Overall Rating of 30 Nursing Homes
Rating: 5 out of 5 (5) Much above average
Rating: 4 out of 5 (6) Above average
Rating: 3 out of 5 (7) Average
Rating: 2 out of 5 (3) Below average
Rating: 1 out of 5 (1) Much below average
August 2018
Placing a loved one in a nursing facility is often a difficult and traumatic decision where families can only hope that their spouse, parent or grandparent will receive the highest level of healthcare. Unfortunately, not every nursing facility provides even the minimal standards of care. In fact, the Santa Fe nursing home neglect attorneys at Nursing Home Law Center LLC have handled many nursing home abuse and neglect cases caused by short staffing, inadequate training or intentional harm on an elder caused by a caregiver or other resident.
Medicare routinely gathers information on every nursing home in Santa Fe, New Mexico based on data collected through inspections, surveys and investigations. According to the federal agency, investigators found serious violations and deficiencies at nine (30%) of the thirty Santa Fe nursing facilities that led to resident injuries. If your loved one was mistreated, abused, injured or died unexpectedly from neglect while living in a nursing home in New Mexico, let our team of dedicated lawyers protect your rights. Contact the Santa Fe nursing home abuse lawyers at Nursing Home Law Center (800-926-7565) today to schedule a free case consultation to discuss filing a claim for compensation to recover your damages.
Abuse and neglect against the elderly manifest in a variety of ways including physical assault, sexual abuse, neglect, self-neglect, financial exploitation and abandonment. Without oversight from nursing home regulators and resident advocates, the suffering and harm an elder can experience can last weeks, months or even years. In fact, many cases involving mistreatment are never detected or reported.
The number of incidences of nursing home neglect and abuse has become widespread throughout New Mexico, including in Santa Fe County, Rio Arriba County, and Los Alamos County. One factor for the increase is a significant rise of the aging population where nearly one in five residents of Santa Fe County or approximately 30,000 out of the 150,000 residents), are 65 years and older. With the influx of many more elders reaching their retirement years, the limited number of available nursing home beds and the high demand for competent nurses will likely create far more cases of abuse and neglect in the years ahead.
Once family members make the choice to place a loved one in a long-term care facility, they must rely on the caregiver’s experience and skills to ensure that the resident’s needs are being met 24 hours a day. Our comments are important to note that before making the difficult decision, it’s essential to review publicly available resources to investigate opened investigations, filed complaints, safety violations and health hazards occurring in nursing facilities throughout the community.
In an effort to help, our Santa Fe County elder abuse lawyers continuously review this information from a variety of sources including Medicare.gov. We publish our findings below in an effort to provide assistance to families in choosing the best nursing home location.
The compiled list below was published by our New Mexico nursing home attorneys outlining Santa Fe area nursing facilities that currently maintain average to below average ratings compared other homes nationwide. In addition, we have added our primary concerns in an effort to show specific cases where the resident was harmed by abuse, neglect and mistreatment. Some cases involve the spread of infection, resident to resident assault, malnutrition, dehydration, facility acquired bedsores and other serious problems.
Our attorneys have compiled data from settlements and jury verdicts across New Mexico to give you an idea as to how cases are valued. Learn more about the cases below:
CASA REAL
1650 Galisteo Street
Santa Fe, New Mexico 87505
(505) 984-8313
A “For-Profit” 118-certified bed Medicaid/Medicare-participating facility
Overall Rating – 1 out of 5 possible stars
Primary Concerns –
Failure to Honor the Right of Every Resident of the Nursing Home to Be Free of Coercion and Reprisal as a Resident or Citizen of the United States at a Level to Avoid Causing Actual Harm
In a summary statement of deficiencies dated 01/29/2016, a state surveyor made a notation during an annual licensure and certification survey concerning the facility’s failure to “honor resident’s rights for [one resident the facility] reviewed during a complaint investigation by inappropriately placing a wander guard on [the resident] for 76 days without an order, preventing him from being able to leave the facility and threatening to discharge [the resident] if he didn’t comply with the placement of the wander guard.”
The state investigator also noted that “if residents are being intimidated to comply with facility rules, then staff is violating resident’s rights to have a choice in how they wish to live their lives, which could result in feelings of frustration, fear, humiliation and depression.”
The investigator completed a review of the officially appointed Ombudsman Notes 11/15/2015 revealed that the 11/24/2015 meeting with the resident, tribal officials, daughter, Administrator and Director of Nursing along with the MDS Coordinator and Social Services Director. The survey team noted that the “resident had not been assessed to lack capacity […and] that the resident leaves the facility and usually walks to where his daughter works, several blocks away from [the facility].”
The facility Administrator states that “they need to discharge [the resident] because he does not follow policy by signing out, and therefore they cannot guarantee his safety.” The documentation reveals that the resident “states that he cannot always sign out because the sign-up book is not always present at the front desk.” This was confirmed by the Ombudsman.
The documentation also revealed that “since 11/3/2015, the resident has been wearing a wander guard on his right leg due to his own safety per [instructions by the] Administrator. There were no physician’s orders for a wander guard and the daughter/power of attorney had not been notified that a wander guard was in place until the day of the meeting [on 11/24/2015].”.
The investigator reviewed the resident’s 11/03/2015 Face Sheet at reveals that the resident “is his own responsible party.”
During an interview occurring at 2:54 PM on January 20 15,016 with the facility’s Social Services Director in regards to the resident, the Director stated, “I have known this man [the resident] for about seven years. He walks all over. That has always been his routine. It is Care Planned. When the New Team (Administration) came in, they thought of it as a liability.”
The Social Services Director confirmed that the resident “walks to his daughters work which is a few blocks away and also goes to the next door [the hotel] to play cards with the housekeepers. One day he went out and it was kind of cold, he was wearing a jacket. They got very concerned and put him on the wander guard. We had a meeting with his daughter and tribe [on 11/24/2015]. He stayed with the wander guard until I could get two doctors to say he was competent. That he could make his own decisions and he was aware of the risk. He has Medicaid, so it was hard [to find physicians].” The Social Services Director also confirmed that the resident “never had an order for [the wander guard].”
The investigator then reviewed the resident’s physician’s orders between October 2015 through November 2015 which revealed: “there was no order for a wander guard.” However, the 11/24/2015 Physician Order revealed to “keep wander guard in place until psychiatric consult to evaluate the need for the wander guard related to flight risk and personal safety.” A 01/18/2016 Physician Order revealed “discharge, wander guard related to results of competency evaluations.”
During an interview with the Administrator at 11:27 AM on 01/26/2016, the Administrator was “asked when the wander guard was placed on [the resident]?” The Administrator said that “it was after he [the Administrator] was hired on 10/15/2015, before the Care Plan meeting in November [on 11/24/2015].” The Administrator was then asked what was the reason why the wander guard was placed on the resident. The Administrator stated, “there was a concern about him going out in inclement weather and whether or not he was able to make those decisions.”
During the interview, the Administrator also confirmed that the 11/24/2015 Care Conference “there was a request for some evaluations to be done. It was agreed that the wander guard would be removed once the competency assessment was completed and it was decided that he was capable of making his own decisions.” The Administrator was also asked, “if a wander guard could be put on a resident without a physician’s orders?” The Administrator responded, “it should not be.”
An interview was conducted on 01/26/2015 with the facility’s Clinical Psychologist who stated, “I was asked by the facility if I could perform a competency test on [the resident]. I tested [the resident] with a higher cognitive test and the results indicated he was cognitive and able to make rational decisions. I then submitted the diagnostic evaluation to the facility.”
Finally, the resident was interviewed at 10:24 AM on 07/27/2016 by the state investigator. The resident stated that “they put that thing (wander guard) on me so I wouldn’t leave the building. Buzzed with sound when I would want to leave the building. It made me feel bad because I could not leave the building. It was a nuisance to me every time I walk by the front door the buzzer would sound. I felt like I was in jail. I did not do anything else so they would not punish me anymore. I am not such a bad boy. I don’t want that thing on me again. I tried to obey, I know how to follow instructions.”
Our Santa Fe nursing home abuse attorneys recognize that using coercion or reprisal to control a resident who is fully cognitive violates their rights and causes actual harm to their emotional and mental status. The deficient practice by the nursing staff and administrators at Casa Real might be considered abuse or mistreatment because their actions fail to follow rights given to every citizen of the United States.
SANTA FE CARE CENTER
635 Harkle Road
Santa Fe, New Mexico 87505
(505) 982-2574
A “For-Profit” 120-certified bed Medicaid/Medicare-participating facility
Overall Rating – 2 out of 5 possible stars
Primary Concerns –
Failure to Provide Adequate Care by Qualified Personnel According Every Resident’s Written Plan of Care That Led to an Immediate Jeopardy
In a summary statement of deficiencies dated 7/29/15 a state surveyor made a notation during an annual licensure and certification survey concerning the facility’s failure to “implement the Plan to follow physician’s orders for [three residents of the facility] reviewed for pressure ulcers and thickened liquids by not providing the correct thickened liquid consistency for [two residents].”
The deficient practice was noted by a state investigator who made an observation at the facility 11:53 AM on 07/27/2015 in the restorative dining room during the lunch meal time. During the tour of the facility, five residents were observed as being unattended and three residents “were served thickened juice and water.” One of those residents “had an eight-ounce cup of coffee that did not appear to be thickened.
An interview was conducted with the Restorative Certified Nursing Assistant who was asked if that specific resident should be receiving consistency liquids and if two other residents should be on thickened liquids. At that time, the Dietary Manager “was passing by the restorative dining room and was asked what the consistency of the coffee should be for [one of the resident’s]. The Dietary Manager stated that it should be, “Nectar.” The Manager was then asked what the consistency of coffee that resident was drinking and answered: “there is no thickener in that coffee, and that the Ensure for [that resident] is pudding thick, I will take them back and go redo them.”
An additional observation was made at 5:05 PM on 07/27/2015 of residents in the restorative dining room who “were observed to be drinking an eight-ounce cup of coffee that did not appear to be thickened.” 10 minutes later at 5:15 PM, the surveyor conducted an interview with the facility’s Dietary Aide who was asked if the coffee being consumed by the two residents “was thickened in the kitchen before was delivered to the dining room.” The aide responded, “I do not thicken coffee. I have never done it.”
A few minutes later 5:33 PM, an interview was conducted with the Dietary Manager who was asked if the coffee being consumed by the two residents were “thickened coffee.” The Manager responded that the “coffee is not thickened, nurses should be thickening all liquids, my staff should not be thickening coffee.”
The investigator reviewed one of the resident’s July 2015 physician’s orders that revealed: head turn to the right with every swallow. Nectar thick liquids with all meals. Resource 2.04 ounces nectar thick with meals.”
An interview was conducted at 9:44 AM on 07/28/2015 With the Facility’s Speech and Language Pathologist who was asked if the resident “should have all his liquids thickened.” The Pathologist replied that the resident “should be on nectar thick liquids. He is at high risk. His dementia is severe. He does not follow cues, so that is why he is on purée and thickened liquids. He is a high risk for aspiration. He should not have thin liquids.”
The Speech and Language Pathologist was then asked about a different resident asking if that resident “is inconsistent with thin liquids, we trailed him on thin liquids and he started coughing, so I changed it back to nectar.” The Pathologist also said, “I did ask him [the resident] if he would like to go back to thin liquids, he stated, ‘No I feel safer with nectar’. It would be a risk for [that resident] to go on thin liquids 50 percent of the time, he would aspirate. I don’t want to put him at risk. He is safer on nectar.” When the surveyor asked if “health shakes were nectar thick consistency”, the Pathologist just replied, “health shakes are not nectar thick.”
The state investigator reviewed the resident’s Meal Tracker Ticket that revealed that the resident should be consuming “Nectar Thickened Liquids.” A review of the resident’s 02/16/2015 Care Conference Notes revealed that nectar thickened beverages are not being brought to the resident as directed.
Our Santa Fe nursing home neglect lawyers recognize that failing to follow the resident’s written Plan of Care and provide thickened beverages in accordance with physician’s orders and therapists orders could place the health and well-being of the resident in immediate jeopardy. The deficient practice by the nursing staff and employees at Santa Fe Care Center might be considered negligence or mistreatment because their actions failed to follow established standards of care.
EPANOLA VALLEY NURSING AND REHABILITATION CENTER
720 Hacienda Street
Espanola, New Mexico 87532
(505) 753-6769
A “For-Profit” 120-certified bed Medicaid/Medicare-participating facility
Overall Rating – 1 out of 5 possible stars
Primary Concerns –
Failure to Conduct Initial and Periodic Assessments on Each Resident’s Functional Capacity
In a summary statement of deficiencies dated 05/18/2015, a notation was made during an annual licensure and certification survey by a state investigator concerning the facility’s failure to “adequately assess [a resident] reviewed for accidents by not immediately performing a pain assessment or reassessment after [the resident] complained that her leg hurt.” The state investigator noted that “this deficient practice likely resulted in the delay of pain interventions, inadequate management of pain and decrease mobility.”
The state investigator reviewed a resident’s 05/10/2015 Care Plan revealing that the resident has impaired cognition and impaired memory.
The deficient practice was noted by the state surveyor upon review of a resident’s 04/29/2015 final X-ray report revealing the reason for the exam was “pain, swelling, discoloration.” An x-ray was taken of the left ankle showing “an acute oblique distal fibular shaft fracture extensive the upper lateral malleolus with no evidence for displacement.” The x-ray results showed “an acute fibular shaft fracture.”
Investigator also reviewed the resident’s April 2015 MAR (Medication Administration Record) that revealed that the resident was prescribed pain medication. However, the surveyor notes that “there was no documentation that any of these were administered to [the resident] on 04/27/2015 through 04/29/2015.”
A review was then conducted of the resident’s Progress Notes and PRN [medication administered as needed] Flow Sheets for the resident’s medications that did not contain any documentation from 04/27/2015 to 04/28/2015 that the resident “was experiencing pain and no documentation that assessments were performed by the nursing staff.”
An interview was conducted at 10:50 AM on 05/15/2015 with the facility’s Assistant Director of Nursing who was asked what happened on the day of 04/27/2015 with the resident? The Director responded that according to the facilities investigation when the resident “got up and transferred, she stood up, beared weight and said that her leg hurt.” After the nursing staff “got her to bed, he elevated her legs, made sure she was okay and notified the nurse [a Licensed Practical Nurse at the facility].” The Assistant Director of Nursing confirmed that the resident “was complaining of pain in the evening of 04/27/2015.”
The state investigator conducted a 9:40 AM 05/18/2015 interview with the facility’s Director of Nursing who “confirmed that the only documentation on [the resident] for 04/27/2015 to 04/29/2015 was on the 24-hour report sheet” where it was documented that the resident received 50 milligrams of pain medication administered at 4:00 PM.
Our Espanola nursing home neglect attorneys recognize that failing to conduct initial and periodic assessments on the functional capacity of every resident could place their health and well-being in immediate jeopardy. The deficient practice by the nursing staff at Espanola Valley Nursing and Rehabilitation Center might be considered negligence or mistreatment because their actions fail to follow the facility’s policy titled: Policies and Procedures on Pain Assessment and Management that reads in part:
“Reassess the resident’s pain and consequences of pain at least every shift for acute pain.”
“Document the resident’s reported level of pain with adequate detail (i.e. enough information to gauge the status of pain and the effectiveness of interventions for pain) as necessary and accordance with the pain management program.”
SOMBRILLO NURSING FACILITY
1011 Sombrillo Court
Los Alamos, New Mexico 87544
(505) 662-4300
A “Not for Profit” 66-certified bed Medicaid/Medicare-participating facility
Overall Rating – 3 out of 5 possible stars
Primary Concerns –
Failure to Ensure That All Residents Receive Proper Treatment to Prevent the Development of a New Bedsore or Allow an Existing Bedsore to Heal
In a summary statement of deficiencies dated 06/04/2015, a state surveyor made a notation during an annual licensure and certification survey concerning the facility’s failure to “ensure that [a resident] reviewed for pressure ulcers received necessary wound care treatments to avoid worsening of the pressure ulcer by not implementing physician’s orders.”
The state investigator noted that “this deficient practice likely resulted in the resident’s coccygeal (tailbone) pressure ulcer deteriorating from Stage I to a Stage II [ulcer]. If resident’s pressure ulcers are allowed to deteriorate, residents can experience permanent tissue damage, pain, and infection.”
A Review of the Resident’s 03/10/2015 through 03/17/2015 Wound Care Treatment Order directed the nursing staff to provide extensive wound care to the resident outlining how to cleanse, pat dry and apply skin prep and dressings to ensure optimal healing. “A notation indicated this order was inputted into the electronic record and scheduled to be performed once every three days.
In an interview conducted at 9:26 AM on 05/21/2015 with a Licensed Practical Nurse at the facility, it was confirmed: “the resident’s wound care order was prescribed to be carried out every other day and not every three days.”
The investigator reviewed the resident’s 03/10/2015 through 03/17/2015 TAR (Treatment Administration Record) and Nurse’s Notes that revealed: “the ordered wound dressing change to the resident’s coccyx was performed on 03/10/2015, 03/13/2015 and 03/16/2015 [and not in accordance with the physician’s orders].”
A review was conducted of the resident’s Progress Notes that show that on 03/10/2015 the resident’s coccyx wound measured 5.5 centimeters in length and 0.5 centimeters in width with the depth that was unable to determine. By 03/17/2015, or seven days later, documentation notes that the resident’s Stage II coccyx pressure ulcer now measured 2.5 centimeters in length by 0.5 centimeters in width with a depth of 0.1 centimeters.”
Our Los Alamos nursing home neglect attorneys recognize the failing to ensure that every resident receives proper treatment to allow an existing bedsore to heal or prevent the development of a new bedsore could place their health and well-being in jeopardy. The deficient practice by the nursing staff at Sombrillo Nursing Facility might be considered negligence or mistreatment because their actions fail to follow physician’s orders and provide care every other day instead of once every three days.
THE NEW MEXICO BEHAVIORAL HEALTH INSTITUTE AT LAS VEGAS
3695 Hot Springs Boulevard
Las Vegas, New Mexico 87701
(505) 454-2100
A “Government Owned and Operated” 176-certified bed Medicaid/Medicare-participating facility
Overall Rating – 3 out of 5 possible stars
Primary Concerns –
Failure to Provide Every Resident Environment Free of Accident Hazards and Provide Adequate Supervision to Prevent Avoidable Accidents and Incidences from Occurring
In a summary statement of deficiencies dated 08/21/2015, a notation was made by a state investigator during an annual licensure and certification survey concerning the facility’s failure to “ensure that seven residents received adequate supervision by not ensuring staff is awake, oriented, while supervising residents in the recreation area.” The state investigator also noted that the deficient practice by the nursing staff at The New Mexico Behavioral Health Institute at Las Vegas “has the potential to leave the residents at risk for falls, choking, resident to resident altercations or any other harm not being supervised.”
The state investigator conducted an observation at the facility 8:50 AM on 08/21/2015 where was noted that a technician “was asleep in the recreation room. There is no other staff present in the room.” A Licensed Practical Nurse working at the facility “walked into the Recreation Room and called out to him loudly three times before he woke up.”
A few minutes later at 9:03 AM, during an interview with the technician, the tech was “asked about the resident’s presence in the recreation room and their supervision levels.” The technician responded that “yes all seven residents were in here require constant supervision.”
Five minutes later at 9:08 AM, Licensed Practical Nurse was interviewed by the state surveyor who confirmed that the technician “was asleep in the recreation room while residents were present […and] confirmed that she called out to him [the technician] three times before he woke up.”
During the interview, the Licensed Practical Nurse also stated that the technician “was supposed to be supervising the residents that are in the rec room now. She further stated that she did not inform her manager that she found them sleeping and that his assignment has been changed and he has gone home for the day.”
Our Las Vegas nursing home neglect attorneys recognize that failing to provide adequate supervision to prevent an avoidable accident or incident from occurring could cause the resident actual harm. The deficient practices by the nursing staff and technicians at The New Mexico Behavioral Health Institute at Las Vegas might be considered negligence or mistreatment because their actions left residents who require ongoing supervision unsupervised for an extended period of time.
Many of the signs and symptoms of abuse and neglect on the elderly are very obvious while others are subtle. Certainly one of the most crucial ways any family advocate can intercept to prevent mistreatment is to listen to their loved one. It is important to never assume that any report or investigation into physical mistreatment, negligence, theft or abuse by caregivers or other residents is overblown or imagined.
Research indicates that female resident’s in nursing facilities are more likely than male resident’s to suffer abuse and neglect. The highest incident rates of elder abuse occurred as senior citizens 80 years and older, and those who suffer from cognitive impairment due to Alzheimer’s disease, dementia or other medical condition.
If you have any suspicions that your loved one is the victim of abuse or neglect while residing in a nursing facility, it is crucial to take immediate action now. Any suspicion or uneasiness you have over an incident, event or concern that your loved one has been harmed should be reported immediately to the nursing supervisors, director of nursing or administration of the facility. Often times, it is crucial to report the incident to law enforcement, advocacy groups and state and federal nursing home regulatory agencies.
Many families choose to seek legal assistance from a competent personal injury attorney who specializes in nursing home abuse and mistreatment cases. Some indicators of mistreatment that should prompt family members to obtain the services of an attorney will include:
Every nursing facility in New Mexico is required to follow state and national laws enforced to protect residents from injury, harm or death. Sadly, many facilities do not follow these rules, their actions or inactions are only stopped through legal action or enforcement.
If you believe your spouse, parent, grandparent or other loved one is experiencing neglect or abuse while residing in a nursing facility, do not hesitate to contact the Santa Fe nursing home abuse attorneys at Nursing Home Law Center LLC. For years, our New Mexico elder abuse attorneys have served as legal advocates for nursing home victims all throughout the state.
We encourage you to contact our law offices today at (800) 926-7565 to schedule a full case review at no cost or obligation. We accept all nursing home abuse cases, personal injury claims, and wrongful death lawsuits through contingency fee arrangements. This means all of your legal fees are paid only after we negotiate an acceptable out of court settlement on your behalf or win your case at trial.
For additional information on New Mexico laws and information on nursing homes look here.
If you are looking for information on a specific facility or an attorney, please see links below to respective locality pages.
Carl R. Wilander, Esq.
Licensed in New Mexico
Santa Fe County Nursing Home Injury Lawyer Nursing Home Law Center LLC Home