Cycle 1
Health 2024-12-05 · Fire 2024-12-05
4 health deficiencies
Top issue: Pharmacy Service (3 deficiencies)
2 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Watertown, SD
Avantara Watertown
3-star overall rating with 3-star inspections with $6,368 in total fines with 4 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
415 Fourth Ave Ne, Watertown, SD
(605) 886-8431
Overall
3 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
51
Certified beds
Average residents
46
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Legacy Healthcare
Operator or chain grouping
Approved since
1993-03-01
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
1.16
Registered nurse staffing · state 0.80 · national 0.68
LPN hours / resident day
0.27
Licensed practical nurse staffing · state 0.49 · national 0.87
Aide hours / resident day
2.18
Nurse aide staffing · state 2.61 · national 2.35
Total nurse hours
3.61
All reported nurse hours · state 3.89 · national 3.89
Licensed hours
1.43
RN + LPN hours · state 1.28 · national 1.54
Weekend hours
3.02
Weekend nurse staffing · state 3.32 · national 3.43
Weekend RN hours
0.76
Weekend registered nurse coverage · state 0.51 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.06 · national 0.07
Adjusted RN hours
1.14
CMS adjusted RN staffing hours
Adjusted total hours
3.55
CMS adjusted total nurse staffing hours
Case-mix index
1.39
Higher values indicate more complex resident acuity
RN turnover
17%
Annual RN turnover · state 39% · national 45%
Total nurse turnover
39%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
7,582
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
29.37
Composite VBP score used to determine payment impact.
Payment multiplier
0.9854
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
0.52
Performance 21.19% · Measure score 0.52 · Achievement 0.52 · This facility did not have sufficient data to calculate a baseline period measure result.
Healthcare-associated infections
1.88
Baseline 6.49% · Performance 7.27% · Measure score 1.88 · Achievement 1.88 · Improvement 0
Total nurse turnover
6.91
Baseline 51.06% · Performance 35.42% · Measure score 6.91 · Achievement 6.91 · Improvement 5.47
Adjusted total nurse staffing
2.44
Baseline 3.44 hours · Performance 3.77 hours · Measure score 2.44 · Achievement 2.44 · Improvement 0.91
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 10.95% |
10.72%
0.2 pts worse
|
No Different than the National Rate · Eligible stays 38 · Observed rate 10.53% · Lower 95% interval 6.83% |
| Discharge to community | 41.77% |
50.57%
8.8 pts worse
|
No Different than the National Rate · Eligible stays 34 · Observed rate 35.29% · Lower 95% interval 27.63% |
| Medicare spending per beneficiary | 1.16 |
1.02
0.1 pts worse
|
|
| Drug regimen review with follow-up | 95.31% |
95.27%
About the same
|
Numerator 61 · Denominator 64 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 64 |
| Discharge self-care score | 40.48% |
53.69%
13.2 pts worse
|
Numerator 17 · Denominator 42 |
| Discharge mobility score | 28.57% |
50.94%
22.4 pts worse
|
Numerator 12 · Denominator 42 |
| Pressure ulcers or injuries, new or worsened | 9.38% |
2.29%
7.1 pts worse
|
Numerator 6 · Denominator 64 · Adjusted rate 11.1% |
| Healthcare-associated infections requiring hospitalization | 7.27% |
7.12%
0.1 pts worse
|
No Different than the National Rate · Eligible stays 28 · Observed rate 7.14% · Lower 95% interval 3.92% |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 75 |
| Staff flu vaccination coverage | 77.45% |
42%
35.5 pts better
|
Numerator 79 · Denominator 102 |
| Discharge function score | 38.1% |
56.45%
18.4 pts worse
|
Numerator 16 · Denominator 42 |
| Transfer of health information to provider | 88.24% |
95.95%
7.7 pts worse
|
Numerator 30 · Denominator 34 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 22.22% |
25.2%
3 pts worse
|
Numerator 6 · Denominator 27 |
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 1.3 · Expected 1.4 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.0 |
1.9
0.1 pts worse
|
1.8
0.2 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.0 · Observed 1.5 · Expected 1.3 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 85.7% |
95.4%
9.7 pts worse
|
93.4%
7.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 89.2% · Q2 86.1% · Q3 86.1% · Q4 81.6% · 4Q avg 85.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 94.9% |
96.9%
2 pts worse
|
95.5%
0.6 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 94.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 2.0% |
5.1%
3.1 pts better
|
3.3%
1.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.8% · Q3 2.8% · Q4 2.6% · 4Q avg 2.0% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 9.1% |
4.6%
4.5 pts worse
|
11.4%
2.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 5.9% · Q2 5.9% · Q3 11.4% · Q4 13.8% · 4Q avg 9.1% |
| Percentage of long-stay residents who lose too much weight | 5.3% |
5.5%
0.2 pts better
|
5.4%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 6.7% · Q2 2.9% · Q3 0.0% · Q4 11.1% · 4Q avg 5.3% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 13.2% |
17.8%
4.6 pts better
|
19.6%
6.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 10.0% · Q2 14.3% · Q3 8.8% · Q4 18.9% · 4Q avg 13.2% |
| Percentage of long-stay residents who received an antipsychotic medication | 14.2% |
25.1%
10.9 pts better
|
16.7%
2.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 9.1% · Q2 14.3% · Q3 16.0% · Q4 16.1% · 4Q avg 14.2% · 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 | 33.7% |
21.3%
12.4 pts worse
|
16.3%
17.4 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 33.7% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 24.8% |
21.6%
3.2 pts worse
|
14.9%
9.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 14.3% · Q2 27.3% · Q3 30.0% · Q4 26.5% · 4Q avg 24.8% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.7% |
2.0%
0.3 pts better
|
1.0%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 3.5% · Q2 0.0% · Q3 3.2% · Q4 0.0% · 4Q avg 1.7% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 6.9% |
3.3%
3.6 pts worse
|
1.7%
5.2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 10.8% · Q2 5.7% · Q3 5.7% · Q4 5.4% · 4Q avg 6.9% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 28.7% |
25.8%
2.9 pts worse
|
19.8%
8.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 35.2% · Q2 24.6% · Q3 27.1% · Q4 27.5% · 4Q avg 28.7% |
| Percentage of long-stay residents with pressure ulcers | 6.1% |
4.6%
1.5 pts worse
|
5.1%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.4% · Q2 6.1% · Q3 2.8% · Q4 13.0% · 4Q avg 6.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 68.8% |
83.2%
14.4 pts worse
|
81.7%
12.9 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 79.6% · Q2 69.4% · Q3 70.4% · Q4 56.6% · 4Q avg 68.8% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 14.6% |
11.7%
2.9 pts worse
|
12.0%
2.6 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 14.6% · Observed 15.6% · Expected 11.9% · 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 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 42.9% |
78.2%
35.3 pts worse
|
79.7%
36.8 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 42.9% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 13.1% |
21.5%
8.4 pts better
|
23.9%
10.8 pts better
|
Short Stay · 20240701-20250630 · Adjusted 13.1% · Observed 12.5% · Expected 22.8% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2023-09-28 · Fire 2023-09-28
2 health deficiencies
Top issue: Pharmacy Service (1 deficiency)
2 fire-safety deficiencies
Top issue: Construction (1 deficiency)
Cycle 3
Health 2022-07-20 · Fire 2022-07-20
1 health deficiencies
Top issue: Resident Rights (1 deficiency)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
Fire safety
Fire-safety citations
F · Potential for more than minimal harm
2024-12-05
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2025-01-06
E · Potential for more than minimal harm
2024-12-05
K754 · Miscellaneous Deficiencies
Fire Safety
Provide properly sized and located linen or trash receptacles.
Corrected 2025-01-06
D · Potential for more than minimal harm
2023-09-28
K131 · Construction Deficiencies
Fire Safety
Meet requirements for sections of health care facilities separated by fire resistive construction.
Corrected 2023-10-25
D · Potential for more than minimal harm
2023-09-28
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2023-10-17
F · Potential for more than minimal harm
2022-07-20
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2022-07-27
Inspection history
Recent health citations
G · Actual harm
2025-03-06
F760 · Pharmacy Service Deficiencies
Health
Ensure that residents are free from significant medication errors.
Corrected 2025-02-28
E · Potential for more than minimal harm
2024-12-05
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 2025-01-06
E · Potential for more than minimal harm
2024-12-05
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2025-01-06
E · Potential for more than minimal harm
2024-12-05
F761 · Pharmacy Service Deficiencies
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2025-01-06
E · Potential for more than minimal harm
2024-03-19
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2024-04-24
E · Potential for more than minimal harm
2023-09-28
F761 · Pharmacy Service Deficiencies
Health
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected 2023-11-06
D · Potential for more than minimal harm
2022-07-20
F584 · Resident Rights Deficiencies
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2022-08-19
Penalties and ownership
What sits behind the stars
$6,368
2025-03-06
Fine
Fine · fine $6,368
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
Rajchenbach, Chaim
Operational/Managerial Control · Individual
Shabat, Menachem
Operational/Managerial Control · Individual
Shives, Aaron
Operational/Managerial Control · Individual
Speier, Lynna
Operational/Managerial Control · Individual
Truist Bank
Operational/Managerial Control · Organization
Truist Bank
5% Or Greater Security Interest · Organization
Watertown Sd Property Holdings, LLC
5% Or Greater Security Interest · Organization
Nearby options
Other facilities in reach
#1
Jenkin's Living Center
Watertown, SD
1-star overall rating with 1-star inspections with $53,086 in total fines with 9 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#2
Estelline Nursing and Care Center
Estelline, SD
4-star overall rating with 3-star inspections with $16,826 in total fines
#3
Avantara Lake Norden
Lake Norden, SD
5-star overall rating with 5-star inspections with 1 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
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