Tobacco Root Mountains Care Center
326 Madison St., Sheridan, MT 59749 · Madison County · (406) 842-5600
39 certified beds, about 15 residents a day · Government - County · Medicare and Medicaid since 1996
CMS Care Compare ratings, data as of September 1, 2026 · CCN 275147 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on May 21, 2026, inspectors cited 2 health deficiencies (the Montana average is 11.2, the national average 9.2).
Of 11 health citations since April 2024, 2 were rated as actual harm or immediate jeopardy to residents.
CMS lists 1 fine totaling $56,280 in the last three years; the largest was $56,280, and the latest is dated April 1, 2026.
Nurses and nurse aides worked 7.05 hours per resident per day, against 4.05 across Montana and 3.86 nationally. Registered nurses accounted for 1.74 of those hours.
72.7% of nursing staff left within the year CMS measured (Montana average 54.8%).
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.
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 11 health citations on file.
May 21, 2026Standard inspection · 2 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 observation, interview, and record review, the facility failed to ensure safe labeling of food storage in accordance with professional standards for food service safety, placing all residents at risk for consumption of expired or contaminated food and for food-borne illness. This deficient practice increased the risk of negative outcomes for all residents receiving food services from the facility.
- D Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Inspectors wroteBased on interview and record review, the facility failed to indicate a specific duration for the extended use of an as needed psychotropic medication past 14 days for 1 (#15) of 11 sampled residents. This deficient practice increased the risk of negative outcomes for residents on as needed psychotropic medications.
April 1, 2026Complaint 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, interview and record review, the facility staff failed to proactively identify and address the risks a heater posed to a dependent resident when the heater was next to the resident's bed, and the resident sustained second degree burns on her left calf, left toes, left heel, left foot, and the entire bottom of her left foot from the heater, for 1 (#1) of 10 sampled residents.
- G Provide safe, appropriate pain management for a resident who requires such services.
Inspectors wroteBased on interviews and record review, the facility failed to ensure adequate pain management for 2 (#s 1 and 2) of 10 sampled residents. This deficient practice resulted in residents #1 and #2 having moderate and severe pain during the last day of life.
- D Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Inspectors wroteBased on interview and record review, the facility failed to protect a resident from staff to resident abuse for 1 (#5) of 10 sampled residents.
- D Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Inspectors wroteBased on interview and record review, the facility failed to initially report an incident of suspected resident-to-resident abuse to the State Survey Agency within the required timeframe for 2 (#s 5 and 6) of 10 sampled residents.
- D Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Inspectors wroteBased on interviews and record review, the facility failed to ensure nurses were competent to provide pain management for hospice and end-of-life care for 2 (#s 1 and 2) of 10 sampled residents. This deficient practice resulted in unnecessary pain for residents #1 and #2.
April 9, 2025Complaint inspection · 1 citation
- D Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent an incident of physical and verbal abuse for 1 (#1) of 12 sampled residents. The event was identified as past non compliance due to the facility's actions.
April 10, 2024Standard inspection · 3 citations
- D Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on observation, interview, and record review, the facility staff failed to revise the care plans for 2 (#s 16 and 73) of 14 sampled residents. This deficient practice negatively affected resident #16 due to a lack of pain control in her legs, and after resident #73 was readmitted from the hospital, the staff did not have adequate directions for the provision of care and services for the resident.
- D Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Inspectors wroteBased on observation, interview, and record review, the facility staff failed to ensure medications were given within the one-hour time period before or after the prescribed administration time for 1 (#4) of 14 sample residents; and failed to ensure the residents safely swallowed the medications for 2 (#s 2 and 10) of 14 sampled residents. This deficient practice may result in an increased risk for adverse effects and/or complications with choking or aspiration.
- D Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, interview, and record review, the facility failed maintain a system to ensure cloth recliners in the resident dayroom were monitored for necessary cleaning for infection control prevention. This deficient practice had the potential to affect all residents who utilized the dayroom, and used the recliners, as it increased the risk for the spread of infectious agents.
Fire safety inspections
3 fire safety citations on file: 1 on May 21, 2026, 2 on April 10, 2024.
Every fire safety citation3 citations
- F Have generator or other power source capable of supplying service within 10 seconds.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Ensure that testing and maintenance of electrical equipment is performed.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| April 1, 2026 | Fine | $56,280 |
| April 1, 2026 | Payment Denial | 49 days from May 5, 2026 |
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 | Montana | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 7.05 | 4.05 | 3.86 |
| Registered nurses | 1.74 | 0.98 | 0.69 |
| All nursing staff on weekends | 6.37 | 3.59 | 3.42 |
| Nurse aides | 4.65 | ||
| Licensed practical nurses | 0.66 | ||
| Nursing staff turnover (share who left in a year) | 72.7% | 54.8% | 45.8% |
| Registered nurse turnover | 42.9% | 48.3% | 42.9% |
| Administrators who left | 0 |
CMS expects 4.01 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 7.32 on weekdays and 6.37 on weekends, 13% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 60.1% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 6.67 in April to June 2025 to 7.05 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 | 7.05 | 1.74 | 7.32 | 6.37 | 60.1% | 0 of 90 | 15 |
| Oct to Dec 2025 | 7.79 | 2.01 | 8.14 | 6.91 | 41.9% | 0 of 92 | 13 |
| Jul to Sep 2025 | 7.65 | 1.61 | 8.06 | 6.60 | 7.4% | 0 of 92 | 16 |
| Apr to Jun 2025 | 6.67 | 1.13 | 7.22 | 5.31 | 0.1% | 0 of 91 | 19 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Montana, Jan to Mar 2026 | 3.91 | 0.89 | 4.10 | 3.46 | 11.6% | 0.4% 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 | Montana | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 17.1 | 18.7 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 9.9 | 2.1 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.0 | 2.9 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 12.7 | 4.4 | 3.2 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 23.2 | 17.2 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 7.7 | 6.3 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 18.9 | 20.4 | 15.4 |
Owners and operators
Legal business name: MADISON COUNTY FINANCE.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Madison County Finance | 5% or greater direct ownership interest | Organization | 100% | 01/01/1966 |
| Allhands, Daniel | W-2 managing employee | Individual | 01/01/2017 | |
| Forsythe, Jayne | W-2 managing employee | Individual | 02/06/2020 | |
| Hart, James | W-2 managing employee | Individual | 01/01/2015 | |
| Nye, Ronald | W-2 managing employee | Individual | 01/01/2015 | |
| Oneill, Bonnie | W-2 managing employee | Individual | 02/06/2020 | |
| Allhands, Daniel | Corporate officer | Individual | 01/01/2017 | |
| Hart, James | Corporate officer | Individual | 01/01/2007 | |
| Nye, Ronald | Corporate officer | Individual | 01/01/2015 |
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 are allegations of abuse or neglect reported and investigated, and who tells the family?Inspectors cited 4 problems in this area, most recently on May 21, 2026: "Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function."
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 2 problems in this area, most recently on April 1, 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 1 problem in this area, most recently on May 21, 2026: "Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards."
- How many nurses and aides work each shift, nights and weekends included?Inspectors cited 1 problem in this area, most recently on April 1, 2026: "Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being."
Other nursing homes nearby
- Madison Valley Manor Ennis, 23.5 mi · 5 of 5 stars · 14 citations
Montana contacts for a concern about a nursing home
These are the official offices in Montana. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: Montana DPHHS, Office of Inspector General, Certification Bureau, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: Montana Long-Term Care Ombudsman Program, Senior and Long Term Care Division, (800) 332-2272. 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: Certification Bureau Survey Results and Plans of Correction, where Montana publishes its own records on licensed homes.
Common questions
- What is Tobacco Root Mountains Care Center's Medicare star rating?
- CMS rates Tobacco Root Mountains Care Center 1 out of 5 stars overall, with 2 for health inspections, 4 for staffing and 1 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Tobacco Root Mountains Care Center get at its last inspection?
- 2 health deficiencies at the standard inspection on May 21, 2026. The Montana average is 11.2.
- Has Tobacco Root Mountains Care Center been fined?
- Yes. CMS lists 1 fine totaling $56,280 in the last three years.
- Does Tobacco Root Mountains Care Center 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 Tobacco Root Mountains Care Center?
- CMS lists 9 owners and managers. Legal business name: MADISON COUNTY FINANCE.
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.