Health inspection·January 12, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide evidence that an allegation of abuse was thoroughly investigated for one of two residents (Resident 1). Residents Affected - Few This failure had the potential for further abuse to occur to residents. Findings: During a review of Resident 1's Face Sheet, (a document that gives a patient's information at a quick glance) the Face Sheet indicated, Resident 1 was admitted to the facility on 10/11//23 is with a diagnoses that included, Cardiac Arrest (when the heart stops beating suddenly), Heart Failure (condition that develops when your heart doesn't pump enough blood for your body's needs), Chronic Kidney Disease (condition in which kidneys are damaged and cannot filter blood as well as they should) and an Aneurysm (an abnormal bulge or ballooning in a blood vessel). During a review of Resident 1's Nursing Progress Note (NPN), dated 12/12/23 at 9:20 a.m., the NPN indicated, Alerted by CNA (certified nursing assistant) Resident 1's responsible party (RP) had phoned the facility while on the phone with Resident 1', she stated, she was going to call the police to report molestation (sexual assault or abuse of a person) occurring at the facility. Supervisor was immediately informed and DON was notified of the conversations. During a review of Resident 1's General Nursing Note, dated 12/14/23, the Note indicated, Resident 1 was pleasant and cooperative with personal and nursing care (2 person assist) and Resident 1 was able to verbalize needs and needs were met. During a review of a Facility Reported Incident (FRI) dated 12/12/23 indicated, Social Services (SS) was immediately called to speak to the resident following the incident and Resident 1 had stated that he felt violated when the CNA asked him to roll over to clean his buttock. Further reviews did not show any evidence that the alleged violations were thoroughly investigated. During a review of the facility's policy and procedure (P/P) titled, Prevention of Abuse, last revised 4/22, the P&P indicated, 1. Policy. It is the policy of this facility to take every proactive measure to prevent the occurrence of alleged abuse to any resident. 7. All incidents of witnessed, suspected, or alleged abuse are investigated and information is delivered to the supervisor on duty or the Director of Nursing. Upon receiving the report, the supervisor or Director of Nursing communicates allegation to Administrator and status of investigation. The P&P further indicated, The investigation and report shall include . outcome of investigation, and follow-up resolution or further action if necessary. (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: 055256 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 055256 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lompoc Valley Medical Center Comprehensive Care Ce 216 North Third Street Lompoc, CA 93436 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)