Above average — CMS composite of the measures below.
A standard survey is most likely before around December 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 The Waters Of Clinton, Llc during CMS and state inspections, most recent first.
Surveyors found that the facility did not maintain a sanitary kitchen, with issues including unlabeled and undated sandwiches, debris on food equipment, a contaminated ice machine drain, uncovered eggs stored below ready-to-eat foods, and buildup of dirt and grease in multiple areas. The Dietary Manager confirmed these sanitation lapses.
The facility did not obtain informed consent for psychotropic medications administered to two residents with cognitive impairment and psychiatric diagnoses. Both received multiple medications over several months without documented consent, despite facility policy requiring it. The DON confirmed that the responsible nurse failed to secure the necessary consents.
A medication cart with a computer logged into the electronic medical record system was left unattended and accessible to the public after an RN went to lunch, resulting in residents' personal health information being visible and unprotected. Facility staff confirmed the failure to secure electronic records as required by HIPAA policy.
A resident's MDS assessment was inaccurately coded to indicate the presence of an indwelling urinary catheter during the required look-back period, despite medical records, staff interviews, and direct observation confirming the catheter had been removed and was not in use.
A resident receiving IV antibiotics for a UTI caused by an ESBL-producing organism did not have a physician's order for isolation precautions, as required by facility policy. The care plan indicated contact precautions should be in place, but review and staff interview confirmed the necessary order was not obtained.
A medication cart was observed unlocked and unattended in a hallway, with no staff present. An LPN confirmed leaving the cart unsecured while attending to a resident in another room, contrary to facility policy requiring medication carts to be locked and attended by licensed staff.
Staff failed to consistently use required PPE, including gowns and gloves, during high-contact care activities for a resident with an indwelling device, and did not perform proper hand hygiene during medication administration for another resident. Staff interviews revealed a misunderstanding of the facility's Enhanced Barrier Precautions policy, leading to lapses in infection control practices.
Failure to Maintain Sanitary Kitchen Conditions and Proper Food Labeling
Penalty
Summary
The facility failed to maintain a clean and sanitary kitchen environment, as evidenced by multiple observations and staff interviews. During an inspection, six peanut butter and jelly sandwiches were found in the kitchen refrigerator, with five of them being unlabeled and undated, contrary to the facility's policy requiring leftovers and opened foods to be clearly labeled with a discard date. The Dietary Manager confirmed these sandwiches were available for resident use without proper labeling. Additionally, the commercial can opener had visible debris near the cutting blade, and the ice machine drain contained a thick black substance, matching the appearance of the substance inside the floor drain. Further observations revealed 108 uncovered eggs stored on a bottom shelf in the refrigerator, with desserts, fruits, and vegetables stored on shelves above them. Dirt and debris were present on the floor behind the dry food storage room, the ice machine, and under the dishwasher. There was also a buildup of grease, lint, and hair on all three fire suppression pipes located above the stove. The Dietary Manager acknowledged these sanitation failures during the inspection.
Failure to Obtain Consent for Psychotropic Medications
Penalty
Summary
The facility failed to obtain informed consent for the administration of psychotropic medications for two residents, as required by its own policy. For one resident with severe dementia and psychotic disturbance, medical records showed the ongoing administration of Sertraline, an antidepressant, from June through September, without any documented consent for its use. This resident had a significant cognitive impairment, as indicated by a low BIMS score, and received the medication daily as ordered by the physician. Another resident, who had moderate cognitive impairment and multiple psychiatric diagnoses, was administered several psychotropic medications, including Alprazolam, Buspirone, Sertraline, and Trazodone, over a similar period. Review of the medical record for this resident also revealed no documented consent for any of these medications. During an interview, the DON confirmed that the nurse responsible for admitting residents was tasked with obtaining these consents, but acknowledged that the required consent forms were not obtained for either resident.
Unsecured Electronic Medical Records Left Accessible to Public View
Penalty
Summary
The facility failed to protect and safeguard residents' electronic medical records in accordance with its own HIPAA policy. During an observation, a medication cart was found unattended in the south hall with a computer logged into the electronic medical record system, making residents' personal health information visible and accessible to the public. A charge nurse confirmed that a registered nurse had left the cart and computer unattended while going to lunch, leaving the electronic records unsecured and available for public view. The facility's policy requires all personal health information, including electronic records, to be protected and kept confidential, but this was not followed in this instance.
Inaccurate MDS Assessment for Bladder Appliance Use
Penalty
Summary
The facility failed to ensure the accuracy of Minimum Data Set (MDS) assessments for one resident. According to the MDS 3.0 Resident Assessment Instrument (RAI) Manual, Section H requires documentation of the use of bladder and bowel appliances, including indwelling catheters, during the 7-day look-back period. Medical record review showed that the resident had a history of urinary retention and previously had an indwelling urinary catheter, which was ordered to be removed after 48 hours. Subsequent clinical notes confirmed that the catheter had been removed and the resident was occasionally incontinent of bladder and bowel, but was urinating effectively without the catheter. Despite this, the quarterly MDS assessment inaccurately indicated that the resident had an indwelling catheter during the look-back period. Observations on multiple dates confirmed that the resident did not have a catheter in place, and interviews with the resident, the MDS Coordinator, and the Director of Nursing all verified that the MDS was not accurately coded. The deficiency was identified through review of the MDS, medical records, and staff interviews, which established that the facility did not ensure the accuracy of the resident's MDS assessment regarding the presence of an indwelling urinary catheter.
Failure to Obtain Physician's Order for Isolation Precautions for Resident with ESBL UTI
Penalty
Summary
The facility failed to obtain a physician's order for isolation precautions for a resident who was being treated for a urinary tract infection (UTI) caused by an Extended-Spectrum Beta-Lactamase (ESBL) producing organism. According to the facility's infection control policy, an order from a physician is required to implement isolation precautions for multidrug-resistant organisms (MDROs). Medical record review showed that the resident was admitted with multiple psychiatric diagnoses and later developed a UTI with ESBL, confirmed by laboratory results. While a physician's order was present for the administration of intravenous ertapenem sodium to treat the infection, there was no corresponding physician's order for isolation precautions as required by facility policy. The resident's comprehensive care plan indicated that contact precautions should be implemented per facility policy due to the ongoing IV medication for the ESBL UTI. However, during an interview, the Assistant Director of Nursing/Infection Preventionist confirmed that, despite the resident being treated for an ESBL UTI, no physician's order for isolation precautions had been obtained. This omission was identified through facility policy review, medical record review, and staff interview.
Unattended and Unlocked Medication Cart
Penalty
Summary
The facility failed to ensure that medications were securely stored as required by policy and professional standards. During an observation, the North medication cart was found unlocked and unattended in the hallway, with its drawers facing outward and no employees present. An LPN confirmed that she had left the cart unlocked and unattended while she was in a resident room with the door closed, and acknowledged that medication carts are supposed to be locked when not attended by licensed nursing staff. The facility's policy specifies that medications must be stored safely, securely, and only accessible to licensed nursing personnel, with medication carts locked and attended by authorized persons.
Failure to Adhere to Enhanced Barrier Precautions and Hand Hygiene Protocols
Penalty
Summary
The facility failed to ensure proper implementation of its infection prevention and control program, specifically regarding the use of Personal Protective Equipment (PPE) and hand hygiene. For one resident with multiple comorbidities, including end stage renal disease and an indwelling dialysis catheter, staff did not consistently don both gloves and gowns during high-contact care activities as required by the facility's Enhanced Barrier Precautions (EBP) policy. Observations revealed that a CNA assisted the resident with dressing while wearing gloves but not a gown, and both a physical therapist and a physical therapy assistant provided transferring assistance without donning any PPE, despite clear signage and policy requirements for gown and glove use during such activities. Interviews with staff, including the CNA, physical therapy staff, and the staff development coordinator, indicated a misunderstanding of the EBP policy. Staff believed that gowns were only necessary when providing care directly related to the indwelling device or wounds, rather than for all high-contact activities such as dressing, transferring, and hygiene. This misunderstanding persisted until the infection preventionist reviewed the CDC signage and facility policy, confirming that gowns and gloves were required for all high-contact care for residents on EBP. Additionally, the facility failed to ensure proper hand hygiene during medication administration for another resident with dementia, diabetes, and kidney failure. An LPN was observed preparing and administering insulin without removing gloves or performing hand hygiene between tasks, including after direct resident contact and after glove removal. The LPN confirmed the failure to follow hand hygiene protocols, and the infection preventionist acknowledged the lapse in infection control practices during medication administration.
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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.
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Nursing homes near Clinton
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Andersonville Tn Opco Llc | 6 mi | ★★★★★ | 8 | 0 |
| Rocky Top Care Center | 6.7 mi | ★★★★★ | 7 | 0 |
| Diversicare Of Oak Ridge | 9.2 mi | ★★★★★ | 0 | 0 |
| Nhc Healthcare, Oak Ridge | 9.5 mi | ★★★★★ | 3 | 0 |
| Senator Ben Atchley State Veterans' Home | 10.2 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.