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. Page 1 of 4 145486 145486 08/29/2023 Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362

F 0555 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 8/29/23, at 9:18am, V2 former Director of Nursing/DON stated the following, (V2's) last day was 8-18-23 and V2 was here a little over a year. (V3) is the Medical Director. (V3) has the whole facility right now .Upon admission we have to put (V3) down to be able to get their medications. If another doctor is named for a follow up appointment (V7 Transporter) will ask them prior to their appointment who they want to follow up with - the named doctor or (V3) our Medical Director. Those who are here for therapy usually will go see their Primary Care Physician/PCP and we provide their transportation. The ones who are here long term are (V3's) since (V3) is the Medical Director. It's a convenience to (V3) to follow them and know them. I have never asked them if they want someone else .I don't think anyone asks them what doctor they want. On 8/29/23, at 9:57am, V6 Social Security Director/SSD stated V6 does not ask residents who they want for a doctor. V6 is unsure if it is the nurses or admissions who ask them. When V6 does their initial assessments V6 goes over resident rights in general. It does not include what doctor they want. On 8/29/23, at 10:04am, V7 Transporter/CNA stated V3 (former Director of Nursing/DON) told V7 there is no reason for them to see an outside doctor as their Primary Care Physician/PCP if they are inside the facility and we have a doctor here who sees them. Usually when they come in, they see our facility doctor (V3) automatically. The facility's Resident Roster, dated 8-25-23, documents there are 75 residents currently residing in the facility. 145486 Page 2 of 4 145486 08/29/2023 Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362

F 0712 Ensure that the resident and his/her doctor meet face-to-face at all required visits. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a physician personally conducted the required face to face visits for four of four (R1-R4) residents reviewed for physician visits 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 admission Agreement, undated, documents, Contract Between Resident and Facility. C. Residents' Rights and Obligations. 15. Selection of Health Care Professionals. Resident may select, or have selected on his/her behalf, qualified health care professionals who conforms to the Facility's policies, rules, applicable laws, and regulations. Resident must have, select, or have chosen on his/her behalf a personal physician who will be available, or whose agent will be available, at all times for notification of significant changes in the Resident's clinical condition. On 8/25/23, at 10:50am, V1 Administrator, who stated V1 just spoke with V3 Medical Director, stated the following: (V3) is the primary doctor who sees residents. (V3) does telehealth on Tuesdays and Thursdays. V3 said that because they are rural hospital, they are allowed to do telemedicine. (V3) does telehealth once every 60 days for all long-term residents. For Medicare at least once a week up to three times a week. Our last Covid outbreak was March 2023. V1 confirmed at this time that V3 does not do face to face visits - only telemedicine. V1 is unaware of the last time V3 came into the facility to see residents. On 8/25/23, at 10:55am, V1 was unable to produce a list of residents seen personally by V3 and stated they do not keep a log of (V3's) in-person visits. 1. R1's clinical record documents R1 admitted on [DATE] under the care of V3 Medical Director. R1's current Physician Progress notes document R1 had telemedicine doctor visits on 7/25, 8/1, 8/8, and 8/22/23. These physician notes all begin with the statement, Telemedicine visit performed in lieu of face to face visit during unprecedented COVID-19 national crisis. R1's clinical record documents R1 as cognitively intact and does not document any face-to-face visits with V3 or any other physician. On 8-25-23, at 1:04pm, R1 denied every being physically seen by a doctor and stated, It is always on the computer. 2. R2's clinical record documents R2 admitted on [DATE] under the care of V3 Medical Director. R2's current Physician Progress notes document R2 had telemedicine doctor visits on 7/11, 7/13, 7/18, 7/20, 7/25, 8/1, 8/8, 8/17, 8/22, and 8/24/23. These physician notes all begin with the statement, Telemedicine visit performed in lieu of face to face visit during unprecedented COVID-19 national crisis. R2's clinical record documents R2 as cognitively intact and does not document any face-to-face visits with V3 or any other physician. 145486 Page 3 of 4 145486 08/29/2023 Goldwater Care Spring Valley 1300 North Greenwood Street Spring Valley, IL 61362

F 0712 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many On 8/25/23, at 12:54 pm R2 self-propelled in a wheelchair into R2's room. At this time R2 denied ever seeing V3 personally for a visit. 3. R3's clinical record documents R3 admitted on [DATE] under the care of V3 Medical Director. R3's current Physician Progress notes document R3 had telemedicine doctor on 6/8, 6/13, 6/20, 6/22, 6/27, 6/29, 7/11, 7/20, 8/8, 8/15, and 8/22/23. These physician notes all begin with the statement, Telemedicine visit performed in lieu of face to face visit during unprecedented COVID-19 national crisis. R3's clinical record documents R3 as cognitively intact and does not document any face-to-face visits with V3 or any other physician, On 8/25/23, at 1:11pm, R3 denied ever seeing V3 physically and stated, Only on the computer. R3 stated, I would definitely have remembered if I saw him in person. 4. R4's clinical record documents R4 admitted on [DATE] under the care of V3 Medical Director. R4's current Physician Progress notes document R4 had telemedicine doctor on 3/21, 3/23, 3/28, 3/30, 4/4, 4/6, 4/13, 5/18, 5/25, 5/30, 6/15, 6/27, 6/29, 7/18, and 8/15/23. These physician notes all begin with the statement, Telemedicine visit performed in lieu of face to face visit during unprecedented COVID-19 national crisis. R4's clinical record documents R3 as moderately cognitively impaired and does not document any face-to-face visits with V3 or any other physician, On 8/29/23, at 10:10am, R4 was lying in bed and stated that R4 has never physically seen (V3). (V3) talks to R4 over the computer. R4 stated it makes R4 feel terrible that (V3) doesn't come in to see R4. R4 stated, I would like to see him in person. The facility's Medical Professionals report, dated 8-25-23, documents 75 residents currently residing in the facility have V3 Medical Director listed as their attending physician. The facility's Resident Roster, dated 8-25-23, documents there are 75 residents currently residing in the facility. 145486 Page 4 of 4