Inspection·April 11, 2025

F 0882 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. Based on interview and record review, the facility failed to ensure, they had designated an infection preventionist (IP) that had completed the specialized training in infection prevention and control when the facility did not have an IP with a completion certificate of infection prevention and control training. This failure had the potential for the facility programs and activities to prevent and control infections, not properly implemented that could affect the forty-eight residents currently residing in the facility. Findings: During the interview with the interim director of nursing (IDON) on 2/11/25 at 3:20 p.m., IDON acknowledged that the facility did not have an infection preventionist (IP) right now that had a certificate of infection prevention and control training or had completed the training. During the interview with the director of staff development (DSD) on 2/11/25 at 3:35 p.m., DSD also verified that the facility did not have an IP right now that had a certificate of infection prevention and control training or had completed the training. During an interview with the former administrator (FADM), on 2/24/25 at 10:25 a.m., he acknowledged that their IP now, did not have the certificate of infection prevention and control training yet and still had to complete the training. During an interview with the current designated infection preventionist (CDIP) on 3/13/25 at 4:06 p.m., CDIP verified that she did not have a certificate yet of infection prevention and control training and still had to complete the training. CDIP stated that she will finish the training as soon as possible. Review of the facility's report provided by the current acting administrator (CAADM) on 4/2/25 at 4:04 p.m. indicated, that the facility did not have an IP that had a certificate of infection prevention and control training or had completed the training since 2/1/2025. During the interview with the IDON on 4/10/25 at 3:40 p.m., IDON acknowledged that the CDIP started working at the facility last November, 2024 as DSD and then worked as the facility's infection preventionist last 2/1/25. Review of the facility's policy and procedure titled, Infection Prevention and Control Program (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: 055356 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 055356 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oceanview Post Acute 200 Lighthouse Avenue Pacific Grove, CA 93950 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)