Shelby Oaks Post Acute

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.

39.1% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that worse than the national rate. This is CMS’s risk-adjusted rate over 62 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.

Met the expected recovery: 59.3% of this home’s Medicare short-stay residents left it at or above the ability to care for themselves and move around that CMS predicted for them, across 27 stays in Oct 2024–Sep 2025. The median of the 11,061 homes CMS publishes this for is 56.6%. Read it beside the getting-home figure, not instead of it: unlike the two measures above, CMS makes no better-or-worse call on this one and publishes no confidence interval for it, so this is a comparison and not a verdict — but it is the short-stay measure that separates homes most, and the one to ask about.

Therapy staffing: this home’s payroll records show 0.47 therapist hours per resident per day in 2026Q1 — more than 78% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 14% 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 77 beds and averages 64.2 residents a day — about 83% occupied, or roughly 13 beds typically open. It usually has some room. 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 3.51 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.62 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.03 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 2.91 hrs/resident/day on weekends vs 3.75 on weekdays — 22% thinner on weekends — a notable drop. RN hours go from 0.76 to 0.27 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 60% is well above the national median of 45%.

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.

22 citations, most serious first. The 12 most serious are shown; the remaining 10 are one tap away and print in full.

• Immediate jeopardy · J2025-09-30 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  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, Emergency Medical Services (EMS) run report review, hospital record review, Medicolegal Death Investigator email, and interview, the facility failed to protect the residents' right to be free from abuse for 2 of 9 (Resident #1 and Resident #13) sampled residents reviewed for abuse. On 8/21/2025, the medical record of Resident #1, a vulnerable and cognitively impaired resident, revealed a skin assessment that documented a knot (raised area) to the left and right side of Resident's #1's forehead. On 8/28/2025, the medical record revealed Resident #1's right hand was swollen, warm to the touch, and painful. On 8/29/2025, the medical record documented an opened reddened area to the left side of Resident's #1's abdomen and an abrasion to the Resident's neck, which was documented as a large area of injury from the front of the neck to the back of the neck. On 9/8/2025 at 5:08 AM, Resident #1 was transferred to a local hospital for difficulty breathing, diminished…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · G2022-11-17 · tag F0692 — failed to prevent malnutrition and dehydration — isolated
  Provide enough food/fluids to maintain a resident's health.
  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 accurately assess the nutritional status and to follow the facility's policy for monitoring weights for 1 of 3 sampled residents (Resident #24) reviewed for weight loss. The facility's failure to provide nutritional interventions resulted in Actual Harm when Resident #24 had a severe weight loss of 11.13 % in six months. The findings include: 1. Review of the facility's policy, Dietary: Weight Monitoring revised 11/9/2021, revealed .Weight can be a useful indicator of nutritional status. Significant unintended changes in weight .may indicate a nutritional problem .monitoring the effectiveness of interventions and revising them as necessary .Interventions will be identified, implemented, monitored, and modified .to maintain acceptable parameters of nutritional status .a significant change in weight is defined as 5 % [percent] change in weight in 1 month .7.5 % change in weight in 3 months .10 % change in weight in 6…

  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 · D2026-01-08 · tag F0580 — failed to tell family and doctor about changes — isolated
  Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
  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 notify the provider and resident representative of a resident's change of condition and the failure to obtain stat labs and transfers for 1 of 4 (#76) sampled residents reviewed for notification of change. The findings include: 1. Review of the facility policy titled, Change in a Resident's Condition or Status, dated February 2021, revealed .Our facility notifies the resident, his or her attending physician and the resident representative of change in the resident's medical/mental condition .a nurse will notify the resident's representative.when.it is necessary to transfer the resident to a hospital/treatment center. 2. Review of the medical records revealed Resident #76 was admitted to the facility on [DATE] with diagnoses including Encephalopathy, Aphasia, Heart Failure, and Diabetes. Review of the quarterly MDS assessment dated [DATE], revealed Resident #76 was severely impaired for daily decision making. Review of the medical…

  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 before2026-01-08 · tag F0693 — failed to provide proper feeding-tube care — isolated
  Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
  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 provide care and services for residents with enteral feedings for 2 of 2 (Resident #6 and Resident #54) sampled residents reviewed for Percutaneous Endoscopic Gastrostomy (a plastic tube inserted through the abdominal wall into the stomach) (PEG) tube feedings.The findings include: 1. Review of the facility policy titled, Enteral Nutrition, dated November 2018, revealed .Adequate nutritional support through enteral nutrition is provided to residents as ordered . 2. Review of the medical record revealed Resident #6 was admitted to the facility on [DATE], with diagnoses including Gastrostomy Status, Aphasia, Cerebral Infarction, and Dysphagia. Review of the quarterly Minimum Data Set (MDS) dated [DATE], revealed Resident #6 scored a 14 on the Brief Interview for Mental Status (BIMS) assessment, which indicated the resident had intact cognition. Resident #6 received nutrition through a feeding tube. Review of 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.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2026-01-08 · tag F0880 — failed to prevent and control infections — isolated
  Provide and implement an infection prevention and control program.
  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 practices to ensure the prevention and spread of infection were followed when 3 of 4 staff members (Certified Nurse Assistant (CNA) D and Licensed Practical Nurse (LPN) A, B and C) failed to wear proper personal protective equipment (PPE), failed to use a barrier during medication administration and failed to perform hand hygiene during incontinent care, wound care, medication administration and catheter (a thin flexible tube used to drain fluids from the body) care.The findings include: 1.Review of the facility policy titled, Handwashing/Hand Hygiene, dated August 2019, revealed This facility considers hand hygiene the primary means to prevent the spread of infections.use an alcohol-based hand rub.or alternatively, soap.and water for the following situations.before preparing or handling medications.after contact with a resident's intact skin.after handling used dressings, contaminated equipment.after…

  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 · D2025-09-30 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  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, facility investigation review, and interview, the facility failed to ensure injuries of unknown origin were reported immediately, but not later than 2 hours, after the allegation was made for 2 of 9 (Resident #1 and Resident #13) sampled residents reviewed for abuse. The findings include: 1. Review of the facility's policy Abuse Investigation and Reporting dated10/2022, revealed .All reports of resident abuse, neglect.and/or mistreatment ( abuse)shall be promptly reported to local, state and federal agencies (as defined by current regulations).Findings of abuse investigations will also be reported.Reporting.All alleged violations involving abuse, neglect, exploitation, or mistreatment, and misappropriation of property will be reported by the facility Administrator, or his/her designee, to the following persons or agencies:.The State licensing/certification agency responsible for surveying/licensing the facility;.The local/State Ombudsman;.The Resident…

  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.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · E2022-11-17 · tag F0759 — failed to keep medication error rate low — pattern
  Ensure medication error rates are not 5 percent or greater.
  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 a medication administration rate of less than 5% (percent) when 1 of 5 nurses (Licensed Practical Nurse (LPN) #6) failed to properly administer medications for 1 of 5 sampled residents (Resident #31) observed during medication administration. This resulted in a medication administration error rate of 56 %. The findings include: Review of the facility's policy titled Medication Administration, revised 10/24/2022, revealed .Medications shall be administered by licensed medical or nursing personnel acting within the scope of their practice and per the Physician's Signed Order .Check to ensure the medication is given within the time constraints of the order .Double check directions and mediations prior to administering meds [medications] .Each medication should be administered separately. Flush between each medication . Review of the medical record revealed Resident #31 was admitted on [DATE] with diagnoses of…

  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 · E2022-11-17 · 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, medical record review, observation, and interview, the facility failed to ensure food was food was prepared and served under sanitary conditions when soiled serving scoops were used during serving, when 2 of 6 staff members (Cook #1, Dietary Aide #1) failed to perform appropriate hand hygiene during food preparation and serving, and when 4 of 12 staff members (Certified Nursing Assistant (CNA) #1, #2, Licensed Practical Nurse (LPN) #1, and Assistant Director of Nursing) failed to perform appropriate hand hygiene during dining. The findings include: 1. Review of the facility's policy titled Dietary - Mechanical Dish Washing, with a revision date of 10/15/2022, revealed .To ensure dishes and utensils are cleaned under sanitary conditions. Dishes shall be cleaned and sanitized after each use . Review of the facility's policy titled Dietary: Cleaning, with a revision date of 9/21/2022, revealed .Adequate cleaning and sanitizing shall minimize the risk of food born illnesses . Review of the facility's policy titled Dietary: Hand Washing Techniques, dated…

  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
• Potential for harm · D2022-11-17 · tag F0550 — failed to protect resident dignity and rights — isolated
  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

  Based on policy review, observation, and interview, the facility failed to maintain or enhance residents' dignity and respect when 5 of 12 staff members (Certified Nursing Assistant (CNA) #1 and #2, Assistant Director of Nursing (ADON), Licensed Practical Nurse (LPN) #3 and Business Office Coordinator) referred to residents as feeders, failed to knock prior to entering resident rooms, and stood over residents during dining observations. The findings include: 1. Review of the facility's policy titled, Promoting/Maintaining Resident Dignity Policy, dated 10/24/2022, revealed .It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident's quality of life by recognizing each resident's individuality .Staff attempt to be at eye level during assist feeding . Review of the facility's admission packet Resident's Rights, revealed .Right to a Dignified Existence .Be treated with consideration, respect, and dignity, recognizing…

  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 · D2022-11-17 · tag F0565 — failed to support the resident council — isolated
  Honor the resident's right to organize and participate in resident/family groups in the facility.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on observation and interview, the facility failed to provide privacy for 7 of 7 residents (Resident #1, #12, #18, #27, #33, #41, and #57) during a group interview with Resident Council members. The findings include: Observation in the Main Dining Room on 11/16/2022 at 3:05 PM, revealed the Resident Council meeting was in progress. The Main Dining Room was open and accessible to anyone. Residents #1, #12, #18, #27, #33, #41 and #57 were in attendance at the Resident Council meeting. During an interview on 11/16/2022 at 3:11 PM, Resident #1, the Resident Council President, confirmed the Resident Council meetings are held in the Main Dining Room. Observation in the Main Dining Room on 11/16/2022 at 3:15 PM, revealed Licensed Practical Nurse (LPN) #2 entered the Main Dining Room and sat down at a table in the back of the room with her lunch while the Resident Council meeting was in progress. Observation in the Main Dining Room on 11/16/2022 at 3:24 PM, revealed CNA #3 entered the Main Dining Room and went to the back of the dining room to the vending machine to make a purchase…

  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 · D2022-11-17 · tag F0569 — isolated
  Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
  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 review of resident trust accounts, policy review, medical record review, and interview, the facility failed to refund the residents' funds within 30 days of death or discharge for 1 of 1 sampled resident (Resident #171) reviewed for trust funds. The findings include: Review of the facility's undated policy titled, CHAPTER 10: REFUNDS (WITHDRAWALS), revealed .State regulation, all refunds must be made within 30 days of discharge or expiration . Review of the medical record revealed Resident #171 was admitted to the facility on [DATE] and expired on [DATE]. Review of the trust funds account revealed a check for Resident #171's trust funds was issued on [DATE], 55 days after Resident #171 expired. During an interview on [DATE] at 2:28 PM, the Business Office Coordinator confirmed Resident #171 expired on [DATE], and the facility did not want to write a check until all balances had cleared. The Business Office Coordinator confirmed the facility should have refunded the resident account within 30 days of 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 · D2022-11-17 · tag F0656 — failed to write and follow a full care plan — isolated
  Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
  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 follow the comprehensive Care Plan for 2 of 21 sampled residents (Resident #24 and #57) reviewed for nutrition via Percutaneous Endoscopic Gastrostomy (PEG tube) and for falls. The findings include: 1. Review of the facility's policy titled, Comprehensive Careplan, revised 10/24/2022, revealed .It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident .that includes measurable objectives and time frames to meet the resident's .needs .Qualified staff responsible for carrying out interventions specified in the care plan shall be notified of their roles and responsibilities for carrying out the interventions, initially and when changes are made . 2. Review of the medical record revealed Resident #24 was admitted to the facility on [DATE] with diagnoses of Hemiplegia/Hemiparesis, Dysphagia, Gastrostomy Status, and Malnutrition. Review of quarterly Minimum Data Set (MDS)…

  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 Assessment and Care Planning 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

$79,356 in federal fines across 1 penalty.

• $79,356 — penalty dated 2025-09-30

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 LINKS HEALTHCARE GROUP — 32 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

CMS files one row per role, so the 10 rows in the source record cover these 6 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

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 $1.3M paid to related parties — landlords or management companies under common ownership — equal to about 16% 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