Inspection·December 31, 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure professional standards of practice for ostomy care were provided to one of three sampled residents (Resident 2), when the Licensed Vocational Nurse (LVN 1) used a wound cleanser ([NAME] Dermal Wound Cleanser) containing sorbitol (a sugar alcohol) to cleanse the peristomal skin (the area of skin around a stoma [opening] for a colostomy [a surgical procedure that creates an opening in the abdomen connecting part of the large intestine [colon] to the outside of the body, allowing stool and gas to exit through it into a collection bag). This failure caused Resident 2 to suffer pain and had the potential to irritate and damage fragile peristomal skin. Findings:On December 10, 2025, at 10:07 a.m., an unannounced visit to the facility on a complaint and Facility Reported Incident were initiated. A review of Resident 2's medical records indicated the resident was admitted on [DATE], with diagnoses of encounter for surgical aftercare following surgery on the digestive system, pneumonitis (infection) due to inhalation of food and vomit, pressure ulcer, (bed sore) of sacral region, (lies between the fifth segment of the lower spine and the tailbone), type 2 diabetes mellitus, (a chronic condition that affects the way the body uses sugar. The body either resists the effects of insulin - a hormone that regulates the movement of sugar into the cells - or doesn't produce enough insulin to maintain normal sugar levels), encounter for encounter for attention to colostomy.On December 10, 2025, at 11:59 a.m., an interview was conducted with the Licensed Vocational Nurse (LVN 1). LVN 1 stated he was working on December 10, 2025, and provided care to Resident 2. LVN 1 stated that he changed Resident 2's colostomy bag, cleansed the area with warm water and gauze, and applied a new colostomy bag at approximately 8 p.m. LVN 1 further stated that after returning from a break, a Certified Nursing Assistant (CNA) informed him that Resident 2's colostomy bag was leaking. LVN 1 stated that upon assessment, he observed some redness, where the adhesive contacted the skin, used a wound cleanser to clean the skin and applied a new colostomy bag. On December 10, 2025, at 12:19 p.m., during an interview with the Registered Nurse (RN), the RN stated that on December 6, 2025, she received a call from the Assistant Director of Nursing (ADON) to check on Resident 2. The RN stated that Resident 2 reported that during the colostomy bag change on December 5, 2025, LVN 1 sprayed a liquid on the site that caused severe pain that he had to cover his mouth to avoid screaming out in pain. The RN stated that she reported the incident to the facility administrator. On December 10, 2025, at 12:26 p.m., an interview was conducted with Resident 2. Resident 2 stated on December 5, 2025, at approximately 8:25 p.m., the colostomy bag was leaking and needed to be changed. Resident 2 stated that on December 5, 2025, approximately 9:20 p.m., LVN 1 removed the leaking colostomy bag and used a spray that smelled very strong and burned so badly he had to bite down on his knuckles to keep from screaming. Resident 2 stated that the spray felt like alcohol. Resident 2 stated that on Saturday, December 6, 2025, he reported the incident to ADON by telephone. On December 10, 2025, at 1:30 p.m., an interview was conducted with the Director of Nursing, Residents Affected - Few (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: 555923 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 555923 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Temecula Healthcare Center 44280 Campanula Way Temecula, CA 92592 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)