Federal inspection record · CMS data as of October 1, 2026
Poudre Canyon Rehabilitation And Nursing, LLC
1000 S Lemay Ave, Fort Collins, CO · (970) 482-7925
- Cited for abuse (CMS abuse icon)
- Special Focus Facility
- Certified beds
- 83
- Residents per day
- 68
- Ownership
- For-Profit
- Chain
- The Charly Bello Family, The Maze Family, The Swain Family, & Walter Myers
- Medicare / Medicaid
- Medicare + Medicaid
- Certified since
- July 1, 1982
1
How this home got 1 star
The overall rating isn't an average. CMS starts from the inspection rating and nudges it at most two steps. Here is the arithmetic for this home, using CMS's own rules.
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Health inspections
★★★★★starting point
Everything starts from what state inspectors found on site. This is a ranking against other homes in Colorado.
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Staffing
★★★★★no change (already 1)
Only a 5-star staffing rating adds a star, and only a 1-star rating removes one. Ratings of 2 to 4 change nothing.
-
Quality measures
★★★★★no change
Same rule: 5 stars adds one, 1 star takes one away. These measures are mostly reported by the home itself.
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Overall
★★★★★1 of 5
Matches the rating CMS publishes on Care Compare.
This home carries CMS's abuse icon, which caps its inspection rating at 2 stars and so its overall rating at 4.
2
Where it sits among Colorado homes
Poudre Canyon Rehabilitation And Nursing, LLC carries 207.75 inspection points. That is fewer than 2% of Colorado's 208 rated homes.
Inspectors' citations earn points by how serious and how widespread they were (the grid below). CMS then ranks every home in Colorado: the 10% with the fewest points get 5 stars, the 20% with the most get 1 star, and the middle 70% split evenly into 2, 3 and 4.
- 5★ 0–22 pts
- 4★ 22–44 pts
- 3★ 44–70.75 pts
- 2★ 70.75–104 pts
- 1★ over 104 pts
Bars show every rated home in Colorado by its weighted inspection score. CMS recalibrates the cut points monthly but holds a home's rating until its own score changes, so a home can sit just outside today's band.
3
What inspectors found
43 health citations on record since 2022. Each one gets a letter: the row says how badly residents were affected, the column how many.
Immediate jeopardyResidents at risk of serious injury or death
Actual harmA resident was hurt
Potential for harmNo one was hurt, but could have been
Minimal harmPaperwork-level problems
Read the rows, not the total. Most citations nationwide are a D: one problem, nobody hurt. Rows G–I mean a resident was harmed; J–L mean inspectors found residents in immediate danger of serious injury or death.
Small numbers in each cell are the inspection points CMS assigns per citation. Those points are what the state curve above ranks.
Harm and immediate-jeopardy citations (6)
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G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
-
G
Ensure that residents are free from significant medication errors.
-
K
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
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G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
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G
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
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G
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Everything else, by area of care
Nutrition and Dietary9F
- D
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- D
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
- D
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
- D
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
- F
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.
- F
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- E
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Resident Rights7F
- F
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.
- D
Allow residents to self-administer drugs if determined clinically appropriate.
- D
Reasonably accommodate the needs and preferences of each resident.
- E
The resident has the right to receive notices in a format and a language he or she understands.
- C
Allow residents to easily view the nursing home's survey results and communicate with advocate agencies.
- E
Honor the resident's right to organize and participate in resident/family groups in the facility.
- D
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Quality of Life and Care7D
- D
Provide safe and appropriate respiratory care for a resident when needed.
- D
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
- D
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
- D
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
- D
Assist a resident in gaining access to vision and hearing services.
- D
Provide enough food/fluids to maintain a resident's health.
- D
Provide or obtain dental services for each resident.
Freedom from Abuse, Neglect, and Exploitation6E
- D
Respond appropriately to all alleged violations.
- E
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- E
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- D
Respond appropriately to all alleged violations.
- E
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
- D
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Pharmacy Service4E
- D
Ensure medication error rates are not 5 percent or greater.
- D
Ensure that residents are free from significant medication errors.
- D
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
- E
Ensure medication error rates are not 5 percent or greater.
Infection Control2E
- D
Provide and implement an infection prevention and control program.
- E
Provide and implement an infection prevention and control program.
Administration1E
- E
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Environmental1D
- D
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Inspection history
2025-01-22
18 health deficiencies · 11 fire-safety deficiencies
Top issue: Quality of Life and Care (5 deficiencies)
2023-07-13
11 health deficiencies · 15 fire-safety deficiencies
Top issue: Nutrition and Dietary (4 deficiencies)
2022-06-16
14 health deficiencies · 10 fire-safety deficiencies
Top issue: Quality of Life and Care (5 deficiencies)
4
Nursing time per resident, per day
Each resident here gets about 2 h 43 min of nursing staff time a day, 41 min of it from a registered nurse.
This home
2 h 43 min
Colorado average
3 h 42 min
U.S. average
3 h 54 min
- Registered nurse
- Licensed practical nurse
- Nurse aide
Turnover: 60% of nursing staff and 65% of registered nurses left in the past year.
Reported hours from payroll data the home submits to CMS, divided by its daily resident count. Not adjusted for how sick residents are.
5
Fines and payment denials
$48,308 in federal fines on record over the past three years.
| Date | Penalty | Amount |
|---|---|---|
| 2025-05-15 | Fine | $10,358 |
| 2025-01-22 | Fine | $37,950 |
6
Resident outcomes
Quality measures compared with state and national averages. Most come from assessments the home itself reports.
| Measure | This home | State | U.S. |
|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days0.1 pts worse | 1.5 | 1.4 | 1.8 |
| Number of outpatient emergency department visits per 1000 long-stay resident days0.4 pts worse | 2.1 | 1.7 | 1.7 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine6.4 pts worse | 87.0% | 93.4% | 93.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine34.5 pts worse | 59.2% | 93.7% | 95.3% |
| Percentage of long-stay residents experiencing one or more falls with major injury2.7 pts better | 0.7% | 3.4% | 3.2% |
| Percentage of long-stay residents who have depressive symptoms31.5 pts worse | 40.3% | 8.8% | 13.5% |
| Percentage of long-stay residents who lose too much weight0.3 pts better | 4.5% | 4.8% | 5.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication4.7 pts worse | 16.3% | 11.6% | 19.5% |
| Percentage of long-stay residents who received an antipsychotic medication9.4 pts worse | 29.3% | 19.9% | 15.4% |
| Percentage of long-stay residents who were physically restrained0.1 pts better | 0.0% | 0.1% | 0.1% |
| Percentage of long-stay residents whose ability to walk independently worsened3.7 pts better | 8.0% | 11.7% | 12.7% |
| Percentage of long-stay residents whose need for help with daily activities has increased1.4 pts better | 11.4% | 12.8% | 13.5% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder0.2 pts better | 0.3% | 0.5% | 0.7% |
| Percentage of long-stay residents with a urinary tract infection1 pts better | 0.4% | 1.4% | 1.5% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence5.7 pts better | 14.9% | 20.6% | 18.3% |
| Percentage of long-stay residents with pressure ulcers5 pts worse | 8.4% | 3.4% | 4.5% |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine33.8 pts worse | 43.2% | 77.0% | 82.3% |
| Percentage of short-stay residents who newly received an antipsychotic medication1.6 pts better | 0.0% | 1.6% | 1.5% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine43.6 pts worse | 30.0% | 73.6% | 80.1% |
·
Who owns and runs it
13 owners and managers reported to CMS. The last column counts how many nursing homes each one is tied to.
Show ownership list
| Name | Role | Share | Homes |
|---|---|---|---|
| Bader, Carly | Operational/Managerial Control · Individual | 0% | 2 facilities |
| Bader, Carly | Adp Of The SNF · Individual | 0% | 2 facilities |
| Charly Bello Family Limited Partnership | Direct Ownership Interest · Organization | 0% | 6 facilities |
| Cottonwood Healthcare LLC | Operational/Managerial Control · Organization | 0% | 26 facilities |
| Fraser, Malcolm | Adp Of The SNF · Individual | 0% | 6 facilities |
| Mahrt, David | Indirect Ownership Interest · Individual | 0% | 11 facilities |
| Maze Family Limited Partnership | Direct Ownership Interest · Organization | 0% | 5 facilities |
| Myers, Katie | Indirect Ownership Interest · Individual | 0% | 17 facilities |
| Myers, Walter | Indirect Ownership Interest · Individual | 0% | 25 facilities |
| Myers, Walter | Operational/Managerial Control · Individual | 0% | 25 facilities |
| Pickd LLC | Direct Ownership Interest · Organization | 0% | 3 facilities |
| Swain, Holly | Indirect Ownership Interest · Individual | 0% | 16 facilities |
| Swain, Jared | Indirect Ownership Interest · Individual | 0% | 20 facilities |
·
Fire safety
36 life-safety citations (sprinklers, exits, alarms). These don't count toward the star rating.
Smoke15F
- F
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- F
Inspect, test, and maintain automatic sprinkler systems.
- F
Properly select, install, inspect, or maintain portable fire extinguishes.
- D
Install corridor and hallway doors that block smoke.
- F
Install corridor and hallway doors that block smoke.
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Inspect, test, and maintain automatic sprinkler systems.
- F
Properly select, install, inspect, or maintain portable fire extinguishes.
- F
Install corridor and hallway doors that block smoke.
- E
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- E
Provide properly protected cooking facilities.
- E
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- F
Have approved installation, maintenance and testing program for fire alarm systems.
- F
Inspect, test, and maintain automatic sprinkler systems.
- D
Install corridor and hallway doors that block smoke.
Gas, Vacuum, and Electrical Systems7F
- F
Have generator or other power source capable of supplying service within 10 seconds.
- F
Ensure proper usage of power strips and extension cords.
- F
Have proper medical gas storage and administration areas.
- F
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
- F
Have generator or other power source capable of supplying service within 10 seconds.
- E
Have proper medical gas storage and administration areas.
- F
Have generator or other power source capable of supplying service within 10 seconds.
Services6F
- F
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- F
Install properly constructed and protected linen or trash chutes.
- F
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- E
Have properly installed electrical wiring and gas equipment.
- F
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
- D
Have properly installed electrical wiring and gas equipment.
Egress5F
- F
Install emergency lighting that can last at least 1 1/2 hours.
- F
Have properly located and lighted "Exit" signs.
- F
Keep aisles, corridors, and exits free of obstruction in case of emergency.
- F
Install emergency lighting that can last at least 1 1/2 hours.
- D
Have exits that are accessible at all times.
Miscellaneous3F
- F
Have simulated fire drills held at unexpected times.
- F
Have simulated fire drills held at unexpected times.
- E
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
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Other homes nearby
-
Storybrook Care & Rehabilitation
Fort Collins, CO · Sweetwater Care
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 58 min
- Fines
- $62,985
-
Rehabilitation And Nursing Center Of The Rockies
Fort Collins, CO · The Ensign Group
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 3 min
- Fines
- $21,721
-
Creekside Village Rehabilitation And Nursing LLC
Fort Collins, CO · The Charly Bello Family, The Maze Family, The Swain Family, & Walter Myers · Special Focus · Abuse icon
★★★★★- Worst citation, 3 yrs
- J
- Nursing / resident / day
- 3 h 11 min
- Fines
- $48,875