The Pavilion At Sunny Hills
Inspection Findings
F-Tag F0695
F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
and when visibly soiled, and will be stored in a plastic bag at the resident's bedside to protect the equipment from dust and dirt when not in use. Medical record review for Resident 3 was initiated on 1/30/26. Resident 3 was admitted to the facility on [DATE REDACTED]. Review of Resident 2's care plan for asthma dated 1/20/26, showed give oxygen therapy as ordered by the physician. Review of Resident 3's MDS assessment dated [DATE REDACTED], showed a BIMS score of 12 (moderately impaired cognition). Review of Resident 3's Order Summary Report dated 1/30/26, showed may use oxygen via nasal cannula at one to five LPM as needed to maintain oxygen of more than 92%. On 1/30/26 at 0945 hours, an observation was conducted in Resident 3's room. The oxygen tubing curled around the portable oxygen tank was not bagged and labeled. The portable oxygen tank was inside an oxygen holder at the back of Resident 3's wheelchair. In addition, Resident 3 was on oxygen therapy using an oxygen concentrator via nasal canula.
However, there was no oxygen in use signage outside of Resident 3's room. On 1/30/26 at 0949 hours, an
observation and concurrent interview was conducted with CNA 3. CNA 3 verified Resident 3's oxygen tubing curled around the oxygen tank at the back of Resident 3's wheelchair was not bagged and labeled.
CNA 3 also verified Resident 3's entrance door did not have an oxygen in use sign. On 1/30/26 at 0952 hours, an observation and concurrent interview was conducted with LVN 5. LVN 5 verified Resident 3's oxygen tubing curled around the oxygen tank at the back of Resident 3's wheelchair was not bagged and labeled. LVN 5 stated it should have been bagged and labeled. LVN 5 also verified there was no oxygen in use signage in Resident 3's room entrance door. On 1/30/26 at 1100 hours, an interview was conducted with the IP. The IP was informed and acknowledged the above findings. The IP stated the oxygen and nebulizer tubing should be changed, bagged and dated by the night shift once a week and as needed. The IP stated there should be an oxygen in use signage for all rooms with residents using oxygen. The IP further stated the oxygen and nebulizer tubing should have been bagged and dated when not in use.
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THE PAVILION AT SUNNY HILLS in FULLERTON, 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 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.