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Complaint Investigation

Avera Prince Of Peace

November 6, 2025 · Sioux Falls, SD · 4513 South Prince Of Peace Place
Citations 2
CMS Rating 3/5
Beds 126
Provider ID 435066
Healthcare Facility
Avera Prince Of Peace
Sioux Falls, SD  ·  View full profile →
Inspection Summary

AVERA PRINCE OF PEACE in SIOUX FALLS, SD — inspection on November 6, 2025.

Found 2 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF0627
Resident Rights Deficiencies
Potential for More Than Minimal Harm

Review of the provider's revised January 2024 admission Agreement Addendum for Residents admitted to Rehabilitation, Transitional Care, or Ventilator Units indicated:* By signing this admission Agreement Addendum, you are consenting to be transferred from the Unit when you have met the goals set out in the plan of care.

The determination will be made by an interdisciplinary care team that either: (i) your condition has improved to the point where you can be discharged from the Unit in accordance with your post-discharge plan of care; or (ii) your condition is such that you will no longer benefit from placement within, but require long-term residential care.*If we determine that you can be discharged from the Unit, both you and the Resident Representative consent to discharge from the Facility Unit and agree to fully cooperate with the Facility discharge planning staff in conjunction with your discharge.

You will receive advance notice of discharge regarding this decision along with a notice of termination of Medicare Part A benefits, if applicable.*If you can not [cannot] be safely discharged as you require long term residential care, the Facility will provide notification to both the Resident and Resident Representative and begin making referrals to other long term residential care facilities.

You and the Resident Representative consent to fully cooperate with the facility discharge planning staff in transferring to a long term residential care facility.

Resident and Resident Representative are advised and consent to such transfer understanding the long-term residential care facility may be outside the Sioux Falls area.*This Addendum is integrated into the admission Agreement of this same date.

Review of the provider's revised June 2024 LTC [Long Term Care] Transfer & [and] Discharge policy revealed:* It is the policy of this facility that each resident has the right to remain in the facility and not transfer or discharge a resident unless a transfer or discharge from the facility is:- The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;- The resident required immediate transfer or discharge based on the resident's urgent medical need.- The transfer or discharge is appropriate because the resident's health has improved sufficiently so that the resident no longer needs the services provided by the facility;- The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;- The health of individuals in the facility would otherwise be endangered;- The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility .- The facility ceases to operate.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

11/06/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Avera Prince of Peace

4513 South Prince of Peace Place Sioux Falls, SD 57103

SUMMARY STATEMENT OF DEFICIENCIES

Review of the provider's revised June 2024 LTC [Long Term Care] Transfer & [and] Discharge policy revealed:*The objective of the transfer/discharge policy is to ensure that the resident is informed of an impending discharge and their right to appeal the discharge. *.The facility must provide notice of discharge to the resident and resident representative along with a copy of the notice to the Office of the State LTC Ombudsman at least 30 days prior to the discharge or as soon as possible.

The copy of the notice to the Ombudsman must be sent at the same time the notice is provided to the resident representative.*The notice contains information about the transfer and information about the resident's appeal rights.

The facility will assist the resident to obtain, complete and submit an appeal form at the resident's request.

Facility ID:

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SIOUX FALLS, SD, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from AVERA PRINCE OF PEACE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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