Mountain View Skilled Nursing Community At Wlrc

F 0600 Level of Harm - Actual harm Residents Affected - Few

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

the sidewalk towards the Sunflower unit as that was where his friends lived. The incident showed words were exchanged by resident #1 and resident #3 who is non-verbal, and resident #3 hit resident #1 in the head and ran his/her wheelchair into resident #1. Resident #1 hit resident #3 and stated s/he had a right to defend him/herself. The residents were separated and assessed. Further review showed both residents had minor injuries that were treated by the facility.c. Interview with CNA #1 on 10/15/25 at 12:01 PM revealed on 9/19/25 resident #1 and 2 other resident had gone on nature ride. The CNA revealed after resident #1 was assisted off the bus, he heard another staff member say stop it. The CNA revealed when he turned around, ho observed resident #1 and resident #3 swinging at each other and observed them hit each other. The CNA revealed when the altercation was over, resident #1 had a scratch on his/her chin and resident #3 had

a red area on his/her head and eye. The CNA revealed the following day resident #3 had a black eye.

Further interview revealed resident #1 claimed resident #3 had pushed him/her off the sidewalk and hit him/her. 3. Interview with CNA #2 on 10/15/25 at 10:38 AM revealed resident #3 got along with everyone except resident #1. Following the incident on 9/19/25, the CNA revealed resident #3 was fearful. The CNA revealed she had observed resident #1 resident #3 a retard and stated resident #3 would get mad. She revealed she was unsure what to do with resident #1 because when staff told him/her to stop making statements towards others, resident #1 would increase the statements. The CNA revealed resident #2 had gone after resident #1 because resident #2 was protective of staff and other residents and resident #1 antagonized other residents and staff.4. Interview with CNA #3 on 10/25/25 at 12:23 PM revealed on 9/25/25 resident #1 was upset when s/he woke up. She revealed the resident was calling people derogatory names. She revealed resident #2 was trying to stay out of it by staying in his/her room. The CNA revealed

she asked resident #1 to stop calling others names; however, when s/he was told s/he could not make a phone call, resident #1 got upset and chased after the CNA. The CNA revealed she had called security and when resident #2 came out of his/her room s/he heard the statements resident #1 was making, grabbed some water, and headed to resident #1's room. The CNA revealed by the time she made it to the room, resident #1 was soaked and resident #2 was trying to punch resident #1 while resident #1 was hitting resident #2 on top of the head with a television remote. The CNA revealed after the residents were separated, resident #2 was still angry and was yelling at resident #1. The CNA revealed resident #1 was always agitating others and when staff attempt to redirect him/her, it was not always effective. The CNA revealed resident #2 often stayed in his/her room to avoid resident #1. The CNA revealed once when resident #3 came to the house to visit her, resident #1 stated When you are done playing with the retard, I need a napkin. The CNA revealed on a different occasion resident #1 stated Oh my god, you guys play with [him/her] like [s/he] is a fucking 3-year-old in regards to resident #3. Further interview revealed resident #3 indicated s/he was afraid of resident #1 and when they shared a house, resident #3 would remain in his/her room to avoid resident #1. 5. Interview with RN #1 on 10/15/25 at 11 AM revealed resident #3 was non-verbal and got along with everyone except resident #1 because s/he called resident #3 retarded. The RN revealed following the altercation on 9/19/25 resident #3 shook his/her head no when asked if s/he was ok, then pointed to his/her arm and head. The RN revealed resident #3 had some scratches and his/her eye was red. The RN revealed resident #1 had other incidents with individuals due to derogatory statements.

The RN revealed resident #2 had been in incidents with resident #1 after resident #1 had made derogatory statements to others. 6. Review of the facility policy titled Prevention of Resident Abuse, Neglect, and Exploitation dated 5/14/25 showed .It is the policy and practice of the WLRC that all residents will be protected from abuse and neglect .

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

10/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Skilled Nursing Community at Wlrc

8204 Wyoming State Highway 789 Lander, WY 82520

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on facility incident report review, state survey agency incident database review, staff interview, and policy and procedure review, the facility failed to ensure timely reporting of allegations of abuse for 2 of 13 sample residents (#1, #2) reviewed for allegations of abuse. The findings were: 1. Review of a facility incident report dated 9/27/25 and timed 4 PM showed resident #1 called resident #2 an asshole and resident #2 threw a cup of juice on resident #1.2. Review of the state survey agency incident database showed the incident was reported on 9/30/25 at 8:12 AM, 3 days after the incident occurred.3. Interview with facility investigator on 10/15/25 at 12:46 PM confirmed the incident was not reported timely. She revealed the incident occurred on a Saturday and at that time, they did not have any staff members who had access to the incident database that worked on the weekends. 4. Review of the facility policy titled Prevention of Resident Abuse, neglect, and Exploitation dated 5/14/25 showed .3. WLRC staff will report

the allegation to the Wyoming Healthcare Licensing and Survey (HLS) website immediately, but not later than: Two (2) hours after the allegation is made if the events that cause the allegation involve abuse OR result in serious bodily injury; or Twenty-four (24) hours after the allegation is made, if the events that cause

the allegation do not involve abuse AND do not result in serious bodily injury .

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

10/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Skilled Nursing Community at Wlrc

8204 Wyoming State Highway 789 Lander, WY 82520

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 - Actual harm Residents Affected - Few

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

resident #3 had some scratches and his/her eye was red. The RN revealed resident #1 had other incidents with individuals due to derogatory statements. The RN revealed resident #2 had been in incidents with resident #1 after resident #1 had made derogatory statements to others. 6. Interview with CNA #4 on 10/15/25 at 11:21 AM revealed resident #1 called the other residents retards and upsets the other resident.

The CNA revealed resident #2 gets really upset and has a hard time calming down. The CNA revealed resident #1 will make derogatory statements for hours and the staff don't have any interventions to get resident #1 to stop.7. Interview with CNA #5 on 10/15/25 at 11:39 AM revealed resident # 1 called other derogatory names and upset other residents. The CNA revealed the only intervention was to tell the resident to stop which was effective sometimes and wasn't effective other times.

Event ID:

Facility ID:

If continuation sheet