The Waters of Springfield LLC
704 5th Avenue East, Springfield, TN 37172


The Waters of Springfield LLC is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 445480. The address is 704 5th Avenue East, Springfield, TN 37172. The zip code is 37172. The phone number is 6153847977.


The Waters of Springfield LLC · 704 5th Avenue East, Springfield, TN 37172

Federal Provider Number 445480
Provider Name THE WATERS OF SPRINGFIELD LLC
Address 704 5TH AVENUE EAST
SPRINGFIELD, TN 37172
Phone Number 6153847977
SSA County Code 730
County Name Robertson
Ownership Type For profit - Corporation
Certified Beds 66
Certified Beds Residents 53
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name THE WATERS OF SPRINGFIELD, LLC
Date First Approved to Provide Medicare Medicaid Services 10/07/2005
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 4
Health Inspection Rating 4
Quality Measure Rating 2
Staffing Rating 2
RN Staffing Rating 2
Reported CNA Staffing Hours per Resident per Day 1.7283
Reported LPN Staffing Hours per Resident per Day 1.16509
Reported RN Staffing Hours per Resident per Day 0.52264
Reported Licensed Staffing Hours per Resident per Day 1.68774
Reported Total Nurse Staffing Hours per Resident per Day 3.41603
Reported Physical Therapist Staffing Hours per Resident Per Day 0.04434
Expected CNA Staffing Hours per Resident per Day 2.49425
Expected LPN Staffing Hours per Resident per Day 0.66845
Expected RN Staffing Hours per Resident per Day 1.04124
Expected Total Nurse Staffing Hours per Resident per Day 4.20394
Adjusted CNA Staffing Hours per Resident per Day 1.7002
Adjusted LPN Staffing Hours per Resident per Day 1.44667
Adjusted RN Staffing Hours per Resident per Day 0.37505
Adjusted Total Nurse Staffing Hours per Resident per Day 3.27542
Cycle 1 Total Number of Health Deficiencies 3
Cycle 1 Number of Standard Health Deficiencies 2
Cycle 1 Number of Complaint Health Deficiencies 1
Cycle 1 Health Deficiency Score 16
Cycle 1 Standard Survey Health Date 01/19/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 16
Cycle 2 Total Number of Health Deficiencies 4
Cycle 2 Number of Standard Health Deficiencies 4
Cycle 2 Health Deficiency Score 16
Cycle 2 Standard Health Survey Date 01/06/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 16
Cycle 3 Standard Health Survey Date 12/03/2014
Total Weighted Health Survey Score 13.333
Number of Facility Reported Incidents 1
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · The Waters of Springfield 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

37172 · Nursing Home

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