Avantara Clark City
201 8th Avenue NW, Clark, SD 57225 · Clark County · 35 certified beds · avg 29 residents/day · certified since May 1, 1991
Part of chain: LEGACY HEALTHCARE (89 facilities, chain avg rating 2.9★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★★★★☆4/5 · CMS overall rating: 4/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Actual harm, one-off · Sep 12, 2024 · F-0689
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.
Corrected: Oct 6, 2024 (Deficient, Provider has date of correction)
All citations in the current public record (7)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Jan 8, 2026 | E · Potential for harm, repeated | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Jan 8, 2026 | E · Potential for harm, repeated | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Jan 8, 2026 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. |
| Jul 17, 2025 | D · Potential for harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Sep 12, 2024 | ▲ G · Actual harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| Jun 15, 2023 | E · Potential for harm, repeated | The facility did not develop a resident's complete plan of care within 7 days of the full assessment, or the plan wasn't prepared, reviewed, and updated by a team of health professionals as required. |
| Jun 15, 2023 | E · Potential for harm, repeated | The facility used bed rails without first trying safer alternatives, or without assessing the resident's safety risk, discussing the risks and benefits with the resident or family, getting consent, and installing the rails correctly. |
Inspection trend by year
Citations from standard inspections increased between the last two inspection cycles (1 → 3).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2023 | 2 | 0 | E |
| 2024 | 1 | 1 | G ▲ |
| 2025 | 1 | 0 | D |
| 2026 | 3 | 0 | E |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
1 fine totaling $11,057.
| Date | Type | Amount / length |
|---|---|---|
| Sep 12, 2024 | Fine | $11,057 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | South Dakota avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 3.06 | 4.32 | 3.95 | bottom 7% in South Dakota; bottom 16% in the U.S. |
| Registered Nurse hours | 0.53 | 0.91 | 0.69 | bottom 4% in South Dakota; bottom 43% in the U.S. |
| Weekend total nurse staffing | 2.56 | 3.71 | 3.50 | bottom 6% in South Dakota; bottom 11% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.59 | 0.51 | 0.48 | top 31% in South Dakota; top 24% in the U.S. |
| Total nursing staff turnover (%) | 42.4 | 48.2 | 45.8 | top 35% in South Dakota; top 43% in the U.S. |
| RN turnover (%) | 40.0 | 34.7 | 42.9 | bottom 34% in South Dakota; top 46% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 4.17, RN 0.73, weekend 3.49. Staffing rating: 2/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 2/5 · long-stay residents: 2/5 · short-stay residents: 2/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| Doros Generation Trust U/A/D 1/3/12 | Organization | 5% or Greater Direct Ownership Interest | 43% | 07/01/2019 |
| GPN Family Trust U/A/D 4/28/08 | Organization | 5% or Greater Direct Ownership Interest | 43% | 07/01/2019 |
| Oakway Operations LLC | Organization | 5% or Greater Direct Ownership Interest | 15% | 07/01/2015 |
| Bokf,na | Organization | 5% or Greater Security Interest | NOT APPLICABLE | 03/04/2024 |
| Bokf,na | Organization | Operational/Managerial Control | NOT APPLICABLE | 03/04/2024 |
| Clark City SD Property Holdings, LLC | Organization | ADP of the SNF | NOT APPLICABLE | 07/01/2019 |
| Dickes, Edward | Individual | Operational/Managerial Control | NOT APPLICABLE | 01/01/2025 |
| Dickes, Edward | Individual | ADP of the SNF | NOT APPLICABLE | 01/01/2025 |
| Doros Generation Trust U/A/D 1/3/12 | Organization | ADP of the SNF | NOT APPLICABLE | 07/01/2019 |
| GPN Family Trust U/A/D 4/28/08 | Organization | ADP of the SNF | NOT APPLICABLE | 07/01/2019 |
| Legacy Healthcare Financial Services LLC | Organization | ADP of the SNF | NOT APPLICABLE | 07/01/2019 |
| Morehouse, Rachel | Individual | Operational/Managerial Control | NOT APPLICABLE | 01/06/2020 |
| Morehouse, Rachel | Individual | ADP of the SNF | NOT APPLICABLE | 01/06/2020 |
| Rajchenbach, Chaim | Individual | Managing Control - Governing Body | NOT APPLICABLE | 07/01/2019 |
| Rajchenbach, Chaim | Individual | Operational/Managerial Control | NOT APPLICABLE | 07/01/2019 |
| Rajchenbach, Chaim | Individual | ADP of the SNF | NOT APPLICABLE | 07/01/2019 |
| Roth & Co, LLP | Organization | ADP of the SNF | NOT APPLICABLE | 01/01/2024 |
| Shabat, Menachem | Individual | Managing Control - Governing Body | NOT APPLICABLE | 07/01/2019 |
| Shabat, Menachem | Individual | Operational/Managerial Control | NOT APPLICABLE | 07/01/2019 |
| Shabat, Menachem | Individual | ADP of the SNF | NOT APPLICABLE | 07/01/2019 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "When abuse or theft is suspected, who do you notify, how fast, and how do you inform the family?"
- "Who is on the team that builds each resident's care plan, and how quickly is it in place after admission?"
- "What alternatives do you try before using bed rails, and how do you involve families in that decision?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| Jenkin's Living Center | 30.5 mi | Watertown, SD | ★★★☆☆ | 3/5 | |
| Avantara Watertown | 30.9 mi | Watertown, SD | ★☆☆☆☆ | 1/5 | abuseSFF |
| Sun Dial Manor | 31.7 mi | Bristol, SD | ★★★☆☆ | 2/5 | |
| Bethesda Home | 33.0 mi | Webster, SD | ★★★★★ | 4/5 | |
| Avantara Lake Norden | 33.1 mi | Lake Norden, SD | ★★★★★ | 4/5 | |
| Good Samaritan Society de Smet | 35.8 mi | De Smet, SD | ★☆☆☆☆ | 2/5 | |
| Avantara Redfield | 38.0 mi | Redfield, SD | ★★☆☆☆ | 2/5 | |
| Eastern Star Home of South Dakota, INC | 38.4 mi | Redfield, SD | ★★★★☆ | 4/5 |
Compare this facility with the 3 closest →
Facility data as of CMS processing date 2026-08-01. CCN 435058.