The nursing home failed to provide services that met professional standards of quality. Cited October 2025 — isolated incident, actual harm.
View the original federal record
F-Tag 658 — 42 CFR §483.21(b)(3) — S/S: G
Nursing home report
Big Horn Rehabilitation and Care Center
Sheridan, WY · Medicare-certified · 128 beds
Needs attention
Special Focus candidateFor-profit
1 of 5 overall
Big Horn Rehabilitation and Care Center has a 1-star overall rating, with a 1-star health inspection rating, 2-star staffing, and 3-star quality measures. It is a Special Focus Facility candidate/attention flag, had 3.30 nurse staffing hours per resident per day versus the 4.1 federal benchmark, and had no fines in the last 24 months.
Facility ratings
Health inspections
Staffing
3.3043 hrs/resident/day
Quality measures
Last inspection: February 5, 2026Penalties, last 24 months: $0special focus facility
Federal guidance recommends at least 4.1 nursing hours per resident each day. This facility reports 3.3043.
Staffing detail
- Registered nurses
- 0.48
- Licensed practical nurses
- 0.62
- Nurse aides
- 2.20
- Weekend nursing
- 2.95
Hours per resident per day.
Total staff turnover: 63%
Registered nurse turnover: 57%
Resident outcomes
How often residents experience these outcomes, with the direction over the past year.
Long-stay residents on antipsychotic medication
24.6%Worsening
Residents with a fall causing major injury
3.7%Worsening
Residents with pressure ulcers (bedsores)
4.6%Improving
Residents with a urinary tract infection
0.8%Steady
Residents who lost too much weight
12.4%Steady
Residents who were physically restrained
0%Steady
Residents needing more help with daily activities
8.9%Improving
Residents whose ability to walk got worse
11.5%Improving
Show all measures
Long-stay residents on antianxiety or sleep medication
13.6%Worsening
Short-stay residents newly given an antipsychotic
1%Improving
Residents with a long-term catheter
1.8%Steady
Residents with new or worsening incontinence
23.8%Improving
Residents with depressive symptoms
10.9%Worsening
Long-stay residents given the seasonal flu vaccine
67.9%Steady
Long-stay residents given the pneumonia vaccine
91%Worsening
Short-stay residents given the seasonal flu vaccine
52.9%Steady
Short-stay residents given the pneumonia vaccine
72.1%Worsening
What the inspectors found
The nursing home failed to provide appropriate treatment and care according to residents' orders, preferences, and goals. Cited October 2025 — isolated incident, actual harm.
View the original federal record
F-Tag 684 — 42 CFR §483.25 — S/S: G
The nursing home failed to protect residents from abuse and neglect by others. Cited December 2023 — isolated incident, actual harm.
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F-Tag 600 — 42 CFR §483.12 — S/S: G
The home failed to make sure food was safely sourced, stored, prepared, and served according to professional standards. Cited February 2026 — widespread issue, potential for harm.
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F-Tag 812 — 42 CFR §483.60(i) — S/S: F
The home failed to ensure residents had a safe, clean, comfortable, homelike environment and daily care supports were provided safely. Cited February 2026 — limited pattern, potential for harm.
View the original federal record
F-Tag 584 — 42 CFR §483.10 — S/S: E
Recent history
- STAFFING
Reported nurse staffing was below the federal recommendation of 4.1 hours per resident per day.
- INSPECTION
Health inspection found 5 health deficiencies.
See what inspectors found
- INSPECTION
Health inspection found 6 health deficiencies.
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- PENALTY
A federal payment denial was recorded.
- INSPECTION
Health inspection found 5 health deficiencies.
See what inspectors found
Penalties & enforcement
On record with Medicare: 1 fine · $7,163 in total fines · 1 payment denial.
- 8 days
Medicare/Medicaid payment denial
Oct 8, 2025
- $7,163
Federal fine
Dec 21, 2023
Operator & ownership
- Ownership
- For profit - Corporation
- Occupancy
- 73.5 residents on an average day (57% of 128 beds)
- Resident voice
- Resident council
- Medicare history
- Certified for 48 years
Things at a nursing home change — inspections, staffing, ownership, news.
Source: Centers for Medicare & Medicaid Services — public records, updated monthly. GoodStanding presents official records with plain-language summaries. Always visit a facility in person.