Health inspection·September 5, 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 interview and record review, the facility failed to identify appropriate interventions for two of 12 residents (Resident 4 and 38):1. Resident 4's dysphagia (difficulty in swallowing foods or liquid) care plan had no interventions; and2. Resident 38's wound care plan did not indicate wound care interventions.This failure had the potential to compromise the facility's ability to implement interventions. Findings:1. Review of Resident's 4 medical record indicated Resident 4 was admitted on [DATE] and had diagnoses including Herpes zoster encephalitis (a rare but serious complications of herpes zoster ([shingles] infection), hypertension (high blood pressure), acute kidney infection (AKI, inflammation of the kidney caused by bacterial infection), diabetes mellitus 2 (a disorder characterized by difficulty in blood sugar control).A review of Resident 4 ‘s Minimum Data Set (MDS, a tool used to measure health status in nursing home residents) completed on 8/4/25 indicated a Brief Interview for Mental Status (BIMS, a cognitive screening tool) score of 10 out of 15. A score of 8 to 12 indicated the resident's cognition was moderately impaired.Review of Resident 4's diet report indicated the resident had a dysphagia diet (a modified diet designed for individuals with difficulty swallowing); 4-pureed (food); 2-mildly thick (Nectar Thick liquid).During a concurrent interview and record review with MDS A on 9/4/25 at 11:23 a.m., MDS A stated Resident 4's had a dysphagia diet. Resident 4's had a care plan for dysphagia and confirmed there was no intervention identified. MDS A further stated the intervention should be listed in the care plan because Resident 4 has a dysphagia diet and got food for oral gratification.During a concurrent interview and record review with the Interim Director of Nursing (DON) on 9/5/25 at 2:19 p.m., the interim DON stated the care plan should have an intervention that was specific and specific to the resident. The Interim DON confirmed that there was no intervention in Resident 4's care plan. She stated the goals were set, but the intervention was missing.2. Review of Resident 38's medical record indicated Resident 38 was admitted on [DATE] and had diagnoses including end stage renal disease (ESRD, a chronic condition where the kidneys have permanently lost most of their function).A review of Resident 38's MDS completed on 8/28/25 indicated a BIMS score of 13 out of 15. A score of 13 to 15 indicated the resident was cognitively intact.During an observation inside Resident 38's room on 9/2/25 at 10:19 a.m., Resident 38 was observed with several skin tears on the lower extremities.During a concurrent interview and record review with MDS A on 9/4/25 at 11:13 a.m., MDS A verified Resident 38 had a care plan for the wounds on the right radius left upper extremities (lue, referring to left arm, shoulder and hand) and the right knee left tibia (lower leg bone). MDS A confirmed there was no intervention for Resident 38's wound care plan and stated an intervention should be there. MDS A stated the interventions should reflect what we are providing the resident. MDS A further stated the nurse should be the one putting the intervention into the care plan.During a concurrent interview and record review with the Interim DON on 9/5/25 at 2:41 p.m., the DON verified there was no intervention for the wound care plan in (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: 555143 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 555143 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Westland House 100 Barnet Segal Lane Monterey, CA 93940 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)