Granite Rehabilitation and Wellness
3128 Boxelder Dr, Cheyenne, WY 82001 · Laramie County · (307) 634-7901
146 certified beds, about 79 residents a day · For profit - Corporation · Medicare and Medicaid since 1973
Ownership changed in the last 12 months Certified for Medicaid Certified for Medicare
Overall
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
3 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 535013 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on March 26, 2026, inspectors cited 5 health deficiencies (the Wyoming average is 7.8, the national average 9.2).
Of 25 health citations since May 2023, 3 were rated as actual harm or immediate jeopardy to residents.
CMS lists 2 fines totaling $59,018 in the last three years; the largest was $43,470, and the latest is dated March 26, 2026.
Nurses and nurse aides worked 3.51 hours per resident per day, against 3.87 across Wyoming and 3.86 nationally. Registered nurses accounted for 0.75 of those hours.
44.3% of nursing staff left within the year CMS measured (Wyoming average 51.8%).
CMS links it to Evergreen Healthcare Group, an affiliated group of 43 nursing homes.
Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
505/23
110/23
504/24
708/24
206/25
503/26
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 25 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
0J
0K
0L
Actual harm
3G
0H
0I
Potential for more than minimal harm
11D
8E
3F
Potential for minimal harm
0A
0B
0C
March 26, 2026Standard inspection, Complaint inspection · 5 citations
- G Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, medical record review, resident, resident representative, and staff interview, facility incident review, and policy and procedure review, the facility failed to ensure residents' environment was free of accident hazards on 3 of 4 resident care units (1st floor, 2nd floor, 3rd floor) reviewed for safe water temperatures and for 2 of 3 sample residents (#5, #97) reviewed for falls. The facility implemented a plan of correction regarding the fall during van transport for resident #5, prior to the survey, and verified during the survey. The facility was determined to be in compliance for the fall during van transport on 3/11/26.
- G Provide enough food/fluids to maintain a resident's health.
Inspectors wroteBased on observation, staff interview, medical record review, and review of facility policy, the facility failed to ensure adequate interventions and monitoring were provided to prevent significant weight loss and resulting harm for 2 of 8 sample residents (#2, #10) reviewed for nutrition, and offer sufficient fluid intake for 1 of 4 units (secure unit) reviewed for hydration.
- E 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.
Inspectors wroteBased on observation and resident and staff interview, the facility failed to provide the residents with a comfortable and homelike environment in 3 of 3 showering areas.
- D Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on medical record review, staff and resident interview, facility incident review, and standard of practice review, the facility failed to ensure treatment and care was provided to 1 of 4 sample residents (#5) reviewed for falls.
- D Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure outdated food was disposed of in 1 of 1 kitchen. 1. Observation on 3/23/26 at 2:05 PM in the main kitchen showed there were 5 sealed cups of thickened orange juice that had a best-buy date of 11/8/25 in the refrigerator used for the storage of drinks that were provided to residents. 2. Observation on 3/23/26 at 2:09 PM showed the FANS Manager #2 threw away a case of thickened orange juice cups that had been stored in the dry storage room. 3. Interview with the FANS manager #1 on 3/23/36 at 2:05 PM revealed all drinks in the refrigerator were for resident use, and resident #27 received thickened liquids. Further interview confirmed the juices were outdated, and the juice cups should not be served to residents. 4. Review of the facility policy titled Food Storage last updated 10/2017 showed .11. [...]
June 24, 2025Complaint inspection · 2 citations
- G Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure residents with dementia received the appropriate treatment and services to attain their highest practicable physical, mental, and psychosocial well-being for 1 of 3 residents (#1) reviewed for behavioral and emotional needs. This failure resulted in actual harm to resident #1 who was arrested for aggravated assault and taken to jail.
- D Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.
Inspectors wroteBased on medical record review, staff interview, and policy and procedure review, the facility failed to ensure a safe and orderly discharge from the facility for 1 of 5 sample residents (#1) reviewed for discharge.
August 7, 2024Standard inspection · 7 citations
- F Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Inspectors wroteBased on observation, resident and staff interviews, review of payroll-based journal (PBJ) data, and review of facility staff postings, the facility failed to ensure sufficient nursing staff was provided to ensure sufficient nursing staff to provide resident care. The census was 83.
- E Implement 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.
Inspectors wroteBased on medical record review, staff interview, and policy and procedure review, the facility failed to ensure target symptoms were identified and monitoring of target symptoms was completed for 1 of 5 sample residents (#10) reviewed for unnecessary psychotropic medications.
- E 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.
Inspectors wroteBased on observation, staff interview, and policy review, the facility failed to ensure medications available for resident use were not expired in 1 of 3 storage areas (2nd floor medication room).
- D Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Inspectors wroteBased on medical record review, staff interview, and policy and procedure review, the facility failed to ensure a care plan was developed for 1 of 2 sample residents (#10) with post-traumatic stress disorder.
- D Provide activities to meet all resident's needs.
Inspectors wroteBased on observation, resident and staff interview, medical record review, and policy review, the facility failed to ensure resident activities of interest were provided for 1 of 1 sample resident (#12) with activity concerns.
- D Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder.
Inspectors wroteBased on medical record review, staff interview, and policy and procedure review, the facility failed to ensure behavioral health services were provided to 1 of 2 sample residents (#10) with post-traumatic stress disorder.
- D Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, medical record review, staff interview, and professional standard of practice review, the facility failed to ensure infection prevention practices were implemented during for 1 of 2 sample residents (#81) observed for personal care.
April 12, 2024Complaint inspection · 5 citations
- F Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Inspectors wroteBased on observation, resident and staff interview, medical record review, and resident grievance form review, the facility failed to ensure adequate staffing in 1 of 1 kitchen (main kitchen). The census was 72.
- E Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Inspectors wroteBased on observation, resident, resident representative, and staff interview, and grievance log review, the facility failed to ensure prompt efforts were made to resolve grievances for 1 of 4 grievance areas (food service and palatability). The census was 72.
- E Provide care and assistance to perform activities of daily living for any resident who is unable.
Inspectors wroteBased on observation, resident, resident representative, and staff interview, medical record review, and facility grievance review, the facility failed to ensure bathing was performed per the plan of care on 2 of 2 resident care units (second floor, third floor). The census was 72.
- E Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Inspectors wroteBased on observation, resident and staff interview,review of grievance forms, and medical record review, the facility failed to ensure palatable food was served in 1 of 1 kitchen (main kitchen). The census was 72.
- D Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, staff interview, and review of the facility's policy, the facility failed to ensure staff correctly donned personal protective equipment (PPE) prior to resident care for 1 of 5 sample residents (#17) who were on transmission-based precautions.
October 11, 2023Complaint inspection · 1 citation
- E Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on medical record review, receiving facility staff interview, and staff interview, the facility failed to obtain and/or implement physician orders for follow-up care for 2 of 4 sample residents(#1, #11) admitted following a hospitalization.
May 25, 2023Standard inspection · 5 citations
- F Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on review of the dishwasher temperature log sheet, policy and procedure, and the 2017 U.S. Public Health Service Food Code, and staff interview, the facility failed to ensure the water temperature of the dishwasher was at the proper temperature and/or the sanitizer concentration was checked for 11 of 69 meals. The census was 82.
- E Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, medical record review, staff interview, and policy and procedure review, the facility failed to ensure infection control measures were implemented for 1 observation of resident wound care (#73), and 3 random observations related to personal hygiene and incontinence care which affected residents #8, #13, #26, and #48.
- D Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Inspectors wroteBased on observation, resident and staff interview, and medical record review, the facility failed to provide timely assistance with toileting care for 1 of 7 residents (#48) reviewed for ADLs.
- D Implement 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.
Inspectors wroteBased on medical record review and staff interview, the facility failed to ensure medication-specific target behaviors and appropriate monitoring were in place for 1 of 5 (#43) sample residents reviewed for psychotropic medication use.
- D Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs.
Inspectors wroteBased on observation, resident and staff interview, the facility failed to ensure residents received additional portions of food according to their personal preferences for 2 of 3 (#36, #287) sample residents reviewed for satisfaction with food services. The census was 82.
Fire safety inspections
30 fire safety citations on file: 9 on March 26, 2026, 1 on December 11, 2024, 9 on August 7, 2024, 11 on May 25, 2023.
Every fire safety citation30 citations
- F Install an approved automatic sprinkler system.
- E Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
- E Have properly installed hallway dispensers for alcohol-based hand rub.
- D Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- D Have exits that are accessible at all times.
- D Install emergency lighting that can last at least 1 1/2 hours.
- D Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
- D Inspect, test, and maintain automatic sprinkler systems.
- D Ensure proper usage of power strips and extension cords.
- D Have properly installed electrical wiring and gas equipment.
- F Meet other general requirements.
- E Properly select, install, inspect, or maintain portable fire extinguishes.
- E Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
- D Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- D Have approved installation, maintenance and testing program for fire alarm systems.
- D Install an approved automatic sprinkler system.
- D Inspect, test, and maintain automatic sprinkler systems.
- D Install corridor and hallway doors that block smoke.
- D Ensure precautions for handling oxygen cylinders and equipment are correctly followed.
- F Implement emergency and standby power systems.
- F Meet other general requirements.
- F Have approved installation, maintenance and testing program for fire alarm systems.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Have elevators that firefighters can control in the event of a fire.
- F Have generator or other power source capable of supplying service within 10 seconds.
- E Provide properly protected cooking facilities.
- E Install an approved automatic sprinkler system.
- D Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- D Have restrictions on the use of portable space heaters.
- D Ensure proper usage of power strips and extension cords.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| March 26, 2026 | Fine | $43,470 |
| June 24, 2025 | Fine | $15,548 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Staffing
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Wyoming | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 3.51 | 3.87 | 3.86 |
| Registered nurses | 0.75 | 0.94 | 0.69 |
| All nursing staff on weekends | 3.30 | 3.37 | 3.42 |
| Nurse aides | 1.88 | ||
| Licensed practical nurses | 0.88 | ||
| Nursing staff turnover (share who left in a year) | 44.3% | 51.8% | 45.8% |
| Registered nurse turnover | 36.4% | 44.1% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.57 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Staffing by quarter, from daily payroll records
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 3.60 on weekdays and 3.30 on weekends, 8% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 0.0% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 3.19 in April to June 2025 to 3.51 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 3.51 | 0.75 | 3.60 | 3.30 | 0.0% | 0 of 90 | 79 |
| Oct to Dec 2025 | 3.17 | 0.73 | 3.24 | 2.99 | 0.0% | 0 of 92 | 88 |
| Jul to Sep 2025 | 3.16 | 0.63 | 3.24 | 2.95 | 0.0% | 0 of 92 | 87 |
| Apr to Jun 2025 | 3.19 | 0.60 | 3.31 | 2.89 | 0.0% | 0 of 91 | 83 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Wyoming, Jan to Mar 2026 | 3.61 | 0.86 | 3.80 | 3.15 | 7.5% | 0.1% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Quality measures
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Wyoming | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 11.9 | 16.8 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 0.0 | 1.5 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.7 | 3.0 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 2.0 | 4.7 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 0.0 | 1.2 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 15.1 | 15.3 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 2.1 | 4.6 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 17.9 | 21.8 | 15.4 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission Short Stay residents, 20250101-20251231 | 26.6 | 18.9 | 23.8 |
| Percentage of short-stay residents who had an outpatient emergency department visit Short Stay residents, 20250101-20251231 | 24.3 | 16.7 | 12.0 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.7 | 1.3 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 1.6 | 2.3 | 1.8 |
Owners and operators
Legal business name: NORTH BIG HORN HOSPITAL DISTRICT. CMS links this home to Evergreen Healthcare Group, a group of 43 nursing homes averaging 2.4 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Couve Financial Services LLC | Operational/managerial control | Organization | 09/30/2025 | |
| Couve Healthcare Consulting LLC | Operational/managerial control | Organization | 09/30/2025 | |
| Granite SNF Operations LLC | Operational/managerial control | Organization | 09/30/2025 | |
| Pacific Northwest Opco Management LLC | Operational/managerial control | Organization | 09/30/2025 | |
| Connell, Eric | Operational/managerial control | Individual | 09/30/2025 | |
| Dobson, Joseph | Operational/managerial control | Individual | 09/30/2025 | |
| Hancock, Brenda | Operational/managerial control | Individual | 09/30/2025 | |
| Morrison, Robert | Operational/managerial control | Individual | 09/30/2025 | |
| Simmons, Benjamin | Operational/managerial control | Individual | 09/30/2025 | |
| Spielman, Shimon | Operational/managerial control | Individual | 09/30/2025 | |
| Winterholler, David | Operational/managerial control | Individual | 09/30/2025 | |
| Yenowitz, Yitzchok | Operational/managerial control | Individual | 09/30/2025 | |
| Couve Financial Services LLC | Adp of the SNF | Organization | 11/21/2025 | |
| Couve Healthcare Consulting LLC | Adp of the SNF | Organization | 10/13/2025 | |
| Granite SNF Operations LLC | Adp of the SNF | Organization | 10/13/2025 | |
| Granite SNF Realty LLC | Adp of the SNF | Organization | 10/13/2025 | |
| Pacific Northwest Opco Management LLC | Adp of the SNF | Organization | 10/13/2025 | |
| Connell, Eric | Adp of the SNF | Individual | 09/30/2025 | |
| Dobson, Joseph | Adp of the SNF | Individual | 09/30/2025 | |
| Hancock, Brenda | Adp of the SNF | Individual | 09/30/2025 | |
| Simmons, Benjamin | Adp of the SNF | Individual | 09/30/2025 | |
| Spielman, Shimon | Adp of the SNF | Individual | 09/30/2025 | |
| Yenowitz, Yitzchok | Adp of the SNF | Individual | 09/30/2025 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Questions to ask on a visit
Chosen from this home's own inspection record.
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 9 problems in this area, most recently on March 26, 2026: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
- Can we see a week of menus and the kitchen, and how are special diets handled?Inspectors cited 5 problems in this area, most recently on March 26, 2026: "Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards."
- How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 3 problems in this area, most recently on March 26, 2026: "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."
- How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 3 problems in this area, most recently on August 7, 2024: "Implement 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."
- Who is on the floor on Saturday and Sunday, and how many residents does each aide care for?Weekend nurse staffing here was 3.30 hours per resident per day, below the Wyoming average of 3.37.
Other nursing homes nearby
- Polaris Rehabilitation and Care Center Cheyenne, 0.2 mi · 1 of 5 stars · 41 citations
- Life Care Center of Cheyenne Cheyenne, 2.3 mi · 5 of 5 stars · 13 citations
Wyoming contacts for a concern about a nursing home
These are the official offices in Wyoming. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: Wyoming Department of Health, Healthcare Licensing and Surveys, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: Wyoming Long-Term Care Ombudsman Program, 307-287-7757. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: Wyoming HLS Newest Facility Inspection Reports, where Wyoming publishes its own records on licensed homes.
Common questions
- What is Granite Rehabilitation and Wellness's Medicare star rating?
- CMS rates Granite Rehabilitation and Wellness 2 out of 5 stars overall, with 2 for health inspections, 4 for staffing and 3 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Granite Rehabilitation and Wellness get at its last inspection?
- 5 health deficiencies at the standard inspection on March 26, 2026. The Wyoming average is 7.8.
- Has Granite Rehabilitation and Wellness been fined?
- Yes. CMS lists 2 fines totaling $59,018 in the last three years.
- Does Granite Rehabilitation and Wellness accept Medicaid?
- It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
- Who owns Granite Rehabilitation and Wellness?
- CMS lists 23 owners and managers, and links the home to Evergreen Healthcare Group. Legal business name: NORTH BIG HORN HOSPITAL DISTRICT.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.