Cycle 1
Health 2025-01-14 · Fire 2025-01-14
9 health deficiencies
Top issue: Quality of Life and Care (3 deficiencies)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Rapid City, SD
Avantara North
2-star overall rating with 2-star inspections with $6,168 in total fines with 9 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
1620 North 7th Street, Rapid City, SD
(605) 343-4958
Overall
2 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
3 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
68
Certified beds
Average residents
67
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Legacy Healthcare
Operator or chain grouping
Approved since
1992-07-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
90 facilities
Chain averages 3 overall / 3 health / 3 staffing / 3 quality stars
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
Hours and turnover
RN hours / resident day
0.92
Registered nurse staffing · state 0.80 · national 0.68
LPN hours / resident day
0.29
Licensed practical nurse staffing · state 0.49 · national 0.87
Aide hours / resident day
1.81
Nurse aide staffing · state 2.61 · national 2.35
Total nurse hours
3.02
All reported nurse hours · state 3.89 · national 3.89
Licensed hours
1.21
RN + LPN hours · state 1.28 · national 1.54
Weekend hours
2.42
Weekend nurse staffing · state 3.32 · national 3.43
Weekend RN hours
0.59
Weekend registered nurse coverage · state 0.51 · national 0.47
Physical therapist
0.05
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
0.84
CMS adjusted RN staffing hours
Adjusted total hours
2.75
CMS adjusted total nurse staffing hours
Case-mix index
1.50
Higher values indicate more complex resident acuity
RN turnover
33%
Annual RN turnover · state 39% · national 45%
Total nurse turnover
44%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
8,449
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
26.72
Composite VBP score used to determine payment impact.
Payment multiplier
0.9843
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0.63
Baseline 20.80% · Performance 21.14% · Measure score 0.63 · Achievement 0.63 · Improvement 0
Healthcare-associated infections
7.78
Baseline 9.90% · Performance 5.84% · Measure score 7.78 · Achievement 6.68 · Improvement 7.78
Total nurse turnover
2.27
Baseline 45.45% · Performance 54.39% · Measure score 2.27 · Achievement 2.27 · Improvement 0
Adjusted total nurse staffing
0
Baseline 2.98 hours · Performance 3.12 hours · Measure score 0 · Achievement 0 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.2% |
10.72%
1.5 pts better
|
No Different than the National Rate · Eligible stays 78 · Observed rate 6.41% · Lower 95% interval 6.46% |
| Discharge to community | 50.48% |
50.57%
0.1 pts worse
|
No Different than the National Rate · Eligible stays 64 · Observed rate 42.19% · Lower 95% interval 39.35% |
| Medicare spending per beneficiary | 1.18 |
1.02
0.2 pts worse
|
|
| Drug regimen review with follow-up | 94.92% |
95.27%
0.3 pts worse
|
Numerator 56 · Denominator 59 |
| Falls with major injury | 1.69% |
0.77%
0.9 pts worse
|
Numerator 1 · Denominator 59 |
| Discharge self-care score | 39.53% |
53.69%
14.2 pts worse
|
Numerator 17 · Denominator 43 |
| Discharge mobility score | 51.16% |
50.94%
0.2 pts better
|
Numerator 22 · Denominator 43 |
| Pressure ulcers or injuries, new or worsened | 1.69% |
2.29%
0.6 pts better
|
Numerator 1 · Denominator 59 · Adjusted rate 1.69% |
| Healthcare-associated infections requiring hospitalization | 5.84% |
7.12%
1.3 pts better
|
No Different than the National Rate · Eligible stays 54 · Observed rate 1.85% · Lower 95% interval 3.36% |
| Staff COVID-19 vaccination coverage | 10.39% |
8.2%
2.2 pts better
|
Numerator 8 · Denominator 77 |
| Staff flu vaccination coverage | 28.97% |
42%
13 pts worse
|
Numerator 31 · Denominator 107 |
| Discharge function score | 48.84% |
56.45%
7.6 pts worse
|
Numerator 21 · Denominator 43 |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 18 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 16 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 62.07% |
25.2%
36.9 pts better
|
Numerator 18 · Denominator 29 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.8 |
1.5
0.3 pts worse
|
1.9
0.1 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 2.0 · Expected 2.0 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 1.0 |
1.9
0.9 pts better
|
1.8
0.8 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.0 · Observed 1.0 · Expected 1.8 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 96.2% |
95.4%
0.8 pts better
|
93.4%
2.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 98.2% · Q2 98.3% · Q3 91.4% · Q4 96.8% · 4Q avg 96.2% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 95.2% |
96.9%
1.7 pts worse
|
95.5%
0.3 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 95.2% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 1.7% |
5.1%
3.4 pts better
|
3.3%
1.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.8% · Q2 1.7% · Q3 1.7% · Q4 1.6% · 4Q avg 1.7% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 1.4% |
4.6%
3.2 pts better
|
11.4%
10 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 5.1% · 4Q avg 1.4% |
| Percentage of long-stay residents who lose too much weight | 2.9% |
5.5%
2.6 pts better
|
5.4%
2.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 3.8% · Q4 7.5% · 4Q avg 2.9% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 13.5% |
17.8%
4.3 pts better
|
19.6%
6.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 15.7% · Q2 13.0% · Q3 13.2% · Q4 12.3% · 4Q avg 13.5% |
| Percentage of long-stay residents who received an antipsychotic medication | 13.5% |
25.1%
11.6 pts better
|
16.7%
3.2 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 12.8% · Q2 12.2% · Q3 14.6% · Q4 14.3% · 4Q avg 13.5% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 38.7% |
21.3%
17.4 pts worse
|
16.3%
22.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 48.6% · Q2 50.9% · Q3 23.3% · Q4 37.5% · 4Q avg 38.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 31.2% |
21.6%
9.6 pts worse
|
14.9%
16.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 22.9% · Q2 34.0% · Q3 28.0% · Q4 38.9% · 4Q avg 31.2% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 2.0% |
2.0%
About the same
|
1.0%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.3% · Q2 1.8% · Q3 1.7% · Q4 1.5% · 4Q avg 2.0% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 4.4% |
3.3%
1.1 pts worse
|
1.7%
2.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 1.8% · Q2 1.9% · Q3 5.3% · Q4 8.5% · 4Q avg 4.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 20.8% |
25.8%
5 pts better
|
19.8%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.4% · Q2 27.3% · Q3 15.4% · Q4 13.9% · 4Q avg 20.8% |
| Percentage of long-stay residents with pressure ulcers | 6.3% |
4.6%
1.7 pts worse
|
5.1%
1.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.1% · Q2 5.2% · Q3 7.6% · Q4 6.0% · 4Q avg 6.3% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 79.4% |
83.2%
3.8 pts worse
|
81.7%
2.3 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 91.7% · Q2 80.6% · Q3 71.4% · Q4 70.8% · 4Q avg 79.4% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 14.2% |
11.7%
2.5 pts worse
|
12.0%
2.2 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 14.2% · Observed 15.0% · Expected 11.8% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
1.7%
1.7 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 86.1% |
78.2%
7.9 pts better
|
79.7%
6.4 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 86.1% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 29.2% |
21.5%
7.7 pts worse
|
23.9%
5.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 29.2% · Observed 30.0% · Expected 24.5% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-09-28 · Fire 2023-09-28
6 health deficiencies
Top issue: Freedom from Abuse and Neglect and Exploitation (3 deficiencies)
1 fire-safety deficiencies
Top issue: Smoke (1 deficiency)
Cycle 3
Health 2022-09-15 · Fire 2022-09-15
5 health deficiencies
Top issue: Administration (1 deficiency)
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2025-01-14
K222 · Egress Deficiencies
Fire Safety
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.
Corrected 2025-02-10
D · Potential for more than minimal harm
2023-09-28
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-09-29
Inspection history
Recent health citations
G · Actual harm
2025-08-07
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2025-09-05
E · Potential for more than minimal harm
2025-08-07
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-09-05
D · Potential for more than minimal harm
2025-08-07
F628 · Resident Rights Deficiencies
Health
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Corrected 2025-09-05
D · Potential for more than minimal harm
2025-08-07
F695 · Quality of Life and Care Deficiencies
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-09-05
D · Potential for more than minimal harm
2025-08-07
F726 · Nursing and Physician Services Deficiencies
Health
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.
Corrected 2025-05-07
F · Potential for more than minimal harm
2025-01-14
F804 · Nutrition and Dietary Deficiencies
Health
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Corrected 2025-02-28
E · Potential for more than minimal harm
2025-01-14
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2025-02-28
D · Potential for more than minimal harm
2025-01-14
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2025-02-28
D · Potential for more than minimal harm
2025-01-14
F604 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.
Corrected 2025-01-13
D · Potential for more than minimal harm
2025-01-14
F742 · Quality of Life and Care Deficiencies
Health
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.
Corrected 2025-02-28
G · Actual harm
2024-10-07
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2024-09-29
D · Potential for more than minimal harm
2024-10-07
F609 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2024-09-29
F · Potential for more than minimal harm
2023-09-28
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-11-12
D · Potential for more than minimal harm
2023-09-28
F657 · Resident Assessment and Care Planning Deficiencies
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2023-11-12
D · Potential for more than minimal harm
2023-09-28
F693 · Quality of Life and Care Deficiencies
Health
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Corrected 2023-11-12
E · Potential for more than minimal harm
2022-09-15
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2022-11-01
D · Potential for more than minimal harm
2022-09-15
F600 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected 2022-11-01
D · Potential for more than minimal harm
2022-09-15
F686 · Quality of Life and Care Deficiencies
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2022-11-01
D · Potential for more than minimal harm
2022-09-15
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2022-11-01
D · Potential for more than minimal harm
2022-09-15
F849 · Administration Deficiencies
Health
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Corrected 2022-11-01
Penalties and ownership
What sits behind the stars
$6,168
2024-10-07
Fine
Fine · fine $6,168
Fine
Ownership
Chaim Rajchenbach Descendants Tr Ua 04282008
5% Or Greater Direct Ownership Interest · Organization
Doros Generation Trust U/A/D 1/3/12
5% Or Greater Direct Ownership Interest · Organization
Oakway Operations LLC
5% Or Greater Direct Ownership Interest · Organization
Bokf,na
Operational/Managerial Control · Organization
Bokf,na
5% Or Greater Security Interest · Organization
Legacy Healthcare Financial Services LLC
Operational/Managerial Control · Organization
Lohre, Celina
Operational/Managerial Control · Individual
Ptacek, Travis
Operational/Managerial Control · Individual
Rajchenbach, Chaim
Operational/Managerial Control · Individual
Shabat, Menachem
Operational/Managerial Control · Individual
Nearby options
Other facilities in reach
#1
Fountain Springs Healthcare
Rapid City, SD
4-star overall rating with 3-star inspections with $22,526 in total fines with 10 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
#2
Avantara Mountain View
Rapid City, SD
3-star overall rating with 3-star inspections with $9,318 in total fines with 5 recent health deficiencies
#3
Avantara Saint Cloud
Rapid City, SD
1-star overall rating with 2-star inspections with abuse icon flag with $11,408 in total fines with 6 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle
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