Health inspection·December 22, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure an allegation of employee-to-resident physical abuse was reported by the facility for one of three sampled residents (Resident 1) when on 11/17/25, the facility failed to report Resident 1's allegation of physical abuse by a Licensed Nurse to the state agency.This failure resulted in a delayed abuse investigation and had the potential to affect Resident 1's physical and psychosocial well-being.Findings:During an interview on 12/22/25 at 1 PM, in Resident 1's room, Resident 1 stated that a few weeks ago he had his cat food taken away and his arm twisted by Licensed Nurse (LN) 1 and that it was witnessed by a Certified Nursing Assistant (CNA). Resident 1 explained he called the police on 11/17/25 and made a police report because LN 1 got angry with him, grabbed and twisted his left arm hard enough to tear off a bandage on Resident 1's elbow while LN 1 took away Resident 1's bag of cat food. Resident 1 stated he bought cat food with his own money and liked to leave cat food for the stray cats on the patio outside of his room. Resident 1 further stated that in addition to the CNA witnessing the incident, he also told the Director of Nursing (DON) when she came into the room that he was physically hurt by LN 1. Resident 1 explained that he felt like, I'm nothing and a nobody to them, and that he did not feel like the facility cared about him or his rights. Resident 1 further explained that he told the DON that he no longer wanted LN 1 to be his nurse.During an interview on 12/22/25 at 12:45 PM, LN 2 stated that if he observed or heard a report of an alleged abuse, he would report it immediately to his DON or Administrator (ADM). LN 2 explained the process for reporting any type of alleged abuse including resident to resident, or staff to resident, was to check the resident head to toe and make sure the resident was safe and not injured. LN 2 further explained he would then call the doctor to notify him, report the incident to the police, complete the required abuse reporting forms, notify the Ombudsman (an appointed official to advocate for residents and resident rights), the state agency (state agency responsible for investigating alleged abuse and other resident complaints) and document the incident and who he notified in the resident's medical record. LN 2 stated in addition, we would monitor the residents for 72 hours to make sure the residents felt safe. LN 2 stated it was important to report allegations so that it did not happen in the future and to keep the residents safe. LN 2 further stated this was standard abuse allegation reporting procedures for all staff with knowledge of an alleged abuse.During an interview on 12/22/25 at 1:54 PM, CNA 1 stated that on 11/17/25 she was outside in the hallway around 7:30 to 7:45 AM passing breakfast trays to other residents and only walked past Resident 1's room but did not go inside of the room. CNA 1 further stated she remembered that there was a problem with Resident 1 feeding stray cats and that Resident 1 looked upset and LN 1 was in Resident 1's room. CNA 1 explained when the police came and took the report, she was surprised she was listed as a witness because CNA 1 stated she did not witness anything and was not in the room during the time of the allegation. During a concurrent interview and record review on 12/23/25 at 8:55 (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 12/22/2025 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)