Health inspection·August 29, 2023

F 0555 Honor the resident's right to choose his or her attending physician. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents were informed they could choose their own physician for three residents (R1, R3, and R4) of four residents reviewed for Resident Rights in a sample of four. This failure has the potential to affect all 75 residents in the facility. Residents Affected - Many Findings include: The facility's Residents' Rights for People in Long-Term Care Facilities, undated, documents, You have the right to choose your own doctor. 1. R1's clinical record documents R1 admitted on [DATE] under the care of V3 Medical Director. On 8-25-23, at 1:04pm, R1 was lying in bed. R1 stated that on admission, They did not ask about choosing my own doctor. They said they had one here. He's not my first choice. 2. R3's clinical record documents R3 admitted on [DATE] under the care of V3 Medical Director. On 8/25/23, at 1:11pm, R3 stated the following, When I was admitted they never asked who I wanted for a doctor. They didn't tell me that I could choose. I would have chosen (V8 Medical Doctor). They have (V3 Medical Director) and that is who I have. 3. R4's clinical record documents R4 admitted on [DATE] under the care of V3 Medical Director. On 8/29/23, at 10:10am, R4 stated that no one asked R4 what doctor R4 wanted. On 8/25/23, at 12:20pm, V1 stated the following, On admission, residents are told that we have a house doctor (V3 Medical Director) with his own nurse or they can have one of their own choices .I am not the one who tells them; I believe it would be our Admissions person (V4) and she is not here today. On 8/29/23, at 8:35am, V4 Business Office Director/BOM/Admissions stated that once a resident comes through the door, V4 does the initial admission contract with them. V4 denied talking to residents about their right to choose their own doctor. V4 stated that prior to residents coming to the door, (V5 Marketer) does the initial admission packet which goes over resident rights. On 8/29/23, at 9:08am, V5 Director of Business Development (Marketer) denied reviewing any resident rights with the residents including what doctor they want. V5 stated, I believe you would need to refer to (V1 Administrator) for that. (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: 145486 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 145486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362 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)