Health inspection·February 9, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, interview, and record review, the facility failed to ensure one of twenty sampled residents (Resident 6) was treated with dignity, when the facility failed to replace Resident 6's missing upper dentures, leaving Resident 6 without her upper dentures for over one month. This failure resulted in Resident 6 requiring a change in the texture of her diet (in order to eat without upper teeth) and resulted in Resident 6 self-isolating from other residents due to embarrassment of missing teeth. Findings: Review of Resident 6's clinical record titled, Resident Face Sheet (a document that contains the resident's demographic information), indicated Resident 6's diagnosis included a need for assistance with personal care. During a concurrent observation and interview on 2/06/24 at 11:30 a.m., with Resident 6, Resident 6 was observed without upper dentures in her mouth. Resident 6 stated, Do you know how hard it is to eat with no upper teeth? Resident 6 further stated the dentures were lost soon after admission to the facility, about a month ago. A review of Resident 6's clinical record titled, Observation Report, dated 12/19/23 at 4:56 p.m., by Licensed Nurse (LN) 5, indicated Resident 6 was admitted to the facility with a full set of dentures. A review of the facility's document titled, Theft & Loss Report, dated 12/27/23, indicated Resident 6 was missing the upper dentures. A review of Resident 6's clinical record titled, Fax Communication, dated 12/28/23 at 12:10 a.m., indicated a request was made to the physician regarding a change in Resident 6's diet due to Resident 6 having trouble eating regular food. During an interview on 2/7/24 at 9:40 a.m., with LN 3, LN 3 stated dental appointments were made by the facility's Social Service Department. During an interview on 2/07/24 at 4:00 p.m., with the Social Services Director (SSD), the SSD stated Resident 6's family reported to the facility that Resident 6's upper dentures were missing. The SSD stated the facility had not yet made a dental appointment for Resident 6. The SSD acknowledged it was a dignity concern for Resident 6 not having her upper dentures for over a month. Page 1 of 16 555713 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0550 Level of Harm - Minimal harm or potential for actual harm During a concurrent observation and interview on 2/7/24 at 4:22 p.m., with Resident 6, Resident 6 was observed holding her head down while talking with the Department. When Resident 6 was asked how it made her feel to be missing her upper dentures, Resident 6 stated, How would you feel if you only had half your teeth - it makes me feel lousy. Resident 6 stated she made up her mind that tomorrow she would go to the facility's office and stand up for herself, and find out what could be done to get replacement dentures. Residents Affected - Few During an interview on 2/8/24 at 11:28 a.m., with LN 4, LN 4 stated Resident 6's dentures had been missing for about a month and was unsure if replacement dentures had been purchased. During an interview on 2/8/24 at 2:07 PM, with Resident 6, Resident 6 stated she very seldom ate in the communal dining room, and if she had all her dentures, she would feel more comfortable to eat with other residents. A review of the facility's document titled, Resident Rights, dated 12/13/2016, indicated, . (12). To be treated with consideration, respect, and full recognition of dignity (b). a right to dignity, privacy, and humane care . (d). A right to prompt medical care and treatment . During a review of the facility's document titled, Social Services Designee, not dated, the Job Description indicated, the Social Services Designee's essential job functions included, . assists with processing, verifying coverage or completing applications for all insurance coverage's as needed . uphold resident rights, . assists with providing for each resident social, emotional, and psychological needs . assists residents . in areas of all theft/loss . program, ancillary services coordination for dental . health . 555713 Page 2 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on interview and record review, the facility failed to ensure the Physician's Orders for Life Sustaining Treatment (POLST- a written physician's order that documents the types of medical treatment the resident wants to receive during serious illness, for example, chest compressions if the heart stops beating and/or a tube placed down the throat if breathing stops) was fully completed and/or uploaded to the resident's Electronic Health Record ([EHR]- information stored in the facility's computer system) per facility policy for five of eight sampled residents: 1. Resident 6 2. Resident 25 3. Resident 54 4. Resident 275 5. Resident 276 These failures could have resulted in a delay in treatment during a medical emergency and/or the incorrect life sustaining treatment administered to the Resident. Findings: 1. During a review of Resident 6's clinical record titled, Resident Face Sheet (a record that contains the resident's demographic information), indicated Resident 6's diagnoses included heart failure (when the heart doesn't pump adequately), high blood pressure (the high force of blood flowing through blood vessels), and peripheral vascular disease (blood circulation disorder). A review of Resident 6's clinical record titled, Physician Orders for Life-Sustaining Treatment (POLST), dated 12/20/2023, indicated, Section D was not completed, when it was not documented if Resident 6 had an Advanced Directive (a legal document that provided instructions for medical care and only went into effect if the resident could not communicate his/her wishes), the name of the Health Care Agent (an individual the resident appointed to make health care decisions if incapable of making own decisions) listed on the Advanced Directive (if applicable), and with whom the POLST information was discussed. 2. During a review of Resident 25's clinical record titled, Resident Face Sheet, Resident 25's 555713 Page 3 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some diagnoses included cardiomyopathy (damage to the heart muscle), heart valve replacement, and inability to communicate effectively. A review of Resident 25's clinical record titled, Physician Orders for Life-Sustaining Treatment (POLST), dated 12/29/2023, indicated Section D was not completed when it was not documented whether Resident 25 had an Advanced Directive and the name of the Health Care Agent listed on the Advanced Directive (if applicable). A review of Resident 25's EHR, indicated Resident 25's code (emergency measures to resuscitate if the heart and/or breathing stops) status and the POLST form were not uploaded to Resident 25's EHR. 3. During a review of Resident 54's clinical record titled, Resident Face Sheet, Resident 54's diagnoses included respiratory failure, pneumonia (lung infection), and severe kidney disease (inefficiency in filtering toxins from the body). A review of Resident 54's clinical record titled, Physician Orders for Life-Sustaining Treatment (POLST), dated 2/5/2024, indicated Section D was not completed when it was not documented whether Resident 54 had an Advanced Directive, the name of the Health Care Agent listed on the Advanced Directive (if applicable), and with whom the POLST information was discussed. A review of Resident 54's EHR, indicated Resident 54's code status and POLST form were not uploaded to Resident 54's EHR. 4. During a review of Resident 275's clinical record titled, Resident Face Sheet, Resident 275's diagnoses included a fractured (broken) back, cerebral palsy (a brain disorder that affects movement, balance and posture), and Parkinson's disease (a progressive disorder that affects the ability to control body movements). A review of Resident 275's clinical record titled, Physician Orders for Life-Sustaining Treatment (POLST), dated 1/24/24, indicated Section D was not completed when it was not documented if Resident 54 had an Advanced Directive, and the name of the Health Care Agent listed on the Advanced Directive (if applicable). A review of Resident 275's EHR, indicated Resident 275's code status and POLST form were not uploaded to Resident 275's EHR. 5. During a review of Resident 276's clinical record titled, Resident Face Sheet, Resident 276's diagnoses included heart disease, heart attack (damage to heart muscle), high blood pressure, and pneumonia. A review of Resident 276's clinical record titled, Physician Orders for Life-Sustaining Treatment (POLST), dated, 1/25/2024, indicated Section D was not completed when it was not documented if Resident 276 had an Advanced Directive, and the name of the Health Care Agent. A review of Resident 276's EHR, indicated Resident 276's code status and POLST form were not uploaded to Resident 276's EHR. During a concurrent interview and record review on 2/7/24 at 11:31 a.m., with LN 1, LN 1 stated POLST forms were completed by the admission nurse during the resident's facility admission process. LN 555713 Page 4 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1 stated the POLST form was a legal document and a physician's order with instructions for resident specific life-sustaining treatment. During a concurrent interview and record review on 2/7/24 at 11:44 a.m., with LN 2, LN 2 stated the facility's admission nurse initiated the process of completing the POLST forms. LN 2 stated if a resident did not have an Advanced Directive (Section D), there was a box that should have been checked that indicated, Advance Directive not available or no Advanced Directive. LN 2 further stated some staff members were not aware of the meaning of an Advanced Directive and more education needed to be provided. LN 2 stated the entire POLST form should always be completed in its entirety. During a concurrent interview and record review on 2/8/24 at 8:51 a.m., with the Infection Preventionist Nurse (IPN), Resident 25, Resident 54, Resident 275, and Resident 276's EHR were reviewed. The IPN verified the EHR for Resident 25, Resident 54, Resident 275, and Resident 276 failed to list the residents' code status; and the POLST forms were not uploaded to the EHRs. The IPN stated not having the code status listed in the EHRs could result in a delay of care because a staff member would have to leave the resident's side to search through the paper chart (housed in the nurse's station), to find the resident's code status. During a concurrent interview and record review on 2/8/24 at 11:27 a.m., with the IDON, the POLST forms and EHRs for Resident 6, Resident 25, Resident 54, Resident 275, and Resident 276 were reviewed. The IDON verified the POLST forms and the code statuses for Resident 25, Resident 54, Resident 275, and Resident 276 were not uploaded to the resident's EHR and the POLST forms were not completed in their entirety for Resident 6, Resident 25, Resident 54's, Resident 275, and Resident 276. The IDON stated this practice could result in delayed care to the resident during a medical emergency. During a review of the facility's document titled, Physician Orders for Life-Sustaining Treatment (POLST), dated 10/26/1999, the Policy and Procedure indicated, . if the resident or representative chooses to complete a POLST form . a designated staff member . will discuss the treatment options in the POLST form. Discussion will include the resident's Advanced Directive . The POLST form is uploaded into the resident's EHR in the Resident Documents section . 555713 Page 5 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to maintain a clean environment for two of 20 sampled Residents (Residents 26 and 30) when the fall mats beside their beds were soiled and torn. This failure had the potential to cause infection for Residents 26 and 30. Findings: During an observation on 2/6/24, at 10:00 a.m., the two fall mats in Resident 26's room were observed with sticky substance and tears. During an observation on 2/6/24, at 10:45 a.m., the two fall mats in Resident 30's room were observed with tears. During a concurrent observation and interview on 2/9/24, at 9:00 a.m., with the Infection Preventionist Nurse (IPN), in Resident 30's room, the IPN confirmed the mats in Resident 30's room were torn. The IPN stated the torn mats could lead to infection from cross contamination because it was difficult to clean a torn surface. Review of facility policy and procedure titled, Maintenance Department undated, indicated, The Maintenance Department will implement effective systems to ensure the facility and equipment are clean, safe, and in good repair .The Maintenance Supervisor will work closely with the infection control team to establish and maintain consistent practices and high standards of cleanliness . 555713 Page 6 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide oxygen therapy per its policy for one of two sampled residents (Resident 28) on oxygen therapy, when Resident 28's oxygen tubing had not been changed for 17 days. Residents Affected - Few This failure had the potential to lead to respiratory infection for Resident 28. Findings: During a concurrent observation and interview with Resident 28, on 2/6/24, at 10:05 a.m., Resident 28's oxygen tubing was dated 1/20/24. Resident 28 stated, It has been a while since they changed it. During an interview on 2/6/24, at 2:17 p.m., Licensed Nurse (LN) 3 stated, Oxygen tubing should be changed every Saturday. We missed the 27th of January and the 2nd of February. Review of the facility's policy and procedure titled, Oxygen Equipment dated 5/2017, indicated, .tubing .are to be changed every 7 days and as needed. 555713 Page 7 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the medication error rate was less than 5% (% or percentage is a fraction of a number out of 100) during medication administration. The facility had a total of five errors out of 32 opportunities, which resulted in a facility wide medication error rate of 15.6%. Medication observations were conducted over multiple days, at varied times, in random locations throughout the facility. The five medication errors were identified in two residents (Resident 35 and Resident 175) out of eight residents observed for medication administration observation as follows: Residents Affected - Few 1. Resident 35's medications were crushed and mixed in one cup for Tube Feeding (TF, a way to provide nutrition and medications when one cannot eat or drink safely by mouth. The tube is surgically inserted into the stomach) administration; and, 2. Resident 175's medications were crushed when the product labeling did not indicate crushing the medication was a safe practice. These unsafe medication administration practices could result in medication error and complications from clogging the surgically inserted feeding tube. Findings: 1. During a medication administration observation with Licensed Nurse (LN) 4, on 2/6/24, at 8:50 AM, in the Sequoia unit, LN 4 poured the pills belonging to Resident 35 in a plastic pouch and crushed them all together. The three pills crushed were listed in the medical record's Medication Administration Record (or MAR- a document that listed all drugs resident was receiving) as follows: ascorbic acid [vitamin C, a supplement] tablet; 250 mg [mg is milligram, a unit of measure]; gastric tube [via tube into stomach]; Once a Day; Start Date 1/25/24. carbidopa-levodopa tablet 25-100 mg [medication to treat a movement disorder called Parkinson disease]; gastric tube, Four Times a Day . Start Date 1/10/24. sodium chloride [a salt pill] . 1,000 mg .gastric tube; Twice A Day; Start Date 1/22/24. LN 4 mixed the crushed powder of pills with water in a cup and poured it into a syringe that was connected to the TF. The flow of pills mixed in water into the feeding tube was slow and LN 4 had to add water multiple times to dilute the slurry to go through. Further observation indicated LN 4 did not check the tube feeding residuals (it's the amount of feeding or water inside the stomach. It indicated how fast the stomach clears the liquids to prevent breathing the liquid into the lung) prior to giving the medication. Review of Resident 35's medical record, titled Medication Administration Record (or MAR), dated 2/8/24, the record did not address the medication administration through the tube feeding. The MAR indicated Flush PEG [percutaneous endoscopic gastrostomy] with 80 mL Water Pre and Post Bolus feeding Four Times per Day; Start Date: 1/30/24. In an interview with LN 4, at the Sequoia nursing station, on 2/6/24, at 2:50 PM, LN 4 acknowledged the medications should have been crushed and given individually and separately. LN 4 also 555713 Page 8 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few acknowledged the feeding tube residual was not checked since it was checked earlier that day during the morning tube feeding. In an interview with Interim Director of Nursing (IDON), in her office, on 2/8/24, at 10:07 AM, the IDON stated she expected the nursing staff follow the facility's policy and each medication should have been individually administered through the feeding tube to prevent clogging and the complications. The IDON stated the residuals should have been checked prior to any feeding and medication administration to assess if the feeding tube and stomach were working properly. Review of the facility's policy, tilted Medication Administration, dated 2007, the policy on section 5 indicated If the resident is tube-fed, medications are crushed finely to prevent clogging the tube. Check for specific prescriber order to crush medications . During a review of the facility's policy titled, Medication Administration: Enteral Tubes (Enteral tube same as Tube Feeding), dated 2007, the policy on section 10 indicated Crushed medications are not mixed together. The powder from each medication is mixed with water before administration .The standard of practice is that crushed medications should not be combined and given all at once via feeding tube. The policy in section 12 indicated, .each medication is administered separately to avoid interaction and clumping. 2. During a medication administration observation, with Licensed Nurse (LN) 4, on 2/6/24, at 9:15 AM, in the Sequoia unit, LN 4 crushed 10 pills to administer to Resident 175 and mixed them with apple sauce in a cup. LN 4 then spoon fed Resident 175 the apple sauce mixed with medications. Review of Resident 175's medical record titled, Medication Administration Record (MAR), indicated two of the 10 crushed pills were not crushable per product formulations as follows: aspirin ., delayed release [DR/EC- Enteric Coated and Delayed Release; a blood thinner]; 81 mg . Once A Day; For Pulmonary Embolism [blood clot in lung]; Start Date 1/23/24. guaifenesin . tablet extended release 12hr [a cough medication; slow-release pill]; 600 mg; Twice A Day; For Chronic Cough; Start Date 2/1/24. Further review of the MAR, indicated there was no order to crush medications by the doctor. In an interview with LN 4, at the Sequoia nursing station, on 2/6/24 at 2:55 PM, LN 4 stated she realized that she should not have crushed the slow released pills. LN 4 stated she had access to resources in the facility to check if a medication was crushable or not. In an interview with the Interim Director of Nursing (IDON), in her office, on 2/8/24, at 10:18 AM, the IDON stated the nursing staff should check the DO NOT CRUSH list (a standard medication list that should not be crushed) to check if they can crush a medication. The IDON stated the nursing staff needed to get an order and/or call pharmacy if a medication needed to be crushed. During a review of the facility's policy, tilted Medication Administration, dated 2007, the policy indicated Medications are administered as prescribed in accordance with manufacturer' specification, good nursing principles and practices . The policy in section 5 indicated, .the need for crushing medications is indicated on the resident's order and the MAR so that all personnel administering medication are aware . The policy further indicated, Long-acting, extended release or enteric coated 555713 Page 9 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0759 dosage forms should generally not be crushed; an alternative should be sought. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555713 Page 10 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure medications were labeled and used according to the manufacture specifications for a census of 74 when: 1. The medication cart (a wheeled cart that stores medications given to residents on daily basis) in Sequoia station contained medications not dated upon opening; and, 2. The medication cart in Harmony station contained medications not dated upon opening. These failures could result in unsafe medication use in the facility and ineffective medication treatment. Findings: 1. During a concurrent interview and medication cart inspection, accompanied by Licensed Nurse (LN) 6, in the Sequoia nursing station, on 2/6/24, at 2: 22 PM, medication cart 2 contained the following medications without a date marked when opened as follows: a. albuterol and ipratropium [also called Duoneb, a liquid medication used in a breathing machine to help with asthma or shortness of breath] inhalation solution, inside a box with opened foil pouch, was not marked with an opened date. Review of the manufacturer label on the box indicated, once removed from the foil pouch, the individual vial should be used within one week. b. Flucatisone and Salmeterol (same as Advair, a combination breathing medicine helped with asthma and shortness of breath) inhalation DISKUS [a medication device to breath in the medicine] was in an opened box, out of the foil packaging, and not marked with an opened date. Review of the manufacturer label on the box indicated, Discard inhaler 1 month after opening the foil pouch . LN 6 confirmed the finding and stated the pharmacy's label to put an open date was not marked or noticed when it was first opened. 2. During a concurrent interview and medication cart inspection, accompanied by Licensed Nurse (LN) 7, in the Harmony station, on 2/7/24, at 11:40 AM, the medication cart contained the following medications without a date marked when opened as follows: a. Breztri Aerosphere(a combination of 3 drugs in one inhaler for treatment of breathing problems) inhalation aerosol was open, out of foil, and was not marked with the date opened. The manufacturer label on the box indicated, Discard the inhaler when the labeled number of inhalations have used or within 3 months of opening the foil pouch, whichever comes first. b. Ellipta inhalation Powder (a combination of two drugs used to help treat the breathing problems including asthma) inhaler box was open, out of the foil pouch, and was not marked with the date that it was first opened. The manufacturer label on the drug box indicated, Discard the inhaler 6 weeks after opening the moisture-protective foil tray . LN 7 confirmed the findings and stated the date opened should have been marked on the box when it 555713 Page 11 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0761 was first opened. Level of Harm - Minimal harm or potential for actual harm In an interview with Interim Director of Nursing (IDON), in her office, on 2/8/24 at 10:18 AM, the IDON stated the nursing staff should follow manufacturer direction to look for the beyond use dates or call the pharmacy for the information. Residents Affected - Few Review of the facility's document titled, Appendix of Resources: Medications with Shortened Expiration Dates, dated 2007, the document with a color marking of SAMPLE, had a table that listed medications for inhalation and breathing diseases. The list included Advair inhaler with one month beyond use date. The respiratory table on the appendix did not include Breztri, Ellipta and Duoneb products. Review of the facility's policy titled, Medication Storage, dated 2007, the policy indicated Medications and biologicals are stored properly, following manufacturers or provider pharmacy recommendations, to maintain integrity and to support safe effective drug administration. The policy in section 7 indicated, Medications for oral inhalations are stored in the dispensed containers following manufacture guidelines . 555713 Page 12 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure one of twenty sampled residents (Resident 6) had a referral to a dentist following the loss of Resident 6's upper dentures shortly after admission to the facility. Residents Affected - Few This failure resulted in Resident 6 being without upper dentures for over a month and affected Resident 6's quality of life. Findings: Review of Resident 6's clinical record titled, Resident Face Sheet (a document that contains the resident's demographic information), indicated Resident 6's diagnoses included a need for assistance with personal care. During a concurrent observation and interview on 2/6/24 at 11:30 a.m., Resident 6 was observed without upper dentures in her mouth. Resident 6 stated, Do you know how hard it is to eat with no upper teeth? Resident 6 further stated the dentures were lost soon after admission to the facility, about a month ago. A review of Resident 6's clinical record titled, Observation Report, dated 12/19/23 at 4:56 p.m., by Licensed Nurse (LN) 5, indicated Resident 6 was admitted to the facility with a full set of dentures. A review of the facility's document titled, Theft & Loss Report, dated 12/27/23, indicated Resident 6 was missing the upper dentures. A review of Resident 6's clinical record titled, Fax Communication, dated 12/28/23 at 12:10 a.m., indicated a request was made to the physician regarding a change in Resident 6's diet due to trouble eating regular food. During an interview on 2/7/24 at 9:40 a.m., with LN 3, LN 3 stated dental appointments were made by the facility's Social Service Department. During an interview on 2/7/24 at 4 p.m., with the Social Services Director (SSD), the SSD stated Resident 6's family reported to the facility Resident 6's upper dentures were missing. The SSD stated the facility had not yet made a dental appointment for Resident 6, and had informed Resident 6's family that the family would have the responsibility of making the dental appointment due to insurance issues. The SSD stated it was the job function of the Social Service Department to make the resident's dental appointments, and the SSD could have made a dental appointment for Resident 6 with the resident's regular dentist (not the in-house dentist), and not relied on the family to make the appointment. During a concurrent observation and interview on 2/7/24 at 4:22 p.m., with Resident 6, Resident 6 held her head down while talking with the Department. When Resident 6 was asked how it made her feel to be missing her upper dentures, Resident 6 stated, How would you feel if you only had half your teeth - it makes me feel lousy. Resident 6 stated she made up her mind that tomorrow she would go to the facility's office and stand up for herself, and find out what could be done to get replacement dentures. 555713 Page 13 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0790 Level of Harm - Minimal harm or potential for actual harm During an interview on 2/8/24 at 11:28 a.m., with LN 4, LN 4 stated Resident 6's dentures had been missing for about a month and was unsure if replacement dentures had been purchased. During an interview on 2/8/24 at 2:07 p.m., Resident 6 stated she very seldom ate in the communal dining room, and if she had all her dentures, she would feel more comfortable to eat with other residents. Residents Affected - Few Review of the facility's Policy and Procedure titled, Dental Services, dated 10/23/2017, indicated, . In the event that the resident's dentures are . lost, nursing will work with Social Services and the attending physician to obtain a referral for dental services timely; referral made within 3 business days for an appointment . dental services are available to all residents requiring routine and emergency dental care . During a review of the facility's Job Description titled, Social Services Designee, the Job Description indicated the Social Services Designee's essential job functions included, . assists with processing, verifying coverage or completing applications for all insurance coverage's as needed . uphold resident rights . assists with providing for each resident social, emotional, and psychological needs . assists residents . in areas of all theft/loss . program, ancillary services coordination for dental . 555713 Page 14 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations during the initial tour of the kitchen, interview, and record review, the facility failed to follow its policy and procedure for safe storage of food when: Residents Affected - Few 1. Staff was not wearing a hair covering; and, 2. Expired food was available for consumption These failures had the potential to lead to contamination of food for all 74 residents. Findings: 1. During an observation on 2/6/24, at 8:35 a.m., the Director of Dining Services was in the kitchen without a hair covering. The Director stated he should have a hair covering and forgot to put one on when he entered the kitchen. 2. During an observation on 2/6/24, at 8:42 a.m., there was a box of Popsicles observed in the freezer labeled to use by 9/16/23. During an observation on 2/6/24 at 8:43 a.m., there was a container of curry powder dated good thru 5/28/23. During an interview with the Kitchen Services Manager on 2/6/24, at 8:50 a.m., she stated all staff should be wearing head coverings while in the kitchen and there should be no expired food in the kitchen as this may cause contamination. Review of the facility's policy and procedure titled, Personnel-Sanitary and Dress Standards, dated 7/29/19, indicated, Hair nets or caps are to be worn when in food production, food storage and ware-washing areas of the Dining Services . Review of the facility's policy and procedure titled, Food and Supply Storage dated 1/2024, indicated, Cover, label, and date unused portion of open packages complete all sections of the orange label .Products are good through the close of business on the date noted on the label . 555713 Page 15 of 16 555713 02/09/2024 Meadowood A Health and Rehabilitation Center 3110 Wagner Heights Road Stockton, CA 95209

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, interview, and record review, the facility failed to document in the electronic health record (EHR) for one of twenty sampled residents (Resident 6) when, there was no documentation on the measures taken by the facility to replace Resident 6's missing upper dentures. This failure had the potential to result in staff being unaware of Resident 6's missing upper dentures with the delay in documentation. Findings: During a concurrent observation and interview on 2/6/24 at 11:30 AM, Resident 6 was observed with lower dentures but no upper dentures. Resident 6 stated, Do you know how hard it is to eat with no upper teeth? Resident 6 stated her dentures had been missing since she arrived at the facility, about a month ago. During a concurrent interview and record review on 2/7/24 at 4 PM, Resident 6's progress notes were reviewed with the Social Services Director (SSD). The SSD stated the family reported to her that the dentures of Resident 6 were missing. The SSD stated Resident 6's family was informed the facility would reimburse them for the cost of replacement of the missing dentures. The SSD stated she filed a theft and loss report. The SSD agreed that no follow-up notes regarding communication with the family were documented in the Social Services progress notes section of the EHR related to Resident 6's dentures. During an interview on 2/8/24 at 11:28 a.m., with Licensed Nurse (LN) 4, LN 4 stated Resident 6's dentures had been missing for about a month and was unsure if replacement dentures had been purchased. During a concurrent interview and record review on 2/8/24 at 11:37 AM with the Interim Director of Nurses (IDON), the IDON stated she would like to see documentation somewhere in the medical record to see how the missing dentures were being addressed. Review of an undated facility provided document titled SOCIAL SERVICES DESIGNEE, in the section, Essential Functions, indicated, .8. Thoroughly documents complaints and processes filing requirements as needed as per regulation and reporting protocols . 555713 Page 16 of 16