Sierra Post Acute
1432 Depew St · Lakewood, CO · 80214 · 3032381375
102 certified beds For profit - Limited Liability company Chain: Pacs Group
Why this verdict
- Carries CMS’s abuse warning icon.
- Inspection record is far worse than the national median (deficiency count and severity).
- Federal penalties on record: $78,888 in fines in the last 24 months.
- 5 citations involved actual harm to residents.
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
CMS abuse warning
CMS flags this facility with its abuse icon: cited for abuse that caused harm in the past year, or potential harm in the past two years.
1 immediate-jeopardy citation in prior inspection cycles
Serious past findings — check whether the underlying problems were fixed and stayed fixed.
1 abuse-related citation at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
2 actual-harm citations in the most recent cycle
Inspectors found deficiencies that caused real harm to residents, beyond potential-harm paperwork findings.
$78,888 in federal fines in the last 24 months
3 fines — CMS fines are reserved for verified, serious non-compliance.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 1 of 5 Staffing: 1 of 5 Quality measures: 5 of 5
| Total nurse hours / resident-day | — | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | — | 0.55–0.75 |
| Weekend hours / resident-day | — | ≈ weekday level |
| Nursing turnover / year | 49% | median 45% |
| Fines (3-yr window) | 3 · $78,888 |
Inspection citations (39 in the current record)
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Actual harm · G January 29, 2026 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected February 7, 2026 · Quality of Life and Care
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Potential for harm · D January 29, 2026
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected February 4, 2026 · Resident Rights
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Potential for harm · E January 29, 2026
Ensure residents have reasonable access to and privacy in their use of communication methods.
Corrected February 9, 2026 · Resident Rights
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Potential for harm · D January 29, 2026
Provide safe and appropriate respiratory care for a resident when needed.
Corrected February 7, 2026 · Quality of Life and Care
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Potential for harm · E January 29, 2026
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 February 4, 2026 · Pharmacy Service
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Potential for harm · F January 29, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected February 13, 2026 · Nutrition and Dietary
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Potential for harm · D January 29, 2026
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Corrected February 4, 2026 · Infection Control
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Potential for harm · D January 29, 2026 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected February 9, 2026 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · F January 29, 2026 · found via complaint
Provide and implement an infection prevention and control program.
Corrected February 4, 2026 · Infection Control
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Actual harm · G October 20, 2025 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected November 13, 2025 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D February 26, 2025 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected March 17, 2025 · Quality of Life and Care
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Immediate jeopardy · J September 5, 2024 · found via complaint
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected August 21, 2024 · Quality of Life and Care
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Potential for harm · E March 20, 2024 · found via complaint
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected April 7, 2024 · Environmental
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Potential for harm · F March 20, 2024 · found via complaint
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected April 7, 2024 · Environmental
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Actual harm · G October 24, 2023 · found via complaint
Provide enough food/fluids to maintain a resident's health.
Corrected November 17, 2023 · Quality of Life and Care
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Potential for harm · D October 24, 2023
Reasonably accommodate the needs and preferences of each resident.
Corrected November 17, 2023 · Resident Rights
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Potential for harm · F October 24, 2023
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.
Corrected November 17, 2023 · Resident Rights
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Potential for harm · E October 24, 2023
Provide activities to meet all resident's needs.
Corrected November 17, 2023 · Quality of Life and Care
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Potential for harm · D October 24, 2023
Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.
Corrected December 13, 2023 · Quality of Life and Care
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Potential for harm · D October 24, 2023
Ensure that residents are free from significant medication errors.
Corrected November 17, 2023 · Pharmacy Service
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Potential for harm · D October 24, 2023
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 November 17, 2023 · Pharmacy Service
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Potential for harm · E October 24, 2023
Keep all essential equipment working safely.
Corrected November 17, 2023 · Environmental
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Potential for harm · F October 24, 2023
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected November 17, 2023 · Environmental
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Potential for harm · E October 24, 2023 · found via complaint
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 November 17, 2023 · Resident Rights
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Potential for harm · F October 24, 2023 · found via complaint
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected November 17, 2023 · Nursing and Physician Services
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| January 29, 2026 | Fine | $28,350 |
| October 20, 2025 | Fine | $40,180 |
| September 5, 2024 | Fine | $10,358 |
| October 24, 2023 | Payment Denial | 21 days |
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 065272 · certified since March 1, 1990. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.