Riverdale Post Acute

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

for Resident #17 as wellThe DON said Resident #17's care plan was updated to include his triggers. The DON said she thought this was done recently, but upon review of Resident #17's care plan she said it was not completed. The SSD said keeping Resident #17 within line of sight, having a staff member in the dining room with him whenever he was there, keeping him occupied, or setting the resident up in his room were recent interventions that were added to his plan of care. The NHA said Resident #17's room was right next to the nurses' station. The NHA said he did not know if there were any specific interventions to help prevent Resident #17 from reacting to someone walking up behind him, which was why the facility moved his room to the nurses' station so the staff could keep an eye on him and intervene.The SSD said during the one-to-one activity program, the activities staff tried to take Resident #17off the unit as much as possible and take him to group activities.The DON said a specific person at the facility was not assigned to add care plan interventions. The DON said a staff member took notes during their IDT meetings and someone else added the care plan interventions afterwards. The DON said her goal was to put in a new intervention into

the residents' care plans after each incident.The NHA said the facility staff had made updating the residents' care plans after each incident a goal, but their documentation was not there. The NHA said he,

the DON and the SSD should be responsible for ensuring the residents' care plans were updated after each incident.II. Incidents of physical abuse involving Resident #5A. Incident of physical abuse of Resident #4 by Resident #5 on 6/18/251. Facility investigationThe facility investigation, dated 6/19/25, was provided by the NHA on 9/30/25 at 3:20 p.m. The investigation revealed the following:On 6/18/25 at 6:00 p.m. during

a scheduled smoking time, Resident #4 was upset with another resident when Resident #5 approached her and scratched her arm. The residents were separated, assessed and put on frequent checks. Resident #4 sustained scratch marks down both forearms.The investigation documented Resident #4 had a history of behaviors, including self-destructive behaviors and a history of not taking her medications or eating meals.

The behavioral care plan included interventions such as reminding the resident to choose positive behaviors and encouraging the resident to take her medications. Resident #4 had not been involved in any other incidents in the previous 12 months.The investigation documented Resident #5 did not have a history of behaviors, and did not indicate if Resident #5 had been involved in any other incidents in the previous 12 months.-However, Resident #5 had been involved in a physical altercation two months prior to the 6/18/25 incident with Resident #4.The facility substantiated physical abuse as contact was made from the assailant to the vi

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Riverdale Post Acute

2311 E Bridge St Brighton, CO 80601

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Resident #19 was holding Resident #17's legs and pulling at them. The nurse ran down the hall and immediately separated the residents with assistance from another staff member. Neither resident had any apparent signs of injury. Resident #17 refused to take off his coat so the nurse could perform a skin assessment. Resident #17 was assisted to a position near the nurse's cart for close observation.

The facility investigation, dated 8/31/25, was provided by the NHA on 9/30/25 at 4:30 p.m. The investigation revealed the following:

On 8/31/25 at 7:20 p.m. a nursing staff member saw Resident #17 and Resident #19 engaging in a physical altercation. Resident #19 was holding Resident #17's legs and pulling them. Nursing staff members immediately separated the residents and attempted to assess them. Resident #17 was placed near the nurses' station for close observation. Resident #17 told a member of the nursing staff that Resident #19 had hit him in the face. No injuries were noted to either resident at the time. The NHA, the physician, the on-call nurse, and the residents' representative were all notified within three hours of the incident on 8/31/25.

Interviews with the nursing staff, after the incident on 9/2/25, revealed Resident #17 was kicking his legs at Resident #19 when Resident #19 grabbed his legs. -However, the facility failed to provide documentation to indicate the incident on 8/31/25 was reported to the SSA.

C. Staff interviews

The NHA was interviewed on 10/1/25 at 5:14 p.m. The NHA said he was the abuse coordinator for the facility. He said he was responsible for reporting incidents of alleged abuse to the SSA The NHA said incidents of potential abuse should be reported to him within 24 hours of the incident occurring so he was able to report the incident to the SSA. The NHA said the facility's management team evaluated each allegation of abuse to determine if it met the requirements to be reported to the SSA. -However, the facility abuse investigation documented the NHA was notified regarding the incident on 8/31/25 and failed to report it to the SSA.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet