F 0583
Keep residents' personal and medical records private and confidential.
Level of Harm - Minimal harm
or potential for actual harm
Based on interviews and record reviews, the facility failed to follow their Privacy, Dignity and Discharge
Planning and Instruction policy when a resident was discharged ; and another resident's medication was
found in the discharge medication pile. This deficient practice affects one resident (R3) of three residents
reviewed for privacy and confidentiality and discharge medication.
Residents Affected - Few
Findings Include:
R2 discharged from the facility on 9/29/23.
On 10/5/23 at 11:00 AM, V6 (Complainant) reported that R2 received R3's one medication upon review of
medication when already home. V6 was able to give the information from the medication label, such as R3's
full name, medication name, direction, and prescription number (Rx # XXXXXXXX). V6 also reported that
she informed the facility of this incident on 10/2/23 (Monday).
Concern form dated 10/3/23, reads in part: R2 was discharged on 9/29/23 and was sent home with a
medication which does not belong to R2. Action taken: Spoke with Nurse and education one to one was
given regarding medication reconciliation during discharge. Resident/Responsible Party informed of
outcome on 10/4/23.
On 10/5/23 11:25AM V8 (Discharge Planner) stated that V8 received an email from V6 regarding
medication that belonged to another patient (R3). I forwarded the information to V3 (DON) and V7 (Unit
Nurse Manager). V8 also provided a copy of an email along with attachment of Medication (Bingo Card)
pictures sent to V8 by V6. In there, the label contains the full name of R3, room number, medication name,
directions and indication of use and Prescription number.
On 10/5/23 at 11:15AM V7 (Unit Nurse Manager) stated that on Monday (10/2/23) she was informed by V8
because the family called and informed V8 about medication of another resident in R2's discharged
medication.
Pharmacy provided information of R3's one medication (Sodium Bicarbonate 650mg) for antacids with
prescription number Rx # XXXXXXXX.
On 10/5/23 at 11:45AM (V3) DON When I found out what happened, I talked to V10 right away and
re-educated V10. V10 was busy that day and I told V10 it is not an excuse. My expectation is for the nurse is
to review the list of medication and reconcile it in with the medication on hand, pack the medication and
send it with resident who is being discharged .
On 10/5/23 at 12:00 PM, V10 (RN) stated that he was the nurse that discharged R2. Reviewed the
(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 2
Event ID:
145268
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
145268
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Glenview Terrace
1511 Greenwood Road
Glenview, IL 60025
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 0583
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
medication with the family and R2. One by one, handed the bingo card. However, there was a pile of bingo
cards for extra medication not yet used. I just handed it to the family and did not see R3's medication was
somewhere in the pile. I know I should have done better and checked all the bingo cards, but I was so busy
that day.
Physician order sheet reviewed and R3 has an order for Sodium Bicarbonate 650mg tablet to give 2 tablets
twice a day for antacid.
Privacy and Dignity policy with a revised date of 7/28/23, reads in part: It is the facility policy to ensure the
resident's privacy and dignity is respected by the staff at all times. Resident health information will not be
shared to anyone who is not involved in resident's care and to anyone whom the alert and oriented resident
does not wish to share his and her information with.
Discharge Planning and Instruction policy with the revised date of 7/26/23, reads in part: It is the policy of
this facility to conduct proper discharge planning for all residents and provide appropriate discharge
instructions in preparation for discharge on ce a discharge order is obtained from the resident attending
physician. Medication will be sent with the resident being discharged to the community.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
145268
If continuation sheet
Page 2 of 2
