Failure to Safeguard Residents' Private Health Information
Penalty
Summary
During routine observations on Unit 1 and Unit 2, surveyors found that the facility failed to safeguard residents' clinical record information. On multiple occasions, documents containing private health information (PHI), such as a vital sign sheet, a daily resident census sheet, and a weight list, were left in areas accessible to unauthorized individuals. Specifically, the vital sign sheet and census sheet were left face-up on the nurses' station counters, making residents' names, room numbers, and vital signs visible to anyone approaching the area. Additionally, a weight list with all residents' weights was found hanging outside a resident's room, facing outward and visible to passersby. Interviews with LPNs on both units confirmed that these documents were left inappropriately exposed and acknowledged that they should have been placed face-down or not left in public view. The observations and staff interviews indicate that the facility did not adequately protect residents' PHI during the survey period, resulting in unauthorized access to confidential information.