Inspection·July 13, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, resident and staff interviews it was determined that the facility failed to respond to resident call bells in a timely manner for one of four call bells observed (Resident 1). Residents Affected - Few Findings include: Review of facility policy Call Lights: Accessibility and Timely Response dated 1/6/23, indicated the purpose is to assure the facility is adequately equipped with a call light at each residents' bedside, toilet, and bathing facility to allow residents to call for assistance. Call lights will directly relay to a staff member or central location to ensure appropriate response. Review of admission record indicated Resident R1 admitted to the facility on [DATE]. Review of Resident R1's Minimum Data Set (MDS- a periodic assessment of care needs) dated 6/22/23, indicated the diagnoses of hip fracture, atrial fibrillation (irregular heart rhythm), and deep vein thrombosis (blood clot). Section G requires extensive assistance of two people for activities of daily living (hygiene, toileting, transferring). Review of Resident R1's care plan dated 6/23/23, indicated staff were to cue residents to call for assist with toileting as needed and keep call bell in reach. Interview on 7/13/23, at 8:40 a.m. Resident R1 indicated on more than one occasion she had to wait to go into or come out of the bathroom [ROOM NUMBER] minutes or longer for her call bell to be answered by staff. Observations on 7/13/23, at 10:32 a.m. Resident R1's bathroom call light was illuminated. Further observations showed Resident R1's bathroom call light continued for 16 minutes (10:48 a.m.). Interview on 7/13/23, at 10:33 a.m. Nursing Assistant Employee E1, who answered the light, stated I'm in here to help her. Interview on 7/13/23, at 10:33 a.m. Resident R1 stated I've been waiting so long, my rearend is stuck to the toilet. Observations on 7/13/23, at 1:16 p.m. Resident R1's bathroom call light was illuminated. Further observations showed Resident R1's bathroom call light continued for 16 minutes (1:32 p.m.). Interview on 7/13/23, at 9:54 a.m. Resident R2 indicated I have concerns with the number of staff, (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 2 Event ID: 395684 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 395684 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia Lutheran Health and Human Care 134 Marwood Road Cabot, PA 16023 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)