Trabuco Hills Post Acute: Lab Results Delayed to Doctor - CA
That finding, drawn from a complaint inspection completed August 21, 2025, sits at the center of a deficiency cited against the skilled nursing facility at 25652 Old Trabuco Road in Lake Forest. The violation involved Resident 1, whose complete blood count, a standard panel that screens for conditions ranging from infection to anemia to blood disorders, came back with results outside normal range. What happened next, according to the inspection record, was nothing.
The licensed nurse who received those results did not contact the physician. There was no phone call logged. There was no note in the chart. When inspectors reviewed Resident 1's closed medical record on the afternoon of August 21, they found no documentation showing the physician had been informed of the abnormal CBC at all, promptly or otherwise.
LVN 2, interviewed by inspectors that day, was direct about what should have happened. The licensed nurse, LVN 2 said, should have called the laboratory right away and then reported the abnormal results to Resident 1's physician. That is the sequence. That is not what occurred.
RN 1 confirmed it in a separate interview and record review conducted at 1:53 that afternoon. RN 1 verified there was nothing in the documentation to show the physician had been notified promptly. Then RN 1 said the same thing LVN 2 had said: the licensed nurse should have called the physician right away and documented the notification.
Two nurses, independently, described the same standard. Both confirmed it was not met.
The director of nursing was informed of the findings later that afternoon. The DON acknowledged them.
CMS tagged the deficiency under F0684, which covers the standard of care residents are entitled to receive, and assessed the level of harm as minimal harm or potential for actual harm. A small number of residents were noted as affected.
That designation, minimal harm or potential for actual harm, is the language regulators use when they cannot establish that a resident was hurt but also cannot rule it out. An abnormal CBC can signal something minor or something that requires immediate intervention. Without a physician being told, the decision about which it is never gets made. The clock on any necessary treatment never starts.
What the inspection record does not say is what was in Resident 1's blood count, how far outside normal range the results fell, whether Resident 1's condition changed in the period after the results came in, or why the nurse who received the results did not pick up the phone.
What it does say is that when inspectors arrived and started asking questions, both nurses on staff who spoke to them gave the same answer: this was wrong, and it was avoidable.
The facility's plan of correction is not included in the inspection record reviewed for this article. For information on how Trabuco Hills Post Acute intends to address the deficiency, CMS directs the public to contact the facility or the California state survey agency directly.
Resident 1's physician, the record suggests, still does not know what was in that blood draw unless someone made a call that was never written down.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Trabuco Hills Post Acute from 2025-08-21 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.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 20, 2026 · Our methodology
TRABUCO HILLS POST ACUTE in LAKE FOREST, CA was cited for violations during a health inspection on August 21, 2025.
What happened next, according to the inspection record, was nothing.
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.