Albuquerque Heights Healthcare And Rehabilitation

F-F658

A. Record review of R #177's face sheet revealed the resident was admitted to the facility 03/19/25 with the following diagnoses:

- Non-st elevation (NSTEMI) myocardial infarction (a heart attack that happens when a part of the heart is not getting enough oxygen),

- Congestive heart failure (the heart cannot supply enough blood to meet the body's needs),

- Ischemic cardiomyopathy (a type of heart failure caused by low blood flow to the heart muscle),

- Type II diabetes (means that your body does not use insulin properly),

- End stage renal disease (kidneys reach advanced state of loss of function),

- Dependence on renal dialysis (a blood purifying treatment given when kidney function is not optimum.)

B. On 04/07/25 at 9:36 am, during an interview with R #177, she stated her lunch tray was on her bedside table when she got back to her room after dialysis, and she ate the lunch trays when she got back. She stated she typically got back to the facility between 2:00 pm and 3:00 pm. She stated she did not ask staff to heat up her meal. R #177 stated she was hungry when she got back to the facility. She stated she asked staff to heat up her lunch meal, but they did not warm it up.

C. On 04/07/25 at 12:45 pm, during an observation, staff delivered a meal tray to R #177's room and left the tray on the bedside table. Further observation revealed R #177 was at dialysis.

D. On 04/07/25 at 1:14 pm, 2:18 pm, and 3:34 pm, during an observation, R #177's lunch tray sat on the bedside table. The lunch tray consisted of a tamale and black beans.

E. On 04/07/25 at 3:37 pm, during an observation, R #177 ate her lunch of tamale and black beans. An unidentified Certified Nursing Assistant (CNA) took the tray away from the resident and stated the food was more than two hours old.

F. On 04/11/25 at 11:09 am, during an interview with Nurse #10, she stated staff left a lunch tray for R #177

on her bedside table so she could eat it when she returned from dialysis. Nurse #10 stated R #177 liked having the tray available to eat when she returned. She stated they offered to heat it up for her. She could not say how long the meal tray sat out before R #177 ate it.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 16 325069 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 325069 B. Wing 04/15/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Albuquerque Heights Healthcare and Rehabilitation 103 Hospital Loop NE Albuquerque, NM 87109

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 0804 G. On 04/11/25 at 11:17 am, during an interview with the Dietary Manager (DM), he stated he would not expect staff to leave a meal tray on the resident's bedside table if the resident was at dialysis. He stated he Level of Harm - Minimal harm or expected staff to bring the meal tray back to the kitchen and save it for the resident. He stated staff could potential for actual harm also have something else available for the resident to eat when they returned from dialysis.

Residents Affected - Few

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 16 325069 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 325069 B. Wing 04/15/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Albuquerque Heights Healthcare and Rehabilitation 103 Hospital Loop NE Albuquerque, NM 87109

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 0921 Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 40671

Residents Affected - Some Based on observation and interview, the facility failed to ensure residents had a safe and functional environment for resident rooms 205, 206, 207, 208, 211, and 213 when staff failed to:

1) Replace a broken plastic disposable glove holder in room [ROOM NUMBER] and 208.

2) Repair ripped flooring near a resident bed in room [ROOM NUMBER].

3) Repair the hand rail end piece outside of room [ROOM NUMBER].

4) Repair or replace a broken closet, a broken dresser, missing dresser drawer, broken blinds, and ripped flooring near the resident's bed in room [ROOM NUMBER].

5) Maintain the shower in room [ROOM NUMBER] free of the storage of random items.

6) Replace broken blinds, cleaning a wall, and ensuring the room was free from a pungent (strong) urine odor in room [ROOM NUMBER].

This deficient practice could likely result in residents living in an unsafe environment, could increase their risk for injuries, and decrease their quality of life.

The findings are:

A. On 04/08/25 at 11:20 am, observation of resident room [ROOM NUMBER] revealed a broken glove holder

on the wall, a broken thermostat, and a broken dresser drawer.

B. On 04/08/25 at 11:26 am, observation of resident room [ROOM NUMBER] revealed an wardrobe with a broken door and a missing bottom drawer, broken blinds, and ripped flooring. Further observations revealed large foam pads and cushions stored in shower.

C. On 04/08/25 at 11:28 am, observation of resident room [ROOM NUMBER] revealed the hand rail, directly outside the resident entry door, was missing the end piece. Further observation revealed sharp edges exposed.

D. On 04/08/25 at 11:31 am, observation of resident room [ROOM NUMBER] revealed ripped flooring by bed A.

E. On 04/08/25 at 11:34 am, observation of resident #213 revealed broken blinds; a green gum-like substance on the wall in several spots by bed B, and a strong urine odor.

F. On 04/09/25 at 9:53 am, observation of the Memory Care Unit revealed the following:

- Ceiling vents throughout entire unit were filthy dust build-up.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 16 325069 Department of Health & Human Services Printed: 08/28/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 325069 B. Wing 04/15/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Albuquerque Heights Healthcare and Rehabilitation 103 Hospital Loop NE Albuquerque, NM 87109

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 0921 - Light covering in the hallway by resident room [ROOM NUMBER] was broken and missing a piece of plastic.

Level of Harm - Minimal harm or - Ceiling tiles near the nurses station had brown spots splattered on them. potential for actual harm - A gap around the sprinkler head on the ceiling near the exit door. Residents Affected - Some G. On 04/11/25 at 3:25 pm during an interview, the Maintenance Director stated it was the responsibility of

the Certified Nurse Aides (CNAs) and the nurses to submit work order requests through their electronic system. He stated he was currently the only maintenance person.

H. On 04/14/25 at 2:23 pm during an interview, the Director of the Memory Unit verified the environmental and safety concerns and stated these concerns should be repaired.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 16 325069