Health inspection·October 25, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation on 10/25/24 at 11:02 a.m. with Resident 2 in Resident 2 ' s room, Resident 2 was observed assisted to the restroom by CNA 2. During an interview on 10/25/24 at 11:17 a.m. with Resident 2, Resident 2 stated she recalled that during the night she had requested to go to the restroom. Resident 2 stated she was told by the staff member to wet her bed because the staff member was not going to assist her to the restroom. Resident 2 stated she held the urge to urinate because she could not soil herself and laid in bed until her stomach hurt and was forced to urinate on her bed. Resident 2 stated she felt demeaned, humiliated and felt like she was wrong for wanting assistance to the restroom. Resident 2 stated she told the staff member that she was sorry, I know I could do better. During an interview on 10/25/24 at 11:22 a.m. with CNA 2, CNA 2 stated Resident 2 was continent of bowel and bladder and would use the restroom as needed. CNA 2 stated Resident 2 would stand, pivot and transfer to the restroom and to bed without any issues and requiring one-person moderate assistance. CNA 2 stated it was the facility expectation that assigned staff would assist residents when they requested to go to the restroom. CNA 2 stated it was not acceptable for a staff member to refuse to assist Resident 2 to the restroom. During a review of Resident 2 ' s, Activities of Daily Living (ADL) care plan (CP), dated 10/8/24, the CP indicated, . requires assistance with ADLs . call light within reach and answered promptly . transfers partial to moderate assist . During an interview on 10/25/24 at 11:39 a.m. with CNA 3, CNA 3 stated it was the facility ' s expectation for CNAs to assist residents with care, especially residents such as Resident 2 who used the restroom. CNA 3 stated it was important to maintain the resident ' s ability to transfer and use the restroom to keep residents from declining in physical function. CNA 3 stated, when CNA 1 refused to assist Resident 2 to the restroom, it was a form of neglect. During an interview on 10/25/24 at 11:47 a.m. with CNA 4, CNA 4 stated it was the facility expectation that staff assist all residents in the facility. CNA 4 stated staff could not refuse to assist a continent resident, such as Resident 2, to the restroom because it was the residents right. CNA 4 stated it was considered neglect, when CNA 1 refused to assist Resident 2 to the restroom. CNA 4 stated Resident 2 was put at risk for falls, and episodes of incontinence when she was not assisted. During an interview on 10/25/24 at 12:05 p.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 stated it was the facility expectation for staff to assist residents to the restroom if they are continent. LVN 1 stated it was not acceptable for any staff members to refuse to assist residents to the restroom and ask them to soil themselves. LVN 1 stated it as considered neglect when CNA 1 refused to assist Resident 2 to the restroom. LVN 1 stated Resident 2 was at risk for urinary tract infection, pain and falls when not assisted to the restroom. During an interview on 10/25/24 at 12:27 p.m. with the Director of Staff Development (DSD), the DSD stated it was the facility ' s expectation for staff to assist all residents with their needs. The DSD stated it was considered neglect and abuse when CNA 1 did not assist Resident 2 to the restroom. During an interview on 10/25/24 at 1:06 p.m. with the administrator (ADM), the ADM stated it was the facility ' s expectation that all staff will ensure residents were safe. The ADM stated CNA 1 had been removed from the facility and no longer working pending investigation. The ADM stated the facility was ensuring all residents were safe and free from abuse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056301 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 056301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Modesto Care Center 1900 Coffee Road Modesto, CA 95355 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a telephone interview on 10/30/24 at 9:57 a.m. with CNA 1, CNA 1 stated she was no longer employed by the facility following incident on 10/14/24. CNA 1 stated she could not recall any incident involving residents the night of 10/14/24 and did not recall refusing to take any resident to the restroom. CNA 1 stated during her employment in the facility she was in serviced and trained on abuse and neglect. During a review of the facility ' s policy and procedure (P&P) titled, Abuse, neglect, exploitation and misappropriation prevention program dated 2/2021, the P&P indicated, . Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but.is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms . Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to, facility staff, other residents . During a review of the facility ' s P&P titled, Resident Rights, dated 2/2021, the P&P indicated, . Employees shall treat all residents with kindness, respect, and dignity . free from abuse, neglect, misappropriation of property, and exploitation . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056301 If continuation sheet Page 3 of 3