Inspection·October 9, 2025

F0000 F0000 INITIAL COMMENTS A complaint survey for complaint number 2025014193, was conducted on 10/09/2025 at Clyde E. Lassen State Veterans Nursing Home. Though no deficient practice was identified during this survey, the facility remains out of compliance with 42 CFR 483, Requirements for Long-Term Care Facilities, due to deficiencies cited during the recertification survey conducted from 08/18/2025 through 08/22/2025. 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 reverse for further 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 Event ID: 1D7BE1-H1 Facility ID: 35961021 If continuation sheet Page 1 of 1