Based on observations, record review and interviews, the facility failed to ensure residents who were unable to carry out activities of daily living (ADL) received the necessary services to maintain good nutrition, grooming, personal and oral hygiene for one (#15) of four residents reviewed for ADL care assistance out of 29 sample residents. Resident #15 admitted to the facility for long term care on 2/28/22 with diagnoses of depression, quadriplegia (decreased or no movement of all four limbs), neurogenic bowel (decreased bowel movements), neuromuscular dysfunction of bladder (decreased bladder movement) and colostomy status (an opening into the colon from the outside of the body). The resident was dependent on staff for all of his ADLs. …
F677 citations in Colorado
ADL care for dependent residents · Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Colorado cites F677 more often than its own record predicts
1.34 times the share F677 takes of citations nationally.
Of every deficiency written in Colorado in 2025, this is the portion that was F677.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Colorado surveyors wrote
F677 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 observations, record review and interviews, the facility failed to provide the necessary services to maintain personal hygiene to two (#10 and #22) of four residents reviewed for services to maintain the highest practicable quality of life out of 22 sample residents. Specifically, the facility failed to ensure:-Resident #10 received timely incontinence care; and,-Resident #22 received his scheduled bed baths.Findings include:I. Facility policy and procedureThe Activities of Daily Living policy and procedure, dated 4/11/25, was provided by regional clinical resource #2 on 7/9/26 at 3:57 p.m. …
The short window
Recent years
| Year | Share of Colorado citations | vs expected |
|---|---|---|
| 2023 | 3.05% | 1.10× |
| 2024 | 2.84% | 1.17× |
| 2025 | 3.03% | 1.34× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Colorado surveyors cite →
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