Inspection visit

InspectionMarch 21, 2019

GREENBRIAR NURSING CENTERCMS #36585413 citations on this visit

13 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 13 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, policy review and staff interview, the facility failed to timely address advance directive preferences to clarify the resident's preference. This affected one (#4) of 24 residents records reviewed in the first phase of the survey. The total facility census was 61. Findings include: Review of Resident #4's medical record revealed the resident was admitted to the facility on [DATE], with diagnoses including: fracture of unspecified part of neck of right femur, iron deficiency anemia, atrial fibrillation, cardiac pacemaker, transient ischemic attack, age related osteoporosis, atherosclerotic heart disease, hypertension, proteinuria, type two diabetes mellitus, hyperlipidemia, intestinal malabsorption, insomnia, spinal stenosis, and edema. Review of the medical record revealed the resident did not have code status entered on the electronic record on 03/18/19. The paper medical record was reviewed on 03/19/19 and revealed the resident had a do not resuscitate (DNR) form signed by the physician but the rest of the form was blank not indicating the resident's choice if the resident ceased to have vital signs. Additionally in the paper record and there was a full code green colored sheet of paper that was also blank, not indicating if the resident was a full code or not. Interview with Licensed Practical Nurse (LPN) #447 on 03/19/19 at 8:28 A.M., confirmed the resident had signed blank do not resuscitate form in her chart and a blank full code form in her chart. The nurse looked at the resident face sheet and confirmed the resident was admitted on [DATE] and confirmed the code status should have been addressed on admission, not 19 days later. The LPN stated if something happens the staff would not know what the resident wishes were, but would have to act as if the resident was a full code and perform cardio pulmonary resuscitation. Review of resident orders revealed the resident had an order entered on 03/19/19 that read do not resuscitate comfort care (DNR-CC). Review of the policy titled Advanced Directives Policy dated 2001 with a revision date of December 2016 revealed: Upon admission the resident will be provided with written information concerning the right to refuse or accept medical or surgical treatment and to formulate an advance directive if he or she chooses to do so. Information about whether or not the resident has executed an advanced directive shall be displayed prominently in the medical record. The resident has the right to reuse treatment, whether or not he or she has an advanced directive. A resident will not be treated against his or her own wishes. Residents who refuse treatment will not be transferred to another facility (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 14 Event ID: 365854 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0578 unless all other criteria for transfer are met. 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: 365854 If continuation sheet Page 2 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0582 Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident record review and staff interviews; the failed to provide a skilled nursing facility advanced beneficiary notice (SNF ABN) (form CMS-10055) and a notice of medicare non coverage (NOMNC) (form CMS 10123) to a resident who was discharged from Medicare A services when benefit days were not exhausted and the resident remained at the facility. Additionally, the facility failed to provide a NOMNC to a resident who had skilled benefit days remaining, was discharged from Medicare A services, and discharged from the facility immediately following the last covered skilled day. This affected two (#7 and #58) of three residents reviewed for liability notice. The census was 61. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #58 revealed the resident was admitted to the facility on [DATE]. Diagnoses include left artificial knee joint, chronic kidney disease, osteoarthritis, and hypertension. Review of a skilled nursing facility protection notification review revealed the facility initiated a discharge from Medicare part A services when benefit days were not exhausted. Resident #58's last covered day of part A service was 02/28/19. Review of Resident #58's NOMNC revealed the resident skilled therapy services ended 02/28/19. Documentation revealed the resident was given a copy of the form and acknowledged the document on 02/27/19. Continued review of the NOMNC revealed Resident #58 remained at the facility until 03/01/19, per the residents choice. Review of the medical record for Resident #58 revealed the resident/resident representative was not provided a SNF ABN. Interview on 03/21/19 at 11:30 A.M., with the Administrator revealed Resident #58 was given notice on 02/27/19 that skilled therapy services ended 02/28/19. The Administrator verified Resident #58 was not provided the NOMNC timely. The Administrator revealed the resident remained at the facility after being cut from Medicare A skilled services until 03/01/19. The Administrator confirmed Resident #58 was not provided a SNF ABN. 2. Review of the medical record for Resident #7 revealed the resident was admitted to the facility on [DATE]. Diagnoses include atrial fibrillation, congestive heart failure, chronic kidney disease stage four, heart disease, anemia, and major depressive disorder. Review of physical therapy progress notes dated 11/08/19 revealed the resident had returned to prior level of function with the ability to return to private residence with home health services. Review of progress notes dated 11/09/18 revealed Resident #7 was discharged home. Further review of Resident #7's medical record revealed the resident/resident representative was not provided a NOMNC. Interview on 03/19/19 at 5:51 P.M. with Social Service Director (SSD) #407 revealed Resident #7 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 3 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0582 Level of Harm - Minimal harm or potential for actual harm cut from Medicare A services and discharge home immediately following the last skilled covered day. SSD #407 verified Resident #7's medical record did not have evidence of a NOMNC being given to the resident/resident representative. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 4 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0638 Assure that each resident’s assessment is updated at least once every 3 months. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on resident record review and staff interview; the facility failed to timely complete minimum data set (MDS) assessments. This affected three (#13, #54, and #163) of 24 resident reviewed for accuracy and timing of the MDS assessment. The census was 61. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #13 revealed the resident was admitted to the facility on [DATE]. Diagnoses include congestive heart failure, muscle weakness, hypertension, chronic kidney disease, diabetes mellitus type two, gout, hyperlipidemia, atrial fibrillation, anxiety, recurrent depressive disorder, constipation, retention of urine, insomnia, and peripheral vascular disease. Review of Resident #13's quarterly MDS assessment, assessment reference date (ARD) 02/24/19, revealed the assessment was completed on 03/12/19. Interview on 03/21/19 at 1:23 P.M. with MDS Nurse #422 verified Resident #13's quarterly MDS assessment ARD 02/24/19, was completed on 03/12/19. The MDS nurse confirmed the quarterly assessment ARD 02/24/19 was not completed timely. MDS Nurse #422 revealed a quarterly MDS assessments must be completed 14 days after the ARD. 2. Review of the medical record for Resident #54 revealed the resident was admitted to the facility on [DATE]. Diagnoses include dementia, orthostatic hypotension, amnesia, dysphagia, altered mental status, heart disease, major depressive disorder, and seizures. Review of the quarterly MDS assessment ARD 12/07/18, revealed the assessment was completed on 02/05/19. Interview on 03/21/19 at 1:23 P.M. with MDS nurse #422 verified Resident #54's quarterly MDS assessment ARD 12/07/18, was completed on 02/05/19. The MDS nurse confirmed the quarterly assessment was not completed timely. 3. Review of the medical record for Resident #163 revealed the resident was admitted to the facility on [DATE]. Diagnosis include epilepsy, osteoarthritis, hyperlipidemia, mental disorder, unsteadiness on feet, non psychotic mental disorder, hypertension, and mild intellectual diabetes. Review of the quarterly MDS assessment ARD 02/22/19, revealed the assessment was completed on 03/11/19. Interview on 03/21/19 at 2:09 P.M. with MDS nurse #422 verified Resident #163's quarterly MDS assessment ARD 02/22/19 was completed on 03/11/19. MDS nurse #422 confirmed the quarterly MDS assessment was not completed timely. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 5 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to develop a comprehensive care plan that included addressing behavior/mood problems. This affected two (#41 and #47) of five residents reviewed for unnecessary medications. The total resident census was 61. Findings include: 1. Review of Resident #41's medical record revealed an admission dated of 05/23/16, with diagnoses: Alzheimer's disease, dementia in other diseases classified, hypertension, diabetes mellitus with hyperglycemia and diabetic peripheral angiopathy without gangrene, benign prostatic hyperplasia with lower urinary tract symptoms, generalized anxiety disorder, major depressive disorder, toxic encephalopathy, Vitamin D deficiency, chronic obstructive pulmonary disease, lumbago with sciatica left side, other osteoporosis without current pathological fracture, hyperlipidemia, obsessive compulsive disorder, primary insomnia, constipation, and primary generalized osteoarthritis. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #41 was identified with a brief interview for mental status (BIMS) score of 6, which indicated the resident had severe impairment of cognitive skills. The MDS reflected the resident had received antipsychotic, antianxiety, and antidepressant medications 7 times in last 7 days. The Mood section noted resident has felt down, depressed or hopeless 7-11 days out of the last 2 weeks, feels tired or having little energy 2-6 days, feels bad about himself or that he is a failure ad lets himself or family down 2-6 days. The Behavior section reflected: resident displayed other behavior symptoms not directed at others (e.g., physical symptoms such as hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing or smearing food or bodily waste, or verbal/vocal symptoms like screaming, disruptive sounds-occurred 1-3 days. Review of the medical record revealed Resident #41 had been transferred to a near by hospital psychiatric unit 01/11/19, for aggression and combativeness. The resident returned on 01/29/19 and psychoactive medications had been adjusted. The resident had hallucinations and delusions, sexually inappropriate behavior with female staff while at the hospital. Review of current physician orders for March 2019 revealed on 01/29/19, the resident had orders to receive a mood stabilizer medication (Depakote), two antidepressant medications (Myrbetriq and Cymbalta), and an antipsychotic medication (Seroquel). Review of the care plan for Resident #41 was conducted. The care plan reflected the resident had several behavior issues, but did not reflect aggression, combativeness, sexual inappropriateness, hallucinations, delusions, or other behavior identified in the MDS of 02/09/19. The care plan was also silent to the resident experiencing anxiety or depression. There were no intervention put into place to address these behavior and mood indicators. Interview with the Director of Nursing (DON) on 03/21/19 at 2:30 P.M., verified the care plan did not address the aggression, combativeness, sexual inappropriateness, hallucinations, delusions, or other behavior identified in the MDS of 02/09/19. 2. Review of Resident #47's medical record revealed the resident was admitted to the facility on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 6 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few [DATE], with diagnoses including: dementia with lewy bodies, hypertension, hyperlipidemia, atherosclerotic heart disease, poly neuropathy, asthma, gastro esophageal reflux disease, pain, sciatica, visual hallucinations, dermatitis, anxiety , insomnia and psychosis. Review of Resident #47's physician orders revealed orders for trazodone (antidepressant) 50 mg give 12.5 mg at bedtime for dementia with lewy bodies, Risperidone (antipsychotic) 0.5 mg give one for unspecified psychosis and Buspar (antianxiety) 10 mg two three times a day for agitation. Review of most recent quarterly MDS dated [DATE], revealed the resident has a brief interview of mental status score of 6 indicating the resident is cognitively impaired, the resident had no delusions, hallucinations or behaviors during the review period. The resident requires extensive assist for toileting, limited assist for hygiene, eating, dressing, transfers and bed mobility and only requires supervision for walking in the room, corridor, locomotion on the unit. Resident #47 is coded as frequently incontinent of bladder and always incontinent of bowel. During the review period the resident was coded as receiving seven days of antipsychotic, antidepressant, and antianxiety medications. Review of Resident #47's care plans revealed there was no care plan to address the use of psychotropic medications used in the resident care, including the goal, care and intervention the staff will use for the resident while the resident is on these medications. Interview with the Director of Nursing (DON) on 03/21/19 at 10:43 A.M., verified the care plan did not include a care plan to address the psychotropic medications that were used in the care of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 7 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, family and staff interview, and review of facility policies, the facility failed to involve the resident and/or resident family or legal representative in the care planning process. This affected three (#20, #22, #60) of three residents reviewed for care plans. The total resident census was 61. Findings include: 1. Review of Resident #20's medical record revealed an admission date of 04/09/18, with diagnoses: chronic obstructive pulmonary disease, other seasonal allergic rhinitis, Vitamin D deficiency, other symbolic dysfunctions, acute kidney failure, repeated falls, Alzheimer's disease, muscle weakness, other instability of right knee, pain in right knee, hypokalemia, type II diabetes mellitus without complications, atherosclerotic heart disease, hypertensive heart disease without failure, angiodysplasia of colon without gangrene, heart failure, other osteoporosis, gastro-esophageal reflux disease, hyperlipidemia, major depressive disorder, thrombocytopenia, and dysphagia. Review of the base line care plan dated 04/09/18, contained no documentation of the resident or her husband being provided with a copy. Review of the comprehensive Minimum Data Set (MDS) assessments dated 04/16/19, 07/11/18, 10/04/18, and 01/04/19 revealed assessments were completed. There was no documentation in the medical record of a care conference ever being held. Nor was there documentation the resident and/or her husband had been ever been invited to participate in the process. Interview on 03/18/19 at 2:57 P.M., with Resident #20 and her spouse revealed neither knew what a care conference was, and after explanation, they both stated they had never been invited to participate in any such meeting. Interview on 03/19/19 at 4:45 P.M., with the Director of Nursing (DON) verified there was no documented evidence of the resident being invited to participate. Review of the undated facility policy titled Planning - Interdisciplinary Team revealed to the extent practicable, the resident, the resident's family or the resident's legal representative should participate in the development of the care plan. Every effort will be made to schedule care plan meetings at the best time of day for the resident and family. Review of the undated facility policy titled Resident/Family Participation revealed each resident and his/her family members and/or legal representative shall be permitted to participate in the development of the resident's comprehensive care plan. 2. Review of Resident #60's medical record revealed an admission date of 06/07/18, with diagnoses: dementia with Lewy Bodies, dementia in other diseases classified elsewhere without behavioral disturbance, rapid eye movement (REM) sleep behavior disorder, benign prostatic hypertrophy without lower urinary tract symptoms, other intervertebral disc degeneration lumbar region, hyperlipidemia, restless leg syndrome, and Parkinson's dementia. Review of the base line care plan dated 06/07/18, contained no documentation of the resident or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 8 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few family member being provided with a copy. The resident's medical record contained comprehensive MDS assessments dated 06/17/18, 09/14/18, 12/15/18, and 02/19/19. There should have been care plan meetings held at each of these dates. Interview on 03/18/19 at 10:26 A.M., with Resident #60's family member revealed she had never been invited to a care conference. Interview on 03/19/19 at 2:12 P.M., with the DON verified the base line care plan had not been provided to the family, and there was no documentation in record that the resident and/or family had ever been invited to or involved in care plan meetings. 3. Review of Resident #22's medical record revealed the resident was admitted to the facility on [DATE], with diagnoses including weakness, difficulty walking, hypertension, hyperlipidemia, chronic ischemic heart disease, hypothyroidism, history of falling, and unsteadiness on feet. Review of the Quarterly MDS dated [DATE] revealed the resident has a brief interview of mental status score of 7 indicating the resident has cognitive impairment. The resident had no delusions, hallucinations or behaviors and requires extensive assist for toileting, dressing and transfers, limited assist for bed mobility, personal hygiene, locomotion on and off the unit and supervision with. Resident #22's medical record contained no evidence of the resident having a care conference, or being included in the care planning process and Resident #22 has resided in the facility over 180 days. Review of care plans revealed the resident has a base line care plan that was initiated in her medical record however their is no evidence the care plan was discussed, shared or completed with the resident or responsible party. Interview with the Director of Nursing on 03/19/18 at 1:20 P.M., verified the baseline care plan for Resident #22 had no evidence of involvement with the family or responsible party. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 9 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 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 observation, record review, staff interview and review of facility policy for nail care, the facility failed to provide timely nail care to a diabetic resident unable to care for himself. This affected one (#41) of one residents reviewed for Activities of daily living. The total resident census was 61. Residents Affected - Few Findings include: Review of Resident #41's medical record revealed an admission dated of 05/23/16 with diagnoses: Alzheimer's disease, dementia in other diseases classified, hypertension, diabetes mellitus with hyperglycemia and diabetic peripheral angiopathy without gangrene, benign prostatic hyperplasia with lower urinary tract symptoms, generalized anxiety disorder, major depressive disorder, toxic encephalopathy, Vitamin D deficiency, chronic obstructive pulmonary disease, lumbago with sciatica left side, other osteoporosis without current pathological fracture, hyperlipidemia, obsessive compulsive disorder, primary insomnia, constipation, and primary generalized osteoarthritis. Review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #41 was identified with a brief interview for mental status (BIMS) score of 6, which indicated the resident had severe impairment of cognitive skills. In the area of personal hygiene the resident was identified as requiring limited assist of one staff to complete tasks. No rejection of care was documented on the MDS. Observation on 03/18/19 at 10:03 A.M., Resident #41 was observed with long fingernails, approximately 1/4 inch past the ends of his fingers. Licensed Practical Nurse (LPN) #415 at that time stated the resident was usually compliant with care. Interview on 03/18/19 at 11:58 A.M., with State Tested Nurse Aide (STNA) #448 stated she had reported the resident's long fingernails to the nurse last Thursday on the bath sheet that his fingernails were very long and needed cut. STNA #448 stated the resident is diabetic and the nurses have to cut his fingernails. Interview on 03/18/19 at 2:58 P.M., with LPN #415 verified that nursing staff are to trim finger nails of residents who are diabetic, then STNA's may file them. Observation on 03/19/19 at 8:45 A.M. and 3:03 P.M., revealed Resident #41 was observed to still have long fingernails. Observation on 03/21/19 at 8:15 A.M., revealed the resident was observed in his room, his long fingernails remained. Interview on 03/21/19 at 8:20 A.M., with the Director of Nursing (DON) revealed licensed nurses are to cut the fingernails of diabetic residents. Nails may be filed by STNA's. Review of the facility policy titled Fingernail/Toenails, Care of with a revision date of February 2018, is directed at STNAs. This policy stated under general guidelines, Step 3: Unless otherwise permitted, do not trim the nails of diabetic residents with circulatory impairments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 10 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 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 record review and staff interview, the facility staff failed to follow physician daily weight orders. This affected one (#161) of one resident reviewed for dialysis services. The total facility census was 61. Residents Affected - Few Findings include: Review of Resident #161's medical record revealed the resident was admitted to the facility on [DATE], with the diagnoses including: fracture of right lower leg subsequent encounter for closed fracture with routine healing, dependence on renal dialysis, hypertension, type two diabetes, long term use of insulin, hyperlipidemia, atherosclerotic heart disease, endocrine disorder, end stage renal disease, chronic kidney disease stage five, anemia, hyperkalemia, insomnia, and atypical atrial flutter. Review of physician orders revealed the resident had an order on admission for daily weights and to inform the physician if there is a greater than two pound weight gain in one day and a greater than five pound weight gain in five days. The daily weight order was updated on 03/06/19, to read daily weights for one week with no parameters. Review of current orders revealed the resident orders do not reflect the daily weight order written on 03/06/19, and the medical record still reflects daily weight, inform physician of a greater than two pound weight gain in one day and a greater than five pound weight gain in five days. Review of the vital sign report and the Treatment Administration Record (TAR) revealed the resident did not have a weight obtained and documented on 03/08/19, 03/11/19, 03/12/19. There is no documentation of the resident refusing to have his weight obtained in the medical record. Review of the nursing progress notes revealed there was no physician notification of the missing weights. Interview with the Director of Nursing on 03/20/19 at 3:30 P.M., confirmed the medical record did not reflect the current physician order for Resident #161's weights, nor did the facility complete the weights as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 11 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and facility staff interview, the facility failed ensure residents with hearing deficits received timely treatment. This affected two (#36 and #16) of two residents reviewed for hearing services. The facility census was 61. Residents Affected - Few Findings include: 1. Review of Resident #36's medical record revealed an admission date of 04/20/16, with diagnoses including: hearing loss, hypertension, type two diabetes mellitus, deficiency of other specified B group vitamins, dementia, weakness, difficulty in walking, hyperlipidemia, peripheral vascular disease, polyneuropathy, osteoarthritis, dorsopathies occipito atlanto-axial region, cardiac murmur, history of transient ischemic attack, spinal stenosis, anemia, stress incontinence, depression, and gastro esophageal reflux disease. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed the resident was coded as having moderate difficulty with hearing and as using hearing aides and vision is coded as impaired and the resident wears corrective lenses. Resident #36 has a brief interview of mental status score of 5 indicating the resident has cognitive impairment. Resident #36 coded as not having any delusions, hallucinations or behaviors during the review period and requires extensive assist with daily cares with the exception of eating which is supervision. Review of 02/21/18, Audiology progress note revealed Resident #36 is recommended hearing Aids for right and left ear. The progress note stated hearing aides will be for directionality, next visit: fit with hearing device. There are no additionally audiology notes in the medical record. Review of facility records for doctor visits revealed the Audiologist was in the facility in 05/24/18 and was also in the facility on 06/20/18. Review of care plans revealed the resident has a communication problem related to diagnosis of un-specified [NAME] loss. The goal is resident will maintain current level of communication function, and the resident will be able to make basic needs known on a daily basis through the review date. The intervention includes resident requires staff to speak in elevated tones in order to communicate. Interview with Social Service Worker (SSW) #407 on 03/19/19 at 3:25 P.M., revealed the facility had a previous audiology provider who had seen residents in 2018 and had assessed residents and then stopped coming to the facility. SSW #407 stated Resident #36 was on the list to be seen on 03/25/19. SSW #407 stated she was informed the company was going to see Resident #36 to assess her for hearing needs and fit her for hearing devices. SSW #407 confirmed Resident #36 was last seen by audiology services on 02/21/18, and still needed to be fit for hearing devices. 2. Review of the Resident #16's medical record revealed the resident was admitted to the facility on [DATE]. Diagnoses included dementia with behavioral disturbances, diverticulosis of intestine, osteoarthritis, muscle weakness, hypertension, major depressive disorder, melena, chronic obstructive pulmonary disease, hypokalemia, disorder or the kidney and ureter, chronic kidney disease stage three, peripheral vascular disease, gout, and anxiety. Review of Resident #16's quarterly MDS assessment dated [DATE] revealed the resident had intact (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 12 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0685 cognition. Level of Harm - Minimal harm or potential for actual harm Review of an audiology consult dated 05/24/18, revealed Resident #16 was scheduled to be assessed by the audiologist. The resident was not able to be assessed related to the need for ear wax removal. The hearing test was to be rescheduled and a recommendation was made for ear wax removal drops 2 to 3 drops per ear each day for 7 days before the next visit. Review of the residents medical record revealed the residents next audiology consult was scheduled for 06/20/18. Residents Affected - Few Review of the medication administration record (MAR) dated 06/18 revealed Resident#16 was to be administered debrox 6.5 percent solution; three drops in each ear twice daily for seven days. The debrox solution start date was 06/13/18 and stop date was 06/20/18. Continued review of the MAR dated 06/18 revealed debrox drops were not administered on 06/13/18 at 8:00 P.M., on 06/14/18 at 8:00 A.M. and 8:00 P.M. and on 06/15/18 at 8:00 P.M. Review of nurse progress notes dated 06/13/18 to 06/15/18 revealed debrox solution was not administered to Resident #16 because the debrox was not available. Review of an audiology consult dated 06/20/18 revealed Resident #16 was assessed by the audiologist. The residents right ear was partially clear and the left ear was moderately occluded. Irrigation was recommended bilaterally and debrox drops were recommenced for the left ear. Review of the audiology consult note documented results of the hearing evaluation revealed mild to moderately severe sensorineural hearing loss bilaterally. The audiologist recommended amplification/hearing instrument. The resident was to be fitted with a hearing device on the next visit and have cerumen removal if it is still present. Continued review of the medical record for Resident #16 revealed the resident was not provided bilateral ear irrigation or debrox drops for the left ear as recommended. Further review of the medical record revealed no documentation of the resident being fitted for a hearing device. Interview on 03/18/19 at 9:55 A.M., with Resident #16 revealed the resident was hard of hearing. The resident reported wax build up in the left ear which made it hard to hear anything in the left ear. The resident further reported he/she was suppose to see a doctor to have the wax removed from the left ear and to be fitted for hearing aides but it never happened. Interview on 03/19/19 at 3:20 P.M., SSW #407 revealed Resident #16 did not have hearing devices. The SSW #407 verified the contract with the audiologist had ended and the resident did not follow up with an audiologist for the recommended treatment made on 06/20/18. Interview on 03/19/19 at 5:34 P.M., with the Director of Nursing (DON) verified Resident #16 was not administered debrox solution as ordered from 06/13/18 to 06/19/18. The DON further verified the recommendation for bilateral ear irrigation and debrox drops for the left ear was not provided to Resident #16 as recommended by the audiologist on 06/20/18. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 13 of 14 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 365854 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbriar Nursing Center 501 West Lexington Road Eaton, OH 45320 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 staff interview, the facility failed to monitor psychotropic medications for side effects. This affected one (#47) of five reviewed for unnecessary medications. The total facility census was 61. Residents Affected - Few Findings include: Review of Resident #47's medical record revealed the resident was admitted to the facility on [DATE], with diagnoses including: dementia with lewy bodies, hypertension, hyperlipidemia, atherosclerotic heart disease, poly neuropathy, asthma, gastro esophageal reflux disease, pain, sciatica, visual hallucinations, dermatitis, anxiety , insomnia and psychosis. Review of Resident #47's physician orders revealed orders for trazodone (antidepressant) 50 mg give 12.5 mg at bedtime for dementia with lewy bodies, Risperidone (antipsychotic) 0.5 mg give one for unspecified psychosis and Buspar (antianxiety) 10 mg two three times a day for agitation. Review of most recent quarterly MDS dated [DATE], revealed the resident has a brief interview of mental status score of 6 indicating the resident is cognitively impaired, the resident had no delusions, hallucinations or behaviors during the review period. The resident requires extensive assist for toileting, limited assist for hygiene, eating, dressing, transfers and bed mobility and only requires supervision for walking in the room, corridor, locomotion on the unit. Resident #47 is coded as frequently incontinent of bladder and always incontinent of bowel. During the review period the resident was coded as receiving seven days of antipsychotic, antidepressant, and antianxiety medications. Resident #47's medical record revealed no evidence of the monitoring of antipsychotic use such as an Abnormal involuntary movement scale (AIMS) test for the resident and she has been in the facility over 6 months. Interview with the Director of Nursing (DON) on 03/21/19 at 10:43 A.M., verified the resident should have some type monitoring for the use of antipsychotic medication used in her care and the DON verified there was not any monitoring in place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 365854 If continuation sheet Page 14 of 14

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Citations

13 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
0582GeneralS&S Dpotential for harm
F582 - The facility must—
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
0638GeneralS&S Dpotential for harm
F638 - Quarterly Review Assessment
Assure that each resident’s assessment is updated at least once every 3 months.
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0657GeneralS&S Dpotential for harm
F657 - Comprehensive Care Plans
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
0677GeneralS&S Dpotential for harm
F677 - A resident who is unable to carry out activities of daily living receives
Provide care and assistance to perform activities of daily living for any resident who is unable.
0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0685GeneralS&S Dpotential for harm
F685 - Vision and hearing
Assist a resident in gaining access to vision and hearing services.
0757GeneralS&S Dpotential for harm
F757 - Unnecessary Drugs—General
Ensure each resident’s drug regimen must be free from unnecessary drugs.
0293GeneralS&S Epotential for harm
Have properly located and lighted "Exit" signs.
0353GeneralS&S Fpotential for harm
Inspect, test, and maintain automatic sprinkler systems.
0372GeneralS&S Epotential for harm
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
0712GeneralS&S Fpotential for harm
F712 - Frequency of physician visits
Have simulated fire drills held at unexpected times.

FAQ · About this visit

Common questions about this visit

What happened during the March 21, 2019 survey of GREENBRIAR NURSING CENTER?

This was a inspection survey of GREENBRIAR NURSING CENTER on March 21, 2019. The surveyor cited 13 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at GREENBRIAR NURSING CENTER on March 21, 2019?

Yes, 13 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate ..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

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Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·March 21, 2019