Health inspection·November 18, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the plan which said Specify were not filled out for specific disruptive behaviors and tasks that should have been offered to Resident 4. The ADON stated the care plan should be person centered. The ADON stated the expectation was that it was filled in with tasks such as offering of food and/or assisting behavior. The ADON stated the care plan was a guide for staff including how to manage behaviors and to prevent them for residents. The ADON stated the ‘Intervention' section was not clear on what staff should do. The ADON acknowledged the last revision date was 6/6/24 and stated there should be a review date listed and should have been revised after the most recent altercation with Resident 3 in May of 2025. During a phone interview on 9/10/25, at 12:49 p.m., LN 2 stated Resident 4 would scream and scream if nobody was there with him. LN 2 stated Resident 4 needs someone there with him and it was important to let him know that someone was there as this provides comfort for him. LN 2 stated staff would push Resident 4 in his wheelchair to the dining room to keep him company. During an interview and record review on 9/10/25, at 1:55 p.m., the ADON stated Resident 4 was confused and tended to be aggressive. The ADON stated Resident 4 currently had a roommate. The ADON stated Resident 4 can stand up and he cannot see and on the night of 5/27/25 he might have gotten lost. The ADON stated Resident 4 was transferred to another room after the incident. Through review of Resident 4's clinical record the ADON stated Resident 4 had a BIMS score of 5 which indicated a severe cognition deficit. The ADON stated Resident 4 was receiving psychiatric care, but his family did not want him medicated with psychiatric drugs because they thought it made him overly sleepy and because of this his medications had been reduced. The ADON stated when Resident 4 was on the medications the psychiatrist had recommended, he was more pleasant. During an interview on 9/10/25, at 3:11 p.m., CNA 2 stated Resident 4 was always yelling, and he thought it was part of his mental health condition. CNA 2 stated he kept an eye on Resident 4, and he would not listen to staff. CNA 2 stated Resident 4 often yells out in his native language, and he cannot understand him. CNA 2 stated Resident 4 could walk with assistance. CNA 2 explained if staff use the proper soft voice soft, Resident 4 can be calm, and he likes staff to stay close to him. CNA 2 stated they take Resident 4 out of his room and place him by the nursing station. CNA 2 stated he was not sure if Resident 4 was blind. CNA 2 stated Resident 4's yelling bothers other residents and they will often begin yelling at Resident 4 to shut up. During an observation on 9/10/25, at 3:17 p.m., Resident 4 was observed in the hallway across from the nursing station, he was standing up from his wheelchair, and an alarm was heard. CNA 2 was observed running towards Resident 4 to assist him. During a concurrent observation and interview on 9/10/25, at 3:20 p.m., Resident 5's room door was observed to be closed, and a sign was attached to the door stating to knock prior to entering, the room was observed to be a few doors down the hall from Resident 4's room. Resident 5 was observed laying in her back and was wearing headphones. Resident 5 stated she had lived at the facility for many years and preferred to stay in her room due to her limited mobility. Resident 5 stated Resident 4 (name redacted) could not be controlled, and he was awake at all hours of the night and early morning and would start hollering nonstop. Resident 5 stated the hollering was at all hours, was sporadic, loud, and in different languages and would get everyone else worked up. Resident 5 stated in response the other residents would start yelling too. Resident 5 stated Resident 4 had been physically aggressive with another roommate and was hitting them. Resident 5 explained Resident 4 had hit a staff member and fractured their rib and had bit another staff member. Resident 5 stated she wore noise counseling headphones due to lack of sleep from the noise, and she had been woken up from her sleep due to Resident 4's yelling. Resident 5 stated the yelling, and noise affected her mental health and made her feel crazy and frazzled. During an interview on 9/10/25, at 3:27 p.m., CNA 3 stated Resident 4 screams and shouts and staff will ask him what the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 2 of 21 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 11/18/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some matter and he will say nothing. CNA 3 thought he was confused. CNA 3 stated Resident 3 screams very loudly throughout the day and night. CNA 3 explained it was very disturbing and disruptive to the other residents, and they could not get any sleep. CNA 3 stated Resident 4 had been like this the whole time he had been at the facility. CNA 3 stated Resident 4's medications help him, but he will refuse his medication. CNA 3 stated Resident 4 would shout out profanities to other residents and one time he tried to hit a resident. CNA 3 explained the incident that happened in his room and was an altercation with a roommate where Resident 4 hit the roommate. CNA 3 stated Resident 4 went through many roommates due to his shouting. CNA 3 stated Resident 4 shouts at staff but there was no altercation involving staff for over a year. During a concurrent observation and interview on 9/10/25, at 3:43 p.m., Resident 6 stated his room was across the hall from Resident 4's room (name redacted) and he had been at the facility for two weeks and could not sleep. Resident 6 stated Resident 4 kept him up all day and all night due to his yelling. Resident 6 stated he had complained to staff many times. Resident 6 stated the noise and lack of sleep had negatively affected his attitude. Resident 6 stated he could not hear the conversation when he was on the phone with his grandkids and this was upsetting. During a concurrent observation and interview on 9/10/25, at 3:45 p.m., Resident 7 stated Resident 4 (name redacted) yells throughout the day and night. Resident 7 stated he had an altercation with Resident 4 because he told him to shut up because he was about to get socked [to hit or strike very hard] up. Resident 7 stated he was angry because he could not sleep. Resident 7 stated he had karate chopped his table because of his frustration and having to listen to the guy constantly yelling. During a concurrent observation and interview on 9/11/25, 10:58 a.m., Resident 8 was observed in his wheelchair, leaving an adjacent room, and requested to speak to the surveyor. Resident 8 stated his room was two doors down from Resident 4's (name redacted) room and Resident 4 get up at 3:30 a.m. in the morning and he screams and yells at the top of his lungs for 13 hours straight. Resident 8 stated Resident 4 screams at night and during the day and it has been going on since he got here in July of 2025. Resident 8 stated this made him feel exhausted and tired. Resident 8 explained he tried to sleep in the morning but sometimes could not sleep at all. Resident 8 further explained the residents were angry. Resident 8 stated Resident 4 was agitated because he was blind and bored. Resident 8 stated even Resident 4's roommate would tell him to shut up'. Resident 8 stated Resident 4 was very disruptive, and this led to other residents constantly yelling out shut up and take my life. During a concurrent observation and interview on 9/11/25, at 10:38 a.m., Resident 4 was observed in his room, sitting in a wheelchair at the end of his bed. It was observed that Resident 4 had a roommate who was sleeping in his bed. Resident 4 stated he could not see, he needed help, and someone needed to take his hand and help him. Resident 4 stated he needed someone to bring him to school. Resident 4 stated there were no activities for him to do. Resident 4 repeated he needed someone to stand next to him and to hold his hand and it was too difficult for him to find out what to do. Resident 4 stated he had a problem with calling out, and if he needed help, he could talk with his mouth. During an observation on 9/11/25, at 10:45 a.m., in the hallway, outside of Resident 4's room an alarm was heard, staff members were observed running into Resident 4's room. During an interview on 9/11/25, at 10:50 a.m., CNA 8 stated he responded to Resident 4's wheelchair alarm and it went off because Resident 4 stood up and needed redirection. CNA 8 stated Resident 8 was very physically and verbally combative, disruptive, and not easily redirected. CNA 8 stated Resident 4 would curse other residents. CNA 8 stated Resident 4 could get up from his wheelchair and staff tried to redirect and called the family and he missed his family and was mean and angry. CNA 8 stated Resident 4 could not see, was blind. CNA 8 explained he would put music on, and it calmed Resident 4. CNA 8 stated Resident 4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 3 of 21 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 11/18/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some would yell out for pretty much eight hours straight. CNA 8 stated other residents told him they cannot sleep and cannot rest because of the yelling at night. CNA 8 stated the nursing staff tried to redirect him, but he still screamed all night. CNA 8 stated staff have tried to have Resident 4 join activities and the assisted feeding program, but he was disruptive and caused the other residents to become more confused and disruptive, so they did not have him attend. During an interview on 9/11/25, at 1:31 p.m., LN 1 stated Resident 4 yells constantly and it was all through the day and night and has done so since admission. LN 1 stated residents complained they could not sleep, and administration were aware, and they had tried to adjust medications. LN 1 stated when Resident 4 goes to the activities room he will yell which aggravates the other residents, so he mostly stays in his room or by the nursing station. LN 1 stated Resident 4 was blind and if he has someone close by, he will stop screaming, as he just wants someone to talk to. LN 1 stated Resident 4 had never had a continuous one on one. During a phone interview on 9/11/25, at 12:20 p.m., Responsible Party (RP) stated Resident 4 had a stroke which caused him vision issues and was blind. RP 1 stated the nurses wanted to make Resident 4 take more drugs to sedate him. During a phone interview on 9/11/25, 12:30 p.m., LN 4 stated he worked nights and was primarily the desk nurse. LN 4 explained he created care plans and provides a resource in case the bedside nurses needed help. LN 4 stated he was familiar with Resident 4, and he was unpredictable, screamed a lot, and does not follow commands or listen. LN 4 stated Resident 4 could understand and communicate in English. LN 4 stated there were times he was confused and communicated nonsense. LN 4 stated other residents close to Resident 4's room were bothered by his shouting and complaining. LN 4 stated he was not really sure what to do about the situation. During a phone interview on 9/15/25, at 5:17 p.m., CNA 4 stated Resident 4 was pretty confused, tended to yell out throughout night saying hello or yelling out his family member's name. CNA 4 stated they will get calls from other residents that Resident 4 is keeping them up due to his yelling. During a phone interview on 9/15/25, at 3:25 p.m., CNA 5 stated she worked nights and Resident 4 was confused, did not sleep at night and was loud at night. CNA 5 explained Resident 4 would say Hello, Hello or Help, Help repeatedly. During a phone interview on 9/16/25, at 9:39 a.m., CNA 6 stated Resident 4 had been aggressive and abusive with staff including punching a staff member in the chest and another CNA in the face and had dragged and held another CNA down on the ground. CNA 6 stated staff were scared of Resident 4. CNA 6 stated Resident 4 could be violent and currently had a tab alarm on his wheelchair and bed alarm that rings when he gets up. CNA 6 stated Resident 4's bed and chair alarms were implemented after the incident with Resident 3. CNA 6 stated her opinion was no one should be sharing a room with Resident 4. CNA 6 stated people who cannot protect or defend themselves have been roommates with Resident 4 and she did not feel this was fair to them. CNA 6 stated Resident 4 will yell all the time and people cannot sleep which upsets all the residents. During a phone interview on 9/23/25, at 9:45 a.m., the ADON stated Resident 4 had resided in the facility since October of 2023, had dementia, was blind, was unpredictable, and yelled out a lot. The ADON stated Resident 4 does not use a call light due to being blind and will call out because he does not know who was there with him. The ADON stated Resident 4 needed reassurance that someone was there with him and when someone speaks to him it helps to calm him and stops him from yelling out. The ADON stated staff had been monitoring Resident 4's behavior since 2023 due to him being the aggressor in an altercation involving staff. The ADON explained the altercation occurred on 11/27/23 and after the altercation a staff member was assigned to provide one-on-one supervision for Resident 4. The ADON stated the one-on-one was always with Resident 4 and provided him with support and calmed him, so he was not disruptive to other residents. The ADON explained additionally the one-on-one was there to keep Resident 4's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 4 of 21 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 11/18/2025 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)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete roommate safe. The ADON stated Resident 4's roommates tended to be confused and not alert. The ADON stated staff, including CNAs and LNs, were currently monitoring and charting Resident 4's behavior including cursing of others, disruptive sounds, disruptive screaming, and aggression. The ADON stated Resident 4's behaviors tend to manifest more during the night and morning shift. The ADON stated Resident 4 does not currently have a one-on-one staff member assigned to him providing constant supervision and was not sure when it was discontinued but thought it was sometime in the summer of 2024. The ADON explained she was not sure if administration conducted an IDT (interdisciplinary team meeting) prior to discontinuing Resident 4's one-on-one support and through review of Resident 4's electronic record, the ADON acknowledged she could not locate a progress note regarding this. The ADON stated she felt like the disturbance Resident 4's yelling caused other residents was mentioned in the daily stand-up morning meetings and administration meetings but could not recall when it was last discussed. The ADON explained Resident 4's yelling mostly affected the residents in the rooms next to him or located in the same hall. The ADON stated residents could hear him yelling. The ADON stated we have told residents they cannot move them to another location or room. The ADON stated the nurses have told her Resident 4 yelled at night, and it was constant, and residents complained they were not able to sleep. The ADON stated the issue came up recently and she felt like the Social Services was in charge of addressing the situation. The ADON stated the expectation for residents was they can rest at night and have a relaxing day and not listen to constant yelling. The ADON stated the expectation was if a resident was yelling staff needs to attend to that resident right away as yelling can be a stressor to others. During a review of a facility policy and procedure (P&P) titled HOMELIKE ENVIRONMENT, revised 1/2025, the document indicated, .The facility strives to provide a personalized, homelike environment which recognizes the individuality and autonomy of the resident, provides an opportunity for self-expression.DEFINITIONS: Homelike Environment: is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment . facility environment should enhance the quality of life for residents, in accordance with resident preferences. Facility personnel strive for person-centered care that emphasizes individualization, relationships and a psychosocial environment that welcomes each resident and makes her/him comfortable. During a review of a facility P&P titled DEVELOP-IMPLEMENT COMPREHENSIVE CARE PLANS POLICY STATEMENT, revised 1/2025, indicated, .The facility develops a person-centered comprehensive care plan that are culturally competent and trauma-informed, developed and implemented to meet each resident's preferences and goals, and address the resident's medical, physical, mental and psychosocial needs.Resident's Goal: The resident's desired outcomes and preferences for admission, which guide decision making during care planning.Interventions: Actions, treatments, procedures, or activities designed to meet an objective.Person-Centered Care: means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives.The interdisciplinary team develops the care plan with corresponding interventions for care that is in accordance with professional standards of practice and accounting for residents' experiences and preferences to eliminate or mitigate triggers that may cause re-traumatization of the resident.Care plans shall describe the resident's needs and preferences and how the facility will assist in meeting these needs and preferences.Care plans shall include the discipline providing care or services, measurable objectives, and timeframes in order to evaluate the resident's progress toward his/her goal(s). Event ID: Facility ID: 055833 If continuation sheet Page 5 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to protect one of two sampled residents (Resident 3) right to be free from physical abuse and neglect (failure to provide goods and services necessary to avoid physical harm or mental anguish) when, 1. Resident 3, with a diagnosis of paraplegia (inability to feel or move your legs, making it impossible to stand or walk) was placed in Resident 4's room as his roommate even though Resident 4 had a history of aggressive behavior towards staff and other residents. Subsequently, on 5/27/25, Resident 3 called repeatedly for staff assistance due to Resident 4 coming over to his side of the room and at approximately 2:20 a.m., Resident 4 walked over to Resident 3's side of the room, pulled his room curtain, grabbed Resident 3's call light and tossed it off the bed, grabbed his throat, and began choking him. 2. The facility failed to implement measures that would ensure residents in the facility were safe from Resident 4 by constructing an individualized plan detailing approaches to maintain the safety of Resident 3 and other residents in the facility. These failures resulted in Resident 3 feeling trapped and scared for his life, and had the potential to negatively affect Resident 3's psychosocial (the mental, emotional, social, and spiritual effects of a disease) wellbeing and/or cause him serious injury and/or death.1.Review of Resident 3's admission RECORD, indicated, Resident 3 was admitted to the facility late June/2025 with a diagnosis including but not limited to paraplegia, fusion of the cervical (neck) spine (surgery to connect two or more bones in the neck which prevents them from moving), contracture left hand (causes one or more fingers to bend toward the palm of the hand and can reduce movement and flexibility), and contracture right hand. Review of Resident 3's Care Plan, dated 5/22/25, indicated, .The resident has paraplegia r/t [related to] PERSONAL or HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA [temporary blockage of blood flow to brain and cause symptoms of stroke), AND CEREBRAL INFARCTION [blood flow to brain is stopped or reduced causing brain cells to die, can cause paralysis, memory loss, trouble talking, and may need help with self-care] , resulting in .SPINAL STENOSIS, CERVICAL REGION.Goal.The resident will maintain optimal status and quality of life within limitations through review date. Review of Resident 3's Care Plan, dated 5/22/25, indicated, .The resident had limited physical mobility r/t [related to] . CONTRACTURE.PARAPLEGIA.SPINAL STENOSIS.PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION.Goal.The resident will maintain current level of mobility. Review of Resident 3's Care Plan, dated 5/22/25, indicated, .The resident has altered respiratory status/Difficulty Breathing r/t DX [diagnosis] of Pneumonia [infection in the lungs which can cause difficulty in breathing] .Goal.The resident will have no complication related to SOB [shortness of breath] . Review of Resident 3's SBAR [which stands for Situation, Background, Assessment, and Recommendation (or Request), is a structured communication framework that can help teams share information about the condition of a patient that the team needs to address] Change of Condition, dated 5/29/25, written by Licensed Nurse (LN) 4, indicated, .Situation.alleged physical abuse.This started on.5/27/25.Primary diagnosis.Pneumonia.Assessment Details.CNA found resident (alleged abuser [name redacted, Resident 4]) at the victim's side of bed. Per victim, abuser hit him on the right hip and stomach. While victim tries to push abuser away, he grabbed his face, poke his left eye, and choke. Upon assessment, no post incident injury noted. No bruising or discoloration. Victim denies any pain. Orientation remains within baseline. Review of Resident 3's IDT [Interdisciplinary Team, a group of professionals who collaborate to accomplish a common goal] PROGRESS NOTES - INCIDENT / ACCIDENT, dated, 5/27/76, written by the Director of Nursing (DON), indicated, .On 5/27/25 approximately 0220 [2:20 a.m.], [redacted, Resident 4] standing beside [redacted, Resident 3] bed side. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 6 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Immediately CNA [Certified Nurse Assistant] removed [redacted, Resident 4] aggressor away from [redacted, Resident 3]. CN [charge nurse] relocated [redacted, Resident 4] into rm [room number redacted] then went back inside [redacted, Resident 3] room for full body assessment, no scratches, or redness around his neck, no discoloration/redness to left eye but observed watery, no skin discoloration o right hip or RLQ [right lower quadrant] abd [abdomen]/stomach. [redacted, Resident 3] stated that [redacted, Resident 4] came to his side of the bed and sat down beside him on the right side and said press it press it, I know he can see because he kept saying press it to my call light then he threw my call light away from me. [redacted, Resident 3] tried to move his hand to tell him to get off from his bed butcan't [sic] move his arms so much, that's when [redacted, Resident 4] hit his right hip and RLQ abd/stomach, while [redacted, Resident 3 tries to push [redacted Resident 4] away, he [Resident 4] grabbed his [Resident 3] face, pressed his left eye and choke him. CN informed res. [Resident 3] he doesn't have any skin impairment like scratch or discoloration around neck, right hip or RLQ of abd/stomach, no discoloration to left eye however CN observed eye to be watery. CNA got wet wash cloth to wipe res [Resident 3] eyes and it was helpful and eased the stinging to left eye. CN notified res. [Resident 3] that [Resident 4] will be transferred to [redacted, room number] .then CN left res. [resident] to rest. Review of Resident 3's Social Services Progress Notes,, dated 5/27/25, indicated, .SS [Social Services] visited resident this morning to ask in regards the roommate incident. Resident mentioned roommate kept going back and forth to resident's side until roommate sat down next to resident. Roommate taped [sic, meaning tapped] resident to make it was on bed, then attempt hitting him in face, threw call light, placed hands around resident's neck, and [NAME] [sic, meaning poked] in resident's left eye. After assessment no injuries were noted besides left watery eye. Psychosocial support was provided. Psych services were offered as well to make sure resident was ok. During a phone interview on 9/10/25, at 2:53 p.m., Resident 3 stated he cannot move his legs due to being a paraplegic and had limited use of his hands due to a previous stroke. Resident 3 stated he was sharing a room with Resident 4. Resident 3 stated Resident 4 screams and hollers all day and night, and he could not get any sleep. Resident 3 recalled the altercation involving Resident 4 on 5/27/25, and stated it happened in the early morning around 3:00 a.m. Resident 3 stated Resident 4 had walked over to his side of the room, stood next to his bed and kept trying to hit him. Resident 3 stated he had used his call light prior to the altercation, to alert staff that Resident 4 was on his side of his room, and he did not want him there and he feared Resident 4. Resident 3 stated on the third incident of Resident 4 walking over to his side of the room that night, Resident 4 pulled his room curtain then grabbed his call light and tossed the call light off the bed. Resident 3 explained Resident 4 grabbed his throat and began choking him. Resident 3 stated he could not get away from Resident 4, felt trapped, was scared for his life and started hollering for help. Resident 3 stated every time Resident 4 came over to his side of the room, he felt scared, and he would use his call light and yelled out for help. Resident 3 stated staff came into his room to assist every time, and each time Resident 4 was over on his side of the room. Resident 3 stated staff told Resident 4 he was not supposed to be there. Resident 3 explained that staff told him they could not move Resident 4 to a different room because it was in the middle of the night. Resident 3 stated after Resident 4 choked him, staff came in and moved Resident 4 outside of the room and placed him in the hallway. Resident 3 stated there was a scratch on his neck after the altercation and police came and took a statement form him and spoke to Resident 4 as well. 2. Review of Resident 4's admission RECORD, indicated, Resident 4 was originally admitted to the facility in the fall of 2023 with a diagnosis including but not limited to cerebrovascular disease (condition that affect blood flow to your brain), vascular (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 7 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dementia (changes in thinking and memory that occur when there isn't enough blood flow to part of the brain, as can happen with a stroke), schizophrenia (A serious mental health condition that affects how people think, feel and behave. It may result in a mix of hallucinations, delusions, and disorganized thinking and behavior.) psychotic disorder (severe mental disorders that cause abnormal thinking and perceptions) not due to a substance or known physiological condition, generalized anxiety disorder (mental health conditions that cause fear, dread and other symptoms that are out of proportion to the situation), legal blindness (status that government agencies can grant when you have severe vision loss), and difficulty in walking. Review of Resident 4's BRIEF INTERVIEW FOR MENTAL STATUS (BIMS) (a tool that healthcare providers use to assess a person's cognitive function), dated 7/18/25, indicated, Resident 4 had a BIMS score of 5, which indicated severe cognitive impairment (0-7 points, when a person has significant trouble with cognitive tasks, and will likely need extensive help from the others to navigate daily life). Review of Resident 4's Order Summary Report, indicated, .monitor for any combative behavior such as hitting and scratching staff, every shift for combative behavior.Order Date 11/4/23. Review of Resident 4's Behavior Care Plan, dated 11/6/23, indicated, .The resident has a behavior r/t increased agitation/combative w/ [with] screaming and yelling.Goal.The resident will have fewer episodes by review date.Interventions.Anticipate and meet the resident's needs.Assist the resident to develop more appropriate methods of coping and interacting. Encourage the resident to express feelings appropriately.If reasonable, discuss the resident's behavior. Explain/reinforce why behavior is inappropriate and/or unacceptable to the resident.Minimize potential for the resident's disruptive behaviors (Specify) by offering tasks which divert attention (Specify).Staff will provide one on one care in resident's room as staffing allows to promote calming environment for [name redacted, Resident 4] which decreases his disruptive behavior within the facility. During a phone interview and record review on 9/23/25, at 9:45 a.m., the ADON reviewed Resident 4's Behavior Care Plan and acknowledged the areas of the plan which said Specify were not filled out for specific disruptive behaviors and tasks that should have been offered to Resident 4. The ADON stated the care plan should be person centered. The ADON stated the expectation was that it was filled in with tasks such as offering of food and/or assisting behavior. The ADON stated the care plan was a guide for staff including how to manage behaviors and to prevent them for residents. The ADON stated the ‘Intervention' section was not clear on what staff should do. The ADON acknowledged the last revision date was 6/6/24 and stated there should be a review date listed and should have been revised after the most recent altercation with Resident 3 in May of 2025. The ADON stated her expectation for staff was they were to ask Resident 4 what he needed and stated his behavioral care plan should have been more specific so staff know how to care for Resident 4 and what interventions should be implemented to manage his behaviors. Review of Resident's 4's Behavior Management Care Plan, dated 1/30/24, indicated, .The resident uses psychotropic medications Depakote [mood altering medication] r/t [related to] Behavior management.Goal.The resident will have fewer episodes by review date.Interventions.The resident is on a behavior management program with (Specify: alternatives to prn [as needed] medication use).Monito/record occurrence of for target behavior symptoms (Specify: pacing, wandering, disrobing, inappropriate response to verbal communication, violence/aggression towards staff/others. Etc.) and document per facility protocol. Review of Resident 4's SBAR: Change of Condition, dated 5/27/25, written by LN 3, indicated, .Situation.physical aggression (initiated).This started on.5/27/25.Primary diagnosis.CEREBRAL VASCULAR DISEASE.Assessment Details.Resident unable to provide details of the resident. alert and verbally responsive to care. Review of Resident 4's IDT PROGRESS NOTES INCIDENT / ACCIDENT, dated, 5/27/76, written by the DON, indicated, .On 5/27/25 approximately 0200 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 8 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some [2:20 a.m.], [redacted, Resident 4] had an alleged aggression (recieved0 from [redacted, Resident 4]. CN went to res [redacted, Resident 4] to ask about the incident, however res [sic, Resident 4] unable to provide description of the incident r/t cognitive impairment AEB [as evidence by] BIMS of 07 with confusion upon admission. Will continue plan of care.IDT rec [recommendation].separated both res [sic, residents] and transferred to another rm [room].by himself. During a concurrent interview and record review on 9/9/25, at 2:50 p.m., the Social Services Director (SSD) stated resident to resident altercations required the facility to complete a three day follow up which includes monitoring the resident for psychiatric changes. The SSD stated for residents who engaged in repeated resident to resident altercations the primary intervention would be a psychiatry consultation. During a phone interview on 9/10/25, at 12:49 p.m., LN 2 stated Resident 4 would scream and scream if nobody was there with him. LN 2 stated Resident 4 needed someone there with him and it was important to let him know that someone was there as this provides comfort for him. LN 2 stated staff would push Resident 4 in his wheelchair to the dining room to keep him company. During a concurrent interview and record review on 9/10/25, at 1:55 p.m., the ADON stated Resident 3 was bedbound, and could not get up, and required staff assistance to move and lift him off his bed or chair. The ADON explained Resident 3 could respond verbally and he was orientated and not confused, and had a BIMS score of 15 which meant he was cognitively intact. The ADON stated Resident 3 was paraplegic and previously had a spinal fusion and stroke and could not use his arms or legs. The ADON stated Resident 3 came into the facility for respite care (short-term relief for primary care givers), which was always a five day stay, and it provided his family an opportunity to take a break from caring for him. The ADON stated Resident 4 was confused and tended to be aggressive. The ADON stated Resident 4 currently had a roommate. The ADON stated Resident 4 could stand up, cannot see, and on the night of 5/27/25 he might have gotten lost. The ADON stated Resident 4 was transferred to another room after the incident. Through review of Resident 4's clinical record the ADON stated Resident 4 had a BIMS score of 5 which indicated a severe cognition deficit. The ADON stated Resident 4 was receiving psychiatric care, but his family did not want him overly medicated with psychiatric drugs because they thought it made him sleepy, and because of this his medications had been reduced. The ADON stated when Resident 4 was on the medications the psychiatrist had recommended, he was more pleasant. During an interview on 9/10/25, at 3:11 p.m., CNA 2 stated Resident 4 was always yelling, and he thought it was part of his mental health condition. CNA 2 stated he kept an eye on Resident 4, and he would not listen to staff. CNA 2 stated Resident 4 often yells out in his native language, and he cannot understand him. CNA 2 stated Resident 4 could walk with assistance. CNA 2 explained if staff use the proper soft voice soft, Resident 4 can be calm, and he likes staff to stay close to him. CNA 2 stated they take Resident 4 out of his room and place him by the nursing station. CNA 2 stated he was not sure if Resident 4 was blind. CNA 2 stated Resident 4's yelling bothers other residents and they will often begin yelling at Resident 4 to shut up.During an interview on 9/10/25, at 3:27 p.m., CNA 3 stated Resident 4 screams and shouts and staff will ask him what the matter and he will say nothing. CNA 3 thought he was confused. CNA 3 stated Resident 3 screams very loudly throughout the day and night. CNA 3 explained it was very disturbing and disruptive to the other residents, and they could not get any sleep. CNA 3 stated Resident 4 had been like this the whole time he had been at the facility. CNA 3 stated Resident 4's medications help him, but he will refuse his medication. CNA 3 stated Resident 4 would shout out profanities to other residents and one time he tried to hit a resident. CNA 3 explained the incident that happened in his room and was an altercation with a roommate where Resident 4 hit the roommate. CNA 3 stated Resident 4 went through many roommates due to his shouting. CNA 3 stated Resident 4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 9 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some shouts at staff but there was no altercation involving staff for over a year. During a concurrent observation and interview on 9/11/25, at 10:38 a.m., Resident 4 was observed in his room, sitting in a wheelchair at the end of his bed. It was observed that Resident 4 had a roommate who was sleeping in his bed. Resident 4 stated he could not see, he needed help, and someone needed to take his hand and help him. Resident 4 stated he needed someone to bring him to school. Resident 4 stated there were no activities for him to do. Resident 4 repeated he needed someone to stand next to him and to hold his hand and it was too difficult for him to find out what to do. Resident 4 stated he had a problem with calling out, and if he needed help, he could talk with his mouth. During an observation on 9/11/25, at 10:45 a.m., in the hallway, outside of Resident 4's room an alarm was heard, staff members, including CNA 8 were observed running into Resident 4's room. During an interview on 9/11/25, at 10:50 a.m., CNA 8 stated he responded to Resident 4's wheelchair alarm and it went off because Resident 4 stood up and needed redirection. CNA 8 stated Resident 8 was very physically and verbally combative, disruptive, and not easily redirected. CNA 8 stated Resident 4 would curse other residents. CNA 8 stated Resident 4 could get up from his wheelchair and staff tried to redirect and called the family and he missed his family and was mean and angry. CNA 8 stated Resident 4 could not see, was blind. CNA 8 explained he would put music on, and it calmed Resident 4. CNA 8 stated Resident 4 would yell out for pretty much eight hours straight. CNA 8 stated other residents told him they cannot sleep and cannot rest because of the yelling at night. CNA 8 stated the nursing staff tried to redirect him, but he still screamed all night. CNA 8 stated staff have tried to have Resident 4 join activities and the assisted feeding program, but he was disruptive and caused the other residents to become more confused and disruptive, so they did not have him attend. During a phone interview on 9/11/25, at 12:20 p.m., Responsible Party (RP) stated Resident 4 had a stroke which caused him vision issues, and he was blind. RP 1 stated the nurses wanted to make Resident 4 take more drugs to sedate him. During a phone interview on 9/11/25, 12:30 p.m., LN 4 stated he worked nights and was primarily the desk nurse. LN 4 explained he created care plans and provides a resource in case the bedside nurses needed help. LN 4 stated he was familiar with Resident 4, and he was unpredictable, screamed a lot, and does not follow commands or listen. LN 4 stated Resident 4 could understand and communicate in English. LN 4 stated there were times he was confused and communicated nonsense. LN 4 stated other residents close to Resident 4's room were bothered by his shouting and complaining. LN 4 stated he was not really sure what to do about the situation. During an interview on 9/11/25, at 1:31 p.m., LN 1 stated Resident 4 yells constantly and it was all through the day and night and has done so since admission. LN 1 stated residents complained they could not sleep, and administration were aware, and they had tried to adjust medications. LN 1 stated when Resident 4 goes to the activities room he will yell which aggravates the other residents, so he mostly stays in his room or by the nursing station. LN 1 stated Resident 4 was blind and if he has someone close by, he will stop screaming, as he just wants someone to talk to. LN 1 stated Resident 4 had never had a continuous one on one. During a phone interview on 9/11/25, at 2:16 p.m., LN 3 stated Resident 3 was admitted to the facility for respite care, he could not walk, and his hands were contracted. LN 3 stated Resident 4 was legally blind and could walk. LN 3 stated she was working the night when CNA 5 (name redacted) found Resident 4 on Resident 3's side of the bed. LN 3 explained Resident 3 said Resident 4 (name redacted) had choaked him. LN 3 further explained Resident 3 stated Resident 4 had sat on his bed, threw the call light and tossed it to the side, then chocked him. LN 3 stated Resident 3 told Resident 4 to get out because it was his bed. LN 3 stated CNA 5 had witnessed Resident 4 standing on Resident 3's side of the room by Resident 3's bed. LN 3 stated the situation was not right. LN 3 stated she reported it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 10 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to the police department, notified the medical doctor, and administration. LN 3 stated Resident 3 told her he felt frightened, and she told him they were relocating Resident 4. LN 3 stated Resident 4 felt like he could not get away or protect himself with his hands. LN 3 stated Resident 4 screamed and yelled a lot, tended to get aggressive and angry. LN 3 explained that CNAs would step away from him if he gets angry or physically aggressive. LN 3 stated other residents expressed frustration from Resident 4's yelling, and residents would say they could not get any rest, and it was not fair. LN 3 explained from the experience with Resident 3, and because Resident 4 currently had a roommate she would try to have a CNA stay with him when she could at night. During a phone interview on 9/15/25, at 5:17 p.m., CNA 4 stated Resident 4 was confused, tended to yell throughout the night saying hello or yelling out his family member's name. CNA 4 stated there was a few times when Resident 4 had gotten aggressive. CNA 4 stated there was an incident about a year ago with a CNA where Resident 4 choked her. CNA 4 explained Resident 4 tended to stand up and would wander to his roommate's side of the room. CNA 4 explained this will happen if a roommate responds to Resident 3's yelling by yelling back. CNA 4 stated staff would attempt to calm Resident 4 down. CNA 4 stated she was working on the early morning of 5/27/25, when the altercation occurred in Resident 3 and Resident 4's shared room. CNA 4 stated on that night Resident 4 was agitated and kept yelling out. CNA 4 stated Resident 3 was alert, and he had used his call light a few times to let us know that Resident 4 was coming over to his side of the room. CNA 4 stated we did our best to go over and calm Resident 4 down, but he was really confused. CNA 4 stated Resident 4 choked Resident 3. CNA 4 explained when LN 3 (name redacted) came to the room she saw redness around Resident 3's neck. CNA 4 stated in the past Resident 4 did have one-on-one for a month or two due to his tendency to get up and wander to his roommate's side. CNA 4 stated Resident 4 currently has a chair alarm but if staff hear yelling, they will respond to the room. During a phone interview on 9/15/25, at 3:25 p.m., CNA 5 stated she worked nights and Resident 4 did not sleep, was loud at night, and would say Hello, Hello or Help, Help repeatedly. CNA 5 stated Resident 4 was confused, can walk with assistance but sometimes will not wait for staff to assist him. CNA 5 stated Resident 4 could be aggressive towards staff or residents. CNA 5 stated other residents would complain about Resident 4's loudness and his roommates and neighbors would yell at him to stop and say, here we go again. CNA 5 recalled the altercation on 5/27/25 between Resident 4 and Resident 3 and stated Resident 4 was standing by Resident 3's bed. CNA 5 stated she did not remember if Resident 3 had called for help earlier regarding Resident 4 coming over to his side of the room. CNA 5 stated she could not recall if she saw Resident 4 choking Resident 3. CNA 3 stated Resident 3 was scared after the incident. During a phone interview on 9/16/25, at 9:39 a.m., CNA 6 stated Resident 4 had been aggressive and abusive with staff including punching a staff member in the chest and another CNA in the face and had dragged and held another CNA down on the ground. CNA 6 stated staff were scared of Resident 4. CNA 6 stated Resident 4 could be violent and currently had a tab alarm on his wheelchair and bed alarm that rings when he gets up. CNA 6 stated Resident 4's bed and chair alarms were implemented after the incident with Resident 3. CNA 6 stated her opinion was no one should be sharing a room with Resident 4. CNA 6 stated people who cannot protect or defend themselves have been roommates with Resident 4 and she did not feel this was fair to them. CNA 6 stated Resident 4 will yell all the time and people cannot sleep which upsets all the residents. During a phone interview on 9/23/25, at 9:45 a.m., the ADON stated Resident 4 had resided in the facility since October of 2023, has dementia, was blind, was unpredictable, and yelled out a lot. The ADON stated Resident 4 does not use a call light due to being blind and will call out because he does not know who was there with him. The ADON stated Resident 4 needs reassurance that someone was there with him (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 11 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and when someone speaks to him it helps to calm him and stops him from yelling out. The ADON stated staff had been monitoring Resident 4's behavior since 2023 due to him being the aggressor in an altercation involving staff. The ADON explained the altercation occurred on 11/27/23 and after the altercation a staff member was assigned to provide one-on-one supervision for Resident 4. The ADON stated the one-on-one was always with Resident 4 and provided him with support and calmed him, so he was not disruptive to other residents. The ADON explained additionally the one-on-one was there to keep Resident 4's roommate safe. The ADON stated Resident 4's roommates tended to be confused and not alert. The ADON stated staff, including CNAs and LNs, were currently monitoring and charting Resident 4's behavior including cursing of others, disruptive sounds, disruptive screaming, and aggression. The ADON stated Resident 4's behaviors tended to manifest more during the night and morning shift. The ADON stated Resident 4 did not currently have a one-on-one staff member assigned to him providing constant supervision and was not sure when it was discontinued but thought it was sometime in the summer of 2024. The ADON explained she was not sure if administration conducted an IDT (interdisciplinary team meeting) prior to discontinuing Resident 4's one-on-one support and through review of Resident 4's electronic record, the ADON acknowledged she could not locate a progress note regarding this. The ADON explained Resident 4 did not constantly have staff eyes on him and due to this and because he was unpredictable, she did not feel it was safe for him to have a roommate. The ADON stated she felt Resident 4 should have one-on-one supervision. The ADON stated if Resident 4 had a roommate he needed one-on-one to prevent Resident 4 from being aggressive and altercations engaging in altercations with the roommate. The ADON stated at night there were not as many staff working. The ADON explained on 5/27/25, Resident 3 could not get away due to his physical limitations. The ADON stated Resident 4 has delusions and thinks he was at war. The ADON stated Residents who share a room with Resident 4 have the right to feel safe in the facility. The ADON stated there was potential for future altercations involving roommates of Resident 4, especially if the roommate was cognitively or physically impaired and could not get away. The ADON explained there was a potential risk for them to get physically hurt by Resident 4 and this could lead to serious injury or fall. During a review of a facility policy and procedure (P&P) titled DEVELOP-IMPLEMENT COMPREHENSIVE CARE PLANS POLICY STATEMENT, revised 1/2025, indicated, .The facility develops a person-centered comprehensive care plan that are culturally competent and trauma-informed, developed and implemented to meet each resident's preferences and goals, and address the resident's medical, physical, mental and psychosocial needs.Resident's Goal: The resident's desired outcomes and preferences for admission, which guide decision making during care planning.Interventions: Actions, treatments, procedures, or activities designed to meet an objective.Person-Centered Care: means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives.The interdisciplinary team develops the care plan with corresponding interventions for care that is in accordance with professional standards of practice and accounting for residents' experiences and preferences to eliminate or mitigate triggers that may cause re-traumatization of the resident.Care plans shall describe the resident's needs and preferences and how the facility will assist in meeting these needs and preferences.Care plans shall include the discipline providing care or services, measurable objectives, and timeframes in order to evaluate the resident's progress toward his/her goal(s). During a review of a facility P&P titled admission POLICY, revised 1/2025, the document indicated, .Abuse: The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. During a review of a facility P&P titled ABUSE PROHIBITION AND PREVENTION PROGRAM, revised 4/2024, the document indicated, .The facility has policies and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 12 of 21 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 11/18/2025 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)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete procedures for screening and training employees, protection of residents and for the prevention, identification, investigation, and reporting of abuse, neglect, exploitation, mistreatment, including injuries of unknown source and misappropriation of resident property .PURPOSE .To provide staff guidelines to ensure protection for the health, welfare and rights of each resident residing in the facility; and to assure the facility is doing all that is within its control to prevent occurrences of abuse.Serious bodily injury: An injury involving extreme physical pain; involving substantial risk of death; involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty; requiring medical intervention such as surgery, hospitalization, or physical rehabilitation; or an injury resulting from criminal sexual abuse (see sections 2011(19)(A) and (B) of the Act).PREVENTION. The facility strives to provide an environment which prohibits and prevents abuse, neglect, and exploitation of residents and misappropriation of resident property through.Providing residents, families, and staff information on how and to whom they may report concerns, incidents, and grievances without the fear of retribution; and provide feedback regarding the concerns that have been expressed.Identification, correction, and intervention in situations in which abuse, neglect and/or misappropriation of resident property is more likely to occur.Deployment of staff on each shift in sufficient numbers to meet the needs of the residents, and assure the staff assigned have knowledge of the individual residents' Event ID: Facility ID: 055833 If continuation sheet Page 13 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement appropriate safety measures to ensure a safe environment free of accidents or hazards and prevent elopement (form of unsupervised wandering that leads to the resident leaving the facility) for two of two residents (Resident 1 and Resident 2) when, 1. Resident 1 had a documented history of substance use disorder (SUD, a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine and can refer to the use of illegal substances, such as marijuana, methamphetamine and the misuse of legal substances such as alcohol or prescription medications) and was homeless, and there was not a plan in place to address Resident 1's risk of exit seeking or eloping behavior, nor was Resident 1 advised of the risk of leaving the facility early, and subsequently Resident 1 eloped from the facility in the early morning hours of 7/8/25, with his PICC (peripherally inserted central catheter, is a long, thin tube that's inserted through a vein in the arm and the tube is passed through to the larger veins near the heart and is used to give medications or liquid nutrition) line intact. As a result of the Resident 1s elopement, he did not finish his intravenous (IV) antibiotic (medication used to treat serious infections and administered directly into the person's bloodstream through a vein) treatment, scheduled to end on 7/30/25; and, 2. Resident 2 had a documented history of SUD and the facility did not have careplan in place to provided access to or offered drug counseling or other access to SUD support groups and to monitor Resident 2's visitors who may be under the influence of illicit drug (illicit drug includes not only illegal drugs but also prescription medications that are obtained or used unlawfully), and subsequently on 8/29/25, Resident 2 was visited by her boyfriend who was under the influence of drugs and assaulted Resident 2 in her room. These failures had the potential to result in Resident 1 and Resident 2 sustaining life-threatening injury and/or psychosocial (the mental, emotional, social, and spiritual effects of a disease) harm. 1.Review of Resident 1's admission RECORD, indicated, Resident 1 was admitted to the facility late June/2025 with a diagnosis including but not limited to osteomyelitis (bone infections), Type 2 diabetes mellitus (body cannot regulate blood sugar) with foot ulcer (open sore that often develops in people with diabetes), absence of right toes (surgical removal of toes), acquired absence of right toe(s), acquired absence of left toe(s), other stimulant abuse (stimulants have high addiction potential, example is methamphetamine, can cause anxiety, rapid heart rate, or fatal overdose), and abnormalities of gait (walking) and mobility.Review of Resident 1's ED [Emergency Department] Physician Notes, dated 6/18/25, indicated, .FROM [name redacted, shelter] FOR LOWER EXTREMITY PAIN. PT [patient] STATES HE HAS FOOT ULCER. PMH [past medical history] .AMPUTATION [surgical removal] OF ALL 10 TOES AND DM [diabetes mellitus] .Diagnosis this visit. Problem List/Past Medical History.Diabetic foot infection.Methamphetamine abuse (lab made stimulant with high addiction potential) .Review of Resident 1's Hospital History and Physical, dated 6/18/25, indicated, .[name redacted, Resident 1] is a 50yo [year old] homeless male.pt [patient] says his right stump has started to hurt more for past one day.Problem List/Past Medical History.Ongoing. Diabetic foot infection.Methamphetamine abuse.noncompliance with medication regimen.severe sepsis [life-threatening medical emergency}.suicide risk.Review of Resident 1's Hospital Discharge summary, dated [DATE], indicated, . Patient was seen and evaluated on the day of discharge. PICC line was placed on 6/24/25.He will continue to IV vancomycin [strong antibiotic used to treat bacterial infections] [1 g [gram, unit of measure] twice daily till 7/30/25.PICC line can be removed after this last dose. He will follow up with podiatry [medical specialty dedicated to conditions affecting the foot and lower leg] .Review of Resident 1'a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 14 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Psychosocial Assessment/Social History/Discharge Planning, dated 6/27/25 and signed by the Social Service Director (SSD), indicated, .History of alcohol/substance use.No.Currently smokes .No.Living arrangement prior to hospitalization.shelter [temporary living situation for someone experiencing homelessness, providing a bed in a shared space] . Review of Resident 1's Wandering/Elopement Risk Evaluation,, dated 6/25/25, indicated, .RESIDENT EVALUATION FACTORS: Does the resident have the ability to walk or self-propel off the premises without assistance .No. Review of Resident 1' Smoking Risk Assessment, dated 6/25/25, indicated, .Does the resident currently smoke .Yes.Review of Resident 1' History and Physical Option, dated 6/26/25, written by the Medical Doctor (MD) 1, indicated, .he [Resident 1] will be on iv vancomycin till 7/30/35.via picc line.Review of Resident 1's Health Status Note, dated 6/29/25, indicated, .on monitoring for IV ABT [antibiotics]/osteomyelitis.also on monitoring for hyperglycemia [high blood sugar] with noncompliant with food.resident continue to request for food.education resident on the importance oof a balance diet for a diabetic resident.resident verbalized okay but continue to request for food. Review of Resident 1's Assessment Summary, written by LN 4, dated 7/8/25, indicated, SBAR [which stands for Situation, Background, Assessment, and Recommendation (or Request), is a structured communication framework that can help teams share information about the condition of a patient that the team needs to address] Communication for Changes in Condition.The change in condition, symptoms, or signs I am calling about is/are: elopement.Started on 7/08/25.Staffs observed that resident could not be located within the facility. Resident [Resident 1] was last seen by his primary nurse around 0310 [3:10 a.m.] on a black shirt in his wheelchair coming out from the patio. Also, one of the CNAs saw resident around 0320 [3:20 a.m.] asking if resident needs anything. Resident is AO4 [alert and orientated times four, meaning alter to person, place, time, and event], no signs of distress or eloping noted, PICC line present, Facility wide search conducted, code green initiated [meaning resident elopement], looked at the nearby park but resident still cannot be found. Police department notified.During an interview on 9/8/25 at 4:00 p.m., the Administrator (ADM) stated Resident 1 left in the middle of the night and as far as she knew he had not contacted his family, and she was not sure of his whereabouts. The ADM stated Resident 1 was admitted to the facility for IV antibiotics and was here from June 24th through July 8th. The ADM stated he was normally a night owl, and his mother said he was homeless prior to coming to the facility. During a concurrent interview and record review on 9/9/25, at 2:50 p.m., the SSD stated Resident 1 had a history of being homeless and prior to his hospital and facility admission he was living in a homeless shelter. The SSD explained the plan was for him to return to the shelter on discharge. The SSD stated Resident 1 decided to leave the facility unannounced in the middle of the night on 7/8/25. The SSD stated she spoke to Resident 1's mom and she said she was not concerned with his whereabouts. The SSD stated Resident 1 was being treated for osteomyelitis with IV antibiotics administered via a PICC line and had not finished his antibiotic course when he left the facility. The SSD confirmed Resident 1 left the facility with his PICC line intact. The SSD stated she had performed a risk assessment for Resident 1 on admission due to his current homelessness and was not aware Resident 1 had been using methamphetamines prior to him being admitted into the facility. The SSD stated if a resident voiced, they were drug seeking then staff would create a care plan to address the behavior. Through record review of Resident 1's Psychosocial Assessment/Social History/Discharge Planning, the SSD confirmed it was marked no for history of drug use. The SSD stated if a resident was using illicit drugs before their hospital admission, then the facility would want to address the drug use. The SSD explained they would want to offer the resident counseling and a psychiatry referral. The SSD stated Resident 1 was homeless and the shelter he was previously staying at would not take him back if he was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 15 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some actively using drugs or alcohol because sobriety was a condition of the housing agreement. The SSD stated he was living at the shelter a couple of months prior to being admitted to the hospital so she thought he was not using drugs. The SSD stated nursing staff would be looking at Resident 1's hospital discharge papers and not social services, so she was not aware of the hospital's documentation. Through record review of Resident 1's ED Physician Notes, the SSD confirmed the last date of methamphetamine use was 5/18/25. The SSD stated Resident 1 should have had a care plan addressing his methamphetamine drug use. The SSD stated the care plan would have included resources such as drug counseling and a psychiatric referral. The SSD stated Resident 1 should have had an addiction care plan and this was important so other staff are aware and could mitigate and intervene for drug seeking or exit seeking behaviors. The SSD acknowledged her role was to assist the residents with drug counseling, mental health, and housing.During an interview on 9/9/25 at 2:02 p.m., Certified Nurse Assistant (CNA) 1 stated Resident 1 was always nice to her. CNA 1 stated Resident 1 would complain of pain, and she would inform the nurse he wanted his pain medication. During an interview on 9/10/25, at 12:02 p.m., Licensed Nurse (LN) 1 stated Resident 1 never had visitors, and she remembered he smoked. LN 2 stated she did not ask residents about their living situation or if they engage in or have a history of drug use. LN explained this would be a role for social services. During an interview on 9/10/25, at 3:27 p.m., CNA 3 stated Resident 1 was here for IV medications and was quiet. CNA 3 stated there were signs Resident 1 was homeless such as he would gather extra towels, supplies, and food to keep. CNA 3 explained Resident 1 would ask for four to five sandwiches at a time. CNA 3 stated Resident 1 always had his bag packs and would hang them off his wheelchair and would take them with him when he moved about in the facility. During a phone interview on 9/11/25, 12:30 p.m., LN 4 stated he worked nights and was primarily the desk nurse. LN 4 explained he creates care plans and provides a resource in case the bedside nurses need help. LN 4 stated he was familiar with Resident 1 and was not aware he had a history of homelessness and could not remember if he had a history of drug use. LN 4 stated Resident 1 had no belongings with him when he was admitted into the facility. LN 4 stated he was working the night Resident 1 left the facility. LN 4 recalled the primary nurse told him the resident was last seen by a CNA. LN 4 stated Resident 1 usually slept during the day and was awake at night. LN 4 stated he administered Resident 1's IV antibiotics at midnight the night he left. LN 4 stated Resident 1's primary nurse informed him around 4:00 a.m. that he was missing. LN 4 stated a care plan would have been helpful to inform staff that he had a history of drug abuse so staff could have been focusing more on Resident 1's potential for exit-seeking behavior. LN 4 stated for residents who experience homelessness, he would do a care plan to address their homelessness so staff can plan for resources when they get discharged . LN 4 stated it was important to check a resident's medical diagnosis for alcohol or drug abuse. LN 4 explained he would create a care plan to address a resident's drug and alcohol abuse because it was important for interventions to be implemented including monitoring the residents for drug and/or alcohol withdrawal symptoms and exit seeking behavior. During a phone interview on 9/11/25, at 2:16 p.m., LN 3 stated she was Resident 1's LN or the supervisor the night he woke up and left the facility. LN 3 stated Resident 1 would ask staff for snacks at nighttime and would stay awake through the night. LN 3 stated she noticed Resident 1 was missing because she needed to check his morning blood sugar and could not locate him. LN 3 explained the CNA reported to her she last saw him at 3:30 a.m. coming back from the outside patio after a smoking break. LN 3 stated the guard checked the outside camaras which showed Resident 1 left through the front of the building, in his wheelchair, around 4:00 a.m. LN 3 recalled Resident 1 was outside in the patio a lot for that night. LN 3 stated she was not aware Resident 1 had a history of homelessness, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 16 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and he never told her. LN 3 stated she would have wanted to know Resident 3 had a recent history of methamphetamine use. LN 3 explained it could have helped to prevent Resident 1 from leaving and she would have wanted to know if he was exit-seeking. LN 3 stated Resident 1 did take pain medication that night. LN 3 stated Resident 1 was not a typical resident due to him being younger and doing his own thing. LN 3 stated she would have wanted Resident 1's homelessness and illicit drug use to be addressed, and a plan of care developed. LN 3 stated if this was not done then the resident could relapse or have a feeling of uneasiness or go through drug withdrawals. LN 3 explained Resident was at risk for drug withdrawals and could have needed a mental health consultation or behavioral health or drug counseling. LN 3 stated resources would have been helpful. LN 3 explained Resident1 left with his PICC line and still required his IV antibiotic treatment. LN 3 stated she would have wanted him to complete his antibiotics prior to leaving. During a phone interview on 9/15/25, at 5:17 p.m., CNA 4 stated Resident 1 was in isolation due to MRSA (bacterial infection) and stated he had his own (private) room. CNA 4 stated Resident 1 did things for himself. CNA 4 stated Resident 1 did not listen and would go outside to the patio to smoke at night. CNA 4 stated we did have smoking times, and the last smoking time of the day was 8:00 p.m. CNA 4 stated the residents who were alert just go smoking on their own in the inside patio without staff supervision. CNA 4 stated she was working the night Resident 1 went missing. CNA 4 stated around 3:30 a.m., she was performing her rounds and saw Resident 1 watching television. CNA 4 stated around 3:40 a.m. she saw Resident 1 headed in the direction of the patio, and assumed he was smoking. CNA 4 explained around 4:30 a.m. she noticed he was not in room. CNA 4 further explained she went to the parking lot, and Resident 1 was not there. CNA 4 stated she informed the nurse she could not locate Resident 1. CNA 4 stated did not know Resident 4 was homeless and was not aware of his past illicit drug use. CNA 4 stated the nurses knew he would go hang out at night in front of the building. CNA 4 stated in the past staff had told Resident 1 not to go out the front door of the building at night. CNA 4 stated once out-front Resident 1 would not have been able to come back in due to the door locking. CNA 4 stated there was a doorbell outside that could be ringed. During a concurrent interview and record review on 9/9/25, at 4:36 p.m., the Assistant Director of Nursing (ADON) stated Resident 1 was alert and orientated and was receiving IV antibiotics for a wound infection. The ADON stated Resident 1 left the facility in his wheelchair in the middle of the night on 7/8/25. The ADON stated the facility had not heard from Resident 1 since. The ADON stated they called and reported his elopement to the police. The ADON stated Resident 1 treatment wise was very young to be in the facility. The ADON stated Resident 1 had uncontrolled diabetes and osteomyelitis and had a PICC or midline to administer his antibiotics. The ADON stated she was not aware Resident 1 had a history of homelessness or that he was using methamphetamines prior to being admitted to hospital. Through review of Resident 1's hospital discharge document History and Physical, the ADON acknowledged Resident 1 had a current problem list of methamphetamines use and was homeless. The ADON stated nursing staff, and social services should have reviewed Resident 1's hospital discharge paperwork and addressed his illicit drug use and current homelessness living situation with care plans and other interventions, The ADON stated staff would want to address Resident 1's psychosocial wellbeing and monitor resident for exit seeking behaviors, drug withdrawals, pain management adjustments due to the drug use, counseling for addiction and a psychiatric consult. The ADON stated the residents illicit drug addiction would need be care planned as it provided a guide for staff on how to care for the residents. The ADON explained homelessness and drug addiction caused risk factors for Resident 1, such as leaving the facility without finishing their scheduled antibiotic therapy, lack of wound care, and psychosocial aspects not being addressed and this ultimately (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 17 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resulted in him leaving. During a phone interview and record review on 9/23/25, at 9:45 a.m., the ADON reviewed Resident 1's Wandering/Elopement Risk Evaluation, and confirmed the answer to question 1 was marked ‘No' related to the ability for Resident 1 to be mobile. The ADON stated this meant Resident 1 was not an elopement risk. The ADON stated the answer should have been marked ‘Yes' due to Resident 1's ability to self-propel his wheelchair and was mobile in the facility. The ADON stated if the form had been answered correctly more questions would have been generated to accurately assess Resident 1's elopement risk. Through review of Resident 1's Psychosocial Assessment/Social History/Discharge Planning, the ADON acknowledged Resident 1 was identified as homeless in the form and some of the questions including Resident 1's History of alcohol/substance abuse was marked incorrectly as ‘No' and should have been answered ‘Yes' due to his medical diagnosis and hospital discharge paperwork. The ADON acknowledged the question Currently smokes? was marked incorrectly and should have been marked ‘Yes'. The ADON stated her expectation was the form was filled out accurately so Resident 1's history of alcohol and substance abuse could have been addressed and care planned. The ADON stated Resident 1 had the potential for exit seeking behavior based on his recent history of being homeless and drug use. The ADON stated Resident 1's drug seeking and elopement risk should have been identified and care planned as he could have experienced drug withdrawals or suffered a relapse of drug use while in the facility. The ADON explained the drug seeking and potential elopement risk was important to care plan and address clinically so nursing staff were aware so the residents could be monitored, and staff can ensure measures were in place to keep the residents safe. The ADON confirmed Resident 1 left the faciity on 7/8/25, with his PICC line and did not finish his antibiotic treatment course which was scheduled to end on 7/30/25. The ADON stated for residents with a history of homelessness and recent drug use, nursing staff would have wanted to address the risks of leaving before their treatment ends. The ADON stated the risk for Resident 1 would have been at increased risk for infection from not completing his antibiotic treatment. The ADON stated that normally social service deals with homelessness and drug use, but she could see how this could affect the clinical nursing side of ensuring the care of the residents. 2.Review of Resident 2's admission RECORD, indicated, Resident 2 was admitted to the facility late July//2025 with a diagnosis including but not limited to ulcer with perforation (hole or break in the stomach and is a medical emergency), perforation of intestine (a hole or break in the wall of the gastrointestinal (GI) tract, which causes intestinal contents to leak into the abdomen), other psychoactive substance abuse (drug addiction), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest and can affect how a person feels, thinks and behaves and can lead to a variety of emotional and physical problems), and unsteadiness on feet.Review of Resident 2's Hospital Adult admission History, dated 8/21/25, indicated, .admitted From.Homeless.Transportation Issues.Yes.Alcohol.Current.Beer, Wine, Liquor.Substance Abuse.Current.Marijuana.Review of Resident 2's Order Summary Report, indicated, .Appointment with [Medical Doctor, name redacted] on 9/8/25 @ 3:30 pm.pt [patient] will arrange [name redacted, ride-hailing service] transport.Review of Resident 2's Health Status Note, dated 9/9/25, indicated, .Resident makes her appointment on 9/10/25.Resident arrange her transportation via [name redacted, ride-hailing service] .Review of Resident 2's Care Plan, dated 9/2/25, indicated, .Resident has discharge plans pending to a less restrictive environment. History of being homeless at risk for leaving AMA [against medical advice] .Goal. Resident will be discharged to less restrictive environment per MD's [medical doctor] order when deemed appropriate.Interventions.Invite resident/support person to care plans meetings as planned/and requested.Review of Resident 2's History and Physical Option, dated 8/30/25, written by the MD 2, indicated, .This is a medically complex patient.Patient has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 18 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some a history of hypertension, meth [methamphetamine] use.Review of Resident 2's Psychosocial Assessment/Social History/Discharge Planning, dated 9/2/25 and signed by the SSD, indicated, .Gender Female.History of alcohol/substance use.Yes.Have you ever experienced any physical/psychological trauma.NO.MOOD & BEHAVIORAL/MEDICATION RECEIVED.Resident Mood/Areas of Concern Review.Episodes of depression due to previous relationships and health concerns. Referral to psyc [sic, meaning psychiatrist, a medical doctor specializing in treating mental health conditions] was submitted.Psychiatric/ Psychological consult. [not marked] .Living arrangement prior to hospitalization.living alone.Location prior to hospitalization.Homeless. Review of the report indicated Resident 2 did not have a history of alcohol, substance use, and/or history of trauma, and contradicted to Resident 2's clinical medical record.Review of Resident 1's SBAR: Change of Condition, dated 8/30/25, written by LN 2, indicated, .Situation.Alleged Abuse from Boyfriend.This Started on.8/29/25.Other relevant information.Residents boyfriend noted with alleged drug abuse.Assessment/ Appearance.Appearance Details:. at 1905 [7:05 p.m.], resident reported that her boyfriend, [name redacted] visited her @ [at] 1900 [7:00 p.m.] and talked to her about money. The visitor was allegedly under the influence of drugs and got triggered when the resident's bedside phone started ringing, causing [name redacted, boyfriend] to get agitated. He began questioning the resident Who's calling you on the phone and grabbing her face by cheeks and pushing her onto the bed when the resident tried to move away. [name redacted, boyfriend] was reported to have threatened to slap her but didn't follow through. Resident also reported he called her a [redacted, derogatory term], and other names. Visitor last seen exiting the building @ 1902 [7:02 p.m] .Resident noted calm and cooperative with staff.but also requesting to ban [name redacted, boyfriend] and his friends from any future visits.Resident noted with discolorations to her cheeks upon assessment.During a concurrent observation and interview on 9/9/25, at 2:15 p.m., Resident 2 was observed in her room, Resident 2 stated she came to the facility for leg therapy after being discharged from the hospital for a foot infection. Resident 2 stated prior to coming here she was homeless and lived on the streets. Resident 2 stated her boyfriend came to the facility a few days after being admitted and was pacing back and forth in her room, was angry with her, and she could tell he was high on the drug fentanyl. Resident 1 stated she told him if he was not going to act right, he could leave, and he came over to her and grabbed her by the jaw, cussed her out and then left. Resident 2 stated she started to yell out and staff came into her room. Resident 2 stated her nurse told her she had visible marks on her cheeks, later the police came and last she heard her boyfriend was in jail. Resident 1 stated when she first was admitted the facility staff asked about her living situation, and she told them she was homeless. Resident 2 stated social services came and spoke with her and asked her if she had a history of drug use and she told them she shad used methamphetamines and had stopped using one week prior to entering the hospital. Resident 2 stated her nurse told her she had marks on her cheeks after the altercation. During a concurrent interview and record review on 9/9/25, at 2:50 p.m., the Social Services Director (SSD) stated Resident 2 was homeless, had a history of illicit drug use but no recent drug use. The SSD stated regarding Resident 2's boyfriend, he came in once, and was thought to be high on illicit drugs, and he grabbed Resident 2 by the face and shoved her. The SSD explained if a resident was using illicit drugs within the last 6 months the facility would want to provide a care plan for the drug use. Through review of Resident 2's current diagnosis, the SSD confirmed Resident 2 diagnosis of psychoactive drug abuse substance abuse. The SSD acknowledged Resident 2 should have had a drug addiction care plan, as the point was to make everyone aware and make necessary interventions. The SSD stated Resident 2 should have been offered a psychiatrist consultation and drug counseling. The SSD stated the risk to the residents if illicit drug use was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 19 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not addressed was leaving the facility unplanned, return of drug abuse or relapse, or overdose. During a concurrent interview and record review on 9/9/25, at 4:36 p.m., the ADON reviewed Resident 2's electronic clinical record and confirmed Resident 2 had a diagnosis of substance abuse and stated the facility would need to put measures in place to address the diagnosis. Through a record review of Resident 2's hospital discharge paperwork, the ADON confirmed Resident 2's use of marijuana and alcohol and acknowledged this should have been addressed in a care plan and monitoring. The ADON stated they would want to protect residents with a history of drug use from visitors who might be bringing illicit drugs, alcohol, or marijuana into the facility. The ADON acknowledged this was for the safety of all the residents, visitors, and staff. The ADON stated staff would need to be observant about potential issues related to addiction, including exposure to illicit drugs and overdose. The ADON stated Resident 2 had previously been homeless and was partaking in illicit drug use so staff would want to monitor the residents for behaviors to prevent a negative outcome such as relapse of drug use. The ADON explained there should be follow-up for the mental health piece including drug counseling for the residents who have a history of homelessness and drug use. During an interview on 9/11/25, at 3:00 p.m., CNA 7 stated she was working the evening Resident 2' had an altercation with her boyfriend. CNA 7 stated she heard a female yelling and screaming while she was in a room across the hall. CNA 7 stated she went into Resident 2's room and asked her what was going on. CNA 7 stated Resident 7 told her she did not want her boyfriend to come into the building because he squeezed her face and pushed her into the bed. CNA 7 stated Resident 2 told her the boyfriend did it in the hospital too. CNA 7 stated Resident 2 told her she was scared of him but wanted to give him another chance. CNA 7 stated she reported the incident to the nurse. During a phone interview on 9/11/25, at 1:00 p.m., LN 2 stated he was Resident 2's nurse the evening when the alteration happened with her boyfriend. LN 2 stated a CNA came to him and told him Resident 2's boyfriend had been rough with her. LN 2 recalled Resident 2 stated her boyfriend was agitated, got physical and held her by her cheeks and pushed her onto the bed. LN 2 stated Resident 2 had discoloration on both sides of the cheeks. LN 2 stated he followed protocol including calling the police department and filing the abuse report. LN 2 stated Resident 2 told him she thought her boyfriend was under the influence of harder drugs like fentanyl and did not want to be around him or his friends requested he not be allowed in the facility. LN 2 stated for new admissions the night shift creates resident care plans. LN 2 stated Resident 2's former illicit drug use should have been care planned. LN 2 explained the care plans would help to inform staff of the needs of residents and staff should be aware that visitors could potentially bring illicit drugs or alcohol in the building for residents with addiction issues. LN 2 stated there was potential risk to the resident or others for exposure to illicit drugs or potential overdose. LN 2 stated the interventions were necessary due to the high risk of relapse and addiction was a very serious thing. LN 2 explained residents with addiction issues could exhibit exit seeking behavior such as wandering or leaving the facility.During a concurrent observation and interview on 9/11/25, at 1:32 p.m., Resident 2 stated yesterday she took a lift ride to her primary care doctor appointment and facility did not help her arrange the appointment or transportation. Resident 2 stated she had to wait two hours after her appointment to get a ride back and needed help getting her blood work done the doctor ordered. Resident 2 explained she could not get a ride there and needed help getting transportation to her medical appointments. Resident 2 stated she had shared with the nurses how difficult it has been to get her medical appointments arranged and trying to get her own transportation but no one from the facility has offered to help her. Resident 2 stated she tried to go to the Social Service office but has not been able to speak with anyone. Resident 2 stated she has anxiety about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055833 If continuation sheet Page 20 of 21 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 11/18/2025 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)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete where she was going to live when she leaves because she doesn't want to go back to living on the streets. Resident 2 stated she would like to have drug counseling while at the facility. Resident 2 stated she loved the feeling of being sober and because of being sober her daughter had come around to visit her at the facility. Resident 2 explained it had been three years since she had spoken with her children. Resident 2 stated she was scared she was going to relapse. Resident 2 stated staff had not offered help with addiction, behavior, or housing support. Resident 2 stated she had been diagnosed with anxiety and was taking medications to help with it. Resident 2 stated she had PTSD and felt sad and would start to cry randomly.During an interview on 9/11/25, at 2:53 p.m., with the SSD and the ADON, the SSD stated the facility can provide transportation for residents with outside medical or other appointments and the assistant administrator helps with this. The ADON stated nursing staff could help schedule medical appointments. The SSD stated she could help with locating substance abuse programs and scheduling appointments for residents. The SSD stated for residents with a history of substance abuse within the last six months, staff would want to address this with the residents and develop interventions to be used in a care plan. The SSD explained residents who were agreeable to participate in a drug or alcohol abuse pro Event ID: Facility ID: 055833 If continuation sheet Page 21 of 21