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Complaint Investigation

The Pavilion At Sunny Hills

May 26, 2026 · 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)
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 May 26, 2026.

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

FF0684
Quality of Life and Care Deficiencies

morning, the resident appeared upset and reported her head hurt because CNA 5 had transferred her

transfers. On 5/26/26 at 1348 hours, an interview and concurrent closed medical record review was

after reviewing Resident 5's MAR for May 2026, LVN 2 acknowledged the notification occurred on 5/5/26. LVN 2 stated the SSD came to her before CNA 1 and informed her Resident 5 reported an incident and stated she had hit her head on the headboard. LVN2 stated she assessed the resident and found no injury.

When asked about documentation and notification, LVN 2 stated she completed a paper body check but did not document elsewhere because there was no injury, and did not need to notify the resident's physician. On 5/26/26 at 1354 hours, an interview and concurrent closed medical record review was conducted with the DON.

The DON stated if a resident reported hitting their head on the headboard during a transfer and continued to experience pain the next day, the licensed nurse should notify the physician and perform neurological checks.

The DON initially stated this did not apply because the resident was discharged when the facility became aware of the incident.

However, upon being informed the resident reported the incident on 5/5/26, while still in the facility, the DON stated that the nurse should have notified the physician and monitored the resident for possible injury.

The DON verified Resident 5's medical record failed to show documentation of the resident reporting the incident, physician notification or , continued monitoring. On 5/26/26 at 1400 hours, an interview was conducted with the SSD.

The SSD stated on 5/5/26, after Resident 5's care conference, the resident asked if he could stay behind, and reported CNA 5 transferred her without assistance and that she almost hit her head on the headboard.

555733 05/26/2026

The Pavilion at Sunny Hills 2222 N.

Harbor Blvd.

Fullerton, CA 92835

sampled residents (Resident 7). *

The facility failed to ensure Resident 7's floor mat was stored

surface of the mat touching the bed linen.

This failure placed the risk for contamination of Resident 7's bedding and the potential spread of microorganisms, increasing the risk of infection.Findings: Medical record review for Resident 7 was initiated on 5/26/27. Resident 7 was admitted to the facility on [DATE]. On 5/26/26 at 1030 hours, an observation and concurrent interview was conducted with CNAs 2 and 3. CNAs 2 and 3 were observed using a mechanical lift to transfer Resident 7 from his bed to a wheelchair. Resident 7 was observed lying in his bed. A floormat was observed propped up lengthwise against the left side of Resident 7's bed and the upper grab bar, with the upper portion of the floormat touching the resident's bedding. A photograph was taken documenting the floormat's placement. CNA 2 stated he had moved Resident 7's the floormat off the floor and leaned it against the resident's bed to make while performing the mechanical lift to transfer Resident 7. CNA 2 verified the floor and items placed on the floor are considered contaminated and acknowledged he should have placed the floormat against the wall instead of the resident's bed. On 5/26/26 at 1333 hours, an interview was conducted with the DON.

The DON stated any items on the floor were considered dirty.

The DON stated the floormat should not have been leaned along Resident 7's bed and acknowledged the issue as an infection control concern.

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.


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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.