Concord Care And Rehabilitation Center

Based on resident interview, observation of a meal test tray, and staff interview, the facility failed to ensure food was served at an appetizing temperature and acceptable palatability for 13 (#4, #5, #6, #11, #12, #21, #24, #26, #27 and #33) residents with food complaints. The census was 40. Findings include: Interviews were completed with Resident #4, #5, #6, #11, #12, #21, #24, #26, #27 and Resident #33 at various times on 04/18/22 regarding meals services. All 13 residents had concerns regarding meals being cold, The residents identified this has been an on-going concern for quite a while. Observation on 04/19/22 at 12:37 P.M. revealed the requested test tray was placed on top of the food delivery cart and exited the kitchen. All resident meals were placed inside the delivery cart. Residents trays were delivered by staff on 04/19/22 between 12:39 P.M. and approximately 12:53 P.M. The test tray was removed from cart on 04/19/22 at 12:55 P.M. Test tray temperatures on 04/19/22 at approximately 12:57 P.M. revealed the diced potatoes were 90 degrees Fahrenheit, some pieces were…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interviews and review of facility policy, the facility failed to provide dining assistance during with meals in a dignified manner when staff stood up while feeding residents. This affected one (Resident #27) of two residents reviewed for dining assistance. The facility census was 40. Findings include: Review of Resident #27's medical record revealed an admission date of 09/13/19. Diagnoses included cerebral vascular accident (CVA), dysphasia, hemiplegia, diabetes mellitus, and congestive heart failure. Review of Resident #27's quarterly Minimum Data Set (MDS) assessment, dated 03/28/22, revealed the resident had low cognitive function. The resident required supervision and set up assistance with eating. Observation on 04/20/22 at 8:09 A.M. revealed State Tested Nurse Aide (STNA) #419 standing next to Resident #27 while feeding her bites of oatmeal. Interview at that time with STNA #419 confirmed she was standing over Resident #27 while feeding her. Review of the facility policy titled Assistance With Meals, revised July 2017, revealed residents who…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review and staff interviews, the facility failed to inform in advance of the risks and benefits of a new treatment order and the option to choose an alternative order of treatment for one (#40) resident out of 15 residents sampled. The facility census was 40. Findings include: Review of Resident #40's medical record identified admission to the facility occurred on 01/25/22. Diagnoses included end stage renal disease, anemia, diabetes and peritonitis. Resident #40 discharged on 02/19/22. Review of the admission assessment dated [DATE] revealed Resident #40 was alert and oriented and and independent with decisions. Resident #40 was independent with eating. Review of progress notes on 01/26/22 revealed Resident #40 was upset over his diet order and stated he was not going to be able to tolerate thickened liquids. Review of progress notes on 01/27/22 revealed Resident #40 requested and was denied ice for a dry throat. The notes revealed the dietician assessed Resident #40 on 01/26/22 and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on medical record reviews, resident interviews, staff interviews, observations, and review of the facility policy, the facility failed to ensure resident food preferences were served during meals. This affected two (#12 and #25) of three residents reviewed for choices. The facility census was 40. Findings include: 1. Review of the medical record for Resident #12 revealed an admission date of 02/08/22. Diagnoses included end stage renal disease, type 2 diabetes mellitus, vascular dementia with behavioral disturbance, and hypertension. Review of the Minimum Data Set (MDS) assessment, dated 02/23/22, revealed Resident #12 had intact cognition. Review of the care plan initiated 02/10/22 for Resident #12 revealed he had a potential nutritional problem related to type 2 diabetes mellitus and end stage renal disease requiring hemodialysis. Interventions added on 04/06/22 included double portions at all meals. Review of a progress note dated 04/06/22 revealed Resident #12 requested double portions at all meals. Review of the physician orders for Resident #12 revealed an order dated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review and staff interview, the facility failed to ensure a Minimum Data Set (MDS) assessment was completed within 14 days of admission for one (#238) our of 15 residents sampled. The facility census was 40. Findings include: Review of Resident #238's medical record revealed an admission date of 04/07/22. Diagnosis included diabetes mellitus, obesity, seizures, and homicidal ideations. The resident was admitted on Hospice care due to congestive heart failure. As of 04/21/22 Resident #238 did not have a completed MDS assessment. Interview with Licensed Practical Nurse #430 on 04/21/22 at 9:02 A.M. verified the facility failed to complete a MDS assessment for Resident #238.

Based on medical record review, resident interview, and staff interviews, the facility failed complete care conferences and provide the opportunity to participate in care planning meetings to make decisions about care for one (#5) out of 15 residents sampled. The facility census was 40. Findings include: Review of Resident #5's medical record revealed admission to the facility occurred on 02/07/20. Diagnoses included stroke, high blood pressure, dysphasia, and COVID-19. Review of the Minimum Data Set (MDS) assessment, dated 01/10/22, revealed Resident #5 was cognitively intact. The medical record revealed the most recent care plan meeting for Resident #5 occurred on 10/29/21. No additional care plan meetings have occurred since 10/29/21. Interview on 04/18/22 at 7:47 P.M., Resident #5 revealed she has no had a care conference in a long time and she would like to discuss therapy options with the facility. Interview on 04/21/22 at 7:43 A.M., the Assistant Director of Nursing (ADON) confirmed there was no evidence the facility has conducted a care plan meeting for Resident #5 since…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, medical record review, resident interview, and staff interview, the facility failed to ensure showers were provided at a frequency to maintain a clean hygienic appearance for one (#5) of two residents reviewed for activities of daily living. The facility census was 40. Findings include: Review of Resident #5's medical record revealed admission to the facility occurred on 02/07/20. Diagnoses included stroke, high blood pressure and seizures. Review of the Minimum Data Set assessment, dated 01/10/22, revealed Resident #5 was cognitively intact and dependant on staff for bathing. Observation and interview with Resident #5 on 04/18/22 at 7:43 P.M. Resident #5's hair was observed to be greasy and somewhat matted together. Resident #5 stated she was not even sure when the last time she received a shower and or her hair was washed. Review of the facility shower schedules revealed Resident #5 should be showered on Wednesdays and Saturdays, on the night shift. Review of the facility shower sheets revealed Resident #5's had one shower sheet completed for 04/06/22 with no…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on record review, resident interview, staff interview, and review of facility policy, the facility failed to complete preventive wound care per physician orders for one (#26) of two residents reviewed for pressure ulcers. The facility identified three residents receiving wound care and 35 residents with preventative skin care. The facility census was 40. Findings include: Review of Resident #26's medical record revealed an admission date of 10/08/21. Diagnoses included seizures, chronic obstructive pulmonary disease, metabolic encephalopathy, cerebral vascular accident and fibromyalgia. Review of Resident #26's Minimum Data Set (MDS) assessment, dated 03/23/22, revealed the resident had intact cognitive function. She required limited assistance for bed mobility and was dependent on staff for transfers. Review of Resident #26's most recent care plan revealed she had a potential and actual impairment of skin integrity related to fragile skin, immobility, incontinence, and poor nutritional intake. Record review revealed Resident #26 had a healed pressure sore to the right hip and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, record review, and staff interview, the facility failed to apply a hand splint as ordered for one (#23) out of two residents reviewed for positioning. The facilty had seven residents with contractures. The facility census was 40. Findings include: Resident #23 was admitted to the facility on [DATE]. Diagnoses included hemiplegia affecting left side, diabetes mellitus, neuralgia and neuritis, muscle weakness, and major depressive disorder. Review of the physician order, dated 03/04/21, revealed an order for left resting hand splint to be applied with A.M. care and off with P.M. care as tolerated. Splint to be worn for up to 8 hours daily. Observations on 04/19/22 at 9:59 A.M., 12:40 P.M. and again at 4:19 P.M. revealed no splint to Resident #23's left hand. Observations on 04/20/22 at 7:45 A.M. revealed Resident #23 was up in the wheelchair in the dining room. Resident #23 did not have the left hand splint in place. Interview on 04/20/22 at 07:47 AM with the Executive Director and Assistant…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, resident interview, staff interview, and review of facility policy, the facility failed to provide a physician ordered nutritional supplements and failed to provide a physician prescribed therapeutic renal diet. This affected two (#12 and #27) out of five residents reviewed for nutrition. The facility identified four residents who were on nutritional supplements. The census was 40. Findings include: 1. Review of Resident #27's medical record revealed an admission date of 09/13/19. Diagnoses included cerebral vascular accident (CVA), dysphagia, hemiplegia, diabetes mellitus, and congestive heart failure. Review of the Minimum Data Set (MDS) assessment, dated 03/28/22, revealed Resident #27 had a low cognitive function. The resident required supervision and set up assistance with eating. Review of Resident #27's current care plan revealed she had nutritional problems related to CVA and dysphasia. The care plan showed fluctuating weight changes over the past year. Review…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview, review the dialysis correspondence notebook, and review of the policy, the facility failed to ensure communication was received from the dialysis clinic after dialysis treatment and failed to check for a bruit and thrill per physician order. This affected two (#12 and #11) of two residents reviewed for dialysis. The facility census was 40. Findings include: 1. Review of the medical record for Resident #12 revealed an admission date of 02/08/22. Medical diagnoses included end stage renal disease, type 2 diabetes mellitus, vascular dementia with behavioral disturbance, and orthostatic hypotension. Review of the physician orders dated 04/19/22 revealed Resident #12 had hemodialysis on Monday, Wednesday, and Friday. Review of the dialysis correspondence notebook for Resident #12 revealed the facility received no documentation from the dialysis clinic upon return of Resident #12 from the treatment. Interview on 04/20/22 at approximately 12:00 P.M. confirmed the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on medical record reviews and staff interviews, the facility failed to obtain physician ordered laboratory (lab) tests for two (#3 and #23) of seven residents sampled for medication review. The facility census 40. Findings include: 1. Review of Resident #3's medical record revealed admission to the facility occurred on 09/01/20. Diagnoses included atrial flutter, chronic obstructive pulmonary disease and congestive heart failure. Review of the current physician orders revealed Resident #3 was to have a liver function and thyroid stimulating hormone (TSH) lab test completed every six months. Review of Resident #3 lab tests revealed a liver function test and a TSH level were obtained on 08/19/21. The record identified no testing was completed in February 2022 as ordered. Interview with the Director of Nursing (DON) on 04/21/22 at 12:11 P.M. confirmed the facility did not complete the TSH and liver function testing for Resident #3 as ordered. 2. Review of Resident #23's medical record identified admission to the facility occurred on 04/20/16. Diagnoses included diabetes, stroke,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on medical record review, observation, resident interview, staff interview, and review of the facility policy, the facility failed to ensure residents received regular dental services. This affected one (#35) of two residents reviewed for dental services. The facility census was 40. Findings include: Review of Resident #35's medical record revealed an admission date of 07/12/21. Diagnoses included type II diabetes, dysphagia, major depressive disorder, and dysphagia. Review of the Minimum Data Set (MDS) assessment, dated 03/25/22, revealed Resident #35 was cognitively intact. Resident #35 had no mouth or facial pain or discomfort with chewing and had no obvious cavities or broken teeth at the time of the review. Review of Resident #35's care plan, revised 04/19/22, revealed supports and interventions for oral/dental health problems. Interventions included coordinating arrangements for dental care and transportation as needed, monitor for any signs or symptoms of oral problems needing attention, and to encourage to brush his teeth at least in the morning and at night. Review of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, observation, resident interview, observation of meal tickets, policy review and staff interview, the facility failed to provide the correct physician ordered diet consistency for three(#4, #27, #338) out of five residents reviewed for nutrition. The facility identified four residents who were ordered mechanical soft diets. The census was 40. Findings include: 1. Review of Resident #27's medical record revealed an admission date of 09/13/19. Diagnoses included cerebral vascular accident (CVA), dysphagia, hemiplegia, diabetes mellitus, and congestive heart failure. Review of Resident #27's Minimum Data Set (MDS) assessment, dated 03/28/22, revealed the resident had a low cognitive function. The resident required supervision and set up assistance with eating. Review of Resident #27's most recent care plan revealed she had nutritional problems related to CVA and dysphagia. The resident needed a therapeutic diet and mechanical soft diet texture due to aspiration precautions. Review of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on medical record review, observation, policy review and staff interview, the facility failed to provide adaptive devices at meals for one (#27) of five residents reviewed for nutrition. The facility identified no residents requiring assistive meal devices. The census was 40. Findings include: Review of Resident #27's medical record revealed an admission date of 09/13/19. Diagnoses included cerebral vascular accident (CVA), dysphasia, hemiplegia, diabetes mellitus, and congestive heart failure. Review of Resident #27's Minimum Data Set (MDS) assessment, dated 03/28/22, revealed the resident required supervision and set up assistance with eating. Review of Resident #27's most recent care plan revealed she had nutritional problems related to CVA and dysphasia. Interventions added on 01/21/22 included the use of a plate guard and a non-skid mat. Observation of breakfast service on 04/20/22 at 8:14 A.M. revealed Resident #27 was in the dining room. The resident failed to be provided a non-skid mat and dish with plate guard. Observation of lunch service on 04/20/22 at 12:14 P.M.…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and staff interview, the facility failed to maintain an accurate medical record. This affected one (#12) of 15 residents reviewed. The facility census was 40. Findings include: Review of the medical record for Resident #12 revealed an admission date of 02/08/22. Medical diagnoses included end stage renal disease, type 2 diabetes mellitus, vascular dementia with behavioral disturbance, and orthostatic hypotension. Review of the hospital records for Resident #12 revealed he was hospitalized from [DATE] to 02/21/22. Review of the medication administration record for Resident #12 for February 2022 revealed staff documented vital signs on 02/18/22 during day shift, 02/19/22 during night shift, and 02/20/22 during day shift. Interview on 04/20/22 at 1:34 PM with the Director of Nursing confirmed Resident #12 was hospitalized and not in the facility from 02/15/22 to 02/21/22 and staff charted vital signs on 02/18/22, 02/19/22, and 02/20/22. Review of the policy titled Charting and Documentation,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, staff interview, review of manufacturer's instructions and policy review, the facility failed to ensure the dishwashing machine maintained the proper chemical sanitizing level to sanitize dishes; and failed to store foods in a safe and sanitary manner. This had the potential to affect all residents who received food from the kitchen. The facility identified all 43 residents received food from the kitchen. The facility census was 43. Findings include: Observation on 05/28/19 at 8:48 A.M. of the low temperature dishwasher revealed the sanitization level test strip showed no sanitizer was found in the rinse cycle of the dishwasher. The bottle of sanitizer connected below the dishwasher was empty. Interview on 05/28/19 at 8:50 A.M. with Dietary Staff #101 verified the sanitizer bottle was empty and the test strip was white which indicated no sanitizer was present in the rinse cycle of the dishwasher. Interview on 05/28/19 at 8:52 A.M. with Dietary Staff #101 revealed no rinse sanitizer solution was available to replace the empty bottle. Dietary Staff #101 reported…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on medical record review, staff interview and policy review, the facility failed to develop a baseline care plan for newly admitted residents. This affected one (Resident #28) of two residents reviewed for baseline care plans. The facility identified ten newly admitted residents. The facility census was 43. Findings include: Review of Resident #28's medical record revealed an admission date of 04/03/19. Diagnoses included chronic obstructive pulmonary disease, cerebral infarction, dysphagia, lack of coordination, type II diabetes, anxiety disorder, major depressive disorder, hypertension, osteoarthritis, anemia, hyperlipidemia, and Wernicke's encephalopathy. Review of Resident #28's Minimum Data Set (MDS) assessment dated [DATE] revealed the resident was cognitively intact. Resident #28 required extensive assistance with bed mobility, transfer, dressing, toilet use, and personal hygiene. Resident #28 required limited assistance with walking and supervision with eating and locomotion. Resident #28 displayed…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on medical record review, staff interview and policy review, the facility failed to develop and implement a comprehensive care plan for residents who smoked, experienced pain and used psychotropic medications. This affected two (Residents #33 and #41) of 14 care plans reviewed. The facility census was 43. Findings include: 1. Review of Resident #33's medical record revealed an admission date of 04/11/19. Diagnoses included symbolic dysfunctions, hypertension, lack of coordination, osteoarthritis, major depressive disorder, anxiety disorder, nicotine dependence, fracture of upper end of tibia subsequent encounter for closed fracture, and encounter for surgical aftercare. Review of Resident #33's Minimum Data Set (MDS) assessment, dated 05/09/19, revealed the resident was cognitively intact. Resident #33 required supervision of staff for set up only for bed mobility, transfer, walking, locomotion, eating, toilet use and personal hygiene. Resident #33 displayed no behaviors during the review period. Resident #33 received as needed (PRN) pain medications and non-medication…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.