Monument Health Sturgis Care Center
Sturgis, South Dakota · CCN 435102
23 surveys since 2011, 14 of them producing a finding at harm level or worse.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
- Citations on record
- 111
- Surveys
- 23
- Harm or worse
- 14
- Immediate jeopardy
- 0
Findings where a surveyor recorded actual harm to a resident.
Older surveys no longer in CMS’s monthly file or on Care Compare. They are shown here.
The facility
- Certified beds
- 40
- Ownership
- Non profit - Corporation
- Chain
- Independent
- County
- Meade
- Medicare-certified since
- 1997
CMS ratings
- Overall
- 3
- Health inspection
- 3
- Staffing
- 4
- Quality measures
- 3
CMS’s own Five-Star ratings.
Compared with similar facilities
Since 2021, this facility recorded somewhat more weighted findings than its peer group.
Weighted by harm level, against 48 not-for-profit facilities with fewer than 66 beds in South Dakota.
Last survey on record
Mar 19, 2026
235 days ago.
Counts surveys with at least one finding. A clean survey leaves no record here, so the real gap may be shorter.
Staffing
| Measure | This facility | Peer median |
|---|---|---|
| Nurse hours per resident day | 5.09 | 3.73 |
| Registered-nurse hours per resident day | 0.81 | — |
| Annual nurse turnover | 54.7% | 49.0% |
As reported by the facility to CMS, beside the peer-group median.
Enforcement
- Fines
- $26,272 across 2 penalties
Federal civil money penalties and remedies as CMS currently publishes them. Amounts may still be under appeal.
Severity of recent findings
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy | J— | K— | L— |
| Actual harm | G29.1% | H— | I— |
| No harm, potential for more than minimal | D1254.5% | E627.3% | F29.1% |
| No harm, potential for minimal | A— | B— | C— |
Most frequently cited here
In CMS’s current monthly file.
- F6583×
Ensure services provided by the nursing facility meet professional standards of quality.
- F8803×
Provide and implement an infection prevention and control program.
- F6892×
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
- F7612×
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.
- F5501×
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
In the surveyor’s words
From the most serious findings on record at Monument Health Sturgis Care Center, in the surveyor’s own words.
- Actual harm, isolatedF610Jun 10, 2025
Based on observation, record review, interview, and policy review, the provider failed to ensure one of one cognitively impaired sampled resident's (2) bruises of unknown origin had been thoroughly investigated to: *Identify their root cause. *Develop interventions to prevent or decrease the likelihood of them recurring. *Rule out potential abuse or neglect. Findings include: 1. Observations on 6/10/25 at 8:30 a.m. and again at 9:30 a.m. of resident 2 revealed: *She sat in her wheelchair at a dining room table. She was assisted by staff to eat her breakfast. *A sit-to-stand lift (a mechanical lift used to assist from a seated to a standing position) was used to transfer her from the bathroom to a recliner in her room. […]
- Actual harm, isolatedF656Apr 3, 2024
Substantial compliance was confirmed on 4/3/24 after record review revealed the facility had followed their quality assurance process; after mechanical lift education was provided to all nursing staff; after multiple staff interviews revealed competence and understanding of the mechanical lift training; after resident interviews confirmed transfers with a mechanical lift were provided with the proper number of staff; and after observations of staff showed they performed proper transfers with a mechanical lift.
- No harm, potential for more than minimal, widespreadF812Oct 3, 2024
Based on observation, interview, and policy review the provider failed to maintain appropriate temperatures for one of one high-temperature dishwasher utilized to clean dishes used to prepare and serve resident food items according to the manufacturer's instructions. Findings included: 1. Observation and interview on 10/1/24 at 8:10 a.m. with retail manager H in the kitchen revealed: *The wash cycle temperature of the dishwasher was supposed to be between 170 and 175 degrees Fahrenheit. *The final rinse cycle temperature of the dishwasher was supposed to be between 180 and 190 degrees Fahrenheit. *The retail manager said if the temperatures of the dishwasher were below the manufacturer's recommended minimal temperature the staff were to have maintenance service the dishwasher. […]
- No harm, potential for more than minimal, widespreadF726Jul 20, 2023
Based on observation, interview, record review, and policy review, the provider failed to ensure there was licensed nursing oversight and supervision to ensure the following: *One of one CMA (I) had not crushed and administered a delayed seizure medication to one of one sampled resident (18) to prevent a medication error from having occurred. *One of one CMA (I) had received initial medication administration orientation. *One of one CMA (K) had not calculated a Lactulose medication dose for one of one sampled resident (32). *One of one CMA (J) had not decided whether or not it was safe for one of one sampled resident (47) to have taken his medications whole without crushing them. […]
- No harm, potential for more than minimal, patternF880Mar 19, 2026
Based on observation, interview, and policy review, the provider failed to ensure the staff followed infection prevention and control practices regarding:*Hand hygiene (handwashing) and glove use by one of one registered nurse (RN) (E) during resident blood sugar level testing (measuring the amount of sugar in the blood using a glucometer or a blood glucose meter) for one of one sampled resident (29), and by one of two certified medication aides (CMA) (F) during medication administration for one of three sampled residents (24).*Hand hygiene and no gown use by one of one RN (E) during wound care for one of one sampled resident (13). Findings include:1. Observation on 3/17/26 at 8:10 a.m. […]
Read 32 findings in full →The most serious and the most recent: 32 of 111 on record.
Every survey on record
FindingsAt actual harm or above
- Mar 19, 2026Standard4 findings
- Jun 10, 2025Complaint2 findings · 1 harm
- Feb 19, 2025Complaint3 findings
- Oct 3, 2024Standard5 findings
- Apr 3, 2024Complaint1 finding · 1 harm
- Nov 15, 2023Complaint1 finding
- Jul 20, 2023Standard6 findings
- Jun 9, 2022Standard2 findings
Show the 15 earlier surveys
- Oct 29, 2020Infection control1 finding
- Nov 7, 2019Standard12 findings
- Jan 24, 2019Complaint6 findings
- Sep 19, 2018Standard2 findings
- Aug 24, 2017Standard9 findings · 3 harm
- Mar 21, 2017Complaint4 findings
- Feb 1, 2017Complaint1 finding · 1 harm
- Jul 21, 2016Standard10 findings · 3 harm
- Jan 14, 2016Complaint2 findings · 2 harm
- Aug 27, 2015Standard13 findings
- Feb 25, 2015Complaint2 findings · 1 harm
- Jun 12, 2014Standard7 findings
- May 15, 2013—11 findings · 2 harm
- Feb 29, 2012—4 findings
- Mar 2, 2011—3 findings
Surveys that found no deficiencies are not in CMS’s files and do not appear here.
Comparable facilities
The nearest facilities to this one in the same peer group, by weighted findings.
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