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Strand-Kjorsvig Rest Home: Admin Skipped Meetings - SD

Healthcare Facility
Strand-kjorsvig Community Rest Home
Roslyn, SD  ·  2/5 stars

ROSLYN, SD - State inspectors found that the administrator at Strand-Kjorsvig Community Rest Home failed to participate in required quality assessment meetings for more than a year, attending only two meetings out of 15 months of documented sessions between February 2024 and May 2025.

Leadership Absence Undermines Quality Oversight

The inspection revealed a significant breakdown in administrative oversight at the 801 S Main facility, where the Quality Assessment and Assurance (QAA) committee operated without consistent leadership participation. Federal regulations require nursing homes to maintain QAA committees with specific membership that must include at least one administrator, owner, board member, or other individual in a leadership role.

According to inspection records, Administrator A attended QAA meetings on only two occasions during the 15-month review period - once on June 25, 2024, and again on May 6, 2025. The facility's Director of Nursing reported that "Administrator A attended the QAPI meeting that week for the first time in quite a while," referring to the May meeting that occurred during the inspection week.

The medical director, identified as MD N, confirmed the pattern of administrative absence during her interview with inspectors. She stated that she "did not recall seeing administrator A present at those meetings routinely" and was "unaware of how often administrator A was at the facility or how often he attended the QAPI meetings in the past two years."

Critical Gap in Quality Management Structure

Quality Assessment and Performance Improvement (QAPI) programs serve as the backbone of nursing home safety and care standards. These committees are responsible for identifying problems, analyzing data, implementing corrective actions, and monitoring outcomes to ensure resident safety and quality of care.

The facility's own policy documents emphasize that "the governing body, administrator, and/or management firm are responsible for the development and implementation of the QAPI program." This includes identifying and prioritizing problems based on performance data, incorporating resident and staff input, ensuring corrective actions address system gaps, setting clear expectations for safety and quality, and ensuring adequate resources exist for quality improvement efforts.

Without consistent administrative participation, nursing homes face significant challenges in implementing effective quality improvements. Administrators typically have the authority to allocate resources, make policy changes, and coordinate between departments - functions that are essential for addressing systemic issues identified through quality assessment processes.

The medical director expressed concern about the lack of administrative support, indicating that "she expected that the administrator would be involved in identifying and correcting areas of concern identified in the QAPI program" and noted that "the facility could use his support."

Staffing Patterns Compound Leadership Challenges

The inspection also revealed concerning patterns in administrative presence at the facility. Director of Nursing C reported that Administrator B, who appears to be another administrative figure, "had been at the facility approximately three hours a week for the last couple of months, but she had not attended a QAPI meeting."

This limited administrative presence raises questions about day-to-day oversight and management of facility operations. Effective nursing home administration requires consistent on-site presence to monitor care quality, address staff concerns, respond to emergencies, and ensure compliance with regulatory requirements.

The Director of Nursing indicated that she "had requested that another QAA member be assigned the responsibility for overseeing the QAPI program," suggesting that the lack of administrative participation had created additional burdens for nursing staff who were attempting to maintain quality oversight functions.

Editorial Standards & Data Disclosure

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.

Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.

Last verified: September 19, 2026  ·  Our methodology

Quick Answer

Strand-Kjorsvig Community Rest Home in ROSLYN, SD was cited for violations during a health inspection on May 8, 2025.

The medical director, identified as MD N, confirmed the pattern of administrative absence during her interview with inspectors.

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.

Frequently Asked Questions

What happened at Strand-Kjorsvig Community Rest Home?
The medical director, identified as MD N, confirmed the pattern of administrative absence during her interview with inspectors.
How serious are these violations?
Violation severity varies from minor documentation issues to serious safety concerns. Review the inspection report for specific deficiency codes and scope. All violations must be corrected within required timeframes and are subject to follow-up verification inspections.
What should families do?
Families should: (1) Ask facility administration about specific corrective actions taken, (2) Request to see the follow-up inspection report verifying corrections, (3) Check if this represents a pattern by reviewing prior inspection reports, (4) Compare this facility's ratings with other nursing homes in ROSLYN, SD, (5) Report any new concerns directly to state authorities.
Where can I see the full inspection report?
The complete inspection report is available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request a copy directly from Strand-Kjorsvig Community Rest Home or from the state Department of Health. The report includes specific deficiency codes, facility responses, and correction timelines. This facility's federal provider number is 435125.
Has this facility had violations before?
To check Strand-Kjorsvig Community Rest Home's history, visit Medicare.gov's Care Compare and review their inspection history, quality ratings, and staffing levels. Look for patterns of repeated violations, especially in critical areas like abuse prevention, medication management, infection control, and resident safety.