Codington County, South Dakota · Nursing home
Avantara Watertown
1 of 5 overall from CMS
415 Fourth Ave NE, Watertown, SD 57201
At a glance
- Overall rating 1 of 5 Below the state average of 2.9
- Nurse time per resident, per day 3.57 hours Below the state average of 3.79
- Nursing staff who left in a year 44.2% Below the state average of 48.2%
- Health citations, last 3 inspection cycles 32 4 at the harm level or above
- Fines in 3 years $71,591 3 fines
- Certified beds in use 91.4% of 51 beds, on an average day
Arrows only show whether a figure is above or below the state average. They are not a judgment of the home.
Avantara Watertown is a 51-bed nursing home in Watertown, South Dakota (Codington County). CMS rates it 1 of 5 stars overall as of Sep 2026. It reports 3.57 nurse staffing hours per resident per day, below the South Dakota average of 3.79. CMS lists 3 fines totaling $71,591 in the past three years.
- Certified beds
- 51
- Residents per day (average)
- 46.6
- Certified since
- 1993 (33 yrs)
For profit - Limited Liability company Participates in Medicare and MedicaidPart of Legacy Healthcare (95 homes)CMS Special Focus: SFF CandidateCMS abuse citation icon: Yes
Bed use is this site's calculation: average residents per day divided by certified beds. It is an average, so it does not show today's openings.
- Special Focus candidate. CMS lists this home as a candidate for its Special Focus Facility program: its inspection record qualifies it for the program, but it has not been selected. What a Special Focus Facility is
- Abuse citation icon. CMS assigns this icon when a home was cited for abuse where residents were found to be harmed, on its most recent standard inspection or on a complaint or infection-control inspection in the past 12 months, or was cited for abuse with potential harm in that period and again in the period before. Signs of abuse and how to report it
These labels are shown as CMS publishes them. They describe the inspection record, not what has changed since.
Terms used on this page
- CMS
- The Centers for Medicare & Medicaid Services, the federal agency that publishes the ratings, staffing figures, inspection results and penalties shown here.
- Certified beds
- The number of federally certified beds CMS lists for the home.
- Deficiency or citation
- A federal requirement that inspectors found the home did not meet. Each one gets a letter from A to L for how serious it was and how many residents were affected. What the letters mean
- Actual harm
- Letters G, H and I: actual harm to a resident that is not immediate jeopardy.
- Immediate jeopardy
- Letters J, K and L: the problem caused, or was likely to cause, serious injury, harm, impairment or death to a resident.
- Inspection cycle
- A standard inspection plus the complaint and infection-control citations CMS assigns to it. This page shows the three most recent cycles.
- Special Focus Facility (SFF)
- A home CMS has placed under closer oversight because of its inspection record. More about the program
Questions to ask Avantara Watertown
Chosen from this home's public data.
- CMS lists this home as a candidate for its Special Focus Facility program, which means it qualifies but has not been selected. What has changed since the inspections behind that listing?Special Focus status in CMS data
- CMS lists 3 fines totaling $71,591 in the past three years. What changed after the most recent one?Penalties in CMS data
- CMS counts 26 health deficiencies in the latest inspection cycle (the standard inspection on Apr 29, 2026 plus complaint and infection-control inspections); the South Dakota average is 6.7. Which have been corrected?Inspection results in CMS data
More in what to ask on a nursing home tour.
CMS star ratings
- Overall 1 of 5 South Dakota average 2.9
- Health inspections 1 of 5 South Dakota average 2.9
- Staffing 3 of 5 South Dakota average 3.5
- Quality measures 2 of 5 South Dakota average 2.7
The vertical line marks the South Dakota average. Ratings run from 1 to 5. How to read CMS star ratings
Nurse staffing
Hours of care per resident per day, as the home reported to CMS.
What these roles do
Nurse aides give most hands-on daily care, such as help with bathing, dressing and meals. Licensed practical nurses give medications and routine nursing care. Registered nurses assess residents and direct their care.
- All nursing staff 3.57 h South Dakota average 3.79
- Nurse aides 2.09 h South Dakota average 2.52
- Licensed practical nurses 0.42 h South Dakota average 0.47
- Registered nurses 1.06 h South Dakota average 0.80
- All staff, weekends 2.87 h South Dakota average 3.26
How much nurse staffing is enough? All bars share one scale, 0 to 9 hours. The vertical line marks the South Dakota average; the national average for all nursing staff is 3.86 hours.
- Nursing staff turnover44.2%
- South Dakota average48.2%
- Registered nurse turnover27.3%
- South Dakota average34.7%
- Administrators who left1
Quality measures
CMS calculates these from residents' assessments and Medicare claims. They are shown as published, next to the South Dakota and national averages. marks the measures CMS uses in its quality star rating; for those, the rating gives more points for a lower rate.
Long-stay residents
| Measure | This home | South Dakota | U.S. |
|---|---|---|---|
| ★ Percentage of long-stay residents whose need for help with daily activities has increased | 31.6% | 21.3% | 13.9% |
| Percentage of long-stay residents who lose too much weight | 10.5% | 5.6% | 5.2% |
| ★ Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.7% | 2.1% | 0.8% |
| ★ Percentage of long-stay residents with a urinary tract infection | 5.9% | 2.9% | 1.6% |
| Percentage of long-stay residents who have depressive symptoms | 14.0% | 5.7% | 12.8% |
| Percentage of long-stay residents who were physically restrained | 0.0% | 0.0% | 0.1% |
| ★ Percentage of long-stay residents experiencing one or more falls with major injury | 2.5% | 5.5% | 3.2% |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 86.0% | 94.9% | 93.6% |
| ★ Percentage of long-stay residents whose ability to walk independently worsened | 23.9% | 19.4% | 14.1% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 15.0% | 17.4% | 19.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 94.9% | 96.9% | 95.5% |
| ★ Percentage of long-stay residents with pressure ulcers | 7.5% | 4.6% | 4.6% |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 28.7% | 25.4% | 19.0% |
| ★ Percentage of long-stay residents who received an antipsychotic medication | 15.3% | 24.6% | 15.4% |
| ★ Number of hospitalizations per 1000 long-stay resident days | 1.00 | 1.52 | 1.90 |
| ★ Number of outpatient emergency department visits per 1000 long-stay resident days | 1.86 | 1.75 | 1.78 |
Short-stay residents
| Measure | This home | South Dakota | U.S. |
|---|---|---|---|
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 65.7% | 83.5% | 82.0% |
| ★ Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% | 2.0% | 1.6% |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 42.9% | 78.2% | 79.8% |
| ★ Percentage of short-stay residents who were rehospitalized after a nursing home admission | 11.1% | 19.9% | 23.8% |
| ★ Percentage of short-stay residents who had an outpatient emergency department visit | 19.0% | 12.0% | 12.0% |
Measure periods: April 2025 to March 2026 for most measures; July 2024 to June 2025 for the flu vaccine measures; January to December 2025 for the hospital and emergency department measures, which CMS risk-adjusts. See the measures on Medicare.gov
Inspection history
Inspectors cited 32 health deficiencies in the three most recent inspection cycles. Of these, 2 were at the immediate jeopardy level and 2 involved actual harm; the rest were graded as no actual harm. 11 were cited in connection with a complaint investigation. The most recent citation at the harm level or above was on Apr 29, 2026: Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
| Standard inspection | Health | Fire safety |
|---|---|---|
| Apr 29, 2026 | 26 | 4 |
| Dec 5, 2024 | 4 | 2 |
| Sep 28, 2023 | 2 | 2 |
South Dakota homes averaged 6.7 health deficiencies in the latest cycle; the national average is 9.2. Each cycle's health count covers the standard inspection on that date plus the complaint and infection-control citations CMS assigns to that cycle.
Health citations, three most recent inspection cycles (32)
-
EPotential for more than minimal harm, pattern
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jul 15, 2026)
-
KImmediate jeopardy, pattern
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Complaint investigation · Quality of Life and Care · Deficient, Provider has date of correction (Jun 2, 2026)
-
JImmediate jeopardy, isolated
Protect 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 · Deficient, Provider has date of correction (Jun 2, 2026)
-
GActual harm, isolated
Ensure that residents are free from significant medication errors.
Pharmacy Service · Deficient, Provider has date of correction (Jun 2, 2026)
-
FPotential for more than minimal harm, widespread
Keep residents' personal and medical records private and confidential.
Resident Rights · Deficient, Provider has date of correction (Jun 2, 2026)
Show 25 more
-
FPotential for more than minimal harm, widespread
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
Complaint investigation · Administration · Deficient, Provider has date of correction (Jun 2, 2026)
-
FPotential for more than minimal harm, widespread
Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.
Administration · Deficient, Provider has date of correction (Jun 2, 2026)
-
FPotential for more than minimal harm, widespread
Have a plan that describes the process for conducting QAPI and QAA activities.
Administration · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Complaint investigation · Resident Rights · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Resident Rights · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Complaint investigation · Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Complaint investigation · Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care · Deficient, Provider has date of correction (Jun 2, 2026)
-
EPotential for more than minimal harm, pattern
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Quality of Life and Care · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Ensure that residents are fully informed and understand their health status, care and treatments.
Resident Rights · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Freedom from Abuse, Neglect, and Exploitation · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.
Resident Rights · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Resident Assessment and Care Planning · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Complaint investigation · Pharmacy Service · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Ensure 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 locked compartments, separately locked, compartments for controlled drugs.
Pharmacy Service · Deficient, Provider has date of correction (Jun 2, 2026)
-
DPotential for more than minimal harm, isolated
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Nutrition and Dietary · Deficient, Provider has date of correction (Jun 2, 2026)
-
GActual harm, isolated
Ensure that residents are free from significant medication errors.
Complaint investigation · Pharmacy Service · Past Non-Compliance (Feb 28, 2025)
-
EPotential for more than minimal harm, pattern
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Resident Rights · Deficient, Provider has date of correction (Jan 6, 2025)
-
EPotential for more than minimal harm, pattern
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Complaint investigation · Pharmacy Service · Deficient, Provider has date of correction (Jan 6, 2025)
-
EPotential for more than minimal harm, pattern
Ensure 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 locked compartments, separately locked, compartments for controlled drugs.
Pharmacy Service · Deficient, Provider has date of correction (Jan 6, 2025)
Showing the 30 most recent of 32.
What severity letters A to L mean
Each sentence above is the requirement that was not met, in CMS's wording. For the inspection results as Medicare publishes them, open this home's page on Medicare.gov and look under "Health inspections".
Penalties, past three years
| Date | Type | Amount |
|---|---|---|
| Apr 29, 2026 | Fine | $27,378 |
| Apr 29, 2026 | Fine | $37,845 |
| Mar 6, 2025 | Fine | $6,368 |
South Dakota homes averaged 1.9 fines and $40,815 in fine amounts; the national averages are 0.9 and $30,972.
Cost
Not in the public data. CMS does not publish what a nursing home charges.
Ask the home for its daily private-pay rate and whether a bed is open for your coverage. See what Medicare covers and how Medicaid pays for a nursing home.
Compared within South Dakota
- Size49 of 96 by certified beds
- South Dakota average residents per day52.1
- ChainLegacy Healthcare
- Chain average overall rating2.9 of 5
- Resident or family councilResident
- Homes in Codington County2
Common questions
What is the CMS star rating for Avantara Watertown?
Avantara Watertown has an overall rating of 1 of 5 stars from CMS as of Sep 2026. Its health inspection rating is 1, staffing is 3 and quality measures is 2.
How many beds does Avantara Watertown have?
Avantara Watertown has 51 certified beds. It averages 46.6 residents per day, about 91.4% of its certified beds.
How much nursing care do residents get at Avantara Watertown?
The home reports 3.57 hours of nurse staffing per resident per day, including 1.06 hours from registered nurses. The South Dakota average is 3.79 hours and 0.80 hours from registered nurses.
Has Avantara Watertown been fined?
Yes. CMS lists 3 fines totaling $71,591 in the past three years.
Does Avantara Watertown accept Medicare or Medicaid?
CMS lists its participation as "Medicare and Medicaid". Ask the home whether a bed is open for your coverage.
Guides for families looking at this home
- Understanding the recordWhat to ask on a nursing home tourQuestions that turn a home's public record into a useful conversation when you tour, plus what to look for yourself.
- Understanding the recordInspection severity letters A to LHow inspectors grade each deficiency by harm and by how many residents were affected.
- Understanding the recordHow to read CMS star ratingsWhat the overall, health inspection, staffing and quality measure ratings cover, and what they leave out.
Nearest nursing homes
- 3 of 5 Jenkin's Living Center 110beds 65.5%in use 3.67nurse hours a day
- 4 of 5 Estelline Nursing and Care Center 60beds 93.5%in use 2.04nurse hours a day
- 5 of 5 Avantara Lake Norden 50beds 93.6%in use 3.23nurse hours a day
Sorted by straight-line distance. This is not a ranking or a recommendation. Compare all homes in Codington County
Source: CMS Provider Data Catalog, nursing home datasets processed Sep 1, 2026. CMS Certification Number 435068. See this home's official record on Medicare.gov
See something shown incorrectly? Tell us. This site shows each record as CMS publishes it and cannot change the underlying record.