Inspection·February 5, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, review of clinical records, select facility policies, and staff and resident interviews, it was determined the facility failed to ensure the resident environment was free from potential accident hazards related to unsecured medications on two out of two nursing units reviewed (Units 2 and 3) and for three out of eight residents sampled (Residents 1, 5, and 13). Findings include: A review of the facility policy titled Administering Medications, last reviewed July 28, 2025, revealed it is the facility's policy that medications are administered in a safe and timely manner and only as prescribed.A review of the facility policy titled Self-Administration of Medications, last reviewed July 28, 2025, revealed it is the facility's policy that medications permitted for self-administration are stored in a safe and secure manner and are not accessible to other residents. The policy further states that if safe storage is not possible in the resident's room, medications are to be stored on a central medication cart or in the medication room. A clinical record review revealed Resident 13 was admitted to the facility on [DATE]. Review of a quarterly Minimum Data Set assessment (MDS, a federally mandated standardized assessment process conducted periodically to plan resident care) dated November 23, 2025, revealed that Resident 13 is cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status, a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13 to 15 indicates cognition is intact). A clinical record review revealed a Medication Self-Administration Screen dated April 16, 2025, which indicated Resident 13 was appropriate for self-administration of medications. An observation conducted on February 5, 2026, at 9:15 AM revealed an orange oblong pill partially obscured by papers on the bedside table in Resident 13's room. During an interview conducted on February 5, 2026, at 9:15 AM, Resident 13 stated the pill must have fallen out of her medication cup. During an interview conducted on February 5, 2026, at 9:20 AM, Employee 1, Licensed Practical Nurse (LPN), collected and secured the medication and identified it as methocarbamol 750 mg (a muscle relaxant medication used to relieve muscle spasms). Employee 1 confirmed Resident 13 had a current physician's order for methocarbamol 750 mg. An additional observation on February 5, 2026, at 9:24 AM in Resident room [ROOM NUMBER] revealed two pills and a clear medication cup on the floor near the window-side bed. One pill was oval shaped and salmon-colored with an 894 imprint. The second pill was yellow and oblong with a dividing line and an imprint of 1 and 8. During an interview on February 5, 2026, at 9:26 AM, Employee 2, LPN, confirmed the medications should not have been on the floor and secured the pills. During an interview on February 5, 2026, at 11:15 AM, the Nursing Home Administrator (NHA) identified the salmon-colored pill as Eliquis 5 mg (an anticoagulant medication used to prevent blood clots) and the yellow pill as sertraline 100 mg (a selective serotonin reuptake inhibitor, a class of medication commonly used to treat depression and anxiety). The aforementioned information was reviewed with the NHA. The facility failed to ensure the resident (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 2 Event ID: 395929 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 395929 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/05/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgeview Healthcare & Rehab Center 200 Pennsylvania Avenue Shenandoah, PA 17976 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)