D

LAKEWOOD VILLA

1625 SIMMS ST, LAKEWOOD, CO 80215
Score: 47 / 100

Lakewood Villa faces challenges in its CMS ratings, earning a D grade with a score of 47/100. The facility ranks in the 41th percentile among Colorado nursing homes, suggesting significant room for improvement.

Staffing levels are a potential concern at Lakewood Villa, with 3.03 total nursing hours per resident per day — below the national average of 3.8 hours. Lower staffing can impact care quality and staff responsiveness.

Recent CMS inspections identified 22 deficiencies at Lakewood Villa, including 1 classified as serious — among the most concerning citation levels. The most notable finding involved: protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody..

Score Breakdown

Overall CMS Rating 24 / 40 pts
3 ★ CMS rating
Health Inspections 10 / 25 pts
2 ★ inspection rating
Staffing 12 / 20 pts
3 ★ staffing rating
Quality Measures 15 / 15 pts
5 ★ quality measures

🏥 Staffing Details

Staff Type Hours/Resident/Day National Avg Comparison
Total Nursing 3.03 3.8 Below Average
Registered Nurses (RN) 0.63 0.7 Average
Licensed Practical Nurses (LPN) 0.44 0.7 Below Average
Certified Nursing Assistants (CNA) 1.96 2.4 Below Average
Weekend Total Nursing 2.82 3.8 Below Average
Weekend RN Hours 0.46 0.7 Below Average

🔍 Inspection & Deficiency History

22
Total Deficiencies
Jul 6, 2025
Most Recent Inspection
🟠 21 Moderate 🔴 1 Serious
View recent deficiencies (5 shown)
  • Tag 0600 Severity D
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    Jul 6, 2025 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
  • Tag 0600 Severity D
    Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
    Mar 24, 2025 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
  • Tag 0812 Severity F
    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
    Dec 18, 2024 · Nutrition and Dietary Deficiencies
  • Tag 0880 Severity E
    Provide and implement an infection prevention and control program.
    Dec 18, 2024 · Infection Control Deficiencies
  • Tag 0759 Severity D
    Ensure medication error rates are not 5 percent or greater.
    Dec 18, 2024 · Pharmacy Service Deficiencies

📊 Resident Outcome Measures

Based on CMS quality measure data. Lower percentages are better for most metrics.

Measure This Facility Nat'l Avg
Residents with pressure ulcers 1.3% 4.5% Better
Falls with major injury 2.6% 3.0% Better
On antipsychotic medication 64.3% 14.5% Worse
Urinary tract infections 0.5% 2.5% Better
ADL decline (daily activities) 21.1% 14.0% Worse
Excessive weight loss 4.6% 7.5% Better
New/worsened incontinence 29.1% 45.0% Better

⚠️ Penalties & Fines

2 penalties recorded by CMS

Total fines: $40,006

How This Grade Was Calculated

This facility's grade of D is based on a score of 47 out of 100, calculated from official CMS Nursing Home Compare data:

  • Overall CMS Rating: 3★ → 24 pts (max 40)
  • Health Inspection Rating: 2★ → 10 pts (max 25)
  • Staffing Rating: 3★ → 12 pts (max 20)
  • Quality Measures Rating: 5★ → 15 pts (max 15)
  • Penalty deductions: -10 pts
  • Fine deductions: -4 pts

Grades: A=85+, B=70–84, C=55–69, D=40–54, F=below 40

Facility Details

Ownership
For profit - Limited Liability company
Certified Beds
57
Provider Type
Medicare and Medicaid
Resident Council
Yes
Family Council
No
Sprinkler System
Yes
Last Inspection
Dec 18, 2024
Deficiencies (Cycle 1)
6