Bear Canyon Rehabilitation Center

F-F684.

A. Record review of R #42's face sheet revealed an initial admitted [DATE REDACTED] and included the following diagnoses:

- Sequelae of cerebral infarction (long term effects and complications that can occur after a stroke),

- Congestive systolic and diastolic heart failure,

- Peripheral vascular disease (disorder that causes abnormal narrowing of arteries).

B. Record review of R #42's hospital discharge records, dated 10/23/24, revealed the following :

- An order for clopidogrel (blood thinning medication) tablet, 75 milligrams (mg) daily. Route: Oral (by mouth). Date first scheduled: 10/11/24.

- Continue home medication Lipitor (medication that lowers the amount of fats in the blood), 890 mg daily and Plavix (brand name for clopidogrel) 75 mg daily.

C. Record review of R #42's Medication Administration Records (MAR), dated October 2025 through February 6, 2025, revealed staff did not administer clopidogrel, 75 mg to R #42.

D. On 02/06/25 at 4:58 pm during an interview with the Medical Director (MD), he stated R #42's hospital discharge records contained an order for clopidogrel 75 mg on admission to the facility. He verified staff missed the order and did not administer clopidogrel to R #42 since the resident's admission to the facility on [DATE REDACTED].

E. On 02/07/25 at 9:18 am during an interview, the Director of Nursing (DON) stated she missed the resident's order for clopidogrel when she verified R #42's admission orders.

F. On 02/07/25 at 10:47 am during an interview, the Nurse Practitioner (NP) stated R #42's hospital discharge orders included an order for clopidogrel. She stated R #42 should have received clopidogrel while at the facility.

Based on record reviews and interviews, an Immediate Jeopardy (IJ) was identified. The facility Administrator was notified on 02/07/25 at 10:42 am.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 12 of 15 325125 Department of Health & Human Services Printed: 09/09/2025 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 325125 B. Wing 02/10/2025

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

Bear Canyon Rehabilitation Center 5123 Juan Tabo Boulevard NE Albuquerque, NM 87111

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 0760 The facility took corrective action by providing an acceptable Plan of Removal (POR). The Plan of Removal was approved on 02/07/25 at 3:15 pm. Implementation of the POR was verified onsite on 02/10/25 by Level of Harm - Immediate conducting record reviews and staff interviews. Scope and Severity was reduced to Level 2, E. jeopardy to resident health or safety Plan of Removal:

Residents Affected - Some All residents have the potential to be affected by this alleged deficient practice. The following corrections were completed by 02/07/25: Note: The nursing home is disputing this citation. - Audit all residents with a diagnosis of CVA to ensure antiplatelet therapy was in place as ordered.

- Audit of recent admissions to ensure accurate medication reconciliation, review, and continuation of medications and treatments.

- All licensed staff educated regarding medication transcription, medication reconciliation upon admission, and documentation in the resident's chart.

- During morning clinical meetings, medication reconciliation audits occur for new admissions and medication order changes.

- Nurse Practice Educator or Designee will begin education on 02/07/25 and continue until all licensed nursing staff have been educated prior to their next shift. Any licensed staff member on leave of absence (FMLA), vacation, or PRN (as needed) staff will be re-educated prior to returning to duty. New hires will be educated on this process upon hire.

- The Director of Nursing (DON) or designee will audit five random residents three times a week to ensure all medications reconciliation have occurred.

- The DON or designee will bring results of audits to Quality Assurance and Performance Improvement (QAPI) committee for further recommendations based on tracking and trending. It will be presented monthly for the next two months or until ongoing compliance is achieved. The QAPI committee is overseen by the Administrator.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 13 of 15 325125 Department of Health & Human Services Printed: 09/09/2025 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 325125 B. Wing 02/10/2025

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

Bear Canyon Rehabilitation Center 5123 Juan Tabo Boulevard NE Albuquerque, NM 87111

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 0761 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately Level of Harm - Minimal harm or locked, compartments for controlled drugs. potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 50752 Residents Affected - Few Based on observations, interviews, and record review, the facility failed to ensure nurses and Certified Medication Aids (CMAs) dated opened insulin glargine (a medication prescribed to help the body turn food into energy and manage blood sugar levels) pens and discarded glargine pens within 28 days of opening for 1 (R #19) of 1 (R #19) resident and to ensure medication carts were locked when unattended. These deficient practices are likely to result in R #19 receiving medications that are less effective or expired and is likely to negatively impact the health of residents on the 200 unit if they were to ingest (swallow) medications not intended for them.

The findings for medication storage are:

A. Record review of R #19's physician orders, dated [DATE REDACTED], revealed R #19 received insulin glargine.

B. Record review of the manufacturer's instructions for insulin glargine pens, dated ,d+[DATE REDACTED], revealed staff must throw away all opened pens after 28 days of first use, even if there was insulin left in the pen.

C. On [DATE REDACTED] at 1:47 pm, during an observation of the 600-hall medication cart, three insulin glargine pens were opened and not dated. The pens belonged to R #19.

D. On [DATE REDACTED] at 1:50 pm, during an interview, Nurse #12 stated the insulin glargine pens belonged to R #19, and the resident actively received it. He stated he should have dated the insulin glargine pens and discarded them within 28 days of the opening date. Nurse #12 stated he just missed it. He also stated the assigned nurse on each hall should check the expiration date before administering the insulin to the resident.

E. On [DATE REDACTED] at 10:55 am, during an interview with the Director of Nursing, she stated staff must date the opened glargine insulin pens and discard them within 28 days from the opening date.

F. On [DATE REDACTED] at 9:00 am, during an interview, the facility's pharmacist consultant stated she expected nurses and CMAs to date the opened glargine insulin pens and discard them within 28 days from the opening date.

Medication carts:

G. On [DATE REDACTED] at 7:47 am, during an observation of the 200-unit medication cart, the medication cart was unattended and unlocked.

H. On [DATE REDACTED] at 7:47 am, during an interview, Registered Nurse (RN) #1 confirmed the medication carts should be locked and secured at all times when left unattended.

51919

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 14 of 15 325125 Department of Health & Human Services Printed: 09/09/2025 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 325125 B. Wing 02/10/2025

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

Bear Canyon Rehabilitation Center 5123 Juan Tabo Boulevard NE Albuquerque, NM 87111

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 0947 Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Level of Harm - Minimal harm or potential for actual harm 35632

Residents Affected - Some Based on record review and interview, the facility failed to ensure Certified Nurse Aides (CNAs) received the required in-service training of at least 12 hours per year for 4 (CNAs #4, #5, #6, and #7) of 5 (CNAs #3, #4, #5, #6, and #7) CNAs randomly reviewed for required in-service training. This deficient practice is likely to result in the nurses aides not receiving the necessary training to meet the care needs of the residents. The findings are:

A. Record review of the facility's employee training transcripts, dated 01/01/24 through 12/31/24, revealed

the following:

- CNA #4 completed 6.33 hours of training.

- CNA #5 completed 6.30 hours of training.

- CNA #6 completed 1.22 hours of training.

- CNA #7 completed 1.38 hours of training.

B. On 02/06/25 at 10:56 am, during an interview with the Director of Nursing (DON), the DON stated CNA #4, CNA #5, CNA #6, and CNA #7 did not have any other trainings during the last 12 months. She stated she was aware the CNAs did not meet the annual 12 hour training requirement.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 15 325125