Inspection·February 6, 2026

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure a clean environment for facility residents when three out of 4 shower rooms in use were left unclean for a census of 130.This failure had the potential to spread infections to facility residents.During a concurrent observation and interview on 2/6/26 at 10:17 a.m. with Licensed Nurse (LN 1) in the South Station Shower room (SS), LN 1 confirmed there was mold on the shower curtain, a used tan bandage on the floor of the shower, a ball of hair on the shower drain, a used bandage on the shelf adjacent to the shower, and the sharp container was full and had razors sticking out. LN 1 further confirmed there were broken tiles in the shower room.During a concurrent observation and interview on 2/6/26 at 10:35 a.m., with LN 1 in the East Station Shower Room (ES), LN 1 confirmed that there was an overflowing trash bin with soiled items bagged and no cover and an overfilled sharps container with razors overflowing. LN 1 further confirmed there was a dirty yellow Person Protective Equipment (PPE) gown on the floor and another gown on a bedside table, an open air freshener can on the floor of the ES shower room.LN 1 stated that the ES was dirty and a resident or staff member could get hurt if they had touched the blades overflowing from the sharp's container. LN 1 further stated the SS and ES rooms could have spread infectious organisms to facility residents since she did not know which resident the PPE gowns belonged to. LN 1 confirmed this could be a safety risk and infection control risk for facility residents. LN 1 stated the shower rooms are utilized by most facility residents and had the potential to spread infections to different residents throughout the facility.During a concurrent observation and interview on 2/6/26 at 11:14 a.m. with Licensed Nurse (LN 2), LN 2 confirmed the northwest shower room was out of order. LN 2 further confirmed mold was observed in the northeast shower room. LN 2 confirmed cracked tiles, and peeled paint was present in the north station shower room. LN 2 confirmed the North East shower room was unclean, and the shower rooms should have been clean after each use to prevent the spread of infections.During a concurrent interview and record review on 2/6/26 at 11:34 a.m., with Infection Prevention Nurse (IP), IP stated the expectation is for the shower rooms to be cleaned after each resident use. IP nurse confirmed the presence of the dirty tan bandage on the floor of the SS shower room, a used bandage with dry blood on the shelf adjacent to the shower, cracked tiles in the shower, mold present on the shower tiles, dark mold on the shower curtain, and overflowing sharp container in the South Station shower room. The IP nurse confirmed the presence of a used PPE gown, a PPE gown in a plastic wrap, an opened air freshener can on the floor, overflowing trash bin with soiled items bagged and no cover, and overflowing sharp container with razors sticking out and on top of the sharp container with plastic trash items in the South East shower room. The IP confirmed mold was present in the North East shower room. The IP nurse stated that the shower rooms were dirty and that both shower rooms had the potential to spread infections to facility residents. IP confirmed that improper cleaning practices can lead to spread of infections and improper disposal of full sharp containers can lead to a resident or staff member being cut by a sharp item and contracting infectious organisms. IP confirmed she did not do daily checks on the shower rooms to ensure staff was cleaning the rooms properly.During an interview on 2/6/26 at 12:10 p.m. with Director of Nursing (DON), the DON confirmed the expectation for facility staff is to ensure that the shower rooms are cleaned after each resident use. The DON further acknowledged the overflowing sharp materials in the shower rooms could have spread infectious organisms to staff and facility residents. During a review of facility policy and procedure (P&P) titled, . Infection prevention and Control., dated December 2023, indicated, .The facility adopted infection prevention and control policies and procedures are intended to maintain a safe, sanitary, and comfortable environment and to help prevent and manage transmission of Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055308 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 055308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2026 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete diseases and infections . policies and procedures are to: . monitor, prevent, detect . maintain a safe, sanitary, and comfortable environment for personnel, residents . Provide .infection. control based on current best practices.During a review of facility policy and procedure (P&P) titled, .Sharps Disposal., dated January 2012, indicated, . Contaminated sharps will be discarded into containers that are. Closable. Puncture resistant. Leakproof on sides and bottom. Designated individuals will be responsible for sealing and replacing containers when they are 75% to 80% full to protect employees from punctures and/or needlesticks when attempting to push sharps into the containers . Event ID: Facility ID: 055308 If continuation sheet Page 3 of 3