Ebony Lake Nursing And Rehabilitation Center

F 0583

Keep residents' personal and medical records private and confidential.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review, the facility failed to ensure residents had a right to personal privacy and confidentiality of his or her personal and medical records for 12 residents' reviewed for residents' rights.The facility failed to ensure CMA A locked the medication cart computer screen and left an unidentified resident's picture exposed. This failure could place residents at risk of resident-identifiable information being accessed by unauthorized persons. The findings include:Observation and interview on 9/16/25 at 3:40 p.m. revealed CMA A walked out of a resident room from across the hall on the 400 hall and walked up to the unlocked computer screen on top of the medication cart counter which exposed a resident's picture. CMA A stated, she forgot to lock the computer screen and left the computer screen open which was a HIPAA violation and could result in an unauthorized person obtaining information from the resident and using their name fraudulently. During an interview on 9/16/25 at 5:40 p.m., the DON stated it was her expectation that staff locked the computer screens because exposed resident information was a HIPAA violation. The DON stated a resident's visible information could be used in the wrong way. Record

review of the facility's document titled, Resident Rights, with revision date November 2021, revealed in part, .You have the right to: privacy, including during visits, phone calls and while attending to personal needs.

Have facility information about you maintained as confidential

Residents Affected - Few

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

Event ID:

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Ebony Lake Nursing and Rehabilitation Center

1001 Central Blvd Brownsville, TX 78520

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)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

09/23/24 and a second one on 09/30/24. She said she was not sure why they had received two. The DON said she was certain Resident #1's staples were removed on 09/23/24 as it was signed off on her electronic medical record. She said who signed off on the removal was the wound care nurse at that time and was no longer working at the facility. She said she could not explain why a second order was received on 09/30/24 and the documentation dated 09/30/24 was vague. The DON said the previous wound care nurse who removed Resident #1's staples had not documented the required information in Resident #1's electronic medical record. She said there were no negative outcomes to Resident #1 as her staples were removed on 09/23/24. This surveyor requested the facility's previous wound care nurse phone number but was not provided.Record review on 09/18/25 of Resident #1's electronic medical record reflected the previous wound care nurse had not documented she had removed Resident #1's staples. Record review of the facility's Documentation in the Medical Record policy dated 10/24/22 reflected: Policy: Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation. Policy Explanation and Compliance Guidelines: 1. Licensed staff and interdisciplinary team members shall document all assessments, observations, and services provided in the resident's medical record in accordance with state law and facility policy. 2.Documentation shall be completed at the time of service, but no later than the shift in which the assessment, observation, or care service occurred.

Event ID:

Facility ID:

If continuation sheet