Pioneer Health Care Center
900 S 12th St · Rocky Ford, CO · 81067 · 7192543314
101 certified beds For profit - Limited Liability company Chain: Madison Creek Partners
Why this verdict
- 4 citations involved actual harm to residents.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
1 abuse-related citation at the actual-harm level
Inspectors cited failures in the abuse-prevention rules (F600–F610) that resulted in actual harm to a resident.
No standard inspection in over 2 years
The inspection record here is older than usual — conditions may have changed since.
If someone you love was harmed at a facility with findings like these, you have options — read this.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 4 of 5 Inspections: 3 of 5 Staffing: 4 of 5 Quality measures: 5 of 5
| Total nurse hours / resident-day | 3.53 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.61 | 0.55–0.75 |
| Weekend hours / resident-day | 3.33 | ≈ weekday level |
| Nursing turnover / year | 49% | median 45% |
| Fines (3-yr window) | 1 · $10,033 |
Inspection citations (24 in the current record)
-
Potential for harm · D March 4, 2025 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected March 28, 2025 · Freedom from Abuse, Neglect, and Exploitation
-
Potential for harm · E August 29, 2024 · found via complaint
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.
Corrected September 18, 2024 · Resident Rights
-
Potential for harm · D August 29, 2024 · found via complaint
Provide safe and appropriate respiratory care for a resident when needed.
Corrected September 16, 2024 · Quality of Life and Care
-
Potential for harm · F August 29, 2024 · found via complaint
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Corrected September 18, 2024 · Environmental
-
Actual harm · G April 18, 2024
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected April 2, 2024 · Quality of Life and Care
-
Potential for harm · D April 18, 2024
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected May 10, 2024 · Resident Rights
-
Potential for harm · D April 18, 2024
Provide safe and appropriate respiratory care for a resident when needed.
Corrected May 10, 2024 · Quality of Life and Care
-
Potential for harm · E April 18, 2024
Observe each nurse aide's job performance and give regular training.
Corrected May 10, 2024 · Nursing and Physician Services
-
Potential for harm · D April 18, 2024
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.
Corrected May 10, 2024 · Pharmacy Service
-
Potential for harm · F April 18, 2024
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected May 10, 2024 · Nutrition and Dietary
-
Potential for harm · D April 18, 2024 · found via complaint
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected May 10, 2024 · Quality of Life and Care
-
Potential for harm · E November 13, 2023 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected December 25, 2023 · Freedom from Abuse, Neglect, and Exploitation
-
Potential for harm · E December 29, 2022
PASARR screening for Mental disorders or Intellectual Disabilities
Corrected February 11, 2023 · Resident Assessment and Care Planning
-
Potential for harm · E December 29, 2022
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Corrected February 11, 2023 · Quality of Life and Care
-
Potential for harm · E December 29, 2022
Perform COVID19 testing on residents and staff.
Corrected February 11, 2023 · Infection Control
-
Actual harm · G September 16, 2021
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected October 11, 2021 · Freedom from Abuse, Neglect, and Exploitation
-
Actual harm · G September 16, 2021
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected October 11, 2021 · Quality of Life and Care
-
Actual harm · G September 16, 2021
Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Corrected October 11, 2021 · Quality of Life and Care
-
Potential for harm · D September 16, 2021
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected October 11, 2021 · Freedom from Abuse, Neglect, and Exploitation
-
Potential for harm · D September 16, 2021
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected October 11, 2021 · Freedom from Abuse, Neglect, and Exploitation
-
Potential for harm · D September 16, 2021
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Corrected October 11, 2021 · Quality of Life and Care
-
Potential for harm · D September 16, 2021
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected August 2, 2021 · Quality of Life and Care
-
Potential for harm · D September 16, 2021
Provide safe and appropriate respiratory care for a resident when needed.
Corrected October 11, 2021 · Quality of Life and Care
-
Potential for harm · F September 16, 2021
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected October 11, 2021 · Nursing and Physician Services
Federal penalties
| Date | Type | Amount / length |
|---|---|---|
| April 18, 2024 | Fine | $10,033 |
Better-scoring options nearby
Family & resident reviews — a separate signal, never mixed into the score
No approved reviews yet. If your family has experience with this facility, yours could be the review that helps the next family decide.
Sign in to share your family's experience — reviews are moderated and never affect the Safety Score.
Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 065235 · certified since February 1, 1987. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.