Health officials: Four long-term care facilities in New Mexico fail surprise visits

ALBUQUERQUE — When state workers paid a surprise visit to an Albuquerque assisted living facility earlier this year, they stumbled across a family wandering the halls, looking for a relative who lived there.

They eventually found her about a mile away.

At an Albuquerque nursing home, workers spoke with a woman who was recovering from surgery and had been left in a soiled diaper for 12 hours overnight. She was still clad in a hospital gown after her own clothes got lost in the laundry.

The two situations — at Morada Albuquerque and Las Palomas Center, respectively — were uncovered in May when state workers made a flurry of surprise visits over a single weekend at 91 long-term care facilities across the state. The results were unveiled by Gov. Michelle Lujan Grisham and several other state leaders in a news conference Wednesday.

“Absolutely no one should ever be in that kind of a condition for that length of time,” New Mexico Health Secretary Patrick Allen said at the event.

In addition to Las Palomas and Morada, Bonney Home and Red Rocks Care Center, both in Gallup, also failed expected standards and were referred for more follow-up scrutiny.

A third Albuquerque facility, Uptown Rehabilitation Center, was also referred for further follow-up because of a COVID-19 outbreak at the time of the visit, and 88% of the facilities failed some component of the visit.

Lujan Grisham said the widespread issues found in the facilities are a problem.

“The federal requirement for this level of care is that you should be getting better care and better outcomes living there than you would by yourself at home, even maybe living with a caregiver or informal caregiving at home,” Lujan Grisham said. “Well, I can tell you that, by and large, New Mexico does not meet that standard.”

The governor said the 91 surprise visits, which hit about one-third of the long-term care facilities in the state, are just the beginning.

She urged New Mexicans who are long-term care residents or family members who have complaints to call the state ombudsman program, which uses staff and volunteers to visit, investigate and resolve complaints.

The state is “going to be doing a lot more” to ensure standards are being met, she added.

The governor said industry leaders running inadequate facilities should see the efforts as a warning.

“They should expect that long gone are the days where we’re not paying attention because it’s COVID,” Lujan Grisham said. “Long gone are the days when we’re looking in the window. We’re coming in, and we expect the conditions to be a hell of a lot better than they are today in New Mexico.”

LeAnn Behrens, director of operations for the New Mexico Department of Health, said in an email Wednesday that Morada Albuquerque and Las Palomas Center were reported to the state’s Abuse, Neglect and Exploitation team.

Representatives from Morada Albuquerque did not respond to requests for comment Wednesday afternoon.

Bryan Woods, administrator of Las Palomas Center, didn’t answer questions about the results of the surprise visit to the facility but said in a statement, “Unfortunately, the Governor’s Office has not shared any results of their visit with us so we are unable to respond at this time.”

Las Palomas is owned by Genesis HealthCare, which also owns Red Rocks Care Center and Uptown Rehabilitation Center.

Bonney Home, Red Rocks and Uptown Rehabilitation were reported to licensing officials for further review but not to the abuse team because there were no “specific allegations,” Behrens wrote.

The surprise visits to long-term care facilities followed a similar endeavor launched last year around a program that provides care for developmentally disabled New Mexicans. After the death of 38-year-old Mary Melero — a developmentally disabled woman who officials believe suffered horrific abuse at the hands of her caretaker and two other women — the state began carrying out unannounced health and safety checks on all people enrolled in the Developmental Disability Waiver program.

“We learned from what we developed and what we found out in our work with the developmental disabilities program,” Allen said. “In addition to the regulatory structure, they’re bringing people in to go visit and go lay eyes on facilities and people. … That system has improved significantly since then as a result.”

Allen said the effort in this case included state workers from the Aging and Long-Term Services Department and the New Mexico Department of Health’s Division of Health Improvement and Developmental Disabilities Supports Division.

The state included assisted-living, skilled nursing and nursing facilities, but set its sights in particular on facilities with prior complaints. Teams of employees ultimately visited sites in 13 counties, including Santa Fe County, over the course of the May 17-19 weekend.

“We consciously started this on a Friday afternoon, with the visits occurring over Saturday and Sunday,” Allen said. “We wanted to see what family members are likely to see … not what you’re going to see if you go in 8 to 5, Monday through Friday.”

The visits were not the technical inspections typically done for regulatory purposes, but instead aimed to collect basic information about residents’ experiences and the environment.

“Are people clean and hygienic? Do things smell? Are there activities or are people parked in wheelchairs in hallways with nothing to do?” Allen said. “… These are things that every single facility should have been able to pass.”

Only 11 facilities received a perfect score, including several in Santa Fe: Montecito Santa Fe, Montecito Santa Fe Memory Care, Kingston Residence of Santa Fe and, with an asterisk, Pacifica Senior Living Santa Fe, a troubled assisted living center that at the time of the visit was nearly empty of residents as it prepared to transition to 55-and-up apartments.

Jen Paul Schroer, the state’s Cabinet secretary of aging and long-term services, said the results of the surprise visits highlight the need to expand her department’s ombudsman program, although she said it’s already expanded massively in the last year.

“We are getting more and more complaints and referrals coming into our agency,” Schroer said, adding both complaints and the number of volunteers powering the program are up 75% from 2023.

Schroer also said her department recently received a grant from the federal Administration for Community Living to help state agencies study workforce challenges for long-term care, and is launching a study on the ownership models and on-the-ground realities for long-term care facilities.

The state is also banking on its New MexiCare Caregiver Health Model, Paul Schroer said, a mechanism that provides financial assistance and training to caregivers of friends and family members to help build the network of community-based options for people who need help.

Lujan Grisham said she underwent the same training as state employees who made surprise visits, and she made a number of visits herself, both with state staff and on her own. While she said she’s not looking for a “gotcha,” she takes the visits seriously and expects all state workers to do the same.

The governor said the surprise visits will continue, and while the first batch didn’t uncover “heinous” behavior, it’s possible more will come to light in the future.

“The more work we do, the more we’re going to find,” she said. “… Some of those could, very frankly, be devastating cases.”