Five Counties Nursing Home: Staffing Data Failures - SD
It wasn't.
When inspectors arrived at the facility on March 12, 2025, they found data missing from the staffing reports the home had submitted to the federal Payroll-Based Journal system, the database Medicare uses to track how many nurses and aides are actually working in nursing homes on any given day. The staff member could not explain the gaps. She told inspectors she had no idea how data had gone missing, because the system had never flagged a problem.
The Payroll-Based Journal, known as PBJ, is one of the primary tools federal regulators use to hold nursing homes accountable for the staffing levels they claim to provide. Facilities are required to submit detailed records of nursing hours, and that data feeds directly into the star ratings that families use when choosing a home for an aging parent or spouse. When the data is wrong, the ratings can be wrong. When the ratings are wrong, families make decisions based on numbers that don't reflect reality.
At Five Counties, the staff member told inspectors she handled the submissions in two ways. Hours for travel staff, workers brought in from outside agencies to fill gaps in the schedule, she entered manually. Hours for the facility's regular employees were pulled automatically from their timecards. Somewhere in that process, data disappeared. She didn't know where.
The facility's own nursing staffing policy, reviewed by inspectors during the survey, states that the home is required to provide licensed nursing staff around the clock. The policy names nurse aides among the nursing personnel who must be available to residents. Whether the missing data reflected gaps in that coverage, or simply errors in how existing coverage was recorded, the inspection report does not say. What it says is that data was missing, and the person responsible for submitting it didn't know.
Inspectors rated the deficiency at the lowest level of harm, finding minimal harm or potential for actual harm. Many residents were affected.
That last detail is worth sitting with. The staffing data submitted to federal regulators is not an administrative abstraction. It is the paper trail that tells the public, and Medicare, how many hands were available to answer a call light, reposition a resident at risk for pressure wounds, or help someone who had not eaten enough get through a meal. When that trail has gaps, the picture it paints of daily life inside the building is incomplete.
Five Counties Nursing Home sits at 405 6th Avenue West in Lemmon, a small city in the northwest corner of South Dakota. The region is rural, and facilities in rural areas often face staffing pressures that urban homes do not, including a thinner labor pool and greater reliance on the kind of travel staff that the employee at Five Counties was entering into the federal system by hand.
The staff member's account raises a question the inspection report leaves open. If the federal submission portal accepted every report and returned a confirmation showing 100 percent completion, where did the missing data go? Was it a problem with how she entered the information, or a problem with what the system confirmed? She told inspectors she didn't know. The inspection report does not record whether anyone else did either.
What the record does show is that families researching Five Counties on Medicare's nursing home comparison tool, or any other database drawing on PBJ data, were looking at staffing numbers with holes in them. They had no way of knowing that. Neither, apparently, did the person who submitted the reports.
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.
Corrections: We strive for accuracy in everything we publish. If you believe any fact in this article is incorrect, please contact us with details, and we will review and correct it promptly.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: November 10, 2026 · Our methodology
Five Counties Nursing Home in LEMMON, SD was cited for violations during a health inspection on March 12, 2025.
The staff member could not explain the gaps.
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.