Health inspection·January 2, 2026

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on interview and record review the facility failed to ensure Levothyroxine was administered for one of one resident (Resident 6) reviewed for quality of care, when Resident 6 did not receive the scheduled dose of Levothyroxine on November 30, 2025 and December 4, 2025.This failure had the potential for Resident 6 not to receive the desired benefit of the medication and may cause adverse reactions.Findings:On December 5, 2025, at 10:44 a.m., an interview was conducted with Resident 6 in her room. Resident 6 stated she did not receive her daily scheduled dose of Levothyroxine on November 30, 2025 and December 4, 2025. A review of Resident 6's admission Record dated December 5, 2025, indicated an admission date of February 6, 2023, with a diagnoses which included hypothyroidism (condition where the thyroid gland does not produce enough essential hormones (like thyroxine) to regulate the body's energy use, slowing down metabolism and bodily functions like heart rate, breathing, and digestion).A review of Resident 6's History and Physical dated October 20, 2025, indicated resident had the capacity to understand and make decisions.A review of Resident 6's Physician Orders dated December 22, 2025, indicated Levothyroxine (thyroid hormone medication to treat hypothyroidism (an underactive thyroid gland)) Sodium Oral Capsule 150 micrograms (mcg - a unit of measurement), give 150 mcg by mouth in the morning for Hypothyroidism was ordered on August 28, 2025.A review of Resident 6's November 2025 Medication Administration Record (MAR) for Levothyroxine 150 mcg dated November 30, 2025, at 6 a.m., indicated the medication was not administered. A review of Resident 6's Medication Administration Note dated November 30, 2025, at 5:36 a.m. indicated, .Levothyroxine Sodium Oral Capsule 150 mcg Give 150 mcg by mouth in the morning for Hypothyroidism waiting on meds to be delivered.A review of Resident 6's December 2025 Medication Administration Record (MAR) for Levothyroxine 150 mcg dated December 4, 2025, at 6 a.m. was blank and did not indicate a checkmark, representing the medication was administered.There was no documented evidence that Levothyroxine was administered on November 30, 2025 and December 4, 2025.A review of the Electronically Transmitted Prescription dated December 4, 2025, indicated Resident 6's Levothyroxine 150 mcg 14 tablets was received and signed by Licensed Vocational Nurse (LVN) 1 on December 4, 2025, at 5:24 a.m.On December 17, 2025, at 4:47 p.m. an interview was conducted with LVN 1. LVN 1 stated Resident 6 missed a dose of Levothyroxine on November 30, 2025 due to not being available. LVN 1 stated she signed the Electronically Transmitted Prescription for Resident 6's Levothyroxine on December 4, 2025 at 5:24 a.m., which indicated Levothyroxine was received and available for administration. LVN 1 stated Resident 6's Levothyroxine was not administered on December 4, 2025, at 6 a.m. and it should have been. LVN further stated it was important to administer the medication to prevent any adverse reactions from a missed dose.On December 19, 2025 at 2:08 p.m., an interview was conducted with the Director of Nursing (DON). The DON stated Resident 6 missed Levothyroxine dose on November 30, 2025 and was unsure why when it was administered prior to and after this date. The DON stated Resident 6's Levothyroxine was received and signed by LVN 1 on December 4, 2025 at 5:24 a.m. and was available for (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 3 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 01/02/2026 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)