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🔎 Juniper Village - The Spearly Center

Inspection Results


Inspection Overview

Juniper Village - The Spearly Center has been cited for a total of 58 deficiencies since we began saving each survey.

In Colorado, the average facility has **29.64 deficiencies** in our database. This profile shows the longer-term view.

Tip: Surveys happen throughout the year. Always check the official Medicare Care Compare site for the most recent data.



Understanding Deficiency Severity (A-L Scale)

The farther along in the alphabet (A through L) the Scope value is, the more severe the deficiency. **A through F means no actual harm has happened.**

Severity (Harm)Scope (Widespread?)Code Range
No Actual HarmIsolated to PatternA - C
No Actual HarmWidespreadD - F
**Actual Harm**IsolatedG
**Actual Harm**PatternH
**Actual Harm**WidespreadI
**Immediate Jeopardy**IsolatedJ
**Immediate Jeopardy**PatternK
**Immediate Jeopardy**WidespreadL


Detailed Deficiency List (Most Recent First)

Scope/Severity: D

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Resident Rights Deficiencies
From Complaint: N

Scope/Severity: D

Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Resident Rights Deficiencies
From Complaint: N

Scope/Severity: D

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Resident Assessment and Care Planning Deficiencies
From Complaint: N

Scope/Severity: D

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: D

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: J

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: E

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.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Nutrition and Dietary Deficiencies
From Complaint: N

Scope/Severity: E

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Nutrition and Dietary Deficiencies
From Complaint: N

Scope/Severity: D

Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Administration Deficiencies
From Complaint: N

Scope/Severity: F

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Administration Deficiencies
From Complaint: N

Scope/Severity: E

Provide and implement an infection prevention and control program.

Survey Date: 2025-04-25
Correction Date: 2025-04-26
Category: Infection Control Deficiencies
From Complaint: N

Scope/Severity: L

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey Date: 2024-12-11
Correction Date: 2024-12-12
Category: Quality of Life and Care Deficiencies
From Complaint: Y

Scope/Severity: F

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Survey Date: 2024-12-11
Correction Date: 2025-01-04
Category: Administration Deficiencies
From Complaint: Y

Scope/Severity: G

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey Date: 2024-10-23
Correction Date: 2024-09-25
Category: Quality of Life and Care Deficiencies
From Complaint: Y

Scope/Severity: 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.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: L

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: D

Provide care or services that was trauma informed and/or culturally competent.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: C

Post nurse staffing information every day.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Nursing and Physician Services Deficiencies
From Complaint: N

Scope/Severity: 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.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Pharmacy Service Deficiencies
From Complaint: N

Scope/Severity: 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.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Nutrition and Dietary Deficiencies
From Complaint: N

Scope/Severity: F

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Nutrition and Dietary Deficiencies
From Complaint: N

Scope/Severity: F

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Administration Deficiencies
From Complaint: N

Scope/Severity: D

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: E

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: Y

Scope/Severity: E

Protect each resident from separation (from other residents, his/her room, or confinement to his/her room).

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: Y

Scope/Severity: D

Respond appropriately to all alleged violations.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: Y

Scope/Severity: K

Honor each resident's preferences, choices, values and beliefs.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Quality of Life and Care Deficiencies
From Complaint: Y

Scope/Severity: E

Dispose of garbage and refuse properly.

Survey Date: 2024-05-23
Correction Date: 2024-05-24
Category: Nutrition and Dietary Deficiencies
From Complaint: Y

Scope/Severity: G

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

Survey Date: 2023-12-19
Correction Date: 2024-01-10
Category: Quality of Life and Care Deficiencies
From Complaint: Y

Scope/Severity: E

Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

Survey Date: 2023-05-24
Correction Date: 2023-07-15
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: E

Honor the resident's right to manage his or her financial affairs.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Resident Rights Deficiencies
From Complaint: N

Scope/Severity: E

Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Resident Rights Deficiencies
From Complaint: N

Scope/Severity: E

PASARR screening for Mental disorders or Intellectual Disabilities

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Resident Assessment and Care Planning Deficiencies
From Complaint: N

Scope/Severity: G

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: F

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Nutrition and Dietary Deficiencies
From Complaint: N

Scope/Severity: E

Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Administration Deficiencies
From Complaint: N

Scope/Severity: F

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Administration Deficiencies
From Complaint: N

Scope/Severity: K

Provide and implement an infection prevention and control program.

Survey Date: 2023-01-30
Correction Date: 2023-02-28
Category: Infection Control Deficiencies
From Complaint: N

Scope/Severity: E

Develop and implement policies and procedures for flu and pneumonia vaccinations.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Infection Control Deficiencies
From Complaint: N

Scope/Severity: D

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.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: D

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: Y

Scope/Severity: E

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Survey Date: 2023-01-30
Correction Date: 2023-02-23
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: Y

Scope/Severity: D

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Resident Rights Deficiencies
From Complaint: N

Scope/Severity: D

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: N

Scope/Severity: D

Allow resident to participate in the development and implementation of his or her person-centered plan of care.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: F

Honor the resident's right to receive visitors of his or her choosing, at the time of his or her choosing.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: D

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Resident Rights Deficiencies
From Complaint: Y

Scope/Severity: D

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Quality of Life and Care Deficiencies
From Complaint: Y

Scope/Severity: E

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.

Survey Date: 2021-09-30
Correction Date: 2021-10-21
Category: Pharmacy Service Deficiencies
From Complaint: Y

Scope/Severity: G

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Survey Date: 2021-03-29
Correction Date: 2021-04-22
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: Y

Scope/Severity: D

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Survey Date: 2021-02-24
Correction Date: 2021-03-29
Category: Quality of Life and Care Deficiencies
From Complaint: Y

Scope/Severity: F

Provide and implement an infection prevention and control program.

Survey Date: 2020-07-14
Correction Date: 2020-08-11
Category: Infection Control Deficiencies
From Complaint: N

Scope/Severity: D

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Survey Date: 2019-10-31
Correction Date: 2019-12-31
Category: Resident Rights Deficiencies
From Complaint: N

Scope/Severity: D

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Survey Date: 2019-10-31
Correction Date: 2019-11-24
Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies
From Complaint: N

Scope/Severity: D

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Survey Date: 2019-10-31
Correction Date: 2019-11-24
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: D

Provide safe and appropriate respiratory care for a resident when needed.

Survey Date: 2019-10-31
Correction Date: 2019-11-24
Category: Quality of Life and Care Deficiencies
From Complaint: N

Scope/Severity: E

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.

Survey Date: 2019-10-31
Correction Date: 2019-11-24
Category: Pharmacy Service Deficiencies
From Complaint: N

Scope/Severity: D

Have a plan that describes the process for conducting QAPI and QAA activities.

Survey Date: 2019-10-31
Correction Date: 2019-11-24
Category: Administration Deficiencies
From Complaint: N


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All deficiency data is sourced directly from the **Centers for Medicare & Medicaid Services (CMS)**.
Data Aggregation and Review provided by **The Nursing Home Site.**