Health inspection·May 1, 2023

F 0573 Level of Harm - Minimal harm or potential for actual harm 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, clinical record and policy review, the facility failed to ensure that; Residents Affected - Few 1. Two of two sampled resident's (Resident 1 and 2) received a copy of their medical records within two-working days of the request, in accordance with federal regulations; and 2. The facility's medical records policy was in accordance with federal regulations. This failure violated Resident 1 and 2's right to allow them to have a copy of their medical records within 2 business days from their requests. Findings: 1. On 5/1/23 at 12:23 pm, an interview was conducted with Resident 1's family member (FM). The FM indicated that Resident 1 had signed a record release form on 2/21/23, and had not received Resident 1's records timely and in a manner that he could access. FM indicated that he received a flash drive (a memory device of data that plugs into a computer) in the mail on 4/18/23, two months after the records were requested. FM indicated he could not see the medical record information because the flash drive required a password that he was not given. The FM stated that on 4/18/23, he called the facility and notified the Health Information Manager (HIM) about this issue, but never heard back from the facility and the issue remains unresolved. On 5/1/23, Resident 1's medical record was reviewed. Resident 1 was admitted to the facility on [DATE] with the diagnoses of a lung disease, altered mental status and Post-Traumatic Stress Disorder. Resident 1 was capable of making his own healthcare decisions. He was discharged from the facility on 2/21/23. A review of the facility's form titled, Request and Authorization for Release Of Health Information reflected that Resident 1 had signed and requested a copy of his entire medical record on 2/21/23. On 5/1/23 at 2:20 pm, an interview and concurrent record review was conducted with the HIM concerning Resident 1's record requests. Resident 1's medical records request form was reviewed, and the HIM confirmed that the record was requested on 2/21/23. She stated that there was confusion with what format the Resident wanted his records in (paper or electronic). When it was confirmed to be electronic, she attempted to download the files on a flash drive but was unsuccessful. The HIM emailed their IT (Information Technology, the management of storing data using computers) Manager (ITM) on 3/31/23, for help. HIM indicated that she did not hear back from ITM until 4/5/23 (5 days later). The ITM (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: 555151 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 555151 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Willows Post Acute 320 North Crawford Street Willows, CA 95988 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)