Desert Springs Health Care: Accident Hazard Harm - NM
The resident, identified in federal inspection records only as Resident 81, had been living at the facility with a list of conditions that made her especially vulnerable to serious injury: congestive heart failure, morbid obesity, generalized muscle weakness, type 2 diabetes, and major depressive disorder. Her care plan, revised the previous June, was explicit. She required two staff members for every personal care task, including bed baths, dressing, and transfers. The plan had been in place for months.
That morning, she was in her room with her husband when she asked for a bed bath. One aide came.
The certified nursing aide, identified in inspection records as CNA #2, later told investigators he had no idea she needed a second person. He said he greeted the resident and her husband, positioned himself on one side of the bed, and began the bath. At some point, the resident rolled toward the opposite side. He could not stop her. She went over the edge and hit the floor.
She was sent by ambulance to a local hospital, where imaging confirmed a displaced oblique fracture at the lower end of her femur and a displaced fracture of the middle bone in her left pinky finger. Two days later, on December 29, she underwent surgery to repair both fractures.
She was discharged from the hospital and transferred to a rehabilitation facility. As of the inspection date, January 30, 2026, she had not returned to Desert Springs.
The Director of Nursing told inspectors she expected residents who required two-person assistance to receive it, and that CNA #2 should have been told about the requirement when the nurse gave him his shift report that morning. The administrator confirmed the resident's transfer and her continued absence from the facility.
Nobody disputed what the care plan said. Nobody disputed that only one aide showed up.
What the inspection report does not explain is how a care plan requiring two-person assistance for bed baths failed to reach the person performing the bed bath. CNA #2 said he was unaware of the requirement. The Director of Nursing said he should have been told at the start of his shift. The gap between those two statements, between what should have been communicated and what actually was, is where the fractures happened.
The resident's husband was in the room when she fell.
Federal inspectors cited the deficiency at the "actual harm" level, the designation used when a violation results in measurable injury to a resident rather than the potential for it. The finding covered one of three residents reviewed for falls during the complaint inspection.
A fractured femur in an elderly person with heart failure, diabetes, and muscle weakness is not a minor setback. Surgery carries risks of its own, and recovery, even under the best conditions, is long. The resident who asked for a bed bath on a December morning is now in a rehabilitation facility, working to recover from injuries she sustained in the place that was supposed to keep her safe.
Her care plan said two people. One came.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Desert Springs Health Care LLC from 2026-01-30 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 5, 2026 · Our methodology
Desert Springs Health Care LLC in Hobbs, NM was cited for violations during a health inspection on January 30, 2026.
Her care plan, revised the previous June, was explicit.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.