Brookdale Greenwood Village

In the surveyor’s words

From the most serious findings on record at Brookdale Greenwood Village, in the surveyor’s own words.

• Actual harm, isolatedF686Apr 9, 2026

  Based on observations, record review and interviews, the facility failed to provide the necessary treatment and services to prevent and treat pressure injuries for one (#20) of two residents out of 34 sample residents.Resident #20, who was dependent on staff for all care and mobility and was known to be at risk for skin breakdown, was admitted to the facility on [DATE] with a right hip surgical incision, but did not have any pressure injuries. The facility did not implement interventions to offload the resident's heels or provide a low-air loss mattress upon the resident's admission to the facility.Additionally, the facility failed to conduct a Braden Scale assessment (a tool utilized for predicting pressure ulcer injury risk) upon the resident's admission to the facility.On 4/6/26,… […]

• Actual harm, isolatedF689Apr 9, 2026

  Based on record review and interviews, the facility failed to ensure residents had adequate supervision and assistive devices to prevent accidents for one (#28) of three residents reviewed out of 34 sample residents. Specifically, the facility failed to ensure supervision was provided, as determined in an assessment, to prevent a fall for Resident #28 that resulted in fractures. Resident #28 was admitted on [DATE] with diagnoses of sepsis (infection of the blood), unsteadiness on feet, generalized muscle weakness, repeated falls and other Alzheimer's disease.Resident #28, was identified as a fall risk and had a history of repeated falls. Resident #28 was found outside by facility staff on 3/29/26. Resident #28 was bleeding from her mouth and had pain when trying to bend her knees. […]

• No harm, potential for more than minimal, widespreadF812Apr 9, 2026

  Based on observations and interviews, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in two of two kitchenettes. Specifically, the facility failed to ensure staff used proper hand hygiene during meal service. Findings include: I. Professional referenceThe Colorado Department of Public Health and Environment Colorado Retail Food Establishment Rules and Regulations, revised 3/16/24, was retrieved on 4/16/26. […]

• No harm, potential for more than minimal, widespreadF812Dec 1, 2025

  Based on observations, record review and interviews, the facility failed to ensure that food was stored, prepared, distributed, and served in accordance with professional food safety standards in the main kitchenSpecifically, the facility failed to ensure:-The kitchen was kept in a sanitary manner;-Perishable foods were properly labeled, stored, and maintained; and, -The ice machine was maintained in a sanitary condition. Findings include:I. Failure to ensure the kitchen was kept in a sanitary mannerA. Professional referenceAccording to the U.S. […]

• No harm, potential for more than minimal, patternF565Apr 9, 2026

  Based on record review and interviews, the facility failed to complete grievance forms consistently to address and promptly resolve resident grievances.Specifically, the facility failed to effectively address, resolve, and demonstrate the facility's response to group grievances. Findings include:I. Facility policy and procedureThe Grievance policy and procedure, reviewed March 2018, was provided by the nursing home administrator (NHA) on 4/6/2 at 9:00 a.m. It revealed in pertinent part, A resident, his/her representative, family member, visitor or advocate may file a verbal or written comment, grievance or complaint concerning resident rights, treatment, abuse, neglect, harassment, medical care, behavior of other residents, theft of property without fear of threat or reprisal in any… […]