Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

SOUTHEAST COLORADO HOSPITAL LTC

SPRINGFIELD, CO · 56 certified beds · Last Life Safety survey November 21, 2024

CMS Certification Number 06A185 · first certified December 1991

Ownership

Independently operated (no chain recorded by CMS) · Non profit - Corporation

No change of ownership on CMS record since January 1, 2016, when the records begin.

15
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
1
Tags cited more than once
Across separate surveys
6
Inspection & testing records
Of the citations on file

Position within CO

15 citations — more than 43% of the 210 certified nursing homes in CO. Compared within CO rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Holding steadyabout the same at the latest survey as at its earlier surveys in the window.

The latest survey found 5 citations; the earlier surveys in the window averaged 5. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window is open now: May 2026 to November 2026. This facility’s last Life Safety survey was November 2024. Facilities in CO are typically surveyed 17–24 months after the last one (median 19), measured over 177 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Emergency preparedness

3 of the 15 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

3 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 15 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0880 Provide and implement an infection prevention and control program.
  • F-0584 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.

How that compares

Citations on file over three years

Compared with the median facility in CO, and nationally. Surveyors differ markedly between states, so the CO figure is the meaningful one.

This facility15CO median16National median11
Citations on file over three years, compared
MeasureCitations
This facility15
Median facility in CO16
Median facility nationally11

Survey history

Citations at each Life Safety survey
32022-0472023-0652024-11
Citations at each Life Safety survey
Survey dateCitations
April 14, 20223
June 15, 20237
November 21, 20245

Most-cited tags

Most-cited tags at this facility
K-02232K-03241E-00251K-03531E-00091K-09181K-09121K-05211
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0223Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.22024-11-21
K-0324Provide properly protected cooking facilities.12024-11-21
E-0025Create arrangements with other facilities to receive patients.12024-11-21
K-0353Inspect, test, and maintain automatic sprinkler systems.12022-04-14
E-0009Include a process for Emergency Preparedness collaboration.12024-11-21
K-0918Have generator or other power source capable of supplying service within 10 seconds.12023-06-15
K-0912Have power receptacles that are properly grounded.12023-06-15
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.12022-04-14

What the citations cover

Citations by CMS category
  • Egress Deficiencies 3
  • Emergency Preparedness Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 3
  • Services Deficiencies 2
  • Other 4
Citations by CMS category
CategoryCitations
Egress Deficiencies3
Emergency Preparedness Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies3
Services Deficiencies2
Smoke Deficiencies2
Construction Deficiencies1
Miscellaneous Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

November 21, 2024 — 5 citations

Citations issued on November 21, 2024
TagWhat the surveyor checksStatus
E-0009Include a process for Emergency Preparedness collaboration.Deficient, Provider has date of correction (December 16, 2024)
E-0025Create arrangements with other facilities to receive patients.Deficient, Provider has date of correction (December 16, 2024)
E-0026Establish roles under a Waiver declared by secretary.Deficient, Provider has date of correction (December 16, 2024)
K-0223Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.Deficient, Provider has date of correction (December 9, 2024)
K-0324Provide properly protected cooking facilities.Deficient, Provider has date of correction (December 14, 2024)

June 15, 2023 — 7 citations

Citations issued on June 15, 2023
TagWhat the surveyor checksStatus
K-0133Install a two-hour-resistant firewall separation.Deficient, Provider has date of correction (July 27, 2023)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (July 28, 2023)
K-0511Have properly installed electrical wiring and gas equipment.Deficient, Provider has date of correction (July 27, 2023)
K-0712Have simulated fire drills held at unexpected times.Deficient, Provider has date of correction (July 28, 2023)
K-0908Ensure gas and vacuum systems are inspected and tested as part of a maintenance program.Waiver has been granted (December 7, 2023)
K-0912Have power receptacles that are properly grounded.Deficient, Provider has date of correction (July 27, 2023)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (July 28, 2023)

April 14, 2022 — 3 citations

Citations issued on April 14, 2022
TagWhat the surveyor checksStatus
K-0223Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.Deficient, Provider has date of correction (May 2, 2022)
K-0353Inspect, test, and maintain automatic sprinkler systems.Deficient, Provider has date of correction (May 9, 2022)
K-0521Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.Deficient, Provider has date of correction (May 2, 2022)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.