Five Counties Nursing Home: Arbitration Agreement Failures - SD
The form was an arbitration agreement, a document that, when signed, requires residents to resolve legal disputes with the facility outside of court. She confirmed to inspectors that she received no training on the form or on the arbitration process itself.
She added the form to the admission packet going forward. But residents who were already living at the facility when that email arrived, those admitted before November 8, 2022, had never signed one. Nobody went back to ask them.
When inspectors visited Five Counties in March 2025, more than two years had passed. Those residents still had not been asked to sign the arbitration agreement. The facility had simply moved on.
Administrator A, interviewed on the morning of March 11, reviewed the arbitration agreements on file for three residents and confirmed what the social services director had said. Residents admitted before November 2022 had not entered into the agreement. He agreed the form did not clearly state that signing was voluntary, that a resident or their representative was not required to sign it as a condition of admission.
His description of the document was blunt. He called it a poorly written agreement.
That acknowledgment matters. An arbitration agreement that obscures whether signing is optional is not a technicality. Residents and their families who believe they must sign to get through the door are not making a free choice. They are surrendering legal rights under what amounts to false pretense.
The facility had no policy on arbitration agreements at all. When inspectors asked Administrator A for the facility's written policy governing how these forms should be handled, he had nothing to provide. The provider simply did not have one.
What the inspection record shows, taken together, is a facility that introduced a significant legal document through a single forwarded email, gave the staff member responsible for presenting it to incoming residents no instruction on what it meant or how to use it, failed to circle back to the residents already living there, allowed more than two years to pass without correcting that gap, and never wrote down any rules for how the process should work.
The social services director confirmed all of this herself. She knew the pre-November 2022 residents had not signed. She knew they had not been approached afterward. She had the email. She had no training.
The deficiency was cited at a level of minimal harm or potential for actual harm, and inspectors noted it affected many residents. That classification reflects the regulatory finding, not the practical weight of what residents may have unknowingly given up. A resident who believes arbitration is mandatory, because the form did not say otherwise, and who signs under that belief, has lost access to a jury. They cannot sue in court if something goes wrong. They resolve their grievance, whatever it is, through a private process they never truly agreed to enter.
Administrator A did not dispute any of the findings. He agreed the language was unclear. He agreed the form was poorly written. He confirmed the gap in the resident population.
The social services director, for her part, did what she was told. She got an email, she added a form to a packet, and she waited for guidance that never came.
Five Counties Nursing Home sits at 405 6th Avenue West in Lemmon, a town of roughly 1,200 people in the northwestern corner of South Dakota. For the residents who were already there when that November 2022 email landed in an inbox, the question of what rights they still hold remains, for now, unanswered.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Five Counties Nursing Home from 2025-03-12 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
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Last verified: November 8, 2026 · Our methodology
Five Counties Nursing Home in LEMMON, SD was cited for violations during a health inspection on March 12, 2025.
The form was an arbitration agreement, a document that, when signed, requires residents to resolve legal disputes with the facility outside of court.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.