Inspection·February 26, 2024

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 observations, interviews, record review, and facility policy review the facility failed to ensure Resident #5 and Resident #292 received assistance with activities of daily living (ADL). This affected two residents (#5 and #292) of 35 residents reviewed for ADL care. The facility census was 35. Residents Affected - Few Findings Include: 1. Review of the medical record for Resident #5 revealed an admission date on 03/04/16. Diagnoses include multiple sclerosis and muscle weakness. Review of quarterly Minimum Data Set (MDS) dated [DATE] revealed Resident #5 was dependent for personal hygiene, toileting, and showers. Review of the plan of care dated 11/21/22 for ADL due to multiple sclerosis revealed inventions included assist Resident #5 with ADL completion as needed, and resident will participate in activities as ordered. Showers were to be given Tuesdays and Fridays. Interview on 02/20/24 at 11:54 A.M. with Resident #5 revealed she does not always get her showers per shower schedule. Resident #5 stated she does not feel there was enough staff to provide residents with all of their showers and grooming. Resident #5 was very upset that she had visible chin hairs and wanted them shaved. Observation at the time of the interview revealed visible chin hairs approximately one inch long. Review of the shower sheets and shower task documentation revealed Resident #5 did not receive a shower or bed bath from 01/23/24 through 02/02/24 (10 days). Interview on 02/21/24 at 3:00 P.M. with the Director of Nursing (DON) verified there was no documented evidence Resident #5 received showers from 01/23/24 to 02/02/24. Review of the facility policy Resident Showers, dated 10/17/22, revealed residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety. 2. Review of the medical record for Resident #292 revealed admission date 02/14/24. Diagnosis included depression, cognitive communication deficit, unsteadiness on feet, and surgical aftercare. Review of baseline assessment dated [DATE] revealed Resident #292 required two assists for bed mobility, toileting, and showers. (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 9 Event ID: 366289 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 366289 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia at Sumner 970 Sumner Parkway Copley, OH 44321 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)