Health inspection·November 2, 2023

F 0583 Keep residents' personal and medical records private and confidential. 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 provide Personal Privacy/Confidentiality for 1 of 3 residents (R2) reviewed for dignity and respect in the sample of 13. Residents Affected - Few Findings include: R2's Face Sheet, not dated, documents, that R2 was readmitted to the facility on [DATE] with diagnosis of Pressure ulcer of sacral region, unspecified stage listed as diagnosis. R2's Care Plan, dated 10/10/2023, documents, Pressure Ulcer: Unstageable (Slough and/or eschar) to Sacrum. R2's Minimum Data Set, dated [DATE], documents that R2 is severely impaired cognitively and never/rarely made decisions. On 10/30/2023 at approximately 10:10 AM V16, LPN, stated, that she is the Nurse on the hall and also helps with the wounds. V16 stated, that she does take pictures of wounds for treatment purposes. V16 stated, that she sends those pictures to V2, Director of Nurses, and V17, Wound Nurse (from outside company). On 10/30/2023 at approximately 11:00 AM. V2, Director of Nurses, stated that the facility does not take pictures of wounds in the facility. V2 stated, that this is not a requirement of the Wound Nurse. V2 stated, that they do not have a policy on taking photos of wounds, because this is not something that is done at this facility. V2 stated, that he is not aware of staff taking pictures of residents and or resident wounds on their personal phone. On 10/30/2023 at approximately 11:30 AM V18, R2's daughter, stated that she was not aware of facility staff taking pictures of R2's wound. V18 stated that she did not give permission for staff to take pictures of residents wound on her coccyx. On 10/30/2023 at 4:07 PM V15, R2's Daughter-in-law, stated that she came in to visit R2 in the afternoon. R2 stated that R2 was soiled with bowel. V15 stated that she pulled the call light and waited for staff. V15 stated that she waited a little while and then went to the Nurse. V15 stated that she voiced her concerns to the Nurse. V15 stated that she informed V16, Licensed Practical Nurse, that R2 was sitting in stool. V15 stated that she asked V16 how was R2's wound supposed to heal if R2 is sitting in stool for over 2 hours. V15 stated that V16 informed V15 that R2's wound was improving. V15 stated that V16 then pulled out her phone and showed V15 a picture of R2's coccyx wound when R2 was first admitted and the wound at a later date. V15 stated, that V16 scrolled through her personal Page 1 of 3 146052 146052 11/02/2023 Alhambra Rehab & Healthcare 417 East Main Street, Box 310 Alhambra, IL 62001

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few photos of her family and children and then showed the photos of the wound on the coccyx. V15 stated that anyone looking at her pictures would see R2's wound on her buttocks. V15 stated that R2 can't say anything at this point, but that R2 would not like that. V15 stated that R2 would not have given the ok to take pictures and keep them in their personal phone. V15 stated that if she gave the phone to someone to look at her photos R2's coccyx wound would be seen. V15 stated that R2 would be embarrassed. V15 stated that she asked V16 why she had pictures of R2's coccyx wound. V15 stated that V16 informed her that she sends the pictures to her Director of Nurses. V15 stated now V2 has pictures of R2's coccyx wound and rear end in his personal phone. V15 stated that I don't know if this is how things are done, but I do know that R2 would not be ok with this. On 10/31/2023 at 11:01 AM V17, APRN FNP-BC, stated, that she is the (Wound Management Company), Wound Nurse. V17 stated that the normal process of new admits with wounds is the staff will describe the wound to her and then review the current orders if any and then either continue the current order or change it. V17 stated that this will treat the wound until she sees the wound on Tuesday. V17 stated that she did receive a picture of R2's wound from V16. V17 stated that R2 was admitted from the hospital. V17 stated per R2 the wound was worse than what was reported from the hospital. V17 stated that V16 sent V17 the picture of the wound. V17 stated that the picture did not identify the area of the body. V17 stated that she had to respond to V16 and ask where the wound was and who was the resident. V17 stated that V16 did respond. V17 stated that she gave direction and orders for R2. V17 stated that this is not the normal way of communicating. V17 stated that V16 was having a difficult time describing the wound and sent the picture. V17 stated that she felt it was ok, because the location was unidentifiable. V17 stated that she would expect that the picture be deleted immediately. On 10/31/2023 at approximately 2:50 PM V16 stated, that she did take a picture of R2's wound on her coccyx with her personal phone. V16 stated that she was notified of R2 had a stage 4 wound on her coccyx the day before admission. V16 stated that she was aware of the wound. V16 stated that she had not had any visual of the wound. V16 stated that in report from the hospital on the day of admission she was again notified of the stage IV pressure ulcer to R2's coccyx. V16 stated that when R2 was admitted the wound was different that she expected and did not know what to do. V16 stated that she notified the (V2) Director of Nurses and they both looked at the wound. V16 stated that at that time she took a picture of the wound and sent it to V17 for guidance. V16 stated that V2 was with her when she took the picture. V16 stated that she deleted the picture immediately. When asked if she showed a picture of the wound to the family? V16 denied. V16 stated that she did not discuss with the family a picture of the wound. When asked how would the family know that pictures were taken by V16 and visually seen them? V16 stated that she does not know. On 10/31/2023 at approximately 3:00 PM V2 stated that V16 did take the picture of R2's coccyx wound. V2 stated that he went down to the room. V2 stated that the facility does not have wounds of this caliber. V2 stated that upon admission (V2 ) and V16 looked at the wound. V2 stated that they were unsure if the treatment was the correct one and did not know how to proceed with this wound treatment. V2 stated at that time V16 took a picture of the wound, with V16's personal cell, and sent it to V17 cell. V2 stated that it was easier to show her then try to describe what was being seen. V2 stated that he thought the photo was deleted and would have expected it to be deleted. V2 stated that this is the not normal practice but felt this was an extenuating circumstance. When asked what was the extenuating circumstance? V2 stated that the wound was different than what was received in report. V2 stated that the expectation would be that the Nurse would delete the photo and not keep it in her personal phone. The Illinois Long Term Care Ombudsman Program Residents Rights for people in Long-Term Care 146052 Page 2 of 3 146052 11/02/2023 Alhambra Rehab & Healthcare 417 East Main Street, Box 310 Alhambra, IL 62001

F 0583 Level of Harm - Minimal harm or potential for actual harm Facilities, dated 11/18, documents as Long-term care resident in Illinois, you retain the same rights as every citizen of Illinois and the United States. It also documents, your facility must treat you with dignity and respect and must care for you in a manner that promotes your quality of life. It continues, Your medical and personal care are private. Facility must respect your privacy when you are being examined and given care. Residents Affected - Few 146052 Page 3 of 3