Inspection·November 13, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few functioning properly, it had an alarm on it that had to be manually shut off. He stated no staff had to reset that alarm on 11/08/25 at the time of the elopement. The facility was supposed to be doing every 15-minute checks on Resident #28 prior to the elopement because of Door #2.Interview on 11/13/25 at 12:33 P.M. with CNA #301 revealed Resident #28 had a fall between 9:30 A.M. and 10:15 A.M. and was found in the doorway to the enclosed courtyard, and the resident had been with a nurse since the fall. CNA #301 and CNA #307 were getting residents ready for lunch when CNA #307 told her a visitor informed her Resident #28 was found in parking lot. CNA #301 stated she was unaware the wanderguard alarm was not working. She stated the nurse reached out to management about it and was told a different door was not working prior to this and staff were told to do fifteen-minute checks of the four residents who wore wanderguard bracelets until it was fixed. CNA #301 revealed none of them were informed about doing every 15-minute checks due to Door #2 not working. She stated they started to do 15 minute checks after Resident #28 eloped. CNA #301 stated they were busy the day Resident #28 eloped and revealed Resident #28's behaviors were normal on the day of elopement.Interview and review of documentation on 11/13/25 at 1:24 P.M. with Systems Administrator (IT) #500 revealed he checked the doors every week and showed weekly audits. The audit indicated Door #2, a side door, was not functioning. It had a note for an outside company coming to fix it on 11/14/25. According to the audit. Door #2 was functioning on 11/04/25. IT #500 stated there was a temporary alarm on this door that had to be manually turned off. He stated they suspected Resident #28 eloped from Door #1, the front door, because none of the staff heard Door #2's alarm on 11/08/25, nor did anyone manually turn off any alarm. IT #500 also stated Door #2 was used by staff with a key fob to get to the parking lot on the side of the building. IT #500 revealed they started doing every 15-minute checks on 11/06/25 when they discovered the issue with Door #2.Interview on 11/13/25 at 1:43 P.M. with LPN #205 revealed CNA #307 notified her on 11/08/25 at approximately 12:00 P.M. an unknown visitor said Resident #28 was found outside in the parking lot. She assessed him and when she brought him through the doors, the alarm did not sound or secure the doors. She replaced his wanderguard and stayed with him one one one (1:1). LPN #205 notified nursing manager (LPN #600) who was in the other building who then informed the DON. LPN #205 notified the guardian. LPN #205 also spoke to the DON who told her to initiate every 15-minute checks on the four residents with wanderguard bracelets after learning the dayshift staff had not been doing them. LPN #205 told the DON they did not get that information in report. The DON had said they should have been doing every 15-minute checks due to Door #2 not functioning properly. LPN #205 reiterated she was never told about this. LPN #205 revealed she last saw Resident #28 around 11:00 A.M. and he had a t-shirt, pants and tennis shoes on. She stated he did not look distressed. LPN #205 revealed she did not get in report about the every 15-minute checks nor did she see any paperwork for the checks. LPN #205 revealed Resident #28's behaviors were no different than normal. She stated he had frequent falls and had one that morning around 10 A.M. at the entrance of the enclosed courtyard. She stated they had normal staffing, one nurse and two CNAs for up to 24 residents.Interview on 11/13/25 at 2:13 P.M. with LPN #600 revealed she happened to be working as a CNA in the other building on 11/08/25 when she received a text about the elopement from LPN #205. She called the DON then went to the other building to get witness statements and start investigation. LPN #600 recounted what LPN #205 told her about the situation.Observations on 11/13/25 from 2:34 P.M. to 3:55 P.M. revealed Resident #28 was in his room. Other residents with wandergaurd bracelets (Residents #11, 24, and 35) were in the dining room for an activity. Multiple staff were present. Observation of Door #2 alarm sounding when staff exited showed a staff member manually turning it off. Observation of the front hallway revealed a set of unmarked doors which led to the lobby. There was a set (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366289 If continuation sheet Page 2 of 3 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 11/13/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete of doors with the wanderguard keypad leading to vestibule and a second set of doors that lead to the parking lot. LPN #205 tested the alarm by bringing a resident with a wandergaurd bracelet near the door. The keypad turned red (from green) and would not open when the nurse briefly pushed on it. The keypad was reset by the nurse after removing the resident from the area.Interview on 11/13/25 at 4:12 with Administrator and DON revealed DON learned of Resident #28's elopement on 11/08/25 by LPN #600. She stated all residents' wanderguards were checked and Resident #28 was assessed. DON found out on 11/08/25 first shift did not know about the every 15-minute checks because of Door #2 malfunctioning. She was unable to determine if the prior shift shared that in report or not as they claimed to tell the next shift and the staff on 11/08/25 dayshift denied getting it in report. DON expected them to start every 15-minute checks at that point. Wanderguards were moved to residents' wrist if it was on ankle. Orders were changed on Monday to check the wanderguard bracelet every Monday. They started using a handheld device to check the bracelets wherever the resident was instead of taking them to a door. The DON provided education to staff starting 11/08/25.Review of the every 15-minute checks forms revealed some pages had initials for all four residents who used a wanderguard bracelet plus initials of the staff. Staff also drew arrows down the page instead of making an entry for every 15 minute increment. DON verified on 11/13/25 at 4:22 P.M. the form was blank on 11/08/25 for the dayshift until after the elopement occurred.Review of facility policy titled Elopements and Wandering Resident, dated 12/22/2023, revealed the policy read the facility was equipped with door locks/alarms to help avoid elopements. Alarms were not a replacement for necessary supervision. Adequate supervision would be provided to help prevent accidents or elopements.This deficiency represents non-compliance investigated under Complaint number 2664797. Event ID: Facility ID: 366289 If continuation sheet Page 3 of 3