C71

PAONIA CARE AND REHABILITATION CENTER

Grade C 71/100 composite score

For profit - Limited Liability company

CMS Star Ratings

Overall
3/5
Health Insp.
2/5
Quality
5/5
Staffing
3/5
RN Staffing
Not rated

Certified Beds

60

Ownership

For profit - Limited Liability company

Total Fines

$39,316

Last Survey

N/A

1625 MEADOWBROOK BLVD, PAONIA, CO 81428
9705274837

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Staffing Hours & Turnover

Hours per Resident per Day (PBJ)

RN
0.96h
LPN
0.63h
CNA
2.14h
Total
3.72h
Facility
State Average

Turnover Rates

RN Turnover
N/A
Total Nurse Turnover
N/A
Admin Turnover
N/A

Ownership

MADISON CREEK PARTNERS LLC

Organization5% OR GREATER DIRECT OWNERSHIP INTERESTSince Jul 2016

100%

BRUCE, LELAND

Individual5% OR GREATER INDIRECT OWNERSHIP INTERESTSince Jul 2016

30%

CHRISTENSEN, COVEY

Individual5% OR GREATER INDIRECT OWNERSHIP INTERESTSince Jul 2016

70%

BRUCE, LELAND

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Jul 2016

CHRISTENSEN, COVEY

IndividualOPERATIONAL/MANAGERIAL CONTROLSince Jul 2016

SILVER, RACHEL

IndividualCORPORATE DIRECTORSince Jul 2016

BRUCE, LELAND

IndividualCORPORATE OFFICERSince Jul 2016

CHRISTENSEN, COVEY

IndividualCORPORATE OFFICERSince Jul 2016

BRUCE, LELAND

IndividualW-2 MANAGING EMPLOYEESince Jul 2016

CHRISTENSEN, COVEY

IndividualW-2 MANAGING EMPLOYEESince Jul 2016

SILVER, RACHEL

IndividualW-2 MANAGING EMPLOYEESince Jul 2016

Penalties & Fines (2)

$39,316total fines
DateTypeDescriptionAmount
Aug 7, 2025Fine$19,135
Mar 1, 2024Fine$20,181

Health Inspection Deficiencies (44)

August 7, 2025Health11 deficiencies1 severe
0600EMinimal harm, Pattern

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Sep 2, 2025
0603GActual harm, Isolated

Protect each resident from separation (from other residents, his/her room, or confinement to his/her room).

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Sep 2, 2025
0605DMinimal harm, Isolated

Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Sep 2, 2025
0677DMinimal harm, Isolated

Provide care and assistance to perform activities of daily living for any resident who is unable.

Quality of Life and Care Deficiencies

Corrected Sep 2, 2025
0695DMinimal harm, Isolated

Provide safe and appropriate respiratory care for a resident when needed.

Quality of Life and Care Deficiencies

Corrected Sep 2, 2025
0699DMinimal harm, Isolated

Provide care or services that was trauma informed and/or culturally competent.

Quality of Life and Care Deficiencies

Corrected Sep 2, 2025
0740DMinimal harm, Isolated

Ensure each resident must receive and the facility must provide necessary behavioral health care and services.

Quality of Life and Care Deficiencies

Corrected Sep 2, 2025
0880DMinimal harm, Isolated

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Sep 2, 2025
0881DMinimal harm, Isolated

Implement a program that monitors antibiotic use.

Infection Control Deficiencies

Corrected Sep 2, 2025
0883DMinimal harm, Isolated

Develop and implement policies and procedures for flu and pneumonia vaccinations.

Infection Control Deficiencies

Corrected Sep 2, 2025
0887DMinimal harm, Isolated

Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Infection Control Deficiencies

Corrected Sep 2, 2025
March 24, 2025Health1 deficiency
0600DMinimal harm, Isolated

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Apr 29, 2025
March 1, 2024Health23 deficiencies2 severe
0552DMinimal harm, Isolated

Ensure that residents are fully informed and understand their health status, care and treatments.

Resident Rights Deficiencies

Corrected Mar 28, 2024
0567EMinimal harm, Pattern

Honor the resident's right to manage his or her financial affairs.

Resident Rights Deficiencies

Corrected Mar 28, 2024
0569EMinimal harm, Pattern

Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.

Resident Rights Deficiencies

Corrected Mar 28, 2024
0574CNo harm, Widespread

The resident has the right to receive notices in a format and a language he or she understands.

Resident Rights Deficiencies

Corrected Mar 28, 2024
0584EMinimal harm, Pattern

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Resident Rights Deficiencies

Corrected Mar 28, 2024
0626DMinimal harm, Isolated

Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.

Resident Rights Deficiencies

Corrected Mar 28, 2024
0656DMinimal harm, Isolated

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Resident Assessment and Care Planning Deficiencies

Corrected Mar 28, 2024
0660DMinimal harm, Isolated

Plan the resident's discharge to meet the resident's goals and needs.

Resident Assessment and Care Planning Deficiencies

Corrected Mar 28, 2024
0676DMinimal harm, Isolated

Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.

Quality of Life and Care Deficiencies

Corrected Mar 28, 2024
0680EMinimal harm, Pattern

Ensure the activities program is directed by a qualified professional.

Quality of Life and Care Deficiencies

Corrected Mar 28, 2024
0759EMinimal harm, Pattern

Ensure medication error rates are not 5 percent or greater.

Pharmacy Service Deficiencies

Corrected Mar 28, 2024
0760DMinimal harm, Isolated

Ensure that residents are free from significant medication errors.

Pharmacy Service Deficiencies

Corrected Mar 28, 2024
0801FMinimal harm, Widespread

Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

Nutrition and Dietary Deficiencies

Corrected Mar 28, 2024
0803FMinimal harm, Widespread

Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

Nutrition and Dietary Deficiencies

Corrected Mar 28, 2024
0805KImmediate jeopardy, Pattern

Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.

Nutrition and Dietary Deficiencies

Corrected Mar 1, 2024
0806DMinimal harm, Isolated

Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.

Nutrition and Dietary Deficiencies

Corrected Mar 28, 2024
0812FMinimal harm, Widespread

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Nutrition and Dietary Deficiencies

Corrected Mar 28, 2024
0867FMinimal harm, Widespread

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Administration Deficiencies

Corrected Mar 30, 2024
0880EMinimal harm, Pattern

Provide and implement an infection prevention and control program.

Infection Control Deficiencies

Corrected Mar 28, 2024
0679EMinimal harm, Pattern

Provide activities to meet all resident's needs.

Quality of Life and Care Deficiencies

Corrected Mar 28, 2024
0689EMinimal harm, Pattern

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Mar 28, 2024
0692GActual harm, Isolated

Provide enough food/fluids to maintain a resident's health.

Quality of Life and Care Deficiencies

Corrected Mar 28, 2024
0804EMinimal harm, Pattern

Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.

Nutrition and Dietary Deficiencies

Corrected Mar 28, 2024
November 3, 2022Health9 deficiencies2 severe
0600EMinimal harm, Pattern

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Dec 13, 2022
0604DMinimal harm, Isolated

Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Dec 13, 2022
0609EMinimal harm, Pattern

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Dec 13, 2022
0610DMinimal harm, Isolated

Respond appropriately to all alleged violations.

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Corrected Dec 13, 2022
0689GActual harm, Isolated

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Corrected Jan 31, 2023
0692GActual harm, Isolated

Provide enough food/fluids to maintain a resident's health.

Quality of Life and Care Deficiencies

Corrected Dec 13, 2022
0744EMinimal harm, Pattern

Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.

Quality of Life and Care Deficiencies

Corrected Dec 13, 2022
0825DMinimal harm, Isolated

Provide or get specialized rehabilitative services as required for a resident.

Quality of Life and Care Deficiencies

Corrected Jan 31, 2023
0867FMinimal harm, Widespread

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Administration Deficiencies

Corrected Dec 13, 2022

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Frequently Asked Questions

What is the CareGrader rating for PAONIA CARE AND REHABILITATION CENTER?

PAONIA CARE AND REHABILITATION CENTER in PAONIA, Colorado has a CareGrader grade of C (Average), with a composite score of 71.3 out of 100. This grade is based on health inspections, staffing levels, quality measures, and penalty history from official CMS government data.

What is the CMS star rating for PAONIA CARE AND REHABILITATION CENTER?

PAONIA CARE AND REHABILITATION CENTER has an overall CMS star rating of 3 out of 5, a health inspection rating of 2/5, and a staffing rating of 3/5. CareGrader combines this with additional data to calculate an A-F grade.

How many health deficiencies does PAONIA CARE AND REHABILITATION CENTER have?

PAONIA CARE AND REHABILITATION CENTER has 44 health deficiencies on record from CMS health inspection surveys. Deficiencies are rated from A (minimal harm potential) to L (immediate jeopardy, widespread). View the full inspection timeline above for details on each deficiency.

Has PAONIA CARE AND REHABILITATION CENTER been fined?

Yes. PAONIA CARE AND REHABILITATION CENTER has $39,316 in total fines from CMS enforcement actions across 2 penalties.

How many beds does PAONIA CARE AND REHABILITATION CENTER have?

PAONIA CARE AND REHABILITATION CENTER has 60 certified beds with approximately 47 current residents (78% occupancy). The facility is located at 1625 MEADOWBROOK BLVD, PAONIA, Colorado 81428. It is a for profit - limited liability company facility.

Data Disclaimer

Inspection data, staffing levels, and star ratings are sourced from CMS Medicare Nursing Home Compare and are largely self-reported by facilities. A 2019 GAO study found that 43% of facilities under-reported falls. CareGrader provides this data for informational purposes only and is not affiliated with CMS or Medicare. Always visit facilities in person before making a decision.