Pennsylvania Department of Health
CONCORDIA AT REBECCA RESIDENCE
Patient Care Inspection Results

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Severity Designations


Minimal Citation - No Harm	Minimal Harm	Actual Harm	Serious Harm

CONCORDIA AT REBECCA RESIDENCE
Inspection Results For:

There are 105 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.


CONCORDIA AT REBECCA RESIDENCE - Inspection Results	Scope of Citation Number of Residents Affected By Deficient Practice

Initial comments:

Based on a Medicare Recertification, State Licensure, and Civil Rights Compliance survey, completed on March 13, 2025, it was determined that Concordia at Rebecca Residence was not in compliance with 42 CFR 483.80 Subpart B Requirements for Long-Term Care facilities and the 28 PA Code, Commonwealth of Pennsylvania Long-Term Care licensure regulations as they relate to the Health portion of the survey process.

Plan of Correction:

483.25(i) REQUIREMENT Respiratory/Tracheostomy Care and Suctioning:

This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.

§ 483.25(i) Respiratory care, including tracheostomy care and tracheal suctioning.
The facility must ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals and preferences, and 483.65 of this subpart.

Plan of Correction - To be completed: 04/30/2025

Resident R10 nebulizer tubing changed, and date added, nebulizer tubing placed in bag when not in use. Resident R154 CPAP/BIPAP order placed in PCC, CPAP placed in bag when not in use, care plan updated to include a plan for use and management. Resident R155 does not have orders for CPAP, physician notes verify resident non-compliant and not used, CPap not at bedside. Resident R156 oxygen concentrator checked, and filter replaced. Initial audit of all oxygen, nebulizer and CPAP/BIPAP equipment completed to ensure all tubing is dated/bagged and filters clean, as well as appropriate orders and care plans present in medical records. DON or designee will educate nursing staff on changing and dating nebulizer tubing and placing in a bag when not in use. Nursing staff will be educated on placing CPAP/BIPAP orders in PCC, updating care plans, and placing in a bag when not in use. Nursing staff will be educated on checking oxygen concentrators and replacing filters as needed. DON or designee will audit 3 residents using nebulizer tubing weekly for 1 week for tubing dated and placed in bags and then 3 residents monthly for 1 month or until sufficient compliance is met. DON or designee will audit 3 residents with a CPAP or BiPap for correct order, care plans, and bags when not in use weekly for 1 week, and then 3 residents monthly for 1 month or until sufficient compliance is met. DON or designee will audit five oxygen concentrators weekly for 1 week for filters, and then five oxygen concentrators monthly for 1 month or until sufficient compliance is met. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance

483.10(i)(1)-(7) REQUIREMENT Safe/Clean/Comfortable/Homelike Environment:

This is a less serious (but not lowest level) deficiency and is isolated to the fewest number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status.

§483.10(i) Safe Environment.
The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

The facility must provide-
§483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.
(i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.
(ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft.

§483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior;

§483.10(i)(3) Clean bed and bath linens that are in good condition;

§483.10(i)(4) Private closet space in each resident room, as specified in §483.90 (e)(2)(iv);

§483.10(i)(5) Adequate and comfortable lighting levels in all areas;

§483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81°F; and

§483.10(i)(7) For the maintenance of comfortable sound levels.

Observations:

Based on review of facility policy, observations and staff interviews it was determined that the facility failed to provide a clean, safe, comfortable, and homelike environment for three of twelve resident rooms (Residents R6, R19, and R159).

Findings include:

Review of the facility policy "Resident Rights" reviewed 4/1/24, indicated the resident has a right to a safe, clean, comfortable and homelike environment including but not limited to receiving treatment and supports for daily living safely.

Review of the admission record indicated Resident R6 admitted to the facility on 11/14/17.

Observation on 3/10/25, at 9:34 a.m. Resident R6 was in the electric wheelchair in his room. The foot board of the bed's right side had the corner broken with the particle board halfway off exposing rough, irregular shapes at the perimeter of the board. The perimeter of the resident room walls, just above the baseboards, were gouged deeply and under the wall vent was actually separated from the wall.

Interview with Resident R6 on 3/10/25, at 9:35 a.m. indicated he was unsure how long it's been broken.

Review of the admission record indicated Resident R19 was admitted to the facility on 7/12/24.

Observation of Resident R19's room on 3/10/25, at 9:40 a.m. indicated a vertical wall vent with multiple louver slats damaged.

Review of the admission record indicated Resident R159 was admitted to the facility on 3/1/25.

Observation of Resident R159's room on 3/10/25, at 9:45 a.m. indicated a vertical wall vent with multiple louver slats damaged.

Interview and tour with Registered Nurse (RN) Employee E1 on 3/10/25, at 9:50 a.m. confirmed the observations for Resident R6, Resident R19, and Resident R159, and that there were damaged environments.

Interview on 3/10/25, at 12:00 p.m. the Director of Nursing confirmed the facility failed to provide a clean, comfortable homelike environment for three of twelve resident rooms (Residents R6, R19, and R159).

28 Pa. Code: 201.14(a) Responsibility of licensee.
28 Pa. Code: 201.18(b)(1)(3) Management.

Plan of Correction - To be completed: 04/30/2025

Resident R6 footboard was replaced with brand new footboard. Resident R6 walls were repaired with new drywall/drywall compound and freshly painted. R159/R19 vertical wall vents were repaired. Maintenance Director and maintenance tech will be educated on regulation 483.10 (i) Safe Environment by administrator or designee. No residents were affected by deficient practice Maintenance director or designee will audit 5 rooms daily for 5 days, weekly for 2 weeks and monthly thereafter to ensure compliance. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance.

483.12(a)(1) REQUIREMENT Free from Abuse and Neglect:

§483.12 Freedom from Abuse, Neglect, and Exploitation
The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms.

§483.12(a) The facility must-

§483.12(a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;

Observations:

Based on review of facility policies, facility provided documents, clinical records and staff interviews, it was determined that the facility failed to make certain a resident was free from neglect for one of three residents reviewed (Resident R1).

Findings include:

The facility's policy "Abuse Neglect, and Exploitation" policy reviewed 4/1/24, indicated it is the facility's policy to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property. Neglect means failure of the facility, its employees, or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.

Review of admission record indicated Resident R1 was admitted to the facility on 1/28/25.

Review of Resident R1's Minimum Data Set (MDS - a periodic assessment of care needs) dated 1/28/25, indicated the diagnoses of congestive heart failure (heart doesn't pump blood as well as it should), high blood pressure, and cellulitis (a bacterial skin infection that affects the middle layer of the skin and underlying tissues) of right lower leg. Section C indicated a BIMS score of 14 (Brief Interview for Mental Status - a screening test that aides in detecting cognitive impairment). A total score of 13-15, indicated cognitively intact.

Review of facility provided documents dated 2/1/25, indicated Resident R1 reported Nurse Aide (NA) Employee E2 refused to help her out of bed and just watched her while she struggled to get her right leg out of the bed, without help which caused pain. In the bathroom the staff member poured water over her head without telling her and roughly scrubbed her hair. While on the toilet staff member refused to help her get off the raised toilet seat and watched her try to get herself up for five to 10 minutes while insisting that she needed to do it on her own.

Review of Resident R1's singed witness statement dated 2/3/25, indicated NA Employee E2 poked and laughed at her belly while on the toilet. After wiping her face with a washcloth, without telling or explaining what she was going to do, dumped soapy shampoo water on top of her head, and started to roughly scrub her head, then viciously brushed her hair. Staff member refused to help get resident out of bed. Resident's entire right leg was in severe pain and lifting it was extremely painful. NA Employee E2 did not wait for the larger toilet seat, the regular one was too small for resident's hips. NA Employee E2 wouldn't help try to get it over residents hips for some time. Finally got powder to try to ease it off, but it didn't work. Finally, the aide pushed all the hip tissue through. It was a very painful ordeal. Resident tried a long time without assistance and NA Employee E2 just stood there.

Review of NA Employee E2's Witness Statement, not dated, indicated "I had Resident R1 on Saturday. I took her to the bathroom a couple of times. I told her I'd give her privacy and to ring. She rang. I cleaned her from behind. Her foot is inflamed, so I tried being as gentle as I could".

Review of facility investigation dated 2/6/25, at 3:03 p.m. indicated the facility's conclusion that NA Employee E2 was found to be negligent in care practices and was terminated from her position.

Interview on 3/12/25, at 9:30 a.m. the Director of Nursing confirmed that the facility failed to make certain a resident was free from abuse and neglect for one of three residents reviewed (Resident R1).

28 Pa. Code 201.14(a) Responsibility of licensee.
28 Pa. Code 201.18(b)(1)(3) Management.
28 Pa. Code 211.10(d) Resident care policies.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.

Plan of Correction - To be completed: 04/30/2025

This plan of correction constitutes our written allegation of compliance for the deficiency cited. However, submission of this plan of correction is not an admission that a deficiency exists or that one was cited correctly. This plan of correction is submitted to meet requirements established by state and federal law.
Employee E2 was suspended pending investigation and subsequently terminated for potential neglect. ERS and PB-22 were completed/submitted and approved. All appropriate nursing staff will receive education on abuse prevention and reporting by administrator or designee. All residents will be provided with education on Resident Rights during resident council meetings. Residents who do not attend will be given a copy of residents rights via resident handbook. Director of nursing or designee will interview 5 residents weekly x 4 weeks then monthly thereafter regarding staff treatment of residents. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance.

483.21(a)(1)-(3) REQUIREMENT Baseline Care Plan:

§483.21 Comprehensive Person-Centered Care Planning
§483.21(a) Baseline Care Plans
§483.21(a)(1) The facility must develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The baseline care plan must-
(i) Be developed within 48 hours of a resident's admission.
(ii) Include the minimum healthcare information necessary to properly care for a resident including, but not limited to-
(A) Initial goals based on admission orders.
(B) Physician orders.
(C) Dietary orders.
(D) Therapy services.
(E) Social services.
(F) PASARR recommendation, if applicable.

§483.21(a)(2) The facility may develop a comprehensive care plan in place of the baseline care plan if the comprehensive care plan-
(i) Is developed within 48 hours of the resident's admission.
(ii) Meets the requirements set forth in paragraph (b) of this section (excepting paragraph (b)(2)(i) of this section).

§483.21(a)(3) The facility must provide the resident and their representative with a summary of the baseline care plan that includes but is not limited to:
(i) The initial goals of the resident.
(ii) A summary of the resident's medications and dietary instructions.
(iii) Any services and treatments to be administered by the facility and personnel acting on behalf of the facility.
(iv) Any updated information based on the details of the comprehensive care plan, as necessary.

Observations:

Based on review of facility policy, clinical record review, and staff interview, it was determined that the facility failed to ensure that a baseline care plan, that included the minimum healthcare information necessary to properly care for a resident was fully developed and implemented for two of seven residents (Residents R154 and R155).

Findings include:

Review of Code of Federal Regulations (CFR) Baseline Care Plans The facility must develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The baseline care plan must-
(i) Be developed within 48 hours of a resident's admission.
(ii) Include the minimum healthcare information necessary to properly care for a resident including, but not limited to-
(A) Initial goals based on admission orders.
(B) Physician orders.
(C) Dietary orders.
(D) Therapy services.
(E) Social services.
(F) PASARR recommendation, if applicable.
The facility must provide the resident and their representative with a summary of the baseline care plan that includes but is not limited to:
(i) The initial goals of the resident.
(ii) A summary of the resident's medications and dietary instructions.
(iii) Any services and treatments to be administered by the facility and personnel acting on behalf of the facility.

Review of Resident R154's clinical record indicates an admission date of 3/6/25.

Review of Resident R154's Provider Note dated 3/7/25, indicated the diagnosis of left Tri malleolar fracture (a rare but serious ankle injury that involves simultaneous breaks in the three bones of the ankle), osteoarthritis (flexible tissue at the ends of bone wears down), and high blood pressure.

Review of Resident 154's physician order dated 3/6/25, indicated Rivaroxaban 20 mg (milligrams) (an anticoagulant - blood thinning medication) give once daily in the evening for blood clots.

Review of Residents R154's baseline care plan for the admission date of 3/6/25, failed to include anticoagulant care.

Review of Resident R155's clinical record indicated an admission date of 3/5/25.

Review of Resident R155's physician orders dated 3/5/25, indicated the diagnosis of Parkinson's Disease (disorder of the nervous system that results in tremors), obstructive sleep apnea (a chronic condition in which the throat muscles relax during sleep and the airway may become partially or fully blocked), and sepsis (a life-threatening complication of an infection).

Further review of Resident R155's physician orders dated 3/5/25, indicated the following:
-Device type: Right upper extremity PICC line (peripherally inserted central catheter) every shift.
-JP drain (Jackson-Pratt a closed -suction medical device used after surgery to collect excess fluid from the surgical site, promoting healing and reducing the risk of infection) empty drain, record amount and characteristics of drainage every shift.

Observation of Resident R155 on 3/10/25, at 9:20 a.m. indicated a left shoulder surgical site with JP drain and gauze dressing.

Review of Resident R155's baseline care plan for the admission date of 3/5/25, failed to include PICC line care, JP drain care, or surgical site care.

Interview on 3/11/25, at 1:17p.m. the Director of Nursing confirmed that the facility failed to ensure that a baseline care plan, that included the minimum healthcare information necessary to properly care for a resident was fully developed and implemented for two of seven residents (Residents R154 and R155).

28 Pa. Code 211.10(d) Resident care policies.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.

Plan of Correction - To be completed: 04/30/2025

Resident R154 baseline care plan has been updated to include Rivaroxaban for anticoagulant care, and continued monitoring for bleeding and bruising. Resident R155 baseline care plan has been updated to include PICC line care, JP drain care, and surgical site care. Current residents' care plans will be audited to ensure anticoagulant, PICC line, JP drain and surgical site care are included. DON or designee will educate nurses on thorough completion of baseline care plans, to be completed and locked within 48 hours. Director of nursing or designee will audit five admissions weekly for 1 week, and then 5 admissions monthly for 1 month or until sufficient compliance is met. Baseline care plans will include instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance.

483.21(b)(2)(i)-(iii) REQUIREMENT Care Plan Timing and Revision:

§483.21(b) Comprehensive Care Plans
§483.21(b)(2) A comprehensive care plan must be-
(i) Developed within 7 days after completion of the comprehensive assessment.
(ii) Prepared by an interdisciplinary team, that includes but is not limited to--
(A) The attending physician.
(B) A registered nurse with responsibility for the resident.
(C) A nurse aide with responsibility for the resident.
(D) A member of food and nutrition services staff.
(E) To the extent practicable, the participation of the resident and the resident's representative(s). An explanation must be included in a resident's medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident's care plan.
(F) Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.
(iii)Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments.

Observations:

Based on review of facility policy, clinical records, and staff interview, it was determined the facility failed to update care plans to be reflective of residents' current needs for two of seven residents (Residents R10 and R33).

Findings include:

Review of the Code of Federal Regulations (CFR) Care Plans:
A comprehensive care plan must be-
(i) Developed within 7 days after completion of the comprehensive assessment.
(ii) Prepared by an interdisciplinary team, that includes but is not limited to--
(A) The attending physician.
(B) A registered nurse with responsibility for the resident.
(C) A nurse aide with responsibility for the resident.
(D) A member of food and nutrition services staff.
(E) To the extent practicable, the participation of the resident and the resident's representative(s). An explanation must be included in a resident's medical record if the participation of the resident and their resident representative is determined not practicable for the development of the resident's care plan.
(F) Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.
(iii)Reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments.

Review of the Admission Record indicated Resident R10 was admitted to the facility on 2/4/25.

Review of Resident R10's Minimum Data Set (MDS - a periodic assessment of care needs) dated 2/11/25, indicated the diagnoses of osteomyelitis (inflammation of bone caused by infection) left ankle and foot, atrial fibrillation (irregular heart rhythm), and heart failure (heart doesn't pump blood as well as it should), and presence of a pacemaker (a small device used to treat arrhythmias that sends electrical pulses to help the heart beat at normal rate and rhythm).

Review of Resident R10's care plan dated 2/17/25, failed to indicate a plan for care and management of the pacemaker.

Interview on 3/11/25, at 1:17 p.m. the Assistant Director of Nursing Employee E6 confirmed the facility failed to update care plans to be reflective of residents' current needs and that a plan for the care and management of the pacemaker was not completed for Resident R10.

Review of Admission Record indicated Resident R33 was admitted to the facility on 10/17/22.

Review of Resident R33's Minimum Data Set (MDS - a periodic assessment of care needs) dated 1/28/25, indicated the diagnoses of cerebral infarction (also known as a stroke, occurs when blood flow to the brain is disrupted due to issues with the arteries that supply it), dysphagia (difficulty swallowing solids and liquids), and heart disease.

Review of Resident R33's clinical nutrition progress note dated 2/28/25, indicated nutrition interventions were reviewed for skin integrity; 2/24/25 weight reflects a 13% weight loss (significant weight loss) in six months; stage 3 sacral wound is healing.

Review of Resident R33's current "Nutrition: Potential for altered Nutrition status" plan of care, initiated 10/7/22, updated 3/10/25, failed to identify focused nutritional problems, goals, and interventions specific to significant weight loss, and sacral wound.

During an interview on 3/12/25, at 9:57 a.m., Registered Nurse Assessment Coordinator (RNAC) Employee E3 confirmed that Resident R33's care plan failed to be updated and identify focused nutritional problems, goals, and interventions specific to resident's current nutritional status.

During an interview on 3/13/25, at 11:15 a.m., the Nursing Home Administrator (NHA) and Director of Nursing (DON) confirmed that the facility failed to update care plans to be reflective of residents' current needs for two of seven residents (Residents R10 and R33).

28 Pa. Code: 211.10(c) Resident care policies.

28 Pa. Code: 211.12(d)(1)(5) Nursing services.

Plan of Correction - To be completed: 04/30/2025

Resident R10's comprehensive care has been updated to include a plan of care and management of pacemaker. Resident R33's comprehensive care plan has been updated to include focused nutritional problems, goals, and interventions specific to significant weight loss and sacral wound. Current residents' care plans will be audited to ensure pacemaker and nutritional interventions are included. DON or designee will educate nurses on completion of comprehensive care plans. DON or designee will audit five residents comprehensive care plans weekly for 1 week and then five resident care plans monthly for 1 month or until sufficient compliance is met. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance.

§ 201.20(a)(1) LICENSURE Staff development.:

(1) Accident prevention.

Observations:

Based on a review of facility policy, employee education records and staff interviews, it was determined that the facility failed to ensure that employees completed the required annual accident prevention education for one of five employees reviewed (Nurse Aide (NA) Employee E5).

Findings include:

Review of facility policy "Compliance Training and Education" dated 4/1/24, indicated that the facility is committed to providing ongoing compliance training for employees, management, and Board of Directors. Employees are provided general compliance training and job-specific compliance training related to the high-risk aspects of their jobs. Examples of compliance training topics include: Federal and state regulations.

Review of NA Employee E5's personnel file indicated a hire date of 5/23/23, and failed to include accident prevention in-service education between 1/1/24 and 12/31/24.

During an interview on 3/12/25, at 2:24 p.m., Human Resource (HR) Director Employee E4 confirmed that the facility failed to ensure that employees completed the required annual accident prevention education for one of five employees as required.

Plan of Correction - To be completed: 04/30/2025

Employee E5 will complete the missing training (Accident Prevention). Administrator or designee will educate HR director on 201.20 (a)(1) Licensure Staff Development. No residents were affected by deficient practice. HR director or designee will audit new employees 1 week for 4 weeks, monthly thereafter to ensure training is assigned and Medbridge (Electronic education program) is activated, and training is occurring. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance.

§ 201.20(a)(2) LICENSURE Staff development.:

(2) Restorative nursing techniques.

Observations:

Based on a review of facility policy, employee education records and staff interviews, it was determined that the facility failed to ensure that employees completed the required annual restorative nursing techniques education for one of five employees reviewed (Nurse Aide (NA) Employee E5).

Findings include:

Review of facility policy "Compliance Training and Education" dated 4/1/24, indicated that the facility is committed to providing ongoing compliance training for employees, management, and Board of Directors. Employees are provided general compliance training and job-specific compliance training related to the high-risk aspects of their jobs. Examples of compliance training topics include: Federal and state regulations.

Review of NA Employee E5's personnel file indicated a hire date of 5/23/23, and failed to include restorative nursing techniques in-service education between 1/1/24 and 12/31/24.

During an interview on 3/12/25, at 2:24 p.m., Human Resource (HR) Director Employee E4 confirmed that the facility failed to ensure that employees completed the required annual restorative nursing techniques education for one of five employees as required.

Plan of Correction - To be completed: 04/30/2025

Employee E5 will complete the missing training (Restorative Nursing Techniques). Administrator or designee will educate HR director on 201.20 (a)(1) Licensure Staff Development. HR director or designee will audit new employees 1 x week for 4 weeks, monthly thereafter to ensure training is assigned, no residents were affected by deficient practice. Medbridge (Electronic education program) is activated, and training is occurring. Corrective process will be reviewed quarterly by the quality improvement and quality assurance committee for further analysis and recommendation to ensure further compliance.

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