Paloma Springs Healthcare Llc
Inspection Findings
F-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
reports no SOB or discomfort at this time. 10. 04/12/25 at 11:54 PM, R #1 was given hydroxyzine. 11. 04/13/25 at 2:40 AM, hydroxyzine effective. 12. 04/13/25 at 4:53 AM resident was given acetaminophen. 13. 04/13/25 at 6:20 AM, acetaminophen effective. 14. 04/13/25 at 4:53 PM, R #1 has been short of breath throughout my shift, progressively worsening. Unable to get oxygen above 83-84% (95%-100% oxygen level is considered normal for most adults) this evening, with crackles (abnormal breath sounds that may be heard in the lungs of people with raspatory diseases) in both lower lung bases (bottom of each lung). R #1 also has increased weakness noted this evening. Primary care provider responded with the following feedback: Send to local emergency room via emergency medical services (ambulance). 15. Further record
review of R #1's progress notes revealed staff did not document the quality, severity, onset, duration, aggravating factors or relieving factors of pain when they administered acetaminophen for complaints of pain on 04/12/25 at 7:08 AM, 04/12/25 at 4:19 PM, and on 04/13/25 at 4:53 PM. D. On 08/19/25 at 11:42 AM, during an interview, RN #1 stated the following: 1. She was the day shift nurse that worked with R #1
on 04/13/25. 2. On 04/13/25 after lunch (unable to remember the exact time) approximately 12:30 R #1 complained of shortness of breath and anxiety. 3. RN #1 stated this was not an uncommon complaint for R #1, RN #1 further stated R #1 would have increased anxiety related to diagnosis of COPD which causes her to have difficulty breathing. 4. RN #1 stated she administered hydroxyzine to R #1 at approximately 12:30 to help decrease her anxiety and help her to breathe easier. 5. RN #1 stated R #1 received her scheduled nebulizer treatment at approximately the same time (12:30 PM). 6. RN #1 stated she returned to check on R #1 after she had given her the hydroxyzine and scheduled ipratropium-albuterol (combination medication with two bronchodilators [inhaled medication that relaxes muscles in the airways which helps to open them up an make it easier to breathe]) nebulizer (approximately 1:00 PM) and resident reported the medication had helped. 7. RN #1 stated she checked on R #1 again at approximately 4:00 PM, R #1 complained of shortness of breath. RN #1 administered the PRN albuterol nebulizer treatment. 8. RN #1 stated she checked on R #1 at approximately 4:45 PM. R #1 still complained of shortness of breath and at that time also had increased weakness. RN #1 stated she contacted the on-call provider and received orders to send the resident to the emergency room via ambulance. E. Record review of R #1's administration record (spreadsheet where nurses initial to indicate the completion of a treatment or administration of medication), dated April 2025, revealed the following: 1. RN #1 did not document that she administered PRN hydroxyzine on 04/13/25 at 12:30 PM. 2. RN #1 did not document that she administered PRN albuterol nebulizer treatment on 04/13/25 at 4:00 PM. F. On 08/19/25 at 1:24 PM, during an interview with the DON, the following was confirmed: 1. RN #1 did not document her assessments of R #1 throughout
the day that prompted her to administer PRN medications. 2. Staff are expected to document all resident assessments. 3. RN #1 did not document the administration of the PRN medications she administered on 04/13/25 4. Staff are expected to document all medications administered on the administration record when
they are given. 5. Staff did not document the pain characteristics as indicated on R #1's care plan. 6. Staff are expected to document at minimum the pain levels for which they are administering PRN pain medications.
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Paloma Springs Healthcare LLC in T OR C, 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 T OR C, 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 Paloma Springs Healthcare LLC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.