Nursing HomeInspections

Palisade Healthcare Center

Nursing home in Garretson, SD

Medicare & Medicaid certified1★ overall (CMS)CMS abuse icon

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Public-record details

Address
920 4th St, Garretson, SD 57030
Phone
(605) 594-3466
Listed under
For-profit
Medicare CCN
435115
Overall star rating
1 of 5 ★☆☆☆☆
Health inspection rating
1 of 5
Staffing rating
2 of 5
Quality measures rating
4 of 5
Certified beds
55
Average residents per day
49
Ownership
For-profit, corporation
Legal business name
Palisade SNF Operations, LLC
Chain
Evergreen Healthcare Group (44 facilities)
Certified for
Medicare and Medicaid
First approved by Medicare/Medicaid
Oct 1, 1998
Changed ownership in last 12 months
No
Continuing care retirement community
No
Located inside a hospital
No
Resident or family council
Resident council
Sprinklers in all required areas
Yes

CMS certification number 435115. Source: CMS Nursing Home Provider Information, Health Deficiencies and Penalties (record). Data as of 2026-09-30.

Inspection record

Most recent standard health inspection: Aug 7, 2025. CMS lists 29 health citations for this facility across its last three standard inspection cycles and complaint inspections (Mar 8, 2023 to Apr 16, 2026): 12 from complaint inspections, 5 at the “actual harm” level or higher, including 1 at “immediate jeopardy”. CMS shows its abuse icon for this facility, which it uses for nursing homes cited for abuse at the harm level recently or at the potential-harm level in each of the last two years.

InspectionCitationSeverity
Apr 16, 2026Provide and implement an infection prevention and control program.
Infection Control · complaint inspection		D
Potential for more than minimal harm, isolated
Apr 16, 2026Make sure that a working call system is available in each resident's bathroom and bathing area.
Environmental · complaint inspection		E
Potential for more than minimal harm, pattern
Apr 16, 2026Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Freedom from Abuse, Neglect, and Exploitation · complaint inspection		H
Actual harm, pattern
Nov 19, 2025Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care · complaint inspection		J
Immediate jeopardy, isolated
Sep 17, 2025Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care · complaint inspection		G
Actual harm, isolated
Aug 7, 2025Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Resident Rights		D
Potential for more than minimal harm, isolated
Aug 7, 2025Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation · complaint inspection		D
Potential for more than minimal harm, isolated
Aug 7, 2025Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Nursing and Physician Services		E
Potential for more than minimal harm, pattern
Aug 7, 2025Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in…
Pharmacy Service		E
Potential for more than minimal harm, pattern
Aug 7, 2025Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary		E
Potential for more than minimal harm, pattern
Aug 7, 2025Provide and implement an infection prevention and control program.
Infection Control		E
Potential for more than minimal harm, pattern
Aug 7, 2025Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care		G
Actual harm, isolated

Showing the 12 most recent of 29. Full inspection reports are on Medicare Care Compare.

Severity letters follow CMS's scope-and-severity grid: A–C potential for minimal harm, D–F potential for more than minimal harm, G–I actual harm, J–L immediate jeopardy. Most citations are corrected; a citation is what inspectors found on that date. Source: CMS Health Deficiencies file, processed Aug 1, 2026.

Fines and payment denials

CMS records 4 fines totalling $154,946 in the last three years.

Nov 19, 2025Fine: $122,476
Sep 17, 2025Fine: $8,608
Aug 7, 2025Fine: $11,713
Nov 26, 2024Fine: $12,149

Source: CMS Penalties file, processed Aug 1, 2026. Amounts are as CMS reports them and may reflect later reductions or appeals.

Staffing

Total nurse staffing per resident per day
3.16 hours
Registered nurse (RN) time per resident per day
0.54 hours
Nurse aide time per resident per day
1.99 hours
Total nurse staffing on weekends
2.64 hours
Nursing staff turnover (yearly)
60%
RN turnover (yearly)
40%
Administrators who left in the past year
1

From payroll-based staffing data the facility submits to CMS. Hours are per resident per day.

A citation is what inspectors found on one date; most are corrected within weeks. Look for patterns — the same problem cited in several inspections — and for anything at the G–L level (actual harm or immediate jeopardy). The full inspection narrative (Form CMS-2567) is linked from Medicare Care Compare, and your state long-term care ombudsman can tell you about complaints.