Health inspection·March 28, 2024

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the correct insulin (medication use to lower blood sugar levels) dose was administered as prescribed by the physician, for one of three residents (Resident 3). Residents Affected - Few This failure has the potential risk of dangerously low blood sugar level for Resident 3, leading to harm and or death. Findings: On [DATE] at 9:30 a.m., an unannounced visit to the facility was conducted to investigate quality care issues. A review of Resident 3's admission RECORD, indicated, Resident 3 was admitted to the facility on [DATE], with diagnoses which included diabetes mellitus (abnormal blood sugar levels). A review of Resident 3's Minimum data Set (an assessment tool), dated [DATE], indicated a Brief Interview for Mental Status (brief cognitive screening measure that focused on orientation and short-term word recall) score of 14 (intact cognition). A review of Resident 3's Order Summary Report, dated [DATE], indicated, .Lantus (a type of Insulin) Subcutaneous (beneath or under, all the layers of the skin) Solution .Inject 10 unit (sic) (unit of measurement) subcutaneously at bedtime . A review of Resident 3's Medication Administration Note, dated February 26, 2024, at 8:00 p.m., indicated, .Realized I had administered the wrong dose of 100u (units) of Lantus into her left arm . A review of Resident 3's eINTERACT Change in Condition Evaluation, dated February 26, 2024, at 8:41 p.m., indicated, .Wrong dosage of insulin Lantus was given. 100 units .pt (patient) sent to Hospital .Recommendation of Primary Clinician .he ordered to transfer pt to the hospital . A review of Resident 3's Post-Event Review, dated February 27, 2024, at 1:47 p.m., indicated, . IDT (Interdisciplinary Team - team members from different discipline working collaboratively) Review .the IDT met to review the reported incidents of the incorrect dose of insulin that was administered to resident .License nurse .inadvertently administered the incorrect dose of Lantus . On [DATE], at 11:53 a.m., during a concurrent interview and review of Resident 3's Progress Notes, with Licensed Vocational Nurse (LVN) 2, she stated, Resident 3 was transferred to the hospital on (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 555247 Printed: 05/15/2026 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 555247 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rancho Mirage Health and Rehabilitation Center 39950 Vista Del Sol Rancho Mirage, CA 92270 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)