Health inspection·September 6, 2024

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to ensure privacy was maintained while obtaining a blood glucose monitor and administering an insulin injection for 1 of 1 resident (R39) reviewed for privacy in a sample of 18. Residents Affected - Few Findings include: On 9/5/2024 at 12:00 noon, V9(Licensed Practical Nurse-LPN) was observed with R39 obtaining a blood glucose and administering insulin, with the room door open to the hallway. On 9/5/2024 at 12:05 PM V9 said 'I should have pulled the curtain or closed the door to the hallway. On 9/5/2024 at 2:00 PM V2 (Director of Nursing-DON) said I expect all nurses to provide privacy when they are administering care to a resident. A medication review report indicates dated 9/5/2024 that indicates R39 has a diagnosis of Type 2 Diabetes Mellitus without complications. A medication order dated 5/17/2023 for insulin lispro sliding scale three times a day. Facility Policy: Residents rights 8/23/17 Purpose: To promote the exercise of rights for each resident, including any who face barriers (such as communication problems, hearing problems and cognition limits) in the exercise of these rights. A resident, even though determined to be incompetent, should be able to assert these rights based on his or her degree of capability. Guidelines: Notice of resident rights will be provided upon admission to the facility. These rights include the resident's rights to: Privacy and Confidentiality. 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 3 Event ID: 145947 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 145947 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Aperion Care Midlothian 3249 West 147th Street Midlothian, IL 60445 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)