Health inspection·April 18, 2022

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 medical record review, staff interview, and review of the online Resident Assessment Instrument (RAI) manual, the facility failed to complete required Minimum Data Set (MDS) assessments. This affected 10 (#1, #6, #9, #10, #12, #116, #117, #118, #164, and #166) of 17 residents reviewed for completed MDS assessments. The facility census was 23. Residents Affected - Some Findings include: 1. Record review for Resident #1 revealed no MDS assessments had been completed for the resident since the annual MDS assessment dated [DATE]. 2. Record review for Resident #6 revealed no MDS assessments had been completed for the resident since the quarterly MDS assessment dated [DATE]. 3. Record review for Resident #9 revealed no MDS assessments had been completed for the resident since the quarterly MDS assessment dated [DATE]. 4. Record review for Resident #10 revealed no MDS assessments had been completed for the resident since the quarterly MDS assessment dated [DATE]. 5. Record review for Resident #12 revealed no MDS assessments had been completed for the resident since the quarterly MDS assessment dated [DATE]. 6. Record review for Resident #116 revealed no MDS assessments had been completed for the resident since the admission MDS assessment dated [DATE]. 7. Record review for Resident #117 revealed no MDS assessments had been completed for the resident since the quarterly MDS assessment dated [DATE]. 8. Record review for Resident #118 revealed no MDS assessments had been completed for the resident since the Medicare-30 Day/End of Therapy MDS assessment dated [DATE]. 9. Record review for Resident #164 revealed no MDS assessments had been completed for the resident since the annual MDS assessment dated [DATE]. 10. Record review for Resident #166 revealed no MDS assessments had been completed for the resident since the quarterly MDS assessment dated [DATE]. (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 3 Event ID: 366360 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 366360 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vineyards at Concord, The 119 West High Street Frankfort, OH 45628 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)