Health inspection·July 2, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure necessary services were provided for two of three sampled residents (Resident 1 and Resident 2) when Resident 1 went one week (6/19/24-6/26/24) without receiving a shower and Resident 2 did not have a shower for six days. Residents Affected - Few These failures placed Resident 1 and Resident 2 at risk for poor hygiene, poor skin integrity, increased risk of infection, and self-isolation. Findings: a. Review of Resident 1's admission record indicated Resident 1 was admitted with diagnosis of generalized weakness and difficulty walking. Review of Resident 1's Minimum Data Set (MDS, an assessment tool), dated 6/12/24, in section GG (functional abilities and goals) and section E (ability to shower/bathe self) indicated Resident 1 needed partial to moderate assistance with bathing and other Activities of Daily Living (ADL's). During an interview with Resident 1 on 7/2/24, at 2:26 PM, Resident 1 stated, Sometimes they only do showers once a week. They keep saying they have too many people to shower. Resident 1 also stated, Sometimes I'll get a shower once a week and sometimes not at all. Resident 1 stated bed baths were offered in place of a shower. Resident 1 stated the facility did not offer a choice of a shower when she received a bed bath. Resident 1 stated, I would prefer to have a shower and have never refused a shower. Resident 1 stated, I feel awful all over when I don't get a shower. During an interview on 7/2/24 at 2:26 PM, with Family Member (FM) 1, in response to Resident 1's missed showers, FM 1 stated, Usually I'll get involved and they'll put her on the schedule. FM 1 also stated, I've had to talk to them [facility] three times about her showers. She's been here since the beginning of June. b. Review of Resident 2's admission record indicated Resident 2 was admitted for generalized weakness and rehabilitation. During a concurrent Interview and record review with Certified Nurse Assistant (CNA) 1 on 7/2/24, at 2:44 PM, Resident 2's document titled, Task: Shower, dated 6/5/24 through 7/2/24, was reviewed. CNA 1 stated showers were given twice a week. CNA 1 stated when residents were new admissions, sometimes they were put on the schedule right away. CNA 1 explained, sometimes a resident was placed on the morning shift but not given a group (CNA the resident was assigned to). CNA 1 stated staff needed to double check both schedules or the showers could be missed. CNA 1 stated Resident 2 complained about her shower not being given to her family member. CNA 1 stated Resident 2's family member (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 2 Event ID: 055833 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 055833 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fulton Gardens Post Acute, LLC 537 E. Fulton Street Stockton, CA 95204 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)