Kiowa Hills Rehabilitation and Nursing, LLC

In the surveyor’s words

From the most serious findings on record at Kiowa Hills Rehabilitation and Nursing, LLC, in the surveyor’s own words.

• Actual harm, isolatedF689Jan 16, 2025

  Based on observations, record review and interviews, the facility failed to ensure the residents environment remained as free of accident hazards as possible and ensured residents received adequate supervision and assistance to prevent a fall with major injury for one (#38) of three residents reviewed for accidents/hazards out of 33 sample residents. Resident #38, who was at high risk for falls and had a history of a fall with a fracture, was admitted to the facility on [DATE] and readmitted on [DATE] after a hospital stay for repair of a right femur fracture. Per the resident's fall care plan, staff were instructed to anticipate and meet the resident's needs, keep the call light within reach and keep personal items within reach. […]

• Actual harm, isolatedF600Dec 13, 2022

  Based on record review and interviews, the facility failed to ensure two (#1 and #2) of four residents reviewed for abuse out of nine sample residents were protected from abuse. Resident #2, with a diagnosis [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident #2 was in Resident #1's room doorway on 10/12/22 when she was pushed by Resident #1 out of his room. Resident #1 had verbal and physical behaviors directed towards others. Due to the facility's failures of not appropriately addressing Resident #2's wandering behaviors, they failed to protect her from abuse which resulted in her sustaining a traumatic subdural hemorrhage (brain bleed) as a result of being pushed by Resident #1. Findings include: I. […]

• No harm, potential for more than minimal, widespreadF812Aug 27, 2025

  Based on observations and interviews, the facility failed to prepare, distribute and serve food in accordance with professional standards for food service safety in the main kitchen.Specifically, the facility failed to ensure:-Hand hygiene was conducted appropriately;-Food was held at the correct temperature; and,-Room trays were covered during transportation from the kitchen to the residents' room. Findings include:I. Failure to perform hand hygiene appropriatelyA. Professional referenceThe Colorado Department of Public Health and Environment Colorado Retail Food Establishment Rules and Regulations, revised 3/16/24, was retrieved on 9/4/25. […]

• No harm, potential for more than minimal, widespreadF812Jan 16, 2025

  Based on observations, record review and interviews, the facility failed to ensure food was prepared, distributed and served under sanitary conditions in the main kitchen, satellite kitchen, and one of two nourishment refrigerators. Specifically, the facility failed to: -Ensure ready to eat foods were handled in a sanitary manner to prevent cross contamination in the main kitchen; -Ensure safe and appropriate storage of food items in the kitchen and nourishment room refrigerators; -Ensure proper hair restraints were worn in the kitchen; -Ensure the kitchen and food service areas were kept clean; and, -Ensure frozen meats were thawed in a safe manner. Findings include: I. Failed to ensure ready-to-eat foods were handled in a sanitary manner A. […]

• No harm, potential for more than minimal, widespreadF880Jan 16, 2025

  Based on record review, observations and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the possible development and transmission of infectious disease. Specifically, the facility failed to: -Wear the appropriate personal protective equipment (PPE) when entering transmission based precaution rooms; -Offer updated COVID-19 vaccinations and document consent or declination for vaccination for Residents #16, #36, #205 and #255; -Ensure staff followed proper hand hygiene practices during meal delivery; -Ensure staff followed proper infection prevention practices during wound care for Resident #37; and, -Ensure resident's glucometers were disinfected after each use. Findings include: I. […]