Health inspection·July 3, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few term].During an interview on 7/3/25, at 10:49 a.m., CNA 3 stated Resident 4 had yelled at CNA 3 when CNA 3 provided one-to-one care (a personalized caregiving approach where a dedicated caregiver provides focused attention and support to a single individual) to Resident 4.During an interview on 7/3/25, at 11:02 a.m., the Director of Nursing (DON) stated Resident 4 was placed on one-to-one care after the third resident to resident incident. The DON stated after the first incident facility staff made sure Resident 4 did not go near Resident 1. The DON stated if Resident 4 was not put on one-to-one care, Resident 4 could have struck other residents. The DON further stated resident to resident altercation were not ok for Resident 1, Resident 2, and Resident 3 because of safety. The DON stated something could have happened to Resident 1, Resident 2 and Resident 3. The DON stated the residents might not have felt safe when another resident scratched them. The DON stated the facility was home to the residents and residents should have felt safe in their home-like environment.Review of Resident 1's Care Plan, initiated on 1/9/25, the record indicated, .Interventions: .Assure/encourage homelike environment to aid in emotional contentment .Review of Resident 1's Progress Note, dated 1/22/25 at 3:39 p.m., the record indicated, . [Resident 1] alleged that another female resident scratched [Resident 1's] face, upon skin assessment [Resident 1] does have a scratch mark and discoloration to her left cheek bone .Review of Resident 1's Progress Note, dated 1/23/25 at 1:52 p.m., the record indicated, . [Resident 1] stated I got scratched . [Resident 1] had scratches on her face .Review of Resident 1's Progress Note, dated 1/24/25 at 4:36 p.m., the record indicated, . I'm scared of the lady .Review of Resident 1's Progress Note, dated 1/27/25 at 3:55 p.m., the record indicated, . The lady, the lady scratched my leg .The lady, the lady hit me and scratched me .Review of Resident 2's Care Plan, initiated on 4/25/23, the record indicated, .Focus .Resident has [history of] trauma [related to] being abused by domestic partner .Goal .Resident will maintain optimal quality of life despite trauma .Resident will remain stable and free from trauma triggers .Review of Resident 2's Care Plan, initiated on 10/26/23, the record indicated, . Interventions .Resident will not suffer any mood/behavior declines .Review of Resident 2's Care Plan, initiated on 12/8/23, the record indicated, .Goal .The resident will have no indications of psychosocial wellbeing problem .Review of Resident 2's Care Plan, initiated on 12/22/24, the record indicated, . Interventions .Assure/encourage a homelike environment to aid in emotional contentment .Review of Resident 2's Progress Note, dated 3/31/25 at 4:22 p.m., the record indicated, . [Resident 2] stated that her roommate came out of the bathroom and [Resident 2] told her to be careful don't fall or hurt yourself and then her roommate came to her and scratched her on the arm .Review of Resident 2's Progress Note, dated 4/1/25 at 4:42 p.m., the record indicated, . [Resident 2] was asked does she feels safe and if she is in fear. She replied no she does not feel safe .Review of Resident 2's Progress Note, dated 4/3/25 at 3:14 p.m., the record indicated, . [Resident 2] is refusing to be changed and is complaining to her CNA's that she does not want to be here and is accusing her old roommate was roaming up and down the hall .Resident is hard to calm down while talking to her .Review of Resident 3's Care Plan, initiated on 10/27/22, the record indicated, . Goal . [Resident 3] will maintain optimal quality of life despite trauma .Review of Resident 3's Care Plan, initiated on 12/8/23, the record indicated, . Goal .The resident will have no indications of psychosocial wellbeing problem .Review of Resident 3's Care Plan, initiated on 9/27/24, the record indicated, . Goal .Will have no placement issues .Interventions .Monitor for any psychosocial issues that may impede her daily living .Provide a homelike environment for the resident .Review of Resident 3's Care Plan, initiated on 1/5/25, the record indicated, . Interventions .Encourage/maintain homelike environment to aid in emotional contentment .Review of Resident 3's Progress Note, dated 4/2/25 at 10:16 a.m., the record indicated, . [Resident 3's] roommate was coming (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055917 If continuation sheet Page 2 of 3 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055917 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Harvest Crossing Post Acute 469 East North Street Manteca, CA 95336 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete out of the bathroom and walked over to bed A where [Resident 3] sleeps and said to get out of my bed. [Resident 3] replied, this is not your bed. Her roommate then patted her firmly on the arm 3 times . [Resident 3] replied no it's just that I can't defend myself .it was just a strong pat on the arms .Review of Resident 4's Care Plan, initiated on 12/29/24, the record indicated, . Interventions .Encourage/maintain homelike environment to aid in emotional contentment .Review of Resident 4's Care Plan, initiated on 1/23/25, the record indicated, . Focus .The resident has a behavior problem of yelling and demonstrating aggressive behaviors to others .Interventions .Intervene as necessary to protect the rights and safety of others .Review of Resident 4's Care Plan, initiated on 1/23/25, the record indicated, . Focus .The resident has a behavior problem of wandering through hallways .Interventions .Encourage the resident to express feelings appropriately .Provided opportunity for positive interaction .Review of Resident 4's Progress Note, dated 1/22/25 at 4:10 p.m., the record indicated, .resident does not take any psychotropic meds, but does have untoward behaviors at times. Resident wanders around the facility in her wheelchair .The behaviors she exhibits are attempting to strike at others when agitated, makes a fist at others .argumentative .On 1/22/25, it was reported by another resident that [Resident 4] scratched her face .Review of Resident 4's Progress Note, dated 1/23/25, the record indicated, .1.Psychiatric Diagnostic Evaluation .This morning, the patient scratched a CNA who was passing by. According to staff, the patient is known to exhibit aggressive behavior spontaneously and unprovoked, often forgetting about such incidents afterward. The main issues identified in this visit were impulsivity, disinhibition [the loss or lessening of the ability to restrain one's thoughts, feelings, and behaviors, often leading to impulsive or socially inappropriate actions], and displays of physical aggression .Review of Resident 4's Progress Note, dated 4/1/25 at 9:22 a.m., the record indicated, .resident wanders around the facility in her wheelchair .The behaviors she exhibits are attempting to strike at others when agitated, argumentative, accusing people .if she feels someone is in her space she gets agitated then will probably strike out .On 3/31/25, it was reported by another resident that [Resident 4] scratched her right arm .Review of Resident 4's Progress Note, dated 4/1/25 at 4:28 p.m., the record indicated, . [Resident 4] was asked if she remembered what happened yesterday with her old roommate. She said yes but she got confused and said no. She mentioned that she did not like her .Review of Resident 4's Progress Note, dated 4/1/25 at 4:40 p.m., the record indicated, .Resident is having a room change from room [ROOM NUMBER]B to 24A. Resident is having a room change due to roommate compatibility .Review of Resident 4's Progress Note, dated 4/2/25 at 10:07 a.m., the record indicated, .resident wanders around the facility in her wheelchair .The behaviors she exhibits are attempting to strike at others when agitated, argumentative .if she feels someone is in her space she gets agitated then will probably strike out .On 4/01/23, it was reported by another resident that [Resident 4] slapped her left arm 3 times .During a review of a facility policy and procedure (P&P) titled Homelike Environment, revised 2/21, the P&P indicated, .Residents are provided with a safe, clean, comfortable and homelike environment . 2. The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics include: . comfortable sound levels . During a review of a facility P&P titled Residents Rights revised 2/21, the document indicated, .basic rights to all residents of this facility .b. be treated with respect, kindness, and dignity .During a review of a facility P&P titled Dignity, revised 2/21, the document indicated, .2. The facility culture supports dignity and respect for residents by honoring resident goals, choices, preferences, values and beliefs. This begins with the initial admission and continues throughout the resident's facility stay . Event ID: Facility ID: 055917 If continuation sheet Page 3 of 3