Inspection·June 23, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow its facility policy to re-weigh residents with a five percent (5%) or greater weight loss and immediately notify the Registered Dietician (RD) in writing for one (1) of three (3) sampled residents (Resident 1). Residents Affected - Few This failure resulted in Resident 1's increased weight loss, worsening malnutrition (not getting enough healthy food or nutrients), delayed medical treatment, and adverse consequences as evidenced by slower healing of pressure sores. Findings: Review of [NAME] and [NAME], 7th Edition, Mosby's Fundamentals of Nursing, page 243 in the section titled, Data Documentation indicates, Observation and recording of client status is a legal and professional responsibility. The nurse practice acts in all states and the American Nurses Association Nursing's Social Policy Statement (2003) mandate, or require, accurate data collection and recording as independent functions essential to the role of the professional nurse. During a review of Resident 1's admission Record (AR), the AR indicated the resident was admitted on [DATE] with diagnoses including anemia (low number of red cells in the blood), malnutrition, dysphagia (difficulty swallowing) and multiple pressure ulcers (injuries to the skin/tissue from prolonged pressure) on various areas of the body. During a review of Resident 1's Weights and Vitals Report (WVR), dated 4/19/25 - 5/28/25, the WVR indicated Resident 1 had the following weight readings: On 4/19/25, Resident 1 weighed 88.8 pounds. On 4/27/25, Resident 1 weighed 83.8 pounds, indicating a 5.63% weight loss in one week. On 5/05/25, Resident 1 weighed 81.2 pounds, indicating a 3.10% weight loss in one week. On 5/12/25, Resident 1 weighed 76.4 pounds, indicating a 5.91% weight loss in one week. On 5/18/25, Resident 1 weighed 72.2 pounds, indicating a 5.49% weight loss in one week. During a review of Resident 1's Progress Notes dated 4/28/25 to 5/28/25, there was no documentation indicating the Registered Dietitian (RD) notified of Resident 1's significant weight loss. (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 3 Event ID: 555830 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 555830 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lompoc Skilled Nursing & Rehabilitation Center 1428 West North Avenue Lompoc, CA 93436 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)