The Waters of Robertson, LLC
104 Watson Road, Springfield, TN 37172


The Waters of Robertson, LLC is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445137. The address is 104 Watson Road, Springfield, TN 37172. The zip code is 37172. The phone number is 6153849565.


The Waters of Robertson, LLC · 104 Watson Road, Springfield, TN 37172

Federal Provider Number 445137
Provider Name THE WATERS OF ROBERTSON, LLC
Address 104 WATSON ROAD
SPRINGFIELD, TN 37172
Phone Number 6153849565
SSA County Code 730
County Name Robertson
Ownership Type For profit - Corporation
Certified Beds 120
Certified Beds Residents 40
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name THE WATERS OF ROBERTSON LLC
Date First Approved to Provide Medicare Medicaid Services 10/01/1980
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months true
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 1
Health Inspection Rating 1
Quality Measure Rating 3
Staffing Rating 2
RN Staffing Rating 4
Reported CNA Staffing Hours per Resident per Day 1.50875
Reported LPN Staffing Hours per Resident per Day 0.8875
Reported RN Staffing Hours per Resident per Day 0.84875
Reported Licensed Staffing Hours per Resident per Day 1.73625
Reported Total Nurse Staffing Hours per Resident per Day 3.245
Reported Physical Therapist Staffing Hours per Resident Per Day 0.06125
Expected CNA Staffing Hours per Resident per Day 2.53083
Expected LPN Staffing Hours per Resident per Day 0.70636
Expected RN Staffing Hours per Resident per Day 1.19612
Expected Total Nurse Staffing Hours per Resident per Day 4.43331
Adjusted CNA Staffing Hours per Resident per Day 1.46277
Adjusted LPN Staffing Hours per Resident per Day 1.04284
Adjusted RN Staffing Hours per Resident per Day 0.5302
Adjusted Total Nurse Staffing Hours per Resident per Day 2.95045
Cycle 1 Total Number of Health Deficiencies 13
Cycle 1 Number of Standard Health Deficiencies 9
Cycle 1 Number of Complaint Health Deficiencies 4
Cycle 1 Health Deficiency Score 60
Cycle 1 Standard Survey Health Date 05/09/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 60
Cycle 2 Total Number of Health Deficiencies 18
Cycle 2 Number of Standard Health Deficiencies 14
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 92
Cycle 2 Standard Health Survey Date 05/04/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 92
Cycle 3 Total Number of Health Deficiencies 15
Cycle 3 Number of Standard Health Deficiencies 15
Cycle 3 Health Deficiency Score 108
Cycle 3 Standard Health Survey Date 04/24/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 108
Total Weighted Health Survey Score 78.667
Number of Facility Reported Incidents 5
Number of Substantiated Complaints 3
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · The Waters of Robertson, LLC

Owner Name Role Association Date
A & F REALTY LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
20%
since 09/01/2016
BLISKO, MICHAEL (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
40%
since 09/01/2016
GUBIN ENTERPRISES LIMITED PARTNERSHIP (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
40%
since 09/01/2016
RAY, CHRISTOPHER (Individual) OPERATIONAL/MANAGERIAL CONTROL since 09/01/2016

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