The Waters Of Cheatham, LLC

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

Therapy staffing: this home’s payroll records show 0.21 therapist hours per resident per day in 2026Q1 — more than 24% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 17% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 80 beds and averages 49.2 residents a day — about 62% occupied, or roughly 31 beds typically open. It often has substantial empty capacity — worth asking why, since low census can reflect either a new or shrinking home or one families are avoiding. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 3.09 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.48 is below the 0.55-hour RN benchmark and nurse-aide staffing of 1.79 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.90 hrs/resident/day on weekends vs 3.17 on weekdays — 8% thinner on weekends. RN hours go from 0.48 to 0.48 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 68% is well above the national median of 45%. 4 administrators have left in the past year — frequent leadership churn is a warning sign families often miss.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

24 citations, most serious first. The 10 most serious are shown; the remaining 14 are one tap away and print in full.

• Potential for harm · F2026-03-26 · tag F0882 — widespread
  Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on policy review, Centers for Medicare & Medicaid Services guidelines, Infection Prevention Control Officer Training certificate review, and interview, the facility failed to ensure employment of a qualified Infection Control Preventionist to monitor and maintain the facility's Infection Prevention and Control Program. This could have affected 54 out of 54 residents residing in the facility. The findings include: 1. Review of the undated facility policy titled, Infection Prevention and Control-Policy and Procedure (IPCP), revealed .It is the policy of the facility to ensure that a comprehensive system is in place that prevents, identifies, investigates reports, records, and controls infections and prevent the development and transmission of communicable disease processes for residents/ care providers, staff, visitors, and others within the facility to include those providing contractual services in an effort to provide a safe, sanitary, comfortable environment. Further, to determine the most effective practices to reduce infection rates as well as identifying ways to integrate…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Infection Control Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-03-26 · tag F0686 — failed to prevent and treat pressure sores (bedsores) — pattern
  Provide appropriate pressure ulcer care and prevent new ulcers from developing.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on policy review, medical record review, observation, and interview the facility failed to ensure wound assessments and treatments were completed correctly as ordered by the physician for 2 of 4 (Resident #8 and #51) sampled residents reviewed for pressure ulcers/wounds. The findings include: 1.Review of the facility's policy titled GUIDELINES FOR PREVENTION / TREATMENT OF PRESSURE INJURIES . dated 10/9/2023, revealed .It is the intent of the facility to recognize the following information and to act on it in such a way as to practice evidence-based recommendations for the prevention/treatment of pressure injuries to the residents who reside in the facility .A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing .Pressure injuries are significant health issues and one of the biggest challenges for long term care facilities . Review of the facility's policy…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2026-03-26 · tag F0851 — pattern
  Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on Quarterly Payroll Based Journal (PBJ) review, facility staffing information review, and interview, the facility failed to submit accurate staffing data for Quarter 1 for PBJ 2026 (October 1, 2025- December 31, 2025) reviewed for staffing data. The findings include: 1. Review of the Centers for Medicare & [and] Medicaid Services Electronic Staffing Data Submission Payroll-Based Journal Long-Term Care Facility Policy Manual dated June 2025, revealed . Direct care staffing and census data will be collected quarterly, and is required to be timely and accurate. 2. Review of the PBJ (Payroll-Based Journal) Staffing Data Report for Quarter 1 of 2026 (October 1, 2025 - December 31, 2025) revealed excessively low weekend staffing. 3. Review of LICENSURE STAFFING REQUIREMENTS for the following dates between October 1, 2025 - December 31, 2025, revealed the weekend staffing percentages as follows:a. 10/4/2025 - 3.65% (percent) b. 10/5/2025 - 3.32% c. 10/11/2025 - 3.18% d. 10/12/2025 - 3.12% e. 10/18/2025 - 2.81% f. 10/19/2025 - 2.93% g. 10/25/2025 - 3.0% h. 10/26/2025 - 3.23% i.…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Administration Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-03-26 · tag F0584 — failed to keep a safe, clean, comfortable home — isolated
  Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, review of the Administrator's Job Description, review of the TELS (telephone communication system designed for healthcare environments to handle maintenance) work orders, Previous Maintenance Director employee file, medical record review, observations and interviews, the facility failed to provide a safe, clean, comfortable and homelike environment for 2 of 8 (400 Hall women's communal bathroom and 400 Hall men's communal bathroom) communal bathrooms observed. The findings include: 1. Review of the undated facility policy titled, Your Rights and Protections as a Nursing Home Resident, revealed, .As a nursing home resident, you have certain rights and protections under Federal and state law that help ensure you get the care and services you need. Review of the facility policy titled, ENVIRONMENTAL CARE POLICIES AND PROCEDURES MANUAL, dated 8/12/2015 revealed, .RESTROOM - DAILY CLEANING PURPOSE.To maintain a clean, orderly and attractive environment for residents.that prevents the…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-03-26 · tag F0679 — failed to provide activities — isolated
  Provide activities to meet all resident's needs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on facility policy review, medical record review, and interview, the facility failed to provide an ongoing program of activities designed to meet the interests, physical, mental, and psychosocial well-being for 7 of 10 sampled residents (Resident #5, #9, #22, #26, #29, #41, and #54) reviewed for activities. The findings included: 1. Review of the undated facility policy titled, Your Rights and Protections as a Nursing Home Resident, revealed, .Be Treated with Respect.Participate in Activities: You have the right to participate in an activities program designed to meet your needs. Review of the undated facility policy titled, Activities Program, revealed, .It is the policy of the facility to provide an ongoing program of Activities designed to meet, in accordance with.the interests and the physical, mental and psychosocial well-being of the residents.Facility will provide a 1:1 program for residents who are unable or who desire not to attend or join group activities.All staff will assist in transporting…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2026-03-26 · tag F0732 — isolated
  Post nurse staffing information every day.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on facility policy review, observations and interviews, the facility failed to ensure nurse staffing information for licensed and unlicensed staff responsible for resident care was posted daily for 3 of 3 (3/23/2026, 3/24/2026, and 3/25/2026) days reviewed. The findings include: Review of the facility policy titled, Guidelines for BIPA [Benefits Improvement and Protection Act] Staffing Posting Requirements, dated 7/24/23, revealed It is the policy of the facility, in cooperation with Medicare/Medicaid Services.to comply with the requirement of daily posting of nursing staff in the facility.must post daily, at the beginning of each shift, the facility specific shift schedule for the 24 hour period, the number and category of nursing staff employed or contracted by the facility for each 24 hour period.the total number of hours worked by licensed [unlicensed] and licensed nursing staff who are directly responsible for resident care. Observations at the nurse's station on 3/23/2026 at 9:55 AM, 1:30 PM, and 4:35 PM, revealed the daily number of licensed and unlicensed nursing staff…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Nursing and Physician Services Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Ecited before2022-04-27 · tag F0550 — failed to protect resident dignity and rights — pattern
  Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on policy review, observation, and interview, the facility failed to maintain or enhance residents' dignity and respect when 4 of 7 staff members (Certified Nursing Assistant (CNA) #1, #2, and #4, and Licensed Practical Nurse (LPN) #3) failed to use courtesy titles, stood over a resident when assisting with a meal, and failed to knock when entering the residents' rooms for 14 of 64 residents (Resident #3, #7, #12, #17, #18, #20, #23, #29, #31, #33, #34, #40, #56, and #214) observed. The findings include: Review of the facility's undated policy titled, Dignity, revealed .Staff will be polite and respectful at all times .When addressing a resident, staff will refrain from calling the resident names like .Sweetie .Honey .as this can be interpreted as undignified . Dining observation outside the resident's room on 4/24/2022 at 1:00 PM, revealed CNA #1 failed to knock on the door or announce herself prior to entering Resident #40's room to serve a meal tray. Dining observation outside the resident's room on…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2022-04-27 · tag F0553 — failed to let residents help plan their care — pattern
  Allow resident to participate in the development and implementation of his or her person-centered plan of care.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on policy review, medical record review, and interview the facility failed to ensure 5 of 16 sampled residents (Resident #29, #49, #52, #56, and #60) or their families were invited to participate in planning their care. The findings include: Review of the facility's policy titled Baseline Care Plan Assessment/Comprehensive Care Plans, dated 11/25/2017, revealed .Social Service Director .will notify the resident's responsible party either by letter or phone call to inform them of the scheduled Care Plan Conference to include the date and time. This notification will continue for subsequent Care Plan Conferences. The notifications will be documented for reference .Social Service Director .will invite and encourage the resident to attend . Review of the medical record revealed Resident #29 was admitted to the facility on [DATE] with diagnoses of Paraplegia, Diabetes, Colostomy, Depression, Anxiety, Bipolar Disorder, Cervical Spine Injury, and COVID-19. Review of the admission Minimum Data Set (MDS) assessment…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2022-04-27 · tag F0761 — failed to label and store drugs safely — pattern
  Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on policy review, observation, and interview, the facility failed to ensure medications were properly stored and secured when medications were found unsecured and not attended by authorized staff, open, undated, and expired in 4 of 9 medication storage areas (100 Hall Medication Cart, 300 Hall Medication Cart, 200 Hall Medication Cart, and 100/200 Hall Medication Room) reviewed. The findings include: Review of the facility's undated policy titled, MEDICATION STORAGE IN THE FACILITY, revealed .Medications and biologicals are stored safely, securely, and properly .The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications .Outdated .will be immediately withdrawn from stock . Observation during medication administration at the 100 Hall Medication Cart on [DATE] at 8:02 AM, revealed Licensed Practical Nurse (LPN) #1 removed a Lidocaine 5 percent (%) patch ( a non-medicated pain patch) for Resident #29, handed the…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Pharmacy Service Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2022-04-27 · tag F0812 — failed to store, cook, and serve food safely — pattern
  Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on policy review, observation, and interview, the facility failed to ensure food was served under sanitary conditions when 3 of 7 staff members (Certified Nursing Assistant (CNA) #1, CNA #5, and CNA #6) failed to perform proper hand hygiene for 13 of 64 residents (Resident #7, #12, #15, #17, #37, #40, #43, #47, #49, #51, #56, #57, and #59) observed during meal service. The findings include: Review of the facility's undated policy titled, Hand Hygiene Guidelines, revealed .The scope of this guideline includes all interdisciplinary members .and individuals that partake in the resident plan of care .Procedure .When hands are visibly soiled, exposure to a spore forming organism has been suspected .before and after eating .hands should be washed . Observation on the 200 Hall on 4/24/2022 beginning at 1:00 PM, revealed CNA #1 entered Resident #40's room, donned a glove on her left hand, moved Resident #40's urinal from his over bed table to his nightstand, removed the glove and prepared his meal tray, without performing hand hygiene. CNA #1 returned to the meal cart, poured coffee…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Nutrition and Dietary Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Fines & penalties

$6,350 in federal fines across 2 penalties.

• $2,117 — penalty dated 2023-10-23
• $4,233 — penalty dated 2023-10-02

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to INFINITY HEALTHCARE CONSULTING — 69 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

2 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

This home reported $1.5M paid to related parties — landlords or management companies under common ownership — equal to about 19% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in TN