Inspection·May 28, 2025

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation. received a letter from the Attorney. I immediately called the Attorney's office and faxed the requested paperwork on Friday [DATE]. (V5) was not doing her job correctly, and that is why she was terminated. (V5) would send me a lot of things and I would have to tell her what to do with them. I do not remember seeing anything from (V5) regarding (R2), and there should not have been any delay with that request. If things are done correctly, it is a very smooth process and would have been processed immediately, especially from an Attorney. When I spoke with the Attorney's office, they were very understanding, was not upset, and felt like everything was ok. I do not remember talking to (V5) about (R2), however, it could have been via email, which I would have told her how to handle it. On [DATE] at 12:58 PM, V7, Attorney, stated I have assistants that request medical records and things like that, so I am not sure exactly when it was requested for (R2). I know that I don't send a letter or complaint to the State unless it is longer than 30-days, so I know it had to be later than that. I know we received paperwork from the facility this past Friday ([DATE]). On [DATE] at 1:14 PM, V8, Paralegal, stated We use an outside company to ask for medical record requests so I will reach out to them to get the original request to the facility. From what I can see, our report shows that the first fax was sent to the facility on [DATE] at 2:29 PM. We then called the facility on [DATE] but was unable to talk to someone about it. We did receive all of the requested records this past Friday [DATE] which was given to (V7) for his review. V3's Email, dated [DATE], sent to V1 and V5, documents I have attached what was received today [DATE] via mail for a medical records request on (R2). I have the original if needed. The attachment was the medical record request for R2, dated [DATE]. V8's Email, dated [DATE], documents I spoke with our team at (medical records company) and they said that the fax number was auto populated in their system, but they called and followed up with the facility to confirm receipt. The facility confirmed the fax had been received on [DATE]th by (V5). This was the first time we were able to contact a live agent. We had called the facility 8 times prior to try and confirm receipt. However, I did a quick google search of the fax number to double check it and found multiple sites that provide the same fax number for (this facility). All timestamps are shown in the client portal I originally sent you (MR request tracking), but I have attached our original fax including our medical authorization and all necessary documents for release, which was sent on [DATE], and the violation fax that was sent on [DATE]. The same request had also been mailed to the facility on [DATE]. The Medical Record Request Tracking, dated from [DATE] to [DATE], documents several faxes were sent to the facility's (Fax Number B), including the first medical record request dated [DATE], as well as multiple phone calls to the facility's main phone number. The facility's website documents the facility's fax number is (Fax Number B). On [DATE] at 4:00 PM, V1 verified the facility's fax numbers and stated The (Fax Number A) is the secured fax/email number, and the (Fax Number B) is the one that goes directly to our copier/fax machine and does not go to anyone's email. So, if anyone faxes to (Fax Number B), it would have been picked up by someone. On [DATE] at 2:40 PM, V1 stated I am supposed to be notified of any medical record request, and I was not notified of (R2's) request until the email sent by (V3) on [DATE]. A medical record request can come two ways, one by email/fax - comes as an email (Fax Number A), and the other as a regular (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145655 If continuation sheet Page 2 of 3 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 145655 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bria of Woodriver 393 Edwardsville Road Wood River, IL 62095 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 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note: The nursing home is disputing this citation. fax (Fax Number B). If it comes as an email/fax, then (V3) would get it, and if it comes by regular fax, then most likely (V5) would have gotten it. I would expect anyone who receives a medical record request to make sure I am aware of it as mentioned in the policy. The Facility's Resident Rights Policy, dated [DATE], documents The facility shall: follow HIPAA (Health Insurance Portability and Accountability Act) guidelines. This includes insuring that residents have personal privacy, access to their personal records upon request and that the privacy and confidentiality of their records is protected. The Facility's Medical Records Request Policy, dated 9/2024, documents General: To provide a process for Medical Record Requests. Responsible Party: Medical Records, Administrator. Guidelines: 1. All requests for medical records will be given to the Administrator. 2. If the request is determined to be in anticipation of litigation, the RNC (Regional Nurse Consultant) will complete a review of the medical record. 3. Once a medical record review is complete and the requesting party has been determined to have authority to obtain a copy, the facility will notify the requesting party of the cost of copies. 4. All parties requesting copies of medical records will be charged for the copies in accordance with State regulations. 5. The Administrator may, after consultation with the RNC, waive the copying cost in order to reduce the likelihood of litigation. 6. Medical records should be sent offsite to be scanned in order to reduce copying costs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145655 If continuation sheet Page 3 of 3