Center At Park West Llc, The

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

representative was upset about the new weight-bearing order. The resident's representative felt the therapy department changed Resident #2's weight bearing status and not the orthopedic surgeon. The grievance form documented the therapy team provided education to the resident's representative indicating the resident was not fully weight-bearing and Resident #2 was able to bear weight as tolerated. The grievance form documented the date the grievance was received by social services, the signature line, the substantiated and unsubstantiated line, and the NHA's signature were left blank. It revealed Resident #2's satisfaction was hesitant, concerned, and the comments read that the representative still believed therapy had changed the resident's weight bearing status order. III. Staff interviewsThe NHA was interviewed on 10/23/25 at 6:48 p.m. The NHA said anyone could fill out a grievance form. He said residents and family members can turn in the grievance form to any staff or put it in the box in front of the social services office.

He said once a grievance was turned in, the facility had 48 hours to resolve the grievance. He said if a resident was discharged prior to the grievance being resolved, the facility should contact the resident or representative to resolve the grievance. The NHA said based on the format of the grievance form, he was unable to show when any grievance was resolved, including the grievances filed for Resident #2, because there was no section on the form with a date when the grievance was resolved. The NHA said the words cautiously optimistic, doubtful, hesitant and concerned did not reveal if the grievance was resolved to the resident or family's satisfaction. The NHA said before October 2025, nursing documented resident concerns as a progress note. The NHA said resident's concerns documented as a progress note should have been documented on a grievance form to ensure the grievance was resolved.

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Center at Park West Llc, The

3727 Parker Blvd Pueblo, CO 81008

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 0655 Level of Harm - Minimal harm or potential for actual harm

The DON was interviewed on 10/23/25 at approximately 6:00 p.m. The DON said the admitting nurse was responsible for reviewing the baseline care plan with the resident and/or the resident's responsible party and getting the baseline care plan signed by the resident or the responsible party. The DON said after the Acknowledgement of Care Plan form (for the receipt of the baseline care plan) was signed by the resident or the responsible party, the form was uploaded into the resident's EMR.

Residents Affected - Some

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Center at Park West Llc, The

3727 Parker Blvd Pueblo, CO 81008

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 0677

-It indicated Resident #7 received two out of eight opportunities.

Level of Harm - Minimal harm or potential for actual harm

-Review of the daily skilled notes from admission to 10/21/25 did not reveal any refusals of bed baths.

E. Staff interviews

Residents Affected - Few Wound care nurse (WCN) #1 was interviewed on 10/22/25 at 10:50 a.m. WCN #1 said it was important to bathe residents with skin conditions. She said the odor coming from Resident #7's room has not changed since she started in July 2025. WCN #1 said she did not believe the odor was from the wound and said he may need more hygiene care and bathing. She said the staff may not be cleaning him well enough after a bowel movement. She said she saw feces on the dressing while she changed it on 10/22/25. WCN #1 said

she was not aware Resident #7 had refused bed baths.

LPN #2 was interviewed on 10/22/25 at 3:30 p.m. LPN #2 said Resident #7 was particular about his care but she was not aware he had refused bed baths. LPN #2 said if a resident refused any care, treatment or medication, the refusal should be documented in the daily skilled note.

The director of nursing (DON) was interviewed on 10/22/25 at 4:28 p.m. The DON said the IDT monitors the bathing schedule about every two weeks. She said if a resident refused they are not offered another bath until their next scheduled bath day. The DON said if a resident refused a bath they would fill out a shower form. -However, there were no shower forms for Resident #7 during that time period.

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Center at Park West Llc, The

3727 Parker Blvd Pueblo, CO 81008

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 0684

facility.

Level of Harm - Actual harm

On 10/23/25 at 9:30 a.m. WCN #1 was observed changing Resident #5's dressing to her left lower leg skin tear. The wound was a golf-ball size skin tear on the mid-upper lateral side of her calf with a large amount of red and purple discoloration. There was an additional skin tear on the lower section of her calf that was smaller in size, but with the same dark red and purple discoloration. The skin tears were not actively bleeding and were partially scabbed over.

Residents Affected - Few

C. Record review

The 10/20/25 nursing admission note documented that Resident #5 had a single wound on her left ankle.

The note specified that the wound was a skin tear on her lower calf, however, the note did not address the larger skin tear on her left upper-mid calf. The note documented that the skin tear dressing was changed. -However, according to registered nurse (RN) #1 (see interview below), she did not change Resident #5's dressing on the day the resident admitted to the facility (10/20/25), but only looked under the dressing that was already on the wound prior to her admission. -The facility failed to obtain physician's orders for a dressing change until 10/22/25 at 11:44 a.m., two days

after Resident #5 had been admitted to the facility.

D. Hospice RN interview

The hospice RN was interviewed on 10/22/25 at 11:05 a.m. The hospice RN said Resident #5 was on hospice services and was at the facility for respite care. The hospice RN said the resident had fallen while at home and sustained a skin tear to her left lower leg. The hospice RN said that the old bandage she removed had adhered to Resident #5's skin and she had to use a wound cleaner to moisten the bandage in order to remove it.

E. Staff interviews RN #1 was interviewed on 10/22/25 at 5:40 p.m. RN #1 said she had admitted Resident #5 to the facility on [DATE REDACTED]. RN #1 said she had peeked under Resident #5's wound dressing on her lower left leg upon her admission, but she said she did not change the dressing because she was waiting for official wound care orders. She said she expected the WCN would have put in wound care orders the following day after the resident's admission.

WCN #1 was interviewed on 10/23/25 at 10:29 a.m. WCN #1 said she saw Resident #5 on 10/21/25 but forgot to enter the wound care orders from the physician into the resident's electronic medical record (EMR). She said she forgot to document the wound care she completed on Resident #5's leg on 10/21/25.

The DON was interviewed on 10/23/25 at 12:56 p.m. The DON said she had provided WCN #1 with education regarding correct and timely documentation of resident care.

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Center at Park West Llc, The

3727 Parker Blvd Pueblo, CO 81008

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 0686

-However the progress note dated 8/15/25 documented signs of macerated skin but WCN #1 did not assess until 8/19/25, five days later.

Level of Harm - Actual harm

The daily skilled progress notes through October 2025 did not document the macerated periwound.

Residents Affected - Few

The skin/wound progress notes continued to document macerated skin to the periwound through October

1. 2025. The progress notes did not indicate the physician had been notified of the resident's skin

deterioration.

E. Staff interviews NP #1 was interviewed on 10/22/25 at 12:50 p.m. NP #1 said she was not notified of any changes in Resident #7's wound. She said she did not know about, and was not notified about, any concern for MASD.

NP #1 said the provider should be notified of any changes to the skin or a wound. She said she relied on staff assessments, progress notes, signs and symptoms of infection and laboratory results for any changes

in the treatment of the wounds.

LPN #2 was interviewed on 10/22/25 at 3:30 p.m LPN #2 said she would check the air mattress settings by asking the resident if they were comfortable and push on the mattress to check the air pressure. She said

she did not check the air mattress settings and thought she was verbally told the settings of the bed.

LPN #2 said if there was a change in a resident's skin condition she would notify the WCN. She said the WCN was responsible for notifying the physician. She said Resident #7 was particular about his care but

she was not aware that he refused bed baths. She said the daily skilled note should indicate if a resident refused care.

The DON was interviewed on 10/22/25 at 4:28 p.m. The DON said the floor nurse should notify the WCN of any skin concerns. She said the CNAs were educated to notify the nurse of anything abnormal to a resident's skin. She said the nurses should document all skin conditions in the skin evaluation.

The DON said if the TAR was not marked, the assumption would be that the task was not completed.

WCN #1 was interviewed on 10/23/25 at 10:29 a.m. WCN #1 said she completed wound care on Resident #7 once a week and measured the wound once a week when she completed the wound care. She said if

she forgot to measure a wound, then she would remove the wound dressing and redo the wound care so

the wound could be measured. She said she had only changed Resident #7's wound dressing once, on 10/22/25, although she had not obtained measurements at that time (see observations above).

WCN #1 said she had changed Resident #7's wound vac on 10/20/25, but did not document the wound care. She said the measurements she documented on 10/22/25 were actually obtained on 10/20/25. She said she did not document wound care on 10/20/25 or label the wound dressing at that time.

F. Facility follow up

On 10/23/25 at 12:56 p.m. the DON said she had provided WCN #1 with education on correct documentation. She said documentation on wound care was completed and back-dated for 10/20/25 when WCN #1 said she had measured

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

10/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Center at Park West Llc, The

3727 Parker Blvd Pueblo, CO 81008

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 0744

disturbances/ psychosis for Resident #3. Resident #3 hit a CNA, was verbally aggressive, his behaviors were difficult to control and displayed exit seeking behaviors.

Level of Harm - Minimal harm or potential for actual harm

The 10/23/25 progress note revealed Resident #3 was moved to the second floor for safety reasons.

Residents Affected - Some

D. Staff interviews CNA #1 was interviewed on 10/23/25 at 2:10 p.m. CNA #1 said Resident #3 often became combative with

the CNAs when they were providing care. CNA #1 said Resident #3 did not let staff assist him with toileting or hygiene. CNA #1 said Resident #3 sometimes wore briefs, but Resident #3 would not allow staff to physically check the briefs during their rounds. CNA #1 said Resident #3 was moved to the second floor for safety reasons on 10/23/25 because another resident tried to fight him.

LPN #1 was interviewed on 10/23/25 at 3:25 p.m. LPN #1 said Resident #3 required supervision while allowing Resident #3 to clean himself. She said on 10/23/25 Resident #3 allowed them to clean him as he was very unkempt. LPN #1 said Resident #3 sometimes did not wear briefs during daytime as he was able to use the toilet, but he wore briefs at night. LPN #1 said Resident #3 was yelling at her, which upset another resident. She said that resident attempted to confront Resident #3. LPN #1 said she notified her manager who decided to move Resident #3 to the second floor for safety reasons.

The AD was interviewed on 10/23/25 at approximately 5:30 p.m. The AD said Resident #3 spoke Spanish and English. He said he had offered Resident #3 puzzles, but he did not like them. The AD said he had tried to keep Resident #3 busy, but had not found anything that he liked so far. The AD said the facility did not have any Spanish speaking activities.

The DON was interviewed on 10/23/25 at 6:00 p.m. The DON said Resident #3 became combative during care and resisted care if he did not recognize the staff member. He said to de-escalate the situation, he would show Resident #3 his badge, explain the care that was going to be provided, and offer Resident #3 a cup of coffee. The DON said the staff needed to approach Resident #3 at his level and he was more willing to listen and allow staff to assist him.

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

Event ID:

Facility ID:

If continuation sheet