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Colorado Department of Public Health and Environment | Health Facilities

How the State Surveys Nursing Homes

Licensing and Certification:



All Colorado nursing homes are licensed by the state through the division. Nursing homes are also certified to provide services to eligible Medicare and Medicaid beneficiaries and are expected to meet federal regulations. The division enforces state and federal regulations through unannounced annual surveys and complaint investigations.


Annual surveys take place every 9 to 15 months, with an average of every 12 months. Complaint investigations are conducted whenever the division receives a formal regulatory-related complaint that falls under division jurisdiction from a family member, staff member, resident or friend. The division can investigate complaints relating to quality of life and quality of care at a facility, including residents' rights, abuse, dietary concerns, staffing and environmental concerns. The division cannot investigate complaints related to billing or insurance concerns.


During surveys and inspections, interdisciplinary teams evaluate the care and services provided to residents in accordance with regulatory requirements. Deficiencies may be cited if the facility fails to meet any of the requirements.


Each deficiency cited is assigned a scope and severity, which indicates the level of harm and the pervasiveness of the deficient practice. Scope and severity levels range from A, no actual harm on an isolated basis, to L, immediate jeopardy to resident health and safety on a widespread basis.


Prior to beginning a survey, team members review the nursing home's background. They look at previous survey results, complaint investigations, occurrence reports and quality indicators that give information specific to each facility. They also consult with the ombudsmen assigned to that facility to get an idea of whether there are special concerns or problems that they should be aware of during the survey.


All surveys are unannounced. Once in the facility, surveyors observe what is going on in the nursing home, review medical records and other documents, and interview residents, family members and nursing home staff. The surveyors summarize their observations to facility staff at the conclusion of the visit.


If there are deficiencies, the nursing home receives a letter and a survey form (Form 2567). They are given ten days to respond with a plan of correction. The plan of correction is reviewed for acceptance. A follow-up survey, the revisit, takes place to verify the accurate and timely implementation of the plan of correction.