Inspection·May 31, 2023

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 record review, staff interview, and family interview, the facility failed to provide a requested medical record for one Resident (#2) reviewed for access to medical records. Findings included: Resident #2 was originally admitted on [DATE], hospitalized on [DATE], and discharged home on [DATE] according to the clinical record. During an interview with the facility Medical Records Coordinator on [DATE] at 3:21 PM, she was asked to explain the procedure for a resident or family requesting a copy of their medical record. The Medical Records Coordinator stated she gives the resident or family an authorization for release form, she will scan the paper record, and send it up to Corporate. The facility medical records consists of both electronic information and paper information. The Medical Records Coordinator would wait for the response from corporate and then would forward the medical record to corporate. Corporate sends the medical record from their headquarters with a letter of approval. The Medical Records Coordinator stated it normally takes about 3 days. The Medical Records Coordinator said that the facility would charge for copies of the medical record. The resident or family would have to pay up front before receiving the medical records. After payment, the resident or family would receive a paper copy of their medical record. The facility Medical Records Coordinator provided a copy of the Authorization for Release of Health Care Information signed by Resident #2's family member on [DATE] to request Resident #2's medical records and billing records for continued medical care and insurance. Additionally, the Medical Records Coordinator provided a copy of a letter dated [DATE] from the facility's attorneys that was sent via email to the Medical Records Coordinator regarding the Authorization for Release of Health Care Information. The letter documented that the request for the medical records was determined to be HIPAA (Health Insurance and Portability and Accountability Act (federal health care privacy of information rule)) and the facility attorneys would send further correspondence and an invoice for copy reproduction and postage charges. The Medical Records Coordinator showed a copy of a letter sent via email to the facility Risk Manager on the same date to authorize the facility to send the resident's paper record to attorneys. The facility Medical Records Coordinator was asked for documentation that Resident #2's family member received the medical record that they requested. The Medical Records Coordinator could not find any proof that the medical record was sent to the resident's family. The Medical Records Coordinator tried to call the attorney group several times, but did not ask to speak to anyone. The surveyor asked the Medical Records Coordinator if the family paid the facility for the copy reproduction and postage charges for the medical record. The Medical Records Coordinator stated the Business Office would have documentation of payment by the family. (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 5 Event ID: 106112 Printed: 05/28/2026 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 106112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Tampa Lakes Health and Rehabilitation Center 750 Hayes Rd Lutz, FL 33549 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)