Health inspection·December 14, 2023

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, this requirement was not met when the facility failed to obtain the services of a registered nurse for eight consecutive hours, seven days a week. This had the potential to adversely affect residents' care, which could lead to potential negative clinical outcomes (worsening condition). A review of the facility's Registered Nurse (RN) staffing/schedule documentation from the period of 10/1/23 to 10/31/23 indicated that the RN working as Director of Nursing (DON) was scheduled to work weekdays (Monday through Friday) leaving nine weekend days (10/1, 10/7, 10/8, 10/14, 10/15, 10/21, 10/22, 10/28, and 10/29/23) uncovered during this four-week time period. There were four days (10/26, 10/27, 10/30, and10/31/23) when the DON was on time off. During an interview on 12/12/23 at 3:16 PM, DON confirmed that an RN was not on duty for eight consecutive hours, seven days a week. DON stated, We are a very small town, RNs are difficult to recruit. The position is almost continuously posted, for 5-6 years we have had staffing waivers. DON acknowledged that an RN was available in the acute hospital, through an adjoining hallway, if needed. The facility's Chief Nursing Officer (CNO) requested the federal waiver for RN coverage, indicating a reduction in the required registered nurses' hours from 56 hours a week to 40 hours a week be renewed this year. The facility provided evidence of ongoing advertisements and efforts to fill the open position. The surveyor team found no negative outcomes related to continuing this federal waiver for RN coverage, and recommend that it be continued. 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: 555022 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 555022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seneca District Hospital D/P Snf 130 Brentwood Dr Chester, CA 96020 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)