The Waters of Shelbyville, LLC
835 Union Street, Shelbyville, TN 37160


The Waters of Shelbyville, LLC is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445171. The address is 835 Union Street, Shelbyville, TN 37160. The zip code is 37160. The phone number is 9316802300.


The Waters of Shelbyville, LLC · 835 Union Street, Shelbyville, TN 37160

Federal Provider Number 445171
Provider Name THE WATERS OF SHELBYVILLE, LLC
Address 835 UNION STREET
SHELBYVILLE, TN 37160
Phone Number 9316802300
SSA County Code 10
County Name Bedford
Ownership Type For profit - Partnership
Certified Beds 96
Certified Beds Residents 82
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name THE WATERS OF SHELBYVILLE, LLC
Date First Approved to Provide Medicare Medicaid Services 01/11/1985
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 2
Reported CNA Staffing Hours per Resident per Day 1.9378
Reported LPN Staffing Hours per Resident per Day 0.89024
Reported RN Staffing Hours per Resident per Day 0.44756
Reported Licensed Staffing Hours per Resident per Day 1.3378
Reported Total Nurse Staffing Hours per Resident per Day 3.2756
Reported Physical Therapist Staffing Hours per Resident Per Day 0.02256
Expected CNA Staffing Hours per Resident per Day 2.2958
Expected LPN Staffing Hours per Resident per Day 0.63892
Expected RN Staffing Hours per Resident per Day 0.9711
Expected Total Nurse Staffing Hours per Resident per Day 3.90582
Adjusted CNA Staffing Hours per Resident per Day 2.07108
Adjusted LPN Staffing Hours per Resident per Day 1.15649
Adjusted RN Staffing Hours per Resident per Day 0.34437
Adjusted Total Nurse Staffing Hours per Resident per Day 3.3805
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 3
Cycle 1 Health Deficiency Score 24
Cycle 1 Standard Survey Health Date 09/14/2016
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 24
Cycle 2 Total Number of Health Deficiencies 7
Cycle 2 Number of Standard Health Deficiencies 7
Cycle 2 Health Deficiency Score 32
Cycle 2 Standard Health Survey Date 08/06/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 32
Cycle 3 Total Number of Health Deficiencies 24
Cycle 3 Number of Standard Health Deficiencies 24
Cycle 3 Health Deficiency Score 646
Cycle 3 Standard Health Survey Date 06/14/2014
Cycle 3 Number of Health Revisits 2
Cycle 3 Health Revisit Score 323
Cycle 3 Total Health Score 969
Total Weighted Health Survey Score 184.167
Number of Substantiated Complaints 2
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · The Waters of Shelbyville, LLC

Owner Name Role Association Date
A & F REALTY LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
20%
since 08/01/2016
BLISKO, MICHAEL (Individual) 5% OR GREATER DIRECT OWNERSHIP INTEREST
40%
since 08/01/2016
GUBIN ENTERPRISES LIMITED PARTNERSHIP (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
40%
since 08/01/2016
RAY, CHRISTOPHER (Individual) OPERATIONAL/MANAGERIAL CONTROL since 08/01/2016

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