Public Record
Lakewood Villa
Operated by Madison Creek Partners
From CMS
Facility profile
- CMS overall rating
- 3 / 5
- Certified beds
- 57
- Avg. residents per day
- 53.7
*CMS Five-Star
*CMS
*CMS
Inspection record
On record from CMS
- Health citations
- 22
- Fire safety findings
- 21
- Inspections on file
- 11
- Last inspection
- 2025-07-07
*CMS
*CMS
*CMS
*CMS
Citations
22 citations on record
Each deficiency cited on a CMS health inspection of this facility, sourced from the federal record. Open a report for the raw CMS Scope and Severity grade on each finding.
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
- 0600Generalpotential for harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0600Generalpotential for harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0760Generalpotential for harm
Ensure that residents are free from significant medication errors.
- 0812Generalpotential for harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- 0759Generalpotential for harm
Ensure medication error rates are not 5 percent or greater.
- 0880Generalpotential for harm
Provide and implement an infection prevention and control program.
- 0600Generalpotential for harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0689Seriousimmediate jeopardy
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- 0921Generalpotential for harm
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
- 0925Generalpotential for harm
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
- 0812Generalpotential for harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
- 0553Generalpotential for harm
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
- 0600Generalpotential for harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0689Seriousactual harm
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- 0692Seriousactual harm
Provide enough food/fluids to maintain a resident's health.
- 0761Generalpotential for harm
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.
- 0758Generalpotential for harm
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.
- 0600Generalpotential for harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0625Generalpotential for harm
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
- 0600Seriousactual harm
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
- 0744Seriousactual harm
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
- 0923Generalpotential for harm
Have enough outside ventilation via a window or mechanical ventilation, or both.
Inspection history
Every health inspection on record
Each CMS health inspection of this facility, and the deficiencies the surveyors cited. Where the verbatim Form 2567 statement of deficiencies is on file, it links to the full report.
- View inspection reportInspection1 deficiency
- View inspection reportInspection1 deficiency
- View inspection reportInspectionFire Safety10 deficiencies
- View inspection reportInspection5 deficiencies
- View inspection reportInspection1 deficiency
- View inspection reportInspection2 deficiencies
- View inspection reportInspection7 deficiencies
- View inspection reportInspectionFire Safety6 deficiencies
- View inspection reportInspection1 deficiency
- View inspection reportInspection4 deficiencies
Showing the 10 most recent inspections. 1 earlier inspection is also on record.
Ownership
Madison Creek Partners
13nursing homes nationwide, in CMS records
FAQ
Questions and answers
- What is Lakewood Villa?
- Lakewood Villa is a Medicare- and Medicaid-certified nursing home in Lakewood, CO, tracked by the Centers for Medicare & Medicaid Services (CMS). Its CMS Certification Number (CCN) is 065408.
- What is the CMS rating for Lakewood Villa?
- Lakewood Villa has a CMS overall rating of 3 out of 5 stars. CMS rates nursing homes on health inspections, staffing, and quality measures.
- How many beds does Lakewood Villa have?
- Lakewood Villa is certified for 57 beds. It serves an average of 53.7 residents per day.
- How many citations does Lakewood Villa have?
- Lakewood Villa has 22 citations on record from CMS health inspections, each tied to a federal deficiency tag.
- When was Lakewood Villa last inspected?
- Lakewood Villa was last inspected on July 7, 2025. CMS surveys nursing homes about once a year and after complaints.
- What can I do if I have concerns about care at this facility?
- Start by raising the concern with the facility administrator or director of nursing. Every state also runs a free long-term care ombudsman program that advocates for residents and families; the federal Eldercare Locator at eldercare.acl.gov can connect you with yours. Complaints about quality of care can also be filed with your state survey agency.
*Sourced from the Centers for Medicare & Medicaid Services (CMS). See the official record on CMS Care Compare. If you believe any information is inaccurate, report it here.
/nursing-home/065408-lakewood-villa