Golden Modesto Care Center

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

grooming and showering.During a concurrent interview and record review on 8/21/25 at 1:12 p.m. with CNA 3, Resident 7's, Point of Care (POC)-Showers, dated 7/1/25-7/31/25, was reviewed. The POC indicated there were no documented refusals or changes in Resident 7's schedule to move showers to a different date, shift or time. CNA 3 stated the facility process was to give all resident showers on the scheduled date, document the shower, refusal to shower or any changes in the schedule on the residents POC. CNA 3 validated Resident 7 had not received a scheduled shower on 7/18/25, 7/25/25 and 7/29/25. CNA 3 stated all residents have the right to shower and live with dignity and respect.During a concurrent interview and

record review on 8/21/25 at 1:40 p.m. with the director of staff development (DSD), Resident 7's, CNA Shower Review Forms, dated 7/15/25 and 7/22/25, were reviewed. The forms indicated Resident 7 received

a total of two showers for the month of July. The forms indicated Resident 7 had not received a scheduled shower on 7/18/25, 7/25/25, and 7/29/25. The DSD stated the facility expectation was for the CNAs to follow

the shower schedule for each resident and to document the showers, baths or refusals on the POC and notify the nurse. The DSD stated it was not acceptable to have a resident refuse a shower and not document it to alert the nurse and other staff. The DSD stated Resident 7 had not received a shower on 7/18/25, 7/25/25 and 7/29/25 after review of all CNA documentation.During an interview on 8/21/25 at 2:12 p.m. with the director of nursing (DON), the DON stated the facility expectation was for all residents to receive their scheduled showers on the scheduled dates. The DON stated if the resident was refusing the showers, the CNA should have alerted the nurse and completed documentation in the POC and on the shower forms. The DON stated, the facility did not have a policy and procedure (P&P) on showers or Activity of Daily Living (ADL).During a review of the facility's policy and procedure (P&P) titled, Notice of Resident Rights, dated 7/2015, the P&P indicated, . Each resident of a skilled nursing facility has the rights.

The Center will seek to ensure that those rights are not violated. The Center will establish and implement written policies and procedures that include these rights and will make a copy of these policies available to

the Resident, Resident's Representatives, or the public upon request. General rights. To be encouraged and assisted throughout the period of stay to exercise rights as a resident. To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care of personal needs.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Modesto Care Center

1900 Coffee Road Modesto, CA 95355

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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

(DON), the DON stated there was no expectation for the facility staff to initiate a baseline care plan. The DON stated the baseline care plan should not have included every diagnosis residents had upon admission if the diagnosis was being treated with medications or other services. The DON stated the baseline care plan should have consisted of new diagnosis or changes in condition while in the facility.During a review of

the facility's policy and procedure (P&P) titled, Baseline Care Plan, dated 7/2025, the P&P indicated, .A baseline plan of care (BPOC) is developed and provided to each resident and/or his/her Representative, following admission. The facility develops the baseline plan of care for each resident, within 48 hours of admission. The baseline plan of care includes information regarding care and services sufficient to promote safe delivery of care. The baseline plan of care consists of the following, Physician Orders, Dietary Orders, Therapy Services, Applicable Social Services Intervention, Applicable PASARR Recommendations, Initial Goals.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Golden Modesto Care Center

1900 Coffee Road Modesto, CA 95355

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 0692 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Nutrition Hydration Skin Committee or designee reviews the weights, the Committee determines which residents are evaluated. The team or designee reviews the resident's status and makes recommendations.

Obtaining and Recording Weights: Weights are obtained by nursing personnel designated by the Director of Nursing Services. The staff member weighing the resident records the weight on the Weight Worksheet.

The nurse reviews the current weight and compares it to prior weight on Weight Worksheet. The nurse requests a re-weigh in accordance with the re-weigh definition outlined above. The nurse records validated weights on the Weight Record in the resident's medical record. Licensed nurses will notify physician, resident/responsible party of significant change in weight and document notification in progress notes.

Progress note to include responses.During a professional reference review retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892745/pdf/nihms156446.pdf, Patterns of Weight Change Preceding Hospitalization for Heart, dated October 2007, indicated, . Increases in body weight are associated with hospitalization for heart failure and begin at least [one] week before admission. Daily information about patients' body weight identifies a high-risk period during which interventions to avert decompensated heart failure that necessitate hospitalization for Heart Failure . Frequent monitoring of heart failure patients' clinical status, specifically their body weights, can alert clinicians to the early stages of heart failure decompensation. By focusing on weight changes, clinicians would be well positioned to implement interventions that could prevent decompensation of heart failure that necessitates hospitalization .During a review of professional reference titled, Practice Paper of the American Dietetic Association, dated 2010, indicated, . In older adults, a 5% or more unplanned weight loss in 30 days often results in protein-energy undernutrition as critical lean body mass is lost . that may trigger sarcopenia [a condition characterized by loss of skeletal muscle mass and function] and functional decline [a loss of independence

in self-care capabilities and deterioration in mobility and in activities of daily living]. (Practice Paper of the American Dietetic Association: Individualized Nutrition Approaches for Older Adults in Health Care Communities, October 2010 Journal of the American Dietetic Association). During a review of a professional reference publication titled, Nutrition Care of the Older Adult from the Academy of Nutrition and Dietetics, dated 2016, indicated, . The goal of Medical Nutrition Therapy is to maintain or restore the individual's usual body weight .

Event ID:

Facility ID:

If continuation sheet