Benefis Senior Services Grandview: Infection Control Failures - MT
The device never got wiped down. Not before the first resident. Not between residents. Not after.
Federal inspectors observed the sequence in real time on the morning of August 12. At 7:37 a.m., the staff member, identified in the report as Staff Member C, retrieved the glucometer from a locked room near the nurses' offices. A minute later, she was in Resident 3's room, pulling on gloves she had not washed or sanitized her hands before donning. She pricked the resident's finger, got the reading, then set the device on a supply cart in the bathroom. She pulled off her gloves and washed her hands. Then she walked back to her medication cart, set the glucometer on top of it, and moved on.
She did not clean the device.
At 7:45 a.m., she entered Resident 1's room and used the same glucometer to check that resident's blood sugar. Afterward, she returned to the supply room, set the monitor back on its charger, and left.
The glucometer had touched surfaces in two residents' rooms, rested on a bathroom cart, sat on a medication cart in the hallway, and gone back into storage. It had not been disinfected at any point.
When inspectors interviewed Staff Member C less than two hours later, she did not dispute any of it. She said the glucometer was supposed to be cleaned with purple-top Sani wipes between every resident use and again before being returned to the charger. She said she had not done that. She also confirmed that she knew hand hygiene was required before gloving, and acknowledged she had skipped that step before entering Resident 3's room.
The concern with shared blood glucose devices is not theoretical. The monitors make direct contact with blood. A finger prick draws a small amount, and traces can remain on the device's surface or casing even when the lancet is changed. Bloodborne pathogens, including hepatitis B, can survive on surfaces for days. That is why disinfection between every patient use is a standard precaution, not an optional one.
Staff Member B, a supervisor or colleague interviewed separately at 9:56 a.m., confirmed the same expectations: sanitize the glucometer between residents, sanitize it again before returning it to the charger, perform hand hygiene before gloving and after degloving. The facility's own Point of Care Testing Safety Manual, last revised in February 2024, states the same requirement plainly: portable handheld testing devices must be disinfected after each patient use.
The policy existed. The staff member knew the policy. She did not follow it.
Inspectors classified the violation at the level of minimal harm or potential for actual harm, meaning no resident was documented as having suffered an injury as a direct result. The complaint-driven inspection found the deficiencies affected two sampled residents.
What the inspection cannot resolve is how many mornings looked like this one before an inspector happened to be standing there at 7:37 a.m.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Benefis Senior Services - Grandview from 2025-08-12 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
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Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: November 3, 2026 · Our methodology
BENEFIS SENIOR SERVICES - GRANDVIEW in GREAT FALLS, MT was cited for violations during a health inspection on August 12, 2025.
The device never got wiped down.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.