Average — CMS composite of the measures below.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Jefferson County Nursing Home during CMS and state inspections, most recent first.
Failure to Resubmit PASRR After New Mental Health Diagnoses: The facility did not submit new PASRR Level I screens after several residents developed additional MH diagnoses. Records showed residents with dementia later had diagnoses such as adjustment disorder, impulse disorder, delusional disorder, anxiety, psychosis, hoarding disorder, and paranoid personality disorder added, along with care plans and psychotropic meds referencing paranoia, delusions, and impulse control issues. Staff confirmed the original PASRRs did not include the new diagnoses and that updated PASRRs were not submitted.
Failure to revise care plan after falls: A resident with a hx of falling, CVA, and muscle weakness had two unwitnessed falls, one involving loss of balance while going to the bathroom and another with the resident found on the bathroom floor with gait imbalance and weakness. Interventions included high-visibility tape on the call light and a 3-in-1 toilet, but the comprehensive care plan did not include these measures even though the resident required assistance with transfers, toileting hygiene, and personal hygiene.
Failure to Obtain Ordered Routine Laboratory Tests: A resident with atrial fibrillation, HLD, bipolar disorder, DM2, and anemia had a physician order for routine labs including CBC, CMP, magnesium, lipid panel, vitamin D, ferritin, TIBC, folate, valproic acid, and Hgb A1c, but the facility could not locate results for the ordered January and July lab draws. The ADON confirmed the labs were not found and the NP stated staff were expected to follow all physician orders; he also stated the resident did not have a negative outcome such as decline in health status or hospitalization.
Incomplete Dialysis Communication Records: A resident with ESRD on chronic dialysis, functional quadriplegia, obesity, and diabetes had a dialysis care plan and an order to complete dialysis communication sheets before and after treatment. Staff stated the sheets were used for pre- and post-dialysis assessments, but the post-dialysis sections were left incomplete on multiple occasions, and the DON confirmed the records had not been completed.
Failure to Offer Hand Hygiene Assistance Before Meals: A CNA delivered meal trays to five residents and, after setting up the trays and removing gloves, left without offering hand hygiene assistance before the meal. The residents had varying needs including cognitive impairment, ADL assistance, and dependence for personal hygiene. The CNA confirmed the omission, and the DON stated staff were to offer hand hygiene assistance to all residents prior to meals.
Failure to Resubmit PASRR After New Mental Health Diagnoses
Penalty
Summary
The facility failed to resubmit a new PASRR Level I screening after new mental health diagnoses were added for four residents reviewed for PASRR compliance. Facility policy stated that residents with a significant change in status should be screened by submitting a new Level I PASRR, but the records reviewed showed no evidence that this occurred for the affected residents after their diagnoses changed. For one resident, the initial PASRR completed before admission indicated no mental health diagnosis was known or suspected, although the resident had dementia. After admission, diagnoses of Adjustment Disorder with Mixed Anxiety and Depressed Mood and later Impulse Disorder were added to the medical record, and the care plan later noted psychotropic medication use and impulse disorder. The record contained no evidence that a new PASRR was submitted after those diagnoses were added. The Admissions RN confirmed the original PASRR did not identify mental health diagnoses and confirmed no new PASRR had been submitted when the new diagnoses were added. For a second resident, the pre-admission PASRR also indicated no mental health diagnosis was known or suspected, with dementia noted. After admission, diagnoses of Delusional Disorder, Anxiety, and Psychosis were added, and care plans referenced paranoia, delusions, hallucinations, dementia, and psychotropic medication use. The record contained no documentation that a new PASRR was submitted after those mental health diagnoses were entered. The Admissions RN stated PASRRs were reviewed on admission and that the MDS Coordinator would resubmit them after changes in mental health diagnoses, but confirmed this resident’s new PASRR had not been submitted timely. For two additional residents, the records showed pre-admission PASRR findings related to dementia and mental health status, but later diagnoses of Impulse Disorder for one resident and Hoarding Disorder and Paranoid Personality Disorder for the other were added after admission. Their care plans and psychiatric notes referenced impulse control disorder, paranoia, delusions, anxiety, depression, and psychotropic medications. Review of the records showed no documentation that new PASRR Level I screens were submitted after those new mental health diagnoses were added. An LPN MDS Assistant reviewed the records and confirmed the new diagnoses were not included on the prior PASRRs and that the facility failed to submit new Level I screens when the diagnoses changed.
Failure to Revise Care Plan After Falls
Penalty
Summary
The facility failed to revise the comprehensive care plan for one resident after two falls and related interventions were identified. Resident #117 was admitted with diagnoses including history of falling, cerebral infarction, and muscle weakness. A facility incident report dated 5/17/2025 documented an unwitnessed fall in which the resident reported trying to go to the bathroom and losing balance; no injuries were observed, and the intervention included high visibility tape to the resident’s call light. A quarterly MDS assessment showed the resident had a BIMS score of 14, indicating cognitive intactness, and required supervision or touching assistance with toileting hygiene and transfers, and partial/moderate assistance with personal hygiene. A second incident report dated 11/2/2025 documented another unwitnessed fall with the resident observed on the bathroom floor with gait imbalance and weakness; the intervention included a 3 in 1 toilet placed over the toilet. Review of the comprehensive care plan dated 12/9/2025 showed the resident required touching/partial assistance with transfers and was at increased risk for falls/trauma, but the plan did not include the high visibility tape to the call light or the 3 in 1 toilet. During observation on 12/11/2025, the yellow tape was present on the call light and the 3 in 1 toilet was in the resident’s restroom, and the ADON confirmed the care plan had not been revised to include those fall interventions.
Failure to Obtain Ordered Routine Laboratory Tests
Penalty
Summary
The facility failed to follow a physician’s order for routine blood tests for one resident who was admitted with diagnoses including atrial fibrillation, hyperlipidemia, bipolar disorder, diabetes mellitus type 2, and anemia. The physician’s order dated 5/31/2022 required routine labs including CBC, CMP, magnesium, lipid panel, vitamin D, ferritin, TIBC, folate, valproic acid, and Hgb A1c in January and July. The resident’s quarterly MDS assessment showed a BIMS score of 15, indicating the resident was cognitively intact. Review of the medical record showed no results for the ordered blood tests for January 2025 or July 2025. The care plan included monitoring lab values for hyperlipidemia, history of DVTs, diabetes, anemia, diuretic therapy, and psychotropic medication use, including Depakote levels as ordered. During interview, the ADON confirmed the ordered labs could not be located and confirmed the facility failed to follow the physician’s order. The NP stated it was his expectation that staff follow all physician orders and said the resident did not experience any negative outcome such as decline in health status or hospitalization as a result of the missed labs.
Incomplete Dialysis Communication Records
Penalty
Summary
The facility failed to complete dialysis communication records for Resident #55, who was admitted with End Stage Renal Disease with dependence on renal dialysis, functional quadriplegia, obesity, and diabetes. The resident’s record showed he was cognitively intact, received dialysis services, had a dialysis care plan, and had a physician’s order to complete the dialysis communication sheet before and after dialysis. The facility policy also stated that the licensed nurse would communicate with the dialysis facility in written format using a dialysis communication form. During interview and observation, the resident stated he went to dialysis three days a week and carried a dialysis notebook with communication sheets. An LPN stated the dialysis communication sheets were kept in a notebook behind the nurses’ desk and that residents were assessed before leaving for dialysis and upon return using the sheet. Review of the dialysis communication sheets showed the post-dialysis assessments were not completed on multiple dates, including 11/1/2025, 11/4/2025, 11/6/2025, 11/8/2025, 11/11/2025, 11/20/2025, 11/22/2025, 11/29/2025, 12/2/2025, and 12/6/2025. The DON confirmed it was the facility’s expectation to complete the dialysis communication sheet before dialysis treatment and upon return to the facility, and confirmed the sheets for Resident #55 had not been completed.
Failure to Offer Hand Hygiene Assistance Before Meals
Penalty
Summary
The facility failed to provide hand hygiene assistance prior to meals for 5 residents during meal tray distribution on 1 of 7 units observed. The facility policy titled, HANDWASHING POLICY, dated 5/20/2025, stated that hand hygiene is any method that removes microorganisms from the hands and that residents should perform hand hygiene at the beginning of the meal. Resident #28 had diagnoses including unspecified lack of coordination, reduced mobility, need for assistance with personal care, and cognitive communication deficit. The resident’s quarterly MDS showed a BIMS score of 12, indicating moderate cognitive impairment, and the care plan documented substantial assistance and supervision with bathing and grooming as well as cognitive deficits with periods of confusion. During observation, CNA A delivered the lunch tray, donned gloves, set up the tray, doffed the gloves, sanitized hands, and left without offering hand hygiene assistance. Resident #111 had diagnoses including dysphagia, need for assistance with personal care, and cognitive communication deficit, with an annual MDS BIMS score of 13. The care plan documented dependent assistance and supervision with bathing and grooming and assistance for daily care and hygiene. Resident #162 had diagnoses including COPD and encounter for palliative care, was oriented to person and time only, and required 1-person assist with all ADL care; the care plan noted cognitive deficits and need for assistance with decision making. Resident #40 had diagnoses including COPD, need for assistance with personal care, and delusional disorders, with severe cognitive impairment on MDS and dependence for personal hygiene. Resident #78 had diagnoses including muscle weakness, need for assistance with personal care, and cognitive communication deficit, with a BIMS score of 13 and dependence for personal hygiene. During observations for each of these residents, CNA A set up the meal tray and exited without offering hand hygiene assistance. CNA A stated residents were to be offered hand hygiene assistance prior to meals, and the DON confirmed staff were to offer hand hygiene assistance to all residents prior to meals.
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Illustrative
What surveyors actually found near you
We read the 12 citations issued within 25 miles in the last 12 months — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
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Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Dandridge
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Jefferson City Health And Rehab Center | 7.2 mi | ★★★★★ | 0 | 0 |
| Life Care Center Of Jefferson City | 7.5 mi | ★★★★★ | 0 | 0 |
| Jefferson Park At White Pine | 9.6 mi | — | 1 | 0 |
| Newport Tn Opco Llc | 10.8 mi | ★★★★★ | 6 | 0 |
| Sevierville Health And Rehabilitation Center | 12.6 mi | ★★★★★ | 2 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release July 2026) and official state health department websites.