Below average — CMS composite of the measures below.
A standard survey is most likely before around September 2026
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 Colby Operator, Llc during CMS and state inspections, most recent first.
A CNA was hired and allowed to provide direct resident care for several days without verification of a current, active license. Staff interviews revealed that required license checks were not completed prior to employment, with administrative staff each assuming the other had performed the verification.
A resident with severe cognitive impairment and multiple health conditions was left uncovered in bed wearing only an incontinence brief while staff waited for supplies to perform catheter care. The resident expressed discomfort and requested to be covered, but staff did not do so until care was completed, resulting in a failure to maintain the resident's dignity.
A resident with multiple mental health diagnoses and impaired cognition did not have a comprehensive ADL care plan with measurable interventions, despite documented needs and facility policy. The resident missed several showers over multiple months, was observed unshaven and disheveled, and administrative staff confirmed the lack of an ADL care plan.
A resident with severe cognitive impairment and multiple mental health diagnoses did not receive consistent bathing and grooming care, with extended periods without showers and repeated observations of poor hygiene. Staff reported attempts to reapproach after refusals, but the care plan lacked specific ADL interventions and documentation was inconsistent, resulting in unmet hygiene needs.
A resident with diabetes and impaired cognition received insulin on multiple occasions when their blood glucose was below the physician-ordered threshold, contrary to the care plan and facility policy. Nursing staff and administration confirmed that staff were expected to follow physician orders, but documentation showed repeated failures to hold insulin as directed.
A resident with multiple medical conditions developed facility-acquired Stage 2 pressure ulcers that worsened due to inadequate interventions and lack of regular assessments. Despite being on a repositioning program and having pressure-reducing devices, the resident often sat in a recliner, refusing to lie in bed. The facility's failure to implement timely interventions led to the development of an unstageable pressure ulcer and other severe wounds, resulting in the resident's transfer to a hospital.
Failure to Verify CNA License Prior to Employment
Penalty
Summary
The facility failed to verify that a Certified Nurse Aide (CNA) had a current and active license prior to employment and assignment to resident care duties. Review of the Kansas Department for Aging and Disability Services (KDADS) nurse aide registry showed that the CNA's license was expired at the time of hire. Despite this, the CNA was hired and allowed to work on the floor providing direct care to residents for seven days with an expired license. Multiple staff interviews confirmed that the required license verification was not completed before the CNA began working, with administrative staff each believing the other had conducted the necessary checks. The facility's own policy required that nursing personnel present verification of their license or certification to the DON before or upon employment and prohibited them from performing direct resident care services until all licensing and background checks were completed. However, this policy was not followed in the case of the CNA, resulting in the individual providing resident care without a valid license for an extended period.
Resident Left Uncovered During Care, Compromising Dignity
Penalty
Summary
A deficiency occurred when a resident with severely impaired cognition and multiple medical conditions, including urinary retention, diabetes mellitus, hypertension, anxiety, benign prostatic hyperplasia, and peripheral vascular disease, was left uncovered in bed wearing only an incontinence brief. During morning care, two CNAs were providing personal hygiene and catheter care. After removing the resident's blanket and incontinence brief, one CNA realized there were no wipes available for catheter care and asked the other CNA to retrieve them. While waiting for the wipes, the resident remained uncovered and expressed discomfort, stating he was freezing and asking to be covered. The CNA did not cover the resident and waited by the bedside until the wipes were brought back, after which care continued and the resident was eventually covered. The resident's care plan indicated a need for assistance with bed mobility, personal hygiene, and catheter care, and the facility's policy required residents to be treated with dignity and respect. The failure to cover the resident while no care was being provided resulted in a lack of dignity and respect for the resident, as observed and documented by surveyors.
Failure to Develop Comprehensive ADL Care Plan for Resident with Cognitive Impairment
Penalty
Summary
A deficiency occurred when the facility failed to develop a comprehensive, resident-centered care plan with measurable objectives and interventions for Activities of Daily Living (ADL) for one resident. The resident had multiple diagnoses, including dementia, bipolar disorder, schizoaffective disorder, and major depressive disorder, and was documented as having moderately to severely impaired cognition over time. Despite assessments indicating a risk for alterations in ADL function and the need for interventions, the resident's care plan did not include an ADL care area or specific interventions. Documentation showed that the resident did not receive showers for extended periods, with records indicating missed showers over several days in April, May, and June, and only two documented refusals. Observations revealed the resident was repeatedly unshaven and had disheveled hair. Administrative staff confirmed the absence of an ADL care plan for the resident, despite facility policy requiring individualized, comprehensive care plans to address each resident's needs.
Failure to Provide Consistent Bathing and Grooming for Resident with Cognitive Impairment
Penalty
Summary
A deficiency occurred when the facility failed to provide consistent bathing and grooming care for a resident with multiple mental health diagnoses, including dementia, bipolar disorder, schizoaffective disorder, and major depressive disorder. The resident's medical records indicated a progression from moderately to severely impaired cognition over time, with documented needs for assistance or supervision with activities of daily living (ADLs) such as oral hygiene, dressing, and personal hygiene. Despite these needs, the resident did not receive showers for extended periods, including gaps of 12, 17, and 9 consecutive days, with only two documented refusals during these times. Observations showed the resident was repeatedly unshaven and had disheveled hair on multiple occasions. Staff interviews revealed that when the resident refused showers, staff would attempt to reapproach or offer alternatives, and were instructed to notify nursing staff and document refusals. However, the care plan lacked specific interventions for ADLs or for managing refusals of care. The facility's policy required documentation of refusals, education about risks and benefits, and substitute interventions, but these were not consistently documented or implemented. This failure to provide and document necessary care and services for ADLs resulted in the resident not receiving adequate hygiene and grooming support.
Insulin Administered Outside Physician Parameters
Penalty
Summary
Staff failed to follow a physician's order regarding the administration of insulin for a resident with multiple diagnoses, including diabetes mellitus, hypertension, and impaired cognition. The physician's order specified that insulin glargine should be held if the resident's blood glucose was less than 120 mg/dl. Despite this, the Medication Administration Record (MAR) documented multiple instances in April and May where insulin was administered when the resident's blood glucose was below the ordered threshold. These instances were confirmed by review of the MAR and by a licensed nurse who acknowledged that insulin had been given outside of the prescribed parameters. The resident's care plan directed staff to monitor blood glucose as ordered, administer diabetes medication as directed by the physician, and monitor for side effects and effectiveness. Facility policy required staff to verify orders, document results, and follow appropriate nursing interventions based on blood sugar results. Interviews with nursing staff and administration confirmed that staff were expected to follow physician orders, but the records showed repeated failures to do so, resulting in the administration of unnecessary medication.
Failure to Prevent and Treat Pressure Ulcers
Penalty
Summary
The facility failed to provide appropriate interventions to prevent the development and worsening of pressure ulcers for a resident, identified as R1. Initially, R1 developed two facility-acquired Stage 2 pressure ulcers on her buttocks, which were not adequately addressed with preventative measures such as offloading or repositioning until several months later. The facility also failed to conduct weekly assessments of R1's pressure wounds to evaluate the effectiveness of treatments. As a result, R1's condition deteriorated, leading to the development of an unstageable pressure ulcer on her coccyx, Stage 3 pressure ulcers on both buttocks, and deep tissue injuries on her right heel and left trochanter. R1's medical history included conditions such as fibromyalgia, morbid obesity, diabetes mellitus, and chronic obstructive pulmonary disease, which increased her risk for pressure ulcer development. Despite being on a turning/repositioning program and having pressure-reducing devices for her chair and bed, R1 was often found sitting in her recliner, refusing to lie in bed due to discomfort. The facility's care plan noted R1's potential for altered skin integrity and directed staff to follow protocols for skin breakdown prevention and treatment. However, the facility did not consistently implement these interventions, and R1's wounds were not measured or documented regularly. Throughout the report, it is evident that the facility's inaction and lack of timely intervention contributed to the worsening of R1's condition. Despite recommendations from wound care specialists and the implementation of some interventions, such as the use of Triad paste and pressure-relieving cushions, the facility did not adequately address R1's needs. This failure placed R1 in immediate jeopardy, as evidenced by her transfer to an acute care hospital where her pressure ulcers were further assessed and treated.
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Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
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What surveyors actually found near you
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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.
Illustrative
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Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Colby
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Citizens Medical Center Ltcu | 0.2 mi | ★★★★★ | 0 | 0 |
| Logan County Senior Living Inc | 20.2 mi | ★★★★★ | 7 | 0 |
| Good Samaritan Society - Atwood | 30 mi | ★★★★★ | 0 | 0 |
| Topside Manor Inc | 35.8 mi | ★★★★★ | 0 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.