Average — CMS composite of the measures below.
A standard survey is most likely before around December 2026
Estimate from public CMS data, current as of October 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Smp Health - St Raphael during CMS and state inspections, most recent first.
Failure to prevent repeated resident-to-resident physical abuse occurred when a resident with Alzheimer’s disease, dementia with agitation, depression, severe psychotic disorder with delusions, and wandering was involved in multiple altercations with peers. The resident’s care plan documented agitation, physical aggression, verbal aggression, wandering into peers’ rooms, and taking items, and progress notes showed incidents of grabbing, kicking, flicking, hitting, choking, and punching other residents, as well as being struck by peers during these events. Admin staff said behaviors were discussed daily, but the facility did not effectively manage the resident’s behaviors, resulting in repeated abuse episodes.
A resident with dementia, agitation, psychosis, and wandering behaviors was involved in multiple resident-to-resident altercations, including grabbing, kicking, hitting, choking, and being pushed in common areas. Staff reviewed behaviors and camera footage, but the facility did not report the potential abuse incidents to the SSA within the required 2-hour timeframe, despite its abuse policy requiring immediate reporting for allegations involving abuse.
Food storage and sanitation deficiencies were identified in the main kitchen and multiple kitchenette areas. Surveyors found expired ready-to-eat foods, a refrigerator at an unsafe temp with incomplete temp logs, a broken and unreadable thermometer, dirty microwaves and a crumb-filled toaster, and a leaking pipe dripping onto food storage. An administrative dietary staff member stated expired foods should be discarded and that the facility’s policy was to discard after five days.
Glove use and hand hygiene standards were not followed during wound care and perineal care for two residents. A nurse changed a dressing on one resident's hip without removing contaminated gloves or performing hand hygiene before applying the clean dressing, and a CNA provided perineal care for another resident, then used the same gloves to handle ointment, clothing, room items, and equipment before removing gloves and washing hands. An administrative nurse confirmed staff should remove gloves and perform hand hygiene after soiled dressing care and perineal care.
The facility failed to follow infection control practices, including hand hygiene and enhanced barrier precautions (EBP), for several residents. Staff did not perform hand hygiene after glove removal and failed to wear appropriate PPE during wound care and medication administration for residents requiring EBP. These deficiencies were observed during care activities, potentially increasing the risk of infection spread.
The facility did not follow its grievance process for two residents who reported inappropriate treatment by CNAs during care. One resident experienced disrespectful behavior from a CNA on the night of admission, while another reported a similar incident three weeks earlier. Although the incidents were discussed in management meetings, the facility failed to follow up with the residents to resolve their grievances.
The facility failed to follow professional standards for insulin administration and order transcription. Nurses did not remove the needle cover before priming insulin pens for two residents, contrary to facility policy. Additionally, a medication aide replaced an Interdry dressing for a resident without a documented order in the medical record, as required by policy.
A medication cart was left unlocked and unattended for 55 minutes by a nurse, contrary to facility policy requiring carts to be locked when not in sight. The cart was out of view at the nurses' station with staff and residents present, leading to a deficiency in medication security.
Failure to Prevent Repeated Resident-to-Resident Physical Abuse
Penalty
Summary
The facility failed to ensure residents remained free from abuse when Resident #1 was involved in repeated resident-to-resident physical altercations. The facility policy stated that resident-to-resident altercations should be reviewed as potential abuse and that physical abuse includes hitting, slapping, and punching. Resident #1’s record showed diagnoses of Alzheimer’s disease, dementia with agitation, depression, severe psychotic disorder with delusions, and wandering. Her care plan documented behaviors related to dementia, including elopement attempts, agitation, restlessness, physical aggression, verbal aggression, barricading, wandering into peers’ rooms, taking items, and refusing to let them go. The progress notes documented multiple incidents in which Resident #1 either initiated or was involved in physical contact with other residents, including grabbing another resident, kicking a resident in the leg, flicking a resident in the forehead, hitting another resident in the face, being hit by another resident after touching a toy, having a book hit her hand, hitting another resident after being struck, grabbing another resident’s shirt collar and choking that resident, being pushed against a wall after grabbing a male resident, and punching another resident in the back of the head while leaving the dining room. During interviews, administrative staff stated they discussed behaviors daily and described Resident #1 as trying to annoy other residents rather than intentionally hurt them, noting she could be nice one minute and act out the next and did not target any one person. The facility failed to effectively manage Resident #1’s behaviors, resulting in repeated episodes of resident-to-resident abuse.
Failure to Timely Report Suspected Resident-to-Resident Abuse
Penalty
Summary
The facility failed to report suspected abuse incidents to the State Survey Agency within the required time frame for a resident with Alzheimer’s disease, dementia with agitation, depression, severe psychotic disorder with delusions, and wandering. The resident’s care plan documented a history of elopement attempts, agitation, restlessness, physical aggression, verbal aggression, barricading, wandering into peers’ rooms, and taking items from others. The resident’s record contained multiple progress notes describing resident-to-resident altercations, including grabbing, kicking, flicking, hitting, choking, and being pushed by other residents during interactions in common areas such as the dining room and activity room. Facility staff stated they reviewed behaviors each morning with social services and unit managers, talked to staff, and reviewed camera footage, which in some cases occurred up to three days later. Two administrative staff members said they did not believe abuse occurred in the listed incidents after reviewing the footage. Despite these reviews, the facility did not report the potential resident-to-resident verbal and physical abuse incidents to the SSA within two hours as required by its abuse policy, which stated that alleged violations involving abuse must be reported immediately, but no later than 2 hours after the allegation is made.
Food Storage and Sanitation Deficiencies in Multiple Kitchen Areas
Penalty
Summary
The facility failed to store food in accordance with professional standards in the main kitchen and in multiple food storage areas, including the Third Floor Kitchenette, First Floor Kitchenette, First Floor Sub-station, Special Care Unit, Sunshine Kitchenette, and Circle of Life Cottage Kitchenette. During observation with an administrative dietary staff member, the walk-in cooler in the main kitchen had a black substance on the fan grates and around the outside of the fan, and a black pipe in the dry storage room was dripping liquid onto the floor next to a rack of food. In the Third Floor Kitchenette, expired food items were found, including a turkey sandwich, hard boiled eggs, sliced cheese, thickened water, cheese slices in a plastic bag, shredded American cheese in a plastic bag, and shredded cheese in a plastic bag. In the Special Care Unit Kitchenette, the refrigerator was 52 degrees Fahrenheit, and the refrigerator log showed 44 degrees Fahrenheit earlier that morning; an unidentified kitchen staff member stated he had not been in the refrigerator recently. In the Circle of Life Cottage Kitchenette, expired cheese slices and yogurt cups were present. In the Sunshine Kitchenette, the refrigerator thermometer was broken and unreadable, the refrigerator/freezer log had not been completed since 08/16/25, and the silverware drawer contained scattered crumbs. In the First Floor Kitchenette, the microwave had pieces of cooked eggs inside and on the side wall, and the toaster had numerous crumbs on top. In the First Floor Substation, the microwave contained food debris. The administrative dietary staff member stated she expected staff to discard expired foods and stated the policy was to discard after five days.
Glove Use and Hand Hygiene Not Followed During Resident Care
Penalty
Summary
Failure to follow infection control and prevention standards was identified during observed care for 2 residents. Facility policy on glove usage stated that once gloves are contaminated, they must be changed before touching clean items or proceeding to a clean procedure, and hand hygiene must be performed prior to gloving and after removing gloves. The hand hygiene policy stated that hand hygiene is an effective method for preventing the spread of pathogens and is required when hands are visibly soiled with blood or other body fluids, after handling contaminated objects, and before and after handling clean or soiled dressing. During a dressing change for Resident #73, a nurse applied PPE, removed a soiled ABD pad from the left hip, and then cleaned the area, placed a new ABD, and applied tape without removing gloves or performing hand hygiene before applying the clean dressing. During perineal care for Resident #16 after a soft bowel movement, two CNAs used gowns and gloves for a transfer and care. One CNA completed perineal care, then with the same gloves reached into an ointment container and applied ointment, fastened the brief, pulled up pants, retrieved a bandana from a drawer and placed it by the resident's mouth, and continued to touch other items in the room, including a pump, garbage bags, the bed, television, and pillowcase, before removing gloves and performing hand hygiene. An administrative nurse confirmed staff should remove gloves and perform hand hygiene after removing a soiled dressing and after performing perineal cares.
Infection Control Deficiencies in Hand Hygiene and Barrier Precautions
Penalty
Summary
The facility failed to adhere to infection prevention and control standards, specifically in hand hygiene, glove use, and enhanced barrier precautions (EBP) for eight residents. Observations revealed that staff did not perform hand hygiene after removing gloves and gowns, as seen with a CNA who assisted a resident on EBP and failed to sanitize hands after removing protective gear. Similarly, two CNAs did not perform hand hygiene after providing incontinent care to a resident. In wound care, nurses were observed not performing hand hygiene between glove changes, compromising the sterile environment needed for wound dressing changes. Additionally, the facility did not consistently implement EBP for residents with chronic wounds or indwelling medical devices. Nurses were observed not wearing the required gowns during wound care for residents with surgical wounds and pressure ulcers, despite care plans indicating the need for EBP. A nurse also failed to wear appropriate PPE while administering medications through a feeding tube to a resident under EBP. These lapses in infection control practices have the potential to spread infections within the facility.
Failure to Address Resident Grievances
Penalty
Summary
The facility failed to adhere to its grievance process for two residents who reported concerns about staff treatment during care. Resident #133 reported that on the night of admission, after repeatedly using the call light, a CNA responded inappropriately by yelling an explicit comment from the doorway. This incident occurred twice on the same night, leading the resident to avoid further interaction with the CNA by independently using the bathroom. Resident #99 also reported a similar incident three weeks prior, where an unknown CNA yelled disrespectfully from the doorway during the night shift. Both residents confirmed they reported these incidents to the staff. Administrative staff acknowledged that all resident incidents are discussed during management meetings and that these specific incidents were assigned to the unit manager for further review. However, the facility failed to follow up with the residents to resolve their grievances and keep them informed of any progress, resulting in a violation of the residents' rights.
Failure to Follow Insulin Administration and Order Transcription Protocols
Penalty
Summary
The facility failed to adhere to professional standards of practice in the preparation and administration of insulin for two residents. Observations revealed that nurses did not remove the needle cover before priming the insulin pens for both residents, which is a necessary step to ensure accurate dosing. The facility's policy, revised in July 2023, clearly states that insulin pens must be primed by removing the needle cover and ensuring a drop of insulin appears at the needle tip. An administrative staff member confirmed the expectation that staff should remove the needle cover during priming. Additionally, the facility did not accurately transcribe a treatment order for a resident during a dressing change. A medication aide was observed replacing an Interdry antimicrobial dressing without a corresponding order documented in the resident's medical record. The facility's policy requires that standing orders be entered into the Medication Administration Record (MAR) and Treatment Administration Record (TAR) for implementation. An administrative staff member confirmed the absence of the required order and instructions in the resident's record.
Medication Cart Security Lapse
Penalty
Summary
The facility failed to ensure the safe and secure storage of medications in one of the two medication carts observed, specifically the Union Square cart. This deficiency was identified during an observation where a staff nurse left the medication cart unlocked and unattended for 55 minutes. The cart was positioned by the nurses' station, out of the nurse's view, with both staff members and residents present. The facility's policy, revised in 2023, mandates that medication carts must be locked when not within the complete sight of the nurse or medication aide. An administrative nurse confirmed the expectation that staff should lock the medication cart when it is out of eyesight.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Valley City
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Smp Health - Maryhill | 28.1 mi | ★★★★★ | 3 | 0 |
| Eventide Jamestown | 32.5 mi | ★★★★★ | 0 | 0 |
| Smp Health - Ave Maria | 33 mi | ★★★★★ | 5 | 0 |
| Griggs County Care Center | 35.4 mi | ★★★★★ | 0 | 0 |
| Parkside Lutheran Home | 36.9 mi | ★★★★★ | 10 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release October 2026) and official state health department websites.