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F0628
D

Failure to Complete Personal Effects Inventory Documentation at Discharge

Mountain View, California Survey Completed on 07-08-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Facility staff failed to follow established procedures for documenting a resident's personal belongings at the time of discharge. Specifically, the inventory list of personal effects form, which is used to record a resident's possessions, was not signed by either the resident or facility staff upon discharge. There was also no notation indicating that the resident refused to sign the form. This omission was confirmed during interviews with both a registered nurse and the assistant director of nursing, who acknowledged that the form should have been signed according to facility policy. The resident involved had been admitted with multiple diagnoses, including osteomyelitis, depression, diabetes mellitus, and generalized muscle weakness, and was discharged to an assisted living facility. Review of the medical record indicated that personal belongings were discharged with the resident, but the required documentation acknowledging receipt of these items was incomplete. Facility policy requires both the resident or responsible party and a staff member to sign and date the inventory on admission and discharge, which was not done in this case.

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