Health inspection·December 4, 2025

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 interview and record review, the facility failed to provide Resident 1's requested copies of medical records in a timely manner when Resident 1 submitted a request for his medical records in January 2025 and did not receive the records until June 2025. This failure resulted in a delay in obtaining Resident 1's medical records. Resident 1 received the medical records from the facility three days before a scheduled court date, which did not allow him sufficient time to prepare and share the information with the judge.Findings:During a record review of Resident 1's admission Record (AR) printed on 12/3/25, the AR indicated Resident 1 was admitted to the facility on [DATE] and discharged on 11/25/2022. During a phone interview on 12/3/25 at 9:24 a.m., Resident 1 stated that in December 2023 he verbally requested copies of his medical records from Administrator (ADM) 1. Resident 1 also stated that in mid-January 2024, he went into the facility and submitted a written request for copies of his medical records with the facility's receptionist. During a phone interview on 12/3/25 at 9:30 a.m., Resident 1 stated in January 2024, the Facility's Attorney (FA)1 contacted him and told him he no longer needed to go into the facility and that she would facilitate any medical record requests he had made from the facility. During a phone interview on 12/3/25 at 9:35 a.m., Resident 1 stated he informed FA 1, both verbally and by e-mail, that he wanted a copy of his medical records. Resident 1 stated there were several subsequent emails and text messages sent to FA 1 and to other attorneys of the facility making the same request for his medical records. During a phone interview on 12/3/25 at 9:33 a.m., Resident 1 stated he received the medical records in mid-June 2025, which was three days before his scheduled court date. During a phone interview on 12/4/25 at 9:09 a.m., Resident 1 stated he went into the facility and handed his written request for medical records to the receptionist in January 2025. Resident 1 stated at that time, no one asked him to sign a consent form. During an interview on 12/4/25 at 9:55 a.m., Receptionist stated in January or February 2025, Resident 1 came into the facility one afternoon and dropped off a lined piece of notebook paper with handwriting on one side, asking her to give it to ADM 2. The Receptionist stated she did not read the content of the paper and gave the paper to ADM 2. During an interview on 12/3/25 at 10:11 a.m., Medical Record Coordinator (MRC) stated that in early 2025 she received a call from Resident 1 requesting his medical records. MRC stated she told Resident 1 he would need to come into the facility to complete a consent form titled HIPAA (Health Insurance Portability and Accountability Act) Compliant Authorization for the Release of Patient Information Pursuant to 45 CFR 164.508. MRC stated she had not released Resident 1's medical records. MRC stated she had never seen Resident 1 nor received the completed consent form. During a concurrent interview and record review on 12/3/25 at 10: 30 a.m., with MRC, emails between the Administrator (ADM) 1 and MRC were reviewed. An email dated 2/6/25 indicated ADM 1 instructed MRC to gather Resident 1's complete medical record for the defense firm. A subsequent email dated 2/21/25 indicated that MRC sent the Electronic Medical Record (EMR) of Resident 1 to ADM 1 (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: 555684 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 555684 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Post Acute Care 1790 Muir Road Martinez, CA 94553 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)