Health inspection·November 24, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few take off socks and shoes and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable.03.I. Personal hygiene: The ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands (excludes baths, showers, and oral hygiene).03.GG0170.Mobility.A. Roll left and right: The ability to roll from lying on back to left and right side, and return to lying on back on the bed.03.B. Sit to lying: The ability to move from sitting on side of bed to lying flat on the bed.03.C. Lying to sitting on side of bed: The ability to move from sitting on side of bed to lying flat on bed.03.D. Sit to stand: The ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed.03.E. Chair/bed-to-chair transfer: The ability to transfer to and from a bed to a chair (or wheelchair).03.F. Toilet transfer: The ability to get on and off a toilet or commode.03.I. Walk 10 feet: Once standing, the ability to walk at least 10 feet in a room, corridor, or similar space.88. Not attempted due to medical condition or safety concerns. A review of Resident 1's MDS Section Q Participation in Assessment and Goal Setting - Admission, dated 10/29/2025 indicated, .Q0110.Participation in Assessment and Goal Setting.Identify all active participants in the assessment process.A. Resident.Resident's overall goal for discharge established during the assessment process.1. Discharge to the community. A review of Resident 1's MDS Section C - Cognitive Patterns - Admission, dated 10/29/2025 indicated that Resident 1's Brief Interview for Mental Status (BIMS, a tool to assess cognition. The total possible BIMS score ranges from 00 to 15. 13 - 15: cognitively intact; 08 - 12: moderately impaired; 00 - 07: severe impairment) score was 14. A review of Resident 1's Physical Therapy (PT) Evaluation, dated 10/22/2025 indicated, .Reason for Referral: Patient (Resident) referred to PT due to new onset of decrease in strength, decreased neuromotor (relationship between the body's nerves and muscles) control.decrease in functional mobility, functional limitation with ambulation, falls/fall risk, increased need for assistance from others and compromised physical exertion level during activity.History of Falls.Has Patient fallen in past year? Yes.How many times? Exact number unknown.Was Patient injured from fall? No.Does Patient have a fear of falling? Yes. A review of Resident 1's Occupational Therapy (OT) Evaluation, dated 10/22/2025 indicated, .Reason for Referral: patient exhibits new onset of compromised physical exertion level during activity, decrease in functional mobility, decrease in strength, decreased coordination, falls/fall risk.increased need for assistance from others.Reason for Skilled Services: Patient requires skilled occupational therapy services.to address the following.increase.develop and instruct on.strategies and develop and instruct on.techniques in order to enhance this patient's quality of life by improving the ability to increase participation with functional daily activities and decrease level of assistance.without skilled therapeutic intervention, this patient is at risk for rehospitalization, decreased ability to return to prior level of functioning, falls, further decline in function and increased dependency upon caregivers. A review of Resident 1's PT Treatment Encounter Note, dated 11/7/2025 indicated that Resident 1 actively participated with skilled interventions. A review of Resident 1's OT Treatment Encounter Note, dated 11/7/25 indicated that Resident 1 was compliant with skilled interventions. A review of Resident 1's PT Discharge Summary, dated 11/7/25 indicated, .Short-Term (STG) #1 - Patient will improve ability to safely transfer from lying on the back to sitting on the side of the bed, feet flat on the floor with set up/clean up in order to participate in activities of daily living and participate in self care [sp] activities.Baseline 10/22/2025.Section GG: Partial/Moderate Assist.Discharge 11/7/2025 Section GG: Partial/Moderate Assist.STG #2 - Patient will improve ability to safely and efficiently transfer to and from a bed to a chair (or wheelchair) with supervision/stand by assist with implementation of compensatory strategies.Baseline 10/22/2025.Section GG: Partial/Moderate Assist.Discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055735 If continuation sheet Page 2 of 8 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 055735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Oaks Post Acute 6940 Pacific Avenue 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 11/7/2025.Section GG: Partial/Moderate Assist.STG #3 - Patient will safely ambulate on level surfaces 60 feet using two-wheeled walker with supervision/stand by assist with adequate cardiopulmonary (heart and lung) function and with functional dynamic balance.Baseline 10/22/2025.Section GG: Substantial/Maximal Assist.Discharge 11/7/2025.Section GG: Substantial/Maximal Assist. A review of Resident 1's OT Discharge Summary, dated 11/7/2025 indicated, .STG #2.1 - Met on 11/7/2025.Patient will improve ability to complete toilet/commode transfers with set up/clean up with use of compensatory strategies, and adaptive/assistive devices, with improved strength and with ability to right self to achieve/maintain balance, with implementation of compensatory strategies and recognition of safety hazards.Baseline 10/22/2025.Section GG: Partial/Moderate Assist.Discharge 11/7/2025.Section GG: Set Up/Clean Up (Assist prior to, or following activity).STG #3.0 Patient will improve ability to safely and efficiently perform LB (lower body) dressing with modified independence with use of compensatory strategies, and adaptive/assistive devices, with use of adaptive equipment with improved strength in order to be able to return to prior level of living.Baseline 10/22/2025.Section GG: Substantial/Maximal Assist.Discharge 11/7/2025.Section GG: Supervision/Touching Assist (Cueing, coaxing, standby for safety).STG #4 - Patient will improve ability to safely and efficiently maintain perineal hygiene, adjust clothes before/after voiding or having a bowel movement with modified independence with use of compensatory strategies, and adaptive/assistive devices, with improved strength in order to facilitate independence with toileting tasks.Baseline 10/22/2025.Section GG: Partial/Moderate Assist.Discharge 11/7/2025.Supervision/Stand by Assist/Touching Assist. A review of Resident 1's Social Service Progress Note, dated 11/6/2025 at 18:34 indicated, .Note: The patient's Family Member (FM, niece) confirmed that she will be present at home when the patient is discharged from the facility on Sunday, November 9, 2025, at 8:00 AM. The patient's FM confirmed that she will be taking care of the patient when he gets home. A review of Resident 1's Discharge Plan Documentation, dated 11/9/2025 06:22 indicated, .Discharge Destination.home alone.Will home care be provided? Yes.Estimated start date.11/10/2025.Home care services to be provided.PT.OT.other.RN (Registered Nurse).Continence.BLADDER CONTINENCE.Occasionally incontinent - Has some control; incontinent episodes, but not all the time.BOWEL CONTINENCE.Incontinent - No control.Assistance Level.Bed Mobility.Needs assistance.Toileting.Dependent.Household tasks (meal prep, bill paying, simple cleaning).Needs assistance.Transfer from bed/chair.Needs assistance.Walking.Needs assistance. A review of Resident 1's Nurses Progress Notes, dated 11/9/2025 at 08:46 indicated, .Resident prepared for discharge home.Nurse explained that.home health services will be assisting with care upon return home. During an interview by phone with Resident 1 on 11/17/25 at 11:09 a.m., Resident 1 stated that he was in the acute care hospital. Resident 1 stated that he needed help when he was ready to be discharged . Resident 1 stated that he remembered being at the skilled nursing facility. Resident 1 stated that he was not sure why he was discharged from the skilled nursing facility. Resident 1 stated that his FM was having medical issues and could not help him. Resident 1 stated that he did not know what to do. During an interview on 11/17/25 at 12:10 p.m. with the facility Occupational Therapist (OT), the OT stated that she remembered Resident 1. The OT stated that Resident 1 did exercises in the therapy room. The OT stated that she worked with Resident 1 on safety because he was impulsive at times. The OT stated that she focused on ADLs - bathroom, dressing and hygiene - with Resident 1. The OT stated that she advised Resident 1 to use a walker and advised him to have staff help him while he was at the facility. The OT stated that Resident 1 could do his own ADLs at time of discharge with use of a walker but needed to focus on energy conservation. The OT stated that Resident 1 told her that his family helped him from time to time. The OT stated that she advised Resident 1 to continue his exercises. During an interview on 11/17/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055735 If continuation sheet Page 3 of 8 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 055735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Oaks Post Acute 6940 Pacific Avenue 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few at 12:46 p.m. with the Physical Therapist (PT), the PT stated that he remembered Resident 1. The PT stated that he worked with the resident on exercises in the rehabilitation room. The PT stated that by the time Resident 1 was discharged he could walk using a walker. The PT stated that Resident 1 would be able to go home with a walker. The PT stated that when the resident first arrived at the facility, he could not walk due to leg pain but later, he was able to walk with a walker and participate with his therapy. During an interview on 11/17/25 at 1:55 p.m. with the PT, the PT stated that based on his professional opinion Resident 1 would be safe at home living with a family member who can assist him and a walker so he could ambulate (walk). The PT stated that the therapists understood that Resident 1 would be sent home to live with a family member. During an interview by phone on 11/17/25 at 3:13 p.m. with the home health agency Social Worker (SW), the SW stated that she was called by the home health agency RN who stated that she found Resident 1 on the floor at his home without his walker on 11/10/25. The SW stated that it sounded like an unsafe discharge and advised the RN to call the facility that discharged the resident or send the resident to the acute care emergency department (ED). The SW stated that the RN stated that Resident 1 refused to have the RN call for assistance to lift him off the floor. The SW stated that Resident 1 was talking to his FM on his cell phone while the RN was there and stated that his FM was on her way to his house to help. The SW stated that Resident 1 told the RN that he would be fine until his FM got there and he had his cell phone handy in case of an emergency. The SW stated that she talked with the FM by phone that day, and the FM stated that she would check in with the resident that day and move in with the resident the following week. The SW stated that a neighbor stated that she saw Resident 1 being dropped off at his house on her security camera on 11/9/25. The SW stated that the neighbor stated that she took Resident 1 to his front door and let him into his residence. The SW stated that Resident 1 was discharged home the day before the home health services started. The SW stated that, per the FM and the resident, he was supposed to be taken home by the transport service at 11:00 a.m. but was dropped off at 9:00 a.m. on 11/9/25, and no one was at his residence when he was dropped off. The SW stated that the RN stated that she could not find food, silverware, or plates at the residence. The SW stated that she requested that the home health staff follow up with Resident 1 the next day. The SW stated that she went to the residence to see Resident 1 on 11/10/25. The SW stated that there were cups and containers of urine, and two filled urinals on the floor. The SW stated that Resident 1 told her that his FM had lived with him at a previous home, but he sold that home and moved to the current residence. The SW stated that she called Resident 1's FM the next day, on 11/11/25, but the FM did not respond. The SW stated that she reported the conditions to Adult Protective Services (APS, an agency that helps elder adults when they are unable to meet their own needs, or are victims of abuse, neglect or exploitation). The SW stated that the RN and a Home Health Aide (HHA) went to Resident 1's home on [DATE], and Resident 1 was still on the floor. The SW stated that the RN reported that Resident 1 stated that his FM was on her way yesterday but became dizzy, so he told her to go back home. The SW stated that Resident 1 received lift assistance off the floor. The SW stated that the RN stated that Resident 1's FM stated that she would come to the residence to clean up. During an interview by phone with the Director of Nursing for the home health agency (HH DON) on 11/17/25 at 3:41 p.m., the HH DON stated that the RN that visited Resident 1 was in the field, but she had access to the clinical notes from the home visits. The HH DON stated that Resident 1 was on the floor when the RN arrived on 11/10/25 at 3:00 p.m. and was short of breath and his oxygen saturation (how much oxygen circulating in the blood measured with a device that clips onto a finger) was 90% on room air (without oxygen provided by a tube or mask). The HH DON stated that the RN reported that Resident 1 had crackles (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055735 If continuation sheet Page 4 of 8 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 055735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Oaks Post Acute 6940 Pacific Avenue 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (bubbling noises that represent fluid in the lungs) when she listened to his breathing. The HH DON stated that the RN reported that the rest of his vital signs (temperature, heart rate, blood pressure measurements) were stable. The HH DON stated that the RN looked for an oxygen concentrator (a medical device that delivers supplemental oxygen), but there was not one at the residence. The HH DON stated that the RN wanted to call for lift assistance to get Resident 1 off the floor, but he refused. The HH DON stated that the RN reported that there was no food, but she found some milk to give to Resident 1. The HH DON stated that the RN stated that there were no supplies, so she gave Resident 1 urinals to use because he couldn't stand. The HH DON stated that the agency provided services to Resident 1 for two days, 11/10/25 and 11/11/25 because on 11/12/25 he went to the acute care ED. The HH DON stated that the RN stated that she spoke with Resident 1's FM who stated that she cared for another family member who was ill and stated that she couldn't be there to care for Resident 1. The HH DON stated that the RN was with Resident 1 for two and one-half hours on 11/10/25, and the SW went to see Resident 1 the same day. The HH DON stated that the RN and a Home Health Aide (HHA) went to Resident 1's home on [DATE], and he was still on the floor with seven to eight empty containers of Ensure (dietary supplement). The HH DON stated that the RN stated that Resident 1 stated that he got off the couch to find food, ate two bananas, and was on the floor again. The HH DON stated that the RN and the HHA gave Resident 1 incontinence care (bathing after involuntary loss of urine and/or bowel movement), but he wanted to remain on the floor. The HH DON stated that on 11/11/25 at 5:00 p.m., the evening HHA went to check on Resident 1 and stated that Resident 1 was not on the floor, and that a neighbor and Resident 1's FM were arguing. The HH DON stated that the neighbor stated that it was not safe for Resident 1 to be alone and that she was going to call the home health agency to report. The HH DON stated that the HHA gave Resident 1 incontinent care twice that evening. The HH DON stated that on 11/12/25 a HHA went to check on Resident 1 that morning and found him in bed incontinent with spilled urinals in his bed. The HH DON stated that the HHA gave incontinent care and changed the bed linens. The HH DON stated that the RN arrived and tried to place a condom catheter (an external urinary collection device) on Resident 1 but was unable to do so. The HH DON stated that the home health staff gave Resident 1 empty urinals and made sure that his cellphone was in reach when they left. The HH DON stated that when the HHA went at 5:00 p.m. on 11/12/25 to check on Resident 1, the neighbor told the HHA that a fire truck came to Resident 1's home and Resident 1 went to the acute care ED. During an interview by phone on 11/17/25 at 4:18 p.m. with Resident 1's FM, Resident 1's FM stated that there was no discharge plan for Resident 1. Resident 1's FM stated that the skilled nursing facility staff told her that they were getting transportation ready. Resident 1's FM stated that Resident 1 called her when he was discharged and stated that he felt good and that he could walk. Resident 1's FM stated that when she arrived at Resident 1's home, he was on the floor. Resident 1's FM stated that she and her son got him off the floor and helped him to the couch. Resident 1's FM stated that she didn't get much information from the skilled nursing facility. Resident 1's FM stated that she thought that Resident 1 would be at the skilled nursing facility for 30 days. Resident 1's FM stated that the Social Services Director (SSD) at the skilled nursing facility stated that after 30 days Resident 1's stay would be extended for rehabilitation. Resident 1's FM stated that she didn't think that Resident 1 should have been discharged from the facility. Resident 1's FM stated that she had no idea that he was going to be discharged . Resident 1's FM stated that the home health agency staff told her that she had to stay with him. Resident 1's FM stated that she could not stay with Resident 1 because she cared for another sick relative. Resident 1's FM stated that the goal was for Resident 1 to be able to walk and to get better. Resident 1's FM stated that Resident 1 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055735 If continuation sheet Page 5 of 8 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 055735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Oaks Post Acute 6940 Pacific Avenue 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few using a walker before he got sick. Resident 1's FM stated that after rehabilitation at the skilled nursing facility, Resident 1 still could not walk. Resident 1's FM stated that she didn't want Resident 1 home if he was not safe. Resident 1's FM stated that she called 911 on 11/12/25, and the ambulance took him to the acute care ED. During an interview by phone on 11/17/25 at 4:27 p.m. with the Contracted Transport Driver (Driver), the Driver stated that he remembered Resident 1. The Driver stated that he transported Resident 1 home from the facility with a wheelchair in the transport van. The Driver stated that when they arrived at the home, Resident 1 told him to open the gate to the backyard. The Driver stated that he asked Resident 1 if he was okay, and Resident 1 stated, I'm not better. The Driver stated that he said, Then why are you going home? The Driver stated that Resident 1 replied, I don't know. The Driver stated that Resident 1 told the Driver to wheel him to the backyard. The Driver stated that Resident 1 stated to leave him there. The Driver stated that Resident 1 stated, I'll be fine; my girlfriend is coming! The Driver stated that one of the neighbors came to the back yard and talked with Resident 1. The Driver stated that he left Resident 1 with the neighbor in his wheelchair. 2. A review of Resident 1's Acute Care Interfacility Transfer Report, dated 10/21/2025, indicated, .admit date .10/17/2025.Consultation.10/18/2025 17:27.reason for consultation.hyperglycemia (high blood sugar level) .Social Worker is evaluating for a safe discharge.Emergency Department (ED) Physician Notes.10/20/2025 06:17.being comanaged by the.physician group presents the emergency department with an elevated blood glucose. His home is currently under foreclosure, has no safe disposition.will need social work assistance for placement. During an interview by phone with Resident 1 on 11/17/25 at 11:09 a.m., Resident 1 stated that he was in the acute care hospital. Resident 1 stated that he needed help when he was ready to be discharged . Resident 1 stated that he was behind on his mortgage payments. During an interview and concurrent record review of Resident 1's Occupational Therapy (OT) Evaluation Notes on 11/17/25 at 1:55 p.m. with the Physical Therapist (PT), the PT confirmed that Resident 1 told an OT that his home was in foreclosure. During an interview by phone on 11/17/25 at 3:13 p.m. with the home health agency Social Worker (SW), the SW stated that she was not sure exactly what Resident 1 said, but there was something about foreclosure. During an interview by phone on 11/17/25 at 4:27 p.m. with the Transport Driver (Driver), the Driver stated that he remembered Resident 1. The Driver stated that when they arrived at the home, Resident 1 told him to open the gate to the backyard. The Driver stated that there were boxes and clothing in the back yard. The Driver stated that Resident 1 stated, I'm being evicted and discharged at the same time! During an interview by phone on 11/18/25 at 3:00 p.m. with the Social Services Director (SSD), the SSD stated that she no longer worked at the facility. The SSD stated that she did not know that Resident 1's home was in foreclosure. The SSD stated that if she had known that Resident 1's home was in foreclosure, she would not have initiated the discharge. During an interview with the facility Administrator in Training (AIT) on 11/24/25 at 2:51 p.m., the AIT stated that she read Resident 1's Acute Care Interfacility Transfer Report from the acute care facility dated 10/21/25 which indicated that his home was in foreclosure when she was notified by an acute care ED that Resident 1 may have experienced an unsafe discharge. 3. A review of Resident 1's Acute Care Interfacility Transfer Report, dated 10/21/2025, indicated, .Physician Consultation.10/18/2025 17:23.Patient is poor historian.patient states.takes Metformin (medication taken with meals to treat Diabetes) for.diabetes although patient was given Insulin (injectable medication to treat Diabetes) prescription during last hospitalization.does not have anything at home. A review of Resident 1's Medication Self-Administration Evaluation, dated 10/22/2025 11:05 indicated, .Assessment Criteria.1. Can correctly state medication and what it's used for.able with assist.2. Can read print on prescription label.able with assist.3. Can (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055735 If continuation sheet Page 6 of 8 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 055735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Oaks Post Acute 6940 Pacific Avenue 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few correctly state common side-effects of each medication.able with assist.4. Can correctly state what times medications are to be taken.able with assist.5. Can correctly state the proper dosage for each medication.able with assist.6. Can demonstrate proper hand wash technique prior to and following medication administration.able with assist.7. Can correctly measure the appropriate amount of medication from the container.able with assist.8. Can correctly state situations warranting administration of PRN (as needed) medications.able with assist.9. Can open and close medication containers.fully capable.10. Can demonstrate secure storage for medications kept in room.able with assist.11. Can correctly request medications stored at nurses' station.fully capable.12. Can correctly administer oral medications.fully capable.13. Can correctly administer eye drops or eye ointments according to proper procedure.able with assist.14. Can apply topical ointments, creams or transdermal patches according to proper procedure.able with assist.15. Can administer ear drops according to proper procedure.able with assist.16. Can administer suppositories according to proper procedure.able with assist.17. Can administer inhalant medication according to proper procedure.able with assist.18. Can correctly administer nebulizer treatment (medications that promote airway clearance thus improving breathing) .able with assist.20. Can correctly obtain blood glucose readings.able with assist.21. Can demonstrate administration of subcutaneous injections (medications given by injecting into the tissues below the top skin layer) .able with assist.2. Approval granted to self administer [sp]? .no.If approval not granted.explain.Resident requires assistance with medication administration, including correct dosage and proper use of medications. During an interview and concurrent record review of Resident 1's Electronic Medical Record (EMR) on 11/17/25 at 11:53 a.m. with the facility Social Services Assistant (SSA), the SSA stated that teachings for the resident and family in preparation for discharge was usually documented in the resident's progress notes. The SSA stated that the facility gave three-day training with the resident and the family as applicable prior to the resident's discharge from the facility to ensure that the resident had a safe discharge. The SSA stated that the IDT Care Conferences (Interdisciplinary Team, a group of healthcare professionals who work together towards the goals of the residents) were held, and the resident and family were included to discuss the resident's discharge plan. The SSA stated that everything had to be in line for the resident's discharge: Social Services checked to make sure the durable equipment (example, walker or wheelchair) was delivered as applicable, checked to make sure that transportation was arranged if needed, coordinated discharge with the resident, family and home health even if the resident was their own Responsible Party (RP). The SSA confirmed that she did not see nursing progress notes on teaching Resident 1 how to check blood glucose (FSBS) before and after medications for diabetes, or notes on teaching Resident 1 about self-medication administration in his EMR. During an interview and concurrent record review of Resident 1's Care Plan Report, on 11/17/25 at 12:33 p.m. with the facility Administrator in Training (AIT) and the SSA, the AIT stated that the nursing staff documented teaching Resident 1 to monitor his FSBS and about signs and symptoms of hypoglycemia (low blood glucose) on the Care Plan Report per the Minimum Data Set Nurse (MDS, a long-term care facility nurse who specializes in assessing the needs of long-term care residents). During an interview and concurrent record review of Resident 1's Care Plan Report on 11/17/25 at 12:36 p.m. with the MDS, the MDS stated that the Care Plan Report documented the licensed nurses (LNs) teaching Resident 1 about the LNs checking his FSBS prior to giving him his medications for diabetes, and teaching Resident 1 about signs and symptoms of hypoglycemia (low blood glucose) to watch for while in the facility. The MDS stated that education for Resident 1 regarding checking his own FSBS and giving his own medications at home should have been documented on a progress note or on a discharge assessment in his EMR. During an interview by phone with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055735 If continuation sheet Page 7 of 8 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 055735 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Delta Oaks Post Acute 6940 Pacific Avenue 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Social Services Director (SSD) on 11/18/25 at 3:00 p.m., the SSD stated that she no longer worked at the facility. The SSD stated that the LNs usually did the discharge teaching with the residents and families. The SSD stated that she informed the charge nurse working on 11/6/25 that Resident 1 was to be discharged on 11/9/25 and needed teaching. The SSD stated that she did not remember the charge nurse's name that she reported the impending discharge to. The SSD stated that the charge nurse stated that she would pass the information along. During an interview by phone with LN 1 on 11/24/25 at 3:20 p.m., LN 1 stated that she was notified that Resident 1 was being discharged on the day of discharge. LN 1 stated that the notification of discharge was short notice. LN 1 stated that on 11/7/25, she was asked to place an order for Resident 1 to be discharged on 11/8/25. LN 1 stated that the notice of discharge was cancelled, so she thought that Resident 1 was not going to be discharged . LN 1 stated that on the morning of 11/9/25 she was told to provide discharge teaching for Resident 1. LN 1 stated that she reviewed all of Resident 1's discharge medications, including Insulin and FSBS with Resident 1, and Resident 1 voiced understanding. LN 1 stated that during the discharge teaching on the morning of discharge, she had Resident 1 watch her as she checked his FSBS and administered his insulin. LN 1 acknowledged that she did not have Resident 1 demonstrate to her how he would self-check his FSBS or how he would self-administer his insulin injection before he was discharged . 4. During an interview and concurrent record review of Resident 1's Electronic Medical Record (EMR) on 11/7/25 at 11:53 Event ID: Facility ID: 055735 If continuation sheet Page 8 of 8