Inspection visit
Inspection
2 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 2 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0661
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure necessary information is communicated to the resident, and receiving health care provider at the
time of a planned discharge.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
closed clinical record review and staff interview it was determined that the facility failed to provide a
discharge summary with the necessary components for two of two closed records reviewed (Residents
CR1 and CR2).
Findings include:
Closed clinical record review for Resident CR1 revealed nursing documentation dated July 10, 2024, at
5:33 PM that Resident CR1 was discharged to home with home health services.
An electronic Discharge summary dated [DATE], revealed no evidence that Resident CR1 or her
responsible party received the document. The document did not include a reconciliation of all medications
with Resident CR1.
Closed clinical record review for Resident CR2 revealed nursing documentation dated July 26, 2024, at
3:14 PM that arrangements were made for home health and infusion (intravenous medication) therapy to
assist with wound treatment and continuous antibiotic infusion in her home. Resident CR2's son assisted
Resident CR2 from the facility via the family car. The documentation indicated that a discharge summary
was reviewed with Resident CR2 that included future appointments. The documentation indicated that
Resident CR2 received wound dressing supplies and her belongings; however, the documentation did not
include the disposition or reconciliation of Resident CR2's medications.
An electronic discharge summary for a discharge date of July 26, 2024, revealed no evidence that Resident
CR2 or her responsible party received the document. The document did not include a reconciliation of all
medications with Resident CR2.
The surveyor reviewed the above concerns regarding the discharge instructions provided to Residents CR1
and CR2 during an interview with the Nursing Home Administrator and Employee 1 (clinical consultant) on
August 1, 2024, at 3:05 PM. The interview confirmed that the facility had no evidence the resident or
responsible party received discharge instructions that included medication reconciliation, prescriptions
needed, or prescriptions/medications provided. There was no indication that medications were sent with the
residents when they were discharged from the facility.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services
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
08/01/2024
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on review of select facility policies and procedures, observation, clinical record review, and staff
interview, it was determined that the facility failed to ensure an environment free from the potential spread
of infection for two of two residents reviewed for COVID-19 transmission based precaution concerns
(Residents 1 and 3).
Residents Affected - Some
Findings include:
The facility policy entitled, Coronavirus Disease (COVID-19) - Infection Prevention and Control Measures,
last reviewed without changes on August 1, 2023, revealed that the facility follows infection prevention and
control (IPC) practices recommended by the Centers for Disease Control (CDC) and Prevention to prevent
the transmission of COVID-19 within the facility. The infection prevention and control measures that are
implemented to address the SARS-CoV-2 are incorporated into the facility infection prevention and control
plan. These measures include:
Ensuring everyone is aware of recommended IPC practices in the facility, including the use of visual alerts
with dates to reflect that recommendations are current and implementing source control measures. The
policy references referred to the Interim Infection Prevention and Control Recommendations for Healthcare
Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
The Interim Infection Prevention and Control Recommendations for Healthcare Personnel (HCP) During the
Coronavirus Disease 2019 (COVID-19) Pandemic,
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html, notes that the
facility should ensure everyone is aware of recommended IPC practices in the facility. Post visual alerts
(e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias).
These alerts should include instructions about current IPC recommendations (e.g., when to use source
control and perform hand hygiene). Source control options for HCP include a NIOSH (National Institute for
Occupational Safety and Health, federal agency that conducts research, training, and surveillance to
prevent work-related illnesses and injuries) approved particulate respirator with N95 filters or higher; a
respirator approved under standards used in other countries that are similar to NIOSH-approved N95
filtering facepiece respirators (Note: These should not be used instead of a NIOSH-approved respirator
when respiratory protection is indicated); a barrier face covering that meets ASTM F3502-21 (voluntary
standard for mask manufacturers) requirements including Workplace Performance and Workplace
Performance Plus masks; or a well-fitting facemask. If they are used during the care of patient for which a
NIOSH-approved respirator or facemask is indicated for personal protective equipment (PPE) (e.g.,
NIOSH-approved particulate respirators with N95 filters or higher during the care of a patient with
SARS-CoV-2 (COVID-19) infection, or during care of a patient on droplet precautions), they should be
removed and discarded after the patient care encounter and a new one should be donned. Source control
is recommended for individuals in healthcare settings who have suspected or confirmed SARS-CoV-2
infection.
CDC Transmission-Based Precautions,
https://www.cdc.gov/infection-control/hcp/basics/transmission-based-precautions.html, note that the
recommendation is to use droplet precautions for patients known or suspected to be infected with
pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or
talking. The CDC sign for droplet precautions indicates that everyone must make sure their eyes, nose, and
mouth are fully covered before room entry.
Observation of Resident 1's room doorway on August 1, 2024, at 12:15 PM revealed a sign for contact
precautions (use of a gown and gloves for all interactions that involve contact with the resident
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396137
If continuation sheet
Page 2 of 3
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
08/01/2024
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)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
or resident's environment). The sign included handwritten, Droplet, in black marker over the word, Contact.
The sign for contact precautions did not include reference to eye protection. The door included a yellow
PPE organizer that included gowns, gloves, surgical masks, and N95 masks.
Clinical record review for Resident 1 revealed nursing documentation dated July 31, 2024, at 2:01 PM that
Resident 1's nephew was updated on his positive COVID status.
Observation of Resident 3's room doorway on August 1, 2024, at 12:23 PM revealed a sign for contact
precautions. The sign included handwritten, Droplet, in black marker over the word, Contact. The sign for
contact precautions did not include reference to eye protection. The door included a yellow PPE organizer
that included gowns, gloves, surgical masks, and N95 masks.
Clinical record review for Resident 3 revealed nursing documentation dated July 29, 2024, at 2:16 PM that
Resident 3 tested positive for COVID during routine testing.
Interview with Employee 3 (registered nurse) on August 1, 2024, at 12:49 PM confirmed that Residents 1
and 3 were the only residents in the facility currently isolated for COVID-19 infection. Employee 3 confirmed
that the signage on the doorways for Residents 1 and 3 did not include measures necessary for droplet
precautions (eye protection); and that the facility used the sign intended for contact precautions and just
overwrote the word, Contact, with, Droplet.
Observation of Resident 1's room on August 1, 2024, at 1:04 PM revealed Employee 2 (nurse aide) inside
the doorway removing personal protective equipment. Employee 2 removed a blue surgical (not N95) mask.
Interview with Employee 2 on August 1, 2024, at 1:05 PM indicated that she just finished emptying the
urine storage bag for Resident 1's indwelling urinary catheter (catheter inserted through the penis and into
the bladder to drain urine). Employee 2 confirmed that she needed to be within a few feet of Resident 1 to
access his urine collection bag. Employee 2 stated that she, just grabbed the one on top (surgical mask
versus N95 mask), and that the sign, doesn't say, which mask is required. Employee 2 verified N95 masks
were available in the PPE organizer. Employee 2 questioned, Well, why do they have them (blue surgical
masks) there?
The surveyor reviewed the above concerns regarding COVID isolation precautions during an interview with
the Nursing Home Administrator and Employee 1 (clinical consultant) on August 1, 2024, at 1:14 PM.
483.80(a)(1)(2)(4)(e)(f) Infection Control
Previously cited deficiency 6/14/24
28 Pa. Code 201.18(b)(3)(d)(e)(1) Management
28 Pa. Code 211.12(d)(1)(5) Nursing services
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
396137
If continuation sheet
Page 3 of 3
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Back to topCitations
2 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F661 - Quality of life
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the August 1, 2024 survey of ATHENS NURSING AND REHABILITATION CENTER?
This was a inspection survey of ATHENS NURSING AND REHABILITATION CENTER on August 1, 2024. The surveyor cited 2 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ATHENS NURSING AND REHABILITATION CENTER on August 1, 2024?
Yes, 2 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planne..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.