BALFOUR AT RIVERFRONT PARK

SUMMARY OF FINDINGS:On 4/1/26, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to help prevent a future recurrence. The healthcare entity reported physical abuse of a client. Client (B) smacked the back of client (A)'s head after client (A) asked them to stop touching their hair. During the course of the investigation, the healthcare entity separated both clients, contacted police, conducted interviews, and reviewed records. Due to cognitive impairment, both clients were unable to provide detailed information about the incident. No visible injuries or complaints of pain for client (A) were indicated when assessed. Client (B)'s medical provider reviewed and adjusted their medications to help stabilize their mood. Staff provided line of sight and behavior monitoring, and activity engagement for client (B). Staff witnessed the incident. Although the facility determined contact occurred, it did not result in a visible injury or pain; therefore, the event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.

Sent to facility 5/19/2026 · released to the public 5/26/2026.

SUMMARY OF FINDINGS:On 8/15/25, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported misappropriation of client property. Client (A) alleged their face wash was missing and did not recall anyone in their apartment besides a housekeeper a week ago. However, the client indicated using the face wash the prior night. During the course of the investigation the healthcare entity conducted a search, and interviews. The client did not want the police called and was educated on keeping their apartment door locked. The client was assisted with purchasing a lock box. No assailant was identified and the facility could not determine what happened to the face wash. The event was not substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.

Sent to facility 10/1/2025 · released to the public 10/8/2025.

SUMMARY OF FINDINGS:On 12/6/24, the healthcare entity investigated a reportable event. The facility acted appropriately to protect their clients by taking immediate protective actions, investigating the event, and implementing a plan to prevent a future recurrence. The healthcare entity reported misappropriation of client property. During the course of the investigation the healthcare entity conducted interviews as a family member alleged money was missing from the clients account. The police were notified. The private caregiver was asked not to enter the facility until further notice and staff were made aware. The case is ongoing with the police at the time of the report. The client was assisted by family to close their accounts that were compromised. The event was substantiated. This public occurrence summary was provided in accordance with 25-1-124, C.R.S., and was based on the report and investigation provided by the licensed healthcare entity. Department investigation of this occurrence was conducted off-site. The healthcare entity occurrence report was submitted within the required timeframe.

Sent to facility 3/24/2025 · released to the public 3/31/2025.

DESCRIPTION OF OCCURRENCE: On 4/12/24 resident (A) could not be located in the secured unit during safety checks. After a search was conducted resident (A)’s whereabouts were still unknown. Resident (A) was identified to be at risk. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, family, and the physician. No other residents were missing. All exits were checked and it was identified the back door alarm was not sounding when the panic bar was pushed on. Resident (A) was discovered after calling a local hospital. It was indicated resident (A) fell while outside and a bystander called the paramedics. Resident (A) was transported to the hospital. Resident (A) sustained minor scrapes and bruising and returned to the facility without any new physician orders. The facility investigation concluded the back door malfunctioned when pressed. To help prevent a recurrence, line of sight supervision was implemented for resident (A) during waking hours. The alarm sensitivity was increased to notify staff 24 hours a day if an exit door was opened. All doors will be checked periodically for functionality. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence. However, the licensing standard for timely reporting was not met.

Sent to facility 11/26/2024 · released to the public 12/3/2024.

DESCRIPTION OF OCCURRENCE: On 6/12/23, two residents (A and B), in their 80s, mentioned missing several items. Resident (A) was missing a makeup mirror and resident (B) was missing face cream, i-pad, and pumpkin bread. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, families/guardians, and ombudsman. The makeup mirror was found in the employee breakroom tucked in an otherwise empty locker. A staff member reported seeing it in the breakroom. The mirror was retrieved and the item was returned. The other items were not located after a search was conducted. The facility was unable to identify an alleged perpetrator. To help prevent a recurrence, in services were provided to staff regarding the seriousness of misappropriation and timely reporting requirements. Residents and legal representative were also asked to report any missing items in a timely manner. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.

Sent to facility 3/25/2024 · released to the public 4/1/2024.

DESCRIPTION OF OCCURRENCE: On 1/11/23 a female resident (A) in her 70s reported to qualified medication administration person (QMAP) (1) that the private caregiver (2) had called her in the past and asked for money. Resident (A) stated that she had given caregiver (2) thousands of dollars in checks. FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, physician, the owner of the facility and Adult Protective Services. Resident (A) again stated she had been paying the alleged caregiver in checks and volunteered the money. Caregiver (2) was put on the list of individuals that were not allowed in the facility. Caregiver (2) stated s/he never received any money from resident (A). Resident (A) will not share her financial records or checkbook information for this investigation. The facility investigation concluded that due to the resident not sharing her financial information to staff, police or the detective it was difficult to make a final conclusion regarding resident (A)’s funds. Resident (A) is her own responsible party. To help prevent a recurrence, resident (A) was encouraged to cease telephone communication with caregiver (2) and will not be allowed into the facility. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.

Sent to facility 6/14/2023 · released to the public 6/21/2023.

DESCRIPTION OF OCCURRENCE: On 1/5/23 qualified medication administration person (1) went to the room of a couple, a female resident (A) in her 80s and her husband resident (B) in his 90s to find resident (B) screaming angrily and resident (A) stated to a family friend who was also present at the time that when the husband got like that he hurts her. This information was reported to management (staff member 2) for the alleged physical abuse from the husband resident (B) to resident (A). FACILITY / AGENCY ACTION: The facility conducted an internal investigation and notified the police, physician, families/guardians, Adult Protective Services and ombudsman. Staff member (2) went to the room of resident (A) and (B) and asked resident (A) if her husband would hurt her and resident (A) shook her head yes and gestured that he would grab her arms and shake her. Resident (A) was questioned again in private and stated that he (resident B) never got physical with her before moving to the facility and his anger has gotten worse and it scared her. Resident (A) did not have any current injuries but did have diffuse bruising on her body likely due to falls according to the facility. The husband was removed from the area. A family member was called to come to the facility. This family member reported the resident (B) did have an anger problem but did not know of any physical abuse. Resident (B) had been verbally abusive to staff in the past. Resident (A) was hesitant to answer questions when the police arrived to interview her and did not want staff member (2) to report the incident. The friend who was in the room confirmed resident (A) stated that her husband would hurt her when he got upset. The facility investigation concluded based on the statements and witnesses the allegation was accurate and the husband admitted fault. To help prevent a recurrence resident (B) left the facility and went back home for a few days. Staff implement frequent monitoring of resident (B). Resident (B) was allowed to stay in the facility under the stipulation he took anger management courses, saw a behavioral health nurse for counseling and had frequent monitoring by staff. Staff were informed to report immediately if they saw resident (B) anger or showing behavioral outburst as resident (B) would then be discharged from the facility. DEPARTMENT FINDINGS: In accordance with Colorado Revised Statute 25-1-124, the Department conducted an off-site investigation of this reportable event and investigative findings submitted by the agency/facility. This public summary is based on information provided by the agency/facility to the Occurrence Section of the Department and is accurate and complete at this time. Prior to the next onsite investigation of the agency/facility, this occurrence will be reviewed. The occurrence report indicated the agency/facility acted appropriately in response to this occurrence by complying with licensing standards of reporting and investigating this occurrence.

Sent to facility 7/24/2023 · released to the public 7/24/2023.