Inspection·April 2, 2025

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 record review, the facility failed to safeguard residents ' privacy and confidentiality, for two of two residents (Residents 1 and 2), when the residents were filmed by a staff member and posted on to social media without the residents or resident representative's consent. Residents Affected - Few The deficient practice had the potential to affect the resident psychosocial well being. Findings: On April 1, 2025, at 9 a.m., an unannounced visit was conducted at the facility to investigate a complaint regarding resident's rights. 1. On April 1, 2025, at 11:05 a.m., a concurrent observation and interview with Resident 1 was conducted. Resident 1 was observed alert and was sitting in a wheelchair in the activity room. Resident 1 stated she did not dance anymore and pointed to the wheelchair. Resident 1 further stated she had bad memory and did not remember dancing with the Social Service Director (SSD) or gave permission to post her video on social media. On April 1, 2025, a review of Resident 1's record indicated Resident 1 was admitted to the facility on [DATE], with diagnoses which included major depressive disease(a persistent feeling of hopelessness, sadness and loss of interest), dementia (a mental disease that interferes with daily functioning) and anxiety (excessive worry, fear or nervousness). A review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated January 31, 2025, indicated Resident 1 had a Brief Interview for Mental Status (BIMS) score of 04 (severe cognitive impairment). Further review of Resident 1's record indicated there was no documented evidence Resident 1 or Resident 1's representative gave permission for the facility staff to get a video of the resident and post a video on social media. 2. On April 1, 2025, at 11:15 a.m., a concurrent observation and interview with Resident 2 was conducted. Resident 2 was observed alert and sitting in a wheelchair singing with the music videos in the activity room. Resident 2 further stated he did not remember dancing with the SSD or gave permission for the SSD to post the video. On April 1, 2025, a review of Resident 2's record indicated Resident 2 was admitted to the facility on [DATE], with diagnoses which included dementia, anxiety, and malignant neoplasm of the prostate (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 4 Event ID: 555404 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 555404 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Village Healthcare Center 17040 Arnold Dr. Riverside, CA 92518 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)