Princeton Health & Rehabilitation
Inspection Findings
F-Tag F0604
F 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
interventions first. She stated if nothing was working, then staff should leave R #10 alone for five minutes and go back to try again. She stated the medication should not be the first choice. The UM stated she had Nurse #4 strike out the note, because the charting was not appropriate. The UM stated a training with all staff about physically restraining residents needs to be done. She stated sometimes agency staff worked at
the facility, and they thought restraints were okay to use. G. On 09/11/25 at 9:24 am, during an interview, Nurse #4 stated she worked at the facility for one year. She stated R #10 could be unpredictable, and he spat on her before. She stated R #10 was very difficult when he first came to the facility. She stated they only gave the injection when he was physically aggressive. She stated the resident fought her and spat at her the day she gave the injection to him. She stated he really needed the medication. Nurse #4 stated the UM spoke with her about not holding a resident down to give medication. She stated the UM told her holding R #10 down to give an injection for his behavior was not appropriate. H. On 09/11/25 at 12:00 pm,
during an interview, Certified Nursing Assistant (CNA) #3 stated the nurse gave R #10 the injection on 08/16/25, and she held R #10 down while they gave the medication. She stated R #10 fought and spat on them. She stated they were not aggressive when they held R #10 down. I. On 09/11/25 at 12:30 pm, during
an interview, the Director of Nursing (DON) stated she was familiar with R #10. The DON stated R #10 had
a hard adjustment to the facility, and they were continuing to adjust his medications. The DON stated physically holding a resident down to give medication was not okay. She stated she would expect staff to re-direct and talk the resident through it. She stated she would not expect staff to hold the resident down.
She stated if the resident was unsafe and could not be left alone, then staff should call the police to get a certificate of evaluation. She stated staff should call the resident's guardian as well.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Princeton Health & Rehabilitation
500 Louisiana Boulevard NE Albuquerque, NM 87108
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-Tag F0605
F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
to the resident. The medication took time to kick in, but it eventually helped as the patient went to sleep.Dated 8/20/25 at 11:09 pm, staff administered Haldol 5 mg intramuscularly to the resident during the morning when the resident started screaming and acting upset. R #10 stayed in his room all day, and he decided to go to the nurse's station in the evening to look for his dog.- Dated 8/24/25 at 8:15 am, staff heard R #10 yelling in hallway and trying to hit hall monitor. He held onto the Hall Monitor's right forearm tightly. The Hall Monitor reported R #10 grabbed a spray bottle with chemicals from housekeepers' cart and tried to spray another resident with it. The Hall Monitor immediately reacted and took the spray bottle away from R #10. R #10 became very angry and began yelling and cussing at th eHall Monitor. The resident grabbed the Hall Monitor and tried to hit him. Staff assisted the Hall Monitor and redirected R #10 away from the Hall Monitor.- Dated 8/24/25 at 8:20 am, R #10 was redirected to his room and stated that man hated him and wanted to hurt him. R #10 was given Haldol 5 mg injection, and he tolerated it well. - Dated 9/9/25 at 1:00 pm, R #10 was out of bed ambulating (walking) in hall. R #10 did not have a steady gait. R #10 was impulsive and did not allow staff to help him. He tried to hit the Certified Nursing Assistants (CNAs) and threw food and drink at them. Called Nurse Practitioner and Haldol 5 mg was ordered and given on right dorsogluteal (upper part of the buttock) area. G. On 09/11/25 at 8:52 am, during an interview,
the Social Services Assistant (SSA) stated R #10 had moments were he quiet and content. The SSA stated R #10's anger and behaviors were due to being at the facility. She stated R #10 made statements about killing everyone, but the SSA stated she thought he just wanted to be let out of the facility. She stated she did not think the resident was suicidal. H. On 09/11/25 at 9:05 am, during an interview, Unit Manager (UM) of Floor 200 stated R #10 was fairly new to the facility, and he did not want to be there. The UM stated R #10 became physically aggressive at times. She stated R #10 did not always require medication to calm him down. The UM stated her expectation was for staff to try other interventions before giving the Haldol medication for his behaviors. She stated if the other interventions did not work, then staff should leave R #10 alone for five minutes and try again later. She stated the medication should not be the first choice. I. On 09/11/25 at 1:30 pm, during an interview, the Physician Assistant (PA) stated he saw R #10 the first time, because R #10 made homicidal threats (threats to harm others). The PA stated he was not concerned R #10 would kill anyone, because the resident did not have any means to hurt someone. He stated R #10 made suicidal threats (threats to harm self) during a different visit. He stated he ordered the Haldol to be administered for severe agitation. He stated suicidal threats alone would not warrant R #10 receiving the Haldol. He stated the facility staff could interpret extreme agitation as they needed and perhaps making threats of killing everyone rose to the level.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Princeton Health & Rehabilitation
500 Louisiana Boulevard NE Albuquerque, NM 87108
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-Tag F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
Based on interviews and record reviews, the facility failed to demonstrate its measures to minimize the risk of Legionella (bacteria naturally found in water that can cause a severe type of lung infection called legionnaires' disease when people inhale tiny water droplets containing the bacteria) in the building's water system, when the Legionella Water Management Program (LWMP) team failed to develop and implement
an adequate LWMP. This failure had the potential to affect all residents in the facility. This deficient practice is likely to lead to outbreaks of legionellosis (legionnaires' disease and Pontiac fever, a milder flu-like illness).The findings are:A. Record review of the facility's LWMP, last revised in August 2024, showed the following: - The policy did not have a procedure on how to use the control measures to control the introduction and/or spread of Legionella in the building water system. - The policy did not include control limits (the maximum value, minimum value, or range of values that are acceptable for the control measures that you are monitoring to reduce the risk for legionella growth and spread) and parameters.- The policy did not have monitoring procedures to include:a. Specified and documented testing protocols for legionella.b.
Established control limits acceptable for the control measures the facility monitored to reduce the risk for Legionella growth and spread.- The policy did not have established ways to intervene when control limits were not met or when there was a case of healthcare-associated legionellosis in the facility. B. On 09/10/25 at 10:00 am, during an interview with the facility's Administrator, Regional Corporate Nurse, Director of Nursing, Maintenance Director, and Environmental Services Manager, they stated they were not aware the LWMP was inadequate to prevent the growth and spread of legionella in the building water system. They stated they were not aware the plan was missing procedures to explain how to use the control measures, acceptable control limits and parameters, monitoring procedures, and established ways to intervene when control limits were not met or when there was a case of healthcare-associated legionellosis in the facility.
Residents Affected - Many
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Princeton Health & Rehabilitation in Albuquerque, NM inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Albuquerque, NM, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Princeton Health & Rehabilitation or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.