Inspection·September 20, 2023

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review the facility failed to maintain privacy and confidentiality of personal and health information for two residents (R8 and R9) of 4 residents reviewed for medical records in the sample of 10. Residents Affected - Few Findings include: R8's Assessment signed by V13 (Nurse Practitioner) dated 7/1/22 at 1:52 PM, documents R8's personal information was uploaded into R1's electronic medical record. The information included the following: R8's date of birth , address, and phone number. It included that R8 has dementia due to Parkinson's Disease without behavioral disturbance, Anxiety, Chronic Diastolic Congestive Heart Failure, Diabetes Mellitus Type 2, and a Urinary Tract Infection. The record also went on to state that R1 was a new resident and included additional information concerning R8's plan of care, active problems, and physical exam. (This information was included with R1's electronic records that were to be sent to a facility R1 requested to transfer to.) On 9/19/23 at 11:23 AM, V2 (Director of Nursing) and V12 (Regional Support Nurse) came in with a laptop computer and showed that there was information about R8 in R1's electronic medical records. On 9/19/23 at 11:23 AM, V1 (Regional Director of Operations) stated that the uploaded progress notes that were in the history for R1 included documents in the file that were for R8. This is the file that the corporate office could have sent to V9 (R1's Power of Attorney). V1 also stated, We cannot prove or disprove it was sent to V9 (R1's Power of Attorney), but there is the possibility. On 9/19/23 at 12:58 PM, V9 (R1's Power of Attorney) stated that in with R1's paperwork that V9 received from the facility was information about a catheter for (R9) and it was signed by a doctor. V9 emailed the above-mentioned records that were included in R1's records and review indicted the paperwork was a Physician Notification Form that was sent to V10 (R9's Primary Care Physician) dated 8/05/22, which documented (R9) requests SP (Super Pubic) catheter be changed on routine basis. Need orders please for SP cath (catheter) change and how often. On 9/19/23 at 1:12 PM, V2 (Director of Nursing) stated Evidently we do have an issue with confidentiality of resident's medical records that we need to figure out. On 9/20/23 at 12:12 PM, V2 (Director of Nursing) stated that each resident is given a copy of their rights upon admission, and they are told in Resident Council Meetings about their rights. They are aware their information is to be confidential. On 9/20/23 at 1:41 PM, V2 (Director of Nursing) stated that she assumes the mix up (with R9's (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: 145820 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 145820 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/20/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mount Sterling Health and Rehab Center 435 Camden Rd Mount Sterling, IL 62353 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)