Citations in New Mexico
Statistics, citations and compliance trends for long-term care facilities in New Mexico.
Statistics for New Mexico (Last 12 Months)
Financial Impact (Last 12 Months)
Latest citations in New Mexico
Delayed Notification of Positive FOBT Result: A resident with an ileostomy, scoliosis, fibromyalgia, and thyroid disease was sent to the hospital after a CIC with abnormal VS and later returned with a pneumonia dx. After a stool sample was ordered for C-diff/FOBT, the FOBT was positive for blood, but the resident was not notified for several weeks. The result was not discussed until a later provider encounter, when GI eval and colonoscopy were recommended, and the resident reported frustration about the delay.
A resident with an ileostomy and tremors was not receiving ordered colostomy assistance. The physician ordered nursing staff to change the appliance and provide colostomy care as needed, but the resident filed a grievance saying staff were not helping empty the bag. A CNA told the resident she should do it herself despite her tremors, and the DON later stated there was confusion about CNA responsibilities for colostomy care.
PHI Left Exposed on Medication Cart: An open laptop on an unattended med cart displayed a resident’s EHR, and multiple papers with residents’ PHI were left visible on top of the cart, including diet orders, med lists, appointment information, physician notes, and personal effects records. Facility leadership stated resident information and computer screens should be secured and not left visible or unattended.
An unlocked med cart on the 300 Hall was left unattended in the hallway and accessible to anyone passing through the area. RN stated he left the cart unlocked, even though it contained narcotic meds in a locked box and other resident meds in the drawers. The UM and DON stated all med carts are expected to remain locked and secured, and that the assigned nurse is responsible for keeping the cart secured.
A resident’s oxygen order lacked a flow rate and delivery device, and three residents using oxygen via nasal cannula were observed with tubing that had no label or date showing when it was changed. Staff confirmed the missing labels, and the DON stated the order and tubing did not meet expectations.
Delay in Obtaining Ordered Narcotic Pain Medication: A resident admitted after multiple amputations reported severe post-op pain and had orders for hydrocodone-acetaminophen and other pain meds. The MAR showed the narcotic was unavailable from the pharmacy overnight and was not administered until the next morning, while staff documented repeated attempts to get the prescription filled and noted the pharmacy did not receive it until the next day.
Delayed Notification of Positive FOBT Result
Penalty
Summary
The facility failed to notify the resident in a timely manner of a significant health-related test result. The resident was admitted with diagnoses including ileostomy, scoliosis, fibromyalgia, and thyroid disease. After a change in condition with abnormal vital signs, the resident was sent to the hospital, diagnosed with pneumonia, and later returned to the facility. Following treatment with antibiotics for pneumonia and diarrhea, the provider instructed nursing staff to obtain a stool sample for C-diff testing, and an order was entered for a fecal occult blood test (FOBT) on the stool sample. The laboratory result from the stool sample was positive for blood on 05/06/26, but the provider follow-up note on 06/09/26 did not indicate that the resident had been notified of the result. The resident was not informed until the provider encounter on 06/17/26, when the positive FOBT was discussed and a gastrointestinal evaluation and colonoscopy were recommended. During interview, the resident stated she was not notified for a long time about the result and said she is not always informed of important changes in her care. The DON stated residents should be informed in a timely manner of important changes in their care and confirmed the resident was not informed of the FOBT result until 06/17/26.
Failure to Provide Ordered Colostomy Care
Penalty
Summary
The facility failed to provide colostomy care consistent with professional standards for a resident admitted with an ileostomy and diagnoses including scoliosis, fibromyalgia, and thyroid disease. Physician orders dated 01/20/26 required nursing staff to change the resident’s colostomy appliance one time a day, every three days, and as needed, and to provide colostomy care during both day and night shifts as needed. The care plan also directed staff to monitor the skin around the stoma and change the appliance as needed. The resident filed a grievance stating she was not receiving assistance with her colostomy bag. Nursing progress notes documented a CNA telling the resident she should empty the bag herself because she was independent, despite being informed the resident had tremors and could not empty it by herself. During interviews, the resident stated staff were not helping her with the colostomy bag and that tremors made it difficult for her to manage. The ST reported the resident had complained about not receiving help and said there were times when the bag was full and nurses did not assist. The DON stated there was confusion about what CNAs can and cannot do regarding colostomy care and said CNAs should empty colostomy bags for residents who use them. The UM stated colostomy care must be provided by nursing staff.
PHI Left Exposed on Unattended Medication Cart
Penalty
Summary
The facility failed to safeguard protected health information (PHI) for 4 of 4 residents identified in the report. During observation of the 300 hall, a laptop computer was left open on an unattended medication cart and displayed one resident’s electronic health record. In the same observation, multiple documents containing residents’ PHI were left exposed on top of the cart, including a diet order communication form with a room number, a medication list, appointment information, a physician appointment summary with physician notes, and an inventory of personal effects form for four different residents. Record review of the facility’s privacy policy stated that confidential or protected health information on desks or in other publicly accessible areas must be secured in designated work areas or locked storage, and computer screens must be locked when staff step away. During interviews, the Unit Manager stated that computer screens should be locked and patient information should not be left visible, the Corporate Director of Nursing stated all resident information must be secured and that staff are responsible for doing so, and the Administrator stated resident information should be secured by the person handling it and that leaving it visible and unattended could allow unauthorized access.
Unsecured Medication Cart Left Unattended on Hallway
Penalty
Summary
The facility failed to ensure medications were properly stored and secured when an unlocked hall medication cart on the 300 Hall was left unattended in the hallway and accessible to anyone passing through the area. The facility’s medication storage policy, revised January 2026, stated that medication supplies must remain locked when not in use or when not attended by authorized personnel, and that access is limited to licensed nursing personnel, pharmacy personnel, or other staff lawfully authorized to administer medications. During observation on 07/01/26, surveyors found the medication cart unsecured and unattended. RN #1 stated he had left the cart unlocked and explained that it contained narcotic medications in a locked box, with other resident medications in the remaining drawers. In interviews, UM #1 and the CDON both stated their expectation was that all medication carts remain locked and secured, and that the nurse assigned to the cart was responsible for keeping it secured. RN #1, UM #1, and the CDON each stated that if medication carts are left unlocked, residents could access medications not prescribed to them and become ill.
Incomplete oxygen orders and unlabeled tubing
Penalty
Summary
The facility failed to provide respiratory care in accordance with professional standards for four residents reviewed for respiratory care. For one resident with respiratory failure with hypoxia, atrial fibrillation, and CHF, the physician order for oxygen dated 06/26/26 did not include a flow rate or an oxygen delivery device such as a nasal cannula, simple mask, or non-rebreather mask. The Director of Nursing stated the order did not meet her expectations because oxygen orders should contain the appropriate information to ensure residents receive the appropriate amount of oxygen and by which device. The facility also failed to ensure oxygen tubing was labeled with a date showing when it was changed for three residents. During observations, one resident with respiratory failure with hypoxia, A-fib, and CHF, another resident with respiratory failure with hypoxia, COPD, and CHF, and a third resident with respiratory failure with hypoxia and COPD were each seen using oxygen via nasal cannula, and the tubing did not have a label or date. Their oxygen tubing orders required weekly changes and labeling with the date and initials every Sunday night shift. Staff including the BOM, OTA, and CMA confirmed the tubing was not labeled or dated, and the DON stated this did not meet her expectations.
Delay in Obtaining Ordered Narcotic Pain Medication
Penalty
Summary
The facility failed to ensure timely acquisition and provision of ordered narcotic pain medication for a resident who required post-operative pain management. The resident was admitted with diagnoses including surgical amputation, ESRD, and osteomyelitis, and had recently undergone a left above-knee amputation as well as multiple finger amputations. On admission, the resident reported 10/10 pain. Physician orders dated 06/26/26 included hydrocodone-acetaminophen 5 mg/325 mg every 4 hours as needed for pain, along with other pain medications such as celecoxib, gabapentin, pregabalin, capsaicin cream, and acetaminophen. The MAR showed hydrocodone-acetaminophen was unavailable from the pharmacy on 06/26/26 and was not given until 06/27/26 at 8:15 am. Pregabalin was also not administered because it was unavailable from the pharmacy. Other pain medications were administered, including acetaminophen and gabapentin, and capsaicin cream was not administered. Progress notes documented ongoing pain and repeated attempts to obtain the narcotic medication from the pharmacy. RN #1 documented multiple attempts to get the narcotic filled throughout the evening, and noted the medication remained pending pharmacy delivery. During interviews, RN #2 stated the prescription was sent to the pharmacy after the physician signed it and resent when it did not go through, but she did not know it still had not gone through until the next day. RN #1 and the DON stated the facility relied on the pharmacy receiving the signed narcotic prescription before the medication could be dispensed, and the DON stated the pharmacy reported it did not receive the prescription until the next morning.
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Compliance trends in New Mexico
Data through May 2026Comparisons below measure the most recent period Jun 2025 – May 2026 against the prior period Jun 2024 – May 2025 (two equal 12-month windows). The most recent 2 months are excluded because CMS is still publishing them.
Top tags by month · last 24 months
dashed = still reportingMonthly citation counts for the 5 most-cited tags. The dashed tail is the 2-month reporting lag.
Frequency movers
Biggest change in how often each tag is cited, as a rate per 100 inspections (so it isn't skewed by survey volume): Jun 2025 – May 2026 vs the prior period Jun 2024 – May 2025. Only tags with at least 20 citations in both periods are shown.
Severity movers
Tags whose average scope/severity shifted the most: Jun 2025 – May 2026 vs the prior period Jun 2024 – May 2025. The number is the average severity on the A–L scale (A=0…L=11); the letter is the band it falls in. A rise means the same tag is being cited at a more serious level — note the average can move enough to rank here while staying within the same letter. Same 20-citation minimum applies.
Care domain movers
Citations grouped into CFR care domains — F-tags by their §483 regulatory section (CMS State Operations Manual, Appendix PP) — measured as a rate per 100 inspections: Jun 2025 – May 2026 vs the prior period Jun 2024 – May 2025. Share is the domain's portion of citations this period; avg severity is the mean scope/severity letter and immediate jeopardy the percentage cited at J–L, both over the current period. Domains with at least 20 citations in both periods are shown; the sparkline tracks the last 12 months (left = oldest).
Immediate jeopardies · this period
Citations at the most serious scope/severity — J–L, immediate jeopardy, residents placed at risk of serious harm or death — over Jun 2025 – May 2026 vs the prior period Jun 2024 – May 2025. "Surveys with an IJ" counts distinct health inspections that had at least one.
Survey activity · by month
faded/dashed = still reportingCitations each month split into complaint-driven (unscheduled, triggered by grievances) vs standard surveys — bars, left axis — with the number of inspections as a line on the right axis. Rising inspections signal more scrutiny; a rising complaint share means more off-cycle surveys. The most recent 2 months are still being reported.
Deficiency-free survey rate
Share of health surveys that found zero deficiencies — the odds of a clean survey. Jun 2025 – May 2026 vs the prior period Jun 2024 – May 2025; the most recent 2 months are still being reported (dashed).
Penalties · by month
faded = still reportingTotal civil money penalty dollars imposed on the state's facilities each month — how hard the state is enforcing. The most recent 2 months are still being reported, and penalties often lag citations by several months.
Emerging tags
Tags that weren't established last period but surged — an early warning, distinct from movers (which track already-common tags). Criteria: fewer than 20 citations in the prior period, but at least 10 this period and 2.5× their prior volume. The sparkline shows monthly counts over the last 12 months (left = oldest).
Trusted data from CMS and state health departments
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