Map showing the location of AVANTARA MILBANK in MILBANK, South Dakota
1103 SOUTH SECOND STREET, MILBANK, SD, 57252

Overall Score

CMS Five-Star Quality Rating
1/5Much below averageCMS Five-Star overall rating
  1. Much below average
  2. Below average
  3. Average
  4. Above average
  5. Much above average

Where it ranks

  • South DakotaLowest tier among peers95 rated homes · average 2.9★
  • United StatesLowest tier among peers14,574 rated homes · average 3.0★

How the rating is built

  • Health inspectionsStarting point2★−0.8 vs SD avg
  • StaffingCan add or remove a star2★−1.5 vs SD avg
  • Quality measuresCan add or remove a star1★−1.9 vs SD avg

CMS starts from the health inspection stars, then adds or subtracts a star for staffing and for quality measures. Stars are assigned relative to other facilities in the same state.

Ratings & measures

Tap a row to see what it means
Health inspection ratingCMS stars from the last three on-site inspection cycles2★Above only 19% of peersSD avg2.8★U.S. avg2.8★
What is health inspection rating?

Stars assigned from the last three standard surveys and every complaint investigation in that window, weighted toward the most recent and the most serious findings. CMS assigns these stars relative to other facilities in the same state.

Why it matters

It carries the most weight in the overall rating and is the only domain based on what trained inspectors saw on site rather than what the facility reported.

Staffing ratingCMS stars from payroll-reported hours and turnover2★Above only 7% of peersSD avg3.5★U.S. avg2.9★
What is staffing rating?

Nurse and aide hours per resident day from payroll records CMS collects every quarter, adjusted for how much care residents need, plus staff turnover and weekend coverage.

Why it matters

More hours and lower turnover are the strongest predictors of fewer falls, pressure sores, and avoidable hospital stays.

Quality measures ratingCMS stars from clinical outcomes and resident assessments1★Lowest tier among peersSD avg2.9★U.S. avg3.6★
What is quality measures rating?

Clinical outcomes from resident assessments and Medicare claims: falls with injury, pressure ulcers, hospitalizations, antipsychotic use, and more, for both short-stay and long-stay residents.

Why it matters

It shows whether care is working, but part of it comes from the facility’s own assessments, so read it alongside the inspection results.

Total nurse hoursPer resident per day, all nursing staff3.18hrsAbove only 18% of peersSD avg3.89Benchmark4.10
What is total nurse hours?

All licensed nurse and aide hours worked, divided by the number of residents, on an average day. Reported from payroll, not self-reported.

Why it matters

Federal research links 4.1 hours a day to fewer avoidable harms. Below about 3 hours, residents wait longer for help with basics like toileting and repositioning.

RN hoursPer resident per day, registered nurses only0.78hrsAbove 54% of peersSD avg0.80Benchmark0.75
What is rn hours?

Registered nurse hours only. RNs assess residents, manage medications, and catch changes in condition; LPNs and aides deliver most hands-on care.

Why it matters

RN coverage is the staffing measure most tied to fewer hospital transfers and infections, and it is where thinly staffed facilities cut first.

Nursing staff turnoverShare of nursing staff who left within a year · lower is better83%Lowest tier among peersSD avg50%RN turnover77%
What is nursing staff turnover?

The share of nursing staff who left within the past year, from the same payroll data.

Why it matters

High turnover means residents are cared for by people who do not know them, and it is one of the strongest predictors of inspection problems.

Fines in the last three yearsCivil money penalties imposed by CMS · lower is better$55,361Above only 11% of peersSD avg$25,187Fines · denials3 · 0
What is fines in the last three years?

Civil money penalties CMS imposed after serious or uncorrected deficiencies, and denials of Medicare payment for new admissions.

Why it matters

Penalties follow the worst inspection findings. A recent fine is the clearest sign that inspectors found real harm.

Inspection history

Last three inspection cycles
18citations
6inspection dates
6actual harm (G–I)
0immediate jeopardy (J–L)
Mar 13, 2025most recent

Citations by monthSep 2022 – Mar 2025

  • No actual harm (D–F)
  • Actual harm (G–I)
  • Immediate jeopardy (J–L)
  • $Fine or payment denial

Click a month or a year to filter the findings below. Arrow keys move between months; Esc clears.

Mar 13, 20255 citationsCycle 1worst F · no actual harm
  1. 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.Resident RightsD · isolatedCorrected Apr 21, 2025
  2. F675Honor each resident's preferences, choices, values and beliefs.Quality of Life and CareE · patternCorrected Apr 21, 2025
  3. F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Nutrition and DietaryF · widespreadCorrected Apr 21, 2025
  4. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareE · patternCorrected Apr 21, 2025
  5. F623Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.Resident RightsD · isolatedCorrected Apr 21, 2025
Dec 18, 20243 citationsCycle 2worst G · actual harm$28,912
  1. F585Honor 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 RightsD · isolatedCorrected Jan 17, 2025
  2. F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.Freedom from Abuse, Neglect, and ExploitationD · isolatedCorrected Jan 17, 2025
  3. F760Ensure that residents are free from significant medication errors.Pharmacy ServiceG · isolatedCorrected Jan 17, 2025
Oct 8, 20243 citationsCycle 2worst G · actual harm$15,041
  1. F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.Freedom from Abuse, Neglect, and ExploitationG · isolatedCorrected Nov 2, 2024
  2. F610Respond appropriately to all alleged violations.Freedom from Abuse, Neglect, and ExploitationG · isolatedCorrected Nov 2, 2024
  3. F692Provide enough food/fluids to maintain a resident's health.Quality of Life and CareG · isolatedCorrected Nov 2, 2024
Aug 6, 20241 citationCycle 2worst E · no actual harm
  1. F677Provide care and assistance to perform activities of daily living for any resident who is unable.Quality of Life and CareE · patternCorrected Sep 10, 2024
Nov 8, 20235 citationsCycle 2worst G · actual harm$11,408
  1. F550Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.Resident RightsE · patternCorrected Dec 6, 2023
  2. F656Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.Resident Assessment and Care PlanningD · isolatedCorrected Dec 6, 2023
  3. F658Ensure services provided by the nursing facility meet professional standards of quality.Resident Assessment and Care PlanningG · isolatedCorrected Dec 6, 2023
  4. F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Quality of Life and CareG · isolatedCorrected Dec 6, 2023
  5. F880Provide and implement an infection prevention and control program.Infection ControlD · isolatedCorrected Dec 6, 2023
Sep 1, 20221 citationCycle 3worst E · no actual harm
  1. F880Provide and implement an infection prevention and control program.Infection ControlE · patternCorrected Oct 21, 2022

Staffing

From quarterly payroll reports

Hours per resident per day

  • All nursing staffRNs, LPNs and aides combined3.18hrsAbove only 18% of peers−0.71 vs SD avg
  • Registered nursesRN hours only0.78hrsAbove 54% of peers−0.02 vs SD avg
  • Licensed practical nursesLPN hours0.48hrs
  • Nurse aidesCNA hours1.93hrs
  • Weekend nursingAll staff on Saturdays and Sundays2.94hrs
  • South Dakota average
  • Research benchmark (4.10 total, 0.75 RN)

Turnover & capacity

  • Nursing staff turnoverShare who left within a year · lower is better83%Lowest tier among peersSD avg 50%
  • RN turnoverRegistered nurses only77%Not ranked by CMS
  • Administrators who leftIn the past year1Leadership changed
  • Occupancy55 certified beds · ~37 residents a day68%Above only 14% of peersSD avg 84%

Fines & penalties

Roughly the past three years

Enforcement summary

  • $55,361In fines
  • 3Fines
  • 0Payment denials
  • $25,187SD avg in fines
Above only 11% of peersFewer fines than 11% of rated homes in South Dakota

Actions on record

  1. Dec 18, 2024Civil money penalty$28,912
  2. Oct 8, 2024Civil money penalty$15,041
  3. Nov 8, 2023Civil money penalty$11,408

Ownership

As filed with CMS

Structure

Ownership type
For profit - Corporation
Chain
Legacy Healthcare90 facilities in the chain3.0★ chain average
Certification
Medicare and Medicaid
Location type
Rural
Ownership change
None in the last 12 months

People and entities on file

Direct owners (5%+)
  • Doros Generation Trust U/A/D 1/3/12
  • Gpn Fam Tr Ua 04282008
Operational or managerial control
  • Legacy Healthcare Financial Services LLC
Corporate officers
  • Chaim Rajchenbach
  • Menachem Shabat
Managing employees
  • Celina Lohre
5% Or Greater Security Interest
  • Cibc Bank Usa

Person Organization

Sources & notes

Public data, updated quarterly

Data sources

  • CMS Care Compare · Provider InformationStar ratings, staffing hours, turnover, penalties and flags · processed February 2026.
  • CMS Health CitationsEvery deficiency from the last three inspection cycles, with scope, severity and inspection cycle.
  • CMS Penalties and Ownership filesCivil money penalties, payment denials, and the owners and managers on file.

Notes

  • CMS Certification Number 435009 · 1103 SOUTH SECOND STREET, MILBANK, SD, 57252.
  • Percentiles compare this facility with every rated nursing home in South Dakota and Grant County. Turnover and fines are inverted so a high percentile is always good.
  • This is an informational summary of public data, not medical, legal, or placement advice. Facilities cannot pay to change it; a facility that believes a record is wrong can dispute it with CMS.

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