Based on record review and interviews, the facility failed to provide response, action and rationale to residents involved in group grievances.Specifically, the facility failed to effectively address, resolve and document resolutions to residents' concerns regarding long call wait times in a timely manner.Findings include: I. Facility policy and procedure The Grievance policy, dated 4/11/25, was provided by the nursing home administrator (NHA) on 7/9/26 at 11:06 a.m. It revealed in pertinent part, It is the policy of this facility to support each resident's and family member's right to voice grievances without discrimination, reprisal or fear of discrimination or reprisal. …
F565 citations in Colorado
Resident Rights Deficiencies
Honor the resident's right to organize and participate in resident/family groups in the facility.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Colorado cites F565 more often than its own record predicts
5.43 times the share F565 takes of citations nationally.
Of every deficiency written in Colorado in 2025, this is the portion that was F565.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Colorado surveyors wrote
F565 findings written in Colorado, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
The short window
Recent years
| Year | Share of Colorado citations | vs expected |
|---|---|---|
| 2023 | 0.85% | 2.77× |
| 2024 | 1.27% | 4.13× |
| 2025 | 1.46% | 5.43× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Colorado surveyors cite →
Deficiency Index is independent and is not affiliated with, endorsed by, or approved by CMS, Medicare, or any government agency. About this data · Report a correction