Five Counties Nursing Home: Staffing Data Failures - SD
Inspectors who visited the facility on March 12 found that the administrator knew, when confronted with the underlying records, that there had been days with no licensed nursing coverage at all — and stretches of eight consecutive hours or more with no registered nurse present. Residents were affected across the board. The violation was tagged as having potential for actual harm to many residents.
The administrator's explanation was specific and, in its own way, illuminating. She told inspectors she had no idea how the data could be missing, because every time she submitted the Payroll-Based Journal reports to the federal government, the system sent back a notification that the submission was 100% complete and had been accepted.
What she did not know, and what inspectors documented, was that the confirmation meant something much narrower than she believed. The system was telling her the file uploaded successfully. It was not telling her whether the hours inside that file matched the hours staff actually worked.
The distinction matters. Payroll-Based Journal data is the primary tool the federal government uses to calculate nursing home staffing levels, which in turn feed directly into the star ratings that families consult when choosing a facility for a parent or spouse. A nursing home that submits incomplete or inaccurate staffing data without knowing it is, in effect, invisible to the oversight system designed to catch exactly this kind of problem.
Five Counties is a small facility in a rural corner of South Dakota, in Perkins County near the North Dakota border. The region has no surplus of care options. Families placing a relative there are not choosing from a long list.
Whether the gaps in licensed nursing coverage were brief or extended, isolated or recurring, the inspection report does not say. What it establishes is that they existed, that they were not captured in the federal data the facility was submitting, and that the person responsible for those submissions did not understand the system well enough to know the difference between a file being accepted and a file being correct.
That is not a minor clerical confusion. Licensed nursing coverage is not an administrative metric. On the nights and shifts where no licensed nurse was present, residents who needed clinical judgment, medication decisions, or emergency assessment had no one with that authority in the building.
The administrator was not evasive with inspectors. She answered their questions. She explained her understanding of the reporting process. Her account has the texture of someone who genuinely did not know, which raises its own questions about how long this went on and whether anyone above her in the oversight chain was positioned to catch it.
The federal confirmation system, by returning a "100% accepted" notification on every submission, gave her no reason to look harder. She looked at the indicator. The indicator said everything was fine.
Inspectors determined the level of harm as minimal or potential for actual harm, not actual documented injury. That finding reflects what the report could establish, not necessarily what the coverage gaps meant in practice on any given night.
The plan of correction for this deficiency, per the inspection document itself, requires contacting the facility or the state survey agency directly. The report does not describe what corrective steps were proposed or whether the administrator's understanding of the reporting system has since changed.
What the record shows is a facility that submitted federal staffing data for an unknown period of time, received confirmation that the data was accepted, and did not know that no one on the receiving end was checking whether the numbers reflected reality. The gaps, whatever their full extent, went uncounted.
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.
Residents were affected across the board.
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.