Inspection·May 8, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on clinical record review and staff interview, it was determined that the facility failed to ensure an environment free from potential accident hazards for two of three residents reviewed (Residents 2 and CR1). Findings include: Closed clinical record review for Resident CR1 revealed nursing documentation dated April 9, 2025, at 7:38 PM that the licensed practical nurse (LPN) noted an .obvious smell of marijuana attempting to be covered by (scented brand) air spray. Per the documentation, the LPN notified the registered nurse supervisor of the situation. Resident CR1's closed clinical record contained no evidence that the registered nurse supervisor investigated the allegation of potentially illegal drugs in the facility. Nursing documentation by a different LPN on April 12, 2025, at 2:30 PM revealed that Resident CR1's room smelled like marijuana. When the LPN asked Resident CR1 if she was smoking marijuana in her room, Resident CR1 reportedly .just smiled and stated well I need some kind of pain relief. Per the documentation, the LPN notified the registered nurse supervisor and the Director of Nursing. Resident CR1's closed clinical record contained no evidence that the facility administrative staff investigated this second allegation of Resident CR1's use of illegal drugs in the facility. Social services documentation (by Employee 4, social services) dated May 8, 2025, at 10:56 AM as a late entry for April 22, 2025, at 10:53 AM revealed that Resident CR1 admitted to giving Resident 2 a cigarette. Clinical record review for Resident 2 revealed LPN nursing documentation dated April 12, 2025, at 2:10 PM that the writer noticed what appeared to be a black vape on the bed next to Resident 2's left arm. The LPN asked that Resident 2 relinquish the device so she could secure it; however, Resident 2, refused multiple times throughout the day to let staff obtain this vape. The writer indicated that the registered nurse supervisor and the Director of Nursing was made aware of the situation. Resident 2's clinical record contained no evidence that the facility administration staff investigated the allegation of potentially hazardous smoking materials in the facility. Nursing documentation dated April 20, 2025, at 5:35 PM revealed that the registered nurse caught Resident 2 smoking a cigarette in her room, and she had a lighter in her room. (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 4 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 05/08/2025 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)