Inspection·June 18, 2025

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm Based on review of facility policy, facility documentation, clinical record review, and staff interview it was determined that the facility failed to ensure that residents are free from misappropriation of resident property for 15 of 15 resident (Resident R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15 and R16). Residents Affected - Some Findings include: Review of facility policy Abuse, Neglect, and Exploitation dated 3/10/25, indicated: The facility will not tolerate abuse, neglect, mistreatment, exploitation of residents, and misappropriation of resident property by anyone. Misappropriation the deliberate, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without consent. Review of facility documentation investigation witness statement dated 5/15/25, Licensed Practical Nurse Employee E2, indicated the following: I went to count with LPN Employee E1 from the daylight shift. When we walked into the med room she popped 2 Xanax (alprazolam ) out of a residents card, I asked what they were doing because the Residents Xanax is prn and they only get one. LPN Employee E1 stated, I was going to give them one earlier, I'll give it to them now and you can give them one later. I counted with AP LPN Employee E1 and the count was right but when I went through the narcotic book several meds were given twice in a very small time frame. I immediately notified the ADON and Staff Educator. Review of facility documentation investigation witness statements, dated 5/15/25, indicated the following: LPN Employee E2 came up to the office with the units narcotics book and notified ADON (assistant director of nursing) and RN Employee E3 that the nurse they had several suspicious entries in the log and [the employee] was still in the building. After looking at the log and the MARS (medication administration record) of several residents it was concluded that there was probable diversion had occurred. After notifying the NHA and DON (Nursing Home Administrator and Director of Nursing) the police were called. Upon arrival the police officers and myself escorted the LPN Employee E1 to interview them in private. LPN Employee E1 appeared intoxicated/impaired as evidenced by slow slurred speech, unsteady gait while ambulating, difficulty keeping eyes open while conversing . LPN Employee E1 refused to provide urine test. After the police interview was concluded they escorted LPN Employee E1 out of the facility. LPN Employee E1 was instructed by the police to have someone pick them up and that they were not to drive impaired. Review of facility documentation for Residents R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, and R16 Controlled Medication Utilization Record (Narcotic Count Sheet) and MAR's (Medication Administration Record- form used by facilities to document medication administration) showed discrepancies between what was ordered and what was given by LPN Employee E1. (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: 395682 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 395682 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Health & Rehab Center 900 Third Ave Beaver Falls, PA 15010 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)