Health inspection·June 6, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 interview and record review the facility failed to use safe and appropriate transfer methods according to resident care needs for one of three sampled residents (Resident 3) when Resident 3 was transferred from a shower chair (a waterproof chair on wheels used to transport residents to and from the shower room) into his bed without the use of a mechanical lift (a device used to safely transfer Resident 3 from one surface to another). This failure could have been the cause of Resident 3 ' s right proximal tibia (upper part of the shin bone where it widened to help form the knee joint) fracture and right lower leg skin breakdown, which could have negatively affected his health and well-being. Findings: During a review of Resident 3 ' s admission RECORD, the document indicated Resident 3 ' s diagnoses included muscle weakness and disorders of bone density and bone structure (conditions that led to weakened bones and increased fracture risk). A review of Resident 3 ' s Minimum Data Set, (MDS- a federally mandated resident assessment and screening tool which identifies care needs) dated 3/14/25, indicated, .Section C- Cognitive Patterns .Brief Interview for Mental Status (BIMS) [tool used to screen for cognitive impairment] BIMS Summary Score .13 . A score of 13 suggested cognition was intact. A review of Resident 3 ' s MDS, dated [DATE], indicated, .Section GG-Functional Abilities and Goals .GG0115. Functional Limitation in Range of Motion .Lower extremity [hip, knee, ankle, foot] . was coded 2, which indicated, .Impairment on both sides .GG0130 .Chair/bed-to -chair transfer . was coded 88, which indicated .Not attempted due to medical condition or safety concerns . During an interview on 6/6/25, at 2 PM, in Resident 3 ' s room, with Resident 3 and Resident 4 (the roommate and spouse of Resident 3), Resident 4 stated she observed Resident 3 being taken to the shower in a shower chair. Resident 4 further stated the Certified Nurse Assistants (CNA) got Resident 3 up thinking he could walk but he was not able to walk. Resident 4 stated Resident 3 should have been on a gurney (waterproof bed on wheels used to transport Resident 3 to and from the shower) instead of a shower chair. Resident 3 stated when he was transferred back into the bed he heard a crack sound. Resident 4 stated she did not hear the crack sound, but she heard Resident 3 say ouch. During an interview on 6/6/25, at 2:22 PM, with the Licensed Nurse (LN) 2, LN 2 stated she documented discoloration and pain to Resident 3 ' s leg on the night shift of 3/24/25. LN 2 stated Resident (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 3 Event ID: 056216 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 056216 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Guardian Care and Rehabilitation Center 410 Eastwood Ave 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)