Gardens, The

In the surveyor’s words

From the most serious findings on record at Gardens, The, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF812Dec 11, 2025

  Based on observations, record review and interviews the facility failed to store, prepare, distribute and serve food in a sanitary manner in the main kitchen. Specifically, the facility failed to:-Ensure dietary staff washed their hands and changed gloves appropriately; and,-Maintain the kitchen in a sanitary condition. Findings include:I. Hand hygiene failuresA. Professional referenceThe Colorado Retail Food Establishment Regulations, (3/16/24), retrieved on 12/15/25, read in pertinent part, Food employees shall clean their hands and exposed portions of their arms immediately before engaging in food preparation including working with exposed food, clean equipment and utensils, and unwrapped single service and single-use articles and: after touching bare human body parts other than clean… […]

• No harm, potential for more than minimal, isolatedF686Nov 30, 2023

  Based on observations, interviews, and record review, the facility failed to ensure residents received care consistent with professional standards of practice to prevent the development and worsening of pressure injuries for one (#14) resident reviewed for pressure injuries out of 25 sample residents. Specifically, the facility failed to ensure interventions for Resident #14's pressure injury were consistently implemented. Findings include: I. Professional reference According to the National Pressure Injury Advisory Panel, Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline, third edition, [NAME] Haesler (Ed.), EPUAP/NPIAP/PPPIA: 2019, retrieved from… […]

• No harm, potential for more than minimal, isolatedF600Aug 17, 2022

  Based on interviews and record review, the facility failed to ensure two (#14 and #10) out of 19 sample residents were kept free from abuse. Specifically, the facility: -Failed to prevent a resident-to-resident altercation between Resident #15 and #10; -Failed to prevent a resident-to-resident altercation between Resident #15 and #14; -Failed to care plan and address the altercations involving Resident #15; and, -Failed to educate and train staff on triggers and the potential for Resident #15's aggression. Findings include: I. […]