Based on interviews and record reviews the facility failed to ensure alleged violations related to abuse and/or mistreatment were timely reported to the State Survey Agency for three (#88, #81, and #64) of ten residents reviewed for abuse concerns out of 46 sample residents. (Cross reference to F600, F607, F610). The facility's failue to timely report alleged violations to the State Survey Agency created an environment for repeat incidents of abuse and/or mistreatment by administrative staff which left residents fearful and intimidated. Cross reference F600, F607 and F610. Findings include: I. …
F609 citations in Colorado
Reporting alleged violations · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Colorado cites F609 less often than its own record predicts
0.41 times the national share — cited less often here than elsewhere.
Of every deficiency written in Colorado in 2025, this is the portion that was F609.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Colorado surveyors wrote
F609 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.
Based on record review and interviews, the facility failed to report alleged violations of potentialabuse to the State Survey and Certification Agency in accordance with state law for three (#6, #1 and #3) of 12 residents reviewed for abuse out of 14 sample residents.Specifically, the facility failed to:-Report an incident of potential verbal abuse towards Resident #6 by the dietary manager (DM) to the State Agency; and,-Report allegations of verbal abuse towards Resident #1 and Resident #3 by the nursing home administrator (NHA) within two hours of being notified of the allegations. Findings include: I. Facility policy and procedure The Abuse Investigation and Reporting policy and procedure, undated, was received from the business office manager on 8/27/26 at 6:51 p.m. …
The short window
Recent years
| Year | Share of Colorado citations | vs expected |
|---|---|---|
| 2023 | 0.76% | 0.39× |
| 2024 | 1.12% | 0.49× |
| 2025 | 1.01% | 0.41× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Colorado surveyors cite →
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