Inspection·February 25, 2026

F 0689 Level of Harm - Actual harm Residents Affected - Few immediately called. LPN #562 noted a cologne bottle was on the floor. A written interview dated 02/12/26 at 9:30 A.M. conducted by the Regional Director of Clinical Operations (RDCO) and Clinical Liaison LPN #555 revealed Resident #4 thought he was at home, lit a cigarette, dropped the lit cigarette onto himself and when he attempted to retrieve the cigarette, his arm pressed into his cologne bottle which caused it to spray and ignite. Resident #4 stated he was aware he was not to smoke in his room. Review of the hospital transfer form dated 02/12/26 at 3:15 A.M. revealed Resident #4 was transferred to the hospital. Review of the progress note dated 02/12/26 at 5:14 A.M. revealed Resident #4 was transferred to the hospital. Review of the progress note dated 02/12/26 at 7:10 A.M. revealed Resident #4 was admitted to the hospital with second degree burns. Review of the hospital document titled Internal Medicine History and Physical dated 02/12/26 at 8:42 P.M. revealed Resident #4 presented to the emergency room due to smoking in his room at the nursing home, caught cologne on fire and sustained partial thickness burns (second degree burn) to his right thigh. Resident #4 received bacitracin ointment and silver sulfadiazine cream to his burns. Resident #4 refused intravenous (IV) catheter placement and lab draws. Review of the progress note dated 02/12/26 at 10:33 P.M. revealed Resident #4 returned to the facility.Review of the progress note dated 02/13/26 at 1:39 A.M. by Nurse Practitioner (NP) #873 revealed Resident #4 returned from the hospital due to smoking in bed and sustained second degree burns on three to five percent of their body, primarily the thigh.Review of the smoking assessment dated [DATE] at 1:10 P.M. revealed Resident #4 was an independent smoker.Review of the physician orders for Resident #4 revealed orders to monitor burn areas for signs and symptoms of infection every shift and night shift dated 02/13/26, bacitracin (a topical antibiotic) ointment apply to thigh two times daily dated 02/13/26, and silver sulfadiazine cream (a topical antibiotic used for burns) apply to thigh topically at bedtime dated 02/13/26. Review of the Smoking Acknowledgement Form, signed by Resident #4 on 02/13/26 revealed he received a copy of the facility smoking policy and agree to abide by the policy. Review of the skin grid assessment dated [DATE] at 11:44 A.M. revealed Resident #4 refused the skin and wound assessment. Review of the progress note on 02/18/26 by NP #873 revealed she saw Resident #4 in the facility to follow up for second degree burns of the thigh. Review of the skin grid assessment dated [DATE] at 4:00 P.M. revealed Resident #4 had a burn to his front right thigh which measured 4 centimeters (cm)in length by 6.2 cm width with no depth. Review of the skin grid assessment dated [DATE] at 4:13 P.M. revealed Resident #4 had another burn site to their right thigh which measured 2.5 cm in length by 4 cm in width with no depth. During an interview on 02/19/26 at 12:57 P.M., Resident #4 stated on 02/12/26 he was in bed at the facility, thought he was at home, lit a cigarette, and dropped the lit cigarette onto his lap. When he attempted to retrieve the lit cigarette, it came into contact with spray of cologne that was in the bed causing it to burn on his thigh and abdomen. Resident #4 stated he normally kept his smoking items on his person instead of giving them to the staff to keep secure. Resident #4 confirmed he had received education on the smoking policy and smoking materials were to be kept with the staff. He stated he signed a copy of the smoking policy and no longer kept smoking materials since the incident. During an interview on 02/19/26 at 1:05 P.M., Registered Nurse (RN) #634 stated smoking items were supposed to be secured by staff after residents were done smoking. However, at the time this incident occurred on 02/12/26 with Resident #4, smoking items were not always returned to staff to secure, and residents had kept smoking items on their person. During an interview on 02/19/26 at 1:16 P.M., LPN #515 confirmed smoking items were supposed to be secured by staff after residents were done smoking. However, at the time this incident occurred on 02/12/26 with Resident #4, smoking items were not always returned to staff to secure, and some residents kept smoking items on their person. During an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 2 of 4 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 02/25/2026 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 0689 Level of Harm - Actual harm Residents Affected - Few interview on 02/19/26 at 1:30 P.M., Resident #7 stated she kept her smoking items on her person and didn't return them to staff to secure, but now she did since being educated by the staff. During an interview on 02/19/26 at 1:40 P.M., CNA #692 confirmed smoking items were supposed to be returned to staff after smoking. At the time the incident with Resident #4 had occurred it was known that some residents had kept smoking items on their person or hidden in their rooms. During an interview on 02/19/26 at 2:07 P.M., LPN #562 confirmed smoking items were supposed to be secured by staff after residents were done smoking. However, at the time the incident with Resident #4 occurred, smoking items weren't always returned to staff to secure, and some residents maintained smoking items on their person or in their rooms. During an interview on 02/19/26 at 2:55 P.M., CNA #612 confirmed smoking items were supposed to be secured by staff after residents were done smoking. However, at the time the incident with Resident #4 occurred, smoking items weren't always returned to staff to secure and some residents kept smoking materials on them. Review of the policy titled Resident Smoking Guidelines, undated, revealed that smoking was only permitted in designated smoking areas, the facility would store smoking materials in a secure area when not in use, and smoking items were to be returned to facility staff when smoking was completed. The deficiency was corrected on 02/12/26 when the facility implemented the following corrective action: On 02/12/26 at 8:00 A.M. initial policy review with all 22 smokers was completed by the Administrator. On 02/12/26 Resident #4 was interviewed by Clinical Liaison LPN #555 and Regional Director of Clinical Operations for root cause analysis. The Regional Director of Clinical Operations, Administrator, and Director of Nursing conducted a root cause analysis. On 02/12/26 all residents capable were interviewed by the Director of Nursing if anyone smoked in their room and if they kept smoking items in their room. On 02/12/26 skin checks were performed on residents unable to be interviewed, and no new concerns were identified. On 02/12/26 the Administrator and Director of Nursing were provided education on the new smoking policy and procedure by the Regional Director of Clinical Operations which included staff supervised smoking, designated smoking times, turning smoking items into facility staff at the conclusion of smoking times, and the facility was smoking free for all new admissions. On 02/12/26 the Administrator provided education to all facility staff on the new smoking policy and procedures. Anyone scheduled off would receive education before working next shift. On 02/12/26 from 1:00 P.M. to 1:30 P.M. an ad hoc resident council meeting was conducted by the Administrator, Director of Nursing, and Activities Lead #405 to inform residents of the changes to the smoking policy and procedure. The facility identified smokers were spoken to individually about the changes to the smoking policy and procedures. On 02/12/26 the facility had all smoking residents sign a smoking acknowledgment form, smoking materials were taken by a staff member to secure, a progress note was made that residents received education on the new smoking policy and procedure, the signed policy was scanned into Point Click Care (the electronic medical record), and a new smoking assessment was completed. On 02/12/26 an ad hoc Quality Assurance Performance Improvement (QAPI) meeting was conducted which included a root cause analysis, the new smoking policy and procedure, and the purchase of individual lockable bags to secure resident smoking items. Staff present included the Administrator, Admissions Staff #807, Minimum Data Set (MDS) Registered Nurse (RN) #408, MDS RN #413, Social Services Designee (SSD) #409, Therapy Manager, Business Office Manager (BOM), Administrator in Training (AIT) #205 and the facility Medical Director. On 02/12/26 at 9:21 P.M. a report was made to the State Fire Marshal. On 02/12/26 new signage for designated smoking times were posted throughout the facility. On 02/13/2025 Resident #4's smoke detector in his room was tested by the contracted fire protection company to ensure correct function. Room audits were conducted by the Administrator, Director of Nursing, and Unit Managers on 02/13/26, 02/14/26, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 3 of 4 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 02/25/2026 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 0689 Level of Harm - Actual harm 02/15/26, 02/16/26, and 02/17/26. An interview on 02/23/35 at 9:43 A.M. with the Administrator revealed room audits will be conducted of five smoking resident's rooms each week for two months and then re-evaluated at QAPI. This deficiency represents noncompliance investigated under Complaint Number 2744541. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365853 If continuation sheet Page 4 of 4