Health inspection·November 15, 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 interview and record review, the facility failed to ensure a request for documents was fulfilled in a timely manner for two of three sampled residents (Resident 1 and Resident 2) when the facility did not provide the requested documents within the timeframes specified in their policies. This failure had the potential to result in the Resident ' s denial of a timely due process. Findings: An unannounced visit was made to the facility on November 15, 2023, at 11:00 AM, to investigate a complaint regarding quality of care. During a review of the Medical Records Requests: 1. Resident 1 had a letter sent to the facility by [name of legal firm] which indicated the facility received a request for release of Resident 2 ' s medical records on October 24, 2023. Review of the confirmation fax document (states when the document was sent to the legal firm) indicated the medical records for Resident 1 was sent on November 14, 2023 (sixteen days after they received the typewritten documents request) to the [name of legal firm.] 2. Resident 2 had a letter sent to the facility by [family member] which indicated the facility received a request for release of Resident 2 ' s medical records on October 23, 2023. There was documented evidence that the medical records were released and sent to the [family member] on October 27, 2023. During an interview with the Medical Records representative (MR) on November 15, 2023, at 11:15 AM, MR indicated she received the medical records request but had been advised by Corporate office (CO) that all medical records request are to be sent to their office for approval and she waited for confirmation from CO to release the medical records. MR stated she was aware that per [NAME] 22 she was to release medical records within 2 business days. During an interview with the Administrator (AD), on November 16, 2023, at 9:00 AM, he stated they do send medical records request to CO and that he will check and make sure medical records for [name of legal firm] were released. A review of The Facility Policy and Procedure titled Release of Information, Minimum Necessary Use (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: 555773 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 555773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Indian Canyon Post Acute 57333 Joshua LN Yucca Valley, CA 92284 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)