Health inspection·December 11, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to the facility and had not received any of his items back in return thus far. Resident 1 further stated he had been sad without his phone and was using a loaner phone from one of his friends but it was not the same.During an interview on [DATE], at 2:22 PM, with the Activities Assistant (AA), the AA stated her duties included one to one bedside activities in the room with Resident 1. The AA further stated she encountered Resident 1 daily. The AA stated Resident 1 had reported to her multiple times that his wallet, phone, and other items were missing while residing in the facility. The AA further stated each time he reported it to her she then reported it to her supervisor who then addressed it at her level.During an interview on [DATE], at 3:14 PM, with the Maintenance Director (MD), the MD stated Resident 1's items were placed in a common area that required a four digit code that all staff were aware of. The MD stated when residents were sent to the hospital their stuff was usually packed and placed in a clear bag in the back laundry/shower room in the facility. The MD stated Resident 1's items were eventually located by the housekeeper which included Resident 1's wallet. During an interview on [DATE], at 9:55 AM, with Resident 1, Resident 1 stated although he had reported his items missing a while ago no one from the facility had discussed with him the retrieval of his items. Resident 1 stated after a while they found his wallet and the only item obtained was his identification card while the rest of his items were still missing.During an interview on [DATE], at 11:14 AM, with Certified Nurse Assistant (CNA) 1, CNA 1 stated when a resident was hospitalized the CNA assigned to that resident would place all of the resident's clothing in a bag. CNA 1 then stated all items that belonged to the resident would be removed from the resident's room and placed in a room that used to be a shower room, but was now used for storage.During an interview on [DATE], at 11:19 AM, with Licensed Nurse (LN) 1, LN 1 stated when a resident was admitted to the facility their belongings would be recorded on an inventory sheet. LN 1 further stated when a resident's bed hold policy expired; then staff would bag the residents items up and document them on the inventory sheet and placed in the resident's clinical record. LN 1 stated the inventory sheets were signed by the nurse and the CNA. LN 1 further stated the items were then placed in an unused shower room.During an interview on [DATE], at 11:45 AM, with the Social Services Director (SSD), the SSD stated Resident 1's items were removed from his bedroom and placed in the shower room for storage. The SSD further stated the key to the shower room where the belongings were stored hung on a hook inside the business office.During a concurrent interview and record review on [DATE], at 12:08 PM, with CNA 2, a blank and undated facility document titled, INVENTORY OF PERSONAL POSSESSIONS, was reviewed. CNA 2 stated the licensed nurse and the CNA both needed be present when the resident's items were being placed in a bag. CNA 2 referred to the location on the document that required both the CNA and the licensed nurse to sign acknowledgment of the items upon admission and discharge of the facility. CNA 2 stated once everything was packed the items were given to the Maintenance Director to place in the shower room.During a concurrent interview and record review on [DATE], at 1:01 PM, with the Administrator (ADM), the ADM acknowledged Resident 1's belongings were placed in a shower room without any form of tracking or monitoring process. The ADM stated this practice did not meet his expectations and placed the residents at risk for having their items becoming lost or stolen. The ADM further stated that although the worth valuable of an item was determined by the individual, the staff should have a general understanding of what was considered a valuable item such as a wallet or private personal information. The ADM stated the valuable items should have been stored in a separate location.A review of the facility's undated policy and procedure (P&P) titled, Resident Personal Belongings, indicated, .Policy: It is the policy of this facility to protect the resident's to possess personal belongings and furnishings for their use while in the facility and assure the personal belongings and/or possessions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055304 If continuation sheet Page 2 of 3 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 12/11/2025 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)

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete are rightfully retuned to the resident, or to the resident's representative in the event of the resident's death or discharge from the facility. Policy Explanation and Compliance Guidelines: 1. All resident possessions, regardless of their apparent value to others, will be treated with respect.All resident personal items will be inventoried at the time of admission by the social worker designee.documentation shall be retained in the medical record.The facility will ensure resident belongings are kept in a neat orderly fashion and maintained in the resident's room.The facility will exercise reasonable care for the protection of the resident's property from loss or theft.A review of the facility's P&P titled, Theft and Loss Program, dated 10/2024, indicated, .Policy Statement The facility shall assist all personal and resident safeguarding their personal property.An inventory of resident's personal property shall be established upon admission and retained during the resident's stay.A copy of the inventory shall be made available to the resident. Event ID: Facility ID: 055304 If continuation sheet Page 3 of 3