
Report
TheVardellReport
Oakwood Care and Rehabilitation
Skilled nursing facility and nursing facility
5301 W 1St Ave
Lakewood, CO 80226

TheVardellReport
Skilled nursing facility and nursing facility
5301 W 1St Ave
Lakewood, CO 80226
Life by Vardell Presents
The deeper story, beautifully organized. Available records, historical context, and questions worth asking.
This report is free. Vardell does not certify, grade or endorse; it shows what the record documents.
The Essentials
Across 8 inspections from November 2022 to February 2026, state surveyors documented 72 findings at Oakwood Care and Rehabilitation; 72 have a recorded correction; CMS lists 3 enforcement actions in the window.
* Partial year, through October 1, 2026.
| Year | Inspections | Findings | Of which, actual harm (level G or above) |
|---|---|---|---|
| 2022 | 1 | 18 | 2 |
| 2023 | 1 | 13 | 6 |
| 2024 | 1 | 16 | 1 |
| 2025 | 4 | 19 | 1 |
| 2026 | 1 | 6 | 0 |
Chronology
Every inspection in the record window, newest first. A finding is a deficiency an inspector cited. CMS publishes what a complaint investigation cited, not what the complaint alleged.
6 findings
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
4 findings
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
6 findings
The same visit included a complaint investigation.
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
3 findings
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
6 findings
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
16 findings
The same visit included a complaint investigation.
Enforcement Action
Civil money penalty, $52,416 imposed April 10, 2024. CMS publishes the fine, not whether it has been paid. CMS does not tie a penalty to a survey; listed with the standard health inspection of April 10, 2024, the nearest before the penalty date.
Enforcement Action
Civil money penalty, $53,151 imposed January 29, 2025. CMS publishes the fine, not whether it has been paid. CMS does not tie a penalty to a survey; listed with the standard health inspection of April 10, 2024, the nearest before the penalty date.
Enforcement Action
Denial of payment imposed January 29, 2025. Status: Closed, March 7, 2025. CMS does not tie a penalty to a survey; listed with the standard health inspection of April 10, 2024, the nearest before the penalty date.
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
13 findings
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
18 findings
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Severity levels follow the CMS scope and severity grid. A–C: potential for minimal harm. D–F: no actual harm, potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy.
Context
A repeated citation can merit attention, but context and corrective action must be reviewed before drawing a conclusion.
Inspectors cited F600 in November 2022, October 2023, April 2024, January 2025 and February 2026. This citation covers whether residents are protected from abuse and neglect by anyone. The most serious of these was recorded at level K (immediate jeopardy). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F677 in November 2022, April 2024, September 2025 and February 2026. This citation covers help with bathing, dressing, eating and toileting for residents who cannot manage alone. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F744 in October 2023, April 2024, January 2025 and February 2026. The agency describes it this way: Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. The most serious of these was recorded at level G (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F584 in November 2022, April 2024 and December 2025. This citation covers whether rooms and shared spaces are kept safe, clean, comfortable and homelike. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F610 in October 2023, April 2024 and February 2026. This citation covers how the home responds to and investigates an allegation of abuse, neglect or mistreatment. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F812 in November 2022, January 2025 and September 2025. This citation covers how food is stored, prepared and served. None rose above level F (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F880 in April 2024, January 2025 and September 2025. This citation covers hand hygiene, isolation practice and the home’s infection-prevention program. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F550 in October 2023 and June 2025. This citation covers residents’ right to dignity, to make their own choices and to communicate. The most serious of these was recorded at level G (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F609 in October 2023 and January 2025. This citation covers whether suspected abuse, neglect or theft is reported to the authorities on time, with the results of the home’s investigation. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F684 in October 2023 and April 2024. This citation covers whether residents receive the treatment their orders, preferences and goals call for. The most serious of these was recorded at level G (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F690 in November 2022 and April 2024. This citation covers continence care, catheter care and preventing urinary tract infections. None rose above level D (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F697 in October 2023 and April 2024. The agency describes it this way: Provide safe, appropriate pain management for a resident who requires such services. The most serious of these was recorded at level G (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F730 in October 2023 and September 2025. The agency describes it this way: Observe each nurse aide's job performance and give regular training. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F761 in November 2022 and April 2024. This citation covers how drugs are labeled and kept locked, including controlled drugs. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
Inspectors cited F867 in October 2023 and February 2026. The agency describes it this way: Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action. None rose above level F (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
For Your Next Visit
Bring these to the tour. Each one comes from something in the record; the reason is under the question.
What happened after the abuse or neglect citation, and what changed in training or supervision?
Protection From Abuse and Neglect: cited in five inspections, most seriously at level K.
How long do residents usually wait for help with bathing, dressing or the bathroom, and how is that tracked?
Help With Daily Living: cited in four inspections, most seriously at level E.
What changed after F744 was cited, and how do you check it now?
Citation F744: cited in four inspections, most seriously at level G.
What was done about the cleanliness citation, and how are rooms and shared spaces checked now?
A Clean, Homelike Setting: cited in three inspections, most seriously at level E.
When an allegation is made, who investigates it, and how are residents protected in the meantime?
Investigating Alleged Violations: cited in three inspections, most seriously at level D.
May we see the kitchen, and what do your own sanitation checks look like week to week?
Kitchen and Food Safety: cited in three inspections, most seriously at level F.
Who leads infection control here, and how often are hand-hygiene and isolation practices audited?
Infection Control: cited in three inspections, most seriously at level E.
How do staff learn each resident’s preferences, and how is a complaint about dignity handled?
Dignity and Resident Rights: cited in two inspections, most seriously at level G.
How are staff trained to report suspected abuse or neglect, and who reports it to the state?
Reporting Suspected Abuse: cited in two inspections, most seriously at level D.
How do nurses make sure a doctor’s orders are carried out, and how are families told when something is missed?
Quality of Care: cited in two inspections, most seriously at level G.
How is continence care scheduled, and how do you prevent urinary infections?
Continence and Catheter Care: cited in two inspections, most seriously at level D.
What changed after F697 was cited, and how do you check it now?
Citation F697: cited in two inspections, most seriously at level G.
What changed after F730 was cited, and how do you check it now?
Citation F730: cited in two inspections, most seriously at level E.
How are medications stored and secured, and who checks the medication carts?
Medication Labeling and Storage: cited in two inspections, most seriously at level E.
What changed after F867 was cited, and how do you check it now?
Citation F867: cited in two inspections, most seriously at level F.
How many nurses and aides are on each shift, including nights and weekends, for the unit we are considering?
No staffing citation appears in this window. Staffing levels are published separately by CMS and are worth asking about directly.
What led to the 2025 fine, and has it been paid?
A $53,151 civil money penalty was imposed January 29, 2025. CMS publishes the fine, not whether it has been paid. The record holds three enforcement actions in the window.
The Evidence
Inspection results and penalties are published by the Centers for Medicare & Medicaid Services from surveys conducted by the Colorado state survey agency.
Colorado state survey agency
Inspection Nov 17, 2022 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Oct 9, 2023 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Apr 10, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Jan 29, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Jun 12, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Sep 11, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Dec 18, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Colorado state survey agency
Inspection Feb 26, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Centers for Medicare & Medicaid Services
Published Oct 1, 2026 · Retrieved Nov 1, 2026
Centers for Medicare & Medicaid Services · 065248
Published Oct 1, 2026 · Retrieved Nov 1, 2026
Record windowNovember 17, 2022 – October 1, 2026
Historical coverage varies by agency and location. Missing records do not mean that no complaint or violation occurred.
Data architecture: Cierto supplies the source-backed machine-readable bundle. Life by Vardell independently creates the narrative, design, and consumer report.