Health inspection·December 16, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure blood glucose meters (glucometer - a blood sugar meter measures the amount of sugar in a small sample of blood) were calibrated and documented according to the facility protocol and current professional standards of practice on multiple days on November 2025. This failure had the potential to result in inaccurate blood glucose readings for residents requiring routine monitoring.Findings:A review of Station Three, Cart C November 2025 Quality Assurance Log indicated missing documentation for the following dates, with blank entries for time, staff performing, machine lot number, test strip lot number, low control, high control, and actions taken: -November 14, 2025;-November 15, 2025; and -November 19, 2025. On December 1, 2025, at 10:52 a.m., an interview and review of Station Three Quality Assurance Log were conducted with the Licensed Vocational Nurse (LVN 1). LVN 1 stated, glucometer calibration was the responsibility of the night shift nurse and was documented on the assurance logs located on the medication carts. LVN 1 stated there were two medication carts per station and stated we are good about doing the checks. LVN 1 further acknowledged the November 2025 log had missing documentation on November 14, 15, and 19, 2025, and there should not be any gaps on the logs. A review of the November 2025 Station One's Cart B Quality Assurance Logs indicated missing documentation on the following dates, with blank entries for time, staff performing, machine lot number, test strip lot number, low control, high control, and actions taken:-November 15, 2025;-November 16, 2025;-November 20, 2025;-November 21, 2025; andNovember 25, 2025 (low and high control and actions taken - blank). On December 1, 2025, at 11:18 a.m., a concurrent interview and record review were conducted with Registered Nurse Supervisor (RNS) at Station one. The RNS stated, LVNs on the night shift was responsible for completing glucometer calibration logs including lot numbers, control ranges and results. The RNS stated the logs were necessary to ensure accurate blood glucose readings. The RNS stated if there is nothing written you would not know if the glucometer was checked and then you would not know if your readings were accurate. The RNS stated the licensed nurses for the day shift should double check the logs during reports and make the corrections. RNS stated she was not previously aware of the gaps. On December 1, 2025, at 12:32 p.m., a concurrent interview and record review was conducted with the Director of Staff Development (DSD). The DSD stated the night shift was responsible for completing the calibration logs and that oncoming shifts should review and complete the logs if missing to ensure accuracy. A review of the November 2025 Quality Assurance Log for Station Two Carts B and C indicated missing documentation as follows, with blank entries for time, staff performing, machine lot number, test strip lot number, low control, high control, and actions taken: -Station Two Cart B - November 19, and 25, 2025-Station Two Cart C - November 29, 2025 On December 1, 2025, at 12:53 p.m. an interview and record review were conducted with the Director of Nursing (DON). The DON stated the LVN's conducting the medication administration for the night shift should be doing the glucometer checks and when the checks are done that were to fill out the assurance log fully including the lot number and range and Residents Affected - Some (continued on next page) 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 Page 1 of 2 Event ID: 555297 Printed: 05/15/2026 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 555297 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hemet Hills Post Acute 1717 West Stetson Avenue Hemet, CA 92545 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)