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F0655
D

Failure to Provide Baseline Care Plan Summary to Responsible Party

San Rafael, California Survey Completed on 08-04-2025

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

The facility failed to provide a summary of the baseline care plan (BCP) to the responsible party (RP) of a resident within 48 hours of admission, as required by facility policy. A review of the resident's face sheet confirmed the presence of an RP, and the BCP was completed on 4/14/25. However, there was no documentation indicating that the BCP summary was given to the RP. This was verified during an interview and record review with a licensed nurse, who acknowledged the absence of documentation showing the RP received the BCP summary. Further confirmation came from the Director of Nursing (DON), who reviewed the BCP and also found no evidence that the summary was provided to the RP. The facility's policy states that both the resident and their RP should receive a summary of the BCP, and documentation should be maintained in the electronic health record. The lack of documentation indicated that the required communication with the RP did not occur.

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