The Neighborhood in Rio Rancho

Inspectors wroteBased on record review and interview, the facility failed to ensure 1 (R #1) of 4 (R #1, #2, #3, and #4) residents were free from physical and mental abuse, when: The facility failed to ensure a safe environment by not preventing a physical and verbal altercation between two staff members that occurred on the bed in R #1's room, resulting in R #1 witnessing the altercation and becoming fearful. If the facility fails to provide an environment free from abuse, then residents are at risk for physical injury and psychological harm.

Inspectors wroteBased on video observation, record review, and interview, the facility failed to prevent an employee to resident abuse for 1 (R #9) of 3 (R #9, #10 and #11) residents reviewed for abuse. This deficient practice likely resulted in psychosocial harm based upon the reasonable person concept to the resident related to fear of physical harm and mistrust of the caretaker she was dependent on for all of her care.

Inspectors wroteBased on record review and interview, the facility failed to: - Complete necessary assessments, -Open a risk management report, -Create interventions for a fall, and-Use two staff when using the Hoyer lift (equipment used to move residents who have limited mobility). for 2 (R #1 and R #9) of 2 (R #1 and R #9) residents reviewed for falls. Failure to provide fall prevention interventions and facility staff using the Hoyer lift with only one person are likely to cause accidents, injuring the resident.

Inspectors wroteBased on interview, and record review, the facility failed to capture an accurate and consistent weight for 1 (R #1) of (R #1) residents reviewed for weight loss. This deficient practice potentially created a delay in R #1 receiving a nutritional supplement due to missing and inaccurate weights, which likely contributed to weight loss.

Inspectors wroteBased on interview and record review, the facility failed to have accurate and complete medical records for 2 (R #1 and R #11) of 3 (R #1 and R #9 and R #11) residents reviewed for showers, falls, and nutrition. This deficient practice could likely cause: - confusion on the resident's status if the history and physical was not accurately documented, -residents to go without fall interventions in place because there was no documentation of the fall, -residents could potentially suffer weight loss without appropriate interventions due to inaccurate meal intake documentation.

Inspectors wroteBased on record review and interview, the facility failed to notify the guardian of a change in condition for 1 (R #3) of 2 (R #3 and R #9) residents reviewed for weight loss. This deficient practice is likely to cause residents to go without needed interventions, if the guardian of the resident is unaware of the change in condition.

Inspectors wroteBased on observations, interviews, and record review, the facility failed to ensure:- Staff entering the second-floor kitchen during meal service wore required hair restraints, which had the potential to affect 19 out of 19 residents on the second floor. This deficient practice increased the risk of food contamination which could lead to foodborne illness.

Inspectors wroteBased on record review, interview, and observation the facility failed to ensure professional standards of care for (R #19 and #46) of 2 (R #19 and #46) residents when staff failed to:- Obtain and enter wound care orders for the resident's wounds.- Put away a resident's fall mat after the resident got out of bed. If the facility fails to obtain and enter orders for wound care, then residents may not receive the care needed to improve their wounds. If staff fail to put away a resident's fall mat after they get out of bed, then the resident may not be able to access their bed or other areas of their room.

Inspectors wroteBased on record reviews and interviews, the facility failed to ensure resident records were complete when staff failed to document resident weights into the residents' medical record for 2 (R #45 and #46) of 2 (R #45 and #46) residents. If staff do not document necessary resident information into the medical records, then the resident may not receive the services needed to maintain or achieve optimum health.

Inspectors wroteBased on record review and interviews, the facility failed to complete an annual performance/competency review for 1 (Certified Nurse Assistants - CNA #5) of 5 (CNAs #2, #3, #4, #5 and #10) CNAs. If staff do not receive 12 performance/competency reviews annually, then they may not maintain the competencies necessary to perform daily tasks of providing care and services to meet the needs of all residents.

Inspectors wroteBased on record reviews and interviews, the facility failed to schedule an annual appointment for dental services for one (R #6) of one (R #6) residents. This deficient practice could likely result in an increased risk of developing serious dental issues like tooth loss and infection, which can require extensive treatment.

Inspectors wroteBased on observation, record reviews, and interviews, the facility failed to ensure a call light was within reach for 1 (R #4) of 1 (R #4) resident. If the facility is not ensuring the call light is within residents' reach, then residents may be unable to request immediate assistance when needed.

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing staff were competent to provide nursing and related services. This deficient practice could affect all 53 residents in the facility (residents were identified by Resident Matrix provided by the Administrator on [DATE]). This deficient practice could likely result in CNA's (Certified Nurse Assistant) and RN's (registered nurses) working with residents without adequate knowledge to do so; likely resulting in injury or inappropriate care being provided to the residents.

Inspectors wroteBased on interview and record review, the facility failed to ensure that they did not impose a charge against the personal funds for items or services already being billed for (R #1 and R #3) of 3 (R #1, R #3 and R #4) residents reviewed when staff billed the residents instead of billing the hospice agency for supplies and medications. This deficient practice is likely to cause undue financial strain for the residents.

Inspectors wroteBased on record review and interview, the facility failed to notify the Power of Attorney (POA; legal authorization for a designated person to make decisions about another person's property, finances, and/or medical care) for 1 (R #1) of 3 (R #1, R #2, and R #5) residents when injuries or incidents occurred. If the facility is not notifying the resident's POA when the resident has an injuries or incident occur, then the POA is not able to make decisions related to treatment and advocate for the resident's care.

Inspectors wroteBased on record review and interview, the facility failed to ensure staff revised the care plan for 3 (R #2, R #3 and R #5 ) of 4 (R #1, R #2, R #3, and R #5) residents reviewed when staff failed to update care plans to include hospice care or fall protocol . This deficient practice is likely to result in residents' care and needs not being addressed.

Inspectors wroteBased on record review and interview, the facility failed to ensure hospice services met professional standards for 2 (R #3 and R #5) of 3 (R #1, R #3, and R #5) residents reviewed for hospice services by: 1. Not having an order for hospice services for R #5 2. Not having a qualifying diagnosis for R #3. 3. Not having hospice plans of care for R #3 and R #5. 4. Not communicating with hospice regarding a change in condition for R #3. These deficient practices are likely to result in the resident not receiving the services that she needs.

Inspectors wroteBased on record review and interview, the facility failed to ensure the assessment was accurate for 1 (R #2) of 1 (R #2) resident reviewed. This deficient practice could likely result in the residents' preferences and care needs not being met accurately.

Inspectors wroteBased on record review and interview, the facility failed to prevent an accident for 1 (R #1) of 1 (R #1) residents reviewed for falls when the facility failed to ensure proper use of mechanical lift (a device designed to help staff move a resident from one place to another within a room or from one position to another) which resulted in R #1 falling and sustaining injuries that required treatment at the hospital.

Inspectors wroteBased on record review and interview, the facility failed to ensure patient care equipment was in safe operating condition for 1 (R #1) of 1 (R #1) residents reviewed. This deficient practice likely resulted in a Hoyer sling (a specialized fabric that connects onto the mechanical lift and supports a person's weight when transferring from one position to another using a mechanical lift) breaking and causing R #1 to fall and sustain injuries.

Inspectors wroteBased on observation and interview, the facility failed to store food in accordance with professional standards when staff stored expired food in the facility's walk-in refrigerator. This deficient practice had the potential to negatively impact all 47 residents listed on the census provided by the Director of Nursing on 05/20/24. If the facility fails to adhere to safe food storage practices, residents could likely to be exposed to foodborne illnesses (illness caused by food contaminated with bacteria, viruses, parasites, or toxins).

Inspectors wroteBased on record review, and interview, the facility failed to provide quality of care when they did not provide wound care for 1 (R #17) of 1 (R #17) residents review for skin conditions. This deficient practice could likely result in the resident not receiving appropriate and timely wound care resulting in discomfort and infection.

Inspectors wroteBased on observations and interviews, the facility failed to: 1. Ensure the medication carts did not contain loose medications. 2. Ensure expired supplies were not kept with unexpired supplies in the medication room. 3. Fentanyl patches were destroyed immediately after removal and not stored in the medication cart. These deficient practices are likely to result in all 31 residents of the 200 and 300 halls, as identified on the census list provided by the facility Administrator on [DATE], receiving expired medication, having expired medical supplies used in their treatments, and in the mishandling or misuse of narcotic drugs.

Inspectors wroteBased on interview and record review, the facility failed to ensure the comprehensive care plan was updated for 1 (R #28) of 1 (R #28) residents reviewed for care plan accuracy. This deficient practice could likely result in staff not understanding and implementing the most appropriate interventions and treatments for the resident.

Inspectors wroteRepeat deficiency. Based on record review and interview, the facility failed to meet professional standards of quality when staff failed to notify the Pharmacist and the Director of Nursing (DON) of a morphine spill and a missing fentanyl patch for 2 (R #1 and #13) of 2 (R #1 and #13) residents reviewed for medications. This deficient practice could cause a resident to not receive the pain medication that was prescribed and could also cause confusion when reconciling medications.

Inspectors wroteBased on observation, record review, and interview, the facility failed to meet professional standards of care for 1 (R #30) of 1 (R #30) resident reviewed for respiratory care by not changing the oxygen tubing. This deficient practice could likely lead to respiratory infections by the oxygen tubing becoming clogged due to condensation (a process where water vapor becomes liquid) or becoming dirty, leading to the reduced oxygen flow.

Inspectors wroteBased on interview and record review, the facility failed to notify the power of attorney (POA; a designation given to an agent to handle financial or medical acts on someone else's behalf) and the Nurse Practitioner (NP) of a fall for 1 (R #1) of 3 (R #1, #2, and #3) residents reviewed for falls. This deficient practice could likely cause a breakdown in resident care if the NP is not notified of all falls and the family is left feeling uninformed and frustrated about their loved ones care.

Inspectors wroteBased on record review and interview, the facility failed to follow a physician's order for 1 (R #2) of 1 (R #2) residents reviewed for medication administration. This deficient practice could likely cause staff to administer a medication to a resident when the medication is not necessary.

Inspectors wroteBased on record review and interview, the facility failed to provide behavioral health treatment for 1 (R #1) of 3 (R #1, R #2, and R #3) residents reviewed for insomnia. This deficient practice could likely cause a resident to have increased agitation, restlessness, and falls.

Inspectors wroteBased on record review and interview, the facility failed to monitor behaviors for 1 (R #1) of 3 (R #1, R #2, and R #3) residents reviewed for the use of psychotropic medications. This deficient practice could likely result in residents continuing to exhibiting behaviors of agitation that are not remedied.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure resident furnature was in operable working condition when they continued to use a broken recliner for 1 (R #1) of 3 (R #1, 2, 3) residents reviewed for falls. This deficient practice could likely result in an injury if the reclining chairs are not in good operable condition.

Inspectors wroteBased on observation and interview, the facility failed to store foods under sanitary conditions by not: 1. Ensuring food items in the refrigerator and freezer were properly labeled and dated. 2. Ensuring food items in the refrigerator are properly covered. 3. Ensuring vent over mixing machine was free of debris and debris was not falling on items below These deficient practices are likely to affect all 55 residents listed on the resident census list provided by the Administrator on 01/30/23, and are likely to lead to foodborne illnesses in residents if food is not being stored properly and safe food handling practices are not adhered to.

Inspectors wroteBased on record review and interview, the facility failed to ensure that 2 (R #'s 48 and 53) of 2 (R #48 and 53) resident's New Mexico Medical Orders For Scope of Treatment (MOST) reviewed was completed to reflect medical interventions (Advanced Directives-legal documents that allow you to spell out your decisions about end-of-life care ahead of time). This deficient practice is likely to affect residents' fulfillment of their end-of-life medical care choices and could result in unnecessary suffering for the resident.

Inspectors wroteBased on record review and interview the facility failed to ensure that 2 of (R #32 and 37), of 2 (R #32 and 37) resident's reviewed for Minimum Data Set (MDS) assessments were accurate and reflected the resident's status. This deficient practice is likely to result in residents not receiving the appropriate care and treatment they need.

Inspectors wroteBased on interview, the facility failed to make prompt efforts to resolve resident grievances for 1( R #5) of 1(R #5) resident reviewed. This deficient practice is likely to result in the issue continuing and resident's rights not being honored.

Inspectors wroteBased on interview, the facility failed to ensure that a resident's belongs will be safeguarded from loss for 1 (R #5) of 1 (R #5) resident reviewed for personal property when they failed to follow up on an missing item that had been reported to staff. This deficient practice is likely to result in unaccounted property with no resolve for the resident and family regarding the loss resulting in frustration and not feeling heard.

Inspectors wroteBased on record review and interview, the facility failed to report and provide follow up report within 5 working days from the date of the incidents to the State Survey Agency, for 1 (R's #160) of 1 (R's #160) residents reviewed for incidents. If the facility fails to report incidents to the State Agency, then the State Agency will be unable to assure residents a safe and hazard free environment. A. On 02/01/23 at 4:05 PM during an interview with R #160's granddaughter she stated, that one of the Certified Nurse Aides provided a shower for her grandmother and wrapped a wound on her leg in toilet paper and paper towels and it had stuck to the wound. She (R #160) had to be taken to [name of local hospital] emergency room to get the toilet paper out and get the wound cleaned. B. Record review of [name of local hospital notes] dated 03/21/22 revealed: [...]

Inspectors wroteBased on observation, record review, and interview, the facility failed to ensure the enteral tube feeding [a device utilized to provide liquid nutrition and medications, via a tube into the stomach or intestine] nutritional supplement bottle for 1 (R #214) of 1 (R #214) resident reviewed, was labeled and dated to reflect when the feeding was started.