Health inspection·July 31, 2025

F 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide physical therapy services for one of three sample residents (Resident 1) as ordered by the physician and as outlined in the plan of care when Resident 1 was ordered to receive physical therapy five times per week beginning on 7/4/25 but documentation showed multiple missed therapy sessions.This failure placed Resident 1 at risk for decline in functional abilities and unmet care plan goals.Findings:A Review of Resident 1's admission RECORD, indicated, Resident 1 was admitted to the facility on [DATE] with primary diagnoses of urinary tract infection (UTI, an infection in the urinary system), diabetes type 2 (the body's inability to regulate sugar levels), acute kidney failure (sudden onset usually due to a medical issue), stage 3 chronic kidney disease (a condition where the kidneys are moderately damaged and unable to filter waste products effectively), and muscle wasting atrophy (a condition where muscles lose mass and strength due to prolonged inactivity or immobilization).Review of Resident 1's Brief Interview for Mental Status (BIMS, an assessment tool), dated 7/7/25, indicated Resident 1 scored 15 out of 15 points total. A score of 15 indicated Resident 1 had no cognitive impairment. During an interview with Resident 1 on 7/31/25 at 9:25 a.m., Resident 1 stated that she was informed she would receive physical therapy (PT) and occupational therapy (OT) every Monday, Wednesday and Friday. Resident 1 also reported that just recently, another therapist came in on Saturdays and Sundays to provide therapy. Resident 1 stated that if she does not have therapy, she remained in bed and performed her own exercises with a resistance band (elastic bands of varying resistance used to add tension to strength training exercises, promoting muscle growth), leg lifts, and Kegel exercises (exercises to strengthen the muscles in the pelvis region). Resident 1 stated her last therapy session consisted of sitting on the edge of the bed with her legs hanging down, performing leg exercises, squeezing a ball with her hand, and lifting a weight over her head. Resident 1 expressed that PT/OT services were not helping her improve.A review of Resident 1's physician order, dated 7/4/25, indicated, .PT to address .thera ex [therapeutic exercise], thera ac [therapeutic activity], neuro reeducation [a therapeutic technique used to retrain the brain and body to restore normal coordinated movement patterns], w/c [wheelchair] mgt [management] training, and pt [patient]/care giver training for 5x [times]/week for 6 weeks [stop date of 8/15/25] .During an interview with the Occupational Therapist (OT) on 7/31/25 at 1:46 p.m., the OT stated that the physical therapist was not in the building, and she was unsure if the therapist may be reached via phone. The OT confirmed that Resident 1 was scheduled to receive rehabilitation services five times per week. A review of Resident 1's physician progress note dated 7/4/25, indicated, .[Resident 1] has a chronic left upper extremity weakness, she wears a brace for prevention of contractures [a permanent tightening and shortening of muscles, tendons, skin, or ligaments]. [Resident 1] has generalized weakness, patient will be participating in physical therapy .she is at high risk for decline .A review of Resident1's Care Plan Report initiated on 7/4/25 indicated, .Focus: Physical Therapy Care Plan.Goal: Residents Affected - Some Page 1 of 2 555105 555105 07/31/2025 Noble Care Center 2740 North California Street Stockton, CA 95204

F 0825 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Pt will improve bed mobility to mod [moderate]/min [minimal assistance] .Target Date: 9/30/25. Interventions: .Therapeutic activity.Therapeutic exercise.Wheelchair mobility.A review of PT documentation dated 7/4/25 titled, PT Evaluation & Plan of Treatment showed Resident 1 was evaluated and a treatment plan was developed with the following details: .Treatment Approaches. Frequency: 5 time(s)/week.Duration: 6 weeks.Intensity: Daily.Certification Period: 7/4/2025 - 8/15/2025.A review of Resident 1's Physical Therapy Treatment Encounter Note(s) dated 7/4, 7/6, 7/7, 7/8, and 7/14/25 indicated Resident 1 received a PT session.A review of Resident 1's Physical Therapy Treatment Encounter Note(s) dated 7/9/25 indicated, .[Resident 1] Refused Treatment .A review of Resident 1's Physical Therapy Treatment Encounter Note(s), dated 7/11/25, indicated, .Missed therapy session d/t [due to] staff illness. Despite efforts to cover it, there was insufficient staff available to facilitate the session. The client [Resident 1] has been notified of the situation and rescheduled .A review of Resident 1's Physical Therapy PT Therapy Progress Note dated 8/18/25, indicated, .[Resident 1] was seen for 5 day(s) during the 7/4/25-8/2/25 progress period .During an interview with the Administrator (Admin) on 7/31/25 at 4:28 P.M., the Admin stated that the facility did not have a Physical Therapist at this time but expected one to return on 8/4/25.During a concurrent interview and record review over the phone with the Director of Nursing (DON) on 9/15/25 at 3:45 p.m., the DON confirmed Resident 1's physical therapy progress note read that Resident 1 was only seen 5 times from 7/4/25-8/2/25 and that her PT order was to have five therapy sessions per week. The DON confirmed Resident 1 was not seen by PT in the month of July after 7/14/25. The DON stated missed therapy session risks included missed opportunities for strengthening which was the goal. Review of an online article from the Cleveland Clinic titled, Physical Therapy (Physiotherapy), dated 3/7/24, indicated, .Physical therapy is a common treatment that can help you .manage symptoms from a health condition that affects how you move. It's a combination of exercises, stretches and movements that'll increase your strength, flexibility and mobility to help you move safely and more confidently . https://my.clevelandclinic.org/health/treatments/physical-therapy 555105 Page 2 of 2