The Valley Health And Rehab

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Guidelines:1. The facility will develop and implement written policies and procedures that:a. Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property;b. Establish policies and procedures to investigate any such allegations; andc. Include training for new and existing staff

on activities that constitute abuse, neglect, exploitation, and misappropriation of resident property, reporting procedures, and dementia management and resident abuse prevention; andd. Establish coordination with

the QAPI program. [sic]It was determined that the deficient practices related to the events in the secure unit with the vulnerable residents were corrected, therefore, the failure was cited as past noncompliance. The facility corrected the deficient practice(s) on 9/19/25.

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Valley Health and Rehab

601 N 10th St Hamilton, MT 59840

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 0610

Respond appropriately to all alleged violations.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to complete a thorough investigation on a staff to resident verbal abuse and neglect allegation, by failing to complete resident monitoring, failed to carry out interventions identified and documented on the report, and failed to complete other resident interviews to rule out other concerns of abuse by the staff member, for 2 (#s 17 and 18) of 18 sampled residents.

Findings include:Review of all facility reported incidents and facility investigations since August 27, 2025, showed there was insufficient documentation to show the facility completed thorough investigations on events reported to the State Survey Agency. The concerns included: -Incident #2609523 - There was no summary provided on the incident; there were no other residents and or staff interviews, and no corrective actions or interventions taken by the facility.-Incident #2609623 - The documents failed to include evidence

on how the facility provided education to staff, and there were no bathing logs or audits conducted by the facility for monitoring and sustaining any corrections attempted. -Incident #2609701 - The documentation failed to show that the facility interviewed other residents and staff to identify others who may have been affected by the deficient practice.During an interview on 9/23/25 at 6:30 p.m., staff member C stated she had not reviewed the incident investigation folders yet and would look through them. During an interview on 9/24/25 at 7:20 a.m., staff member C stated she reviewed the incident and investigation folders, and staff member C identified that the investigations were not complete. Staff member C stated the facility was still working on them, as the events were part of the plan of correction from a prior complaint survey. Review of

a facility document titled Abuse, Neglect and Exploitation with an implementation date of 4/11/25 showed: Policy: it is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property.VII. Reporting/Response A. The facility will have written procedures that include:1. Reporting of all alleged violations to the Administrator, state agency, adult protective services and to all other required agencies.5. Taking all necessary actions as a result if the investigation, which may include, but are not limited to, the following:a. Analyzing the occurrence.b. Defining how care provision will be changed.c. Training of staff on changes made and demonstration of staff competency.d. Identification of staff responsible for implementation of corrective actions.e. The expected date for implementation.f. Identification of staff responsible for monitoring the implementation of the plan. [sic]

Residents Affected - Few

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

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Valley Health and Rehab

601 N 10th St Hamilton, MT 59840

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

was identified: staffing issues, lack of understanding of following schedule, documentation expectations. [sic]The facility identified the issue with bathing, but did not follow through with corrective actions, as shown

in the review of resident bathing logs and care plans.Review of a facility document titled Activities of Daily Living (ADLs) with an implementation date of 4/11/25 showed: Policy: The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident's abilities in ADLs do not deteriorate unless deterioration is unavoidable.Care and services will be provided for the following activities of daily living:1. Bathing, dressing, grooming and oral care.

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Valley Health and Rehab

601 N 10th St Hamilton, MT 59840

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

observed in blue pajamas with pink hearts, the same clothing she wore the day before. During an interview

on 9/24/25 at 11:54 a.m., staff member H stated she was the only certified staff member on the memory care unit, providing ADL care, and it was rare that another person (certified) was scheduled to work the unit also. During an observation on 9/24/25 at 12:06 p.m., resident #10 was eating her lunch with her fingers and was not assisted by staff. Resident #10 poured her water onto her lunch plate. Staff present in the dining room did not intervene or assist resident #10 with her meal.During an interview on 9/24/25 at 12:22 p.m., staff member C said she thought the facility was going in the right direction for staffing (improving), and they have identified staffing as an issue.During an interview on 9/24/25 at 12:35 p.m., staff member A stated they have identified staffing as an issue as it pertains to bathing and are working to hire more employees. Staff member A didn't think there were systemic issues that had been identified due to a lack of staffing.Review of a facility document titled QAPI PIP - Action Plan with an initiated date of 8/18/25 showed: .Root Cause Identified: In review with staff, the following was identified: staffing issues.Review of the facility's Daily Staffing Sheets, compared to the facility assessment for the identified staffing needs, showed of the 14 days, 7 days were staffed lower than the facility assessment identified necessary. Dates with low staffing included: 911/25, 9/12/25, 9/15/25, 9/16/25, 9/17/25, 9/19/25, 9/22/25.

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Valley Health and Rehab

601 N 10th St Hamilton, MT 59840

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 0744 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

6 times, biting 6 times, wandering 23 times, and abusive language 2 times.Review of resident #1's activity participation documentation for August and September 2025 showed the resident participated in activities

on 8/15/25 and on 9/20/25. There were no other documented activities for August or September for resident #1.Review of resident #1's admission MDS, with an ARD of 5/7/25, showed:-The resident had a BIMS of 3,

a severe cognitive impairment, and was able to make herself understood and she could understand others.-The resident's mood interview, Section D of the Minimum Data Set assessment, showed resident #1 did not respond to questions A. and B., there was no total severity score assessed for her mood, and there was no staff assessment completed. The resident was unable to respond if she felt lonely or isolated from those around her.-Under section E, of the MDS, for behaviors, the resident was coded as disturbing others 1 to 3 days a week. The resident's behaviors put other at significant risk for physical injury, significantly intruded on the privacy of others and significantly disrupted the care environment. There was not a presence of wandering.-Section GG, for functional assistance, showed the resident was coded as supervision or touching assistance for oral hygiene, toilet hygiene, and putting on/taking off footwear. The resident was coded as requiring partial to moderate assistance with showering/bathing, upper and lower body dressing and personal hygiene.Review of resident #1's Quarterly MDS, with an ARD of 8/7/25, showed the resident's cognition declined, she was unable to complete the mood interview, had increased behaviors, and her functional abilities declined as evidenced by the following:-Section B, Hearing, Speech, and Vision, showed the resident is able to make herself understood or to understand others.-Section C, cognitive patterns, showed the Brief Interview for Mental Status should be conducted. There were dashes in each of the questions in section C, and there was no total BIMS score assessed. Section C0600 showed a staff assessment was to be completed. The staff assessment showed a dash in each of the questions C0700 and C0800. C0900 question was blank. The resident was assessed to have modified independence for daily decision making.-Section D, for #1's mood, showed the mood interview should be conducted. The

interview showed the resident responses as dashes for the entire interview. The resident scored a 99, as unable to complete the interview. The staff assessment for the mood interview was blank. The resident was unable to respond to the question related to how often she feels lonely or isolated from those around her.-Section E, for exhibited behaviors, showed resident #1 was coded to have physical behaviors toward others 1 to 3 days, verbal behavioral symptoms directed toward others 4 to 6 days and she was wandering 4 to 6 days a week.-Section GG, functional abilities, the resident was coded as dependent for oral hygiene, toileting, shower/bathing, upper and lower body dressing, putting on/taking off footwear and personal hygiene.

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Valley Health and Rehab

601 N 10th St Hamilton, MT 59840

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 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interviews, and record review, the facility failed to ensure staff were educated on the importance of Enhanced Barrier Precautions and failed to ensure staff used the appropriate Personal Protective Equipment for 2 (#s 3 and 4) of 18 sampled residents. This deficient practice increased the risk of infection for residents with urinary catheters. Findings include: During an observation and interview on 9/23/25 at 9:54 a.m., staff member E was coming out of resident #4's room, pushing a mechanical lift.

Resident #4 was observed with a catheter tubing and a catheter bag. There was no PPE caddy hanging outside of resident #4's door. When asked if she used PPE during the transfer with resident #4, staff member E stated she did not use PPE, but she was going to go get the PPE supplies.During an interview

on 9/23/25 at 9:57 a.m., resident #4 it would depend on who that person was, if they used PPE during the catheter care. Resident #4 stated the staff used to have PPE hanging on resident #4's door, but they took it off for some reason, and the staff have become more relaxed about using PPE.During an observation and

interview on 9/23/25 at 1:43 p.m., staff member D entered resident #3's room. There was a sign outside of resident #3's room showing the need for enhanced barrier precautions to be used, and a PPE caddy was hanging outside of the door. Staff member D entered resident #3's room, and did not don PPE, and stated, I forgot you had a catheter. Staff member D assisted resident #3 with a transfer to the toilet, using a mechanical lift. Staff member D donned gloves, assisted resident #3 with pulling down her undergarments, and then lowered resident #3 to the toilet. Staff member D said she was told that day that PPE was supposed to be used for residents with catheters. Staff member D said she had worked in the hospital setting prior, and EBP was not used for catheters.During an interview on 9/24/25 at 8:46 a.m., staff member C stated she expected enhanced barrier precautions to be used for residents who had a wound, a catheter, or a multidrug-resistant organism when high-contact care tasks were performed. Staff member C stated high contact care tasks were transferring, with tasks such as making the bed, during wound care, and or cleaning.Review of the facility's policy titled, Enhanced Barrier Precautions, implemented 4/11/25, showed, .Definitions: ‘Enhanced barrier precautions' (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and gloves use during high-contact resident care activities. [sic]. 2. Initiation of Enhanced Barrier Precautions:.b. An order for enhanced barrier precautions will be obtained for residents with any of the following:i. Wounds.and/or indwelling medical devices (e.g. urinary catheters.).3. Implementation of Enhanced Barrier Precautions:a.

Make gowns and gloves available immediately near or outside of the resident's room.4. High-contact resident care activities include:. c. Transferring, d. Providing hygiene, .f. Changing briefs or assisting with toileting.10. Enhanced barrier precautions should be used for the duration of the affected resident's stay in

the facility or until resolution of the wound or discontinuation of the indwelling medical device that placed them at higher risk. [sic]

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet