The Hills Post Acute: Dialysis Access Failures - CA
The patient, identified in inspection records as Resident 816, depended on an arteriovenous shunt in the left upper arm for dialysis access. An AV shunt is a surgically created connection between an artery and a vein, and its function is detectable by touch and sound: a working shunt produces a vibration called a thrill and a rushing sound called a bruit. When those signs disappear, blood is no longer flowing through the site correctly. When redness, bleeding, swelling, or skin breakdown appear around it, infection or clotting may be developing.
Nurses at the facility were documenting both problems, on multiple shifts, across multiple days.
Inspection records show the shunt was recorded as absent for thrill and bruit, and positive for redness, bleeding, skin breakdown, and edema during PM shifts on March 12 and March 14, and during overnight shifts on March 11, March 12, and March 14. The documentation existed in the medication administration record. What did not exist was any record that a physician had been told.
Federal inspectors reviewed Resident 816's medical chart and found no evidence of physician notification tied to any of those assessments.
On March 20, inspectors interviewed the nurse who had been documenting the assessments, identified as LVN 10. The nurse explained the facility's own charting shorthand: a negative sign or an X meant the thrill and bruit were absent, while a Y indicated the presence of redness, bleeding, skin breakdown, or edema. LVN 10 confirmed that the chart showed exactly what inspectors had read, and confirmed what it meant.
"The licensed staff should have notified the physician," LVN 10 told inspectors, "because it was a change in condition if the AV shunt was assessed without thrill and bruit and with the presence of redness, bleeding, skin breakdown and edema."
A second nurse, identified as RN 1, was interviewed the same afternoon. RN 1 said that if a shunt showed absent bruit and thrill along with redness, edema, bleeding, and skin breakdown, the physician needed to be notified "as soon as possible" to implement proper interventions.
Both nurses, in other words, knew what the documentation required. The documentation showed the conditions had been present. The call was never made.
The director of nursing was informed of the findings on March 24, the final day of the inspection, and acknowledged them.
CMS assigned the deficiency a harm level of minimal harm or potential for actual harm, a designation that reflects what inspectors could confirm, not necessarily what the patient experienced. The inspection record does not describe what ultimately happened to Resident 816's shunt, whether dialysis was disrupted, or whether the site required intervention.
What the record does show is a gap between what nurses were trained to recognize and what they did with that recognition. The warning signs of a compromised dialysis access site were charted in the facility's own system, in the facility's own shorthand, by nurses who could explain exactly what those signs meant when an inspector asked. The chart accumulated entries. The physician's line stayed silent.
For a patient dependent on dialysis, access to that shunt is not incidental. It is the mechanism that keeps them alive between treatments. A clotted or infected AV shunt can require surgical revision, hospitalization, or emergency intervention. The nurses who assessed Resident 816 understood that. They wrote it down. They just didn't pick up the phone.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for The Hills Post Acute from 2025-03-24 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
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Last verified: November 5, 2026 · Our methodology
THE HILLS POST ACUTE in SANTA ANA, CA was cited for violations during a health inspection on March 24, 2025.
The patient, identified in inspection records as Resident 816, depended on an arteriovenous shunt in the left upper arm for dialysis access.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.