The director of nursing told inspectors she had not been aware of how many signatures were missing from the shift count sheets.
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Federal inspectors documented the failures after a complaint inspection completed November 19, 2025.
The level of harm inspectors assigned was minimal, and the number of residents affected was listed as few.
The citation covered two separate complaints, filed under numbers 2659561 and 2663004.
The deficiency was one of 11 cited during the complaint inspection.
The resident, identified in inspection records only as Resident 9, had a medical history that made a fall particularly dangerous.
Federal health inspectors visited Franklin Heights Nursing & Rehabilitation on November 25 as part of a complaint investigation.
Ostomy care is not a complex specialty reserved for hospital settings.
Inspectors rated the deficiency at Scope/Severity Level E.
The incident was documented in a facility report titled "Stockton Nursing Center 5-Day Incident Summary Report," dated September 22, 2025.
The inspection, conducted on November 19, 2025, was a complaint visit.
Federal inspectors documented the pattern after three separate complaints prompted a November 2025 visit to the facility at 300 East Bath Road.