LAGUNA RAINBOW NURSING CENTER

Nursing Home Inspector

I-40 EXIT 108 1/2 MILE SOUTH STATE ROAD 23
CASA BLANCA, NM 87007
Cibola County
Phone: 505-552-6034
Provider Number: 325214
Last Inspection: 05/16/2017

About the Nursing Home

Number of Beds: 58
Number of Residents: 57
Beds Available: 1
Percent Occupancy: 98%
Insurance Accepted: Medicare & Medicaid
Types of Councils: Resident
Ownership: Non profit - Other
Within Hospital?: NO

About State Inspection Deficiencies

Nursing Homes that are Medicare and/or Medicaid certified are licensed by the state and are required to comply with rigid standards enforced by regular facility inspections and extensive evaluations.

The state inspection deficiencies provided here are accounts reported by state inspectors of every discrepancy found where the home failed to meet the minimum standards set forth by state and federal regulations. If a home does not show any deficiencies, it has met the minimum standards required.

Please note: Findings in these inspections do not present a complete picture of the quality of care provided. Information in this database should be interpreted carefully and used in conjunction with other sources, as well as a visit to the nursing home.


Deficiency Ratings

Our nursing home inspector tool compares the severity of deficiences rather than the number of deficiences. We calculate the severity of each deficiency using the formula:

Severity Rating = Scope + Level of Harm.

Deficiency Rating= Sum of ALL Severity Ratings

Severity Scope Level of Harm
2 1-Isolated 1-Potential for minimal harm
3 2-Pattern 1-Potential for minimal harm
3 1-Isolated 2-Minimal harm or potential for actual harm
4 3-Widespread 1-Potential for minimal harm
4 2-Pattern 2-Minimal harm or potential for actual harm
4 1-Isolated 3-Actual harm
5 3-Widespread 2-Minimal harm or potential for actual harm
5 2-Pattern 3-Actual harm
5 1-Isolated 4-Immediate jeopardy to resident health or safety
6 3-Widespread 3-Actual harm
6 2-Pattern 4-Immediate jeopardy to resident health or safety
7 3-Widespread 4-Immediate jeopardy to resident health or safety

Deficiency Ratings
By Region

Lower Numbers Are Better

 

22

Facility
20

County
37

NM
20

USA

Deficiency Ratings
By Year

Lower Numbers Are Better

 

22

2017
0

2016
58

2015

Medicare Ratings

Overall Rating: Overall Rating
Health Rating: Health Rating
Staff Rating: Staff Rating
Quality Rating: Quality Rating

 

Details by Inspection Date

5/16/2017 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Ensure that residents are fully informed and understand their health status, care and treatments. Isolated : Minimal 3 7/20/2017
 
Failed To: Ensure the activities program is directed by a qualified professional. Widespread : Potential 4 7/20/2017
 
Failed To: Develop a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Pattern : Minimal 4 7/20/2017
 
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated : Minimal 3 7/20/2017
 
Failed To: Develop policies and procedures for influenza and pneumococcal immunizations. Isolated : Minimal 3 7/20/2017
 
Failed To: Set up an ongoing quality assessment and assurance group to review quality deficiencies quarterly, and develop corrective plans of action. Widespread : Minimal 5 7/20/2017
 

7/10/2015 Inspection

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Provide residents with private access to a telephone. Pattern : Minimal 4 8/10/2015
 
Failed To: Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. Isolated : Minimal 3 8/10/2015
 
Failed To: Ensure residents have the right to have a choice over activities, their schedules, and health care according to their interests, assessments, and plans of care. Isolated : Minimal 3 8/10/2015
 
Failed To: Listen to the resident groups and act on their complaints and suggestions that affect resident care and life. Isolated : Minimal 3 8/10/2015
 
Failed To: Reasonably accommodate the needs and preferences of each resident. Isolated : Minimal 3 8/10/2015
 
Failed To: Provide activities to meet the interests and needs of each resident. Isolated : Minimal 3 8/10/2015
 
Failed To: Provide medically-related social services to help each resident achieve the highest possible quality of life. Pattern : Minimal 4 8/10/2015
 
Failed To: Conduct initial and periodic assessments of each resident's functional capacity. Isolated : Minimal 3 8/10/2015
 
Failed To: Allow residents the right to participate in the planning or revision of care and treatment. Isolated : Minimal 3 8/10/2015
 
Failed To: Provide necessary care and services to maintain or improve the highest well being of each resident . Pattern : Minimal 4 9/23/2015
 
Failed To: Ensure that residents with limited range of motion receive appropriate treatment and services to increase range of motion or prevent further decrease in range of motion. Pattern : Minimal 4 9/23/2015
 
Failed To: Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being. Isolated : Minimal 3 8/10/2015
 
Failed To: Have enough nurses to care for every resident in a way that maximizes the resident's well being. Pattern : Minimal 4 9/23/2015
 
Failed To: Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. Pattern : Minimal 4 9/23/2015
 
Failed To: Provide or obtain dental services for each resident. Isolated : Minimal 3 8/10/2015
 
Failed To: At least once a month, have a licensed pharmacist review each resident's medication(s) and report any irregularities to the attending doctor. Isolated : Minimal 3 8/10/2015
 
Failed To: Maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards. Pattern : Minimal 4 8/10/2015
 

Complaint Investigation Deficiencies

These deficiencies resulted from complaints investigated by the state inspectors and substantiated.

5/13/2016 Investigation

 
Deficiency Description Scope : Level of Harm 1 -- Rating -- 7 Corrected
Failed To: Coordinate assessments with the pre-admission screening and resident review program for mentally-ill and mentally-retarded patients. Isolated : Minimal 3 6/8/2016
 

About The Staff

(Higher Numbers Are Better)

Staffing Hours Per Day Per Resident... This Facility County Avg NM State Avg
Number of Residents 57 61.50 77.72
Registered Nurses 0.76 0.70 0.82
Licensed Practical / Vocational Nurses 0.15 0.26 0.49
Certified Nursing Assistants 2.60 2.33 2.18
Total Staff Hours 3.51 3.29 3.50

 


About the Residents

(Lower Numbers Are Better)

Percent of Residents... This Facility% County Avg% NM State Avg%
of high risk long-stay residents with pressure ulcers 1 3 6
of long-stay residents assessed and appropriately given the pneumococcal vaccine 23 28 84
of long-stay residents assessed and appropriately given the seasonal influenza vaccine 88 94 92
of long-stay residents experiencing one or more falls with major injury 3 6 3
of long-stay residents who have depressive symptoms 2 1 4
of long-stay residents who lose too much weight 2 4 7
of long-stay residents who received an antianxiety or hypnotic medication 8 12 18
of long-stay residents who received an antipsychotic medication 4 10 16
of long-stay residents who self-report moderate to severe pain 10 5 10
of long-stay residents who were physically restrained 0 0 0
of long-stay residents whose ability to move independently worsened 20 19 21
of long-stay residents whose need for help with daily activities has increased 24 19 18
of long-stay residents with a catheter inserted and left in their bladder 10 7 2
of long-stay residents with a urinary tract infection 2 1 3
of low risk long-stay residents who lose control of their bowels or bladder 49 57 44