49 of the 96 Medicare-certified nursing homes in South Dakota (51%) are chain-owned, and all are listed below. Nurse staff turnover runs 51%, 2.8 points higher than the 48.2% across all homes there. They average 3.59 nursing hours per resident per day, 0.2 hours below the 3.79 for every home in South Dakota. Avera Prince Of Peace in Sioux Falls grades highest at A (94 out of 100).
How chain-owned 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
3.59
All homes in South Dakota: 3.79
Worse than the local average
Nurse staff turnover
51%
All homes in South Dakota: 48.2%
Worse than the local average
Average ElderGrade score
68.6/100
All homes in South Dakota: 71.3/100
Worse than the local average
Grade spread
A
B
C
D
5 grade A, 14 grade B, 22 grade C, 7 grade D,
The best-graded chain-owned home in South Dakota is
Avera Prince Of Peace
in Sioux Falls, SD, grade A, 94/100.
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.
Good Samaritan Society Miller runs 50 beds in Hand County, and the numbers here deserve a close look before you decide. Nurse staffing sits just under the national average, but weekends run about 15 percent thinner than weekdays, and annual turnover of 70.8 percent means most of the people caring for residents are relatively new, against a national rate nearer 46 percent. The inspection record shows 22 deficiencies, four of them at harm or jeopardy level and two tied to abuse, with $96,127 in fines across two penalties. A recent February 2026 inspection and a 1-out-of-5 quality measure score round out a picture worth asking hard questions about.
Good Samaritan Society - Wagner runs 50 certified beds as a nonprofit corporation, and its current record shows no deficiencies at all, not at the harm or jeopardy level, not abuse-related, nothing. The last inspection was January 7, 2026, so the state's findings are recent, not a stale snapshot from two or three years back. A clean record like that usually reflects steady day-to-day operations rather than luck, since inspectors tend to flag something on most surveys. What the data here can't tell you is how the place feels to visit, staffing ratios at the moment you'd call, how the dining room runs, whether your family member's specific needs fit. Ask those questions on a tour, and ask what happens when a resident's condition changes.
Frequently asked questions
How many chain-owned nursing homes are there in South Dakota?
There are 49 chain-owned Medicare-certified nursing homes in South Dakota, 51% of the 96 nursing homes there.
Are chain-owned nursing homes better staffed?
In South Dakota they average 3.59 total nursing hours per resident per day, against 3.79 for all nursing homes in South Dakota, a difference of -0.2 hours. Staff turnover averages 51% against 48.2%.
Which chain-owned nursing home grades best in South Dakota?