nursing home in Custer, SD
Custer Care and Rehab Center
1065 Montgomery St, Custer, SD 57730 · (605) 673-2115
CMS overall star rating
- Health inspections★★★★★2
- Staffing★★★★★1
- Quality measures★★★★★1
Source: Centers for Medicare & Medicaid Services (CMS), Medicare Care Compare. We refresh our information from this source. About our data
Custer Care and Rehab Center at a glance
Custer Care and Rehab Center is a 43-bed non-profit nursing home in Custer, South Dakota (Custer County).
CMS gives it 1 out of 5 stars on its overall star rating, worse than the South Dakota average of 2.9.
Its most recent standard health inspection (August 6, 2026) found 2 health citations. The South Dakota average is 6.7.
It has not received a federal fine in the past three years.
Facility details
- Type
- Nursing home
- Ownership
- Non Profit - Corporation
- Beds
- 43
- Certified for
- Medicare and Medicaid
- Medicare-certified since
- December 1, 2025
- Resident/family council
- Resident
- County
- Custer County
- CMS Certification Number
- 435136
Ratings
| Measure | This facility | South Dakota avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Overall star rating ⓘ (higher is better) | 1 / 5 | 2.9 / 5 | 3 / 5 | Worse |
| Health inspection rating ⓘ (higher is better) | 2 / 5 | 2.9 / 5 | 2.8 / 5 | Worse |
| Staffing rating ⓘ (higher is better) | 1 / 5 | 3.5 / 5 | 2.9 / 5 | Worse |
| Quality measures rating ⓘ (higher is better) | 1 / 5 | 2.7 / 5 | 3.6 / 5 | Worse |
| Long-stay quality rating (higher is better) | 1 / 5 | 2.6 / 5 | 3.8 / 5 | Worse |
Inspections
| Measure | This facility | South Dakota avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Health citations in the most recent inspection (lower is better) | 2 | 7 | 9 | Better |
| Citations from complaint investigations (latest cycle) (lower is better) | 0 | 2 | 3 | Better |
| Weighted health inspection score ⓘ (lower is better) | 64.5 | 72.2 | 80.6 | Better |
Penalties
| Measure | This facility | South Dakota avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Fines in the past 3 years (lower is better) | 0 | 2 | 1 | Better |
| Total fines in the past 3 years (lower is better) | $0 | $40,815 | $30,972 | Better |
| All federal penalties in the past 3 years (lower is better) | 0 | 2 | 1 | Better |
Size
| Measure | This facility | South Dakota avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Certified beds | 43 | 61 | 107 |
Long-stay residents
| Measure | This facility | South Dakota avg. | U.S. avg. | vs. U.S. |
|---|---|---|---|---|
| Long-stay residents with a fall causing major injury (lower is better) | 6.9% | 5.5% | 3.2% | Worse |
| Long-stay residents with pressure ulcers (lower is better) | 8.5% | 4.6% | 4.6% | Worse |
| Long-stay residents given antipsychotic medication (lower is better) | 38.5% | 24.6% | 15.4% | Worse |
| Long-stay residents with a urinary tract infection (lower is better) | 6.9% | 2.9% | 1.6% | Worse |
| Long-stay residents with a catheter left in the bladder (lower is better) | 3.6% | 2.1% | 0.8% | Worse |
| Long-stay residents needing more help with daily activities (lower is better) | 28.6% | 21.3% | 13.9% | Worse |
| Long-stay residents who lose too much weight (lower is better) | 6.9% | 5.6% | 5.2% | Worse |
| Long-stay residents with depressive symptoms (lower is better) | 22.2% | 5.7% | 12.8% | Worse |
| Long-stay residents who were physically restrained (lower is better) | 0% | 0% | 0.1% | Better |
| Long-stay residents given anti-anxiety or sleep medication (lower is better) | 41.4% | 17.4% | 19.5% | Worse |
| Long-stay residents with new or worse incontinence (lower is better) | 30.5% | 25.4% | 19% | Worse |
| Long-stay residents given a flu vaccine (higher is better) | 95.7% | 96.9% | 95.5% | Average |
| Long-stay residents given a pneumonia vaccine (higher is better) | 62.1% | 94.9% | 93.6% | Worse |
Inspection citations
State inspectors cited this home for 19 health deficiencies and 2 fire safety deficiencies in the inspection records CMS currently publishes. None were rated as causing actual harm to residents.
| Date | Citation | Severity | Status |
|---|---|---|---|
| August 6, 2026 Standard | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Tag F0880 | D Potential harm, isolated | Corrected August 23, 2026 |
| August 6, 2026 Standard | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Resident Rights Deficiencies · Tag F0578 | D Potential harm, isolated | Corrected August 23, 2026 |
| August 26, 2025 Fire safety | Conduct risk assessment and an All-Hazards approach. Emergency Preparedness Deficiencies · Tag E0006 | D Potential harm, isolated | Corrected October 10, 2025 |
| August 26, 2025 Fire safety | Meet requirements for the use of electrical equipment. Gas, Vacuum, and Electrical Systems Deficiencies · Tag K0919 | D Potential harm, isolated | Corrected October 14, 2025 |
| August 26, 2025 Standard | Have a plan that describes the process for conducting QAPI and QAA activities. Administration Deficiencies · Tag F0865 | F Potential harm, widespread | Corrected October 10, 2025 |
| August 26, 2025 Standard | Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Nursing and Physician Services Deficiencies · Tag F0727 | F Potential harm, widespread | Corrected November 15, 2025 |
| August 26, 2025 Standard | Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Administration Deficiencies · Tag F0851 | F Potential harm, widespread | Corrected October 10, 2025 |
| August 26, 2025 Standard | Provide and implement an infection prevention and control program. Infection Control Deficiencies · Tag F0880 | F Potential harm, widespread | Corrected October 10, 2025 |
| August 26, 2025 Standard | Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. Resident Rights Deficiencies · Tag F0628 | F Potential harm, widespread | Corrected October 10, 2025 |
| August 26, 2025 Standard | Ensure each resident’s drug regimen must be free from unnecessary drugs. Pharmacy Service Deficiencies · Tag F0757 | E Potential harm, pattern | Corrected October 16, 2025 |
| August 26, 2025 Standard | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Resident Assessment and Care Planning Deficiencies · Tag F0655 | E Potential harm, pattern | Corrected October 10, 2025 |
| August 26, 2025 Standard | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Resident Assessment and Care Planning Deficiencies · Tag F0657 | E Potential harm, pattern | Corrected October 10, 2025 |
| August 26, 2025 Standard | Ensure each resident receives an accurate assessment. Resident Assessment and Care Planning Deficiencies · Tag F0641 | E Potential harm, pattern | Corrected October 10, 2025 |
| August 26, 2025 Standard | Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. Nursing and Physician Services Deficiencies · Tag F0841 | E Potential harm, pattern | Corrected October 10, 2025 |
| August 26, 2025 Standard | Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Administration Deficiencies · Tag F0868 | E Potential harm, pattern | Corrected October 10, 2025 |
| August 26, 2025 Standard | Assess the resident when there is a significant change in condition Resident Assessment and Care Planning Deficiencies · Tag F0637 | E Potential harm, pattern | Corrected November 15, 2025 |
| August 26, 2025 Standard | Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Resident Assessment and Care Planning Deficiencies · Tag F0644 | D Potential harm, isolated | Corrected November 15, 2025 |
| August 26, 2025 Standard | Develop 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 Planning Deficiencies · Tag F0656 | D Potential harm, isolated | Corrected October 10, 2025 |
| August 26, 2025 Standard | 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. Environmental Deficiencies · Tag F0909 | D Potential harm, isolated | Corrected October 10, 2025 |
| August 26, 2025 Standard | Post nurse staffing information every day. Nursing and Physician Services Deficiencies · Tag F0732 | D Potential harm, isolated | Corrected October 10, 2025 |
| August 26, 2025 Standard | 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 Deficiencies · Tag F0700 | D Potential harm, isolated | Corrected November 15, 2025 |
Severity letters follow the CMS scope-and-severity grid: A–C no actual harm with potential for minimal harm; D–F potential for more than minimal harm; G–I actual harm; J–L immediate jeopardy to resident health or safety. How to read inspection citations.
Fines and payment denials
CMS reports no federal fines or payment denials in the past three years.
Owners and managers
Individuals and organizations reported to CMS as owning or operating this nursing home.
| Name | Role | Share | Since |
|---|---|---|---|
| CUSTER CARES Organization | 5% or greater direct ownership interest | 100% | 12/01/2023 |
| BARTA, MADISON Individual | adp of the snf | NOT APPLICABLE | 12/01/2023 |
| CUSTER CARES Organization | adp of the snf | NOT APPLICABLE | 12/01/2023 |
| VAN VOORST, SAMUEL Individual | adp of the snf | NOT APPLICABLE | 09/01/2023 |
| BARTA, MADISON Individual | operational/managerial control | NOT APPLICABLE | 12/01/2023 |
| BOYER, JANET Individual | operational/managerial control | NOT APPLICABLE | 09/01/2023 |
| MCGOWAN, MONICA Individual | operational/managerial control | NOT APPLICABLE | 09/01/2023 |
| TENNYSON, MIKE Individual | operational/managerial control | NOT APPLICABLE | 09/01/2023 |
| VAN VOORST, SAMUEL Individual | operational/managerial control | NOT APPLICABLE | 09/01/2023 |
| WHEELER, RICKY Individual | operational/managerial control | NOT APPLICABLE | 09/01/2023 |
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Frequently asked questions
What is Custer Care and Rehab Center's rating?
Custer Care and Rehab Center has 1 out of 5 stars on the CMS overall star rating. The average for South Dakota nursing homes is 2.9 stars.
How many inspection citations did Custer Care and Rehab Center receive?
Its most recent standard health inspection found 2 citations, compared with a South Dakota average of 6.7. Every citation is listed on this page with its severity.
Does Custer Care and Rehab Center accept Medicare and Medicaid?
CMS lists it as certified for: Medicare and Medicaid. Call the facility to confirm bed availability and whether it accepts your specific plan.
Who owns Custer Care and Rehab Center?
It is non profit - corporation. The ownership section on this page lists the owners and managers reported to CMS.
Where is Custer Care and Rehab Center and how do I contact it?
Custer Care and Rehab Center is at 1065 Montgomery St, Custer, SD 57730. Phone: (605) 673-2115.
About this data
Ratings and measures come from the Centers for Medicare & Medicaid Services (CMS), Medicare Care Compare. They're based on state inspections, patient surveys and facility reports, and they describe the past. Facilities change, so visit in person and confirm details directly. About our data · Spotted an error? Let us know.