Health inspection·May 8, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide a written notice of bed hold (holding or reserving a resident ' s bed while the resident is absent from the facility for therapeutic leave or hospitalization) to four of four sampled residents (Resident 1, 2, 3, and 4) or their responsible party (RP) at the time of transfer to acute care hospital. This failure could result in residents and/or their RP not being fully informed of their right to request a bed hold and to return to the facility after hospitalization, potentially leading to inappropriate discharge. Findings: 1. Resident 1 was initially admitted on [DATE] and was readmitted on [DATE], with diagnoses that include encephalopathy (a general term that describes brain disease, damage, or malfunction usually related to inflammation within the body) and urinary tract infection (an infection in any part of the urinary system). During a concurrent interview and record review on 5/8/25 at 3:37 PM, the Assistant Director of Nursing (ADON) reviewed the facility document, titled Admit/Discharge Report (ADR), dated 12/1/24 to 1/31/25. The ADR indicated Resident 1 was hospitalized on [DATE] and returned to the facility on 1/30/25. During an interview on 5/8/25 at 4:36 PM, Resident 1's RP was sent to the emergency room on 1/8/25. Resident 1's RP stated, They (facility) never gave a 7 (seven) - day hold notice (bed hold notice). She was not given anything. Neither was I. During a concurrent interview and review of Resident 1 ' s electronic health record (EHR) on 5/14/25 at 10:04 AM, Registered Nurse (RN) 1 was unable to find evidence that a written notice of bed hold was given to Resident 1 or their RP. 2. Resident 2 was initially admitted on [DATE] and re-admitted on [DATE], with diagnoses that include left femoral neck fracture (a break in the upper part of the thigh bone that connects the rounded ball of the hip joint to the long shaft of the thigh bone). During a concurrent interview and record review on 5/8/25 at 11:12 AM, the ADON reviewed the ADR. The ADR indicated Resident 2 was transferred to the hospital on 1/5/25 and was discharged to another facility on 1/13/25. (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: 555235 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 555235 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ahmc Seton Medical Center 1900 Sullivan Avenue Daly City, CA 94015 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)