Eben Ezer Lutheran Care Center
Brush, Morgan County, Colorado · CCN 065163 · Non-profit (Corporation) · not part of a chain
CMS rates Eben Ezer Lutheran Care Center 2 of 5 overall as of August 2026. 125 certified beds, 82 residents a day on average. 13 citations on record from the current inspection cycles, 4 involving actual harm; no fines on record.
On record
- Abuse icon. CMS marks this facility for a citation of abuse that led to harm, or a repeated potential for it, within the recent inspection cycles.
CMS’s ratings
The Five-Star Quality Rating System, as CMS publishes it. Where CMS gives no rating, the reason CMS gives is printed instead.
| Overall | ★★☆☆☆ 2 of 5 |
|---|---|
| Health inspections | ★★☆☆☆ 2 of 5 |
| Staffing | ★★★★☆ 4 of 5 |
| Quality measures | ★★★☆☆ 3 of 5 |
| Quality: long-stay / short-stay | 3 / 3 of 5 |
Staffing
| Total nurse staffing | 4.2161 hours per resident per day |
|---|---|
| Registered nurses | 0.56191 hours per resident per day |
| Weekend total | 3.82668 hours per resident per day |
| Nursing staff turnover | 40.4% (registered nurses 43.8%) |
| Administrators who left | 0 |
Citations from health inspections
Each is a finding by a state surveyor on the date shown, in CMS’s words. The severity is CMS’s scope-and-severity grid, spelled out: harm on the left, how widespread on the right.
| Survey | Finding | Severity | Status |
|---|---|---|---|
| 2025-12-03 complaint survey |
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0600 |
E No actual harm, with potential for more than minimal harm; pattern | Deficient, Provider has date of correction 2025-12-30 |
| 2024-08-15 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · tag F0812 |
E No actual harm, with potential for more than minimal harm; pattern | Deficient, Provider has date of correction 2024-09-13 |
| 2024-08-15 | Provide and implement an infection prevention and control program. Infection Control Deficiencies · tag F0880 |
E No actual harm, with potential for more than minimal harm; pattern | Deficient, Provider has date of correction 2024-09-05 |
| 2024-08-15 | Ensure services provided by the nursing facility meet professional standards of quality. Resident Assessment and Care Planning Deficiencies · tag F0658 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-13 |
| 2024-08-15 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · tag F0689 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-07 |
| 2024-08-15 | Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. Quality of Life and Care Deficiencies · tag F0700 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-13 |
| 2024-08-15 | Observe each nurse aide's job performance and give regular training. Nursing and Physician Services Deficiencies · tag F0730 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2024-09-06 |
| 2023-03-02 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0600 |
G Actual harm that is not immediate jeopardy; isolated | Past Non-Compliance 2023-01-14 |
| 2023-03-02 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · tag F0689 |
G Actual harm that is not immediate jeopardy; isolated | Deficient, Provider has date of correction 2023-03-30 |
| 2023-03-02 | 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. Pharmacy Service Deficiencies · tag F0761 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2023-03-30 |
| 2021-11-18 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · tag F0689 |
G Actual harm that is not immediate jeopardy; isolated | Deficient, Provider has date of correction 2021-12-17 |
| 2021-11-18 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Pharmacy Service Deficiencies · tag F0758 |
G Actual harm that is not immediate jeopardy; isolated | Deficient, Provider has date of correction 2021-12-17 |
| 2021-11-18 | Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia. Quality of Life and Care Deficiencies · tag F0744 |
D No actual harm, with potential for more than minimal harm; isolated | Deficient, Provider has date of correction 2021-12-17 |
Fines and payment denials
No fines or payment denials on record since 2023.
Who owns and runs it
Every owner, officer and manager CMS lists, as filed. These are the names in CMS’s ownership record; anyone named in the ownership record can ask about it on the about page.
| Name | Role | Share | Since |
|---|---|---|---|
| Eben Ezer Lutheran Care Center Organization | operational/managerial control | — | 1966-01-01 |
| Bass, Sonyou Individual | corporate director | — | 2024-07-01 |
| Chapin, Robert Individual | corporate director | — | 2024-07-01 |
| Frasier, Mark Individual | corporate director | — | 2024-07-01 |
| Lee, Michael Individual | corporate director | — | 2024-07-01 |
| Lefever, Travis Individual | corporate director | — | 2024-07-01 |
| Schaefer, Roger Individual | corporate director | — | 2024-07-01 |
| Tekroney, Michael Individual | corporate director | — | 2024-07-01 |
| Thistle, Jennifer Individual | corporate director | — | 2024-07-01 |
| Vannoy, Douglas Individual | corporate director | — | 2024-07-01 |
| Hergenreter, Shelly Individual | corporate officer | — | 2005-07-06 |
| Mason, Leslie Individual | corporate officer | — | 2011-06-03 |
| Bass, Sonyou Individual | trustee of the snf | — | 2007-09-01 |
| Chapin, Robert Individual | trustee of the snf | — | 2009-01-01 |
| Frasier, Mark Individual | trustee of the snf | — | 2019-07-01 |
| Lee, Michael Individual | trustee of the snf | — | 2022-07-01 |
| Lefever, Travis Individual | trustee of the snf | — | 2024-07-01 |
| Schaefer, Roger Individual | trustee of the snf | — | 2009-07-01 |
| Tekroney, Michael Individual | trustee of the snf | — | 2024-07-01 |
| Thistle, Jennifer Individual | trustee of the snf | — | 2022-11-01 |
| Vannoy, Douglas Individual | trustee of the snf | — | 2021-07-01 |
| Hergenreter, Shelly Individual | w-2 managing employee | — | 2007-09-01 |
| Mason, Leslie Individual | w-2 managing employee | — | 2011-06-03 |
What changed
Nothing has changed in this record since it was first loaded. The next CMS refresh is the next chance.
Tell me when this record changes
One email when the monthly CMS refresh brings a new citation, a fine or payment denial, a rating change, a flag, or a change of ownership for Eben Ezer Lutheran Care Center.
Source: Centers for Medicare & Medicaid Services, Provider Data Catalog (public domain), files dated 2026-08-01. Ratings are CMS’s; citations are state surveyors’ findings; nothing here is estimated or a recommendation. Every nursing home in Morgan County.