Health inspection·October 17, 2023

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on interview and record review, the facility failed to provide sufficient nursing staff to deliver nursing care to residents when 11 of 31 days in the month of July 2023 only one licensed nurse worked the evening shift. This failure had the potential to cause delayed response to call for assistance making residents feel unattended and irritated, or cause falls and other accidents. Findings: During an interview on 8/16/23, at 2:47 p.m., Resident 1 stated it had irritated him to wait for assistance while sitting/lying in soiled underpants/linen. Once at 2 to 3 in the morning he soiled his underpants/sheets and had to wait for 7 a.m. to be cleaned by the morning shift Certified Nursing Assistants (CNAs). He had told the Administrator about the long waiting time, but things are still the same. During an interview on 9/25/23, at 1:57 p.m., Certified Nursing Assistant A (CNA-A) stated they were given more patient assignment and it is possible to have residents wait long if they are short staff because they have more things to do - take care of more residents, leave one resident to answer another call light. CNA-A stated, when residents were made to wait too long, they get mad, they might fall, they will be wet and soiled while waiting. A review of the staffing sign-in and payroll sheets for 7/23 with facility daily census between 46 to 50 residents, indicated only one licensed nurse worked the evening shift from 11 p.m., to 7 a.m., on 11 days (7/4/23, 7/5/23, 7/6/23, 7/7/23, 7/15/23, 7/16/23, 7/22/23, 7/23/23, 7/24/23, 7/26/23, and 7/31/23) of the 31 days of the month. During an interview on 10/4/23, at 9:44 a.m., Licensed Nurse B (LN-B) stated she worked night shift (NOC or graveyard shift usually from 11 p.m. to 7 a.m. the next day or 7 p.m. to 7 a.m. the next day). LN-B stated she had several times experienced working alone. LN-B stated she worked NOC shift by herself the previous week. LN-B stated, when there is one nurse working the NOC shift, it is difficult to respond to call lights as the nurse could not be in two places at one time. LN-B stated a lot of things like falls could happen in the early hours between two and four in the morning. LN-B stated for the month of September, she worked the NOC shift on Mondays by herself. During an interview on 10/4/23, at 10:22 a.m., LN-C stated she last worked NOC shift alone in late June or July. A review of the facility document titled Health Services Advisory Group (HSAG) Facility Assessment Tool dated 8/18/17, under staffing plan from page 8 to 9, indicated: based on the resident (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: 055208 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 055208 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seaview Rehabilitation & Wellness Center, LP 6400 Purdue Drive Eureka, CA 95503 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)