Inspection·December 12, 2024

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide privacy on one out of eight medication cart computer screens and failed to provide privacy during medication administration as evidence by resident's information visible on the unattended open sixth floor's west cart computer screen and staff failed to provide privacy during medication administration for Resident #57. Residents Affected - Few The findings included: Observation on 12/10/24 at 9:23 AM, revealed resident's information visible on the unattended sixth floor's west medication cart. (photo) On 12/10/24 at approximately 9:30 AM, Staff A, Licensed Practical Nurse (LPN) stated: The protocol is to lock the computer screen by pressing the lock icon when I am away from the cart to protect residents' information. I left it open because I was called for an emergency situation. On 12/11/24 at 8:38 AM, during a medication administration observation with Staff C, Registered Nurse (RN) on the second-floor's medication cart for Resident #1. Staff C, RN entered the resident's room and did not close the door and administered the medications without pulling the curtain to provide privacy. Interview on 12/11/24 at 4:05 PM, Staff C, RN was asked to explain the facility's privacy protocol during medication administration. Staff C, RN stated: When I administer medications to a resident who lives in a double occupied room, I close the door. [Resident #57] was in the room by herself and that is why I didn't pull the curtain or close the door. The way the Resident #57 was seated, there was privacy. Staff C, RN went with surveyor and stood at the nursing station located directly before Resident#57's room. Staff C, RN acknowledged the Resident#57 was fully visible while the door was opened and the curtain not pulled, therefore privacy was not provided. Interview on 12/12/24 at 1:43 PM, the Director of Nursing (DON) revealed, the nurses are to lock the computer screens when they walk away from the screen and pull the curtain and close the door during medication administration if the room is double occupied. Review of the facility's title; Policy Confidentiality of Information and Personal Privacy revised January 2024 revealed: Policy Statement: [NAME] Nursing and Rehabilitation Center will protect and safeguard resident confidentiality and personal privacy. Policy Interpretation and Implementation: [NAME] Nursing and Rehabilitation Center will safeguard the personal privacy and confidentiality of all resident personal and medical records. [NAME] Nursing and Rehabilitation Center will strive to protect the resident's privacy regarding his or her: medical treatment; Access to resident personal and (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 8 Event ID: 106031 Printed: 05/28/2026 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 106031 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Victoria Nursing & Rehabilitation Center, Inc. 955 NW 3rd St Miami, FL 33128 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)