Belmont Lodge Health Care Center

To ensure the health and well-being of every nursing home resident, the Centers for Medicare and Medicaid Services (CMS) along with the State of Colorado routinely investigate, survey, and inspect every nursing facility in the state. During these scheduled appointments and unannounced inspections, the surveyors identify minor to serious offenses, violations, and deficiencies that occur within the walls of the nursing home.

When serious violations are identified, the surveyors will often penalize the nursing home with monetary fines or place the facility on a federal watch list. In the most egregious cases, the nursing home will be designated a Special Focus Facility (SFF) to alert the Administrator and nursing staff that their substandard level of care will no longer be tolerated.

If improvements are not made promptly because of any serious underlying problems or lack of a desire to make changes, Medicare and Medicaid might break their contract or force the facility to sell the operation to another company that is compliant with State and Federal regulations.

More than one year ago, Belmont Lodge Health Care Center was designated a Special Focus Facility by the CMS and placed on the Medicare watchlist. Since then, state investigators and federal nursing home regulatory agencies have provided the nursing facility the opportunity to make the necessary corrections and adjustments to ensure the health and well-being of every resident is protected. In the years ahead, the facility will be closely watched to ensure that the positive improvements they have made are permanent.

Belmont Lodge Health Care Center

This 120-certified bed Medicaid/Medicare-participating nursing facility provides cares and services to the residents and visitors of the city of Pueblo and Pueblo County, Colorado. The SSC Pueblo Belmont Operating Company LLC-affiliated Home is located at:

1601 Constitution Road
Pueblo, CO 81001
(719) 562-7200

As a part of the Sava Senior Care System, Belmont Lodge Health Care Center provides rehabilitation services, along with dementia care, bariatric care, respiratory therapy and intravenous therapy.

More than $350,000 in Penalties

When state investigators identify serious concerns and deficiencies at any nursing facility, they might issue a fine against the Home. Over the last three years, Belmont Lodge Health Care Center was fined on four separate occasions.

These monetary penalties include fines for $45,500 on 01/09/2015, $9,950 on 12/08/2015, $174,410 on 10/12/2016, and $135,954 on 05/04/2017.

Current Nursing Home Resident Safety Concerns

To distribute information gathered by investigators and surveyors, the Centers for Medicare and Medicaid Services (CMS) makes public the inspection data of every nursing facility in the US. Families use the information provided in a star rating summary system to search for the best nursing home in their local community.

Currently, Belmont Lodge Health Care Center maintains overall a below-average two out of five stars compared all other facilities nationwide. This ranking includes one out of five stars for health inspections, four out of five stars for staffing, and two out of five stars for quality measures.

Some of the major concerns for their low ranking are listed below.

  • Failure to Provide Care to Residents in a Way That Keeps or Builds Their Dignity and Respect of Individuality

    In a summary statement of deficiencies dated May 4, 2017, the state investigator noted the facility failed “to ensure [a 74-year-old resident] received care in a respectful and dignified manner.” A review of the resident’s Minimum Data Set (MDS) assessment revealed the resident “had short-term and long-term memory problems” and “did not experience hallucinations or delusions during the review period.”

    Observing the resident’s room at 1:25 PM on April 27, 2017, the surveyor noticed a “sign laminated on the wall.” The surveyor noted that “the same sign was also posted at the head of the bed of her spouse” who also resided in the room. “The sign requested the resident ask nursing staff for help when her spouse required help.

    The sign also stated if [she] did not notify staff she may be moved and separated from her spouse. The sign indicated the resident should speak to the nursing home administrator with any questions.”

    The surveyor interviewed the resident on April 27, 2007, who stated that “she did not feel she was treated in a respectful and dignified manner” stating that “she did not like nasty notes and pointed to a sign laminated on her wall.” The female resident indicated that “she was not allowed to touch her spouse” stating that “a large male nurse told her he could move her anytime he wanted to if she helped her husband.”

    The female resident then “pointed back to the sign and paraphrased how she would be moved to another room from her spouse [and] began to get tearful as she spoke about her moving to the facility and her spouse.” One-week follow-up observations of the resident’s room at 12:01 PM on May 3, 2017, revealed that “the laminated signs remained above the bed where her spouse is and on the wall placed above the bedside table of the resident.”

    The state investigator interviewed the Assistant Director of Nursing who “confirmed the signs of the walls of the resident could not provide care to her spouse, and if she did, she would be moved to another room.” The Assistant Director also stated that “the sign could be perceived as a threat to move her out of the room if she provided care to her husband.”

    In an interview with the Social Service Assistant just after noon on May 3, 2017, it was revealed that “the resident experienced confusion and felt the staff was getting after her and upset with her because she tried to help her spouse with fluids and cares.” The Social Services Assistant was asked to read the sign “posted in the resident’s room [and] stated the way the sign was worded, she could see how the resident may have felt threatened if she assisted her spouse.

    She said the sign indicated that the resident helped her spouse she could be moved to another room.”

    An interview with the facility’s Nursing Home Administrator revealed that “it was her mistake to have the sign in the resident’s room” and that “she felt the sign was simple and clear and was intended to protect the resident and the spouse. She acknowledged sign could have been written in a different tone to allow for the resident to still feel she was treated in a dignified and respectful manner.”

  • Failure to Develop, Implement and Enforce Policies That Prevent Mistreatment, Neglect or Abuse

    In a summary statement of deficiencies dated May 4, 2017, the state investigator noted the facility’s failure “to implement the policies and procedures related to general investigation guidelines. This failure contributed to a lack of thorough, accurate, and fact-based information to maintain objectivity.” The state investigator also noted that “clarification questions were not completed to ensure additional events or individuals were further investigated.” These deficiencies involved three allegations of abuse that were being reviewed during the survey.

    The state investigator reviewed the facility’s Rev. 2012 policy titled General Investigation Guidelines that read in part:

    • “Investigation should be conducted immediately after an incident, event, or allegation of improper conduct or non-compliance was reported.”
    • “Investigation should be thorough, accurate, and fact-based.”
    • “Investigations should be well-documented, concise, and understandable.”
    • “Investigations should be communicated as needed to appropriate parties and corrective action implemented as necessary.”
    • “The investigative person … must be independent of the allegations and maintain objectivity.”
    • “Ask clarification questions, if necessary, to ensure understanding between the witness and the interviewer.”

    The state investigator interviewed a resident who stated that “someone had abused him. He said there was a person who dug his finger into a shoulder bone. He said the person was at the facility every day. The resident provided the name but was unable to offer a description of the individual.”

    The surveyor also noted that the resident “said he did not report the issue to the facility staff. He stated he was not in fear of the person but did not like the person poking him in the shoulder. He said the last time the incident occurred was eight or nine days from the date of the interview.”

    The survey stated that the “Nursing Home Administrator was informed of the allegation of abuse reported by [the resident, but stated that] she was not aware of the allegation but would start an investigation.” This person is also “the Abuse Coordinator for the facility.”

    The Nurse Home Administrator “propelled the resident around the facility in search of the individual alleged to [have dug] his finger into the resident’s shoulder which caused discomfort.” The Administrator did this as a way to “rule out the alleged assailant was in the facility [on that date] as reported by the resident.”

    Further review of the staffing schedules failed to “identify staff member based on the name provided by the resident.”

    As a follow-up to the state surveyor’s investigation into the alleged abuse, the Nursing Home Administrator stated that “she contacted the police and filed a report with the State Health Department.” However, the Administrator “confirmed the interviews with residents were not developed further to determine if additional issues warranted further investigation.”

  • Failure to Provide Proper Treatment That Prevents the Development of a New Pressure Sore Allow an Existing Pressure Sore to Heal

    In a summary statement of deficiencies dated May 4, 2017, the state investigator noted facility’s failure “to prevent a pressure injury from developing.” It was also noted by the investigator that the facility had failed to “assess and implement measures to prevent a pressure injury and promote healing; monitor and revise the skin care plan for accuracy of care.” There was also a failure of the staff to “report skin condition changes to the Wound Nurse for monitoring and treatment; and educate the resident on skin breakdown risk options to assist [in] wound healing.”

    The facility was also notified of their failures that “contributed to the resident’s developing an unstageable pressure injury and infection.”

  • Failure to Ensure That Every Resident’s Medication Regimen Is Free from Unnecessary Drugs

    In a summary statement of deficiencies dated May 4, 2017, the State surveyor noted the facility’s failure to “ensure [four residents] remained free from unnecessary medications.” The surveyor said that the facility had specifically failed to:

    • “Provide a risk/benefit assessment for [a resident who] was receiving two anticoagulants.”
    • “Identify and implement nonpharmacological interventions [before] administering ‘as needed’ [PRN] anti-anxiety medication for [another resident].”
    • “Document specific behaviors associated with anti-anxiety medication administration for [a resident] with a dementia diagnosis.”
    • “Consistently document behaviors and use non-pharmacological interventions prior to administering [as needed (PRN)] anxiolytic medication for [a resident].”

    An interview with the facility’s Director of Nursing on the late afternoon of May 3, 2017 revealed that “she had not recognized a breakdown in the system of handling the pharmacy recommendations the previous month.

    She said she did not know if the pharmacy recommendations had ever been addressed with the additions [and that] she was not aware of the severe ‘drug to drug’ interactions with [one resident] until she pulled the report off the computer when requested by a surveyor.” The Director also stated that she “agreed with the resident being on to blood thinners was a concern [that] needed to be addressed”.

  • Failure to Immediately Notify the Resident’s Doctor or Family Member of a Change in the Resident’s Situation

    In a summary statement of deficiencies dated March 2, 2017, the state investigator noted the facility’s failure “to notify the legal representative or the interested family member of a significant change in the resident’s physical, mental or psychosocial status.” The surveyor noted that the facility “failed to notify the [53-year-old] resident’s medical durable Power of Attorney of changes in medication.”

    An interview with the facility’s Director of Nursing midmorning on March 1, 2017, revealed that “the resident’s father should be notified of any new physician’s orders. She was unable to provide documentation to support that the family had been notified of the new orders or transfer to the emergency room.”

Were you Injured in a Colorado Nursing Facility?

Has your loved one suffered an injury while residing in any nursing facility including Belmont Lodge Health Care Center? If so, you should consider hiring a reputable nursing home negligence attorney who specializes in abuse and neglect cases. With legal representation, your family can seek and obtain the financial compensation they deserve to recover damages.

No upfront fees and payment are required because these cases are handled through contingency agreements. This arrangement allows immediate legal representation without making payments for services. Legal fees are paid only after the case is successfully resolved through a negotiated out-of-court settlement or a jury trial award.

Learn more about the laws and regulations that apply to Colorado nursing homes here.


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