Health inspection·November 13, 2025

F 0778 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few staff to accompany her. The Receptionist stated it was her understanding that Resident 1 was just late for the appointment. During a concurrent interview and record review on 9/9/25, at 2:22 PM, with the Assistant Director of Nursing (ADON), the ADON stated there should be a staff member or family member accompanying Resident 1 to her appointment and the facility tried to send staff that spoke Resident 1's language to interpret for Resident 1. The ADON stated she expected the receptionist to make sure that a family member was available to go with Resident 1 or to let the nursing staff know in advance if a nursing staff member was needed. ADON stated if a resident missed their appointment, it could prolong the care and treatment of the resident. During a follow up interview on 9/10/25, at 10:14 AM, with the ADON, the ADON stated that the RN Supervisor told Resident 1 that no one was available to go with her to her appointment that speaks her language. The ADON stated she thought that the facility did not need to send a translator because the doctor's office would have their own translator services and Resident 1 should have gone to the appointment. The ADON stated that follow-up appointments should be made within 2 weeks to remove the staples because otherwise it could cause an infection. During an interview on 9/9/25, at 2:50 PM, with LN 2, LN 2 stated Resident 1's appointment on 9/4/25 was to check the staples and check for possible removal. LN 2 stated the facility could not send a nursing staff member as a translator that day. LN 2 stated that the nurses and the receptionist must coordinate calls to family members for resident appointments. LN 2 stated if a resident missed a doctor's appointment, there would be a delay in care for the resident.During a concurrent interview and record review on 9/10/25, at 10:03 AM, with the Director of staff development (DSD), the DSD stated the nursing staff can go with a resident for appointment and be a translator depending on the staffing number. The DSD further stated they can accommodate if they are given advanced notice. The DSD stated that based on the nursing staff schedule on September 4, 2025, they did not have enough staff to go with Resident 1 for her appointment that day.During a concurrent interview and record review on 9/9/25, at 3:11 PM, with the Director of Nursing (DON), the DON stated when a resident has an upcoming doctor's appointment, the nurse will put the order on the EHR (Electronic Health Records - digital versions of a patient's medical records), the social services (SS) and/or the receptionist will set up the appointment, call the family to accompany the resident, and arrange transportation. The DON stated Resident 1's appointment was set up, but she did not go because there was supposed to be a family member to be the translator but did not come and Resident 1 missed the appointment. The DON stated if residents missed their appointment, there was possibility of a delay of care. The DON stated if a non- English-speaking resident goes to an appointment, there was no requirement for the facility to send somebody that could translate, it would be just an extra service. The DON further stated that the doctor's office should have their own translator service.A review of Resident 1's medical record titled, Progress Notes dated 8/13/25, indicated, .observed BKA to bilateral (both sides) LE (lower extremities). Surgical sites covered with steri strips (sterile, thin, adhesive bandages used to close and support wounds or surgical incisions by holding the skin edges together, promoting healing and reducing scarring).A review of Resident 1's medical record titled, Progress Notes dated 8/20/25, indicated, .observed BKA to bilateral LE. Surgical sites covered with steri strips.A review of Resident 1's medical record titled, Order Details dated 9/2/25, indicated, .Follow Up with [doctor's name] MD on Thu (Thursday) September 4 @ 11 AM.Transport CNA NEEDED .A review of Resident 1's medical record titled, Order Details dated 9/8/25, indicated, .Post op follow up with Vascular MD on 9/11/25.A review of the facility policy and procedure titled, Translation and/or Interpretation of Facility Services, revised May 2017, indicated, .This facility's language access program will ensure that individuals with limited English proficiency (LEP) shall have meaningful access to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555307 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 555307 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Clearwater Healthcare Center 1517 East Knickerbocker Drive Stockton, CA 95210 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 0778 Level of Harm - Minimal harm or potential for actual harm information and services provided by the facility.Family members and friends shall not be relied upon to provide interpretation services for the resident, unless explicitly requested by the resident. If family or friends are used to interpret, the resident must provide written consent for disclosure of protected health information. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555307 If continuation sheet Page 3 of 3