Provider Name: AVERA PRINCE OF PEACE
Address: 4513 SOUTH PRINCE OF PEACE PLACE, SIOUX FALLS, SD 57103
Phone: (605) 322-5600
County: Minnehaha (490)
Ownership Type: Non profit - Church related
Certified Beds: 107
Average Residents Per Day: 107. ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: AVERA MCKENNAN
First Approved Date: October 1, 1992
Affiliated Entity: AVERA HEALTH (61)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 5 ()
Health Inspection Rating: 3 ()
QM Rating: 5 ()
Long Stay QM Rating: 4 ()
Short Stay QM Rating: 5 ()
Staffing Rating: 5 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 2.88537, LPN Staff Hours Per Day: 0.3723, RN Staff Hours Per Day: 1.6230, Licensed Staff Hours Per Day: 1.9954
Total Nurse Staff Hours Per Day, per resident: 4.88082
Weekend Nurse Staff Hours: 4.36337, Weekend RN Staff Hours: 1.1979
PT Staff Hours Per Day, per resident: 0.2591
Nurse Staff Turnover: 42.7, Nurse Turnover Note:
RN Turnover: 51.1, RN Turnover Note:
Admin Left Number: 2, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.0790, Case Mix LPN Hours Per Day: 0.6493, Case Mix RN Hours Per Day: 0.2902
Adjusted Nurse Aide Hours Per Day, per resident: 2.82734, Adjusted LPN Hours Per Day: 0.4232, Adjusted RN Hours Per Day: 2.1068
Total Adjusted Nurse Hours Per Day, per resident: 5.09641
Adjusted Weekend Nurse Hours Per Day, per resident: 4.55611
Health Survey Dates and Scores: Cycle 1: 2023-03-30 (Score: 12), Cycle 2: 2022-03-31 (Score: 32), Cycle 3: 2019-12-19 (Score: 16)
Total Weighted Health Score: 19.333
Reported Incidents: 0, Substantiated Complaints: 0
Infection Control Citations: 1
Fines and Penalties: Number of Fines: 2, Total Fines in Dollars: 13000.00, Payment Denials Number: 0, Total Penalties Number: 2
Location and GPS: 4513 SOUTH PRINCE OF PEACE PLACE,SIOUX FALLS,SD,57103 (43.5035, -96.685)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-05-14
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2023-04-28
Type: Health, Deficiency: Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-05-13
Type: Health, Deficiency: Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-05-13
Type: Health, Deficiency: Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-05-13
Type: Health, Deficiency: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-05-13
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-05-13
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-05-13
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-06-04
Type: Health, Deficiency: Ensure services provided by the nursing facility meet professional standards of quality.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-01-18
Type: Health, Deficiency: Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-01-18
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2020-01-18
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications: