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F0761
D

Unattended and Unlocked Medication Cart Found in Hallway

Albuquerque, New Mexico Survey Completed on 12-18-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A medication cart was observed on the 500 Hall with its drawers unlocked and the nursing computer open to the medication administration record (MAR), while no staff were present in the immediate area. This left the cart and its contents, including resident medications, unattended and accessible to residents passing through the hallway. The facility's Medication Storage and Security Policy requires all medications to be secured at all times, with medication carts locked when not in the direct possession of licensed staff, and controlled substances stored in a separately locked compartment. During interviews, a registered nurse (RN) admitted to leaving the cart unlocked while stepping into a resident's room, acknowledging that the cart contained narcotics in a locked box and other resident medications in the remaining drawers. The Director of Nursing (DON) confirmed the expectation that all medication carts remain locked at all times to prevent unauthorized access. The incident demonstrated a failure to follow facility policy and ensure the security of medications, including controlled substances.

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