Chi Franciscan Villa
Inspection Findings
F-Tag F0573
F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Let each resident or the resident's legal representative access or purchase copies of all the resident's records. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
record review and interview, the facility did not ensure a resident representative written request for a medical record was granted. This was observed with 1 (Resident R3) of 1 resident record requests reviewed. * Resident R3's Representative requested, in writing, a copy of Resident R3's medical record. When initially requested, Resident R3 was responsible for themself and decisions and Resident R3's Representative was not eligible to receive the records. In
the day's following the request and denial, Resident R3's Power of Attorney for Health Care (POAHC) status was reviewed and activated naming Resident R3's Represebtative as the POAHC. The facility did not address the request for records given the change in Resident R3's POAHC status. Findings include:The facility policy and procedure (Name of facility) administrative standards for medical record release dated 5/22/2025. Under 4.) Information from a medical record is released to individuals only upon receipt of a properly executed authorization from the resident for their legal representative.Findings include:Resident R3 was readmitted to the facility on [DATE REDACTED] with diagnoses including End Stage Renal Disease, Altered Mental Status and Pressure Ulcer Sacral Stage 4. Resident R3's medical record contained a document authorization for use or disclosure of protected health information access to protected health information. This was signed by Resident R3's family member on 12/3/2025. The document did not contain authorization by Resident R3, who was their own decision maker until 12/10/2025. On 12/10/2025 Resident R3's Power of Attorney for Healthcare was activated. The Agent listed is the same family member that requested Resident R3's medical records. On 12/22/25, at 10:57 AM, Surveyor interviewed Resident R3's Power of Attorney for Healthcare Agent regarding the medical record request. The Family member stated they have not received any medical records, and the form was not valid.On 12/22/25, at 12:45 PM, Surveyor interviewed the Nursing Home Administrator (NHA) - A who signed Resident R3's medical
record release form on 12/3/2025. The NHA-A stated on 12/3/25 they did not realize Resident R3's Power of Attorney for Healthcare was not activated. The facility legal representatives stated they could not release the medical records due to Resident R3 being their own person on 12/3/25. Resident R3 did not sign the medical record release form due to being in the hospital. Resident R3 had a hospital stay from 12/2/25 - 12/11/25. The request by Resident R3's family member for medical records was not acted upon by the facility. The NHA-A stated they did not follow-up with the medical record request from 12/3/25 that was denied.
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:
CHI FRANCISCAN VILLA in SOUTH MILWAUKEE, WI inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SOUTH MILWAUKEE, WI, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from CHI FRANCISCAN VILLA or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.