Health inspection·February 21, 2024

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 promote one of three sampled residents (Resident 1) right to privacy when the licensed social worker (SW) discussed Resident 1 ' s personal care with Resident 1 ' s family without Resident 1 ' s consent. Residents Affected - Few This failure resulted in Resident 1 feeling emotional distress. Findings: During a review of Resident 1 ' s facility admission Record on 2/7/2024 at 11:15 a.m., the admission Record indicated Resident 1 was admitted in July 2022 with a diagnosis of muscle weakness. The admission Record indicated Resident 1 was his own responsible party. A review of Resident 1 ' s Minimum Data Set (MDS, a resident assessment instrument used to identify resident care problems to be addressed in an individualized care plan.) indicated Resident 1 was alert and oriented to the day, year, month and could recall words presented to him. During an interview on 2/7/2024 at 10:35 a.m., with the facility ' s Director of Nursing (DON), the DON stated the facility had wanted to deep clean Resident 1 ' s room, but Resident 1 often stayed in bed and did not like the smell of the cleaning agents, which made deep cleaning Resident 1 ' s room difficult. The DON stated the suggestion of involving family members to encourage Resident 1 to get out of bed more and participate in his own care had been discussed with the Social Worker (SW). The DON stated after that discussion with the SW, Resident 1 had complained the facility social worker had spoken to one of Resident 1 ' s family members, FM 1, about encouraging Resident 1 to get out of bed more. The DON stated had told Resident 1 the facility would talk to family members in order to encourage residents. The DON stated Resident 1 had told the DON that Resident 1 did not like that, and it was no one else ' s business. During an observation and concurrent interview on 2/7/2024 at 10:50 a.m., with Resident 1, in Resident 1 ' s room, Resident 1 lay in bed, under the bedcovers. Resident 1 stated he stayed in bed because it was a hassle to get up and into the wheelchair. Resident 1 stated the facility social worker had talked to Resident 1 ' s family without his OK and it bothered him a lot. The social worker was not available for interview during the abbreviated survey. During an interview on 2/21/2024 at 10:07 a.m., with FM 1, FM 1 stated Resident 1 wanted to keep FM 1 out of his business. FM 1 stated the social worker told FM 1 Resident 1 had refused showers for the last year and had only had bed baths. FM 1 stated Resident 1 was upset staff had shared the information with FM 1. (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: 055241 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 055241 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willow Pass Healthcare Center 3318 Willow Pass Road Concord, CA 94519 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)