Health inspection·June 19, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm was important abuse allegations were reported to the right agencies to protect residents' rights and to snip the abuse in the bud really quick. During an interview on 6/18/25 at 3:25 p.m., the Infection Preventionist (IP) stated was expected to report abuse allegations only to the ombudsman and law enforcement to protect the resident. Residents Affected - Few A review of the All Facilities Letter (AFL, information contained may include changes in requirements in healthcare, enforcement, new technologies, scope of practice, or general information that affects the health facility) 21-26, dated 7/26/21, indicated, . Pursuant to Title 42 CFR section 483.12(c)(1) . facilities must report any instance of suspected or alleged abuse, neglect, exploitation, and/or mistreatment of elders or dependent adults to their local law enforcement agency, LTC ombudsman, and [CDPH]. When to Report . for incidents that involve abuse or result in serious bodily injury, facilities must: Call local law enforcement immediately, but no later than two hours after the allegation is made. File a written or electronic report to the LTC ombudsman, local law enforcement, and [CDPH] within two hours . for any other reasonable suspicion that does not result in abuse or serious bodily injury, facilities must: Call local law enforcement as soon as possible, but no later than 24 hours after the allegation is made. File a written or electronic report to the [Ombudsman], local law enforcement and [CDPH] within 24 hours . 2. During a review of the Report of suspected dependent adult/elder abuse, dated 5/24/25, indicated an allegation abuse occurred on 5/23/25 when, .observe [Certified Nursing Assistant] holding a sheet over [Resident's] head and pushing her down . A review of the facility's fax confirmations, for date 5/24/25, indicated the Report of suspected dependent adult/elder abuse was faxed to the Ombudsman on 5/24/25 at 9:43 a.m. and the Humboldt Sheriff Department (HSD) on 5/24/25 at 11:39 a.m. During a concurrent interview and record review on 6/18/25 at 3:56 p.m., with the ADM, Report of suspected dependent adult/elder abuse and email and fax confirmation receipts, dated 5/24/25, were reviewed. The ADM confirmed the abuse allegation occurred on 5/23/25 and all abuse allegations should be reported to the state, the Ombudsman and law enforcement within 2 hours. The ADM verified the facility did not meet the two hour reporting time frame requirement when the abuse allegation was reported to the Ombudsman on 5/24/25 at 9:43 a.m. and the HSD on 5/24/25 at 11:39 a.m. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055208 If continuation sheet Page 2 of 4 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 06/19/2025 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)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews and record reviews, the facility failed to ensure staff followed the facility's enhanced barrier precautions (EBP, an infection control intervention, that involves the use of gowns and gloves during high-contact care activities to reduce the transmission of Multidrug-Resistant Organisms [MDROs, bacteria, that have become resistant to multiple antibiotics]) for one out of two sampled residents (Resident 2) when staff did not wear gown while changing Resident 2's incontinence brief (a type of absorbent undergarment, similar to an adult diaper). Residents Affected - Few This failure could result in a higher risk of transmitting MDROs to residents and could make residents sick. Findings A review of Resident 2's face sheet (front page of the chart that contains a summary of basic information about the resident) indicated Resident 2 was admitted to the facility in September 2017 with diagnoses including Neuromuscular Dysfunction of Bladder (neurogenic bladder-a problem in which a person lacks bladder control due to a brain, spinal cord, or nerve condition). A review of Resident 2's care plan (CP, a detailed, written document that outlines a resident's individual needs, goals, and how their care will be managed), dated 1/2025, indicated Resident 2 had an Indwelling Catheter (IC-a hollow tube inserted into the bladder to drain or collect urine). During a concurrent observation and interview on 6/18/25 at 2:58 p.m., Resident 2 was noted to have an IC. Unlicensed Staff E and Unlicensed Staff F was observed not wearing gowns while changing Resident 2's incontinence brief. Resident 2's room had a document by the door titled Enhanced Barrier Precautions (EBP). The EBP document indicated staff should wear gown and gloves when changing incontinence briefs. During an interview on 6/18/25 at 3:00 p.m., Unlicensed Staff E and Unlicensed Staff F verified they did not wear gowns when they changed Resident 2's incontinence brief. Unlicensed Staff E verified Resident 2 had an IC and they should have worn gowns when changing Resident 2s incontinence brief. Unlicensed Staff E stated following the EBP, such as wearing gown when changing incontinence briefs, was for infection prevention and to prevent cross contamination (when bacteria or other microorganisms are unintentionally transferred from one object to another). During an interview on 6/18/25 at 3:05 p.m., Resident 2 verified Unlicensed Staff E and Unlicensed Staff F did not wear gowns when they changed her incontinence brief earlier. Resident 2 stated she was surprised to learn that staff should be wearing a gown whenever they changed her incontinence brief and added, staff had never wore a gown when they were changing her incontinence brief. During an interview on 6/18/25 at 3:17 p.m., Licensed Nurse (LN) G stated residents with ICs were placed on EBP and staff should wear gowns when they were changing incontinence briefs as an infection control measure, to prevent cross contamination and getting others sick. During an interview on 6/18/25 at 3:25 p.m., the Infection Preventionist (IP) stated all residents who had an IC were placed on EBP. The IP verified Resident 2 had an IC and staff should wear gown when they were changing Resident 2's incontinence brief. The IP stated if staff did not wear a gown while changing Resident 2's incontinence brief, it meant the EBP was not followed. The IP stated it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055208 If continuation sheet Page 3 of 4 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 06/19/2025 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)

F 0880 was important to follow the EBP as an infection prevention measure and to prevent cross contamination. Level of Harm - Minimal harm or potential for actual harm A review of the document from California Department of Public Health (CDPH, licensing) titled Enhanced Barrier Precaution (EBP) indicated, .anyone participating in any of these six moments must also: [NAME] [put on] gown and gloves .toileting and changing incontinence briefs . Residents Affected - Few A review of the facility's policy and procedure (P&P) titled Enhanced Barrier Precautions, revised 6/7/24, it indicated, . EBP applies for all residents with any of the following: .wounds or indwelling medical devices such as urinary catheter and to wear gown and gloves when changing briefs . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055208 If continuation sheet Page 4 of 4