends another date or regulations/guidelines require a different date.This deficiency was an incidental finding identified during the complaint investigation. Event ID: Facility ID: 365853 If continuation sheet Page 12 of 12