BELLE FOURCHE, SD - Rolling Hills Healthcare received three federal deficiency citations following a complaint investigation completed on September 29, 2025, including a finding that the facility failed to deliver trauma-informed and culturally competent care to its residents.
Federal Complaint Investigation Reveals Care Gaps
The Centers for Medicare & Medicaid Services (CMS) investigation found Rolling Hills Healthcare deficient under regulatory tag F0699, which requires nursing facilities to ensure that care and services account for residents' trauma histories and cultural backgrounds. The citation, categorized as a Scope/Severity Level D deficiency, indicated an isolated incident with no documented actual harm but with potential for more than minimal harm to residents.
The F0699 tag falls under the broader category of Quality of Life and Care Deficiencies, a regulatory area that addresses the fundamental responsibility of skilled nursing facilities to treat each resident as a whole person with individual needs, experiences, and backgrounds.
This citation was one of three deficiencies identified during the investigation, which was initiated in response to a formal complaint rather than a routine survey. Complaint-driven investigations are typically triggered when concerns are reported to state or federal health authorities by residents, family members, staff, or other parties.
Why Trauma-Informed Care Matters in Nursing Homes
Trauma-informed care is a framework that recognizes the widespread impact of trauma on individuals and integrates that understanding into every aspect of care delivery. Among nursing home residents, trauma histories are common. Research indicates that a significant percentage of older adults in long-term care settings have experienced adverse events ranging from military service and domestic violence to childhood adversity and prior medical trauma.
When a facility fails to incorporate trauma-informed practices, routine care activities such as bathing, dressing, and medical examinations can inadvertently re-traumatize residents. A resident with a history of physical abuse, for example, may experience heightened anxiety or distress during hands-on care if staff members are not trained to recognize and respond to trauma responses.
Cultural competency is equally critical. Nursing home populations increasingly reflect diverse racial, ethnic, linguistic, and religious backgrounds. Residents who feel that their cultural identity is not understood or respected may experience isolation, depression, and decreased engagement with their own care plans. Language barriers alone can lead to miscommunication about medications, dietary needs, and symptom reporting.
What Federal Standards Require
Under CMS regulations, nursing facilities must ensure that staff are trained to deliver care that is both trauma-informed and culturally competent. This includes individualized assessments that identify each resident's trauma history and cultural preferences, staff education programs on recognizing trauma responses, and care planning that incorporates culturally appropriate practices.
Facilities are expected to create environments where residents feel physically and emotionally safe, where cultural and personal identities are respected, and where care approaches are adapted to individual needs rather than applied uniformly.
Correction Timeline and Facility Response
Rolling Hills Healthcare reported that the deficiency was corrected as of October 22, 2025, approximately three weeks after the inspection concluded. The facility's status was listed as "Deficient, Provider has date of correction," indicating that a plan of correction was submitted and a target date established.
A typical plan of correction for an F0699 citation may include staff retraining on trauma-informed care principles, updates to resident assessment protocols, revisions to care plans for affected individuals, and implementation of ongoing monitoring to prevent recurrence.
Broader Context for Belle Fourche Facility
The fact that this citation emerged from a complaint investigation rather than a standard annual survey is notable. Complaint investigations represent a reactive response to reported concerns, meaning that someone connected to the facility identified a problem significant enough to report to regulatory authorities.
While a Level D severity rating represents the lower end of the federal deficiency scale, it nonetheless signals a gap in care delivery that could escalate if left unaddressed. Facilities that fail to meet trauma-informed care standards may face repeated citations, increased scrutiny during future surveys, and potential enforcement actions if patterns of noncompliance develop.
Families and residents can review the full inspection report for Rolling Hills Healthcare, including all three deficiency citations, through the CMS Care Compare database or by contacting the South Dakota Department of Health.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Rolling Hills Healthcare from 2025-09-29 including all violations, facility responses, and corrective action plans.