Health inspection·September 3, 2024

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to secure the confidential medical records for two of three residents (1 and 2) when the facility released Resident 1's and Resident 2's medical records to persons who were not the legal representatives of these two identified residents. This failure violated the residents' rights to privacy and confidentiality. Residents Affected - Some Note: The nursing home is disputing this citation. Findings: Review of Resident 1's admission Record indicated she was admitted to the facility on [DATE] with dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life) diagnosis. Review of Resident 1's Health Care Power of Attorney (HCPOA, a legal document that allows someone to designate another person to make medical decisions on their behalf if they are unable to do so), dated 8/20/15, indicated Resident 1's husband was her health care agent. Review of Resident 1's Authorization for the Release of Protected Health Information (PHI, any health information that can identify an individual and is related to their past, present, or future health), dated 3/8/24, indicated it was signed by Resident 1's son, an emergency contact, and Not Applicable was filled in the Individual/Organization Authorized to Release PHI section. During an interview with the medical records director (MRD), on 8/28/24 at 2 p.m., she confirmed that she received Resident 1's Authorization for the Release of PHI from Resident 1's son, and she released Resident 1's medical records to him in 3/2024. Review of Resident 2's admission Record indicated he was admitted to the facility on [DATE]; Resident 2 was his self-responsible party (RP, an individual who assists the resident in placement or assumes varying degrees of responsibility for the well-being of the resident), and one of his daughters was the substitute decision maker. Review of Resident 2's Authorization for Use or Disclosure of Medical Information, dated 4/23/24, indicated another daughter of Resident 2, an emergency contact, was the person who requested and received Resident 2's medical records. During an interview with the director of nursing (DON), on 9/3/24 at 4 p.m., he reviewed Resident 1's Authorization for the Release of PHI and Resident 2's Authorization for Use or Disclosure of Medical Information and confirmed that Resident 1's and Resident 2's medical records were released to emergency contact persons. The DON stated the resident's medical records should be released to the Page 1 of 2 055316 055316 09/03/2024 Mountain View Healthcare Center 2530 Solace Place Mountain View, CA 94040

F 0583 resident or the resident's legal representative and not to unauthorized legal representative Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy, Release of Medical Records, dated 6/1/23, indicated . 2. Upon request to access or obtain copies of the medical records, the facility should review the authorization to ascertain access rights of that person. Authority to access or release records is only granted by the resident or the resident's legal representative. Residents Affected - Some Note: The nursing home is disputing this citation. 055316 Page 2 of 2