Shasta View Care Center

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

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

interactions between AA J and Resident 1. During an interview on 12/23/25 at 12:20 pm, Certified Nursing Assistant (CNA) M stated, I did hear [AA J] complain about the Activity budget a lot. I did hear residents gave her money to fund the activity budget. I do know [Resident 1] used her own money for some of the supplies. Some of the residents that used their money are no longer here, they're discharged . [AAJ] used to complain to all the residents. It did upset the residents to hear her complaints. Some residents only wanted to do activities with [AA J], so she could get more hours. A review of an email sent to Activity Supervisor (AS), by AA P, dated 11/12/25, titled, To Whom It May Concern, indicated the following, [AA J] is telling residents that she is getting less hours for work and that she is being overworked when she does come into work are unnecessary conversations to have with the residents. These are not concerns for the residents to have for her. If she has concerns about scheduled hours or that she's given too much to handle at once, she should be talking to her manager and not the residents. The residents have nothing to do with that aspect of her work. [AA J] sharing has caused residents to be uncomfortable, stressed out and unwilling to participate in activities when it's not [AA J] who leads those activities for the day. [AA J] is informing residents that she spends money out of her own pocket to provide for materials because the facility is not providing or doesn't have funds to provide. She says the facility lacks funding for materials to run activities for the residents. Again, this is unnecessary information to disclose to the residents. The budget on materials for activities shouldn't be something to share with the residents. Residents should not have to worry about the facilities funds. When [AA J] is telling residents about these things, it makes it difficult for employees to work with them. There shouldn't be conflict between employees and residents, and

this is what is being caused because of how [AA J] is involving residents and things they should not have to worry about. Can someone please follow up. It would be greatly appreciated. During an interview on 12/23/25 at 9:35 am, AS confirmed she received the above email from AA P. AS stated, I did send the email up the chain of command, but nothing was done. AS indicated that she had already ordered the coffee creamer for Resident 2, and had informed AA J of this, but AA J took Resident 2's bank card and uploaded

it to her personal online shopping site anyway. AS indicated that the creamer for Resident 2 was delivered to AA J's home. AS stated that was a violation of the facility's money policy. During an interview on 12/23/25 at 12:45 pm, AA P confirmed he had sent an email to AS on 11/25/25. AA P indicated that AA J was always talking about her personal problems in front of the residents. She would say things like we don't have specific supplies we need, and I have to pay out of my own pocket. It's not fair. They need to give us a bigger budget. These comments would upset the residents and then the residents would mention it to us.

The residents felt sorry for her. A facility disciplinary action document for AA J titled, Violation of Facility Resident Finance Policy, dated 11/28/25, was reviewed. The document indicated; Date of Violation 11/23/25. Nature of violation: Conduct, uncooperative, carelessness, and disobedience. Final written warning. 3-day suspension effective 11/28/25. Admin B documented on 11/28/25, Employee walked out of discussion meeting, said that she is done and not going to work. We will get a written statement of resignation/Admin to term. During an interview on 12/24/25 at 8:54 am, with Regional Registered Nurse Consultant, she confirmed the facility's Transactions Involving Resident Funds policy was violated by AA J for Residents 1 and 2.

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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

12/24/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Shasta View Care Center

1795 Walnut Street Red Bluff, CA 96080

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

on 12/18/25 at 12:03 pm, Administrator (Admin) B confirmed the investigation of alleged abuse by AA J towards Resident 1 was submitted late to CDPH. Admin B stated, I entered the facility on 11/3/25, and the report was dated 11/5/25. It was only a few days late. During a follow up interview on 12/18/25 at 12:25 pm, Admin B confirmed the facility had not reimbursed Resident 1 the $300 as they indicated in their 5 day abuse allegation investigation results on 11/5/25. Admin B stated, I did not substantiate the abuse. I didn't have any proof that it happened. There was no written contract statement, it was a verbal agreement if she wanted [AA J] to cook meals. [Resident 1] confirmed there was a car problem or a delay, but I have no proof. [AA J] explained she needed to replace her tires and there was a conversation between them both, so I cannot substantiate it. During an interview on 12/18/25 at 1:55 pm, the Director of Nursing (DON) confirmed the abuse allegation for Resident 1 was not complete or thorough. DON stated, I confirm the investigation was no complete, we need more witnesses and more interviews. During a concurrent

interview and record review of the facility's Abuse Policy part V: A and B, page 4 (Investigation of Alleged Abuse, Neglect and Exploitation), on 12/18/25 at 2:03 pm, Admin B confirmed the investigation of the abuse allegation of Resident 1 was not complete and did not follow their facility's abuse policy instructions to provide complete and thorough documentation of the investigation.During an phone interview on 12/18/23 at 2:10 pm, Family Member (FM) of Resident 1 stated, No one has called or contacted me from

the facility to ask what I knew about [AA J] taking money from [Resident 1] and not providing promised services. During a phone interview on 12/18/25 at 3:11 pm, Resident 1 indicated that she was never reimbursed any money by the facility or contacted by the facility regarding the abuse allegation or the results of their investigation. During a phone interview on 12/19/25 at 8:41 am, Admin A stated, Yes, I remember the investigation of [Resident 1]. I tried to finish it before I left the facility, and I was told that the next administrator would do it. I confirm the investigation had not been completed for Resident 1 and it was late. I immediately suspended [AA J] until I could gather more information. I was never asked to reimburse money for [Resident 1's] going home party by [AA J]. I would never expect any residents to pay for their own party. I remember she did have a party. We have funds for all activities. I was there the day of the party.

We have a money policy. No staff member can take any money from any resident for any reason. During an

interview on 12/23/25 at 10:25 am, the Regional Registered Nurse Consultant stated, I confirm this was not

a proper or complete investigation. [AA J] should have never been allowed to come back to the facility until

this allegation was thoroughly investigated. I also confirm [AA J] never had the one on one abuse training as the report indicated that was sent to [CDPH]. The last abuse training for [AA J] was completed in August

1. 2024. During an interview on 12/23/25 at 11:10 am, DON confirmed the abuse investigation was not

thorough. DON stated, I have a list of all the names of the alert and oriented residents I interviewed on 12/20/25, which should have been part of the documentation for this investigation of alleged financial abuse.

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