Health inspection·December 12, 2024

F 0550 Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to: Residents Affected - Some 1. Ensure the rights of 1 of 3 sampled residents (Resident 11) were respected and honored when one Certified Nursing Assistant (CNA 9) displayed an obscene finger gesture toward Resident 11. This failure had the potential for Resident 11 to experience a negative effect to his psychosocial well-being, and, 2. Honor the rights of an unknown number of resident rights by ensuring staff followed their policy and procedure and spoke only English in the facility. This failure had the potential for resident rights to not be honored when an unknown number of residents heard staff speaking a non-English language, and possibly thinking staff were speaking about them. Findings: 1. During a review of the facility document titled, Verification of Incident Investigation / Administrative Summary (VIIAS) , dated 11/25/24, the VIIAS indicated, On 11/21/24 at approximately 4 pm an Admissions staff member reported that she witnessed male CNA flip off [Resident 11] with his middle finger. [Director of Staff Development, or DSD] was notified and the CNA was identified as [CNA 9] and was immediately pulled off the floor and suspended pending investigation. [CNA 9] stated he was preparing [Resident 12, who was Resident 11's roommate] for a shower & bumped into [Resident 11's] bed. At this time, [Resident 11] began using foul language and calling [CNA 9] names. [CNA 9] states that on his way out of the room, [Resident 11] kicked at him and continued cursing him and flipping him off. When [CNA 9] left the room with [Resident 12], he states he turned and flipped [Resident 11] off twice because he was frustrated and felt he did not do anything to deserve such treatment from [Resident 11]. [I]t was agreed upon to terminate [CNA 9] involved in the event. During a review of the facility document titled, Notice to Employee as to change in Relationship (Notice) , dated 11/25/24, the Notice indicated, On 11/25/24 [CNA 9's] employment status change/will change as follows: Involuntarily terminated for misconduct. During a review of Resident 1's Progress Notes (PN) , dated 11/21/24, at 5 pm, the PN indicated, [At 4 pm], Called by [Charge Nurse, or CN] regarding abuse [to Resident 1] by staff member. as per admission staff member, she saw staff member flipping off the resident, this nurse and the DSD immediately removed the staff member from the floor. [H]ead to toe skin inspection done by CN no physical (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 5 Event ID: 555240 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 555240 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Turlock Nursing & Rehabilitation Center 1111 E Tuolumne Road Turlock, CA 95380 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)