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On Medicare Special Focus status, a serious quality warning. Visit in person and ask tough questions before deciding.
based on 23 Google reviews
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These current public-data fields deserve follow-up with the facility and the official Medicare record. They are not a clinical risk score or a substitute for an in-person assessment.
Medicare Special Focus status indicates a history of serious quality problems and heightened oversight. Review the latest inspection records, ask what corrective actions remain open, and visit in person before deciding.
Big Horn Rehabilitation and Care Center receives polarized feedback, with recent reviews highlighting a warm, caring staff and effective physical therapy, while older and some critical reviews point to facility maintenance issues and inconsistent rehabilitation intensity. Families should be aware that while many report a compassionate environment, there are specific concerns regarding facility cleanliness and professional conduct during off-hours.
Quality Themes
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Concerns
Rating Trends
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Distribution · 26 analyzed
This facility responds to some reviews.
Personalized based on this facility's data
Key Review Excerpts
“The staff is all incredibly kind and caring. The physical therapists have been wonderful. They are encouraging and patient and my mom has made great improvements under their care.”
“Although it is an “older” building, please don’t let that sway your decision as they are currently remodeling. The most important thing is, the care and the customer service is exceptional.”
“My aunt came for therapy, a few months ago and was very reluctant to go. Now, she and my family couldn’t be happier. The staff is very caring, kind and respectful.”
Both RN and total nursing hours are below the EveryPlace reference benchmarks. Ask the facility how it staffs each shift for current resident needs.
Reference benchmarks (0.75 RN and 4.1 total nursing hours per resident/day) are comparison targets, not current federal minimum requirements.
Resident outcomes compared with national, state, and local averages · 17 measures
7
measures
8
measures
2
measures
Residents vaccinated for the flu
Residents on antipsychotic medication
Residents needing more daily help over time
Residents who lost too much weight
Residents on anti-anxiety or sleep medication
Residents whose walking got worse
Short-stay residents vaccinated for the flu
Short-stay residents vaccinated for pneumonia
Short-stay residents newly given antipsychotics
US average from Medicare published data
Detailed Medicare record · up to 3-year lookback
This facility has significant concerns with 19 complaint-triggered deficiencies showing families have repeatedly filed reports about serious issues. Problems persist across multiple areas including protection from abuse and neglect, nursing staffing adequacy, and daily care assistance. Recent complaints in 2025 indicate ongoing issues with abuse protection and staff reporting that haven't been fully resolved despite corrections.
Resident Rights Deficiencies
Keep residents' personal and medical records private and confidential.
Emergency Preparedness Deficiencies
Establish staff and initial training requirements.
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Egress Deficiencies
Install emergency lighting that can last at least 1 1/2 hours.
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Resident Rights Deficiencies
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Pharmacy Service Deficiencies
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Administration Deficiencies
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Infection Control Deficiencies
Develop and implement policies and procedures for flu and pneumonia vaccinations.
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Smoke Deficiencies
Provide properly protected cooking facilities.
Services Deficiencies
Have properly installed electrical wiring and gas equipment.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Resident Rights Deficiencies
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Resident Rights Deficiencies
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Quality of Life and Care Deficiencies
Provide activities to meet all resident's needs.
Quality of Life and Care Deficiencies
Provide care or services that was trauma informed and/or culturally competent.
Quality of Life and Care Deficiencies
Ensure the activities program is directed by a qualified professional.
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Resident Rights Deficiencies
Honor 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.
Resident Rights Deficiencies
Honor the resident's right to organize and participate in resident/family groups in the facility.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Administration Deficiencies
Hire a qualified full-time social worker in a facility with more than 120 beds.
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies
Provide care and assistance to perform activities of daily living for any resident who is unable.
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.
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Respond appropriately to all alleged violations.
Resident Rights Deficiencies
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Quality of Life and Care Deficiencies
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
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.
Resident Assessment and Care Planning Deficiencies
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Quality of Life and Care Deficiencies
Provide enough food/fluids to maintain a resident's health.
Federal Penalties
Payment Denial
Oct 8, 2025
8-day denial
Fine
Dec 21, 2023
$7,163
Big Horn Rehabilitation and Care Center
for profit
Owners
North Big Horn Hospital District
Owner · Organization
Key personnel
Contact this facility directly and verify the details that matter most to your family.
Medicare Care Compare
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Google Reviews
23 reviews from families & visitors
Official Website
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These are the 2 closest facilities in our data within 10 miles. Proximity does not mean they provide the same care type or have stronger quality signals, so compare each profile and verify services directly.