Health inspection·January 2, 2024

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, the facility failed to ensure a request for documents was fulfilled in a timely manner when the facility did not provide the requested documents to Resident 1's responsible party (RP, the individual that make medical and healthcare decision on behalf of the client) within the timeframes specified in their policies. This failure had the potential to cause undue concern and anxiety on behalf of the Resident 1 ' RP. Findings: Review of Resident 1 ' s medical record indicated he was originally admitted to the facility on [DATE] and was discharged on 5/11/23. Review of the Resident 1 ' s interdisciplinary team (IDT, professional disciplines, as appropriate, will work together to provide the greatest benefit for the resident) meetings dated 9/20/20, 12/27/21, 3/29/22 and 6/29/22 indicated Resident 1 ' s daughter is the RP. During an interview with the facility ' s business office personnel (BOP) on 11/21/23 at 9:42 a.m., the BOP confirmed receiving an e-mail message around first week of November 2023 from Resident 1 ' s RP regarding request for Resident 1 ' s facility financial bill. The BOP further stated she e-mailed a statement of facility ' s balance bill to Resident 1 ' s RP but not the itemized bills on 11/6/23. The BOP stated she did not know that the Resident 1 ' s RP wanted the complete itemized facility bill balance instead of the summary of bill statement for Resident 1. The BOP also confirmed she received a telephone message from Resident 1's relative A (RLA) requesting the complete itemized bills balance for Resident 1 approximately two weeks ago. The BOP stated she will e-mail the Resident 1 ' s facility complete itemized bill balance to Resident 1 ' s RP and mail a complete itemized hard copy of facility bill balance to Resident 1 ' s RLA once the facility ' s Wi-Fi is fixed. During a follow up visit and an interview with the BOP on 12/28/23 at 10:38 a.m., the BOP stated she have not yet e-mailed the complete itemized bill balance to Resident 1 ' s RP and have not yet mailed a printed copy of Resident 1 ' s facility complete itemized bills balance to Resident 1 ' s RLA as requested. During an interview with the administrator (ADM) on 12/28/23 at 3:45 p.m., he stated the facility ' s Wi-Fi was already fixed by the end of 11/2023. During an interview with the ADM on 1/2/24 at 3:44 p.m., he confirmed the Resident 1 ' s daughter is the RP. Page 1 of 2 055315 055315 01/02/2024 Camino Ridge Post-Acute 1949 Grant Road Mountain View, CA 94040

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility ' s policy and procedures dated 2023 Billing Statement and Resident Collections indicated .The billing statement includes an itemized listing of services and charges for: a. Private room rates (if applicable) b. medical supplies not covered under the facility ' s basic Medicare/Medicaid daily reimbursement rate c. Medication not provided under the facility ' s basic Medicare/Medicaid daily reimbursement rate d. and other personal services requested by the resident that are not included in the resident ' s Medicare/Medicaid benefits (i.e., barber/beauty shop, cosmetics, etc.) . Review of the facility ' s policy and procedures dated 2023 Release of Medical Records indicated .Upon a receipt of a request for medical record copies, the facility should notify the requesting party, in writing, of the cost for obtaining records and that record are available 2 days after receipt of payment for the copies . 055315 Page 2 of 2