Inspection·February 7, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on clinical record review, observation, and staff interview, it was determined that the facility failed to provide the highest practicable care regarding physician ordered vital signs, medications, and interventions for two of three residents reviewed (Residents 1 and 2). Residents Affected - Some Findings include: Clinical record review for Resident 1 revealed a current physician's order for staff to administer Cinnamon 500 milligrams (mg) one tablet by mouth (PO) daily for diabetes mellitus and Chromium 200 micrograms (mcg) PO daily for diabetes mellitus. Review of Resident 1's January and February 2024 MAR (medication administration record, a form to document medication administration) revealed staff were administering his Cinnamon and Chromium medications daily with the Chromium being held 14 times and the Cinnamon being held 14 times in January. Neither medication was held in February. There was no documentation in Resident 1's nursing documentation that indicated justification as to why both medications were held. Observation of a facility medication cart on February 7, 2024, at 1:25 PM with Employee 1, licensed practical nurse, confirmed that the facility had Chromium 1000 mcg (not 200 mcg as ordered and five times the ordered dose) and Cinnamon 1000 mg (not 500 mg as ordered and twice the ordered dose) available for administration for Resident 1. Employee 1 acknowledged that she administered both medications to Resident 1 and failed to identify the incorrect milligram and/or microgram dosage for each medication. Observation of the same facility medication cart on February 7, 2024, at 2:32 PM with Employee 1 and the Nursing Home Administrator (NHA) revealed that there was an unopened bottle of Cinnamon 500 mg (Resident 1's correct physician ordered dosage) upside down in the bottom drawer of the cart where other overflow/overstock medications are stored. The NHA revealed that he had purchased the over-the-counter Cinnamon 500 mg bottle at a local business over this past weekend and provided it to nursing staff on February 5, 2024, upon return to work. Employee 1 revealed that she was unaware that the correct Cinnamon dosage was available to administer to Resident 1. The facility failed to procure and administer the correct dosage of Resident 1's Cinnamon and Chromium medications and failed to identify an incorrect dosage prior to administering Resident 1 medications. Clinical record review for Resident 2 revealed a current physician's order for staff to monitor their blood pressure BP (blood pressure) medications if her systolic blood pressure (pressure when the heart contracts) was less than 100 mmHg (millimeters of Mercury) and diastolic blood pressure (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 3 Event ID: 396137 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 396137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Athens Nursing and Rehabilitation Center 200 South Main St Athens, PA 18810 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)