Home / South Dakota / Wilmot
Wilmot Care Center Inc
501 4th St., Wilmot, SD 57279 · Roberts County · (605) 938-4418
26 certified beds, about 25 residents a day · Non profit - Corporation · Medicare and Medicaid since 2002
Special Focus Facility candidate Certified for Medicaid Certified for Medicare
Overall
1 of 5
Health inspections
1 of 5
Staffing
5 of 5
Quality measures
1 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 435119 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on March 6, 2025, inspectors cited 5 health deficiencies (the South Dakota average is 6.7, the national average 9.2).
Of 18 health citations since March 2023, 2 were rated as actual harm or immediate jeopardy to residents (2 immediate jeopardy).
CMS lists 2 fines totaling $28,028 in the last three years; the largest was $17,651, and the latest is dated March 6, 2025.
Nurses and nurse aides worked 4.20 hours per resident per day, against 3.79 across South Dakota and 3.86 nationally. Registered nurses accounted for 0.90 of those hours.
60.5% of nursing staff left within the year CMS measured (South Dakota average 48.2%).
Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
103/23
902/24
106/24
211/24
503/25
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 18 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
1J
0K
1L
Actual harm
0G
0H
0I
Potential for more than minimal harm
9D
4E
3F
Potential for minimal harm
0A
0B
0C
March 6, 2025Standard inspection · 5 citations
- L Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, interview, record review, and policy review, the provider failed to ensure that one of one whirlpool tub was free of environmental hazards due to an active water leak next to an electrical box in the control panel of the tub. Failure to do so increased the potential risk for immediate serious injury, serious harm, serious impairment, or death as a result of potential electric shock to a resident and staff.
- F Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Inspectors wroteBased on observation, interview, and record review, the provider failed to ensure they provided residents' adequate nutrition needs and followed the dietician-approved menu.
- F Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observation, interview, and policy review, the provider failed to label and store food products according to policy and acceptable food standards and discard food products on or before the best by date.
- E Provide and implement an infection prevention and control program.
Inspectors wroteA. Based on interview, observation, and record review, the provider failed to ensure appropriate infection control policies were followed for: *Use of enhanced barrier precautions (gloves and gown use when providing contact care) for one of one sampled resident (14) with a diagnosis of methicillin resistant staphylococcus aureus infection (MRSA) infection. *Use of personal protective equipment (PPE) for two of two sampled residents (17 and 6) with indwelling catheters.
- D Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Inspectors wroteBased on record review, observation, interview and policy review the provider failed to implement prescribed and care-planned preventative pressure injury interventions for one of one (2) sampled resident who developed pressure ulcers to both of her heels.
November 13, 2024Complaint inspection · 2 citations
- D Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Inspectors wroteBased on South Dakota Department of Health (SD DOH) facility reported incident (FRI), record review, and policy review the provider failed to ensure that the care plan reflected the current individualized dietary needs for one of one sampled resident (1).
- D Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Inspectors wroteBased on South Dakota Department of Health (SD DOH) facility reported incident (FRI), record review, interview, and policy review, and interview, the provider failed to ensure the care plan reflected the current individualized diet plan ordered by the resident's physician for one of one sampled resident (1).
June 10, 2024Complaint inspection · 1 citation
- F Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observation, testing, interview, and policy review the provider failed to: *Maintain the temperature of the walk-in cooler below 41 degrees Fahrenheit (F). *Maintain the cleanliness inside of the walk-in cooler.
February 29, 2024Standard inspection, Complaint inspection · 9 citations
- J Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteA. Based on review of a South Dakota Department of Health (SD DOH) Required Healthcare Facility Event Reporting, record review, observation, interview, and policy review, the provider failed to provide a secure physical environment and adequate supervision to minimize the risk of an unwitnessed elopement by one of one sampled resident (22).
- E Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Inspectors wroteBased on observation, interview, and record review, the provider failed to revise individualized care plans as resident changes occurred for 3 of 13 sampled residents (22, 3, and 24).
- E Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on observation, interview, record review and policy review, the provider failed to ensure staff followed the policy to identify and evaluate skin conditions for 2 of 3 sampled residents (3 and 16).
- E Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Inspectors wroteBased on observation, interview, and record review the provider failed to ensure sufficient dietary training for four of five sampled dietary services employees' (P, R, S, T).
- D Ensure services provided by the nursing facility meet professional standards of quality.
Inspectors wroteBased on the South Dakota Department of Health facility reported event, interview, record review, and policy review, the provider failed to follow the five rights of medication administration and to compare the medication package with the physician's orders received from the pharmacy was correct before administering the medication to one of one sampled resident (28).
- D Ensure that residents are free from significant medication errors.
Inspectors wroteBased on the South Dakota Department of Health facility reported event, interview, record review, and policy review, the provider failed to correctly administer medication according to the physician's order and per facility policy for one of one sampled resident (28).
- D Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Inspectors wroteBased on observation and interview, the provider failed to have a policy in place for the dietary staff to follow to ensure the correct serving portions had been used by one of one cook (P) when she prepared the meals for the residents.
- D Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Inspectors wroteBased on observation, interview, and policy review, provider failed to ensure the food storage policy was followed by dating opened food packages in one of one kitchen.
- D Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
Inspectors wroteBased on observation, interview, record review, and policy review, the provider failed to assess for need, obtain a physician order, follow facility policy, and properly install a bedrail for one of one sampled resident (11) to ensure the resident's safety.
March 15, 2023Standard inspection · 1 citation
- D Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, interview, record review, and policy review, the provider failed to ensure: *Necessary contact precautions were posted for one of one sampled resident (19) who had a contagious bacterial infection, methicillin-resistant staphylococcus aureus (MRSA) that could have been spread through skin-to-skin contact. *A care plan was updated to identify a MRSA infection and the need for staff to follow contact precautions for one of one resident (19).
Fire safety inspections
4 fire safety citations on file: 2 on March 6, 2025, 2 on March 15, 2023.
Every fire safety citation4 citations
- D Develop and maintain an Emergency Preparedness Program (EP).
- D Inspect, test, and maintain automatic sprinkler systems.
- D Properly select, install, inspect, or maintain portable fire extinguishes.
- D Have simulated fire drills held at unexpected times.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| March 6, 2025 | Fine | $17,651 |
| February 29, 2024 | Fine | $10,377 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Staffing
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | South Dakota | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 4.20 | 3.79 | 3.86 |
| Registered nurses | 0.90 | 0.80 | 0.69 |
| All nursing staff on weekends | 3.72 | 3.26 | 3.42 |
| Nurse aides | 2.77 | ||
| Licensed practical nurses | 0.53 | ||
| Nursing staff turnover (share who left in a year) | 60.5% | 48.2% | 45.8% |
| Registered nurse turnover | 28.6% | 34.7% | 42.9% |
| Administrators who left | 1 |
CMS expects 3.06 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Staffing by quarter, from daily payroll records
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 4.39 on weekdays and 3.72 on weekends, 15% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 11.5% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 4.76 in April to June 2025 to 4.20 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 4.20 | 0.90 | 4.39 | 3.72 | 11.5% | 0 of 90 | 25 |
| Oct to Dec 2025 | 4.14 | 0.95 | 4.33 | 3.63 | 13.4% | 0 of 92 | 25 |
| Jul to Sep 2025 | 4.59 | 1.00 | 4.79 | 4.06 | 4.7% | 2 of 92 | 24 |
| Apr to Jun 2025 | 4.76 | 0.79 | 5.05 | 4.02 | 10.2% | 5 of 91 | 24 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| South Dakota, Jan to Mar 2026 | 3.76 | 0.79 | 3.97 | 3.25 | 9.1% | 1.1% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Quality measures
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | South Dakota | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 25.0 | 21.4 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 2.1 | 2.1 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 5.6 | 2.9 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 4.2 | 5.5 | 3.2 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 15.1 | 19.4 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 6.3 | 4.6 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 24.4 | 24.6 | 15.4 |
| Number of hospitalizations per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 2.1 | 1.5 | 1.9 |
| Number of outpatient emergency department visits per 1000 long-stay resident days Long Stay residents, 20250101-20251231 | 3.4 | 1.8 | 1.8 |
Owners and operators
Legal business name: WILMOT CARE CENTER.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Beumer, Rachel | Corporate director | Individual | 10/18/2021 | |
| Jurgens, Kevin | Corporate director | Individual | 10/01/2012 | |
| Pelzel, Heidi | Corporate director | Individual | 10/18/2021 | |
| Remund, Linda | Corporate director | Individual | 09/30/2022 | |
| Buttke, Leshea | Operational/managerial control | Individual | 01/01/2024 | |
| Van Beek, Jannette | Operational/managerial control | Individual | 12/02/2019 | |
| Beumer, Rachel | Trustee of the SNF | Individual | 10/18/2021 | |
| Jurgens, Kevin | Trustee of the SNF | Individual | 09/30/2021 | |
| Pelzel, Heidi | Trustee of the SNF | Individual | 09/30/2019 | |
| Remund, Linda | Trustee of the SNF | Individual | 09/30/2022 | |
| Buttke, Leshea | Adp of the SNF | Individual | 02/11/2026 | |
| Van Beek, Jannette | Adp of the SNF | Individual | 04/18/2025 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Questions to ask on a visit
Chosen from this home's own inspection record.
- Can we see a week of menus and the kitchen, and how are special diets handled?Inspectors cited 7 problems in this area, most recently on March 6, 2025: "Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident."
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 4 problems in this area, most recently on March 6, 2025: "Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents."
- When is the care plan meeting, and can family attend it?Inspectors cited 3 problems in this area, most recently on November 13, 2024: "Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals."
- What changed in infection control since the last inspection, and who on staff is the infection preventionist?Inspectors cited 2 problems in this area, most recently on March 6, 2025: "Provide and implement an infection prevention and control program."
- How long has the current administrator been here?CMS counts 1 administrator who left in the period it measured.
Other nursing homes nearby
- Browns Valley Health Center Browns Valley, 12.7 mi · 3 of 5 stars · 9 citations
- St. William's Care Center Milbank, 17.3 mi · 2 of 5 stars · 25 citations
- Avantara Milbank Milbank, 17.6 mi · 1 of 5 stars · 30 citations
- Tekakwitha Living Center Sisseton, 19.9 mi · 2 of 5 stars · 31 citations
- Fairway View Neighborhoods Ortonville, 21.4 mi · 2 of 5 stars · 8 citations
- Essentia Health Grace Home Graceville, 23.2 mi · 5 of 5 stars · 11 citations
South Dakota contacts for a concern about a nursing home
These are the official offices in South Dakota. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: South Dakota Department of Health, Office of Health Facilities Licensure and Certification, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: South Dakota Long-Term Care Ombudsman Program, Department of Human Services. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: South Dakota Department of Health Nursing Facility Reports, where South Dakota publishes its own records on licensed homes.
Common questions
- What is Wilmot Care Center Inc's Medicare star rating?
- CMS rates Wilmot Care Center Inc 1 out of 5 stars overall, with 1 for health inspections, 5 for staffing and 1 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Wilmot Care Center Inc get at its last inspection?
- 5 health deficiencies at the standard inspection on March 6, 2025. The South Dakota average is 6.7.
- Has Wilmot Care Center Inc been fined?
- Yes. CMS lists 2 fines totaling $28,028 in the last three years.
- Does Wilmot Care Center Inc accept Medicaid?
- It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
- Who owns Wilmot Care Center Inc?
- CMS lists 12 owners and managers. Legal business name: WILMOT CARE CENTER.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.