Sanford Care Center Vermillion

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

education on professional communication in long term care and customer service before returning to work.*CNA H returned to work on 1/15/26.*No audits have been completed following the incident.*There had been no further follow-up with residents 3 or 4.*She expected staff to treat residents the way they wish to be treated, that this was their home, the staff were here to care for them. 11. Review of CNA H's employee file revealed:*He was hired on 9/8/25.*A background check had been completed on 8/19/25.*He completed Abuse, Neglect, and Exploitation education on 9/9/25.*He completed An Overview of Quality Dementia Care CNA education on 9/24/25.*There was a final warning written in file regarding the incident that occurred on 1/11/26. 12. Review of the provider's 4/11/25 revised Abuse and Neglect policy revealed:*Patients and residents have the right to be free from verbal, sexual, physical, mental abuse, neglect, misappropriation of property, corporal punishment, exploitation and involuntary seclusion.*Patients and residents must not be subjected to any kind of abuse by anyone, including, but not limited to, facility staff, other patients or residents, consultants, volunteer staff or other agencies serving the individual, family members, legal guardians or personal representatives, friends or other individuals.- Verbal abuse refers to any use of oral, written, or gestured language that includes disparaging and derogatory terms to the resident or their families, or within their hearing distance, to describe patients/residents, regardless of their age, ability to comprehend or disability.

Event ID:

Facility ID:

43A098

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

43A098

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/29/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sanford Care Center Vermillion

125 S Walker Street Vermillion, SD 57069

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

further education completed since resident 2's 1/20/26 elopement from the facility with any staff members.*She was unsure when the last elopement drill had been completed.*Elopement risk assessments were completed upon admission and quarterly depending on minimum data set (MDS) assessment.*Staff are notified of resident care needs through the Kardex (a quick reference guide for resident care) and shift change report, including if a resident has a roam alert device.*Staff were notified of

an elopement over the walkie system by stating security alert, missing resident room number.*She expected to be notified immediately when a resident has an elopement.*If a resident was an elopement risk, the first consideration for resident placement was in the memory care unit.*If there was no availability

in the memory care unit, then the preference for resident placement was in the north hall, which had no outdoor access. This was where resident 1 and 2 resided.*Floor staff were allowed to initiate 15-minute visual checks for residents if wandering or exit seeking behaviors were noted.*She expected staff to utilize PRN medication if available and residents were showing signs of anxiety and pain. 14. Interview on 1/29/26 at 10:09 a.m. with Improvement Advisor G revealed the elopement policy was revised on 10/25/25 and the nurses had completed education and policy review following resident 1's elopement on 11/2/25. 15. Review of the provider's 10/22/25 Missing Person-Elopement policy revealed:*It is the facility's responsibility to protect patients/residents from harm. If a patient or resident should wander from the facility grounds/property without notice, the following procedure will be followed:-Elopement will be defined as any resident leaving the grounds of the facilities without knowledge of staff, or any patient/resident unable to be located on the grounds/facilities.-When a resident is discovered as missing or door alarm is activated, the DON/Charge Nurse will immediately be notified. At the Care Center, a beeper system hooked up to the call light system is activated and lights at the end of the hallway in question will flash red.

Event ID:

Facility ID:

43A098

If continuation sheet