Bonita Hills Post Acute
Inspection Findings
F-Tag F0684
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility P&P review, the facility failed to provide the necessary care and services to ensure one of three sampled residents (Resident 1) attained and maintained their highest practicable well-being. * The facility failed to ensure Resident 1's physician was notified when Resident 1's urine color changed from yellow to dark amber. This failure had the potential for not providing the necessary care and services when the resident had a change in condition. Findings: Review of the facility's P&P title Notification of Changes revised dated [DATE REDACTED], showed the facility must inform the resident, consult with the resident's physician and/or notify the resident's family member or legal representative when there is a change requiring such notification. Closed medical record review for Resident 1 was initiated on [DATE REDACTED].
Resident 1 was readmitted to the facility on [DATE REDACTED], and expired on [DATE REDACTED]. Review of Resident 1's progress note dated [DATE REDACTED], showed a nursing entry regarding Resident 1's dark colored urine output.
However, further review of Resident 1's medical record failed to show if Resident 1's physician was notified when Resident 1 had dark colored urine output. On [DATE REDACTED] at 1445 hours, an interview and concurrent closed medical record review was conducted with LVN 1. LVN 1 stated at the beginning of her shift on [DATE REDACTED], she assessed Resident 1's urine color, which was yellow and clear. However, at the end of the shift LVN 1 observed Resident 1 had dark amber colored urine. LVN 1 stated she documented her observation
on the resident's progress notes but did not report the resident's change in condition to the physician. LVN 1 stated she should have reported the change in the color of the urine of the resident to Resident 1's physician. LVN 1 verified there was no documentation to show Resident 1's physician was notified of Resident 1's dark amber colored urine. On [DATE REDACTED] at 0937 hours, an interview was conducted with the PA .
The PA was asked if he was notified of Resident 1's dark colored urine on [DATE REDACTED]. The PA stated he could not recall if he was notified or not. The PA stated if he was notified then it would be documented in the Resident 1's medical record. On [DATE REDACTED] at 1530 hours, an interview and concurrent closed medical record
review for Resident 1 was conducted with the DON. The DON verified there was no documented evidence to show Resident 1's physician was notified about the resident's dark colored urine on [DATE REDACTED]. The DON was informed and verified the above findings.
Residents Affected - Few
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:
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/22/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Bonita Hills Post Acute
1233 West LA Habra Boulevard LA Habra, CA 90631
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0755
F 0755 Level of Harm - Potential for minimal harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
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, and facility P&P review, the facility failed to provide the pharmaceutical services for one of three sampled residents (Resident 1). * The facility failed to ensure the medications were administered as ordered by the physician for Resident 1. This failure had the potential to negatively affect the resident's health conditions and posed the risk for possible complications. Findings: Review of the facility's P&P title Medication Administration revised [DATE REDACTED], showed the medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice. Closed medical record review for Resident 1 was initiated on [DATE REDACTED]. Resident 1 was readmitted to the facility on [DATE REDACTED], and expired on [DATE REDACTED]. Review of Resident 1's MAR for [DATE REDACTED] showed two tablets of Tylenol (medication to treat pain and/or fever) was administered to Resident 1 on [DATE REDACTED], for a temperature of 99 degrees Fahrenheit. Review of Resident 1's Order Summary Report dated [DATE REDACTED], showed a physician's order dated [DATE REDACTED], to administer acetaminophen (Tylenol-medication to treat pain and/or fever) 325 mg two tablets via GT every six hours as needed for fever, if the temperature was greater than 100.5 Fahrenheit. On [DATE REDACTED] at 1445 hours, an
interview and concurrent closed medical record review for Resident 1 was conducted with LVN 1. LVN 1 verified Resident 1 was administered two tablets of Tylenol 325 mg medication on [DATE REDACTED], for a temperature of 99 degrees Fahrenheit. On [DATE REDACTED] at 1257 hours, an interview and concurrent closed medical record for Resident 1 was conducted with the QA Nurse. The QA Nurse was informed and verified LVN 1 failed to follow the physician's order when LVN 1 administered two tablets of the Tylenol medication to Resident 1 for
a temperature of 99 degrees Fahrenheit. On [DATE REDACTED] at 1530 hours, an interview was conducted the DON.
The DON was informed and acknowledged the above findings.
Event ID:
Facility ID:
If continuation sheet
BONITA HILLS POST ACUTE in LA HABRA, 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 LA HABRA, 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 BONITA HILLS POST ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.