Inspection·November 24, 2025

F 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. Based on observation, interview, and record review, the facility failed to follow a therapeutic diet plan to one of three sampled residents (Resident 2), when Resident 2 was served a hard to chew chicken burger at lunch. This failure had the potential to negatively impact Resident 2's nutritional status.Findings: A review of an admission record indicated Resident 2 was admitted to the facility in October 2024 with diagnoses including moderate protein-calorie malnutrition (a condition that occurs when a person does not consume enough protein to meet their body's needs), dysphagia (a medical condition characterized by difficulty swallowing), and adult failure to thrive (a condition characterized by a significant decline in weight, muscle mass, and overall health in adults). A review of Resident 2's Minimum Data Set (MDS; an assessment tool), dated 7/23/25, indicated Brief Interview of Mental Status score was 15 out of 15 with intact cognition. During an observation on 9/29/25 at 1:20 pm for the B-unit lunch tray pass, Resident 2's tray contained a burger bun with a large, breaded piece of chicken, tomato slice, lettuce, macaroni salad, juice, and pudding. During an interview on 9/29/25 at 1:30 pm with Resident 2, Resident 2 stated she did not eat her lunch because she could not chew it and her upper teeth were broken, which made it hard to eat the chicken burger. Resident 2 further stated the chicken meat was not tender enough to bite for her, and the meat was hard and chewy. A review of Resident 2's therapeutic diet plan, dated 9/3/25, indicated Resident 2 was to be served a regular diet easy to chew level 7 texture. A review of Resident 2's care plan, dated 9/23/25, indicated Resident 2 had a swallowing problem and a potential nutritional risk related to underweight, protein calorie malnutrition, dysphagia, and adult failure to thrive. During an interview on 9/29/25 at 3:58 pm with the Dietary Manager (DM), DM stated if a therapeutic diet plan was not followed correctly, then there could have been a chance that Resident 2 would have not eaten enough, and not eating enough could have caused a lack of proper nutrition. DM further stated if resident 2 was not able to chew the food properly, then it could have been a possible risk of choking. A review of the facility's policy and procedure (P&P) titled, Level 7 Regular Easy to Chew for Adults, dated 1/2019, indicated, Do not use foods that are: hard, tough, chewy, fibrous, have stringy textures, pips/seeds, bones or gristle. P&P further indicated, Meat cooked until tender, if you cannot serve soft and tender, serve meat Minced and Moist. 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 11/24/2025 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)