Health inspection·May 16, 2023

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review and interviews with staff, it was determined that the facility did not develop a person-centered baseline care plan within 48 hours of a resident's admission related to infection control for two out of eight newly admitted residents (Resident R102 and Resident 201). Findings include: The facility Care plan summary policy dated 12/2/22, indicated that the facility will provide the resident with a written summary of the baseline care plan that includes resident's initial goals, summary of resident's medications, any services and treatments to be administered and any information based on the details of the comprehensive care plan. The care plan summary will be completed within 48 hours after admission. Review of Resident R102's admission record indicated he was admitted on [DATE]. Review of Resident R102's MDS assessment dated [DATE], indicated he was admitted with diagnoses that included Bacteremia (infection in the blood stream), Chronic Obstructive Pulmonary Disease (COPD-a disease characterized by persistent respiratory symptoms involving breathlessness, coughing, and obstructed airflow to the lungs), Endocarditis(inflammation impacting the inner lining of the heart), and heart failure (a progressive heart disease that affects pumping action of the heart muscles). The MDS assessment indicated that these diagnoses were the most current upon review. Review of Resident R102's clinical admission assessment dated [DATE], indicated he had an infection upon admission. Review of Resident R102's physician orders dated 5/2/23, indicated to administer Ceftriaxone Sodium (antibiotic) intravenously every morning for 30 minutes until 5/31/23 for Bacteremia. Review of Resident R102's base line care plans did not include that he had an infection and was to receive an IV antibiotic treatment. During observations on 5/15/23, at 10:52 a.m. Resident R102 was observed in his room with use of IV antibiotic treatment in use and under isolation precautions. During an interview on 5/15/23, at 11:18 a.m. interview with Licensed Practical Nurse (LPN) Employee E1 stated that Resident R102 was still on IV antibiotic for an infection. (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 5 Event ID: 396089 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 396089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Concordia of the South Hills 1300 Bower Hill Road Pittsburgh, PA 15243 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)