Health Inspection

The Pavilion At Sunny Hills

April 28, 2025 · Fullerton, CA · 2222 N. Harbor Blvd.

Citations 2

CMS Rating 2/5

Beds 300

Provider ID 555733

Healthcare Facility

The Pavilion At Sunny Hills

Fullerton, CA · View full profile →

Source Document

Official CMS Inspection Report (Medicare.gov) · 69 pages

Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.

Inspection Summary

THE PAVILION AT SUNNY HILLS in FULLERTON, CA — inspection on April 28, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF656

Minimal harm or Few Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure affected

Review of Resident 80's Admission Body Check dated 3/12/25, showed the resident had a RUA PICC line with two lumens (channels or tubes inside the PICC line).

Review of Resident 80's H&P examination dated 3/13/25, showed Resident 80 had the capacity to understand and make decisions.

Review of Resident 80's plan of care showed a care plan problem dated 3/21/25, addressing the resident's RUA PICC line.

The interventions included to measure the IV lines on admission and after dressing change, and the arm circumference three inches above the insertion site every seven days during the day shift (0700 to 1500 hours).

555733

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 555733 B.

Wing 04/28/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Pavilion at Sunny Hills 2222 N.

Harbor Blvd.

Fullerton, CA 92835

FF689

Minimal harm or intended to be delivered into a vein leak into the surrounding tissue instead of the bloodstream) and came Few Further review of Resident 80's plan of care failed to show a care plan problem addressing the resident's affected

Review of Resident 80's H&P examination dated 3/13/25, showed Resident 80 had the capacity to understand and make decisions.

Review of Resident 80's plan of care showed a care plan problem dated 3/21/25, addressing Resident 80's RUA PICC line use.

555733

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 555733 B.

Wing 04/28/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

The Pavilion at Sunny Hills 2222 N.

Harbor Blvd.

Fullerton, CA 92835

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 FULLERTON, 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 THE PAVILION AT SUNNY HILLS or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.

More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.