RAPID CITY, SD - Federal health inspectors identified seven deficiencies at Fountain Springs Healthcare during a standard health inspection completed on December 9, 2025, including a notable citation for failing to provide safe and appropriate respiratory care for residents in need.
Respiratory Care Deficiencies Across Multiple Residents
The inspection found that Fountain Springs Healthcare did not consistently deliver safe and appropriate respiratory care, a violation cited under federal regulatory tag F0695. Inspectors classified the deficiency at Scope/Severity Level E, indicating a pattern of non-compliance rather than an isolated incident. While no actual harm was documented at the time of the inspection, regulators determined there was potential for more than minimal harm to affected residents.
A pattern-level designation means the problem was not confined to a single resident or a one-time lapse. Instead, inspectors observed the deficiency across multiple situations or residents, raising questions about the facility's broader respiratory care protocols and staff adherence to established procedures.
Respiratory care in nursing home settings encompasses a range of critical services, including oxygen therapy administration, nebulizer treatments, suctioning, monitoring of oxygen saturation levels, and management of conditions such as chronic obstructive pulmonary disease (COPD) and pneumonia. When these services are not delivered safely and consistently, residents face increased risk of respiratory distress, oxygen deprivation, infection, and hospitalization.
Why Proper Respiratory Protocols Matter
Nursing home residents are among the most vulnerable populations when it comes to respiratory health. Many residents have compromised lung function due to age, chronic illness, or reduced mobility. Proper respiratory care requires accurate physician orders, trained staff who follow those orders precisely, functioning and clean equipment, and ongoing monitoring of each resident's respiratory status.
When facilities fail to maintain these standards, the consequences can escalate quickly. Inadequate oxygen delivery can lead to hypoxia, which may cause confusion, organ damage, or cardiac events. Improperly maintained nebulizer equipment can introduce bacteria into the lungs, potentially triggering pneumonia — a leading cause of hospitalization and death among nursing home residents. Missed or delayed treatments can cause acute breathing episodes that require emergency intervention.
Federal regulations under 42 CFR §483.25(i) require that facilities ensure residents who need respiratory care receive treatments that are delivered safely, with proper equipment, by adequately trained personnel. The standard also requires that facilities monitor residents' respiratory status and adjust care plans as conditions change.
Seven Total Deficiencies Identified
The respiratory care citation was one of seven deficiencies documented during the December 2025 inspection. While the full scope of additional citations would be detailed in the complete inspection report, the total number suggests broader compliance concerns at the facility beyond respiratory care alone.
Fountain Springs Healthcare reported a plan of correction following the inspection, with a correction date of December 16, 2025 — just one week after the inspection concluded. Plans of correction require the facility to outline specific steps it will take to address each deficiency, prevent recurrence, and monitor ongoing compliance.
A one-week correction timeline is relatively rapid, which may indicate the facility took immediate operational steps such as retraining staff, updating care protocols, or auditing respiratory care documentation. However, the adequacy of these corrections would typically be verified during a subsequent follow-up inspection by state or federal surveyors.
Industry Context and Resident Safety
Respiratory care deficiencies remain a recurring concern across the nursing home industry nationally. Facilities are expected to maintain comprehensive respiratory care programs that include regular staff competency evaluations, equipment maintenance schedules, and individualized care plans for each resident requiring respiratory services.
Families of residents at Fountain Springs Healthcare can access the complete inspection report, including all seven deficiency citations and the facility's corrective action plans, through the Centers for Medicare & Medicaid Services (CMS) Care Compare website or by requesting records directly from the facility.
The facility, located in Rapid City, South Dakota, will be subject to future inspections to verify that corrective measures have been implemented and sustained. Residents and families who have concerns about care quality are encouraged to contact the South Dakota Department of Health or the state's long-term care ombudsman program.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Fountain Springs Healthcare from 2025-12-09 including all violations, facility responses, and corrective action plans.
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