The Waters of Shelbyville, LLC

9316802300 · 835 Union Street, Shelbyville, TN 37160

Overview

The Waters of Shelbyville, LLC is a nursing home approved by U.S Centers for Medicare & Medicaid Services (CMS). The federal provider number is #445171. The provider type is Medicare and Medicaid. The ownership type is for profit - corporation. The address is 835 Union Street, Shelbyville, TN 37160. The overall rating is 2.

Federal Provider Number 445171
Provider Name THE WATERS OF SHELBYVILLE, LLC
Legal Business Name THE WATERS OF SHELBYVILLE, LLC
Address 835 Union Street
Shelbyville
TN 37160
County Bedford
Telephone 9316802300
Ownership Type For profit - Corporation
Provider Type Medicare and Medicaid
Date Approved 1985-01-11
Number of Certified Beds 96
Average Number of Residents per Day 65.2
Provider Resides in Hospital N
Continuing Care Retirement Community N
Abuse Icon N
Cited for abuse or neglect at harm level or above on survey cycle 1 (Scope/severity G or greater) or cited for abuse or neglect at potential harm level (Scope/Severity D or above) on both survey cycles 1 and 2.
Most Recent Health Inspection More Than 2 Years Ago N
Provider Changed Ownership in Last 12 Months N
With a Resident and Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 2
Health Inspection Rating 2
Quality Measure Rating 5
Long Stay Quality Measure Rating 5
Short Stay Quality Measure Rating 4
Staffing Rating 1
Registered Nurses Staffing Rating 1
Reported CNA Staffing Hours per Resident per Day 2.07516
Reported LPN Staffing Hours per Resident per Day 1.25339
Reported RN Staffing Hours per Resident per Day 0.35590
Reported Licensed Staffing Hours per Resident per Day 1.60929
Reported Total Nurse Staffing Hours per Resident per Day 3.68445
Reported Physical Therapist Staffing Hours per Resident Per Day 0.07216
Expected CNA Staffing Hours per Resident per Day 2.32486
Expected LPN Staffing Hours per Resident per Day 0.86272
Expected RN Staffing Hours per Resident per Day 0.60072
Expected Total Nurse Staffing Hours per Resident per Day 3.78830
Adjusted CNA Staffing Hours per Resident per Day 1.83767
Adjusted LPN Staffing Hours per Resident per Day 1.07642
Adjusted RN Staffing Hours per Resident per Day 0.23710
Adjusted Total Nurse Staffing Hours per Resident per Day 3.11218
Rating Cycle 1 Standard Survey Health Date 2019-11-06
Rating Cycle 1 Total Number of Health Deficiencies 5
Rating Cycle 1 Number of Standard Health Deficiencies 4
Rating Cycle 1 Number of Complavarchar Health Deficiencies 2
Rating Cycle 1 Health Deficiency Score 44
Rating Cycle 1 Number of Health Revisits 1
Rating Cycle 1 Health Revisit Score 0
Rating Cycle 1 Total Health Score 44
Rating Cycle 2 Standard Health Survey Date 2018-12-05
Rating Cycle 2 Total Number of Health Deficiencies 5
Rating Cycle 2 Number of Standard Health Deficiencies 3
Rating Cycle 2 Number of Complavarchar Health Deficiencies 2
Rating Cycle 2 Health Deficiency Score 20
Rating Cycle 2 Number of Health Revisits 1
Rating Cycle 2 Health Revisit Score 0
Rating Cycle 2 Total Health Score 20
Rating Cycle 3 Standard Health Survey Date 2017-12-06
Rating Cycle 3 Total Number of Health Deficiencies 8
Rating Cycle 3 Number of Standard Health Deficiencies 6
Rating Cycle 3 Number of Complavarchar Health Deficiencies 2
Rating Cycle 3 Health Deficiency Score 64
Rating Cycle 3 Number of Health Revisits 1
Rating Cycle 3 Health Revisit Score 0
Rating Cycle 3 Total Health Score 64
Total Weighted Health Survey Score 39.333
Number of Facility Reported Incidents 5
Number of Substantiated Complavarchars 4
Number of Citations from Infection Control Inspections 0
Number of Fines 1
Total Amount of Fines in Dollars 10400.00
Number of Payment Denials 1
Total Number of Penalties 2
Processing Date 2021-05-01
Notes CMS: Centers for Medicare & Medicaid Services
CNA: Certified Nursing Assistant
LPN: Licensed Practical Nurse
RN: Registered Nurse

Ownership Information
THE WATERS OF SHELBYVILLE, LLC

Role PlayedOwner NameOwner TypeOwnership PercentageAssociation Date
5% OR GREATER DIRECT OWNERSHIP INTERESTA&F REALTY LLCOrganization20%since 08/01/2016
5% OR GREATER DIRECT OWNERSHIP INTERESTBLISKO, MICHAELIndividual40%since 08/01/2016
5% OR GREATER DIRECT OWNERSHIP INTERESTGUBIN ENTERPRISES LIMITED PARTNERSHIPOrganization40%since 08/01/2016
MANAGING EMPLOYEETACKETT, THOMASIndividualsince 05/16/2019

Location Information

Street Address 835 UNION STREET
City SHELBYVILLE
State TN
Zip Code 37160

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Dataset Information

This dataset includes 15 thousand nursing homes approved by U.S Centers for Medicare & Medicaid Services (CMS) to provide Medicare & Medicaid services. CMS created Care Compare, a healthcare compare tool, for consumers to understand information about doctors, hospitals, and skilled nursing facilities. The information on nursing homes include number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System.