Inspection·July 8, 2025

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. Based on observation, interview, and record review, the facility failed to ensure food preferences were accommodated for three of three sampled residents (Resident 1, Resident 2, and Resident 3), when:Resident 1 did not receive double portions of protein;Resident 2 did not receive salad; andResident 3 did not receive fresh fruit for lunch on 7/8/25 as listed in the meal tickets.These failures had the potential to negatively impact the residents' nutritional status.Findings:1. A review of Resident 1's admission Record, indicated she was admitted to the facility in 6/23 with diagnoses including anemia (the body does not have enough red blood cells to carry oxygen effectively throughout the body) and vitamin D deficiency (not enough vitamin D).A review of Resident 1's meal ticket, dated 7/8/25, indicated Resident 1 had double the portion of protein listed in the preference list. During a concurrent observation, interview, and record review on 7/8/25 at 12:28 p.m. with Resident 1, Resident 1's meal ticket, dated 7/8/25, was reviewed. Double portion of protein was listed in the preference list. Resident 1 confirmed there was no double portion of protein on the lunch plate.During a concurrent interview and record review on 7/8/25 at 1:35 p.m. with the Dietary Manager (DM), Resident 1's meal tray picture was reviewed. DM confirmed Resident 1's lunch tray did not include double the portion of protein for lunch on 7/8/25. 2. A review of Resident 2's admission Record, indicated she was admitted to the facility in 10/23 with a diagnosis of anemia.A review of Resident 2's meal ticket, dated 7/8/25, indicated, [NAME] vegetable every meal listed in the preference list.During a concurrent observation and interview on 7/8/25 at 12:37 p.m. with Resident 2, Resident 2 was eating her lunch in the dining room. Resident 2 confirmed she requested green salad with each meal and did not receive any salad.During a concurrent interview and record review on 7/8/25 at 1:35 p.m. with the DM, Resident 2's meal tray picture was reviewed. DM confirmed there was no salad in the meal tray during lunch. 3. A review of Resident 3's admission Record, indicated she was admitted to the facility in 9/19 with a diagnosis of vitamin D deficiency.A review of Resident 3's meal ticket, dated 7/8/25, indicated, Fresh fruit for dessert listed as the resident's preference. During a concurrent observation and interview on 7/8/25 at 1:02 p.m. with Resident 3, Resident 3 was eating her lunch inside her room. There was no fresh fruit available on the lunch tray. Resident 3 stated, Where is the fresh fruit? They did not bring any. During a concurrent interview and record review on 7/8/25 at 2:16 p.m. with the Registered Dietician (RD), Resident 3's meal tray picture was reviewed. RD confirmed there was no fresh fruit on Resident 3's meal tray during lunch. RD stated the residents' food preferences should have been honored since it was their choices of likes and dislikes of food. A review of the facility's policy titled, Resident Food Preferences, dated 2/9, indicated, Satisfy resident's tastes and appetite by determining and providing their food preferences at meals. The food and dining service staff will . make every attempt to meet the resident's food preferences. Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055922 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 055922 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Courtyard Health Care Center 1850 East 8th Street Davis, CA 95616 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)