Based on observation, interview, and record review, the facility failed to provide an adequate number of staff to provide timely responses to requests for care for 14 (#s 3, 15, 20, 21, 26, 27, 29, 36, 37, 56, 229, 230, 235, and 429) of 15 sampled residents, which included several residents dependent on nursing staff for care. This failure caused a decrease in bathing for resident #21, resident #229 and #26 to have episodes of incontinence, resident #230 to have a decrease in bathing and to receive her pain medications late, resident #235 to have a decrease in bathing and had the potential to negatively affect care for all residents of the facility. It was identified some residents were waiting over an hour to receive assistance from staff. …
F725 citations in Montana
Sufficient nursing staff · Nursing and Physician Services Deficiencies
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2025
Montana cites F725 more often than its own record predicts
1.61 times the share F725 takes of citations nationally.
Of every deficiency written in Montana in 2025, this is the portion that was F725.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Montana surveyors wrote
F725 findings written in Montana, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
Based on observation, interview, and record review, the facility failed to ensure there was an adequate number of staff available to provide resident care needs promptly when residents requested assistance using their call lights or when they needed help with ADL care, for 4 (#s 3, 20, 34, and 59) of 23 sampled and supplemental residents. The failure resulted in the residents being frustrated and going without care for extended periods of time. Findings include:During an interview on 7/13/26 at 2:42 p.m., resident #59 stated, It depends on how busy they (the staff) are, and what time of day it is, regarding how long he waits for help with his activities of daily living. …
The short window
Recent years
| Year | Share of Montana citations | vs expected |
|---|---|---|
| 2023 | 1.98% | 2.46× |
| 2024 | 1.05% | 1.31× |
| 2025 | 1.25% | 1.61× |
Shares of citations, not counts: earlier years hold fewer inspections.
What else Montana surveyors cite →
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