Yellowstone River Nursing And Rehabilitation

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

nursing, and mental and psychosocial needs.1. The care planning process will include an assessment of

the resident's strengths and needs, and will incorporate the resident's personal and cultural preferences in developing goals of care. 3. The comprehensive care plan will describe, at a minimum, the following:a. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being.b. Any services that would otherwise be furnished, but are not provided due to

the resident's exercise of his or her right to refuse treatment. 4. The comprehensive care plan will be prepared by an interdisciplinary team, that includes, but is not limited to:a. The attending physician or non-physician practitioner.b. A registered nurse with responsibility for the resident.f. Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Yellowstone River Nursing and Rehabilitation

2115 Central Ave Billings, MT 59102

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

assess resident #4's cardiopulmonary, GI/GU, musculoskeletal, neurologic, and psychiatric systems on 9/9/25. This did not allow resident 4's complete assessment for ongoing care and treatment. Resident #4 did not receive any other visits from providers, to include a full examination, history and physical, and recommendations while in the facility.Review of a facility policy titled, Comprehensive Care Plans, implemented 7/1/25, showed: . 7. The physician, other practitioner, or professional will inform the resident. of the risks and benefits of proposed care, of treatment, and treatment alternatives/options. The facility will attempt alternate methods for refusal of treatment and services and document such attempts in the clinical record, including discussions with the resident.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Yellowstone River Nursing and Rehabilitation

2115 Central Ave Billings, MT 59102

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

a.m., showed, Resident came out of her room in the early am and went to the Charge nurse stating, I do not want her (me) giving me my meds after the way I was treated yesterday. The resident stated to the charge nurse that she called a female Dr. at a hospital and the Dr. told her she was malnourished and needed Boost maximum protein, which the facility did not have, so the nurse attempted to provide Boost glucose control. The resident requested to speak to the Administrator who was not at the facility at the time, and the nurse documented, Resident will not listen to reason and she will fire you. Review of a facility document, titled Behavioral Health Services, implemented 6/15/25, showed:.It is the policy of this facility to ensure all residents receive necessary behavioral health services to assist them in reaching and maintaining their highest level of mental and psychosocial functioning .4. The facility will ensure that a resident who, upon admission was not assessed or diagnosed with a mental or psychosocial adjustment difficulty or a documented history of trauma and/or PTSD does not develop patterns of decreased social interaction and/or increased withdrawn, angry, or depressive behaviors while residing in the facility. The policy showed staff were to monitor the resident, evaluate for distress or changes, share concerns with the IDT to determine causes for behaviors or changes, accurately document concerns and triggers, and ensure appropriate follow-up assessments are completed as needed. Section 12 of the policy showed the Social Services Director shall serve as the facility's contact person for questions regarding behavioral services provided by the facility and outside sources such as physicians, psychiatrists, or neurologists.Review of staff member F's job description showed duties were to include the ongoing assessment of the social service needs of participants and/or their family caregiver and development of the social service portion of

the participant care plan within five days of admission and evaluation of same with progress notes no later than 14 days after the date of enrollment, to provide individual or group counseling to participants as needed, to assess participants for signs of mental illness and/or dementia and make appropriate referrals, to arrange and coordinate support services which were not available at the facility, to assist program staff in adapting to changes in a resident's behavior and provide or arrange for individual, group or family psychotherapy for participants with significant psychological needs. The document showed staff member F signed the job description on 8/18/25. A request was made on 11/19/25 at 10:35 a.m., for referrals for behavioral health services for resident #4. No documentation was provided prior to the end of the survey.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Yellowstone River Nursing and Rehabilitation

2115 Central Ave Billings, MT 59102

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

appeared to be carried over from prior entries added to the Progress Notes. A review of resident #4's care plan showed she had several issues related to mood/behavior, including:-The resident was taking a psychotropic medication for depression, initiated 9/8/25. There were no interventions for staff to utilize to assist the resident with the depression, other than monitoring the medications and side effects, and observing for changes.-The resident had paranoid tendencies, thinking others were taking her things, initiated on 9/19/25. The only intervention for this problem was a lock box, but there was nothing identified for staff to utilize in the event the resident displayed paranoia.-The resident would manipulate, make up stories, and was anxious, but again, there were no individualized and measurable interventions staff could use to alter or intervene in these behaviors when exhibited by the resident, other than to monitor or observe. Although the resident displayed a multitude of mood, behavior, and psychosocial concerns, these issues were not effectively addressed by the facility. Individualized interventions were not identified for staff to use for altering the resident's mood/behavior. Refer to F-F850 - Social Service Director; F-F740 Behavioral Health Services; and F-F656 - Comprehensive Care Plan

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Yellowstone River Nursing and Rehabilitation

2115 Central Ave Billings, MT 59102

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0850

Hire a qualified full-time social worker in a facility with more than 120 beds.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to hire and employ a full-time social worker who met

the regulatory requirements and to meet the mood, behavioral, emotional, and psychosocial needs of residents. The facility was licensed for 160 beds. Findings include:During an interview on 11/18/25 at 2:35 p.m., staff member A stated that staff member F had been in the social services director position for about three months and held a degree in psychology. Staff member A stated the social services staff member prior to staff member F did not have a degree. Staff member A stated the other staff member who worked in

a social services role (staff member E) did not have a degree.During an interview on 11/19/25 at 11:46 a.m., staff member A stated the facility's census had never reached 120 residents. Staff member A stated that since the census had never reached or went over 120, the facility met the social worker regulation with

the two staff members in their social services roles. Staff member A stated the facility's census was currently 115, so they were getting a little nervous about that number. Staff member A stated the facility's corporate company had a licensed social worker who could oversee staff member F and act as a consultant as needed.Review of the facility's health care facility service license, dated 5/2/24, showed for

the license specifications of Title 18/19 SNF (Skilled Nursing Facility), the facility was licensed for 160 beds.Review of a facility document titled, Job Title: Social Worker, which described staff member F's job description, showed: .QUALIFICATIONS. The requirements listed are representative of the knowledge, skill and or ability required.Education and Experience. - Bachelor's degree in Social Work from an accredited institution is required (Master's degree and/or experience in long-term care is preferred) .Certificates, Licenses, Registrations- Social Work license in the state employed is required.- Become familiar with and comply to all local, state, and federal regulations relating to the job.The document showed staff member F signed the job description on 8/18/25.Review of staff member F's academic transcripts and resume showed staff member F attained a bachelor's degree in psychology. The resume did not show a year of supervised social work experience in a health care setting working directly with individuals.A review of S483.70(o), the long term care regulatory requirements for a social worker showed, any facility with more than 120 beds must employ a qualified social worker on a full-time basis, which included one year of supervised experience in a healthcare setting. The regulatory requirement did not reflect that a facility was allowed to forgo employing a qualified social worker if the census was 120 or less. Refer to F-F656 - Comprehensive Care Plan, and F-F740 - Behavioral Services, related to concerns with a resident not receiving the necessary care and services for mood, behavior, and psychosocial concerns.

Residents Affected - Some Note: The nursing home is disputing this citation.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

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