Health inspection·February 8, 2024

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on closed medical record review, staff interviews and facility policy review, the facility failed to ensure the Power of Attorney (POA) was notified of a change in condition in the area of skin tears for one resident (#74). This affected one (Resident #74) of three residents reviewed for notification. The facility census was 73. Findings Include: Review of the closed medical record for Resident #74 revealed an initial admission date of [DATE] with the diagnoses including encounter for orthopedic aftercare, displaced intertrochanteric fracture of the right femur, chronic obstructive pulmonary disease (COPD), Parkinsonism, generalized muscle weakness, abnormalities of gait and mobility, dysphagia, other symbolic dysfunctions, dysarthria and anarthria, repeated falls, protein-calorie malnutrition, chronic kidney disease, dementia, hypertension, gastro-esophageal reflux disease, hyperlipidemia, insomnia, depression, anxiety disorder, chronic pain syndrome, dementia with behavioral disturbances, abnormal weight loss, psychotic disorder and urinary tract infection (UTI). The resident expired in the facility on [DATE]. Review of the resident's comprehensive Minimum Data Set (MDS) assessment dated [DATE] revealed the resident had a severe cognitive deficit. Review of the mood and behavior revealed the resident had delusions, displayed verbal and physical behaviors directed towards others and rejected care. The resident required was dependent on staff for activities of daily living (ADL). The resident was always incontinent of both bowel and bladder. The assessment indicated the resident had no falls since admission to the facility. The resident was assessed as being at risk for skin breakdown and had no skin issues. Review of the behavior note dated [DATE] at 1:10 A.M. revealed the resident was combative with staff and attempting to get out of bed. Review of the progress note dated [DATE] at 1:15 A.M., revealed the resident had two skin tears on the right and left wrist/lower hand area after resident was being combative with staff and hitting hands of bed railings. Staff was attempting to keep resident from falling out of bed. The resident was assisted with putting pants on and assisted into her wheelchair to help calm resident down. The skin tears were cleansed with wound cleanser, antibiotic ointment was applied and covered with band-aid. The resident was taken to the nurses station and given juice. Review of the progress note dated 01/21 24 at 10:08 A.M. revealed the resident's daughter requested to see the nurse. The resident daughter was upset about the skin tears to the left and right (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 6 Event ID: 366381 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 366381 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concord Health & Rehab Ctr 1242 Crescent Drive Wheelersburg, OH 45694 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)