Health inspection·October 30, 2025

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few Based on observation, interview, and record review, the facility failed to ensure one of three sampled residents (Resident 1) was provided with an environment free from accident hazards when certified nursing assistant (CNA) 1 provided care to Resident 1 alone, but based on Resident 1's assessed needs required two staff members, and Resident 1 had an air mattress (a mattress that works by using air chambers that redistribute pressure, improve blood flow, and reduce friction for residents with limited mobility) placed on his bed without a physician's order or monitors in place to ensure the correct settings were maintained. These failures resulted in Resident 1 falling from his bed and sustaining a broken bone in his right big toe on 9/25/25.Findings:A review of Resident 1's admission RECORD, indicated, Resident 1 was admitted to the facility with diagnoses of cerebral infarction (part of the brain does not get enough blood and oxygen causing brain tissue to die), left hemiplegia (little to no use of one side of the body), and severe obesity (significant excessive body weight that poses serious health risks).A review of Resident 1's Brief Interview for Mental Status (BIMS, an assessment tool), dated 10/8/25, revealed a score of 14 out of 15 total points which indicated Resident 1 had normal memory, thinking, and understanding abilities. A review of Resident 1's Weight Summary, dated 9/1/25, indicated Resident 1's weight was 362.4 pounds.A review of Resident 1's Care Plan Report, revised 5/5/22, indicated, .The resident [Resident 1] has an ADL [activities of daily living] self-care performance deficit r/t [related to] left sided weakness.BED MOBILITY.The resident requires extensive assistance with 2+ [two or more] persons physical assist to turn and reposition in bed as necessary.date initiated 01/02/2023.Review of Resident 1's Progress Notes, dated 9/25/25, indicated Licensed Nurse (LN) 1 documented, .Called by the CNA [certified nursing assistant] in charge and he stated resident [Resident 1] slid from his bed now on the floor.found resident laying on his back on the floor.CNA [CNA 1] stated he turns on his left side then slid on the bed.A review of Resident 1's Radiology Results Report dated 9/26/25 indicated, .Reason for Study.ACUTE PAIN DUE TO TRAUMA.CONCLUSION: Acute fracture proximal phalanx right great toe [broken bone in the right big toe].During a phone interview with CNA 1 on 10/21/25 at 2:18 PM, CNA 1 stated that Resident 1's fall occurred when he was preparing to change Resident 1 and the mattress broke and he rolled out. At the time of the incident, CNA 1 stated he was positioned on the right side of Resident 1's bed and asked Resident 1 to roll over onto his left side. CNA 1 confirmed that the facility required two staff members to assist Resident 1 with Activities of daily living (ADLs, basic skills you need in regular daily life to care for yourself and/or others); however, he was alone at the time of the incident. CNA 1 reported that the air mattress, which had been installed the day prior, was unstable when Resident 1 turned. CNA 1 stated he was unsure who installed the air mattress for Resident 1 the day prior.During a concurrent observation and interview with Resident 1 in his room on 10/21/25 at 1:41 PM, it was observed that Resident 1 was able to move the right side of his body but was unable to move his left side. No air mattress was observed. Resident 1 stated on the day of the fall (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 10/30/2025 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)