Shoreline Care Center
Inspection Findings
F-Tag F0641
F 0641
Ensure each resident receives an accurate assessment.
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 ensure the Minimum Data Set (MDS - a standardized assessment and care-screening tool) accurately reflected the behavior status of one of two sampled residents (Resident 1). This failure had the potential to negatively affect Resident 1's plan of care and delivery of necessary care and services.During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted on [DATE REDACTED], with diagnoses that include Alzheimer's disease (disease characterized by a progressive decline in mental abilities), psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). During a review of Resident 1's Order Summary Report (OSR), dated 8/28/25, the OSR indicated Quetiapine Fumarate (antipsychotic medication used to improve mood, thoughts, and behaviors) tablet 25 mg(milligrams) by mouth two times a day for Psychosis m/b (manifested by) visual and auditory hallucination (the perception of the presence of something that is not actually there) and monitor behavior for anti-psychotic Seroquel for Psychosis m/b auditory/visual hallucinations and tally every shift.During a review of Resident 1's Medication Administration
Record (MAR), dated June 2025, the MAR indicated there were episodes of hallucinations on 6/4/25, 6/7/25, 6/9/25, and 6/10/25.A review of Resident 1's Change In Condition Evaluation report dated 8/26/25 indicated, that screaming was heard from nurses' station and staff was calling out for assistance. When staff proceeded down the hallway it was noted that staff had separated two residents. And when asked what happened Certified Nursing Assistant (CNA) stated I overheard them screaming at each other and both started hitting and slapping one another. Unable to determine who initiated the altercation or verbalize
the reason for altercation. During a concurrent interview and record review on 9/4/25 at 3:56 p.m., with the Health Information Manager (HIM), Resident 1's MDS dated [DATE REDACTED]. Section E0100 potential indicators for psychosis, the hallucinations box was not checked, indicating Resident 1 had no episodes of hallucinations.
HIM acknowledged Resident 1's MDS Assessment was not accurate, and the box for hallucinations should have been marked. During a review of the facility's policy and procedure (P&P) titled, Resident Assessment Instrument, dated 10/2024, the P&P indicated, The Long Term Care Facility Resident Assessment Instrument 3.0 User's Manual V. 1.19.1 October 2024 will be the source of guidance for the RAI Process. 7) Each person completing a section of the MDS attests to its accuracy.
Residents Affected - Few
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
Event ID:
Shoreline Care Center in Oxnard, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Oxnard, CA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Shoreline Care Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.