Victoria Healthcare And Rehabilitation Center
Inspection Findings
F-Tag F0755
F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, facility document review, and facility P&P review, the facility failed to ensure the administration of the controlled medications were accurately documented on the MAR (Medication Administration Record) for one of three sampled residents (Resident 1). * The facility failed to accurately document the hydrocodone/APAP 5-325 mg (a controlled medication) administration to Resident
- 1. This failure had the potential for the medications to be administered in error and opportunities for drug
diversion or drug misuse.Findings: Review of the facility's P&P titled Controlled Medications revised 12/2019 showed when a controlled medication is administered to the resident the licensed nurse enters the date, time, and amount administered on the accountability record. Review of the facility's P&P titled Recognition and Management of Pain revised 7/2017 showed the medications administered to the resident will be documented on the MAR. Medical record review for Resident 1 was initiated on 9/3/25. Resident 1 was readmitted to the facility on [DATE REDACTED], and discharged to the community on 8/23/25. Review of Resident 1's Order Summary Report showed a physician's order dated 8/18/25, for the following:- for hydrocodone/APAP 5-325 mg tablets, give one tablet by mouth every four hours as needed for pain level 4-7 (in a pain scale of 0-10, 0 = no pain to 10 = severe pain); and- for hydrocodone/APAP 5-325 mg tablets, give two tablets by mouth every four hours as needed for pain level 8-10, do not take more than eight tablets in 24 hours, APAP not to exceed 4,000 mg per day. a. Review of Resident 1's Tab Narcotic and Hypnotic Record for hydrocodone/APAP 5-325 mg tablets showed on 8/20/25 at 0132 hours, one tablet of hydrocodone/APAP 5-325 mg was removed from the supply. Review of Resident 1's MAR for August 2025 showed on 8/20/25 at 0132 hours, the nurse electronically signed the administration of two hydrocodone/APAP 5-325 mg tablets to Resident 1 for a pain level of 7. On 9/4/25 at 1021 hours, an
interview and concurrent record review was conducted with the DON. The DON stated the nurse accidentally signed the MAR and showed two tablets were administered instead of the one tablet removed from the controlled supply. b. Review of Resident 1's Tab Narcotic and Hypnotic Record for hydrocodone/APAP 5-325 mg tablets showed on 8/22/25 at 1930 hours, one tablet of hydrocodone/APAP 5-325 mg was removed from the supply. Review of Resident 1's MAR for August 2025 failed to show documentation if the hydrocodone/APAP controlled medication removed from the supply on 8/22/25 at 1930 hours was administered to Resident 1. On 9/4/25 at 1021 hours, an interview and concurrent record review was conducted with the DON. The DON verified the one tablet of hydrocodone/APAP 5-325 mg removed from the controlled supply on 8/22/25 at 1930, was not documented in Resident 1's MAR. The DON stated
the administration of the controlled medication should have been documented.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
VICTORIA HEALTHCARE AND REHABILITATION CENTER in COSTA MESA, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in COSTA MESA, CA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from VICTORIA HEALTHCARE AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.