Inspection·April 4, 2024

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, record review, interview, and facility policy review the facility failed to ensure resident records were protected and only accessed by authorized individuals. This affected one resident (#3) of three residents reviewed for safe record keeping. The facility census was 125. Residents Affected - Few Findings include: Record review of Resident #3 revealed she was admitted to the facility 11/29/23 and had diagnoses including malignant neoplasm of the lung, cognitive communication deficit, and sheltered homelessness. Review of her minimum data set assessment dated [DATE] revealed she had severe cognitive impairment. Her contact list identified POA #601 and #602 as her powers of attorney and Interview with Power of Attorney (POA) #601 on 04/02/24 at 1:43 P.M. revealed she was a POA for Resident #3 and only her and POA #602 were the only non-providers allowed to access Resident #3's medical information. The resident had a sister (Family Member #603) who was not allowed to access the records due to the resident's wishes expressed when she was cognitively intact. The facility was supposed to fax medical information to another facility in preparation for a potential transfer; however, instead they gave the records to Family Member #603 because she said she'd take them to the facility herself. Observation of Resident #3 at the time of the above interview revealed she was not interviewable. Interview with Licensed Social Worker (LSW) #302 on 04/02/24 at 2:32 P.M. revealed she faxed Resident #3's admission information to an outside facility; however, during care conferences got three calls from the receptionist asking for the paperwork and saying the family would take it themselves. She brought Resident #3's information to the front desk and left it for them to pick up. Only later did she learn the requesting family was not authorized to access Resident #3's medical information. Interview with Family Member #603 on 04/02/24 at 3:17 P.M. revealed she asked for a copy of Resident #3's medical information the facility faxed to an outside facility and the facility provided it. She confirmed she was not a guardian or POA for the resident. Interview with the Administrator on 04/03/24 at 11:19 A.M. confirmed that Resident #3's medical information was given to an inappropriate party. Review of the facility's medical information policy dated 09/2021 revealed the facility was to maintain privacy of residents' health information. (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 3 Event ID: 365661 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 365661 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heights Rehabilitation and Healthcare Center, The 2801 E Royalton Rd Broadview Heights, OH 44147 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)