Brookdale Greenwood Village

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

was no documentation of why the order was placed on hold. The director of nursing (DON) was interviewed

on 9/23/25 at 3:17 p.m. The DON said when a resident was admitted , the nurse on duty would fill the role of the admission nurse and would review the hospital orders with the on-call physician and the resident's medical provider. He said all the medications would be verified. He said the orders were then sent to the pharmacy to be filled.The DON said he was not sure how long medication delivery would take but he estimated the ordered medications would be filled and delivered to the facility within a couple hours. He said the facility would not administer medications brought in by family because they could not verify the accuracy of the medications. The DON said he did not know why Resident #2's missed several medications

after admission or why the delivery was delayed. The DON said he would look into the medication delays.

The DON said Resident #2 was administered Trizepatide at the hospital on 5/29/25 prior to his admission to

the facility. The DON said the next dose was scheduled for 6/5/25, however Resident #2 was transferred to

the hospital on 6/4/25. He said that was the reason the medication was not administered at the facility.

Event ID:

Facility ID:

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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

Brookdale Greenwood Village

6450 S Boston St Greenwood Village, CO 80111

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 0689 Level of Harm - Minimal harm or potential for actual harm

implemented based on his fall history upon admission. He said the floor nurse would have provided step-by-step instructions to the resident and CNA's, for safe transfers and walking.The DON said there had been no formal training provided for staff, specifically for CNAs, on orthostatic hypotension fall prevention.

He said all residents in the facility were considered at risk for falls, and staff were aware of the general fall prevention measures in place.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet

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

Brookdale Greenwood Village

6450 S Boston St Greenwood Village, CO 80111

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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

#1 was interviewed on 9/23/25 at 3:26 p.m. RN #1 said she did not know where the vinegar was stored.

She said she did not know what the vinegar was used for. LPN #1 and certified nurse aide (CNA) #1 were interviewed together on 9/23/25 at 3:29 p.m. LPN #1 said she did not know what vinegar would be used for.

CNA #1 said she would use the vinegar to clean a catheter bag. LPN #1 unlocked the medication room and looked in the room for vinegar, she confirmed that there was no vinegar. LPN #2 was interviewed on 9/23/25 at 3:31 p.m. LPN #2 said she did not have vinegar stored at the nurses' station or in the medication room. LPN #2 said she could go to the kitchen staff and ask them for it so that the nursing staff could use it to clean the residents' CPAP machines.

Event ID:

Facility ID:

If continuation sheet

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

Brookdale Greenwood Village

6450 S Boston St Greenwood Village, CO 80111

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

container of pastries and pies that were uncovered and undated.-A bag of expired popcorn.-A dented can was on the same shelf as non-dented cans.-The flour bin lid had smudges and dried debris on it. There was

a use-by date of 8/1/25 written on it. -Boxes of food were on the floor.In the main kitchen the following was observed:-Under the food preparation counter there was a bin of grains that was left open without a lid and did not have a use-by date on it. In the walk-in refrigerator the following was observed:-Food boxes were stacked on the floor in the walk-in refrigerator and dry storage room. -A box of carrots was in the freezer and was left open.-A separate bin of carrots in the walk-in refrigerator was labeled as watermelon and had

an expiration date of 8/1/25 on it. III. Ensure the ice machine was maintained in a sanitary conditionA.

Professional referenceAccording to the U.S. Food and Drug Administration Food Code (Effective 2022) retrieved on 10/1/25, In equipment such as ice makers, a frequency specified by the manufacturer, or the absence of manufacturer specifications, at a frequency necessary to preclude accumulation of soil or mold.

Ice makers and ice bins must be cleaned on a routine basis to prevent the development of slime, mold, or soil residues that may contribute to an accumulation of microorganisms. (chapter 4)B. ObservationsThe initial kitchen tour was conducted on 9/22/25 at 10:50 a.m. The ice machine had debris across the front and sides of the machine. There were dark smudges, brown splatters and a crusted white substance were visible on the outside and inside door of the ice machine. The inside door-flap of the ice machine had similar smudges, splatters and debris. C. Record reviewAccording to the 2025 Ice Machine Cleaning Log was for the year 2025 provided by the NHA on 9/23/25 at approximately 3:20 p.m.On the top of the log it read, The ice machine should be cleaned and sanitized at least once a month and cleaned and sanitized by

a professional service provider every six (6) months. Please refer to your ice machine's manual for cleaning instructions. The ice machine log documented a monthly cleaning being completed by the facility from January 2025 through August 2025. According to the log, a professional service provider came on 5/27/25 for a repair to the ice machine in the main kitchen. IV. Staff interviews The dietary manager (DM) was interviewed on 9/23/25 at approximately 1:00 p.m. The DM said that he recognized that many food items had expired or lacked food labels and that he would monitor expiration dates closely in the future. He said

the kitchen staff tried to deep clean the kitchen every Sunday. The DM said the kitchen recently got a new power washer and he would schedule the kitchen for a deep cleaning using the power washer. The DM said

he was unable to provide documentation that the main kitchen's ice machine was been deep-cleaned by a professional service provider in the last six months and said that the facility no longer contracted with the outside service to provide the deep sanitation and chemical disinfection for the ice machine (see ice machine cleaning record above). The NHA was interviewed on 9/23/25 at 4:22 p.m. The NHA said that she conducted weekly walkthroughs of the kitchen and that her last walkthrough was last week. The NHA said that her expectation of the kitchen was for it to be clean and to have all food items dated properly. The NHA said she understood why kitchen staff was confused about the process for servicing kitchen equipment, specifically the malfunctioning ice machine in the main kitchen that did not keep ice frozen. She said that

the kitchen staff was to place a work order for the maintenance department. From there the maintenance department was responsible for contacting the equipment vendor or completing the maintenance themselves.

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Facility ID:

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