Health inspection·September 2, 2025

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** F 725: Sufficient Staffing - [NAME] Care Center S/S D [NAME] S483.35 Nursing Services The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at S483.70(e). S483.35(a) Sufficient Staff. S483.35(a)(1) The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans: Intent:To assure that there is sufficient qualified nursing staff available at all times to provide nursing and related services to meet the residents' needs safely and in a manner that promotes each resident's rights, physical, mental and psychosocial well-being. F 725: Sufficient Staffing - [NAME] Care Center S/S D [NAME] Based on interview and record review, the facility failed to provide sufficient numbers of staff when six (6) out of 6 sampled days had less than 3.5 direct care service hours per patient day (DHPPD- the total number of hours worked per patient day divided by the average daily number of residents in the facility).This failure had the potential to result in unmet needs, such as psychosocial, physical needs, and safety concerns for 95 residents.Findings:An unannounced complaint investigation was conducted related to quality of care.During an interview with the Director of Nursing (DON) on August 11. 2025, at 4:00 PM, DON stated, We are short staffed mostly on night shift. The DON further stated three (3) Certified Nursing Assistants (CNA) recently quit and they are currently using travelers with the shortage.During a concurrent interview and record review on August 11 , 2025, at 4:15 PM, with the DON, the facility's document titled, Census and Direct Care Service Hours Per Patient Day (DHPPD- the number that results from dividing the actual nursing hours perform by direct caregivers per patient day and the number of residents in the facility), for dates: July 24, 2025 through July 29, 2025, were reviewed. The Census and Direct Care Service Hours Per Patient Day document indicated the following dates when the required 3.5 DHPPD hours was not met:a. July 24, 2025- 3.21 DHPPD (facility was short of 0.29)b. July 25, 2025 - 3.37 DHPPD (facility was short of 0.13)c. July 26, 2025- 2.33 DHPPD (facility was short of 1.17)d. July 27, 2025- 2.22 DHPPD (facility was short of 1.28)e. July 28, 2025- 3.48 DHPPD (facility was short of 0.2) A reference to a document titled All Facilities Letter (AFL) 18-12 [an official notice issued by the California Department of Public Health (CDPH) to licensed healthcare facilities to provides updates on regulations, policies, procedures, or urgent public health information that facilities must follow]. The AFL 18-12 indicated Skilled Nursing Facilities are required to provide a minimum of 3.5 direct care service hours per patient day, with a minimum of 2.4 performed by certified nurse assistants.During a review of the facility's policy titled, Staffing, Sufficient and Competent Page 1 of 2 555777 555777 09/02/2025 Bishop Care Center 151 Pioneer LN Bishop, CA 93514

F 0725 Level of Harm - Minimal harm or potential for actual harm Nursing revised August 2022, was reviewed. The P&P indicated, Our facility provides sufficient numbers of staff with the appropriate skills and competency necessary to provide nursing and related care and services for all residents in accordance with resident care plans and the facility assessment. The DON acknowledged that the policy was not followed and acknowledged they were aware of having fewer DHPPD hours than required on the specified dates. Residents Affected - Few 555777 Page 2 of 2