Inspection Reports for
Taos Healthcare LLC

The complaint involved allegations that a male staff member was rough with a resident while delivering blankets, which resulted in the resident being sent to the local acute care hospital. The facility's Administrator, who is also the abuse coordinator, confirmed the failure to submit the five-day follow-up report and did not pursue further investigation after concluding the incident occurred at another facility, despite family member statements to the contrary.

The facility failed to submit a required five-day follow-up report of abuse investigations to the State Agency and did not thoroughly investigate an allegation of abuse involving a resident, resulting in potential risk of further abuse or neglect to residents.

The complaint investigation included allegations of failure to notify residents and families of room changes, failure to notify providers of changes in condition, inadequate abuse investigations, improper discharge procedures, non-working oxygen equipment, unlocked medication carts, and unsanitary food handling. The investigation found substantiated deficiencies in all these areas.

The facility failed to provide written notice to residents and families before room changes, failed to notify physicians of changes in resident behavior, did not conduct thorough investigations of abuse allegations, failed to document discharge procedures properly, had non-working portable oxygen concentrators for multiple residents, left medication carts unlocked, and did not maintain sanitary food storage and handling practices.

The facility failed to honor resident choices for two residents, failed to prevent accidents and properly assess a resident after falls, and did not provide sufficient nursing staff to meet resident needs including scheduled baths/showers and effective communication.

The facility was found deficient in multiple areas including failure to properly care plan for residents, inadequate assistance with activities of daily living, insufficient restorative therapy services, improper ostomy care, inadequate staffing affecting resident care and communication, incomplete immunization consent documentation, unsanitary kitchen conditions, inaccurate elopement risk evaluation, and failure to maintain clean resident rooms.

The facility failed to promote resident choice by using bladder control pads in briefs without consistent resident permission, affecting 2 residents. Additionally, the facility failed to update the care plan for 1 resident with multiple falls, potentially impacting appropriate care delivery.

The facility was found deficient in multiple areas including failure to ensure call lights were within reach and functioning for some residents, failure to notify resident representatives of hospital transfers, failure to protect residents' rights to voice grievances without fear of retaliation, neglect in responding to a resident's cries for help, failure to update care plans to reflect current resident conditions, lack of ongoing activities for residents, inadequate monitoring of psychotropic medication effectiveness, failure to provide transportation for a resident's medical appointment, inaccuracies in medical records regarding feeding assistance and advanced directives, and failure to maintain working call systems in resident rooms.

The facility was found deficient in multiple areas including failure to accommodate resident preferences, inadequate notification of resident falls to POA, failure to respond to resident grievances, incomplete care plans, improper oxygen equipment maintenance, insufficient nursing staff, lack of psychotropic medication consents, expired medication storage, delayed meal service, improper food temperature control, inadequate hydration provision, infection control lapses, and absence of an antibiotic stewardship program.

The complaint investigation revealed substantiated issues including failure to notify the resident's POA or Emergency Contact after significant changes and death, improper discharge documentation and procedures, and unsanitary conditions in resident rooms and common areas.

The facility failed to notify the Power of Attorney or Emergency Contact for a resident after significant changes and death, failed to prepare and document accurate discharge information for another resident, and did not maintain a clean and safe environment for residents, as evidenced by unclean rooms, hallways, and handrails.

The facility was found deficient in multiple areas including failure to accommodate resident preferences, failure to provide timely showers, failure to notify physicians of changes in condition, failure to provide mobility aids, failure to send a resident to the emergency room after a fall, failure to provide timely transportation to appointments, failure to manage resident pain appropriately, failure to address mental health needs, and failure to provide meals as per the posted menu.

The facility was found deficient in multiple areas including failure to respect resident choices and preferences, inadequate alternate meal availability, inconsistent shower provision, lack of medication self-administration assessments and documentation, insufficient resident council grievance feedback, failure to report and investigate abuse allegations, incomplete care plans, professional care standards not met including post-fall assessments and oxygen administration, inadequate ADL assistance, insufficient and ineffective activities programming, medication errors, staffing shortages impacting care delivery, food service deficiencies, unsanitary food storage and preparation conditions, and lapses in infection control practices.