Health inspection·July 22, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on interviews and record reviews, the facility failed to honor the right to self-determination (making own decisions) nor ensured one out of three sampled residents (Resident 1) was treated with respect and dignity, when Licensed Nurse (LN) B touched Resident 1 without consent.This failure resulted in Resident 1 feeling she was not treated with respect and dignity and that her rights were violated.Findings:A review of Resident 1s face sheet (front page of the chart that contains a summary of basic information about the resident) indicated she was admitted to the facility in April of 2025 and was self-responsible (taking ownership of one's actions and decisions).During an interview on 7/22/25 at 3:00 p.m., Resident 1 stated there was an incident when LN B had dragged her from the floor in the hallway back to her bed. Resident 1 stated at the time of incident, she was in a lot of pain and had laid down on a blanket in the hallway, as she believed it would help relieve her pain. Resident 1 stated LN B had grabbed her on the side by her armpits and dropped her onto her bed. Resident 1 stated while LN B was grabbing her off the floor she was repeatedly yelling, do not touch me! I do not give you permission to touch me! Let go of me! Resident 1 stated she also told LN B to call the police, to which LN B did not comply. Resident 1 stated LN B had completely disregarded her rights not to be touched without her consent and had not treated her with dignity and respect.During an interview on 7/22/25 at 3:23 p.m., LN B stated he recalled an incident, around the time he was giving Resident 1 pain medication, where Resident 1 had laid down on a blanket on the floor in the hallway. LN B stated Resident 1 would not get up from the floor when he asked and verified he had lifted Resident 1 up from the floor and took her to her bed. LN B confirmed Resident 1 had told him not to touch her and had repeated that she did not consent for him to touching her throughout the incident. LN B acknowledged Resident 1 also told him to call the police but he had not. LN B stated that in hindsight, he could have handled the situation better and should not have touched Resident 1 without her consent.During an interview on 7/22/25 at 3:44 p.m., the Director of Nursing (DON) stated she was aware Resident 1 alleged LN B had been physically abusive towards her during an incident when Resident 1 was lying on the floor in the hallway and LN B had taken to her bed. The DON stated she was not aware that Resident 1 had asked LN B not to touch her. The DON verified, when Resident 1 asked LN B not to touch her, LN B should have complied in respect to Resident 1's rights. The DON added, there were other ways to transfer Resident 1 from the floor to the bed.During an interview on 7/22/25 at 3:50 p.m., Unlicensed Staff D stated if a resident told a staff not to touch them, staff should not touch the resident. Unlicensed Staff D added, touching a resident without their consent was a violation of their rights.During an interview on 7/22/25 at 3:53 p.m., LN C stated if a resident said they did not give you consent to touch them, then you should not touch them. LN B stated if you touch a resident without their consent, they could feel their rights were not respected and they were violated.During an interview on 7/22/25 at 3:56 p.m., LN E stated if a resident did not give you permission to touch them and told you not to touch them, regardless of the (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 056090 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 056090 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Blue Oak Post-Acute 850 Sonoma Ave Santa Rosa, CA 95404 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)