Edgewater Health and Rehabilitation
1655 Eaton St., Lakewood, CO 80214 · Jefferson County · (303) 238-5363
67 certified beds, about 67 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 1981
CMS high performing icon Certified for Medicaid Certified for Medicare
Overall
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 065171 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on August 27, 2025, inspectors cited 6 health deficiencies (the Colorado average is 8.7, the national average 9.2).
Of 12 health citations since November 2022, 1 was rated as actual harm or immediate jeopardy to residents.
CMS lists no fines against this home in the last three years.
Nurses and nurse aides worked 3.33 hours per resident per day, against 3.72 across Colorado and 3.86 nationally. Registered nurses accounted for 0.85 of those hours.
46.8% of nursing staff left within the year CMS measured (Colorado average 47.1%).
Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
211/22
402/24
608/25
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 12 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
1G
0H
0I
Potential for more than minimal harm
6D
3E
2F
Potential for minimal harm
0A
0B
0C
August 27, 2025Standard inspection, Complaint inspection · 6 citations
- F Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observations and interviews the facility failed to store, prepare, distribute and serve food in a sanitary manner in the main kitchen. Specifically, the facility failed to ensure kitchen staff appropriately cleaned thermometers before and after use.
- E Provide and implement an infection prevention and control program.
Inspectors wroteBased on observations, record review and interviews, the facility failed to maintain an infection control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of disease and infection on one of two units. Specifically, the facility failed to:-Ensure housekeeping staff performed appropriate hand hygiene when cleaning residents' rooms,-Ensure staff performed appropriate hand hygiene when performing incontinence care for Resident #23; and,-Ensure staff wore appropriate personal protective equipment (PPE) during high contact resident care for Resident #23 and Resident #4, who were on enhanced barrier precautions (EBP).
- D Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Inspectors wroteBased on record review and interviews, the facility failed to ensure money from personal funds accounts was managed accurately for one (#13) of five residents reviewed for personal funds accounts out of 34 sample residents. Specifically, the facility failed to notify Resident #13, who was Medicaid funded, or her legal representative, when the resident's personal funds account reached $200.00 less than the eligibility resource limit.
- D Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents were free from physical restraints for one (#10) of one resident out of 34 sample residents. Specifically, the facility failed to:-Obtain a physician's order that addressed Resident #10's medical symptoms; -Ensure ongoing safety risk assessments were completed for the use of restraints for Resident #10; and,-Ensure that the least restrictive measures attempted and proven unsuccessful for Resident #10 were documented.
- D Provide care and assistance to perform activities of daily living for any resident who is unable.
Inspectors wroteBased on observations, record review, and interviews, the facility failed to ensure one (#69) of four residents reviewed for activities of daily living (ADLs) out of 34 sample residents received the necessary services to maintain good nutrition and personal care. Specifically, the facility failed to provide meal assistance for Resident #69.
- D Provide safe and appropriate respiratory care for a resident when needed.
Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure one (#56) of two residents out of 34 sample residents received proper respiratory care and services in accordance with professional standards of practice, the resident's care plan and the resident's choice. Specifically, the facility failed to:-Ensure Resident #56's continuous oxygen setting was set at the prescribed flow rate; and,-Ensure Resident #56 was provided with continuous oxygen supplementation per physician's orders.
February 14, 2024Standard inspection · 4 citations
- G Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Inspectors wroteBased on observations, record review and interviews, the facility failed to ensure residents received the necessary treatment and services according to professional standards of practice to prevent the development of pressure injuries for one (#31) of two residents out of 26 sample residents reviewed for pressure injuries. Resident #31, who was receiving hospice services related to his diagnosis of senile dementia, was known to be at risk for developing pressure injuries. The resident was admitted to the facility on [DATE] without any pressure injuries. On 10/6/23, a weekly skin assessment was conducted for Resident #31 and documented the resident had no new skin issues. The facility failed to conduct a skin assessment between the dates of 10/6/23 and 10/18/23. On 10/18/23, multiple pressure wounds were noted to Resident #31's left foot. [...]
- F Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observations, interviews and record review the facility failed to store, prepare, distribute and serve food in a sanitary manner in two of two nourishment refrigerators. Specifically, the facility failed to: -Ensure thawed nutritional supplements and thickened liquids were dated appropriately; -Ensure food was labeled and dated in the nourishment refrigerators; and, -Ensure expired food was discarded in the nourishment refrigerators.
- E Ensure that residents are free from significant medication errors.
Inspectors wroteBased on observation, record review and interviews, the facility failed to ensure that residents were kept free from significant medication errors for two (#54 and #47) of six residents out of 26 sample residents. Specifically, the facility failed to: -Ensure an antipsychotic medication for Resident #54 was obtained and administered according to physician's orders; -Notify resident #54's physician that the resident's antipsychotic medication was not refilled which resulted in the resident missing administration of the medication three days; -Ensure Resident #47 received all ordered doses of her prescribed antibiotic medication; and, -Notify Resident #47's physician when the resident did not receive the antibiotic medication.
- E Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Inspectors wroteBased on record review, and observations, the facility failed to ensure six of seven residents out of 36 sample residents received food and fluids prepared in a form designed to meet their needs per speech therapy recommendation, physician orders, and the resident's care plan. Specifically, the facility failed to ensure the puree textures produced were consistent with the International Dysphagia Diet Standard Initiative (IDDSI) level four puree texture (PU4) for residents prescribed a puree diet.
November 3, 2022Standard inspection · 2 citations
- D Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on observations, record review and interviews the facility failed to ensure one (#33) of four residents reviewed received treatment and care in accordance with professional standards of practice out of 24 sample residents. Specifically, the facility failed to have a wound care order in place prior to treatment being provided for Resident #33.
- D Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observations, interviews, and record review, the facility failed to implement interventions to reduce hazards and risks for falls for one resident (#42) out of four residents reviewed for falls out of 24 sample residents. Specifically, the facility failed to ensure Resident #42 was provided the assisted devices and interventions recommended to prevent repeated and avoidable falls.
Fire safety inspections
17 fire safety citations on file: 4 on August 27, 2025, 4 on February 14, 2024, 9 on November 3, 2022.
Every fire safety citation17 citations
- E Install a fire alarm system that can be heard throughout the facility.
- D Have properly located and lighted "Exit" signs.
- D Provide properly protected cooking facilities.
- D Install corridor and hallway doors that block smoke.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Have properly installed electrical wiring and gas equipment.
- E Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- E Have approved installation, maintenance and testing program for fire alarm systems.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Have generator or other power source capable of supplying service within 10 seconds.
- E Have properly located and lighted "Exit" signs.
- E Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- E Provide properly protected cooking facilities.
- E Have approved installation, maintenance and testing program for fire alarm systems.
- E Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- E Have properly installed electrical wiring and gas equipment.
- E Have proper medical gas storage and administration areas.
Fines and payment denials
CMS lists no fines or payment denials against this home in the last three years. The national average is 0.9 fines per home.
Staffing
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Colorado | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.33 | 3.72 | 3.86 |
| Registered nurses | 0.85 | 0.82 | 0.69 |
| All nursing staff on weekends | 2.89 | 3.29 | 3.42 |
| Nurse aides | 2.05 | ||
| Licensed practical nurses | 0.42 | ||
| Nursing staff turnover (share who left in a year) | 46.8% | 47.1% | 45.8% |
| Registered nurse turnover | 27.3% | 44.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.39 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Staffing by quarter, from daily payroll records
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.51 on weekdays and 2.89 on weekends, 18% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 9.6% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.52 in April to June 2025 to 3.33 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.33 | 0.85 | 3.51 | 2.89 | 9.6% | 0 of 90 | 67 |
| Oct to Dec 2025 | 3.18 | 0.83 | 3.35 | 2.77 | 8.9% | 0 of 92 | 67 |
| Jul to Sep 2025 | 3.26 | 0.78 | 3.43 | 2.82 | 7.9% | 0 of 92 | 63 |
| Apr to Jun 2025 | 3.52 | 0.80 | 3.71 | 3.05 | 9.8% | 0 of 91 | 64 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Colorado, Jan to Mar 2026 | 3.59 | 0.76 | 3.75 | 3.18 | 5.9% | 0.2% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Quality measures
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Colorado | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 16.6 | 13.4 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 0.6 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 1.3 | 1.4 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 1.2 | 3.4 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 1.3 | 1.6 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 15.5 | 13.3 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.3 | 3.4 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 15.2 | 20.0 | 15.4 |
Owners and operators
Legal business name: Legal Business Name Not Available.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Ownership data not available |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Questions to ask on a visit
Chosen from this home's own inspection record.
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 5 problems in this area, most recently on August 27, 2025: "Provide care and assistance to perform activities of daily living for any resident who is unable."
- Can we see a week of menus and the kitchen, and how are special diets handled?Inspectors cited 3 problems in this area, most recently on August 27, 2025: "Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards."
- What changed in infection control since the last inspection, and who on staff is the infection preventionist?Inspectors cited 1 problem in this area, most recently on August 27, 2025: "Provide and implement an infection prevention and control program."
- How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 1 problem in this area, most recently on August 27, 2025: "Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death."
- Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 2.89 hours per resident per day, below the Colorado average of 3.29.
Other nursing homes nearby
- Cambridge Care Center Lakewood, 0 mi · 3 of 5 stars · 20 citations
- Cedars Healthcare Center Lakewood, 0.1 mi · 2 of 5 stars · 38 citations
- Sierra Post Acute Lakewood, 0.3 mi · 2 of 5 stars · 40 citations
- Harmony Pointe Care Center Lakewood, 1.1 mi · 3 of 5 stars · 34 citations
- Wheatridge Care Center Wheat Ridge, 1.1 mi · 3 of 5 stars · 21 citations
- Allison Care Center Lakewood, 1.6 mi · 2 of 5 stars · 19 citations
- Sloan's Lake Rehabilitation Center Denver, 1.6 mi · 5 of 5 stars · 12 citations
- Western Hills Health Care Center Lakewood, 1.6 mi · 3 of 5 stars · 16 citations
Colorado contacts for a concern about a nursing home
These are the official offices in Colorado. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: Colorado Department of Public Health and Environment, Health Facilities and Emergency Medical Services Division, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: Colorado State Long-Term Care Ombudsman Program, 303-862-3524. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: Find and compare facilities, where Colorado publishes its own records on licensed homes.
Common questions
- What is Edgewater Health and Rehabilitation's Medicare star rating?
- CMS rates Edgewater Health and Rehabilitation 5 out of 5 stars overall, with 4 for health inspections, 4 for staffing and 5 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Edgewater Health and Rehabilitation get at its last inspection?
- 6 health deficiencies at the standard inspection on August 27, 2025. The Colorado average is 8.7.
- Has Edgewater Health and Rehabilitation been fined?
- CMS lists no fines in the last three years.
- Does Edgewater Health and Rehabilitation accept Medicaid?
- It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
- Who owns Edgewater Health and Rehabilitation?
- CMS lists 1 owner or manager. Legal business name: Legal Business Name Not Available.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.