Health inspection·July 14, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 they had the capability to provide a specific respiratory care need prior to admitting one of three sampled residents (Resident 1) with a tracheostomy (a surgical procedure that creates an opening in the trachea (windpipe) to allow air to enter the lungs) when, the facility was not able provide cool aerosol mist (provides humidity to the airway to prevent airway secretions from drying out because a tracheostomy bypasses the natural humidifying and warming functions of the nose and mouth, potentially leading to dry, thick secretions that can obstruct the airway) to Resident 1 upon admission and readmission to the facility. This failure resulted in Resident 1 being sent to the hospital on 7/1/25 (day of admission to the facility), with Resident 1 returning to the facility on 7/7/25 from the hospital, and Resident 1 being sent back to the hospital on 7/7/25. This failure also had the potential to result in transfer trauma (a condition characterized by a range of symptoms that can occur when someone is moved from one environment to another, particularly affecting older adults) to Resident 1 and a decreased physical and emotional well-being.Findings:A review of Resident 1's Transfer Record, indicated Resident 1 was admitted to the facility on [DATE] with diagnoses which included myotonic dystrophy (an inherited disorder characterized by progressive muscle wasting and weakness) and acute respiratory failure (a condition in which the blood does not have enough oxygen and/or too much carbon dioxide (byproduct of respiration) which can be a life-threatening emergency). A review of Resident 1's Progress Notes, dated 7/1/25, indicated Resident 1 was transferred from the facility to an acute care facility. Further review of the record indicated, .I got a call from the DON [Director of Nursing] to send the resident to the hospital.When the [ambulance] came, they were asking what reason is to send him out and I said this facility is not a sub-acute facility [provides a level of care that is more intensive than a typical nursing home but less intensive than a hospital's acute care unit] and resident is on trach [has a tracheostomy].A review of Resident 1's Progress Notes, dated 7/7/25, indicated Resident 1 was again transferred from the facility to an acute care facility. Further review of the record indicated, .Resident arrived at 1307 [1:07 PM] and was sent back to hospital as per DON [Director of Nursing] and administrator as we are not trained or equipped to meet the resident's needs.During an interview on 7/14/25, at 1:15 p.m., with the Pulmonary Program Coordinator (PPC), the PPC stated Resident 1 had a tracheostomy with a t-piece (corrugated tubing shaped like the letter T connected to the wall flow for oxygen delivery). The PPC further stated Resident 1 had a quick turnaround (was admitted then discharged ) because the facility did not have the oxygen wall air flow to accommodate his needs for cool aerosol mist. The PCC stated that the DON did not consult with her (PCC) regarding the equipment needed to care for Resident 1 prior to his admission to the facility.During a phone interview on 8/11/15, at 10:16 a.m., with the DON, the DON stated the facility did not have an admitting coordinator/nurse in July of 2025. The DON further stated that the facility Marketing Resource, The Administrator in Training, the Consultant, and Residents Affected - Few (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: 055304 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 055304 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookside Care Center 1221 Rosemarie Lane Stockton, CA 95207 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)