Health inspection·October 30, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure professional standards of care were met for one of three sampled residents, (Resident 1) when Resident 1 was not repositioned or assisted with care needs in a timely manner. Residents Affected - Few This failure put Resident 1 at risk of discomfort and skin breakdown. Findings: A review of Resident 1 ' s admission RECORD, indicated, she was admitted to the facility in late 2024 with diagnoses which included dementia (condition characterized by memory disorders, personality changes, and impaired reasoning) and muscle weakness. A review of Resident 1 ' s clinical care plan indicated, Resident is at risk for pressure injury development and skin breakdown r/t [related to] immobility, incontinence. Turn and reposition q2h [every 2 hours] and PRN [as needed] During an observation and interview on 10/29/24, at 12:45 PM, with family member (FM) 1, Resident 1 was observed sitting in her wheelchair, FM 1 was sitting in a chair beside Resident 1. FM 1 stated he visited from 9:30 AM until 2:30 PM everyday and Resident 1 was never repositioned or taken to the bathroom during those times. FM 1 further stated the reason Resident 1 had a urinary tract infection (UTI, when germs enter the urinary tract and cause an infection) was because staff never provided incontinence care (support services for people who are unable to control their bladder or bowel movements.) During an observation and interview on 10/29/24, at 1 PM, the Speech Therapist (ST) was observed feeding Resident 1 her meal. Resident 1 stated she wanted to go to the bathroom. FM 1 stated she needed to go to the bathroom, but no one would help her. The ST stated staff would assist Resident 1, the ST stated she would inform staff of Resident 1 ' s need. During an observation and interview on 10/29/24, at 1:33 PM, in Resident 1 ' s room, Resident 1 was observed sitting in her wheelchair. FM 1 stated Resident 1 had not yet been assisted to the bathroom. During an observation and interview on 10/29/24, at 2:48 PM, in Resident 1 ' s room, Resident 1 was observed sitting in her wheelchair. FM 1 stated staff had not repositioned her or provided bathroom assistance since before he arrived in the morning. During an interview on 10/29/24, at 2:59 PM, CNA 2 stated she had provided care to Resident 1 (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 2 Event ID: 055289 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 055289 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lodi Creek Post Acute 321 West Turner Road Lodi, CA 95240 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)