Health inspection·May 24, 2023

F 0585 these issues approximately three months ago. Level of Harm - Minimal harm or potential for actual harm The facility ' s Grievance Log binder was reviewed for complaints and/or grievances regarding unanswered phone calls made to the facility. The grievance log indicated, there was a grievance/complaint received by the facility on 3/8/23 related to another resident, Resident B. The Grievance/Complaint Report, indicated, Son informed that he regularly has a difficult time connecting c¯ [with] the facility on several occasions to get updates on his mother [Resident B] phone rings and rings. The grievance/complaint report had no information on the following sections of the document: date of incident, assigned department ' s response to grievance/complaint, department ' s discussion of the grievance/complaint with the concerned party, concerned party ' s notification, and the concerned party ' s response, Department Supervisor/Designee ' s Signature and Date, Administrator/Designee Signature ad Date and Grievance Officer ' s Signature and Date. Residents Affected - Some During a follow up interview on 3/14/23 at 2:11 PM, with the ADM, ADM stated another complaint he was aware about included a friend of Resident C who complained that he could not contact the patient nor the facility ' s Social Worker. ADM stated he did not write down this complaint in the grievance log. ADM stated another problem with telephone calls was that calls get through the reception desk but does not get through to the appropriate staff. ADM stated the facility ' s grievance system is broken. During a concurrent observation and interview on 3/14/23 at 6:18 PM and at 6:19 PM, with the Assistant Director of Nursing (ADON) and Social Services Assistant (SSA) present, the surveyor telephoned the facility ' s general telephone line using her mobile phone. The DON and SSA witnessed and confirmed the telephone rang multiple times and no one answered the telephone calls made to the facility. When asked, DON stated she was made aware of this issue last month. DON stated the front desk staff also informed her two weeks ago that the nurses did not answer phone calls transferred to the nursing stations. DON stated she was aware this issue happened during weekends and when nurses were administering medications to residents. When asked, SSA stated she was made aware of the same issues with the unanswered telephone calls two weeks ago. 2. During a concurrent interview and record review on 3/14/23 at 12:20 PM, with the Administrator (ADM), the facility ' s grievance log binder from 1/1/23 through 3/14/23 was reviewed. When asked, ADM stated the facility ' s grievance process was problematic. ADM stated, we get a lot of grievance. ADM explained grievances were discussed and resolved, but we've not done a good job documenting grievances. Review of the Resident Grievance/Complaint Log, for 3/1/23 through 3/14/23, indicated the following: Date Received Date Parties Informed of Findings Disposition of Complaint 3/7/23 Blank Blank 3/8/23 Blank (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 2 of 8 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 555034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Mateo Medical Center D/P Snf 222 West 39th Avenue San Mateo, CA 94403 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)

F 0585 Blank Level of Harm - Minimal harm or potential for actual harm Review of Grievance/Complaint Report, dated 3/7/23 and 3/8/23, the reports had no information on the following sections of the document: assigned department ' s response to grievance/complaint, department ' s discussion of the grievance/complaint with the concerned party, concerned party ' s notification, and the concerned party ' s response. The Grievance/Complaint report on 3/8/23 also had no information on the date of the incident. Residents Affected - Some Random review of the Resident Grievance/Complaint Log, for period 1/1/23 through 3/14/23, provided and updated by the facility on 3/17/23 at 7:19 PM, the log indicated that for the grievance/complaint received on 1/5/23, the parties [resident or interested party] were informed of the findings on 3/17/23. This was 71 days after the grievance/complaint was reported to the facility. The log also indicated that for the grievance/complaint received on 2/25/23, the parties [resident or interested party] were informed of the findings on 3/10/23. This was 13 days after the grievance/complaint was reported to the facility. For the grievance/complaint received on 2/28/23, the log indicated that the parties [resident or interested party] were informed of the findings on 3/17/23. This was 17 days after the grievance/complaint was reported to the facility. During an interview on 3/14/23 at 2:40 PM, with the ADM, ADM stated grievances should be logged according to the facility's policy. ADM explained the grievance log should be updated monthly, and reported, reviewed, and signed off by the Quality Assurance Team. When asked about resolution of grievances, ADM said, we try to resolve right away. ADM stated he did not know the timeline indicated in their policy. ADM stated the goal for him was to respond to the complainant in 2 to 3 days but depending on the issue. ADM stated it was the Social Services staff assigned to the unit who was responsible for contacting the complainant. ADM acknowledged the facility ' s grievance process including logs and forms were not tracked, monitored, and implemented according to the policy. ADM stated, We ' re not consistently filling out the forms. The system is broken. We got to fix it. When asked about the reported complaint on 3/8/23, regarding the unanswered phone calls at the facility, ADM stated he did not know who had followed up on the complaint, and that he had not responded to the complainant. ADM stated a response to this complaint was overdue. ADM stated the goal was to respond in 3 days. Review of the facility ' s Policy and Procedures (P&P), titled, Grievances and Complaints - Operational Manual - Resident Rights, revision dated 12/2017, the P&P indicated, . The Facility advises residents and their representatives (including family, legal representatives and/or advocates) of their right to file grievances without discrimination or reprisal, and of the process for filing grievances or complaints. The facility ensures that there is no retaliation for filing a grievance for complaint and ensures that there is a prompt review, investigation and response to and resolution of grievances and complaints. The disposition of all resident grievances and/or complaints is recorded in the Facility ' s Resident Grievance/Complaint Log. Procedure . II. The facility Administrator is the Grievance Official responsible for overseeing the grievance process, receiving and tracking grievances through their conclusion, maintaining the confidentiality of information associated with the grievance as necessary and assuring written grievance decisions are provided to the residents upon request. In the event the Administrator is not in the facility or is unavailable, he/she delegates the Grievance Official ' s responsibilities to the Assistant Administrator or Director of Nursing . VI. Duties and Obligations of Staff . D. As necessary, the facility staff will take immediate action to prevent further potential violation of resident right while the alleged violation is being investigated . VII. Grievance Investigation - A. Upon receiving a grievance/complaint report, the Grievance Official or designee provides a copy of the grievance/complaint report to the appropriate department manager to begin the investigation, and subsequent resolution . C. The Grievance official will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 3 of 8 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 555034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Mateo Medical Center D/P Snf 222 West 39th Avenue San Mateo, CA 94403 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)

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some provided with a completed Resident Grievance/Complaint Investigation Report within five (5) business days of the start of the investigation . D. If follow up is required, the Grievance Official is responsible for ensuring that the follow up action is taken in a timely manner. E. Social Services department will maintain copies of resident grievance/complaint reports for 3 years from the date of grievance decision. F. The facility will inform the resident or his/her representative of the findings of the investigation and any corrective actions recommended in a timely manner. The facility may provide the resident or his/her representative with a copy of the Investigation Report . VIII. Grievance Complaint Log - A. The disposition of all written grievances is recorded on the Resident Grievance/Complaint Log . B. Social Services Department is responsible for recording and maintaining the log .C. At a minimum, the following information will be recorded . vi. The date the resident, or interested party, was informed of the findings; and vii. The disposition of the grievance (i.e., resolved, dispute, etc.) D. The Resident Grievance/Complaint Log is reviewed by the Quality Assurance and Assessment Committee at least quarterly . Forms: RR-11-Form B - Resident Grievance/Complaint Procedures, RR-11-Form C- Resident Grievance/Complaint Investigation Report, RR-11-Form D - Resident Grievance/Complaint Log . Review of the facility ' s Policy and Procedures (P&P), titled, Resident Rights - Operational Manual Resident Rights, revision dated 1/2012, the P&P indicated, Purpose - To promote and protect the rights of all residents at the Facility. Policy - Residents of skilled nursing facilities have a number of rights under state and federal law. The Facility will promote and protect those rights . Procedure . VII. Residents are encouraged to interact with members of the community, both inside and outside the Facility . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 4 of 8 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 555034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Mateo Medical Center D/P Snf 222 West 39th Avenue San Mateo, CA 94403 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident must receive and the facility must provide necessary behavioral health care and services. Based on interview and record review, the facility did not ensure behavioral health care services were provided to Resident A when there was delay and lack of coordination in providing Resident A with behavioral health care services. 1. There was no Interdisciplinary Team (IDT) care conference meeting that evaluated the resident 's behavioral symptoms and treatment. 2. Behavioral care plans were not individualized and updated to reflect Resident A's clinical symptoms and treatments. 3. The Minimum Data Set (MDS, an assessment tool) on 1/4/23, did not include Resident A ' s behavioral diagnoses. 4. The physician's order, for psychiatry referral on 2/27/23, was not carried out timely by staff. These failures had the potential for Resident A to not attain or maintain the highest practicable physical, mental, and psychosocial well-being. Findings: 1. During a review of Resident A ' s History and Physical (H&P), dated 2/9/23, the H&P indicated, Resident A ' s diagnoses included polysubstance abuse (use of more than one drug including alcohol). The H&P indicated Resident A lacks medical decision-making capacity, decreased safety awareness and impulsivity. The record also indicated Resident A ' s decision maker was his mother. During a review of Resident A's physician Order Summary Report, printed on 3/14/23, the order summary indicated an active status order since 6/29/22 for a psychology/psychiatrist consult, with follow-up treatment as indicated. During an interview on 3/14/23, at 10:55 AM, with Certified Nursing Assistant (CNA), CNA stated Resident A was confused. CNA stated Resident A keeps on saying someone is standing behind curtain. During an interview on 3/14/23, at 10:59 AM, with Licensed Vocational Nurse (LVN), LVN stated Resident A was confused and had hallucinations (false sensory experiences). LVN stated Resident A told staff that he has computer chips on his head. During a review of Resident A ' s clinical records, the records indicated Resident A was seen by a psychologist for diagnoses of Adjustment Disorder [emotional or behavioral reaction to a stressful event] with Anxiety and Psychotic Disorder [mental disorder causing abnormal thinking] with hallucinations on 8/31/22, 9/1/22, 9/13/22, 10/20/22, 10/28/22, and 12/1/22. The clinical record dated on 12/1/22 indicated that the provider recommended psychological services to Resident A two times per month for two to four months and then a review. From 12/1/22 through 3/14/23, there was no record Resident A was provided psychology services for his diagnoses. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 5 of 8 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 555034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Mateo Medical Center D/P Snf 222 West 39th Avenue San Mateo, CA 94403 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on 4/12/23 at 10:52 AM, with the Assistant Director of Nursing (ADON), Resident A's medical records were reviewed. When asked, ADON stated there were no care conference meetings held by the Interdisciplinary Team (IDT) since Resident A's admission to the facility on 6/29/23. ADON stated care conference meetings were done quarterly for residents. ADON stated she did not know what had happened. ADON stated she did not see records of care conference or IDT meetings that evaluated Resident A's behavioral symptoms and treatments from admission until the surveyor's visit on 3/14/23. ADON explained care conference meetings were important for the IDT to evaluate interventions that were appropriate to help Resident A with his diagnoses and behavioral issues. During a review of the facility ' s policy and procedure (P&P) titled, Comprehensive Person-Centered Care Planning, revision dated 11/2018, the P&P indicated, . Policy - It is the policy of this Facility to provide person-centered, comprehensive and interdisciplinary care that reflects best practice standards for meeting health, safety, psychosocial, behavioral and environmental needs of residents in order to obtain or maintain the highest, physical, mental, and psychosocial well-being . II. Interdisciplinary Team (IDT) a. The IDT team will include the following individuals: i. The Attending Physician. ii. A Registered Nurse with responsibility for the resident. iii. A nurse aide with responsibility for the resident. iv. A member of food and nutrition services staff. v. To the extent practicable, the resident and the resident ' s representative(s) . vi. Other appropriate staff or professionals in disciplines as determined by the resident ' s needs or as requested by the resident, such as: 1. The MDS nurse; 2. Social Service staff member responsible for the resident; 3. The Activity Director; 4. Therapists (as applicable); 5. Consultants (as appropriate); 6. The Director of Nursing (as applicable); 7. The Administrator; and 8. Other individuals as appropriate or necessary . V. IDT Care Planning Conference a. The Facility must provide the resident and representative, if applicable, reasonable notice of care planning conferences to enable resident and representative participation. Participation in care planning for both parties, if applicable, can be done via conference call, video-conferencing, etc. b. The Facility will notify the resident and his or her representative as applicable, of the care planning meetings and use its best efforts to schedule care planning meetings at times convenient for the resident and representative . c. The care planning meeting will be documented . 2. During a review of Resident A's clinical records from 8/31/22 through 12/1/22, the records indicated Resident 1 was seen by a psychologist for his psychiatric and substance abuse history. During a review of Resident A's clinical record dated 8/31/22, the record indicated Resident A's psychotic symptoms included auditory hallucinations which began after a stroke and possible brain injury from incident two years ago. The record indicated the provider's recommendation was for psychological services three times a month for two to four months and then a review. During a concurrent interview and record review on 4/12/23 at 11:18 AM with the Assistant Director of Nursing (ADON), Resident A's care plans were reviewed. ADON stated there was no care plan and interventions that addressed Resident A's symptoms of hallucinations related to his psychiatric diagnoses prior to Resident A's change in condition on 2/27/23. ADON stated Resident A s behavioral symptoms had to be care planned for the IDT to come up with interventions that could be implemented to help the resident with his behavior. ADON stated she did not know why there were no psychological services provided to Resident A after 12/1/22. During a concurrent interview and record review on 4/12/23 at 11:40 AM with the ADON, Resident A's care plan related to diagnosis of Adjustment Disorder with Anxiety, dated 7/27/22, was reviewed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 6 of 8 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 555034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Mateo Medical Center D/P Snf 222 West 39th Avenue San Mateo, CA 94403 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ADON stated Resident A's care plan had to be updated and revised. ADON stated the care plan did not incorporate information including recommendations from Resident A's psychology service providers meetings from 8/31/22 through 12/1/22. ADON stated Resident A's care plans should be specific, measurable, and person-centered. During a review of the facility ' s policy and procedure (P&P) titled, Comprehensive Person-Centered Care Planning, revision dated 11/2018, the P&P indicated, Purpose - To ensure that a comprehensive person centered care plan is developed for each resident. Policy - It is the policy of this Facility to provide person-centered, comprehensive and interdisciplinary care that reflects best practice standards for meeting health, safety, psychosocial, behavioral and environmental needs of residents in order to obtain or maintain the highest, physical, mental, and psychosocial well-being . IV. Comprehensive Care Plan - a. Within 7 days from the completion of the comprehensive MDS assessment, the comprehensive care plan will be developed . b. Additional changes or updates to the resident ' s comprehensive care plan will be made based on the assessed needs of the resident . c. The comprehensive care plan will be periodically reviewed and revised by IDT after each assessment . In addition, the comprehensive care plan will also be reviewed and revised at the following times: i. Onset of new problems; ii. Change of condition . iv. To address changes in behavior and care; and v. Other times as appropriate or necessary . During a review of the facility ' s policy and procedure (P&P) titled, Behavior/Psychotropic Drug Management, revision dated 4/1/14, the P&P indicated, Purpose - To provide a therapeutic environment that supports residents to obtain or maintain the highest physical, mental, and psychosocial well-being . Procedure - I. Assessment . B. Collected information about the residents ' physical, functional, psychosocial, and environmental conditions will be used as a basis to understand how the resident expresses distress, pain . anger, and frustration . II. Interventions . ii. The Licensed Nurse will notify and collaborate with the Attending Physician, family, resident, Responsible Party, and IDT members regarding the identified contributing factors to the resident ' s mood/behavior problems and the non-drug interventions taken to address the problems, as well as to evaluate the effectiveness of the non-drug interventions for further recommendations. iii. The License Nurse will document the interventions taken and recommendations in the resident ' s Care Plan . III. Evaluation - A. Following admission, completion of MDS, quarterly, annually, and upon significant change of condition, the IDT will review the following and make recommendations based on resident ' s need: i. The effectiveness of non-drug interventions . 3. During a review of Resident A's clinical records, the records indicated Resident A was seen by a psychologist for diagnoses of Adjustment Disorder [emotional or behavioral reaction to a stressful event] with Anxiety and Psychotic Disorder [mental disorder causing abnormal thinking] with hallucinations [false sensory experiences] on 8/31/22, 9/1/22, 9/13/22, 10/20/22, 10/28/22, and 12/1/22. During a review of the Minimum Data Set (MDS, an assessment tool), dated 1/4/23, the MDS Section I, (Active Diagnoses) had no listed information pertinent to Resident A's diagnoses of Adjustment Disorder with Anxiety and Psychotic Disorder with hallucinations. During a concurrent interview and record review on 4/12/23 at 2:45 PM with the MDS Coordinator, Resident A's MDS record dated 1/4/23, including clinical records of the resident's psychological services from 8/31/22 through 12/1/22 were reviewed. The MDS Coordinator stated Resident A's psychological diagnoses were not included in the MDS Section I under additional active diagnoses. The MDS Coordinator stated we missed it. The MDS Coordinator stated the diagnoses were important as a basis for Resident A's visual hallucination. MDS Coordinator said, we should have known that he's [Resident A] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 7 of 8 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 555034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE San Mateo Medical Center D/P Snf 222 West 39th Avenue San Mateo, CA 94403 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)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few having this hallucination on those quarterly [MDS assessments] so that we know what to expect when this happens. The MDS Coordinator stated the MDS assessments were the basis for the resident's care plans. MDS Coordinator stated, we missed it, we will do modification and include IDT meeting and care plan. 4. During a review of the nursing Progress Note (PN), dated 2/27/23 at 11:56 PM, the PN indicated family members visited Resident A. The PN further indicated that according to the resident's daughter, Resident A had increased confusion, and stated that Resident A was hearing voices, someone trying to harm him and someone put computer chips in his head. During a review of the nursing Change in Condition Evaluation report, dated 2/27/23 at 8:49 PM, the report indicated, the nurse notified the physician of Resident A's condition, and the physician's order included a referral to psychiatry. During a concurrent interview and record review of Resident A's clinical records on 3/14/23 at 4:25 PM, with the Assistant Director of Nursing (ADON), the ADON stated a psychiatry referral was ordered by the physician for Resident A on 2/27/23. ADON stated the referral was faxed on 3/13/23. ADON stated the nurse should have carried out and contacted the referral within 1 to 2 days from receipt of the order. ADON stated the delay was not acceptable. ADON stated she did not know the reason why the referral was made late and stated she was not informed of the situation. ADON explained it was important for Resident A to be seen by a psychiatrist sooner rather than later to be assessed and to be helped in case immediate attention was required. During a follow-up interview on 4/12/23 at 10:17 AM, with the ADON, ADON clarified and stated the staff requested and faxed Resident A's psychiatry referral on 3/14/23 at 3:38 PM, 15 days or more than two weeks from when the order was placed by the physician on 2/27/23. During a review of the facility's policy and procedure (P&P) titled, Physician Order, revision dated 8/21/20, the P&P indicated, . Procedure . VIII. Whenever possible, the licensed nurse receiving the order will be responsible for documenting and carrying out the order . X. Orders pertaining to other health care disciplines will be transcribed onto that discipline ' s appropriate communication system . XII. Documentation pertaining to physician orders will be maintained in the Resident ' s Medical record . During a review of the facility's policy and procedure (P&P) titled, Referrals to Outside Services, revision dated 12/1/13, the P&P indicated, Purpose - To provide residents with outside resources as required by physician orders or the Care Plan. Policy - I. The Director of Social Services coordinates the referral of residents to outside agencies/programs to fulfill resident needs for services not offered by the Facility . Procedure . IV - Referrals for medical services are only made pursuant to an Attending Physician ' s order. V. The Director of Social Services or his or her designee will coordinate with Nursing Staff to ensure that the Attending Physician ' s order and referral to outside provider is documented in the resident ' s medical record . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555034 If continuation sheet Page 8 of 8