Health inspection·December 30, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few services as needed. c. 12/17/25 Activities Progress Notes - .Resident is alert and oriented, can make needs known. She is short term stay, here for rehab.Lives alone.Has caregiver that comes Tuesday and Friday.She is legally blind.Plan discharge is today. d. 12/18/25 Social Services Progress Notes - .SSD was informed by the rep from [HOME HEALTH AGENCY NAME] that they were unable to open the resident for services Per the resident's PCP, resident has not been seen by her PCP for over a year and more so it would require for the resident to follow-up with PCP to establish care again before services can start. During an interview on 12/19/25, at 9:48 a.m., with Licensed Nurse (LN), LN stated Resident 1 was admitted to the facility on [DATE] and was discharged on 12/17/25. LN 1 further stated Resident 1 was considered a short term stay for rehabilitative services following a surgery of a fracture on her left femur at the hospital. LN stated she was the nurse that discharged the resident on 12/17/25 and was notified of the discharge during the change of shift report. LN further stated usually the resident's doctor would order for the discharge and then the social services (SS) and case manager (CM) would start the discharge process. LN stated the SS coordinated with the resident and family and would have sent out the referrals needed for discharge. LN further stated Resident 1 was discharged to her home with her friend present to drive her on 12/17/25. LN stated residents could be discharged home without anyone living with them if they were capable and were provided with HHA services. LN further stated she was not sure if Resident 1's friend lived with her. LN stated it was important to follow the discharge process to know where the residents were getting discharged to, if they were ready and if they were safe for discharge. LN further stated the risk of an unsafe discharge would be the risk of re-hospitalization or the family would find other placement themselves. During a concurrent interview and record review on 12/19/25, at 10:20 a.m., with the CM, Resident 1's electronic health record (EHR) was reviewed. The CM stated the discharge process was a collaboration between the IDT (Interdisciplinary team - a group of healthcare professionals from different fields who work together to create a coordinated plan for the resident's care) and the doctor to clear the resident for discharge. The CM further stated if a resident lived alone at home, the resident would need to have a caregiver for recommended hours with HHA services depending on the coverage hours needed. The CM stated the therapy department would make recommendations on HHA services needs that would be discussed during the IDT meetings. The CM further stated Resident 1 was admitted to the facility for short term stay and the initial plan was for physical therapy (PT) and occupational therapy OT) services for 8 weeks total. The CM reviewed Resident 1's discharge notes and stated social services did Resident 1's discharge planning that was initiated by the resident and her friend. The CM stated if the resident initiated the discharge, the process was to inform the resident's doctor for clearance if the discharge was not anticipated. The CM further stated Resident 1's discharge was her preference and was not a discharge against medical advice. The CM confirmed Resident 1 had a discharge to home order dated 12/17/25. The CM further reviewed Resident 1's SS notes and stated the Social Services Director (SSD) was informed on 12/18/25 by the HHA and was unable to open services for Resident 1. The CM stated the expectation was to have encouraged home health establishment before considering discharging the residents and ideally to have confirmation with the HHA that they could even take the resident at all. The CM further stated that HHA services for PT, RN and home health aides should have been confirmed before a resident was discharged from the facility. The CM stated the risk of an unsafe discharge would be the potential of resident's readmission to the hospital and being unsafe at home without appropriate supervision and assistance. During an interview on 12/19/25, at 11:25 a.m., with the Director of Therapy (DOT), the DOT stated Resident 1 was admitted to the facility on [DATE] and the last therapy session was on 12/16/25. The DOT further stated Resident 1 was using (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555307 If continuation sheet Page 2 of 5 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 12/30/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few a front wheel walker for mobility with standby assistance because she also had vision issues. The DOT stated Resident 1 was not really discharged from PT or OT services but Resident 1 preferred to be discharged on 12/15/25. The DOT further stated Resident 1 was recommended to be discharged home with HHA services for her case. The DOT stated it was ideal for HHA with PT and OT services to have been in place and confirmed before discharging the resident. The DOT further stated HHA services should have started within 72 hours following discharge from the facility. During a concurrent interview and record review on 12/19/25, at 12:19 p.m., with the SSD, Resident 1's EHR was reviewed. The SSD stated on 12/12/25, Resident 1 was agitated and wanted to go home and was offered support to continue working with therapy first and to talk about discharging later. The SSD further stated on the following Monday, 12/15/25, Resident 1 was still agitated and wanted to go home with her friend, so the SSD offered to wait and see to discuss with the IDT and doctor first. The SSD stated it was Resident 1's choice of wanting to discharge home and was offered placement but she was not happy and wanted to go to her own home. The SSD further stated Resident 1 did not live with anyone and owned her own home. The SSD stated Resident 1 was discharged home on [DATE] and her friend with her husband came to pick her up from the facility. The SSD further stated she sent referrals for the HHA and hospital bed on 12/15/25. The SSD confirmed the HHA notified her on 12/18/25 that they would not be able to take Resident 1 for HHA services due to her not being established with her primary care doctor (PCP). The SSD stated she did not know who Resident 1's PCP was. The SSD further stated the risk of an unsafe discharge would be the risk of falls and readmission. The SSD stated if residents lived alone and were independent, it would be good to have someone there with them at home. During a phone interview on 12/30/25, at 8:53 a.m., with the home health agency staff (HHS), the HHS verified the HHA received Resident 1's referral on 12/15/25 from the SNF. The HHS confirmed the HHA did not start services with Resident 1. The HHS stated that the HHA would verify all resident referrals received for insurance coverage, and would only get authorized to start HHA services if the resident's PCP would follow their care. During a phone interview on 12/30/25, at 9:13 a.m., with Resident 1's Emergency Contact (EC), the EC stated Resident 1 was still without HHA services. The EC further stated she visited Resident 1 daily while she was still at the facility and was worried about her discharge because of her mobility and vision issues living at home by herself. The EC stated she would call in and check on Resident 1 daily, but could not be with her 24/7 (24 hours a day, 7 days a week). The EC further stated her main concern was that Resident 1 was not safe living at home by herself following the surgery and with her vision being very limited worried her a lot. During a concurrent interview and record review on 12/30/25, at 10:41 a.m., with the Assistant Director of Nursing (ADON), Resident 1's EHR was reviewed. The ADON stated it was expected for the SS to have verified all referrals for a resident being discharged from the facility. The ADON further stated the SS would have verified with the HHA to discuss when they could go and assess the resident's home situation and caregiver training would also be completed before discharging the resident to their home if needed. The ADON confirmed the SS's note dated 12/18/25 which indicated the HHA was not able to accept Resident 1 for HHA services the day after she was discharged . The ADON stated the HHA should have been verified by the facility before discharging Resident 1 to her home, especially since she was [AGE] years old. The ADON further stated if the HHA was not yet established and if Resident 1 insisted on leaving the facility then a discharge against medical advice (AMA) should have been done, and the facility should have helped Resident 1 establish with a PCP if she did not have one. The ADON confirmed that no discharge AMA was in place or documented in Resident 1's chart. The ADON stated the SS should have notified the IDT team if the HHA and DME setup was not available before discharging Resident 1 to her home. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555307 If continuation sheet Page 3 of 5 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 12/30/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The ADON further stated Resident 1 did not have a safe discharge based on not having the HHA established before being discharged from the facility. The ADON stated the risk of an unsafe discharge would be the risk of falls and readmission to the hospital. During an interview on 12/30/25, at 11:28 a.m., with the DOT, the DOT stated the risk of discharging home without HHA services established would be not getting continued care for therapy, chance of the resident getting weaker and would not progress with the care needed. The DOT further stated if the resident lived alone, the resident would have relied on the HHA services due to not having enough support at home. The DOT stated the risk of falls or readmissions were possible if a resident was discharged home without HHA being established. Review of Resident 1's EHR titled, Physical Therapy PT Discharge Summary, dated 12/18/25, indicated .D/C [Discharge] Destination: Home.D/C Reason: Against Medical Advice.Patient Progress: Progress & Response to Treatment: Patient made consistent progress throughout Plan of Treatment but because she lives alone, needs to manage 6-8 steps to bedroom/legally blind, she needs to be more higher functioning or modified independent before going back home and needs supervision for safety.Discharge Recommendations: Home health services, in-home aide, Lifeline for safety and Shower chair without back.Prognosis .requires 24/7 supervision for safety due to high risk of falls. During a concurrent interview and record review on 12/30/25, at 12:29 p.m., with the DOT, Resident 1's PT Discharge summary, dated [DATE], was reviewed. The DOT confirmed the discharge reason indicated, Against medical advice. The DOT stated Resident 1's discharge summary was done on her last therapy session on 12/15/25 and therapy was under the impression that Resident 1 had a great support system with friends being with her everyday, but it all changed the day of discharge when it was discovered she needed more help. During a concurrent interview and record review on 12/30/25, at 1:32 p.m., with the Physical Therapist (PT), Resident 1's EHR was reviewed. The PT stated the process of discharging residents from therapy was usually discussed weekly during their meetings to discuss their levels. The PT further stated the resident's levels were given to their manager if they were safe to discharge to start the discharge process or could also depend if the resident preferred to discharge home on certain days or based on their insurance coverage. The PT stated if the resident insisted on discharging home, HHA services were usually standard and caregiver assistance would be advised if needed. The PT further stated Resident 1 never mentioned wanting to go home to him and if she did then he would have advised her to continue with therapy for maybe another week. The PT stated he saw Resident 1 two days before being discharged from the facility and Resident 1 was noted to be very unsafe, was impulsive, with poor safety awareness and lived alone at home, with her bedroom on the 2nd floor. The PT further stated the initial plan for Resident 1 was to have therapy for 4 weeks and to get her to an assisted living facility. The PT stated eight days at the facility was not enough for Resident 1 to be discharged home with HHA services. The PT further stated he did not recommend Resident 1 to be discharged because she was unsafe and needed 24/7 supervision. The PT reviewed Resident 1's PT Discharge summary, dated [DATE], and confirmed Resident 1 had an unsafe discharge and was against medical advice. The PT stated he found out Resident 1 was discharged based on her preference the day after she left the faciity on [DATE]. The PT further stated Resident 1 only mentioned discharging to the SSD and the SSD thought she was going home to the friend's home and not to her own home. The PT stated the risk of an unsafe discharge would be for Resident 1 to fall again and be readmitted . The PT further stated the reason why he put against medical advice on Resident 1's summary was due to her needing at least 1-2 more weeks of therapy and due to her being legally blind with vision problems. The PT confirmed Resident 1's should have been discharged against medical advice due to being an unsafe discharge. The PT further confirmed Resident 1 had an unsafe discharge based on her being [AGE] years old, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555307 If continuation sheet Page 4 of 5 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 12/30/2025 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete being legally blind, needed 50% assistance for stairs, lived by herself and HHA was not established before leaving the facility. Review of Resident 1's EHR titled, NOTICE OF TRANSFER/DISCHARGE, dated 12/15/25, indicated .Effective Date: 12/17/25.Transfer/Discharge to: Home. with boxes checked off which indicated, .The transfer or discharge is appropriate because your health has improved sufficiently so that you no longer require services provided to the facility., with handwritten box option checked off which indicated Per Preference. During a concurrent interview and record review on 12/30/25, at 2:42 p.m., with the Director of Nursing (DON), Resident 1's Notice of Transfer/Discharge was reviewed. The DON confirmed the document which indicated Resident 1's preference to be discharged . The DON reviewed Resident 1's PT Discharge summary dated [DATE], and confirmed that Against Medical Advice, was indicated as the discharge reason. The DON stated if the facility knew that Resident 1 would be discharged home by herself it would have been considered discharge against medical advice. The DON further stated the risk of an unsafe discharge would be the higher risk of readmission, going back to the hospital or injuries. During an interview on 12/30/25, at 2:59 p.m., with the Administrator (ADM), the ADM stated it was his expectation for the staff to have verified referrals before a resident was discharged . The ADM further stated the facility should have checked if the agency was in communication with the resident, if they could accept the resident, and if the agency could not accept, the facility should have made arrangements for other agencies. The ADM stated the risk of an unsafe discharge would be the resident's risk of rehospitalization. Event ID: Facility ID: 555307 If continuation sheet Page 5 of 5