Monument Healthcare Cottonwood Creek
1205 East 4725 South · Salt Lake City, UT · 84117 · 8012622908
77 certified beds For profit - Corporation Chain: Monument Health Group
Why this verdict
- 3 citations involved actual harm to residents.
- Inspection results have improved across recent cycles.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
Cited under the freedom-from-abuse rule
Cited 1 time under F600 (freedom from abuse/neglect) below the actual-harm level — worth asking about on a tour.
No standard inspection in over 2 years
The inspection record here is older than usual — conditions may have changed since.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 3 of 5 Inspections: 2 of 5 Staffing: 2 of 5 Quality measures: 5 of 5
| Total nurse hours / resident-day | 3.38 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.85 | 0.55–0.75 |
| Weekend hours / resident-day | 2.99 | ≈ weekday level |
| Nursing turnover / year | — | median 45% |
| Fines (3-yr window) | 1 · $17,940 |
Inspection citations (28 in the current record)
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Actual harm · G April 4, 2024
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected April 25, 2024 · Quality of Life and Care
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Potential for harm · E April 4, 2024
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 April 25, 2024 · Resident Rights
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Potential for harm · E April 4, 2024
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected March 15, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D April 4, 2024
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected April 25, 2024 · Quality of Life and Care
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Potential for harm · D April 4, 2024
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Corrected April 25, 2024 · Pharmacy Service
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Potential for harm · D April 4, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected March 25, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Actual harm · G May 5, 2022
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected June 9, 2022 · Quality of Life and Care
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Actual harm · G May 5, 2022
Provide enough food/fluids to maintain a resident's health.
Corrected June 9, 2022 · Quality of Life and Care
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Potential for harm · E May 5, 2022
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected June 9, 2022 · Resident Rights
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Potential for harm · E May 5, 2022
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected June 9, 2022 · Resident Assessment and Care Planning
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Potential for harm · D May 5, 2022
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected June 9, 2022 · Quality of Life and Care
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Potential for harm · E May 5, 2022
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Corrected June 9, 2022 · Quality of Life and Care
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Potential for harm · D May 5, 2022
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Corrected June 9, 2022 · Pharmacy Service
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Potential for harm · D May 5, 2022
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Corrected June 9, 2022 · Pharmacy Service
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Potential for harm · D May 5, 2022
Provide timely, quality laboratory services/tests to meet the needs of residents.
Corrected June 9, 2022 · Administration
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Potential for harm · E May 5, 2022
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected June 9, 2022 · Administration
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Potential for harm · E May 5, 2022
Provide and implement an infection prevention and control program.
Corrected June 9, 2022 · Infection Control
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Potential for harm · D May 5, 2022
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected June 9, 2022 · Infection Control
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Potential for harm · E May 5, 2022
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.
Corrected June 9, 2022 · Infection Control
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Potential for harm · D December 5, 2019
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected January 20, 2020 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D December 5, 2019
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected January 17, 2020 · Resident Assessment and Care Planning
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Potential for harm · D December 5, 2019
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected January 20, 2020 · Quality of Life and Care
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Potential for harm · D December 5, 2019
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected January 17, 2020 · Quality of Life and Care
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Potential for harm · D December 5, 2019
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected January 20, 2020 · Quality of Life and Care
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Potential for harm · E December 5, 2019
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Corrected January 15, 2020 · Nursing and Physician Services
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| April 4, 2024 | Fine | $17,940 |
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 465074 · certified since May 16, 1980. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.