Homes where the federal record contains at least one of the following: a CMS abuse icon, Special Focus
Facility status or candidacy, or a citation scored at actual harm or immediate jeopardy. Ordered with
Special Focus homes first.
Read this as a prompt, not a verdict. A citation can be years old and the management
responsible may have gone. It means you ask what happened and what changed, and you get a specific answer
before you sign anything.
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.
Winner Regional Healthcare Center sits in a small South Dakota town and puts more direct nursing time into each resident than most homes in the country, about five hours a day against a national figure near four. That cushion matters, and it's the main reason inspections look solid, with the most recent visit in December 2024. The trouble is what the numbers show underneath the surface: weekend coverage drops roughly a fifth below its own weekday pace, and more than two-thirds of staff turned over last year, well above the typical rate. Eighteen deficiencies sit on the record, including three tied to abuse and one involving actual harm. Quality scores are weak despite the staffing.
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.
Wilmot Care Center has enough hands on deck, 4.20 nurse staffing hours per resident day, roughly 9% above the national average, but almost everything else on its record is a problem. The home has been flagged as a Special Focus Facility, the CMS watch list for homes with a pattern of serious, repeated deficiencies: 18 total on the current record, two of them at the harm or jeopardy level, plus two fines totaling $28,028. Its last inspection was in March 2025. Staff turnover sits at 60.5% against a national average of 45.8%, and weekend staffing drops about 11% below the home's own weekday level. The staffing is there; the consistency and the compliance record are not.
Medicine Wheel Village sits in Eagle Butte with 50 certified beds and a staffing picture that looks strong on paper, 4.79 nurse hours per resident day, about 24% above the national average, with turnover at 31.4% versus 45.8% nationally. Weekends run roughly 16% leaner than weekdays, so coverage isn't perfectly even. The trouble is what inspections have found: 27 deficiencies, including one at the harm or jeopardy level and three tied to abuse, plus a $22,636 fine and a place in CMS's Special Focus Facility program. Quality measure scores look good, but a recent inspection and that many citations on record are the numbers that matter most for daily safety.
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.
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.
Avantara Pierre runs a 65-bed for-profit home in Hughes County, and the staffing numbers are the first thing to notice: 2.81 nurse hours per resident day, roughly 27% under the national average of 3.86. Weekends thin out further, about 19% below the home's own weekday coverage. Turnover sits at 40.5%, better than the 45.8% national figure, so the people who stay seem to stay. The trouble is the record: 33 deficiencies, three of them at harm or jeopardy level, one tied to abuse, and a $22,048 fine. Inspectors were last in on April 2, 2025.
Spearfish Canyon Healthcare runs 105 certified beds under for-profit LLC ownership, and the staffing numbers are where your attention should go first. At 3.37 nurse hours per resident day, it sits about 13 percent under the national average, and weekends drop another 13 percent below its own weekday levels, so the coverage gap widens exactly when families tend to visit. Staff turnover of 58.8 percent against a 45.8 percent national figure means caregivers are cycling through steadily, which matters more than any single star rating. The inspection record backs that up: 21 deficiencies, including four tied to abuse and one at the harm level, with a $9,718 fine. The most recent inspection was August 2025, so the record is current, not stale.
Good Samaritan Society Sioux Falls Center runs 98 certified beds as a nonprofit, and its staffing sits at 3.58 nurse hours per resident day, about 7% under the national average of 3.86. Weekends drop roughly 12% below its own weekday coverage, which matters if your family visits or calls on Saturdays and Sundays. Turnover is 44.2%, a hair under the national 45.8%, so retention here isn't the problem. The inspection record is: 18 deficiencies, three of them at harm or jeopardy level and three tied to abuse, plus one fine of $11,261. The most recent inspection was September 5, 2025.
The staffing numbers at United Living Community look strong at first glance, 4.78 nurse hours per resident day, well above the national average, and CMS agrees, giving it 4 out of 5 staffing stars. But weekends run about 12% leaner than weekdays, so the coverage your family member gets on a Saturday won't match a Tuesday. Turnover sits at 50%, higher than the national 45.8%, meaning the people providing that care are often new. The inspection record is where things get concerning: 22 deficiencies, including 2 at the harm level and 5 abuse-related, plus $33,027 in fines. That combination is what pulls the overall picture down to a C.
Centerville Care and Rehab runs 42 certified beds under corporate ownership, and its nurse staffing sits at 3.31 hours per resident day, roughly 14% under the national average of 3.86. Weekends thin out further, running about 18% below the home's own weekday coverage, which matters when you're thinking about who's on hand on a Saturday night.
The inspection record shows 19 deficiencies, including one at the harm or jeopardy level and two tied to abuse. One fine totaling $55,059 has been levied. Staff turnover comes in at 43.9%, slightly better than the national 45.8%, and the most recent inspection was May 2025. The staffing and quality measure ratings both land at 2 out of 5.
Sunset Manor runs a genuinely strong bedside staffing line, 5.10 nurse hours per resident day, roughly a third more than the national norm, and that's the one number here that works in families' favor. But weekends dip about 16% below the home's own weekday coverage, and the same staff is turning over at 70.4% a year against a national 45.8%, so the people delivering that care keep changing. Inspectors cited 17 deficiencies on the current record, four at harm or jeopardy level and five tied to abuse, with $40,596 in fines, and the most recent inspection closed out in late December 2025. Nonprofit ownership hasn't kept the compliance record clean.
Bethany Home in Brandon has plenty of hands on deck, 4.66 nurse hours per resident day, roughly a fifth more than the national average, and that staffing shows up in its four-out-of-five staffing rating. But the numbers stop looking good there. State inspectors have cited 27 deficiencies on the current record, four of them at the level where residents were actually harmed or put in jeopardy, and four tied to abuse. The health inspection and quality ratings both sit at the bottom of the scale, and the home has paid three fines totaling $51,350. Weekend coverage runs about 14 percent thinner than weekdays, and 54 percent of staff turned over last year, above the national rate.