4 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (1 deficiency)
1 fire-safety deficiencies
Top issue: Services (1 deficiency)
Albuquerque, NM
5-star overall rating with 5-star inspections with 4 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
10501 Lagrima De Oro NE, Albuquerque, NM
(505) 296-6700
Overall
5 / 5
CMS overall stars
Health inspections
5 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
4 / 5
Resident outcomes and process measures
Quick facts
Beds
50
Certified beds
Average residents
45
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1983-03-28
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.94
Registered nurse staffing · state 0.63 · national 0.68
LPN hours / resident day
0.74
Licensed practical nurse staffing · state 0.71 · national 0.87
Aide hours / resident day
2.64
Nurse aide staffing · state 2.23 · national 2.35
Total nurse hours
4.32
All reported nurse hours · state 3.56 · national 3.89
Licensed hours
1.68
RN + LPN hours · state 1.33 · national 1.54
Weekend hours
3.54
Weekend nurse staffing · state 3.12 · national 3.43
Weekend RN hours
0.72
Weekend registered nurse coverage · state 0.46 · national 0.47
Physical therapist
0.11
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.99
CMS adjusted RN staffing hours
Adjusted total hours
4.57
CMS adjusted total nurse staffing hours
Case-mix index
1.29
Higher values indicate more complex resident acuity
RN turnover
50%
Annual RN turnover · state 54% · national 45%
Total nurse turnover
51%
Annual nurse turnover · state 53% · national 46%
SNF VBP
Program rank
777
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
63.91
Composite VBP score used to determine payment impact.
Payment multiplier
1.0185
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Healthcare-associated infections
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Total nurse turnover
10
Baseline 12.12% · Performance 23.08% · Measure score 10 · Achievement 10 · Improvement 0
Adjusted total nurse staffing
2.78
Baseline 4.64 hours · Performance 3.87 hours · Measure score 2.78 · Achievement 2.78 · Improvement 0
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.31% |
10.72%
1.4 pts better
|
No Different than the National Rate · Eligible stays 38 · Observed rate 0% · Lower 95% interval 5.75% |
| Discharge to community | 32.71% |
50.57%
17.9 pts worse
|
Worse than the National Rate · Eligible stays 33 · Observed rate 21.21% · Lower 95% interval 20.41% |
| Medicare spending per beneficiary | 0.71 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 28 · Denominator 28 |
| Falls with major injury | 3.57% |
0.77%
2.8 pts worse
|
Numerator 1 · Denominator 28 |
| Discharge self-care score | 47.62% |
53.69%
6.1 pts worse
|
Numerator 10 · Denominator 21 |
| Discharge mobility score | 61.9% |
50.94%
11 pts better
|
Numerator 13 · Denominator 21 |
| Pressure ulcers or injuries, new or worsened | 10.71% |
2.29%
8.4 pts worse
|
Numerator 3 · Denominator 28 · Adjusted rate 13.64% |
| Healthcare-associated infections requiring hospitalization | Not Available |
7.12%
|
Not Available · Eligible stays 21 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly. |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 54 |
| Staff flu vaccination coverage | 0% |
42%
42 pts worse
|
Numerator 0 · Denominator 57 |
| Discharge function score | 61.9% |
56.45%
5.4 pts better
|
Numerator 13 · Denominator 21 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 6 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 3 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 16 · Too few residents or stays to report publicly. |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 0.9 |
1.6
0.7 pts better
|
1.9
1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.9 · Observed 0.9 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.2 |
2.6
2.4 pts better
|
1.8
1.6 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.2 · Observed 0.2 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 86.3% |
97.4%
11.1 pts worse
|
93.4%
7.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 75.0% · Q2 82.2% · Q3 88.6% · Q4 100.0% · 4Q avg 86.3% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 98.0% |
98.7%
0.7 pts worse
|
95.5%
2.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 5.1% |
3.5%
1.6 pts worse
|
3.3%
1.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 4.4% · Q3 4.5% · Q4 7.1% · 4Q avg 5.1% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 3.1% |
1.8%
1.3 pts worse
|
11.4%
8.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 7.1% · Q3 2.3% · Q4 2.8% · 4Q avg 3.1% |
| Percentage of long-stay residents who lose too much weight | 1.4% |
5.4%
4 pts better
|
5.4%
4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 5.9% · 4Q avg 1.4% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 5.4% |
14.1%
8.7 pts better
|
19.6%
14.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 7.9% · Q3 2.6% · Q4 8.6% · 4Q avg 5.4% |
| Percentage of long-stay residents who received an antipsychotic medication | 3.9% |
14.7%
10.8 pts better
|
16.7%
12.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 8.3% · Q2 3.8% · Q3 0.0% · Q4 4.0% · 4Q avg 3.9% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 38.3% |
15.8%
22.5 pts worse
|
16.3%
22 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 38.3% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 25.5% |
14.6%
10.9 pts worse
|
14.9%
10.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 13.9% · Q2 13.5% · Q3 15.8% · Q4 61.8% · 4Q avg 25.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.7% |
1.3%
0.4 pts worse
|
1.0%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.5% · Q4 5.8% · 4Q avg 1.7% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.6% |
0.9%
0.3 pts better
|
1.7%
1.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.3% · Q4 0.0% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 24.6% |
20.6%
4 pts worse
|
19.8%
4.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 34.0% · Q2 22.1% · Q3 8.0% · Q4 35.1% · 4Q avg 24.6% |
| Percentage of long-stay residents with pressure ulcers | 10.4% |
5.7%
4.7 pts worse
|
5.1%
5.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 9.0% · Q2 8.3% · Q3 12.0% · Q4 12.7% · 4Q avg 10.4% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 81.3% |
86.6%
5.3 pts worse
|
81.7%
0.4 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 78.6% · Q2 76.7% · Q3 71.9% · Q4 97.0% · 4Q avg 81.3% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 5.3% |
15.9%
10.6 pts better
|
12.0%
6.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 5.3% · Observed 4.2% · Expected 8.7% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 3.9% |
1.3%
2.6 pts worse
|
1.6%
2.3 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q4 4.0% · 4Q avg 3.9% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 96.7% |
86.4%
10.3 pts better
|
79.7%
17 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 96.7% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 11.2% |
21.3%
10.1 pts better
|
23.9%
12.7 pts better
|
Short Stay · 20240701-20250630 · Adjusted 11.2% · Observed 8.3% · Expected 17.7% · Used in QM five-star |
Survey summary
Top issue: Freedom from Abuse and Neglect and Exploitation (1 deficiency)
1 fire-safety deficiencies
Top issue: Services (1 deficiency)
Top issue: Resident Assessment and Care Planning (3 deficiencies)
2 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Quality of Life and Care (3 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Fire safety
Fire Safety
Meet other general requirements that are deficient.
Corrected 2024-10-25
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2023-08-21
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2023-08-21
Fire Safety
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.
Corrected 2022-06-01
Inspection history
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Not marked corrected
Health
Protect each resident from the wrongful use of the resident's belongings or money.
Corrected 2025-07-29
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-10-25
Health
Provide and implement an infection prevention and control program.
Corrected 2024-10-25
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-08-21
Health
Provide and implement an infection prevention and control program.
Corrected 2023-08-21
Health
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected 2023-08-21
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-08-21
Health
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Corrected 2023-08-21
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2023-08-21
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2023-08-21
Health
Implement a program that monitors antibiotic use.
Corrected 2022-05-20
Health
Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
Corrected 2022-05-20
Health
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Corrected 2022-05-20
Health
Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.
Corrected 2022-05-20
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2022-05-20
Health
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Corrected 2022-05-20
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2022-05-20
Health
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Corrected 2022-05-20
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2022-05-20
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2022-05-20
Health
Post nurse staffing information every day.
Corrected 2022-05-20
Penalties and ownership
Nearby options
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