Advanced Rehabilitation And Healthcare Of Athens

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

restrictions. She said she did not know of any resident who had any restrictions regarding who they could leave the facility with. She said she did not know where she could look to see if a resident had specific instructions regarding visitors or going out on pass. During an interview on 11/17/2025 at 10:45 AM, LVN C said she had worked at the facility for about 1 month and knew of no residents having any visitor restrictions. She said she did not know where that would be documented. During an interview on 11/17/2025 at 10:50 AM, the SW said she was new to the facility and was not familiar with Resident #1's history. She said specific instructions regarding visitors and residents leaving the facility with someone would be communicated on the face sheet. The SW said she did not know what Resident #1's discharge plans were. During an interview with the Administrator on 11/17/2025 at 11:02 AM, the Administrator said

she was not aware of Resident #1's history of being exploited. She said the nursing staff should know where information regarding special instructions about visitors and other safety matters were in the chart.

During an interview with the DON on 11/18/2025, she said the MDS staff were responsible for care plans being updated and/or revised with input from the IDT. During an interview with MDS Coordinator D on 11/18/2025 at 11:18 AM, she said the MDS Coordinators schedule care plan meetings to coordinate with MDS scheduled assessments. She said Resident #1's care plan had not been updated or revised to reflect his history of exploitation and the restrictions on visitors because she and MDS Coordinator E were not aware of Resident #1's exploitation history nor visitor restrictions. She said the care plan had not been revised to reflect Resident #1's plan to remain in the facility long term because it had not been confirmed. A

review of the facility's policy dated 02/10/202/revised 09/04/2024 and titled Comprehensive Care Plans included the following: Policy:It is the policy of this facility to develop and implement a comprehensive perResident #1-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment.Policy Explanation and Compliance Guidelines:1. The care planning process will include an assessment of the resident's strengths and needs and will incorporate the resident's strength and cultural preferences in developing goals of care. Services provided or arranged by the facility, as outlined by the comprehensive care plan, shall be culturally-competent and trauma-informed .5. The comprehensive care plan will be reviewed and revised by

the interdisciplinary team after each comprehensive and quarterly MDS assessment .

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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

Advanced Rehabilitation and Healthcare of Athens

121 Commons Drive Athens, TX 75751

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

12:20 PM, the DON said the medication aides were supposed to tell the charge nurse, ADON, or her when

they did not have prescribed medication available for administration. She said the Carboxymethylcellulose eye solution had been ordered last week, and the facility was awaiting delivery. She said there was an ample supply of the eye drops on the other medication carts and there was enough for all residents who had orders for the eye drops for several days. The DON said the 11/12/2025, 11/13/2025, and 11/17/2025 doses of Carboxymethylcellulose eye drops solution were documented as not being given. She said the reason for not administering a medication was supposed to be documented but she said she did not see where that was documented for the 3 missed doses of Resident #2's eye drops. She said someone would go out and purchase more if needed before the order was delivered. A review of the facility's policy dated 01/09/2024 and revised 04/06/2023 and titled Medication-Treatment Administration and Documentation included the following: Anticipated Outcome: To provide a process for accurate, timely administration and documentation of medication and treatmentsProcess: 4. Administer the medication according to the physician order.7. Medications or treatments that were not administered should be documented as not administered on the EMAR/TAR with the reason for the not administration. 8. Complete a Medication Error Report for medication administration discrepancies .

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