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Complaint Investigation

Falcon Heights Rehabilitation And Nursing Llc

July 31, 2024 · Colorado Springs, CO · 1795 Monterey Rd
Citations 1
CMS Rating 2/5
Beds 107
Provider ID 065168
Healthcare Facility
Falcon Heights Rehabilitation And Nursing Llc
Colorado Springs, CO  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)  ·  5 pages
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

FALCON HEIGHTS REHABILITATION AND NURSING LLC in COLORADO SPRINGS, CO — inspection on July 31, 2024.

Found 1 citation. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF555
Minimal harm or or their responsible parties' consent. call physicians did not call her back after leaving multiple messages. He said since Resident #9 was not affected

F-F555: the facility failed to inform and obtain consent from the residents and/or their responsible party when the corporation changed primary medical groups.

The DON said it took over a month for the new medical group to enter the facility and see residents.

She said the new medical group would not return calls to nursing overnight or on the weekends.

She said she directed the nurses to contact the retired medical director (RMD) to receive care instructions if they had not received a call back within 15 minutes.

She said she was frustrated and the nurses on the floor were frustrated the new physician group would not return calls after hours.

The DON said it had the potential for negative outcomes for residents.

065168

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 065168 B.

Wing 07/31/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Falcon Heights Rehabilitation and Nursing LLC 1795 Monterey Rd Colorado Springs, CO 80910

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in COLORADO SPRINGS, CO, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from FALCON HEIGHTS REHABILITATION AND NURSING LLC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.