Inspection Reports for The Neighborhood in Rio Rancho Life Plan Community
NM, 87124
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Inspection Report
Complaint Investigation
Census: 27
Deficiencies: 2
Mar 19, 2025
Visit Reason
The inspection was conducted as a complaint investigation for the state requirements of NMAC 8.370.14, Regulations for Assisted Living for Adults.
Findings
The facility was found deficient in securing cleaning supplies and hazardous chemicals, which were accessible to residents, posing a risk of harm. Additionally, fire extinguishers were not inspected monthly as required, increasing risk to residents and staff.
Complaint Details
Complaint intake was investigated with no deficiencies cited related to the complaint itself, but other deficiencies were found during the investigation.
Deficiencies (2)
| Description |
|---|
| Facility failed to ensure cleaning supplies and hazardous chemicals were stored in secured areas inaccessible to residents. |
| Facility failed to ensure fire extinguishers were inspected monthly as recommended by the manufacturer. |
Report Facts
Census: 27
Fire extinguishers: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Shawn Moore | Administrator | Signed the inspection report |
| Housekeeping Manager/Designee | Responsible for inspecting storage areas and chemicals weekly | |
| Plant Operations Manager/Designee | Responsible for inspecting fire extinguishers monthly and tagging them | |
| Nurse Manager | Confirmed the fourth floor custodian closet was unsecured and chemicals accessible | |
| Maintenance Technician | Confirmed fire extinguishers had not been inspected for February 2025 |
Inspection Report
Follow-Up
Deficiencies: 1
Nov 7, 2022
Visit Reason
The inspection was a Revisit/Follow-up survey conducted to assess compliance with the state requirements of 7 NMAC 8.2, Regulations for Assisted Living for Adults, specifically regarding nutrition and food safety practices.
Findings
The facility was found deficient in maintaining proper freezer temperatures in the kitchen walk-in freezer, with temperatures not recorded within the required range for multiple days. Corrective actions were implemented including staff training, equipment adjustments, and revised documentation procedures to prevent recurrence.
Deficiencies (1)
| Description |
|---|
| Failure to maintain proper freezer temperature in the facility kitchen walk-in freezer, with temperatures not recorded within or maintained at zero degrees Fahrenheit plus or minus three degrees for multiple days. |
Report Facts
Recorded days with improper freezer temperature: 28
Recorded days with improper freezer temperature: 6
Residents at risk: 21
Meals per day: 3
Hours between meals: 16
Calendar days for menu records: 30
Calendar days for therapeutic diet records: 30
Temperature range for refrigerator: 35
Temperature range for refrigerator: 41
Temperature for hot foods: 140
Temperature for freezer: 0
Inches for food storage off floor: 6
Days for leftover food discard: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Martina S. Ale | Administrator | Signed the report and confirmed findings during interview regarding freezer temperature logs. |
Inspection Report
Complaint Investigation
Deficiencies: 6
Apr 18, 2022
Visit Reason
The inspection was a Full-Onsite/Complaint survey conducted on 04/18/22 to assess compliance with 7 NMAC 8.2, Regulations for Assisted Living Facilities. The visit included investigation of two complaint intakes (#NM53252 and #NM43244) which were found to be unsubstantiated.
Findings
The facility was cited for deficiencies related to admissions and discharge agreements, resident evaluations, individual service plans, custodial drug permits, and nutrition. Several residents' records lacked required documentation such as refund policies upon death, evaluations completed within 15 days prior to admission, expected goals and outcomes in service plans, and availability of physician-ordered medications. The facility also failed to maintain proper temperature logs for freezers and refrigerators, putting residents at risk of foodborne illness.
Complaint Details
Complaint Intake #NM53252 was unsubstantiated with no deficiencies cited. Complaint Intake #NM43244 was unsubstantiated with no deficiencies cited.
Deficiencies (6)
| Description |
|---|
| Admissions and Discharge agreements did not include a refund provision/policy in case of death for 5 residents, not in compliance with Senate Bill (SB) 0335 - 2013 and 7 NMAC 8.2.20. |
| Resident evaluation for 1 of 5 residents was not completed within 15 days prior to admission as required. |
| Individual Service Plans (ISP) for 4 residents did not include expected goals and outcomes. |
| Custodial drug permits: 1 of 4 residents did not have all physician ordered medications available for use. |
| Facility failed to ensure that all physician ordered medications were available for use for 1 of 4 residents. |
| Facility failed to maintain proper temperature logs for freezers and refrigerators, with multiple days missing or out of required temperature range, risking foodborne illness for 24 residents. |
Report Facts
Residents reviewed for Admission/Discharge Agreements: 5
Residents reviewed for Resident Evaluation: 5
Residents reviewed for Individual Service Plans: 4
Residents reviewed for Custodial Drug Permits: 4
Residents at risk due to food temperature issues: 24
Days with improper freezer temperature recordings: 28
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christina S. Salazar | Administrator | Named in relation to confirming findings and corrective actions during interviews |
Inspection Report
Abbreviated Survey
Deficiencies: 0
Aug 18, 2020
Visit Reason
An Offsite Surveillance survey was conducted related to Covid 19 infection prevention and control.
Findings
No deficiencies were cited during the survey.
Inspection Report
Routine
Deficiencies: 0
Jun 25, 2020
Visit Reason
An offsite surveillance survey was conducted related to COVID-19 infection and prevention control.
Findings
No deficiencies were cited during the COVID-19 infection and prevention control survey.
Inspection Report
Routine
Deficiencies: 0
Apr 24, 2020
Visit Reason
Offsite Surveillance survey was conducted related to Covid 19 infection prevention and control.
Findings
No deficiencies were cited during the offsite surveillance survey.
Inspection Report
Routine
Deficiencies: 0
Apr 3, 2020
Visit Reason
An offsite surveillance survey was conducted related to Covid 19 infection and control.
Findings
No deficiencies were cited during the offsite surveillance survey.
Inspection Report
Routine
Deficiencies: 0
Mar 12, 2020
Visit Reason
An onsite surveillance survey was conducted related to Covid 19 infection prevention and control.
Findings
No deficiencies were cited during the Covid 19 infection prevention and control survey.
Inspection Report
Follow-Up
Deficiencies: 0
Dec 16, 2019
Visit Reason
The visit was a Revisit/Follow-up survey to verify compliance with state requirements of 7 NMAC 8.2, Regulations for Assisted Living.
Findings
No deficiencies were cited during the Revisit/Follow-up survey completed on 12/16/19.
Inspection Report
Complaint Investigation
Census: 15
Deficiencies: 4
Aug 19, 2019
Visit Reason
The inspection was conducted as a complaint survey based on Complaint #NM38151, which was substantiated with deficiencies cited related to resident records, individual service plans, and incident reporting.
Findings
The facility was found deficient in maintaining complete and accurate resident records, including documentation of accidents and injuries. Individual Service Plans (ISPs) were not reviewed or revised at least every six months for some residents. The facility failed to report incidents or injuries of unknown origin to the licensing authority within required timeframes. Additionally, residents in the Memory Care Unit could not independently access the secure outdoor area due to staff-controlled access.
Complaint Details
Complaint #NM38151 was substantiated with deficiencies cited related to resident records, individual service plans, and incident reporting. The complaint included reports of injuries of unknown origin that were undocumented and unreported by the facility.
Deficiencies (4)
| Description |
|---|
| Failure to ensure resident records included written accounts of all accidents, injuries, illnesses or reports reflecting appropriate follow-up. |
| Failure to review and/or revise Individual Service Plans at a minimum of every six months. |
| Failure to report incidents or injuries of unknown origin to the Licensing Authority within 24 hours or next business day. |
| Failure to ensure all Memory Care Unit residents could independently access the safe and secure outdoor area. |
Report Facts
Residents on census: 15
Complaint survey date: Aug 19, 2019
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Director of Nursing | Interviewed and confirmed lack of documentation and reporting of resident injuries and incidents. | |
| Social Service Director | Provided census information during the investigation. |
Inspection Report
Re-Inspection
Deficiencies: 0
Nov 30, 2016
Visit Reason
A revisit survey was conducted on 11/30/16 for an initial survey dated 10/03/16 for the state requirements of 7 NMAC 8.2, Regulations for Assisted Living.
Findings
The facility was found to be in compliance during the revisit survey. A deficiency was cited as a result of the initial survey completed on 10/03/16.
Inspection Report
Plan of Correction
Census: 4
Deficiencies: 1
Oct 3, 2016
Visit Reason
The inspection was conducted as a result of an initial survey for the state requirements of 7 NMAC 8.2, Regulations for Assisted Living, focusing on general licensing requirements and compliance with licensure rules.
Findings
The facility failed to apply for an amended Assisted Living license within 10 business days of changing administrators, resulting in a discrepancy between the license name and the current administrator. The Plan of Correction outlines steps taken to ensure compliance, including posting the correct license and monitoring future compliance.
Deficiencies (1)
| Description |
|---|
| Failed to apply for an amended Assisted Living license prior to or within 10 business days of changing Administrators, risking safety and welfare of residents. |
Report Facts
Resident census: 4
Civil monetary penalty maximum: 5000
Temporary license resident admission limit: 3
Temporary license duration limit: 120
Temporary license consecutive limit: 2
Correction completion date: Oct 4, 2017
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Executive Director | Signed the Plan of Correction document | |
| Director of Nursing | DON | Provided resident census information and was interviewed regarding administrator qualifications |
| Administrator | Acknowledged being the only administrator and discussed license issue during interview |
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