Health inspection·November 15, 2023

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record reviews, the facility failed to protect resident's clinical records for 2 of 6 residents (Residents #1 & #5) reviewed for clinical records, in that: MA A failed to lock and disable access to Resident #1's electronic health record while he walked away from his medication cart. LVN B failed to lock and disable access to Resident #5's electronic health record while she walked away from her medication cart. This failure could affect residents by having their records viewed and accessed by unauthorized personnel and violate the HIPAA. The findings included: Record review of Resident #1's face sheet, dated 11/15/2023, reflected an [AGE] year-old female with an admission date of 11/04/2023 and an admitting diagnosis of OTHER FORMS OF ACUTE ISCHEMIC HEART DISEASE (inadequate blood supply (circulation) to a local area due to blockage of the blood vessels supplying the area.) Record review of Resident #5's face sheet, dated 11/15/2023, reflected a [AGE] year-old female with an admission date of 07/10/2023 and an admitting diagnosis of CEREBRAL INFARCTION DUE TO EMBOLISM OF RIGHT MIDDLE CEREBRAL ARTERY (a stroke caused by a blood clot.) Observation on 11/15/2023 at 11:12 AM revealed an unattended medication cart with a computer displaying the physician's orders for Resident #1. Interview on 11/15/2023 at 11:14 AM, MA A stated the unattended medication cart was his. MA A stated he walked away to provide a different resident a cup of orange juice and would normally never leave his computer unlocked. MA stated he was last trained on the HIPAA and resident privacy in the last few months. MA A stated he left it unlocked by accident. MA A stated the risk associated with leaving the EHR open and accessible would be a violation of the HIPAA. Observation on 11/15/2023 at 12:30 PM revealed an additional unattended medication cart with a computer displaying the physician's orders for Resident #5. Interview on 11/15/2023 at 12:34 PM, LVN B stated the unattended medication cart was hers. LVN B (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: 675974 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 675974 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Medina Valley Health & Rehabilitation Center 913 Hwy 90 W Castroville, TX 78009 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)