Sunset Manor Avera Health, Irene, SD

The Essentials

Summary

Across 7 inspections from July 2023 to May 2026, state surveyors documented 17 findings at Sunset Manor Avera Health; 17 have a recorded correction; CMS lists 3 enforcement actions in the window.

Inspections: 7; 2023–2026, complaint and standard
Findings: 17; Deficiencies cited by state inspectors
Corrected: 17; Of 17 findings, with a recorded correction date
Penalties: 3; 3 fines; payment not published

Findings by Year

Findings
Of which, actual harm (level G or above)

* Partial year, through October 1, 2026.

Findings by year
Year	Inspections	Findings	Of which, actual harm (level G or above)
2023	1	1	0
2024	2	4	2
2025	3	10	1
2026	1	2	1

What the Record Shows

17 of 17 findings have a recorded correction date.
CMS lists 3 enforcement actions in the window: 3 fines totaling $56,946, their payment not published.
6 visits in this window included a complaint investigation. CMS publishes what a complaint investigation cited, not what the complaint alleged.
The latest standard inspection, December 31, 2025, recorded 5 findings (most serious: Level F).

What to Ask About

Protection From Abuse and Neglect, Cited in Three Inspections
Quality of Care, Cited in Three Inspections
Accurate Assessments, Cited in Two Inspections
Accident Hazards and Supervision, Cited in Two Inspections

Report at a Glance

Facility: Sunset Manor Avera Health
Address: 129 E Clay St, Irene, SD 57037
CMS Certification Number: 435100
Provider Type: Skilled nursing facility and nursing facility
Certified Beds: 58
Ownership: Non profit - Other
Record Window: July 13, 2023 to October 1, 2026

Chronology

Inspection History

Every inspection in the record window, newest first. A finding is a deficiency an inspector cited. CMS publishes what a complaint investigation cited, not what the complaint alleged.

May 52026
Complaint investigation
2 findings
- F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Level GActual harmCorrected Jun 3, 2026
- F609Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.Level DNo actual harm, potential for moreCorrected Jun 3, 2026
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Dec 312025
Standard health inspection
5 findings
The same visit included a complaint investigation.
- F732Post nurse staffing information every day.Level FNo actual harm, potential for moreCorrected Jan 8, 2026
- F641Ensure each resident receives an accurate assessment.Level ENo actual harm, potential for moreCorrected Feb 4, 2026
- F812Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.Level ENo actual harm, potential for moreCorrected Jan 16, 2026
- F880Provide and implement an infection prevention and control program.Level ENo actual harm, potential for moreCorrected Feb 4, 2026
- F678Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.Level DNo actual harm, potential for moreCorrected Feb 4, 2026
Enforcement Action
Civil money penalty, $16,350 imposed May 5, 2026. CMS publishes the fine, not whether it has been paid. CMS does not tie a penalty to a survey; listed with the standard health inspection of December 31, 2025, the nearest before the penalty date.
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Jun 182025
Complaint investigation
3 findings
- F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Level DNo actual harm, potential for moreCorrected Jul 16, 2025
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level DNo actual harm, potential for moreCorrected Jul 16, 2025
- F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Level DNo actual harm, potential for moreCorrected Jul 22, 2025
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Feb 122025
Complaint investigation
2 findings
- F689Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.Level GActual harmCorrected Mar 13, 2025
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level ENo actual harm, potential for moreCorrected Mar 13, 2025
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Sep 252024
Complaint investigation
2 findings
- F600Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.Level HActual harmCorrected Oct 23, 2024
- F684Provide appropriate treatment and care according to orders, resident’s preferences and goals.Level HActual harmCorrected Oct 23, 2024
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Aug 82024
Standard health inspection
2 findings
The same visit included a complaint investigation.
- F641Ensure each resident receives an accurate assessment.Level ENo actual harm, potential for moreCorrected Sep 6, 2024
- F604Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment.Level DNo actual harm, potential for moreCorrected Sep 22, 2024
Enforcement Action
Civil money penalty, $29,406 imposed September 25, 2024. CMS publishes the fine, not whether it has been paid. CMS does not tie a penalty to a survey; listed with the standard health inspection of August 8, 2024, the nearest before the penalty date.
Enforcement Action
Civil money penalty, $11,190 imposed February 12, 2025. CMS publishes the fine, not whether it has been paid. CMS does not tie a penalty to a survey; listed with the standard health inspection of August 8, 2024, the nearest before the penalty date.
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
Jul 132023
Standard health inspection
1 finding
- F638Assure that each resident’s assessment is updated at least once every 3 months.Level DNo actual harm, potential for moreCorrected Aug 25, 2023
Source: Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)

Severity levels follow the CMS scope and severity grid. A–C: potential for minimal harm. D–F: no actual harm, potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy.

Context

Patterns Worth Examining

A repeated citation can merit attention, but context and corrective action must be reviewed before drawing a conclusion.

1
Protection From Abuse and Neglect, Cited in Three Inspections
Inspectors cited F600 in September 2024, June 2025 and May 2026. This citation covers whether residents are protected from abuse and neglect by anyone. The most serious of these was recorded at level H (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
23242425252526F600 across all 7 inspections, oldest to newest
2
Quality of Care, Cited in Three Inspections
Inspectors cited F684 in September 2024, February 2025 and June 2025. This citation covers whether residents receive the treatment their orders, preferences and goals call for. The most serious of these was recorded at level H (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
23242425252526F684 across all 7 inspections, oldest to newest
3
Accurate Assessments, Cited in Two Inspections
Inspectors cited F641 in August 2024 and December 2025. This citation covers whether each resident’s assessment correctly records their condition. None rose above level E (no actual harm, potential for more). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
23242425252526F641 across all 7 inspections, oldest to newest
4
Accident Hazards and Supervision, Cited in Two Inspections
Inspectors cited F689 in February 2025 and June 2025. This citation covers whether residents are protected from accident hazards and supervised closely enough to prevent accidents, including falls. The most serious of these was recorded at level G (actual harm). Each citation has a recorded correction, and a repeat after correction is worth a direct question.
23242425252526F689 across all 7 inspections, oldest to newest

For Your Next Visit

Questions to Ask on Your Visit

Bring these to the tour. Each one comes from something in the record; the reason is under the question.

01
What happened after the abuse or neglect citation, and what changed in training or supervision?
Protection From Abuse and Neglect: cited in three inspections, most seriously at level H.
02
How do nurses make sure a doctor’s orders are carried out, and how are families told when something is missed?
Quality of Care: cited in three inspections, most seriously at level H.
03
Who completes resident assessments, and how are they checked for accuracy?
Accurate Assessments: cited in two inspections, most seriously at level E.
04
What changed in fall prevention and supervision after the last citation, and how do you check that it is still working?
Accident Hazards and Supervision: cited in two inspections, most seriously at level G.
05
How many nurses and aides are on each shift, including nights and weekends, for the unit we are considering?
No staffing citation appears in this window. Staffing levels are published separately by CMS and are worth asking about directly.
06
What led to the 2026 fine, and has it been paid?
A $16,350 civil money penalty was imposed May 5, 2026. CMS publishes the fine, not whether it has been paid. The record holds three enforcement actions in the window.

The Evidence

Sources and Coverage

Inspection results and penalties are published by the Centers for Medicare & Medicaid Services from surveys conducted by the South Dakota state survey agency.

Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection Jul 13, 2023 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection Aug 8, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection Sep 25, 2024 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection Feb 12, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection Jun 18, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection Dec 31, 2025 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Health inspection results, as published by CMS (Health Deficiencies and Inspection Dates, Provider Data Catalog)
South Dakota state survey agency
Inspection May 5, 2026 · Published Oct 1, 2026 · Retrieved Nov 1, 2026
Penalties, Provider Data Catalog
Centers for Medicare & Medicaid Services
Published Oct 1, 2026 · Retrieved Nov 1, 2026
View Dataset ↗
Provider Information, Provider Data Catalog
Centers for Medicare & Medicaid Services · 435100
Published Oct 1, 2026 · Retrieved Nov 1, 2026
View Dataset ↗

Coverage

Record windowJuly 13, 2023 – October 1, 2026

CMS publishes about three inspection cycles; inspections before July 2023 are not in this release.
CMS refreshes these files monthly, after statements of deficiencies are processed, so an inspection from the last two months may not appear yet.

What This Report Cannot Tell You

Complaints not investigated onsite: Allegations screened out by the state before an onsite visit are not published.
Complaint allegations: CMS publishes the deficiencies a complaint survey cited, not the allegation itself.
Facility-reported incidents: Self-reported incidents appear only if they led to an inspection.
Follow-up visits: CMS's files list standard, complaint and infection control surveys, not revisits; a correction date is the one CMS records.
Fire safety inspections: Published by CMS separately and not included in this record yet.
Staffing levels and ownership history: Published by CMS separately and not included in this record.
Whether fines were paid: CMS publishes the fines imposed, not whether or when they were paid.

Historical coverage varies by agency and location. Missing records do not mean that no complaint or violation occurred.

Data architecture: Cierto supplies the source-backed machine-readable bundle. Life by Vardell independently creates the narrative, design, and consumer report.