F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review the facility failed to ensure one of two residents sampled for dignity (Resident
1), was treated with dignity and respect when Houskeeper (HSK) A made comments to Resident 1
indicating he had sexy legs and a sexy face. This failure caused Resident 1 to feel uncomfortable and
unsafe around HSK A. Findings: A review of the facility's policy titled Implementation of Patients' [NAME] of
Rights dated 9/22/16, indicated Patient right number 10: to be treated with consideration, respect and full
recognition of his/her dignity and individuality. 1. Members of the staff will display respect when speaking
with, care for, or talking about patients as constant confirmation of their individuality and dignity as human
beings. Staff members will address patients with respect at all times. A review of a Facility Reported
Incident (a report written by the facility and sent to the California Department of Public Health (CDPH)
dated 7/21/25, indicated On 7/18/25 the Housekeeping Manager (HSKM) notified DON (Director of
Nursing) that the LTC (Long Term Care) charge nurse (LN B) had concerns that the housekeeper (HSK A)
working in LTC that day was saying inappropriate comments to a male resident (Resident 1). The charge
nurse (LN B) stated that he overheard the housekeeper, (Name) HSK A, tell the male resident, (Name)
Resident 1, that he had a sexy face. The charge nurse also said that he has witnessed multiple occasions
where the housekeeper has referred to (Name) Resident 1, as sexy or make other provocative comments
about his body. A review of the facility's final investigation report dated 7/21/25, indicated the DON spoke
with (name) Resident 1 in the DON office on 7/18/25 at approximately 1:30 pm. (Name) Resident 1 stated
the housekeeper (HSK A), frequently makes inappropriate comments to him. He stated that she often says
things like you have sexy legs and other provocative comments about him being sexy. DON asked (name)
Resident 1 if these comments made him feel uncomfortable and he shrugged his shoulders and nodded his
head. He stated he tries to let these comments roll off his shoulder, but they are occurring more frequently
now. A review of Resident 1's face sheet, indicated Resident 1 was admitted to the facility on [DATE] with
diagnosis that include unsteady gait, confusion, mild cognitive (the ability to remember and make decisions)
impairment, and history of alcohol abuse. A review of Resident 1's Minimum Data Set (MDS, a clinical
assessment) dated 7/4/25, indicated Resident 1 had a Brief Interview for Mental Status (BIMS, a cognitive
evaluation ranging from 00- impaired cognition to 15- cognition intact) evaluation performed and scored 15.
During an interview on 8/15/25 at 1:17 pm, Resident 1 indicated that HSK A would come into his room and
while cleaning his room she would make comments about his legs being sexy. Resident A stated he felt
uncomfortable and unsafe around HSK A and would try and avoid her. During an interview on 9/5/25 at
10:18 am, LN B stated he had witnessed HSK A telling Resident 1 that he had sexy legs, a sexy face, and
other provocative comments about his body since February 2025. LN B stated he should have reported this
sooner but did not think it was an issues because Resident 1 was always laughing and smiling during the
interactions. During an interview on 9/5/25 at 11:15 am, DON
(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:
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
09/05/2025
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)
F 0550
Level of Harm - Minimal harm
or potential for actual harm
stated that she was unaware that HSK A was making these comments to Resident 1 since February and it
should have been reported to her at that time. DON stated that HSK A was hired on 6/17/24 and
discharged from employment to the facility on 7/25/25. DON confirmed that Resident 1 was not treated with
dignity and respect and was made to feel uncomfortable when HSK A made these comments.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555022
If continuation sheet
Page 2 of 2