Cycle 1
Health 2024-10-08 · Fire 2024-10-08
7 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
7 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Brush, CO
South Platte Rehabilitation And Nursing LLC
1-star overall rating with 2-star inspections with $49,843 in total fines with 7 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
2200 Edison St, Brush, CO
(970) 842-2825
Overall
1 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
1 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
78
Certified beds
Average residents
51
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
The Charly Bello Family, The Maze Family, The Swain Family, & Walter Myers
Operator or chain grouping
Approved since
1982-10-14
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
18 facilities
Chain averages 2 overall / 2 health / 2 staffing / 3 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.46
Registered nurse staffing · state 0.83 · national 0.68
LPN hours / resident day
0.56
Licensed practical nurse staffing · state 0.68 · national 0.87
Aide hours / resident day
1.95
Nurse aide staffing · state 2.20 · national 2.35
Total nurse hours
2.98
All reported nurse hours · state 3.70 · national 3.89
Licensed hours
1.02
RN + LPN hours · state 1.51 · national 1.54
Weekend hours
2.62
Weekend nurse staffing · state 3.26 · national 3.43
Weekend RN hours
0.42
Weekend registered nurse coverage · state 0.60 · national 0.47
Physical therapist
0.05
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.49
CMS adjusted RN staffing hours
Adjusted total hours
3.17
CMS adjusted total nurse staffing hours
Case-mix index
1.28
Higher values indicate more complex resident acuity
RN turnover
0%
Annual RN turnover
Total nurse turnover
0%
Annual nurse turnover
SNF VBP
Value-based purchasing
Program rank
11,463
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
16.69
Composite VBP score used to determine payment impact.
Payment multiplier
0.9817
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
3.58
Baseline 19.80% · Performance 19.77% · Measure score 3.58 · Achievement 3.58 · Improvement 0
Healthcare-associated infections
2.45
Baseline 6.96% · Performance 7.10% · Measure score 2.45 · Achievement 2.45 · Improvement 0
Total nurse turnover
0
Baseline 62.71% · Performance 100.00% · Measure score 0 · Achievement 0 · Improvement 0
Adjusted total nurse staffing
0.65
Baseline 4.03 hours · Performance 3.26 hours · Measure score 0.65 · Achievement 0.65 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.21% |
10.72%
0.5 pts better
|
No Different than the National Rate · Eligible stays 59 · Observed rate 6.78% · Lower 95% interval 6.16% |
| Discharge to community | 56.91% |
50.57%
6.3 pts better
|
No Different than the National Rate · Eligible stays 47 · Observed rate 55.32% · Lower 95% interval 44.07% |
| Medicare spending per beneficiary | 0.83 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 96.3% |
95.27%
1 pts better
|
Numerator 26 · Denominator 27 |
| Falls with major injury | 3.7% |
0.77%
2.9 pts worse
|
Numerator 1 · Denominator 27 |
| Discharge self-care score | Not Available |
53.69%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
| Discharge mobility score | Not Available |
50.94%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
| Pressure ulcers or injuries, new or worsened | 0% |
2.29%
2.3 pts better
|
Numerator 0 · Denominator 27 · Adjusted rate 0% |
| Healthcare-associated infections requiring hospitalization | 7.1% |
7.12%
About the same
|
No Different than the National Rate · Eligible stays 33 · Observed rate 6.06% · Lower 95% interval 4.06% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 70 |
| Staff flu vaccination coverage | 75.64% |
42%
33.6 pts better
|
Numerator 59 · Denominator 78 |
| Discharge function score | Not Available |
56.45%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 14 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.9 |
1.3
0.6 pts worse
|
1.9
About the same
|
Long Stay · 20240701-20250630 · Adjusted 1.9 · Observed 2.0 · Expected 1.9 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 3.4 |
1.7
1.7 pts worse
|
1.8
1.6 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 3.4 · Observed 3.4 · Expected 1.7 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 98.4% |
93.5%
4.9 pts better
|
93.4%
5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 95.5% · Q2 100.0% · Q3 97.8% · Q4 100.0% · 4Q avg 98.4% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 95.9% |
94.7%
1.2 pts better
|
95.5%
0.4 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 95.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 3.8% |
3.4%
0.4 pts worse
|
3.3%
0.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 4.4% · Q3 2.2% · Q4 4.2% · 4Q avg 3.8% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 4.2% |
7.4%
3.2 pts better
|
11.4%
7.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 17.5% · Q3 0.0% · Q4 0.0% · 4Q avg 4.2% |
| Percentage of long-stay residents who lose too much weight | 8.1% |
5.0%
3.1 pts worse
|
5.4%
2.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 10.0% · Q3 13.3% · Q4 8.5% · 4Q avg 8.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 8.5% |
11.2%
2.7 pts better
|
19.6%
11.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 11.9% · Q2 0.0% · Q3 8.9% · Q4 12.8% · 4Q avg 8.5% |
| Percentage of long-stay residents who received an antipsychotic medication | 43.1% |
20.6%
22.5 pts worse
|
16.7%
26.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 45.2% · Q2 44.1% · Q3 44.4% · Q4 38.9% · 4Q avg 43.1% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 18.1% |
15.2%
2.9 pts worse
|
16.3%
1.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q3 15.0% · Q4 4.3% · 4Q avg 18.1% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 18.0% |
14.6%
3.4 pts worse
|
14.9%
3.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 17.5% · Q2 36.6% · Q3 17.1% · Q4 2.2% · 4Q avg 18.0% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.4% |
0.8%
0.4 pts better
|
1.0%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.8% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.1% |
1.5%
0.4 pts better
|
1.7%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.4% · Q2 2.4% · Q3 0.0% · Q4 0.0% · 4Q avg 1.1% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 15.1% |
22.4%
7.3 pts better
|
19.8%
4.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 18.1% · Q2 19.6% · Q3 12.3% · Q4 11.0% · 4Q avg 15.1% |
| Percentage of long-stay residents with pressure ulcers | 4.3% |
3.7%
0.6 pts worse
|
5.1%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.5% · Q2 5.6% · Q3 0.0% · Q4 0.0% · 4Q avg 4.3% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 83.6% |
76.4%
7.2 pts better
|
81.7%
1.9 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 83.3% · Q2 80.6% · Q3 78.6% · Q4 92.6% · 4Q avg 83.6% |
| Percentage of short-stay residents who newly received an antipsychotic medication | 3.6% |
1.5%
2.1 pts worse
|
1.6%
2 pts worse
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 3.6% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 77.4% |
75.6%
1.8 pts better
|
79.7%
2.3 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 77.4% |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-05-18 · Fire 2023-05-18
8 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (2 deficiencies)
14 fire-safety deficiencies
Top issue: Smoke (6 deficiencies)
Cycle 3
Health 2019-09-26 · Fire 2019-09-26
3 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (1 deficiency)
8 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-10-08
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2024-10-29
F · Potential for more than minimal harm
2024-10-08
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-10-30
F · Potential for more than minimal harm
2024-10-08
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-10-30
D · Potential for more than minimal harm
2024-10-08
K271 · Egress Deficiencies
Fire Safety
Have exits that are accessible at all times.
Corrected 2024-10-30
D · Potential for more than minimal harm
2024-10-08
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-10-30
D · Potential for more than minimal harm
2024-10-08
K751 · Miscellaneous Deficiencies
Fire Safety
Have restrictions on the use of flammable curtains.
Corrected 2024-10-30
D · Potential for more than minimal harm
2024-10-08
K911 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Meet requirements for the installation and maintenance of electrical systems.
Corrected 2024-10-30
F · Potential for more than minimal harm
2023-05-18
K222 · Egress Deficiencies
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2023-06-28
F · Potential for more than minimal harm
2023-05-18
K271 · Egress Deficiencies
Fire Safety
Have exits that are accessible at all times.
Corrected 2023-07-10
F · Potential for more than minimal harm
2023-05-18
K281 · Egress Deficiencies
Fire Safety
Install proper backup exit lighting.
Corrected 2023-06-27
F · Potential for more than minimal harm
2023-05-18
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-06-20
F · Potential for more than minimal harm
2023-05-18
K345 · Smoke Deficiencies
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2023-07-10
F · Potential for more than minimal harm
2023-05-18
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2023-12-31
F · Potential for more than minimal harm
2023-05-18
K372 · Smoke Deficiencies
Fire Safety
Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
Corrected 2023-07-10
F · Potential for more than minimal harm
2023-05-18
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-06-27
F · Potential for more than minimal harm
2023-05-18
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-06-30
E · Potential for more than minimal harm
2023-05-18
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2023-07-10
E · Potential for more than minimal harm
2023-05-18
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2023-07-10
E · Potential for more than minimal harm
2023-05-18
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-07-10
E · Potential for more than minimal harm
2023-05-18
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2023-07-10
E · Potential for more than minimal harm
2023-05-18
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2023-07-10
D · Potential for more than minimal harm
2019-09-26
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K324 · Smoke Deficiencies
Fire Safety
Provide properly protected cooking facilities.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K355 · Smoke Deficiencies
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2019-11-19
D · Potential for more than minimal harm
2019-09-26
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2019-11-19
Inspection history
Recent health citations
J · Immediate jeopardy
2025-10-15
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-11-05
D · Potential for more than minimal harm
2025-10-15
F659 · Resident Assessment and Care Planning Deficiencies
Health
Provide care by qualified persons according to each resident's written plan of care.
Corrected 2025-11-05
D · Potential for more than minimal harm
2025-10-15
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2025-11-05
G · Actual harm
2025-01-07
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2025-01-24
G · Actual harm
2025-01-07
F742 · Quality of Life and Care Deficiencies
Health
Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Corrected 2025-01-22
E · Potential for more than minimal harm
2025-01-07
F659 · Resident Assessment and Care Planning Deficiencies
Health
Provide care by qualified persons according to each resident's written plan of care.
Corrected 2025-01-20
E · Potential for more than minimal harm
2024-10-08
F584 · Resident Rights Deficiencies
Health
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.
Corrected 2024-11-12
E · Potential for more than minimal harm
2024-10-08
F761 · Pharmacy Service Deficiencies
Health
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.
Corrected 2024-10-31
E · Potential for more than minimal harm
2024-10-08
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2024-10-31
D · Potential for more than minimal harm
2024-10-08
F697 · Quality of Life and Care Deficiencies
Health
Provide safe, appropriate pain management for a resident who requires such services.
Corrected 2024-10-31
F · Potential for more than minimal harm
2023-05-18
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-07-01
D · Potential for more than minimal harm
2023-05-18
F580 · Resident Rights Deficiencies
Health
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected 2023-06-14
D · Potential for more than minimal harm
2023-05-18
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2023-08-14
D · Potential for more than minimal harm
2023-05-18
F744 · Quality of Life and Care Deficiencies
Health
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Corrected 2023-05-19
D · Potential for more than minimal harm
2023-05-18
F813 · Nutrition and Dietary Deficiencies
Health
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Corrected 2023-05-19
E · Potential for more than minimal harm
2019-09-26
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2019-10-29
D · Potential for more than minimal harm
2019-09-26
F561 · Resident Rights Deficiencies
Health
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected 2019-11-06
D · Potential for more than minimal harm
2019-09-26
F610 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Respond appropriately to all alleged violations.
Corrected 2019-10-29
Penalties and ownership
What sits behind the stars
$38,880
2025-10-15
Fine
Fine · fine $38,880
Fine
$10,963
2025-01-07
Fine
Fine · fine $10,963
Fine
Ownership
Maze Family Limited Partnership
5% Or Greater Direct Ownership Interest · Organization
Charly Bello Family Limited Partnership
5% Or Greater Direct Ownership Interest · Organization
Myers, Walter
5% Or Greater Indirect Ownership Interest · Individual
Myers, Katie
5% Or Greater Indirect Ownership Interest · Individual
Swain, Jared
5% Or Greater Indirect Ownership Interest · Individual
Swain, Holly
5% Or Greater Indirect Ownership Interest · Individual
Pickd LLC
5% Or Greater Direct Ownership Interest · Organization
Cottonwood Healthcare LLC
Operational/Managerial Control · Organization
Lessenden, Brittany
Operational/Managerial Control · Individual
Mahrt, David
5% Or Greater Indirect Ownership Interest · Individual
Nearby options
Other facilities in reach
#1
Eben Ezer Lutheran Care Center
Brush, CO
2-star overall rating with 2-star inspections with abuse icon flag with 7 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
#2
Valley View Villa
Fort Morgan, CO
5-star overall rating with 5-star inspections with $7,443 in total fines with 2 recent health deficiencies with 7 fire-safety deficiencies in the latest cycle
#3
Sterling Rehabilitation And Nursing, LLC
Sterling, CO
1-star overall rating with 2-star inspections with $117,325 in total fines with 18 recent health deficiencies with 11 fire-safety deficiencies in the latest cycle
Jump out
Supporting pages
City page
Best nursing homes in Brush, CO
See how this facility ranks inside its city.
2 facilitiesCounty
Morgan County
County ranking page for nearby alternatives.
3 facilitiesChain
The Charly Bello Family, The Maze Family, The Swain Family, & Walter Myers
Chain page for the operating group.
18 facilities