Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Brookshire Post Acute during CMS and state inspections, most recent first.
A resident with dementia and other comorbidities, seated near a unit door, was struck on the scalp with a plastic coffee mug by another cognitively impaired resident with a documented history of hostile and aggressive behavior after the seated resident extended his foot and tripped the other. The victim sustained a small open scalp wound with bleeding and later reported tenderness, while the assailant reported that events happened quickly and that he believed he was being attacked. Although the facility’s policy required the administrator to determine protective actions and for investigations to be thorough and fully documented, record review showed no new safety interventions for either resident, no documented monitoring of the victim for changes from baseline, no new behavioral interventions for the assailant, and no documented immediate staff education or root cause analysis related to the incident.
A resident who was non-verbal and fully dependent on staff for bathing sustained second degree burns over 8% of the body after being exposed to excessively hot water during a shower. Staff failed to perform timely and complete assessments, did not notify a physician, and did not document findings until the following day. Water temperature checks had not been performed for two months, and subsequent inspection revealed dangerously high water temperatures in the shower and resident rooms. Staff had not received recent education on safe water temperatures, and the facility's policy lacked clear parameters for bathing safety.
The facility did not effectively implement its QAPI program, failing to identify and address unsafe hot water temperatures and to conduct timely assessments and provider notifications for a resident with a new skin condition. The maintenance director did not consistently record water temperature checks, and the QAPI committee did not adequately review water management issues.
The facility failed to store and handle food properly, risking contamination by placing raw chicken next to ready-to-eat foods and not discarding expired items. Additionally, food items were not labeled or dated correctly, indicating lapses in food safety protocols.
The facility failed to promptly resolve grievances voiced by residents regarding staff conduct, including loud behavior and disrespect during the night shift. Despite ongoing complaints in resident council meetings, the facility delayed staff education and did not document grievances timely, leading to continued resident dissatisfaction.
The facility failed to provide personalized activity programs for three residents with severe cognitive impairments, leading to a deficiency in meeting their needs and interests. Observations showed that staff did not engage the residents in activities, and there was no documentation of their participation. The activities department was understaffed, and staff were unaware of the residents' activity preferences.
The facility failed to maintain a safe and sanitary environment, with surveyors observing wall damage and exposed metal in the basement staircase, and multiple issues in the laundry room, including damaged sheetrock, chipped paint, and peeling trim. The maintenance supervisor confirmed these issues had been present for years without work orders, though repairs were planned after a new washing machine delivery.
The facility failed to ensure that four CNAs received necessary training in areas such as abuse, dementia management, and infection control. CNAs hired through a staffing agency did not complete required training before providing care, and two CNAs did not receive 12 hours of annual in-service training. Documentation was lacking, and the staffing agency did not mandate essential training.
A facility failed to obtain informed consent from a resident or their legal representative before administering the antidepressant Sertraline (Zoloft). Despite facility policy requiring informed consent for psychotropic medications, the resident's electronic medical record lacked a signed consent form. The resident, diagnosed with dementia and depression, received the medication as ordered, but the necessary consent documentation was missing. Facility staff acknowledged the oversight during interviews.
A facility failed to provide timely notification to a resident's legal representative about the end of Medicare-covered services. The Notice of Medicare Non-Coverage was issued on the same day the benefits ended, rather than two days in advance, as required. This affected a resident with severe cognitive impairment and multiple diagnoses, leaving insufficient time for the representative to prepare or appeal.
The facility failed to develop comprehensive care plans for two residents, one receiving anticoagulant medication and another with dental needs. The absence of care plans meant staff were not guided to monitor medication effects or address dental and vision needs, despite facility policies requiring such plans. Interviews confirmed the oversight, highlighting a lapse in adhering to care planning protocols.
The facility did not complete annual performance reviews for two CNAs, as required. Despite being hired over a year ago, these CNAs did not receive the necessary evaluations or in-service education. The Regional Director of Clinical Services and the Nursing Home Administrator confirmed the oversight but could not explain the lapse.
A resident with spastic quadriplegic cerebral palsy did not receive necessary dental services as required by facility policy. Despite having a physician's order for dental consults, there was no documentation of dental care since a referral in April 2024. Observations showed a thick white substance on the resident's teeth, indicating a lack of care. Staff interviews revealed a lack of documentation and oversight, with recent changes in processes to address the issue.
A resident with severe cognitive impairments did not receive scheduled showers as per physician orders, resulting in a deficiency in maintaining activities of daily living. The facility's policy required assistance for residents unable to perform ADLs independently, but the resident's electronic medical record showed missed showers without documentation of reasons or re-approach attempts. Staff interviews confirmed the lack of adherence to procedures, and the absence of a care plan for ADLs and bathing was noted.
A facility failed to maintain accurate medical records for a resident's toileting program, using inconsistent symbols without clear definitions. The resident, with severe cognitive impairment, required assistance for toileting every two hours as per a physician's order. However, the order lacked documentation instructions, leading to confusion among staff and making it difficult to verify compliance with the order.
Failure to Protect a Resident From Physical Abuse and to Implement Post‑Incident Safety Measures
Penalty
Summary
The deficiency involves the facility’s failure to protect a resident from physical abuse by another resident and to implement and document measures to ensure safety during and after the incident. Facility policy stated that the administrator was responsible for determining needed protective actions and that investigations must include observation of the alleged victim’s interactions with staff and other residents, with complete documentation of the investigation and corrective actions if allegations were verified. On the date of the incident, video footage showed one resident walking in the secured unit carrying a commercial-grade plastic coffee mug, approaching another resident seated near a door, and entering that resident’s personal space. The seated resident extended his foot and tripped the walking resident, who did not fall but immediately struck the seated resident on the top of the head with the coffee mug before walking away. The victimized resident had vascular dementia, cognitive communication deficit, anxiety disorder, and failure to thrive, and was described as alert and oriented to one to two spheres, able to make some needs known verbally, and residing on a secure unit due to a tendency to leave the facility. Following the altercation, staff observed an open scalp wound approximately 0.4 inches in length with bleeding, and the resident reported that someone had hit him with a cup. Nursing documentation described the injury as minor and noted that the resident was stable after first aid, with no pain reported at one point and later tenderness on palpation. However, review of the electronic medical record revealed no new interventions put in place to protect this resident from the assailant after the incident and no documentation that the resident was monitored for any change from his baseline condition following the event. The resident who struck the other had dementia with behavior disturbance, bipolar disorder, cognitive communication deficit, and an unspecified mood disorder, with documented cognitive impairment and a history of hostile and physically aggressive behavior prior to admission. His care plan identified multiple behavioral symptoms, including verbal aggression, paranoia, irritability, agitation, and a history of psychiatric hospitalizations and homelessness, and included various psychosocial and environmental interventions for agitation or aggression. After the incident, he stated that everything happened fast, that he could not remember what occurred, and that he thought someone was going to attack him. Despite his known behavioral history and the altercation captured on video, record review showed there were no new interventions added to prevent another altercation with the victimized resident. The facility’s own investigation documentation lacked evidence of immediate staff education on safety measures for the involved residents and others while the investigation was ongoing, did not identify a root cause for the incident, and did not document interdisciplinary discussion or monitoring that facility leadership later stated had occurred.
Failure to Monitor and Control Hot Water Temperatures Resulting in Resident Burns
Penalty
Summary
The facility failed to ensure that the environment was free from accident hazards and did not provide adequate supervision to prevent accidents, specifically in relation to monitoring and controlling hot water temperatures in resident care areas. One resident, who was non-verbal, under 65 years old, and completely dependent on staff for bathing due to severe cognitive and physical impairments, sustained second degree burns over 8% of his body during a shower. The incident occurred when a CNA noticed the resident's skin flaking off during bathing in a shower room, and subsequent assessment by nursing staff was delayed and incomplete. The LPN and ADON who initially assessed the resident did not perform a full body assessment, did not notify the physician, and did not document their findings until the following day. A full assessment and recognition of the severity of the injury did not occur until several hours later, after which the resident was transferred to the hospital and diagnosed with significant scald burns. The facility's water temperature monitoring practices were deficient. Documentation revealed that water temperature checks had not been performed or recorded since two months prior to the incident. When an external plumbing vendor inspected the facility after the incident, dangerously high water temperatures were found in the shower room where the injury occurred (146°F) and in several resident rooms (ranging from 118°F to 150°F). Staff interviews indicated that there was no recent education on safe water temperatures or procedures for monitoring and reporting abnormal water temperatures. Some residents and staff reported previous experiences with sudden changes in water temperature during showers, but these concerns were not communicated to management or addressed. The facility's policy on water temperature did not specify safe bathing temperatures or clear parameters for all hot water circuits. Maintenance staff were responsible for weekly checks but failed to document or consistently perform these checks. Staff relied on subjective methods, such as testing water with their hands or observing residents' reactions, rather than using thermometers or objective measures. The lack of effective monitoring, documentation, and staff education directly contributed to the incident in which a vulnerable resident suffered significant harm due to exposure to excessively hot water during a routine care activity.
Removal Plan
- The facility stopped use of showers until all water temperatures could be assessed by maintenance staff.
- The nursing staff completed a skin assessment on all residents to assess further skin concerns. No further concerns were identified.
- An external plumbing company assessed the hot water system. Based on the assessment, it was determined facility water temperatures were out of range. The hot water was immediately shut off, and a work order was placed to correct work.
- The water policy was updated to reflect safe bathing temperatures at or below 100 degrees F with monitoring and signage was updated in the facility showers to reflect water temperature range for showers.
- A paper audit tool was created and the maintenance director (MTD) or designees will complete temperature readings upon return of hot water in all resident room sinks and shower rooms will be assessed for hot water temperatures. Temperature for sinks will be below 120 degrees F and shower rooms will be at or below 100 degrees F.
- The ADON/designee will educate additional staff on safe bathing temperatures to be at or below 100 degrees F, what to do if a resident skin change was identified, timely notification to a provider for follow up, and Technology Enabled Life Safety (TELS) notification system of abnormal water temperatures.
- The MTD installed a wireless water temperature monitor in both showers for staff to identify water temperatures prior to and/or during showering residents.
- Hot water temperatures will be monitored and documented in both shower rooms and four resident rooms twice daily for 30 days; four times per week at various times of the day for 30 days; two times per week at various times of the day for 30 days; and then weekly utilizing the TELS notification system. The NHA will implement a review with the Quality Assurance Performance Improvement (QAPI) committee to review and interpret all data findings. All audit findings will be reviewed at the monthly meeting for at least three months or until the compliance pattern is maintained.
Failure to Identify and Address Unsafe Water Temperatures and Resident Safety Concerns
Penalty
Summary
The facility failed to implement an effective Quality Assurance and Performance Improvement (QAPI) program to identify and address compliance concerns, specifically related to resident safety and accident prevention. The QAPI committee did not identify or address issues with hot water temperatures exceeding safe ranges, which rose to the level of immediate jeopardy. The facility also failed to conduct and document a thorough assessment of a resident with a new skin condition and did not notify the resident's provider in a timely manner. These deficiencies were identified through record review and staff interviews. Interviews revealed that the maintenance director, who was new to the facility, was responsible for monitoring water temperatures but did not record them as required. The facility's process involved staff entering work orders into the TELS system for maintenance, and a paper audit tool was created to monitor water temperatures. However, the audit tool was not consistently used, and temperature monitoring records were not properly maintained or reviewed by the nursing home administrator. The QAPI committee met monthly, but water management issues were not consistently included in meeting minutes or reviewed as part of the QAPI process.
Food Storage and Labeling Deficiencies
Penalty
Summary
The facility failed to maintain proper food storage and handling practices in the kitchen, leading to potential food contamination. Observations revealed that raw chicken thighs were stored improperly in the walk-in refrigerator, placed next to ready-to-eat foods such as milk cartons and above fruits and vegetables, which could lead to cross-contamination. The dietary manager acknowledged the improper storage and moved the chicken thighs to a different location, but the initial placement posed a risk of contamination. Additionally, the nursing home administrator confirmed that the raw chicken should have been stored separately and on a metal tray to prevent any leakage from contaminating other foods. The facility also failed to discard expired food and ensure proper labeling and dating of food items. An observation noted that a container of beef gravy was not discarded by its use-by date, and the dietary manager confirmed the labeling system was not followed correctly. Furthermore, individual containers of pureed food were found without labels or dates, which the dietary manager admitted should have been labeled with the name, opening date, and use-by date. The nursing home administrator was unaware of the labeling system, indicating a lack of oversight and adherence to food safety protocols.
Failure to Address Resident Grievances Promptly
Penalty
Summary
The facility failed to ensure a prompt resolution for grievances voiced by residents during resident council meetings. Residents repeatedly expressed concerns about staff conduct, including loud behavior, slamming doors, and disrespectful interactions, particularly during the night shift. Despite these ongoing complaints, the facility did not provide timely or effective resolutions, as evidenced by the lack of documented grievance forms for several months and delayed staff education. During a group interview, residents reported that night shift staff were loud, slammed doors, and were disrespectful, with some staff members yelling and using their phones while on duty. These issues were consistently raised in resident council meetings, with concerns about call lights being ignored, staff rudeness, and arguments in the dining room. Although some problem employees were replaced, similar concerns persisted, indicating that the facility's actions were insufficient to address the residents' grievances. The facility's policies required prompt efforts to resolve grievances, but there was a lack of documentation and timely action. For instance, a group grievance filed in December highlighted ongoing complaints, yet the proposed resolution, including staff education, was not scheduled until several weeks later. This delay in addressing the residents' concerns contributed to the deficiency, as residents continued to experience issues with staff conduct during the survey.
Failure to Provide Personalized Activity Programs for Residents
Penalty
Summary
The facility failed to provide a personalized activity program for three residents, leading to a deficiency in meeting their needs and interests. Resident #32, an 84-year-old with severe cognitive impairment, was observed wandering the secured unit without engagement in activities. Despite her care plan indicating a need for therapeutic visits and cultural programming, there was no documentation of her participation in any activities. Observations showed that staff did not attempt to redirect or engage her in activities, and her representative expressed concerns about her lack of participation. Resident #60, a 70-year-old with severe cognitive impairment, was also not engaged in activities. Observations revealed that staff did not attempt to involve her in group activities, and she was left sitting in a chair without engagement. Her care plan indicated a need for activities consistent with her abilities and interests, such as aroma therapy and music, but there was no documentation of her participation in any activities. Resident #50, an 81-year-old with Alzheimer's disease, was similarly not engaged in activities. His care plan highlighted his interest in arts and crafts and the need for assistance in joining group activities. However, there was no documentation of his participation in any activities. Interviews with staff revealed a lack of awareness of the residents' activity preferences, and the activities department was understaffed, with the interim activities director unable to provide accurate documentation of the activities provided for these residents.
Environmental Deficiencies in Laundry Room and Stairwell
Penalty
Summary
The facility failed to maintain a safe, functional, sanitary, and comfortable environment for residents, staff, and the public, particularly in the laundry room. During an environmental tour, surveyors observed several issues, including wall damage at the bottom of the basement staircase with exposed metal and a screw, which were sharp to the touch. In the laundry room, there was significant damage to the sheetrock on the ceiling above and in front of the washing machine, chipped paint along the upper wall, a hole in the wall next to the laundry folding table, and peeling plastic floor trim. The maintenance supervisor confirmed these observations during an interview, acknowledging that the maintenance concerns had been present since he started in the position a few years ago. He noted that there were no work orders for these issues, but repairs were planned after the delivery of a new washing machine. The supervisor mentioned a signed proposal for repairs, which included tearing out the bottom three stairs and repairing the hole and entryway, but he was unsure of the date when these repairs would occur.
Deficiency in Staff Training Program
Penalty
Summary
The facility failed to develop, implement, and maintain an effective training program for its staff, specifically for four of five certified nurse aides (CNAs) reviewed. CNAs #5 and #6, who were hired through a staffing agency, did not receive training in critical areas such as abuse, dementia management, behavioral health management, infection control, communication, quality assurance and quality improvement (QAPI), compliance and ethics, and resident rights before providing direct care to residents. The facility was unable to provide documentation that these CNAs completed the necessary training prior to working independently in the secure unit. Additionally, CNAs #3 and #4 did not receive the required 12 hours of annual in-service training. The facility could not provide documentation to confirm that these CNAs had completed the necessary training in the past 12 months. Interviews with the Regional Director of Clinical Services (RDCS) and the Director of Nursing (DON) revealed that the staffing agency did not require the CNAs to complete the essential training, and the facility's monthly staff meetings did not ensure compliance with the training requirements.
Failure to Obtain Informed Consent for Antidepressant Medication
Penalty
Summary
The facility failed to ensure that a resident was fully informed and consented to the administration of an antidepressant medication, specifically Sertraline (Zoloft). The facility's policy required that informed consent be obtained from the resident or their legal representative before administering psychotropic medications. However, the electronic medical record for the resident did not contain a signed consent form detailing the risks and benefits of the medication prior to its administration. This oversight occurred despite the facility's policy and the requirement for a licensed nurse to verify that informed consent had been obtained. The resident in question, who was over 65 years old and had diagnoses including dementia, Alzheimer's disease, and depression, was administered the antidepressant medication as per the physician's orders. The medication administration records confirmed that the medication was given as ordered, but the necessary informed consent was not documented. Interviews with the nursing home administrator, director of nursing, and regional directors of clinical services confirmed the absence of consent and acknowledged that it should have been obtained to ensure the resident or their representative understood the diagnosis, side effects, and expected outcomes of the medication.
Failure to Provide Timely Medicare Non-Coverage Notice
Penalty
Summary
The facility failed to provide timely notification to a resident's legal representative regarding the end of Medicare-covered services. Specifically, the Notice of Medicare Non-Coverage (NOMNC) was issued on the same day that the resident's Medicare Part A benefits ended, rather than the required two days in advance. This lack of timely notification did not allow the resident's representative sufficient time to prepare for the discontinuation of services or to request an immediate appeal. Resident #60, who was over 65 years old and had severe cognitive impairment, was affected by this deficiency. The resident had a history of cerebral infarction, metabolic encephalopathy, anxiety, and major depression. The facility's policy required that residents or their representatives be informed at least two days before the end of Medicare Part A skilled services, but this protocol was not followed in this case. Interviews with facility staff, including the nursing home administrator and director of rehabilitation, confirmed the oversight and acknowledged the failure to adhere to the notification policy.
Failure to Develop Comprehensive Care Plans for Residents
Penalty
Summary
The facility failed to develop comprehensive care plans for two residents, which led to deficiencies in addressing their specific medical needs. Resident #46, who was cognitively intact and receiving anticoagulant medication, did not have a care plan in place to monitor the effects and potential side effects of the medication. Despite the resident being able to identify the medication and report no excessive bruising, the absence of a care plan meant that staff were not formally guided to monitor for bruising, bleeding, or therapeutic effects. Interviews with the regional director of clinical services and the minimum data set coordinator confirmed that a care plan should have been developed within 24 hours of the first administration of the anticoagulant. Resident #9, who was also cognitively intact, had dental needs that were not addressed in a comprehensive care plan. Although the resident had been seen by a dentist for a comprehensive exam and x-rays, the care plan did not include person-centered interventions for dental and vision needs. The resident expressed dissatisfaction with not being included in a recent dental visit list, and staff interviews revealed that the social services director was responsible for dental services but had not developed a care plan for these needs. The director of nursing and regional director of clinical services acknowledged the importance of care planning for dental services to ensure staff were aware of the resident's use of dentures and glasses. The facility's policies required comprehensive, person-centered care plans to be developed and implemented for each resident, including measurable objectives and timeframes. These care plans were to be reviewed and updated regularly, especially when there were changes in the resident's condition. However, the facility did not adhere to these policies for the two residents in question, resulting in a failure to meet their highest practicable physical, mental, and psychosocial well-being.
Failure to Conduct Annual Performance Reviews for CNAs
Penalty
Summary
The facility failed to conduct a performance review for two certified nurse aides (CNAs) within the required 12-month period, as mandated by regulations. Specifically, CNA #3, hired on February 1, 2023, and CNA #4, hired on December 22, 2023, did not have documented performance reviews completed within the past year. This deficiency was identified through record reviews and staff interviews. The Regional Director of Clinical Services acknowledged that the annual performance reviews and subsequent in-service education were not completed for these CNAs, but could not provide a reason for this oversight. Similarly, the Nursing Home Administrator confirmed the lack of performance reviews for CNA #3 and CNA #4, also unable to explain why the training had not been conducted.
Failure to Provide Dental Services to Resident
Penalty
Summary
The facility failed to assist a resident in obtaining necessary dental services, as required by their policy. The resident, who is under 65 years old and has spastic quadriplegic cerebral palsy, was dependent on staff for all care, including oral care. Despite having a physician's order for dental consults and follow-up, there was no documentation of dental services being offered or provided to the resident since a referral was made in April 2024. Observations revealed a thick layer of white substance along the resident's upper teeth and gum line, indicating a lack of dental care. The facility's policy mandates that dental needs be identified through assessments and addressed in the resident's care plan, with documentation of all actions related to dental services. However, the resident's electronic medical record lacked a signed consent form for dental services, and there was no follow-up documentation after the initial referral. Interviews with staff revealed that the social services director was unaware of the lack of documentation and had recently implemented a new process to ensure all residents receive necessary ancillary services, including dental care. Staff interviews indicated that the resident's oral care was being performed daily with oral swabs, but there was no recent dental evaluation or treatment. The regional director of clinical services acknowledged that the resident's condition might have led to oversight in dental care, especially since the resident was on enteral feedings. The facility had undergone changes in ownership, which may have contributed to the oversight, and a new system was being put in place to track ancillary visits more effectively.
Failure to Provide Scheduled Showers for Resident
Penalty
Summary
The facility failed to ensure that a resident received assistance with showers in accordance with physician orders, which is a deficiency in maintaining or improving the resident's ability to perform activities of daily living (ADLs). The facility's policy required that residents who could not independently perform ADLs receive necessary services to maintain personal hygiene. However, the facility did not adhere to this policy for a resident with severe cognitive impairments, who required setup or clean-up assistance for showers. The resident, who had diagnoses including vascular dementia and major depression disorder, was supposed to receive showers on specific days as per physician orders. However, the electronic medical record (EMR) showed inconsistencies in shower documentation, with several missed opportunities for showers and no documentation explaining the missed showers or refusals. The care plan for the resident did not include ADLs related to showers, and there was no documentation of re-approaching the resident after refusals. Interviews with facility staff, including the nursing home administrator, director of nursing, and certified nurse aides, revealed that the resident did not receive all scheduled showers. Staff acknowledged that if a resident refused a shower, they should be re-approached, and refusals should be documented in a progress note. However, this procedure was not followed, and the lack of a care plan for ADLs and bathing was noted as a deficiency by the regional director of clinical services.
Inconsistent Documentation of Resident's Toileting Program
Penalty
Summary
The facility failed to ensure that the medical record for a resident was complete and accurate, specifically in documenting the resident's toileting in an understandable manner. The facility's policy required that any notable changes in a resident's condition be documented in a format that facilitates communication between the interdisciplinary team. However, the documentation for the resident's toileting program was inconsistent and unclear, using various symbols without a clear definition or standardization. The resident in question was over 65 years old, had severe cognitive impairment, and required assistance for toileting. The resident had a physician's order for prompted toileting every two hours, which was documented in the treatment administration record (TAR). However, the order did not specify how staff should document the toileting, leading to the use of various symbols such as N, Y, NA, +, -, 0, W, WB, D, B, R, and P, many of which were not clearly defined or understood by the staff. Interviews with the nursing home administrator, director of nursing, and regional directors of clinical services revealed that they agreed on the inconsistency of the documentation methods. The director of nursing admitted to not knowing the meaning of several symbols used by the staff and acknowledged that the physician's order should have included instructions on how to document the resident's toileting. This lack of clarity and standardization in documentation made it difficult to determine if the resident received toileting according to the physician's order.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Denver
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Amberwood Post Acute | 0 mi | ★★★★★ | 4 | 0 |
| Rowan Community, Inc | 0 mi | ★★★★★ | 3 | 0 |
| South Valley Post Acute Rehabilitation | 0.6 mi | ★★★★★ | 17 | 0 |
| Holly Heights Care And Rehabilitation | 0.6 mi | ★★★★★ | 39 | 0 |
| Highline Post Acute | 0.6 mi | ★★★★★ | 1 | 1 |
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