Westview Healthcare Center

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

DA 2 stated she faxed Resident 5's AD to the facility in 2013. DA 2 stated the AD was created in 2011. DA 2 stated she was not aware if it had been changed to indicate Resident 5's EC 1 was made a DA. During an

interview on 9/11/25 at 2:40 p.m. with the Director of Nursing (DON), the DON stated Resident 5's EC 1 was the person the facility contacted. The DON stated that EC 1 was in the facility frequently and staff discussed concerns with her. The DON confirmed that there was no AD in Resident 5's electronic record.

The DON stated all documents since 2022 had been uploaded into the electronic record. The DON stated there was no AD for 2011 in Resident 5's chart.During an interview on 9/11/25 at 3 p.m. with the Social Services Director (SSD), the SSD stated that Resident 5's EC 1 was her Responsible Party (RP). The SSD stated DA 1 was under the impression that she was EC 1 and the SSD notified DA 1 what was on the admission Record. The SSD stated Resident 5's EC 1 was the POA. Reviewed with the SSD that Resident 5's AD had been faxed to the facility in 2013 by DA 2. The SSD stated that electronic charting changed in 2022, but the document should have been uploaded to the new system. The SSD stated Resident 5's 2011 AD would still be in effect unless there was new documentation showing it was revoked or changed. During

an interview on 9/11/25 at 4:07 p.m. with the Medical Records Assistant (MRA), the MRA stated she located Resident 5's AD dated 11/14/11 in past files. The MRA confirmed the document indicated DA 1 and DA 2 are the designated agents and that there was no other document that superseded it. During a subsequent interview on 9/11/25 at 4:10 p.m. with the SSD, reviewed Resident 5's AD provided by the MRA. The SSD stated she had no knowledge of it, and it should have been passed on to the new electronic record. The SSD stated, [AD] was buried. When asked what the consequence was of not having the correct information according to the AD, the SSD stated, The proper person was not making the decisions. The [EC 1] was always involved, so we kept going to her. Was incorrect. A review of the facility's Policy and Procedure (P&P) titled Advance Directives, dated 9/22, indicated .The resident has the right to formulate and advance directive .Advance Directives are honored in accordance with state law and facility policy .

Prior to or upon admission of a resident, the social services director or designee inquires of the resident .about the existence of any written advance directives .If the resident or the resident's representative has executed one or more advance directive(s), or executes one upon admission, copies of these documents are obtained and maintained in the same section of the resident's medical record and are readily retrievable by any facility staff .The resident's wishes are communicated to the resident's direct care staff and physicians by placing the advance directive documents in a prominent, accessible location in the medical

record .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Healthcare Center

12225 Shale Ridge Lane Auburn, CA 95602

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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

The DON stated Resident 2 replied with cussing and expletives and made contact with Resident 1's left temple. The DON stated Resident 2 now has a one-to-one sitter due to this incident. Reviewed with the DON that Resident 2 had been walking in the same hallway where Resident 1's room was. The DON stated, No reason for him to be in that hallway. No reason for that to happen. A review of the facility's Policy and Procedure (P&P) titled Abuse Prevention Program, revised 4/24, indicated .Our residents have the right to be free from abuse .As part of the resident abuse prevention, the administration will: .Make every attempt to protect out residents from abuse by anyone including . other residents .Identify and assess possible incidents of abuse .Protect residents during abuse investigation .A review of the facility's P&P titled Resident-to-Resident Altercations, revised 9/22, indicated . All altercations, including those that may represent resident-to-resident abuse, are investigated and reported to the nursing supervisor, the director of nursing services and to the administrator .Facility staff monitor residents for aggressive/inappropriate behaviors towards other residents .If two residents are involved in an altercation, staff: .separate the residents, and institute measures to calm the situation .identify what happened, including what might have led to aggressive conduct on the part of one or more of the individuals involved in the altercation .

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Westview Healthcare Center

12225 Shale Ridge Lane Auburn, CA 95602

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)

Federal health inspectors cited WESTVIEW HEALTHCARE CENTER in AUBURN, CA for a deficiency under regulatory tag F-F0657 during a complaint investigation conducted on 2025-09-11.

Category: Resident Assessment and Care Planning Deficiencies

The facility was found deficient in the following area: Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 3 deficiencies cited during this inspection of WESTVIEW HEALTHCARE CENTER.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-10.