Billings Rehab and Nursing: Catheter Care Failures - MT
The deficiency was one of seven cited during the August 14 inspection. Inspectors assigned it a scope and severity level of D, meaning the problem was isolated and no actual harm was documented at the time, but that residents faced potential for more than minimal harm.
That last part matters. Urinary tract infections are not a minor inconvenience in a nursing home population. In older adults, particularly those who are frail, have dementia, or are already managing multiple health conditions, a UTI can spiral quickly. Confusion, falls, sepsis. The infection that begins with inadequate catheter hygiene can end with a hospitalization, or worse.
Catheters are among the highest-risk interventions in long-term care. A tube inserted into the bladder and left in place creates a direct pathway for bacteria. Proper care, consistent and documented, is what stands between a resident and that outcome. Inspectors found that standard was not being met here.
The facility's record coming out of this inspection is not a clean one. Seven deficiencies in a single visit is a significant number for a complaint inspection, which typically targets specific concerns rather than sweeping the full range of care practices the way a standard annual survey does. Complaint inspections are triggered, meaning someone, a resident, a family member, a staff member, raised a concern serious enough to send inspectors through the door.
The catheter care citation fell under the Quality of Life and Care category, the broad federal grouping that covers the hands-on, daily work of keeping residents safe and healthy. It is not a paperwork problem or a policy gap on paper. It is a finding about what was or was not being done for residents who depend on staff for some of the most basic and intimate aspects of their physical care.
Incontinence and catheter dependence are common in nursing home populations. Residents in this situation have no ability to manage their own care. They cannot reposition a catheter that has been improperly secured. They cannot ensure their own hygiene between staff visits. They rely entirely on the facility to get it right, every shift, every day.
Billings Rehabilitation and Nursing reported a correction date of September 19, 2025, five weeks after the inspection. CMS records list the deficiency as corrected, meaning the facility submitted a plan of correction and a date, and inspectors have not yet returned to verify the change on the ground.
A plan of correction is not the same as corrected care. It is a document. What happens in the room, with the resident, on the overnight shift when staffing is thinnest, is a different question.
The facility has not responded publicly to the inspection findings.
What the record shows is a nursing home where, on the day federal inspectors walked in, residents with catheters were not receiving the standard of care that prevents infection, and where that same facility had accumulated seven separate deficiencies by the time those inspectors left.
The residents at the center of that catheter care finding are not named in the public record. They are described only by their condition and their vulnerability. Someone, likely more than one person, was lying in a bed or sitting in a chair in that facility, dependent on a catheter, while the care that should have been surrounding that catheter was falling short.
That is where this inspection ends. Not with a corrective action plan dated five weeks later, and not with a regulatory checkbox. With a person in a room, and a gap between what they needed and what they got.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Billings Rehabilitation and Nursing LLC from 2025-08-14 including all violations, facility responses, and corrective action plans.
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.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: October 20, 2026 · Our methodology
BILLINGS REHABILITATION AND NURSING LLC in BILLINGS, MT was cited for violations during a health inspection on August 14, 2025.
The deficiency was one of seven cited during the August 14 inspection.
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.