Athene Nursing And Rehabilitation

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

150 ml water flush every 4 hours. Resident will refuse at times;-No documentation to show why the tube feeding flushes that were left blank were not documented/administered. During an interview on 10/29/25 at 9:39 A.M., the Registered Dietician (RD) said she knew the resident was refusing to eat and refusing his/her tube feedings by checking the administration records. If there was a blank on the TAR she would not know if the resident received his/her tube feeding or not. If he/she was refusing, it should be documented. 2.

Review of Resident #14's quarterly MDS, dated [DATE REDACTED], showed:-Moderate cognitive impairment;-Diagnoses included high blood pressure. Review of the resident's care plan, dated 9/17/25 and

in use at the time of the investigation, showed:-Focus: Resident has hypertension (HTN, high blood pressure);-Goal: Resident will remain free from signs and symptoms of HTN;-Interventions: Avoid taking blood pressure reading after physical activity or emotional distress. Give anti-hypertensive medications as ordered monitor for side effects such as orthostatic hypotension (condition where the blood pressure drops suddenly upon position change) and increased heart rate and effectiveness. Review of the resident's electronic Physician's Orders Sheet (ePOS), dated October 2025, showed an order dated 9/20/25, Hydrochlorothiazide oral tablet 12.5 mg. Give one tablet my mouth one time a day for hypertension. Do not give if systolic blood pressure (pressure in the arteries when the heart contracts) less than 100. Review of

the resident's Medication Administration Record (MAR), dated September 2025, showed an order, dated 9/20/25, Hydrochlorothiazide oral tablet 12.5 mg. Give one tablet my mouth one time a day for hypertension. Do not give if systolic blood pressure less than 100. On 9/21/25 through 9/30/25, documented as administered as ordered. No documentation of the resident's blood pressure. During an interview on 10/24/25 at 1210 P.M., Licensed Practical Nurse (LPN) Z said the resident was assist of one person on the good day. LPN Z checked the physician order for the Hydrochlorothiazide and confirmed it was a blood pressure medication. He/She read the order and confirmed the blood pressure would have to be checked prior to administration. It would be under vitals. He/She looked at the resident's blood pressures under vitals and confirmed it was not documented every day. The nurses signed off on obtaining the blood pressure, but

the Certified Medication Technician (CMT) would administer this medication and would be responsible for getting the blood pressure. During an interview on 10/27/25 at 1:11 P.M., the Nurse Practitioner (NP) said

she expected the resident's blood pressure to be obtained prior to administration of medication, but she was not sure if staff documented it. During an interview on 10/28/25 at 12:17 P.M., the Regional Nurse Consultant said she expected staff takes the resident's blood pressure prior to administering the Hydrochlorothiazide, but the blood pressure could be added as supplemental in the medical record when documented. 3. During an interview on 10/28/25 at 12:16 P.M., the Corporate Nurse G said she would expect staff to document the treatment/medication when administered. The medical record to be complete and accurate. 4. During an interview on 10/24/25 at 4:00 P.M., the Administrator said he would expect staff to follow the facility's policy and procedures. 264655826442152640525

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Athene Nursing and Rehabilitation

13995 Clayton Road Town and Country, MO 63017

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 0677

gowns and pads that is used, if needed, while they waited for the shipment to arrive.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Athene Nursing and Rehabilitation

13995 Clayton Road Town and Country, MO 63017

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

treatments. Treatments/medications should be documented when they are administered. If a resident had a new order, the nurse who received the order was responsible for entering it into the computer. If a treatment was ordered daily, it should start the day it was ordered or the next day. 5. During an interview on 10/27/25 at 10:35 A.M., the Assistant Director of Nursing said the nurse on the floor was responsible for completing

the treatments. Currently, a floor nurse was rounding with the wound doctor. Either the nurse or the corporate nurse entered the orders into the computer. If a new wound was found, the nurse should document it under risk management, notify the physician and obtain a treatment order. Documentation should include a description of the wound, size, and if there was any drainage or odor. Nurses on the floor do not stage wounds. 6. During an interview on 10/24/25 at 3:25 P.M. The Director of Nursing said when residents are admitted , the nurse will do a skin assessment. If the resident had a wound, she would expect

the nurse to note what the wound looked like and give an about size measurement. The wound doctor measured and staged the wounds. A seasoned nurse will document wounds in the progress notes, other nurses will just put it on the skin assessment. Treatment orders usually come from the hospital. If the resident did not have an order or if they needed something else the nurse would call the DON or the Assistant DON and the physician would be notified. The nurse who obtained the order was responsible for entering the orders into the computer. Daily treatment orders should be started within 24 hours. 7. During

an interview on 10/28/25 at 11:50 A.M. and 4:20 P.M., the wound doctor said if a resident was admitted with

a wound, usually they will have treatments from the hospital. The nurse should verify the orders with the primary care physician or if they did not have a treatment order, a treatment order should be obtained until

she can see them. She visited the facility weekly. A nurse from the facility usually rounded with her. The nurse was responsible for entering the orders into the computer, her current orders are included in her notes. Daily treatment orders should be started within 24 hours. If the facility has an issue obtaining something she has ordered, she has told them to let her know. She could not recall if the facility notified her

they were having an issue obtaining Resident # 8's Santyl. 8. During an interview on 10/28/25 at 12:16 P.M., Corporate Nurse G said she would expect staff to document the treatment/medication when administered. The medical record to be complete and accurate. 9. During an interview on 10/24/25 at 4:00 P.M., the Administrator said he would expect staff to follow the facility's policy and procedures.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Athene Nursing and Rehabilitation

13995 Clayton Road Town and Country, MO 63017

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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

The resident had always been thin. During an interview on 10/27/25 at 1:11 P.M., the Nurse Practitioner (NP) said if staff notice a significant change, they look at weights. Staff did not notify her of the resident's lost weight. She expected the resident to be weighed upon admission. During an interview on 10/28/25 at 12:17 P.M., the Regional Nurse Consultant said at the time the resident was admitted , they were aware of

the protein malnutrition. It was related to dementia and the disease process. If a resident is a new admit,

she expected weights to be obtained in the first 24 hours. She prefers the resident to be weighed at the same time whether it is weekly or monthly. The policy is for a new resident to be weighed every week for four weeks and after that every month unless the physician orders something different. Back in the beginning of October, she did an audit and recognized weights were not in there and they started a performance improvement plan immediately.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Athene Nursing and Rehabilitation

13995 Clayton Road Town and Country, MO 63017

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 0740 Level of Harm - Minimal harm or potential for actual harm

refused the medication, it should not be documented as administered. Valproic Acid is more common medication, so it could be in the E-kit, but she was not sure. The E-kit had liquid medications. If psych medications are missed, it could affect the behaviors especially if abruptly stopped or missed after a couple of days. It affects the brain chemistry. Review of the facility's E-kit medication list, received on 10/28/25, showed no documentation of Valproic Acid or Rexulti on the list of medications.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Athene Nursing and Rehabilitation

13995 Clayton Road Town and Country, MO 63017

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)

Federal health inspectors cited ATHENE NURSING AND REHABILITATION in TOWN AND COUNTRY, MO for a deficiency under regulatory tag F-F0880 during a complaint investigation conducted on 2025-11-18.

Category: Infection Control Deficiencies

The facility was found deficient in the following area: Provide and implement an infection prevention and control program.

Scope/Severity Level E: pattern, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 6 deficiencies cited during this inspection of ATHENE NURSING AND REHABILITATION.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-12-05.