31 of the 96 Medicare-certified nursing homes in South Dakota (32%) are for-profit, and all are listed below. 1 of the 31 graded homes earn an A and 6 earn a D or F. They average 3.33 nursing hours per resident per day, 0.46 hours below the 3.79 for every home in South Dakota. Avantara Lake Norden in Lake Norden grades highest at A (85 out of 100).
How for-profit homes in South Dakota compare
This group set against every nursing home in South Dakota, from the current CMS release.
Nursing hours per resident per day
3.33
All homes in South Dakota: 3.79
Worse than the local average
Nurse staff turnover
51.3%
All homes in South Dakota: 48.2%
Worse than the local average
Average ElderGrade score
65/100
All homes in South Dakota: 71.3/100
Worse than the local average
Grade spread
B
C
D
1 grade A, 8 grade B, 16 grade C, 6 grade D,
The best-graded for-profit home in South Dakota is
Avantara Lake Norden
in Lake Norden, SD, grade A, 85/100.
Avantara Clark City runs 35 beds in Clark, and the raw staffing number looks better than it is: 4.17 nurse hours per resident day sits about 8% above the national average, but weekend coverage drops roughly 16% below the home's own weekday level, so the hours aren't spread evenly across the week. Staff turnover of 42.4% is slightly better than the 45.8% national figure, though the CMS staffing rating still lands at 2 out of 5. Inspectors gave a 4 out of 5 health inspection rating and visited recently, in January 2026, but the record carries 7 deficiencies, including one at the harm or jeopardy level and one tied to abuse, plus a single $11,057 fine.
Avantara Huron runs on thin staffing and a rough inspection history. Nurses provide 3.40 hours per resident day, roughly 12 percent under the national average, and weekends drop about 13 percent below what the home manages on weekdays. Staff turnover sits at 54.7 percent, nearly nine points above the national figure, which means the people caring for residents keep changing. The current inspection record carries 21 deficiencies, five of them serious enough to involve harm or jeopardy, and four tied to abuse. State inspectors last visited in March 2026. This is a for-profit limited liability company operating 119 certified beds, with one fine totaling $8,338 on record.
Palisade Healthcare Center runs about 18% below the national average on nurse staffing, and weekends drop roughly another 17% below its own weekday level. The inspection record is the harder problem: 29 deficiencies, five of them at harm or jeopardy level and three tied to abuse, with four fines totaling $154,946. A 60% annual turnover rate against a 45.8% national average means the people at the bedside keep changing. CMS has placed it in the Special Focus Facility program, which is reserved for homes with a persistent pattern of poor care. The quality measure score looks strong on paper, but it sits on top of a staffing and inspection record that families should ask about directly.
Firesteel Healthcare Center runs about 10% below the national average for nurse staffing, at 3.47 hours per resident day, and weekends get thinner still, roughly 15% lighter than the home's own weekdays. The 55% annual turnover rate means more than half the nursing staff leaves within a year, well above the 45.8% national figure. The inspection record is the bigger concern: 33 deficiencies on file, eight serious enough to put residents at risk of harm, one tied to abuse, and $153,308 in fines across six penalties. Ownership is a for-profit limited liability company. The most recent inspection was April 25, 2025, so the picture is current. Ask about weekend coverage and how they've addressed the abuse-related finding.
Rolling Hills Healthcare runs below the national average on nurse staffing, about 3.62 hours per resident day against 3.86, and weekends drop roughly 19% below its own weekday levels, which is when families tend to notice. Staff turnover sits at 65.1% against a national average of 45.8%, meaning most of the people caring for residents this year likely won't be there next year. The inspection record is heavier still: 34 deficiencies, five at harm or jeopardy level, three tied to abuse, and four fines totaling $80,634, with the most recent inspection in February 2026. It's a for-profit limited liability company, and the pattern across these numbers is worth weighing carefully before you decide.
Avantara Milbank runs on thin staffing even before the weekends hit. At 3.23 nurse hours per resident day, it sits roughly 16% under the national average, and weekend coverage drops another 9% below its own weekday level, so the thinnest shifts are also the least supervised. The bigger warning sign is turnover: 91.5% annually, double the national rate, meaning most of the people caring for residents weren't there a year ago. Its inspection record shows 30 deficiencies, including 8 at harm or jeopardy level and 5 tied to abuse, plus three fines totaling $55,361. The most recent inspection was March 2025. For-profit corporate ownership, 55 beds, and a pattern of problems that keep recurring rather than resolving.
Avantara Norton runs 110 certified beds under for-profit limited liability ownership, and its nurse staffing sits right at the national average of 3.86 hours per resident day, essentially no cushion. Weekends drop about 10% below its own weekday coverage, so the thinnest shifts are when families tend to visit. What stands out more is the inspection record: 75 deficiencies, 19 of them at harm or jeopardy level, 5 abuse-related, plus six CMS fines totaling $153,638. Staff turnover is 55.7% against a 45.8% national average, meaning more than half the nursing staff leaves each year. CMS has placed this home in its Special Focus Facility program, a designation reserved for homes with a persistent record of serious problems.
Avantara Watertown is a 51-bed for-profit home, and the numbers that stand out most are on the inspection side. CMS has it in its Special Focus Facility program, a designation reserved for homes with a persistent record of serious problems, and the current file shows 31 deficiencies, including four at the harm or jeopardy level and three tied to abuse. A single CMS fine of $6,368 sits on the record, and the most recent inspection was April 29, 2026. Nurse staffing runs 3.57 hours per resident day, about 8% under the national average, and weekends drop roughly 20% below the home's own weekday levels. Staff turnover, at 44.2%, is close to the national figure, so retention isn't the outlier here. The inspection record is.
Riverview Healthcare Center is a 63-bed for-profit home in Flandreau, and the numbers behind its record deserve a hard look. Nurse staffing sits at 3.62 hours per resident per day, about 6% under the national average, and it thins out further on weekends, roughly 12% below the home's own weekday levels. Annual turnover runs 66.7% against a national 45.8%, so caregivers are cycling through constantly.
That instability shows up in the inspection record: 35 deficiencies, 14 at harm or jeopardy level, 10 abuse-related, and six fines totaling $176,867. CMS has placed it in the Special Focus Facility program, the agency's watchlist for homes with persistent serious problems. If you're considering this one, ask pointed questions about what's changed since the February 2025 inspection.
Avantara Saint Cloud runs a 78-bed for-profit home in Rapid City under an LLC, and the numbers raise real questions. Nurse staffing sits at 3.12 hours per resident day, about 19% under the national average of 3.86, and weekends drop roughly another 9% below the home's own weekday coverage, so the thinnest shifts land when families often visit. Staff turnover is 57.3% against a national 45.8%, meaning more than half the nursing team turns over in a year. On the current record: 17 deficiencies, three at harm or jeopardy level, two tied to abuse, and $24,751 in fines. The most recent inspection was January 2026.
Avantara Arrowhead runs on 3.52 nursing hours per resident day, about 9% under the national average, and weekends dip roughly 7% below its own weekday staffing. That thin coverage sits alongside a 76.1% annual turnover rate, well above the 45.8% national figure, meaning the aides and nurses at the bedside are frequently new. The current inspection record shows 37 deficiencies, nine of them serious enough to cause harm or jeopardy, four tied to abuse, and five fines totaling $82,863, with the last inspection in September 2025. For-profit, LLC-owned, 68 beds. The pattern across staffing, turnover, and inspection history is what drives the low marks.
Frequently asked questions
How many for-profit nursing homes are there in South Dakota?
There are 31 for-profit Medicare-certified nursing homes in South Dakota, 32% of the 96 nursing homes there.
Are for-profit nursing homes better staffed?
In South Dakota they average 3.33 total nursing hours per resident per day, against 3.79 for all nursing homes in South Dakota, a difference of -0.46 hours. Staff turnover averages 51.3% against 48.2%.
Which for-profit nursing home grades best in South Dakota?