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Complaint Investigation

Polaris Rehabilitation And Care Center

Inspection Date: August 28, 2025
Total Violations 3
Facility ID 535025
Location Cheyenne, WY
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Inspection Findings

F-Tag F0677

Quality of Life and Care Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0677 Level of Harm - Minimal harm or potential for actual harm

  1. 10. Review of the facility policy titled Resident Showers provided by the facility on 8/28/25 showed .1.
  2. Residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety .

    Residents Affected - Some

    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

    08/28/2025

    NAME OF PROVIDER OR SUPPLIER

    STREET ADDRESS, CITY, STATE, ZIP CODE

    Polaris Rehabilitation and Care Center

    2700 E 12th Street Cheyenne, WY 82001

    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)

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F-Tag F0725

Nursing and Physician Services Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0725

regional clinical director on 8/28/25 at 4:45 PM confirmed the facility continued to have staffing challenges and confirmed the bathing was not being performed as it should be.

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

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Polaris Rehabilitation and Care Center

2700 E 12th Street Cheyenne, WY 82001

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)

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F-Tag F0732

Nursing and Physician Services Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0732

Post nurse staffing information every day.

Level of Harm - Minimal harm or potential for actual harm

Based on daily staff posting review and staff interview the facility failed to ensure the total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift: RN, LPN, CNA were documented on the posting. The census was

  1. 69. The findings were:1. Review of the daily staff postings from 7/28/25 through 8/28/25 showed staff
  2. names, position worked, and number of hours individual staff worked; however, the posting failed to identify

    the total hours worked for all RNs, LPNs, and CNAs.2. Interview with the administrator on 8/28/25 at 2:47 PM confirmed the daily staff posting did not give the total number of hours for the RNs, LPNs, and the CNAs.

    Residents Affected - Some

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

    Event ID:

    Facility ID:

    If continuation sheet

📋 Inspection Summary

Polaris Rehabilitation and Care Center in Cheyenne, WY inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Cheyenne, WY, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Polaris Rehabilitation and Care Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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