Inspection·March 7, 2025

F 0675 Honor each resident's preferences, choices, values and beliefs. Level of Harm - Minimal harm or potential for actual harm Based on observation record review and interviews, the facility failed to ensure timely incontinence care and services were provided to promote Quality of Life for one (#2) of five sampled residents. Residents Affected - Few Findings included: During a facility tour on 03/07/2025 at 9:29 a.m., Resident #2 was observed continuously calling for help. The resident continued calling for toileting from 9:29 a.m. to 9:58 a.m. and was observed to have waited approximately 30 minutes for bowel and incontinence care. On 03/07/2025 at 9:29 a.m., Resident #2 was heard calling out from her room, stating, Help me, Help. The resident's verbalization could be heard from the middle of the [NAME] hall. During the observation and interview of the resident in her room, Resident #2 was observed on a specialized mattress, and the covers pulled up to her shoulder. Resident #2 stated she needed help, she had messed herself. Resident #2 was heard to continue her cries for help and waiting to be assisted. On 03/07/2025 at 9:30 a.m., Staff A, Licensed Practical Nurse (LPN), was observed at the nursing station. When asked which aide was assigned to Resident #2, she stated it was Staff B, Certified Nursing Assistant (CNA). Staff A, LPN, stated I think she went outside. During multiple observations conducted on 03/07/2025, the following was observed: At 9:33 a.m., Staff A, LPN, was observed to walk through the hall past Resident #2's room. She did not respond to Resident #2's call. At 9:36 a.m., Staff B, CNA, was observed to walk through the hall, past Resident #2's room. She walked to the linen room, pulled out a bin of socks, placed the bin on the nursing station counter, and proceeded to look at the socks in the bin. She did not respond to Resident #2's call. At 9:38 a.m., Staff B, CNA, returned the bin of socks to the linen room, walked past the nursing station, and past Resident #2's room, and proceeded to a resident room on the west hall. She did not respond to Resident #2's call. At 9:38 a.m., the Maintenance Director was observed to enter the hall from the East side of the building, walked past the nursing station, and walked past Resident #2's room. He did not respond to Resident #2's call. During this time period, Resident #2 was observed to be heard calling for help continuously saying, (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 105714 Printed: 05/28/2026 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 105714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia Manor 321 13th Ave N Saint Petersburg, FL 33701 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)