Devonshire Care Center
DEVONSHIRE CARE CENTER in HEMET, CA — inspection on August 22, 2025.
Found 1 citation. 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
night. On August 28, 2025, at 2:19 p.m., RN 2 was interviewed. RN 2 stated she did not recall Resident 1, but stated if a resident asked for narcotic pain medication, and verified that the resident has an order for the narcotic pain medication, but the resident's stock was not available, then authorization has to be obtained from the pharmacy for the medication to be taken out of the emergency kit (e-kit). RN 2 stated two nurses, one RN and one LVN (Licensed vocational Nurse), have to sign for the medication's removal from the e-kit, then it would be administered to the resident. RN 2 also stated she did not recall if Resident 1 was given any regular or narcotic pain medication.On August 28, 2025, at 3:43 p.m., the Director of Nursing (DON) was interviewed.
The DON confirmed Resident 1 had physician's orders for Hydrocodone-Acetaminophen and to monitor pain every shift.
The DON confirmed there was no documentation on Resident 1's MAR and other Resident 1's record regarding pain monitoring for the PM and NOC shifts.
The DON stated she expected LNs to document what they did, saw, or observed regarding pain monitoring in the MAR.
The DON further stated pain monitoring for Resident 1 should have been documented in the MAR.A review of the facility's policy and procedure titled Pain Management, dated August 25, 2021, indicated, .To maintain the highest possible level of comfort for Residents by providing a system to identify, assess, treat, and evaluate pain.To design a plan of care to achieve an optimal balance between pain relief and preservation of function, in accordance with Resident directed goals.Patients will be evaluated.for the presence of pain upon admission/re-admission.with change in condition or change in pain status.At a minimum of daily, Residents will be evaluated for the presence of pain by making an inquiry of the Resident or by observing for signs of pain.Electronic Order Management (EOM): Document pain presence on the Medication Administration Record (MAR).If a Resident has a change in pain status, complete a pain evaluation (electronic).Residents receiving interventions for pain will be monitored for effectiveness and side effects.in providing pain relief.
Document.non-pharmacological interventions and effectiveness.Effectiveness of PRN medications.Ineffectiveness of routine or PRN medications including interventions, follow-up, and physician.notification.The care plan will be evaluated for effectiveness until satisfactory pain management is achieved.
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