Deficiencies (last 3 years)
Deficiencies (over 3 years)
4.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
34% better than New Mexico average
New Mexico average: 7.1 deficiencies/yearDeficiencies per year
12
9
6
3
0
Occupancy
Latest occupancy rate
80% occupied
Based on a November 2025 inspection.
Occupancy rate over time
Inspection Report
Routine
Census: 83
Deficiencies: 8
Date: Nov 17, 2025
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to resident care, privacy, medication consent, advanced directives, care planning, transfer assistance, food safety, and infection control at Retirement Ranches Inc.
Findings
The facility was found deficient in multiple areas including failure to obtain consent for psychotropic medications, lack of mail delivery on Saturdays, failure to document residents' advanced directives, inadequate privacy during medication administration, incomplete care plans, insufficient staff assistance during resident transfers, improper food storage practices, and failure to use required personal protective equipment during care.
Deficiencies (8)
Failed to ensure residents and/or their representatives were informed and consented to psychotropic medications for 1 of 2 residents reviewed.
Failed to ensure residents received mail on Saturdays affecting 83 residents.
Failed to ensure residents' wishes regarding code status, medical interventions, and artificial hydration/nutrition were documented and communicated for 3 residents.
Failed to provide personal privacy during medication administration for 3 of 4 residents reviewed.
Failed to update a resident's care plan to reflect new diagnosis and treatment plans for 1 of 7 residents reviewed.
Failed to provide two-person assistance during transfer for 1 of 3 residents reviewed.
Failed to store and serve food under sanitary conditions; food items in freezer were opened, unlabeled, and undated.
Failed to utilize enhanced barrier precautions (PPE) when providing direct care to 3 residents requiring such precautions.
Report Facts
Residents affected: 1
Residents affected: 83
Residents affected: 3
Residents affected: 3
Residents affected: 3
Residents affected: 4
Residents affected: 7
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Director of Nursing | Confirmed failure to obtain psychotropic medication consent and expectations for PPE use |
| Certified Medical Assistant #1 | Certified Medical Assistant | Administered medications in commons area without privacy |
| Certified Medical Assistant #2 | Certified Medical Assistant | Administered medications in commons area without privacy |
| Certified Nurse Assistant #1 | Certified Nursing Assistant | Transferred resident alone using mechanical lift |
| Certified Nurse Assistant Coordinator | Certified Nursing Assistant Coordinator | Confirmed two-person assist required for resident transfers |
| Dietary Aide #1 | Dietary Aide | Confirmed food items in freezer were unlabeled and undated |
| Certified Nurse Aide #2 | Certified Nurse Aide | Failed to wear PPE when providing care to resident on enhanced barrier precautions |
| Certified Nurse Aide #3 | Certified Nurse Aide | Failed to wear PPE when providing care to resident on enhanced barrier precautions |
| Certified Nurse Aide #4 | Certified Nurse Aide | Failed to wear PPE when providing care to resident on enhanced barrier precautions |
| Social Services Director | Social Services Director | Confirmed mail is not delivered on weekends |
| Admissions Director | Admissions Director | Confirmed lack of documentation of residents' wishes regarding advanced directives |
Inspection Report
Routine
Census: 34
Deficiencies: 1
Date: Jun 12, 2025
Visit Reason
The inspection was conducted to ensure compliance with regulations regarding the secure storage and labeling of drugs and biologicals in the facility.
Findings
The facility failed to ensure the treatment cart on the 200 hall was locked while unattended, potentially allowing unauthorized access to medical supplies and personal health information for 34 residents.
Deficiencies (1)
Treatment cart on the 200 hall was unlocked while unattended, risking unauthorized access to medical supplies and personal health information.
Report Facts
Residents affected: 34
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Registered Nurse (RN) | RN #1 confirmed the treatment cart was unlocked and stated it should be locked and secured while not in use |
Inspection Report
Routine
Census: 80
Deficiencies: 2
Date: Aug 1, 2024
Visit Reason
The inspection was conducted to assess compliance with medication security and dietary menu requirements at the facility.
Findings
The facility failed to ensure medication and treatment carts were securely locked when unattended, risking resident access to medications. Additionally, the facility did not have menus for all physician-prescribed diets, failed to follow menus for all residents, and lacked portion sizes and planned menus for therapeutic and texture-modified diets.
Deficiencies (2)
Medication and treatment carts were left unlocked and unattended multiple times, risking unauthorized access to medications.
Menus were not in place for all physician prescribed diets and the facility failed to follow the menu for all 80 residents; menus lacked portion sizes and planned menus for therapeutic and texture modified diets.
Report Facts
Residents affected: 80
Medication carts observed: 6
Treatment carts observed: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN1 | Registered Nurse | Named in multiple observations related to medication cart security failures |
| Director of Nursing | Director of Nursing (DON) | Provided statements regarding medication cart locking policies and menu compliance |
| Director of Dietary | Director of Dietary (DOD) | Interviewed regarding menu planning and availability |
| Registered Dietitian | Registered Dietitian (RD) | Interviewed regarding menu expectations and compliance |
| Certified Nurse Aid 2 | Certified Nurse Aid (CNA) | Provided information on resident diets and food served |
Inspection Report
Complaint Investigation
Deficiencies: 2
Date: Feb 28, 2024
Visit Reason
The inspection was conducted due to complaints regarding failure to meet professional standards of quality in medication management for resident #3 and failure to prevent accidents during resident transfers, resulting in injuries to resident #4.
Complaint Details
The complaint investigation revealed substantiated deficiencies related to medication management and resident transfer safety. Immediate jeopardy was identified on 02/28/2024 due to unsafe transfer practices leading to resident injury.
Findings
The facility failed to properly assess, notify, and document pain medication use for resident #3, leading to potential overdose risks. Additionally, the facility failed to provide safe transfer procedures for resident #4, resulting in a fall causing new fractures and immediate jeopardy to resident health and safety.
Deficiencies (2)
Failure to meet professional standards of quality for pain medication management for resident #3, including inadequate assessment, notification, and documentation of fentanyl patch use.
Failure to prevent accidents by not providing safe transfer procedures, including inadequate staff training on transfer lifts, failure to identify number of staff needed, and failure to use leg straps, resulting in resident #4 falling and sustaining fractures.
Report Facts
Residents reviewed for pain medications: 3
Residents reviewed for falls: 4
Fentanyl patches found on resident #3: 2
Hydrocodone doses administered: 7
Date of resident #4 fall: Oct 11, 2023
Number of staff required for safe transfer: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| RN #4 | Registered Nurse | Admitted resident #3 and left fentanyl patch on back during shower |
| CMA | Certified Medication Assistant | Removed fentanyl patches from resident #3 and administered hydrocodone |
| DON | Director of Nursing | Interviewed regarding transfer incident and staff training on lifts |
| DOR | Director of Rehabilitation | Interviewed about resident #4 transfer and lift use |
| CNA #1 | Certified Nursing Assistant | Involved in transfer of resident #4 during fall incident |
| CNA #2 | Certified Nursing Assistant | Interviewed about lift use and safety practices |
| CNA Coordinator | Provided information on staff training and lift use policies | |
| LPN #1 | Licensed Practical Nurse | Observed resident #4 after fall and assisted with care |
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: Sep 26, 2023
Visit Reason
The inspection was conducted due to concerns about the facility's failure to administer oxygen to a resident (R #45) in accordance with the physician's orders.
Complaint Details
The complaint investigation found that resident R #45 was not receiving oxygen as prescribed, with observations of the resident without oxygen and staff confirming non-compliance and uncertainty about oxygen orders.
Findings
The facility failed to provide safe and appropriate respiratory care by not administering oxygen continuously as ordered for resident R #45, who frequently removed the oxygen nasal cannula. Observations and interviews confirmed the oxygen was often not in use despite physician orders for continuous administration.
Deficiencies (1)
Failure to administer oxygen in accordance with physician's orders for resident R #45.
Report Facts
Oxygen flow rate: 2
Date of care plan: Feb 2, 2023
Date of physician orders: Feb 2, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Certified Nurse Aide (CNA) #1 | Observed reapplying oxygen to resident and stated resident frequently removes oxygen | |
| Registered Nurse (RN) #1 | Stated CNAs should check if resident is wearing oxygen every time they walk by | |
| Certified Nurse Aide (CNA) #2 | Observed oxygen tank on without nasal cannula attached and turned off tank; uncertain about oxygen orders |
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