Health inspection·May 13, 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 observation, interview, and facility P&P review, the facility failed to ensure the privacy for one sampled resident (Resident 4) was provided during care. Residents Affected - Few * The privacy curtain was not pulled while providing ADL care to Resident 4. This failure had the potential to violate the resident's rights to privacy. Findings: Review of the facility's P&P titled Quality of Life-Dignity revised February 2020 showed the staff to promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during procedures. On 4/25/24 at 0947 hours, CNA 1 was observed speaking to CNA 2 from Shower Room A while providing a shower to Resident 4. The door of the shower room was open with the privacy curtain pulled back by CNA 1, and Resident 4 was observed completely undressed and visible from the hallway. Other residents and staff were observed in the hallway at that time. Medical record review for Resident 4 was initiated on 4/24/24. Resident 4 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 4's MDS dated [DATE], showed Resident 4 was cognitively intact and had legal blindness. On 4/25/24 at 1000 hours, an interview was conducted with CNA 1. CNA 1 acknowledged Resident 4's privacy was not maintained when the shower room door and privacy curtain were kept open when she provided Resident 4 a shower. On 4/24/24 at 1430 hours, an interview was conducted with Resident 4. When asked about providing privacy, Resident 4 stated he did not want anyone to see him naked while he was being bathed. On 4/24/24 at 1500 hours, an interview was conducted with the DON. The DON acknowledged Resident 4's privacy was not maintained while he was being showered by CNA 1. Based on observation, interview, and facility P&P review, the facility failed to ensure the privacy for one sampled resident (Resident 4) was provided during care. * The privacy curtain was not pulled while providing ADL care to Resident 4. This failure had the (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: 056076 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 056076 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anaheim Terrace Care Center 141 South Knott Avenue Anaheim, CA 92804 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)