Independent · Federal inspection records, searchable
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Nursing Home Violations Public inspection data, searchable
Facility profile · CCN 385138

Pilot Butte Rehabilitation Center

45 federal citations on record , including 1 at the Immediate Jeopardy level, and 1 federal enforcement actions totaling $8,827.

Abuse Icon 1 Immediate Jeopardy

Record summary

Federal record · Q1 2026
45
Total citations
32
Last 3 years
2
Actual harm+
1
Federal penalties
$8,827
Total fines
2
Overall ★ rating

Most common violation categories here

Quality of Care14 Resident Rights8 Nutrition & Dietary6 Abuse & Neglect5 Infection Control4

Most common F-tags at this facility

F6894 F6843 F8123 F5522 F6002

Citation history

45 on record
SurveyF-TagViolationSeveritySource
Sep 19, 2025F880Provide and implement an infection prevention and control program.EComplaint
Sep 19, 2025F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Sep 19, 2025F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.DComplaint
Sep 19, 2025F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
Sep 19, 2025F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.EStandard
Sep 19, 2025F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DStandard
Sep 19, 2025F628Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.DStandard
Sep 19, 2025F552Ensure that residents are fully informed and understand their health status, care and treatments.DStandard
Sep 9, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.JComplaint
May 31, 2024F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.DComplaint
May 31, 2024F883Develop and implement policies and procedures for flu and pneumonia vaccinations.DStandard
May 31, 2024F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.EStandard
May 31, 2024F806Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.DStandard
May 31, 2024F804Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.EStandard
May 31, 2024F803Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.EStandard
May 31, 2024F760Ensure that residents are free from significant medication errors.DStandard
May 31, 2024F758Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.DStandard
May 31, 2024F745Provide medically-related social services to help each resident achieve the highest possible quality of life.DStandard
May 31, 2024F698Provide safe, appropriate dialysis care/services for a resident who requires such services.DStandard
May 31, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DStandard
May 31, 2024F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.DStandard
May 31, 2024F685Assist a resident in gaining access to vision and hearing services.DStandard
May 31, 2024F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DStandard
May 31, 2024F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
May 31, 2024F584Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.EStandard
May 31, 2024F582Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.DStandard
May 31, 2024F578Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.DStandard
May 31, 2024F561Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.DStandard
May 31, 2024F552Ensure that residents are fully informed and understand their health status, care and treatments.DStandard
Apr 17, 2024F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.DComplaint
Apr 17, 2024F610Respond appropriately to all alleged violations.DComplaint
Apr 17, 2024F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.DComplaint
Feb 25, 2023F921Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.EStandard
Feb 25, 2023F886Perform COVID19 testing on residents and staff.FStandard
Feb 25, 2023F880Provide and implement an infection prevention and control program.FStandard
Feb 25, 2023F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.FStandard
Feb 25, 2023F726Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.DStandard
Feb 25, 2023F687Provide appropriate foot care.DStandard
Feb 25, 2023F686Provide appropriate pressure ulcer care and prevent new ulcers from developing.GStandard
Feb 25, 2023F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.DStandard
Feb 25, 2023F677Provide care and assistance to perform activities of daily living for any resident who is unable.DStandard
Feb 25, 2023F659Provide care by qualified persons according to each resident's written plan of care.DStandard
Feb 25, 2023F658Ensure services provided by the nursing facility meet professional standards of quality.FStandard
Feb 25, 2023F657Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.DStandard
Feb 25, 2023F580Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.DStandard

Federal enforcement history

Federal regulators have imposed 1 enforcement actions against this facility, including 1 civil money penalties totaling $8,827 .

DateTypeFinePayment denial
Sep 9, 2024Fine$8,827—
About this record A citation is a finding by a state survey team working under federal contract. It is not a court judgment. The description above is drawn verbatim from federal public datasets. Facilities have the right to appeal findings through an Informal Dispute Resolution (IDR/IIDR) process.

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