Above average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Concordia At Rebecca Residence during CMS and state inspections, most recent first.
For a period of 21 consecutive days, the facility did not designate a licensed nurse to serve as charge nurse on any shift. This was confirmed by both the NHA and DON, and staffing documentation showed no licensed nurse was assigned as charge nurse during this time. The NHA also acknowledged inaccuracies in the PBJ Staffing Data Report.
The facility failed to provide appropriate respiratory care for four residents, including improper management of oxygen equipment and CPAP/BIPAP devices. A resident's nebulizer mask was not dated or bagged, while two residents had CPAP/BIPAP devices without physician orders or care plans. Another resident's oxygen concentrator lacked required filters. These deficiencies were confirmed by nursing staff.
The facility failed to maintain a clean, safe, and homelike environment for three residents. Observations showed a broken footboard and gouged walls in one resident's room, and damaged wall vents in two other residents' rooms. Staff confirmed these deficiencies, which violated the facility's policy on resident rights.
A resident with congestive heart failure and cellulitis experienced neglect by a nurse aide who refused to assist her in getting out of bed and roughly handled her during personal care. The aide's actions caused the resident pain and distress, leading to the aide's termination after a facility investigation.
The facility failed to develop comprehensive baseline care plans for two residents. One resident's plan omitted anticoagulant care, while another's lacked details for PICC line, JP drain, and surgical site care. The DON confirmed these omissions, indicating a deficiency in meeting care planning requirements.
The facility failed to update care plans for two residents, leading to deficiencies in addressing their current medical needs. One resident's care plan did not include management for a pacemaker, while another's plan lacked interventions for significant weight loss and a sacral wound. These oversights were confirmed by facility staff.
The facility failed to maintain sanitary conditions in the main kitchen, as brown debris was found in the ice machine. The Assistant Dietary General Manager confirmed the debris and was unable to verify the last cleaning date, indicating a lapse in maintaining sanitary standards, potentially leading to foodborne illness.
The facility failed to follow physician orders for obtaining weights for four residents, as identified through observation, clinical record review, and staff interviews. Residents with various medical conditions, including dysphagia, cancer, heart failure, and cardiomyopathy, had specific orders for weight monitoring that were not followed. The Director of Nursing confirmed the lack of adherence to these orders and the absence of a related policy.
A resident's clinical care grievances were not recorded on the designated grievance form as required by the facility's policy. The resident, with a history of heart failure and other conditions, and their family expressed concerns about medication management, response times to call lights, and staff empathy. The DON confirmed these grievances were not documented, indicating a lapse in the grievance handling process.
The facility failed to communicate necessary resident information during transfers for two residents. One resident with dysphagia and mental health disorders, and another with osteomyelitis, diabetes, and cerebral palsy, were transferred to the hospital and returned without essential information being shared with the receiving provider. The DON confirmed this failure, violating resident rights.
The facility failed to notify the Office of the LTC Ombudsman about the hospital transfers of two residents, as required by policy. One resident had dysphagia, borderline personality disorder, and major depressive disorder, while the other had osteomyelitis, type 2 diabetes mellitus, and cerebral palsy. The Director of Nursing confirmed the lack of notification during an interview.
The facility failed to notify two residents or their representatives in writing about the bed-hold policy during hospital transfers. Despite the facility's policy requiring such notification, the clinical records lacked evidence of this communication. The Director of Nursing confirmed the oversight during an interview.
A resident with Non-Alzheimer's Dementia, high blood pressure, and diabetes did not have a comprehensive care plan addressing behaviors, wandering, or the use of a wander guard, despite a physician's order. Staff confirmed the omission, and the DON acknowledged the failure to provide person-centered care planning.
The facility failed to accurately assess pressure ulcers for two residents, as required by their policy. One resident had a pressure ulcer on the buttocks with no measurements recorded for several days, while another had a pressure ulcer upon admission but no measurements were documented until later. The DON confirmed these assessment failures.
A facility failed to obtain a physician order for the type and care of a supra-pubic catheter for a resident with obstructive uropathy and other conditions. The resident's catheter bag was observed touching the floor, contrary to care plan instructions. The Director of Nursing confirmed the lack of a specific physician order, violating resident care policies.
The facility failed to document nutritional supplement intake accurately for two residents and did not conduct a comprehensive nutritional assessment for one resident after a significant change in condition. The MARs lacked documentation of supplement consumption percentages, and care plans did not reflect necessary interventions.
A facility failed to prevent cross-contamination during a wound dressing change for a resident by taking multi-use supplies into the room, leading to contamination. Additionally, the facility did not adhere to the designated dressing change intervals for another resident with a PICC line, as the dressing was not changed within the required timeframe. The DON confirmed these deficiencies.
Failure to Assign Licensed Nurse as Charge Nurse on Each Shift
Penalty
Summary
The facility failed to ensure that a licensed nurse was designated to serve as charge nurse on each shift for a period of 21 consecutive days. Review of staffing documentation revealed that, from November 30, 2025, through December 20, 2025, there was no licensed nurse assigned as charge nurse on any shift during this timeframe. During interviews, both the Nursing Home Administrator and the Director of Nursing confirmed that the facility did not have a licensed nurse designated as charge nurse for these days. Additionally, the Nursing Home Administrator acknowledged that the information submitted to the PBJ Staffing Data Report was inaccurate and that the facility had recently changed its staffing process to collect actual hours using punch timecards.
Deficiencies in Respiratory Care Management
Penalty
Summary
The facility failed to provide appropriate respiratory care for four residents, as evidenced by deficiencies in the management of oxygen equipment and CPAP/BIPAP devices. Resident R10, who had diagnoses including osteomyelitis, atrial fibrillation, and heart failure, was observed with a nebulizer mask on the bedside stand that was not dated or bagged as required. This was confirmed by a registered nurse during an interview and tour. Resident R154, diagnosed with a left tri malleolar fracture, osteoarthritis, and high blood pressure, had a CPAP/BIPAP device on the bedside stand without any physician orders or a care plan for its use and management. This lack of documentation was confirmed by both a registered nurse and a licensed practical nurse assessment coordinator. Similarly, Resident R155, with Parkinson's disease, obstructive sleep apnea, and sepsis, also had a CPAP/BIPAP device without corresponding physician orders or a care plan, as confirmed by the Director of Nursing. Resident R156, who had respiratory failure, COPD, and diabetes, was observed using an oxygen concentrator that lacked the required filters on either side of the machine. This deficiency was confirmed by a registered nurse. The Director of Nursing acknowledged the facility's failure to provide appropriate respiratory care for these residents, as required by the facility's policies and state regulations.
Failure to Maintain a Homelike Environment
Penalty
Summary
The facility failed to provide a clean, safe, comfortable, and homelike environment for three resident rooms. Observations revealed that Resident R6's room had a broken footboard with exposed rough edges and deeply gouged walls, with a section of the wall vent separated from the wall. Resident R6 was unsure of how long these damages had been present. Additionally, the rooms of Residents R19 and R159 were observed to have vertical wall vents with multiple damaged louver slats. Interviews with staff confirmed these observations. A Registered Nurse (RN) and the Director of Nursing acknowledged the damaged environments in the rooms of Residents R6, R19, and R159. The facility's policy on Resident Rights, which was reviewed on April 1, 2024, states that residents have the right to a safe, clean, comfortable, and homelike environment, which was not upheld in these instances.
Neglect of Resident by Nurse Aide
Penalty
Summary
The facility failed to ensure that a resident was free from neglect, as evidenced by the treatment of Resident R1 by Nurse Aide Employee E2. Resident R1, who was diagnosed with congestive heart failure, high blood pressure, and cellulitis of the right lower leg, reported that Employee E2 refused to assist her in getting out of bed, causing her pain. Additionally, while in the bathroom, Employee E2 poured water over Resident R1's head without warning and roughly scrubbed her hair. The aide also refused to help the resident off the raised toilet seat, leaving her to struggle for several minutes. Resident R1 provided a signed witness statement detailing further neglectful actions by Employee E2, including poking and laughing at her while she was on the toilet and roughly handling her during personal care. The facility's investigation concluded that Employee E2 was negligent in her care practices, leading to her termination. The Director of Nursing confirmed the facility's failure to protect Resident R1 from neglect.
Failure to Develop Comprehensive Baseline Care Plans
Penalty
Summary
The facility failed to ensure that a baseline care plan, which includes the minimum healthcare information necessary to properly care for a resident, was fully developed and implemented for two residents. Resident R154, who was admitted with a diagnosis of a left tri malleolar fracture, osteoarthritis, and high blood pressure, had a physician order for Rivaroxaban, an anticoagulant, which was not included in the baseline care plan. This omission indicates a lack of comprehensive planning to address the resident's anticoagulant care needs upon admission. Similarly, Resident R155, admitted with Parkinson's Disease, obstructive sleep apnea, and sepsis, had physician orders for a right upper extremity PICC line and a JP drain, which were not included in the baseline care plan. Additionally, the resident had a left shoulder surgical site with a JP drain and gauze dressing, which also lacked proper care planning. The Director of Nursing confirmed the facility's failure to develop and implement a complete baseline care plan for these residents, highlighting a deficiency in meeting the regulatory requirements for resident care policies and nursing services.
Failure to Update Care Plans for Residents' Current Needs
Penalty
Summary
The facility failed to update care plans to reflect the current needs of two residents, leading to deficiencies in their care. Resident R10, who was admitted with diagnoses including osteomyelitis, atrial fibrillation, heart failure, and a pacemaker, did not have a care plan addressing the management of the pacemaker. This oversight was confirmed by the Assistant Director of Nursing, who acknowledged that the care plan was not updated to include necessary interventions for the pacemaker. Similarly, Resident R33, admitted with cerebral infarction, dysphagia, and heart disease, experienced a significant weight loss and had a stage 3 sacral wound. Despite these issues, the resident's care plan, which was last updated in March, failed to address specific nutritional problems, goals, and interventions related to the weight loss and wound care. This deficiency was confirmed by the Registered Nurse Assessment Coordinator and further acknowledged by the Nursing Home Administrator and Director of Nursing.
Sanitation Deficiency in Kitchen
Penalty
Summary
The facility failed to maintain sanitary conditions in the main kitchen, specifically in the dish area, which created the potential for cross-contamination. During an observation, brown debris was found in the ice machine. The Assistant Dietary General Manager, Employee E1, confirmed the presence of debris and was unable to confirm the last cleaning date of the ice machine. This lack of maintenance and cleaning in the kitchen area was acknowledged by Employee E1, indicating a failure to uphold sanitary standards, potentially leading to foodborne illness.
Failure to Follow Physician Orders for Resident Weights
Penalty
Summary
The facility failed to adhere to physician orders for obtaining weights for four out of six residents, as identified through observation, clinical record review, and staff interviews. Resident R10, who was admitted with diagnoses including dysphagia, borderline personality disorder, and major depressive disorder, had a physician order for a daily weight to be taken once a month, but no weight was recorded for three months. Similarly, Resident R26, diagnosed with lung cancer, brain cancer, and respiratory failure, had an order for daily weights due to congestive heart failure, but the last recorded weight was from 11 days prior to the survey. Resident R29, with heart failure, peripheral vascular disease, and atrial fibrillation, was to be weighed monthly, yet the last weight was recorded nearly two months before the survey. Resident R207, admitted with obstructive uropathy, cardiomyopathy, and a compression fracture of the spine, had orders to be weighed weekly for four weeks, but no weights were recorded. During an interview, the Director of Nursing confirmed the facility's failure to follow these physician orders. The facility also lacked a policy related to physician orders, as indicated by the Director of Nursing during the interview. This deficiency was noted under the Pennsylvania Code sections 211.10(c)(d) regarding resident care policies and 211.12(d)(1)(2)(3)(5) concerning nursing services.
Failure to Record Clinical Care Grievances
Penalty
Summary
The facility failed to honor a resident's right to voice grievances without discrimination or reprisal, as required by their policy. Specifically, the facility did not record the nature and specifics of verbalized grievances related to clinical care concerns on the designated grievance form for one resident. The facility's grievance logs from May to August 2024 only documented grievances related to missing personal property, with no records of clinical care concerns, despite such issues being raised by a resident's family member. The resident involved, identified as Resident R29, had a history of heart failure, peripheral vascular disease, and atrial fibrillation. The resident's family member expressed multiple unresolved concerns during a meeting with the interdisciplinary team, including issues with medication management, inadequate response times to call lights, and lack of empathy from staff. The Director of Nursing confirmed that these clinical care concerns were not recorded as required, highlighting a failure in the facility's grievance handling process.
Failure to Communicate Resident Information During Transfers
Penalty
Summary
The facility failed to ensure that necessary resident information was communicated to the receiving health care provider during facility-initiated transfers for two residents. Resident R10, who had diagnoses including dysphagia, borderline personality disorder, and major depressive disorder, was transferred to the hospital and returned without documented evidence of communication of essential information. This information should have included the resident's care plan goals, advanced directive information, specific instructions for ongoing care, and resident representative information. Similarly, Resident R7, with diagnoses of osteomyelitis, type 2 diabetes mellitus, and cerebral palsy, was also transferred to the hospital and returned without the necessary documentation being communicated to the receiving health care provider. The Director of Nursing confirmed the facility's failure to provide the required information for both residents, which is a violation of resident rights as per 28 Pa. Code 201.29(a)(c.3)(2).
Failure to Notify Ombudsman of Resident Transfers
Penalty
Summary
The facility failed to provide timely notification to the Office of the Long-Term Care Ombudsman Division regarding the transfer of two residents, identified as R7 and R10, to the hospital. According to the facility's policy dated 1/1/24, all necessary information should be provided to meet the resident's needs for a transfer to another provider. However, the clinical records for both residents lacked documented evidence of written transportation notification to the Ombudsman for their respective hospitalizations. Resident R10 was originally admitted with diagnoses including dysphagia, borderline personality disorder, and major depressive disorder. She was transferred to the hospital on 3/1/24 and returned to the facility later, but there was no documented notification to the Ombudsman. Similarly, Resident R7, who had diagnoses of osteomyelitis, type 2 diabetes mellitus, and cerebral palsy, was transferred to the hospital on 6/6/24 and returned without the required notification. The Director of Nursing confirmed the oversight during an interview.
Failure to Notify Residents of Bed-Hold Policy
Penalty
Summary
The facility failed to notify residents or their representatives in writing about the bed-hold policy during transfers to a hospital, as required by their policy. This deficiency was identified for two residents, who were transferred to the hospital and later returned to the facility. The facility's policy, dated 1/1/24, mandates that all necessary information be provided to meet the resident's needs during a transfer. However, the clinical records for these residents did not contain documented evidence that the bed-hold policy was communicated at the time of their hospital transfers. Resident R10, with diagnoses including dysphagia, borderline personality disorder, and major depressive disorder, was transferred to the hospital on 3/1/24. Similarly, Resident R7, diagnosed with osteomyelitis, type 2 diabetes mellitus, and cerebral palsy, was transferred on 6/6/24. In both cases, the facility did not provide the required written notification of the bed-hold policy to the residents or their representatives. The Director of Nursing confirmed this oversight during an interview, acknowledging the failure to provide a transfer notice to a representative of the Office of the Long-Term Care Ombudsman Division for these residents.
Failure to Develop Comprehensive Care Plan for Resident
Penalty
Summary
The facility failed to develop a comprehensive care plan for Resident R45, who was admitted with diagnoses including Non-Alzheimer's Dementia, high blood pressure, and diabetes. The care plan, dated 8/13/24, did not address the resident's behaviors, wandering tendencies, or the use of a wander guard for elopement prevention, despite a physician's order from 6/1/24 requiring the wander guard to be checked every shift. This omission was confirmed through staff interviews and observations. On 8/15/24, Resident R45 was observed wearing a wander guard bracelet on the left wrist, yet the care plan lacked any mention of this device or related safety measures. Interviews with RN Employee E3 and RNAC Employee E2 confirmed the absence of a care plan addressing these critical aspects. The Director of Nursing also acknowledged the facility's failure to provide person-centered care planning for Resident R45, as required by the facility's policies and state regulations.
Failure to Accurately Assess Pressure Ulcers
Penalty
Summary
The facility failed to accurately assess pressure ulcers for two residents, leading to a deficiency in pressure ulcer care and prevention. According to the facility's policy on Pressure Injury Prevention and Management, licensed nurses are required to conduct a full body assessment upon admission and document findings in the medical record, including the staging of pressure injuries. However, for one resident, the clinical admission assessment indicated a pressure ulcer on the buttocks without any measurements recorded from the time of admission through a specified period. For another resident, the clinical admission assessment noted bruising, but no measurements were documented until several days later, despite the presence of a pressure ulcer upon admission. The Director of Nursing confirmed these assessment failures during an interview.
Failure to Obtain Physician Order for Supra-Pubic Catheter Care
Penalty
Summary
The facility failed to obtain a physician order for the type and care of a supra-pubic catheter for Resident R207, who was admitted with diagnoses including obstructive uropathy, cardiomyopathy, and a compression fracture of the spine. The facility's policy on Indwelling Catheter Use and Removal requires appropriate care in accordance with professional standards, including documentation of clinical indications for catheter use, insertion, and ongoing care. However, a review of Resident R207's physician orders revealed that there was no specific order detailing the type of catheter, its size, when it should be changed, or the reason for its use. Additionally, an observation on August 13th noted that Resident R207 was in the therapy gym with the catheter bag connected under the wheelchair, uncovered, and touching the floor, which was confirmed by RN Employee E3 as inappropriate. The care plan for Resident R207 indicated that the supra-pubic catheter should be managed every shift, with the drainage bag kept off the floor. The Director of Nursing confirmed the facility's failure to obtain the necessary physician order for the supra-pubic catheter, which is a violation of the facility's resident care policies and nursing services regulations.
Failure to Document Nutritional Supplement Intake and Conduct Comprehensive Assessments
Penalty
Summary
The facility failed to ensure accurate documentation of nutritional supplement intake for two residents, Resident R18 and Resident R26. For Resident R18, the Medication Administration Record (MAR) did not document the percentage of a high-calorie liquid supplement consumed as per physician orders. Additionally, the resident's care plan did not include the use of this supplement as an intervention, despite the resident's diagnoses of cerebral infarction, aphasia, and dysphagia. The Director of Nursing and the Registered Nurse Assessment Coordinator confirmed these deficiencies during interviews. For Resident R26, the MAR also failed to document the percentage of an active liquid protein supplement consumed, as ordered by the physician. Furthermore, after a significant change in the resident's condition, indicated by a completed Minimum Data Set (MDS), the facility did not conduct a comprehensive nutritional assessment. The resident had diagnoses including lung cancer, brain cancer, and respiratory failure. The Director of Nursing and the Registered Nurse Assessment Coordinator confirmed the lack of documentation and assessment during interviews.
Infection Control and Dressing Change Deficiencies
Penalty
Summary
The facility failed to implement measures to prevent potential cross-contamination during a wound dressing change for Resident R42. During an observation, RN Employee E3 took multi-use supplies, including a bottle of Dakins solution and a box and tube of medical-grade honey, into the resident's room and placed them on the bedside table. This action was confirmed by RN Employee E3, who acknowledged that these supplies were considered contaminated and no longer appropriate for storage in the treatment cart. Additionally, the Director of Nursing confirmed that the facility lacked a policy for wound dressing changes. The facility also failed to maintain designated dressing change intervals for Resident R17, who had a PICC line. The clinical record indicated that the dressing should be changed every seven days. However, an observation revealed that the dressing, dated 8/5/24, had not been changed by 8/13/24, and blood was visible underneath it. RN Employee E3 confirmed the dressing had not been changed at the designated interval. The Director of Nursing acknowledged the failure to adhere to the dressing change schedule for the PICC line.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 1,433 citations issued within 25 miles in the last 12 months — including the 28 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Allison Park
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Kadima Rehabilitation & Nursing At Cheswick | 1.5 mi | ★★★★★ | 24 | 2 |
| St Barnabas Nursing Home | 4.6 mi | ★★★★★ | 15 | 0 |
| Harmar Village Health & Rehab Center | 6 mi | ★★★★★ | 31 | 1 |
| Willows Of Presbyterian Senior | 6.5 mi | ★★★★★ | 37 | 0 |
| John J Kane Regional Center-ro | 7 mi | ★★★★★ | 9 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Concordia At Rebecca Residence.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.