Inspection Reports for
Valle Vista Rehabilitation and Nursing LLC
402 Summit Ave, Lewistown, MT, 59457
Back to Facility ProfileDeficiencies (last 3 years)
Deficiencies (over 3 years)
5.7 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
2% better than Montana average
Montana average: 5.8 deficiencies/yearDeficiencies per year
12
9
6
3
0
Inspection Report
Deficiencies: 1
Date: Nov 21, 2025
Visit Reason
The inspection was conducted to investigate the facility's compliance with documentation and provision of necessary equipment related to the discharge and transfer of a quadriplegic resident to another facility.
Findings
The facility failed to provide a wheelchair to a quadriplegic resident upon discharge to an Adult Services Residential Program facility and failed to document the transfer discharge in the medical record. This resulted in the resident arriving at the receiving facility without a wheelchair, impacting his primary mode of mobility.
Deficiencies (1)
Failed to provide a quadriplegic resident with a wheelchair after discharge and failed to document the transfer discharge in the medical record.
Inspection Report
Complaint Investigation
Deficiencies: 1
Date: May 20, 2025
Visit Reason
The inspection was conducted due to concerns regarding the facility's failure to timely report suspected abuse, neglect, or theft, specifically related to allegations of misappropriation of property by resident #46's conservator.
Complaint Details
The complaint involved allegations that resident #46's conservator was misappropriating the resident's funds and not paying bills owed to the facility and other care facilities. The facility failed to report and investigate the allegation properly. APS was involved and assigned a case worker to investigate the concern.
Findings
The facility failed to implement policies and procedures to ensure reporting of reasonable suspicion of a crime, increasing the risk of resident #46's potential misappropriation of property. The facility did not document an investigation of the exploitation allegation, and the State Survey Agency reporting portal showed no report of the allegation.
Deficiencies (1)
Failure to timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff member C | Interviewed regarding concerns about resident #46's conservator and notification to APS. | |
| Staff member A | Interviewed regarding awareness of the conservator's handling of finances and APS involvement. |
Inspection Report
Complaint Investigation
Deficiencies: 8
Date: May 20, 2025
Visit Reason
The inspection was conducted based on complaints and concerns regarding consent for psychotropic medications, use of unnecessary psychotropic medications, suspected abuse and exploitation, failure to notify residents of transfers, incomplete care plans, inadequate activities, incomplete medical records, and infection prevention and control deficiencies.
Complaint Details
The complaint investigation included issues with psychotropic medication consent and use, suspected abuse and exploitation not reported or investigated, failure to notify residents of hospital transfers, incomplete care plans and activities, incomplete medical records and unsigned POLST, and inadequate infection prevention and control practices.
Findings
The facility failed to obtain timely consent for psychotropic medications, limit as-needed psychotropic medications to 14 days, report suspected abuse and exploitation, notify residents of hospital transfers, develop comprehensive care plans, provide adequate activities, maintain complete medical records including provider visit notes and properly signed POLST forms, and maintain an adequate infection prevention and control program including cleaning and policy reviews.
Deficiencies (8)
Failed to ensure consent for psychotropic medications was obtained prior to starting medication for 2 of 18 sampled residents.
Failed to limit as-needed psychotropic medications to 14 days unless documented rationale was provided for 2 of 18 sampled residents.
Failed to timely report suspected abuse, neglect, or theft and investigate allegations for 1 of 18 sampled residents.
Failed to notify resident or representative in writing of reason for hospital transfer for 1 of 15 sampled residents.
Failed to develop and implement a comprehensive care plan based on resident activity preferences and physical abilities for 1 of 15 sampled residents.
Failed to provide group and individual activities to meet resident's interests and support well-being for 1 of 15 sampled residents.
Failed to maintain complete medical records including medical provider visit notes for 4 of 15 sampled residents and failed to ensure POLST was signed by a medical provider for 1 of 15 sampled residents.
Failed to maintain an adequate infection prevention and control program including cleaning of equipment and annual review of policies.
Report Facts
Residents sampled: 18
Residents sampled: 15
Residents affected: 2
Residents affected: 1
Residents affected: 1
Residents affected: 1
Residents affected: 4
Residents affected: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff member B responsible for medication regimen review and interviews regarding psychotropic medication consent and use, transfer notices, and medical record documentation. | ||
| Staff member C responsible for obtaining consents for psychotropic medications and involved in abuse reporting and POLST oversight. | ||
| Staff member D responsible for managing monthly medication regimen review process. | ||
| Staff member E responsible for residents' activity preferences and care planning. | ||
| Staff member A mentioned in interviews regarding conservator concerns and housekeeping audits. |
Inspection Report
Deficiencies: 1
Date: Aug 28, 2024
Visit Reason
The inspection was conducted to assess compliance with food procurement, storage, preparation, distribution, and service standards in the facility kitchen.
Findings
The facility failed to maintain the kitchen in a sanitary and clean condition, with debris and dirt observed in multiple kitchen areas. The kitchen cleaning checklists showed gaps in completion, and staffing shortages due to vacations and employee loss were noted.
Deficiencies (1)
Facility failed to maintain the kitchen in a sanitary and clean condition, with debris resembling crumbs and dirt found on floors, shelves, and workspaces.
Inspection Report
Routine
Deficiencies: 4
Date: May 21, 2024
Visit Reason
The inspection was conducted to assess compliance with regulatory requirements related to medication management, dietary services, food safety, and kitchen sanitation at Valle Vista Rehabilitation and Nursing LLC.
Findings
The facility was found to have expired medications and medical supplies in medication and treatment rooms, lacked a certified director of food and nutrition services, failed to provide palatable food at safe temperatures for some residents, and had multiple food safety and sanitation deficiencies in the kitchen including improper food storage, lack of hair and beard nets, and unclean equipment.
Deficiencies (4)
Failed to remove and dispose of expired medications and medical supplies in medication and treatment rooms.
Failed to have a certified person to serve as the director of food and nutrition services.
Failed to provide palatable food at an appetizing temperature for 3 of 23 sampled residents.
Failed to ensure food was stored and prepared in a clean kitchen; staff did not wear beard nets and hair nets appropriately; and open food items were not dated or labeled.
Report Facts
Expired medication items: 6
Expired catheter items: 13
Residents sampled: 23
Residents affected by cold food: 3
Food temperature readings: 5
Dented cans found: 7
Open spice bottles: 15
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff member B | Observed expired medications and supplies; interviewed about medication room checks. | |
| Staff member A | Interviewed regarding expired medication policy and dietary oversight. | |
| Staff member C | Dietary staff with no training or orientation; temperature checked food; commented on kitchen conditions. | |
| Staff member D | Observed kitchen conditions and lack of hairnets. | |
| Staff member E | Kitchen staff observed wearing baseball cap without hairnet. | |
| Staff member F | Observed washing dishes without beard net; found dented cans in storage. |
Inspection Report
Routine
Deficiencies: 2
Date: May 22, 2023
Visit Reason
The inspection was conducted to evaluate compliance with resident rights and infection prevention and control practices at Valle Vista Rehabilitation and Nursing LLC.
Findings
The facility failed to treat residents with dignity by not assisting with personal hygiene tasks such as shaving for some residents, causing embarrassment. Additionally, staff failed to adhere to infection control practices during meal service, including inadequate hand hygiene and not wearing gloves, increasing the risk of infection spread.
Deficiencies (2)
Failure to assist residents with personal hygiene tasks (shaving) for 3 of 6 sampled residents, causing embarrassment.
Failure to perform hand hygiene after touching dirty surfaces and not wearing gloves while serving meals, increasing infection risk.
Report Facts
Residents affected: 3
Residents affected: Many residents affected by infection control deficiencies
Observation dates: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Staff members H, K, J, C, G, F, E, N mentioned in relation to shaving and infection control practices but no full names provided. |
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