Health inspection·November 21, 2025

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to implement its written abuse policies and procedures when staff did not follow the required steps for responding to and reporting a documented allegation of resident-to-resident abuse after Resident 1 reported that Resident 2 threw objects, including cups and utensils, toward Resident 1.This failure left Resident 1 and Resident 2 without required protective interventions and placed them at risk for psychosocial harm.During a review of Resident 1's clinical record titled, admission RECORD, the record indicated Resident 1 was admitted to the facility with multiple diagnoses which included generalized anxiety disorder (a mental health condition that causes fear, a constant feeling of being overwhelmed and excessive worry about everyday things) and depression (mood disorder that causes a persistent feeling of sadness and loss of interest).Review of Resident 2's clinical record titled, admission RECORD, the record indicated Resident 2 was admitted to the facility with multiple diagnoses which included dementia (the loss of cognitive functioning - thinking, remembering, and reasoning - to such an extent that it interferes with a person's daily life and activities) and metabolic encephalopathy (a brain dysfunction caused by a chemical imbalance in the body that can cause confusion, memory problems, and changes in behavior).During an interview on 11/20/25 at 1:36 p.m., with Resident 1, Resident 1 stated she had a problem with Resident 2 about a month ago when Resident 2 urinated on the floor and threw a butter knife and fork at her. Resident 1 stated that the objects did not hit her. Resident 1 also stated that she told the activities director and the Director of Nursing (DON) of the incident.Review of Resident 1's electronic medical records titled, Progress Notes, dated 10/13/25 4:25 p.m., indicated, . RESIDENT [Resident 1] CAME TO ACTIVITIES AND STATED ROOMMATE [Resident 2] IS THROWING OBJECTS AT HER. URINATING ON HER SIDE OF THE ROOM AND SHE [Resident 1] FEELS UNSFAFE- NOTIFIED DON/ADON/SS.Review of Resident 2's electronic medical records titled, Progress Notes, dated 10/13/25 at 4:24 p.m., indicated, . ROOMMATE [Resident 1] CAME TO ACTIVITIES AND STATED RESIDENT [Resident 2] IS PEEING ON HER SIDE OF THE ROOM, THROWING CUPS, UTENSILS AT HER- DOES NOT FEEL SAFE.During a concurrent interview and record review on 11/20/25 at 3:20 p.m. with the Assistant Director of Nursing (ADON), Resident 1 and Resident 2's progress notes were reviewed. The ADON acknowledged that there was no follow-up documentation, no nursing notes, and no investigation was done after the incident. The ADON stated that it put Resident 1 and Resident 2 at risks for harm especially when the intradisciplinary team (IDT - group of health care professionals with various areas of expertise who work together toward the goals of residents) was not aware of the incident.During a concurrent interview and record review on 11/20/25 at 3:40 p.m. with the Activities Director (AD), Resident 1 and Resident 2's progress notes were reviewed. The AD verified that she documented both progress notes for the two residents involved with the incident. The AD stated that the DON took over the investigation and therefore she did not complete any further follow-up or documentation.During a concurrent interview and record review on 11/20/25 at 3:46 p.m. with the DON, Resident 1 and Resident 2's progress notes were reviewed. The DON stated that she was 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 3 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 11/21/2025 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)