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The document summarizes compliance findings from a licensure survey (02/03/26 through 02/05/26) and a complaint survey, lists specific deficiency tags, and provides narrative support based on observation, interviews, and policy review. It also includes corrective action planning for deficiencies, including requirements related to housekeeping cleaning methods, chemical storage safety, and infection prevention and control standard precautions.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/statement-of-deficiencies-and-plan-of-correction-south-dakota-department-of-health/262512/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/statement-of-deficiencies-and-plan-of-correction-south-dakota-department-of-health/262512.png","ImageObject",442,249,{"name":88,"@type":89},"Aria Callaghan","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-30","2026-09-14",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",13,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What facility and survey date are referenced in the statement of deficiencies?","Question",{"text":109,"@type":110},"The statement references The Victorian Assisted Living in Rapid City, SD. 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\u003Cbr>AND PLAN OF CORRECTION   |  | (X1)PROVIDER/SUPPLIER/CLIA  \u003Cbr>IDENTIFICATION NUMBER:  \u003Cbr>11035   | (X2)MULTIPLE CONSTRUCTION  \u003Cbr>A.BUILDING:  \u003Cbr>B.WING   |  | (X3)DATE SURVEY  \u003Cbr>COMPLETED  \u003Cbr>C  \u003Cbr>02/05/2026   |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| STREETADDRESS,CITY,STATE,ZIP CODE  \u003Cbr>NAME OF PROVIDER OR SUPPLIER  \u003Cbr>1321 COLUMBUS ST.  \u003Cbr>THE VICTORIAN ASSISTED LIVING  \u003Cbr>RAPID CITY,SD 57701   |  |  |  |  |  |  |\n| (X4)ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | SUMMARY STATEMENT OF DEFICIENCIES  \u003Cbr>(EACH DEFICIENCY MUST BE PRECEDED BY FULL  \u003Cbr>REGULATORY ORLSC IDENTIFYING INFORMATION)   |  | ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | PROVIDER'S PLAN OF CORRECTION  \u003Cbr>(EACH CORRECTIVE ACTION SHOULDBE  \u003Cbr>CROSS-REFERENCED TO THEAPPROPRIATE  \u003Cbr>DEFICIENCY)   |  | (X5)  \u003Cbr>COMPLETE  \u003Cbr>DATE   |\n| S 000  \u003Cbr>S096   | Compliance Statement  \u003Cbr>A licensure survey for compliance with the  \u003Cbr>Administrative Rules of South Dakota,Artcle  \u003Cbr>44:70,Assisted Living Centers,requirements for  \u003Cbr>assisted living centers,was conducted from  \u003Cbr>2/3/26 through 2/5/26.The Victorian Assisted  \u003Cbr>Living was found not in compliance with the  \u003Cbr>following requirements:S096,S130,S201,S315,  \u003Cbr>S320,S331,S337,S352,S485,S603,S630,  \u003Cbr>S632,S680,S775,and S791.  \u003Cbr>A complaint survey for compliance with the  \u003Cbr>Administrative Rules of South Dakota,Article  \u003Cbr>44:70,Assisted Living Centers,requirements for  \u003Cbr>assisted living centers,was conducted from  \u003Cbr>2/3/26 through 2/5/26.Areas surveyed included  \u003Cbr>resident neglect,physical environment,and  \u003Cbr>infection control.The Victorian Assisted Living  \u003Cbr>was found in compliance.  \u003Cbr>44:70:02:05 Housekeeping Cleaning Methods  \u003Cbr>And Equipment  \u003Cbr>Equipment and supplies shall be provided for  \u003Cbr>cleaning of all surfaces.Such equipment shall be  \u003Cbr>maintained in a safe,sanitary condition.  \u003Cbr>Hazardous cleaning solutions,chemicals,  \u003Cbr>poisons,and substances shall be labeled,stored  \u003Cbr>in a safe place,and kept in an enclosed section  \u003Cbr>separate from other cleaning materials.  \u003Cbr>This Administrative Rule of South Dakota is not  \u003Cbr>met as evidenced by:  \u003Cbr>Based on observation,interview,and policy   |  | S000  \u003Cbr>S 096   |  |  |  |\n\n## LABORATORYDIRECTOR'S ORPROVIDEesuppfEREPRESETATVES SIGNATUREcuivDiector 3.2STATE FORM68990X0C11f contnuation sheet 1 of 37\n\n# PRINTED:02/24/2026\n\nFORM APPROVED  \nSouth Dakota Department of Health  \n\n| STATEMENT OF DEFICIENCIES  \u003Cbr>AND PLAN OF CORRECTION   | (X¹)PROVIDER/SUPPLIER/CLIA  \u003Cbr>IDENTIFICATION NUMBER:  \u003Cbr>11035   | (X2)MULTIPLE CONSTRUCTION  \u003Cbr>A.BUILDING:  \u003Cbr>B.WING   |  | (X3)DATE SURVEY  \u003Cbr>COMPLETED  \u003Cbr>C  \u003Cbr>02/05/2026   |\n| --- | --- | --- | --- | --- |\n| NAME OF PROVDEROR SUPPLIER  \u003Cbr>STREETADDRESS,CITY,STATE,ZIP CODE  \u003Cbr>1321 COLUMBUS ST.  \u003Cbr>THE VICTORIAN ASSISTED LIVING  \u003Cbr>RAPID CITY,SD 57701   |  |  |  |  |\n| SUMMARY STATEMENT OF DEFICIENCIES  \u003Cbr>(X4)ID  \u003Cbr>(EACH DEFICIENCY MUST BE PRECEDED BY FULL  \u003Cbr>PREFIX  \u003Cbr>REGULATORY ORLSC IDENTIFYING INFORMATION)  \u003Cbr>TAG   |  | ID  \u003Cbr>PREFIX  \u003Cbr>TAG   | PROVIDER'S PLAN OF CORRECTION  \u003Cbr>(X5)  \u003Cbr>(EACH CORRECTIVE ACTION SHOULD BE  \u003Cbr>COMPLETE  \u003Cbr>DATE  \u003Cbr>CROSS-REFERENCED TO THE APPROPRIATE  \u003Cbr>DEFICIENCY)   |  |\n| S 096  \u003Cbr>Continued From page 1  \u003Cbr>review,the provider failed to ensure one of two  \u003Cbr>sampled laundry rooms with chemical storage  \u003Cbr>was inaccessible to residents.  \u003Cbr>Findings include:  \u003Cbr>1.Observation on 2/4/26 at 10:28 a.m.revealed:  \u003Cbr>*The main laundry room was next to the  \u003Cbr>resident's dining room.  \u003Cbr>'There was a sign on the door that read \"door to  \u003Cbr>remain locked at all times.\"  \u003Cbr>*The door to the main laundry room was  \u003Cbr>unlocked.There were multiple buckets of  \u003Cbr>industrial dishwashing chemical on the floor.  \u003Cbr>2.Further observation on 2/4/26 at 4:35 p.m.  \u003Cbr>revealed that the main laundry room was still  \u003Cbr>unlocked and those same chemicals were sti","cbCaiqUPqzP6ddl0","https://ap.wps.com/l/cbCaiqUPqzP6ddl0","pdf",9344273,37,"English","# Statement of Deficiencies and Plan of Correction\n## Provider and Survey Information\n## Summary of Compliance Findings\n## Deficiency Tags and Corrective Actions","[{\"question\":\"What facility and survey date are referenced in the statement of deficiencies?\",\"answer\":\"The statement references The Victorian Assisted Living in Rapid City, SD. The survey completed date shown is 02/05/2026.\"},{\"question\":\"What deficiency is described regarding the laundry room and chemical access?\",\"answer\":\"The provider failed to ensure one of two sampled laundry rooms with chemical storage was inaccessible to residents. Observations and interviews indicate the main laundry door was unlocked and chemicals were accessible.\"},{\"question\":\"How does the plan of correction address the laundry room door issue?\",\"answer\":\"The plan states the Executive Director or Administrative Assistant will check the laundry room door daily in March, then weekly for three months ending 7/31/26, using an audit form and documenting results. Staff education is included to reinforce keeping the door locked due to chemical storage and resident safety concerns.\"}]","STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION - South Dakota Department of Health | PDF",1789362839]