Health inspection·December 12, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to develop and revise care plans to meet the medical needs for two of eight residents sampled (Resident 7 and Resident 6) when:1. Resident 7's bladder incontinence (inability to hold urine) was not reflected on her care plan.2. Resident 6 had no care plan developed that addressed her heart condition.These failures had the potential to result in negative clinical outcomes for Resident 6 and Resident 7, by not receiving the care and services they needed.Findings: A review of the facility's Policy and Procedure titled, Comprehensive Care Policy effective 3/27/25, indicated the facility shall ensure a comprehensive care plan will be implemented for each skilled nursing facility resident that includes measurable objectives and timetables to meet a resident's medical, nursing and mental and psychosocial needs that are identified in the comprehensive assessment. 6. The care plan will include the following information: b. All identified medical, physical and psychosocial problems, concerns and needs specific to the resident. Purpose: The purpose of this policy is to properly identify a resident's needs, with the help of IDT, to implement a plan of action to further improve a resident's quality of life. A review of Resident 7's admission Record indicated Resident 7 was admitted to the facility on [DATE] with diagnoses that included dementia, urinary frequency (having to urinate frequently), and high blood pressure. A review of Resident 7's Minimum Data Set (MDS- a comprehensive assessment and screening tool) dated 7/10/25, indicated Resident 7 had a Brief Interview for Mental Status (BIMS, cognitive screening tool scored from 0 to 15) with a score of 9 (moderate cognitive impairment). MDS section H indicated that Resident 7 was always continent (full control) of her bladder. A comparison MDS of section H dated 10/08/25, indicated Resident 7 was occasionally incontinent, a decline from the previous MDS on 7/10/25. During interview on 12/10/25 at 4:52 pm, with Certified Nursing Assistant (CNA) C, CNA C stated Resident 7 gets up and uses the bathroom frequently. CNA C stated Resident 7 was toileted every two hours, but needs to go more frequently than that. During an interview and concurrent review of Resident 7's care plans and MDS assessments on 12/11/25 at 10:19 am, with Minimum Data Set Nurse (MDS) A, MDS A confirmed Resident 7 had a decline in her ability to control her urinary continence and the care plan had not been revised to reflect that. During an interview and record review of Resident 7's care plans on 12/11/25 at 10:40 am, 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 5 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 12/12/2025 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)