Health inspection·November 13, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Based on observation, interview, and record review, the facility failed to protect one of five sampled residents (Resident 1) from abuse when Resident 2 pushed Resident 1 during an altercation.This failure resulted in Resident 1 falling into the ground and had the potential for Resident 1 to experience fear or distress.Findings:During a review of Resident 1's admission records, the records indicated Resident 1 was admitted to the facility in October 2025 with diagnoses that included left femur shaft fracture (a break in the thighbone), hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body), hemiparesis (weakness on one side of the body), and malignant neoplasm of occipital lobe (a cancerous tumor in the part of the brain that controls vision). Resident 1's Minimum Data Set (MDS, a federally mandated resident assessment tool) indicated Resident 1 had moderate cognitive impairment.During a review of Resident 2's admission records, the records indicated Resident 2 was admitted to the facility in March 2025 with diagnoses that included dementia (a progressive state of decline in mental abilities), generalized muscle weakness, and difficulty in walking. Resident 2's MDS indicated Resident 2 had moderate cognitive impairment.During a review of Resident 1's Change in Condition (CIC) notes, dated 11/5/25, the notes indicated, .1100 [11 a.m.] [Resident 1] was found sitting on the floor in [Resident 1's] room next to [Resident 2's] closet. [Resident 1] reports that roommate [Resident 2] pushed [Resident 1] from his chest.Nurse tried to help [Resident 1] up but resident got up and sat on his wheelchair. Resident was then assisted out of his room to the hallway.During a review of Resident 1's Nurses Progress Note, dated 11/5/25, the note indicated, .1100 [11 a.m.] Nurse observed [Resident 1] on a sitting position on the floor. Resident explains that [Resident 2] pushed him on my chest. [Resident 1] was pushed by [Resident 2] and end up on the floor after [Resident 2] tried to stop [Resident 1] from rummaging around [Resident 2's] closet.During a review of Resident 1's Nurses Progress Note, dated 11/5/25, the note indicated, .1100 [11 a.m.] - Elevated voices heard in SE [Southeast] hallway, upon entering observed [Resident 1] and [Resident 2] using profanity towards each other with elevated voices.Upon investigation, [Resident 1] stated [Resident 2] physically pushed [Resident 1] and made [Resident 1] fall. [Resident 2] verbally stated the [Resident 2] physically pushed [Resident 1] after [Resident 2] witnessed [Resident 1] going through his personal belongings and personal side of the closet.During a review of Resident 1's Interdisciplinary Team (IDT) note, dated 11/5/25, the note indicated, .Resident to resident Physical altercation: 11/5/25 at around 11AM [Resident 1] was about to hit [Resident 2] with his cane but was intervened by staff. [Resident 1] said that [Resident 2] push him on the chest area in the room and he fell backwards.ROOT CAUSE: [Resident 1] was going through closet of [Resident 2]. [Resident 2] told [Resident 1] to stop but not listening, so [Resident 2] pushed him from his chest, and he fell on the floor.During a review of Resident 2's CIC Note, dated 11/5/25, the note indicated, .[Resident 2] said he pushed [Resident 1] and he fell backward on the floor. [Resident 2] said that he told [Resident 1] to stop going through his closet. [Resident 1] continued to (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: 055308 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 055308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Elk Grove Post Acute 9461 Batey Avenue Elk Grove, CA 95624 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)