Other·January 6, 2023

F583 42 CFR § 483.10(h) Privacy and Confidentiality. The resident has a right to personal privacy and confidentiality of his or her personal and medical records. §483.10(h)(l) Personal privacy includes accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups, but this does not require the facility to provide a private room for each resident. §483.10(h)(2) The facility must respect the residents right to personal privacy, including the right to privacy in his or her oral (that is, spoken), written, and electronic communications, including the right to send and promptly receive unopened mail and other letters, packages and other materials delivered to the facility for the resident, including those delivered through a means other than a postal service. §483.10(h)(3) The resident has a right to secure and confidential personal and medical records. (i) The resident has the right to refuse the release of personal and medical records except as provided at §483.70(i)(2) or other applicable federal or state laws. (ii) The facility must allow representatives of the Office of the State Long-Term Care Ombudsman to examine a resident's medical, social, and administrative records in accordance with State law. 22 CCR § 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient-related goals and facility objectives are achieved. On 11/8/2022, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a Facility-Reported Incident (FRI). The facility failed to ensure Resident 1 had the right to personal privacy as per facility’s policies and procedures. On 2/26/2021, Certified Nursing Assistant 1 (CNA 1) videorecorded and posted live streaming video on the internet showing Resident 1’s face without the resident’s consent and knowledge. As a result, Resident 1’s right to personal privacy was violated. A review of Resident 1's Admission Record (Face Sheet) indicated the facility admitted the resident on 3/17/2020 with diagnoses including chronic obstructive pulmonary disease (COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Resident 1 was discharged to a lower level of care on 4/30/2021. A review of Resident 1's Minimum Data Set (MDS - a standardized assessment and care-screening tool), dated 4/12/2021, indicated the resident was able to understand and make decisions and required assistance with moving in bed, toilet use, and personal hygiene. A review of facility's investigation report, dated 11/9/2022, indicated that about a year ago, CNA 1 posted a video in a social media which included Resident 1. A review of the video posted by CNA 1 in social media, dated 2/26/2021, indicated it was 33 minutes and 19 seconds long. The video at 25 minutes and 25 seconds to 26 minutes and 17 seconds showed Resident 1 in bed watching TV. During an interview on 11/8/2022 at 9:26 am., the Director of Staff Development (DSD) stated staff were not allowed to take videos while inside the facility to protect the residents. During an interview on 11/8/2022 at 9:46 a.m., the Administrator (ADM) stated he saw the video posted in social media and confirmed Resident 1 was a former resident and CNA 1 was currently working at the facility. The ADM stated CNA 1 should not have taken videos while at work to protect the residents’ right to privacy. A review of facility's Employee Handbook regarding Personal Electronic Device dated 2021, indicated, "The company recognizes that cellphones and other personal communication devices have become valuable tools in managing our professional and personal lives, However, workplace use of these devices can raise a number of issues involving safety, security, and privacy. Employees should conduct personal business during meal breaks and other rest periods. This includes the use of personal communication devices (including cellphones) for personal business (including phone conversations and text messages, personal e-mails, and internet use for personal reasons). Due to the availability of sensitive customer information, no cameras are to be allowed without prior approval from Senior Management. Phones and other devices with cameras or recording capabilities are strictly prohibited in all work areas that contain proprietary information or confidential documents." A review of facility's policy and procedures titled, "Personal Cellphones and Handheld Devices: Use of,” dated 11/27/2019, indicated, "The following are prohibited. 2.3 Keeping, sending, posting, or distributing patient and/ or employee photographs or recordings of any kind through multimedia messages or on social media networks." A review of facility's policy and procedures titled, "Privacy Rights: Patient", dated 11/28/2016, indicated, "Taking unauthorized photographs or recordings of patients in any state of dress or undress using any type of equipment (e.g., cameras, smart phones, and other electronic devices) and /or keeping or distributing them through multimedia messages or on social media networks is a violation of a patient ' s rights to privacy and confidentiality." The facility failed to ensure Resident 1 had the right to personal privacy as per facility’s policies and procedures. On 2/26/2021, CNA 1 videorecorded and posted live streaming video on the internet showing Resident 1’s face without the resident’s consent and knowledge. As a result, Resident 1’s right to personal privacy was violated. The above violation had a direct relationship to the health, safety, or security of Resident 1.