Health inspection·January 11, 2024

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm 4. On January 9, 2024, at 9:17 AM, V11 (Registered Nurse) administered medications to R103. V11 turned on the computer and went to R103's page to check the medications that were due for administration. Without turning off the computer, V11 walked away from the cart to check R103's vital signs, then she came back to the cart to prepare the medication. In the process of preparing medication, V11 walked away again and went inside the nurses' station leaving the computer open while R103's electronic medical record such as his name, date of birth and medications were visible to all the residents and other non-nursing staff who were sitting nearby and/or walking by the cart. The computer was on top of the medication cart which was parked outside the nurses' station. There were alert and oriented residents walking by the cart who could read R103's record. Residents Affected - Some On January 9, 2024, at 1:10 PM, V2 (Director of Nursing) stated that staff should minimize or close the computer every time the staff walks away from the computer to keep resident's information private. The facility's Residents Rights, Privacy, and Dignity policy dated March 2020 documents the following: 2d. The resident has the right to privacy and confidentiality. Based on observation, interview and record review, the facility failed to ensure residents' privacy were maintained while performing blood glucose monitoring and insulin injections. The facility also failed to ensure a resident's private medical information was kept confidential. This applies to 4 of 4 residents (R32, R65, R103 and R107) reviewed for privacy in the sample of 25. Findings include: 1. R107's face sheet showed multiple diagnoses including dementia, and diabetes mellitus. On January 8, 2024 at 10:46 AM, R107 was sleeping in a wheelchair in the hallway outside of her room. V9 (Nurse) rolled R107 to the nurses' station, used a lancet to extract blood from R107's finger and then used a blood glucose monitoring machine to determine R107's blood glucose level. During R107's blood glucose monitoring procedure, no privacy was provided to the resident and during the same procedure, R107 was visible to multiple residents and staff at the nurses' station. V9 stated she usually checks resident's lunchtime and dinnertime blood glucose at the nurses' station or wherever residents are located because they are not usually in their rooms after breakfast. 2. R32's face sheet showed multiple diagnoses including, type 2 diabetes mellitus. On January 8, 2024 at 11:32 AM, V9 was at her medication cart at the nurses' station and stated she was about to give insulin to R32. V9 stated that she had already taken R32's blood glucose and (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 8 Event ID: 146168 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 146168 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahva Care of Winfield 28 West 141 Liberty Street Winfield, IL 60190 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)