Dow Rummel Village

In the surveyor’s words

From the most serious findings on record at Dow Rummel Village, in the surveyor’s own words.

• Actual harm, isolatedF689Jun 10, 2026

  Based on South Dakota Department of Health (SD DOH) Facility Reported Incident (FRI), record review, interview, and policy review, the provider failed to ensure an environment free of accident hazards and supervision when the staff did not complete hourly safety checks according to the provider's policy and left a resident's bed in an elevated position for one of one sampled resident (1) who was not checked on for four hours and subsequently fell out of bed onto the floor and sustained a laceration to her left hand that was sutured in an emergency room.Findings include: 1. Review of the provider's 4/17/26 SD DOH FRI, revealed that on 4/16/26, resident 1 was found lying on the floor in her room at approximately 9:00 a.m. […]

• Actual harm, isolatedF760Nov 13, 2025

  Based on review of the South Dakota Department of Health (SD DOH) Facility-Reported-Incident (FRI), interview, record review, observation, and policy review, the provider failed to ensure one of one resident (1) had not received incorrect medications, which led to the resident vomiting, requesting a transfer and evaluation at the local emergency department, and anxiety related to medication administration.Findings include:1. Review of the provider's 10/29/25 final FRI submitted to the SD DOH revealed that on 10/29/25, certified medication aide (CMA) D administered medications to resident 1 that were prescribed for resident 2. […]

• Actual harm, isolatedF689Oct 30, 2025

  Based on the South Dakota Department of Health (SD DOH) facility-reported incident (FRI) review, interview, observation, record review, and policy review, the provider failed to ensure certified medical assistant (CMA) G and certified nursing assistant (CNA) I followed facility policy to provide individualized care for one of one resident (1) and resulted in the resident having to be transferred to the emergency department. Resident 1 received a large laceration to her right lower leg that required sutures. 1. […]

• Actual harm, isolatedF806Aug 21, 2024

  Based on South Dakota Department of Health (SD DOH) facility-reported incident (FRI), observation, interview, record review, and policy review, the provider failed to ensure resident (1) who had an allergic reaction that required the administration of an antihistamine due to a shellfish allergy was identified by the dietary staff before being served shrimp Alfredo. Findings include: 1. Review of the provider's 8/16/2024 SD DOH FRI revealed: *On 8/16/24, the provider served shrimp [NAME] for lunch. The nurse had looked up residents who had shellfish allergies and reminded the certified nursing assistants (CNA) to be careful of cross-contamination. The nurse then questioned resident 1's meal and confirmed that resident 1 was served the pureed shrimp Alfredo. […]

• No harm, potential for more than minimal, widespreadF851Aug 15, 2024

  Based on Certification and Survey Provider Enhanced Reports (CASPER) reporting data review, interview, and job description review, the provider failed to ensure their Payroll Based Journal (PBJ), (information of the provider's daily staffing hours for the appropriate care of the residents) had been complete and the data had been submitted to the Center for Medicare and Medicaid Services (CMS) for one of two quarters in 2024. Findings include: 1. Review of the provider's CASPER reporting data revealed no PBJ data had been submitted for the time period of January 1, 2024 through March 31, 2024. Interview on 8/15/24 at 12:07 p.m. […]