St. John‘s United

Overview of St. John‘s United

St. John’s United operates a 104-bed nursing facility at 3940 Rimrock Road, Billings, Montana, administered by Karna Rhodes and owned by Gerald Pearsall. This voluntary non-profit church-affiliated community is car-dependent (Walk Score 6), 7.9 miles from downtown Billings with immediate access to Fuller Family Medicine. Current census: 26 residents (25% occupancy), average stay 129 days. Payer mix: 63% Medicare (28 days typical), 36% private pay (5–6 months), 1% Medicaid (18–19 years).
Staffing (Q4 2025): 262 total personnel including 29 RNs, 14 LPNs, and 164 CNAs. Total nursing delivers 5 hours 16 minutes per resident per day (35% above Montana average); weekend nursing reaches 4 hours 43 minutes (38% above state norm). Staff-to-resident ratio of 3.32:1 significantly exceeds benchmarks.
Care modalities include nursing home, independent and assisted living, memory care, home care, and hospice. Amenities: private rooms, aquatic center, fitness center, restaurant-style dining, housekeeping, and storage. 2023 financials: $34.4 million revenue, $19.6 million payroll, $984,311 net income. The facility ranks first statewide in payroll investment.
Quality outcomes show mixed results. Long-stay residents experience falls with major injury at 3.0% (31% better than state), pressure ulcers at 4.3% (32% better), and urinary tract infection at 2.0% (27% better). However, weight loss reaches 11.4% (85% worse), functional decline scores 23.4 (8% worse), and antipsychotic use stands at 20.8% (9% worse). No monetary penalties in three years.
The inspection record reveals significant compliance challenges. Over 34 months (August 2023–July 2025), four inspections yielded 33 deficiencies; 686% above Montana’s per-inspection average. July 2025 annual inspection cited 6 deficiencies: grievance policy gaps, medication errors exceeding 5%, incomplete care plans, expired food disposal, hand hygiene failures, and infection control breaches. A concurrent complaint investigation identified 2 deficiencies for delayed abuse/investigative findings reporting (2 days late).
August 2024 routine inspection documented 15 deficiencies spanning medication assessment, delayed abuse reporting, assessment accuracy, care planning, fall prevention, psychotropic medication governance, dietary and kitchen sanitation failures, and vaccination gaps. An August 2024 complaint investigation substantiated 2 deficiencies: delayed neglect reporting and 3-hour late insulin delivery. April 2024 complaint investigation found 1 deficiency: incorrect antiepileptic dosing for 27 days.
August 2023 routine inspection identified 7 deficiencies including unmet caregiver preferences, dementia care planning gaps, pressure ulcer management, missing equipment, absent nonpharmacological interventions, medication errors, and refrigerator temperature control failures. An August 2023 complaint investigation confirmed 1 deficiency for absent nonpharmacological documentation preceding antipsychotic initiation.
All violations carry moderate severity; no critical or serious citations exist. Deficiency patterns center on medication management, care planning, incident reporting timeliness, infection prevention, dietary operations, and failure to implement nonpharmacological approaches before chemical restraint, demonstrating compliance persistence without documented systemic resolution

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