Health inspection·February 23, 2026

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 interview and record review, for one of four sampled residents (Resident 1), the facility failed to provide Resident 1's Responsible Party (RP) copies of requested medical records within the required timeframe when she requested Resident 1's medical records by mail on [DATE] and sent the same request with documents via fax on [DATE]. The requested medical records were not released until [DATE] after the RP got a lawyer to make the same request on her behalf.This failure resulted in a delay in obtaining Resident 1's medical records, causing RP undue concern pertaining to obtaining the requested medical records.Findings:During a record review of Resident 1's admission Record (AR), undated, the AR indicated Resident 1 was admitted to the facility on [DATE] and discharged on [DATE], with discharge reason: Expired.During a phone interview on [DATE] at 11:15 a.m. with the RP, RP stated there was no response from the facility regarding Resident 1's medical records request sent in [DATE]. RP stated she sent an email to the facility's social worker, made multiple calls, sent a mail to the facility, but there was no response from the facility. RP stated she then sent the request and documents to the facility via fax in [DATE].During a phone interview on [DATE] at 3:56 p.m. with the RP, RP stated when she filed a medical records request initially in [DATE], she emailed the facility's social worker but never got a response from her. RP stated she sent a certified mail to the facility requesting Resident 1's medical records and the tracking information indicated it was delivered. RP stated she never got a response from the facility. RP stated she called again on [DATE] and sent the request with attached documents through fax addressed to Medical Records and she received fax confirmation that it went through, but the facility still did not respond. RP stated she then got in touch with a lawyer who contacted the facility in [DATE] and the records were then released.During a review of a copy of the six pages document titled, Fax Confirmation Report dated [DATE], the documents that were faxed to the facility indicated a medical records request for Resident 1 from the RP addressed to the name of the Medical Records person, the facility's Medical Record Department and the facility's address. The fax included a cover letter that indicated follow up on medical records for Resident 1, and indicated original certified request was mailed on [DATE] and delivered on [DATE] and indicated facility to confirm receipt. The fax document also indicated the request with attached supporting documents - a copy of completed form for Authorization for Release of Information dated [DATE], copy of Resident 1's death certificate, and a copy of RP's government issued ID.During an interview on [DATE] at 2:57 p.m. with Medical Records Director (MRD), MRD stated that when the facility receives a medical records request, the request is submitted to [NAME] (Electronic Risk Management Assistant), which is the facility's record request site. MRD stated when she checked the site, there was a request for Resident 1's records that was released in [DATE]. During a follow up interview on [DATE] at 3:30 p.m. with the MRD, MRD stated she was not aware there was a request by RP in [DATE] and [DATE]. MRD stated the only request found for Resident 1 that had RP's signature, was the one in (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: 055099 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 055099 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Creekside Healthcare Center 1900 Church Lane San Pablo, CA 94806 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)