Health inspection·June 20, 2024

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure staff was available to answer a resident's call light for one of two residents (Resident 1), when the resident requested assistance to go to the bathroom for toileting needs. This failure had the potential for the resident to be incontinent and also cause psychosocial harm. Findings: During a review of the facility document titled, Nursing Staff Sheet (NSS), dated 4/28/24, the NSS indicated for 3-11 shift (afternoon), the census was 88 and seven certified nursing assistants (CNAs) were scheduled for patient care. The NSS further indicated, each CNA had approximately 12 to 13 residents each to care for. During an interview on 5/13/24 at 10:43 am with the director of nursing (DON), the DON stated, We are not understaffed .We currently do not have any staffing waivers . In this facility the expectation is that anyone that works here and sees or hears a call light they are expected to go in and at least see what the resident needs . During a review of Resident 1's Face Sheet, dated 5/13/24, the face sheet indicated, Resident 1 was admitted on [DATE], with diagnoses that included, hemiplegia (paralysis of one side of the body) and hemiparesis (inability to move one side of the body) following acerebral infarction (stroke-disrupted blood flow to the brain) affecting left non-dominant side. During a review of Resident 1's Minimum Data Set (MDS-assessment of current health conditions), dated 5/8/24, the MDS indicated, a BIMS (brief interview of mental status) score of 15, which indicated intact cognition (alert mental processes), no behavioral issues, with upper and lower impairment on one side (left of the body), continent of bladder but requiring maximum assistance for toileting. During a review of Resident 1's Care Plan (CP), revised 9/21/23, the CP indicated, Resident 1 had impaired functional abilities related to left hemiparesis, full dependence on toileting, potential elimination concerns related to hemiparesis with interventions including but not limited to, answer all call bells promptly to ensure continued continence of bowel and bladder; and scheduled/habit toileting program: upon awakening, before and after breakfast, before and after lunch, before or after supper, at bedtime, and during the night if resident is awake. During a concurrent observation and interview on 5/13/24 at 11:53 am with Resident 1 inside the (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 06/20/2024 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)