We arrange tours, appointments, and even moving support so you don’t have to
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
CMS (the Centers for Medicare & Medicaid Services) is the federal agency that rates nursing home quality. Its Overall Rating runs from 1 to 5 stars, combining health inspections, staffing, and quality measures, with inspections weighted most heavily.
Four Oaks Health Care Center provides long-term care and short-term rehabilitation services for residents in Washington County, Tennessee. The community is a privately owned 26-bed skilled nursing facility in Jonesborough operated by Tammy Edwards.
Four Oaks holds a 2-star overall CMS rating, driven primarily by staffing. Nurse hours average 3 hours and 24 minutes per resident per day, roughly 7% below the Tennessee average of 3 hours and 40 minutes, and 59% below the state benchmark on CMS’s adjusted staffing metric. Health Inspection performance is the one bright spot, scoring 2.7 percentage points above the Tennessee average. Quality Measures trail the state by about 20%.
The facility’s occupancy rate is 62%, below Tennessee’s average of 71.6%, which typically indicates near-term availability. The resident mix is weighted toward long-term care, with a smaller share admitted for short-stay rehabilitation. On-site services include a therapy gym and wellness program, a beauty salon, a courtyard, and scheduled activities and social events.
Four Oaks Health Care Center serves residents seeking long-term skilled nursing care in a small, residential setting in the Jonesborough area, particularly those for whom immediate availability and proximity to Washington County matter more than high staffing ratios or quality-of-care performance.
The Overall CMS Rating combines results from health inspections, staffing levels and quality measures. Health inspections carry the most weight. Staffing and quality scores can increase or decrease the final rating based on performance compared to state and national standards.
Based on the results of the facility's three most recent standard inspections and any complaint investigations. CMS reviews the number, scope, and severity of deficiencies, with more recent findings weighted more heavily.
Measures average nursing staff hours per resident per day, including Registered Nurses (RNs) and total nursing staff. Ratings are adjusted based on the level of care residents require and are compared to state and national benchmarks.
Based on clinical and physical health indicators reported to CMS, such as hospital readmissions, falls, pressure ulcers, and improvements in mobility. These measures reflect how well residents' health needs are being managed.
Daily nursing hours per resident by staff type, reported to CMS. Higher is generally better — compare this facility to state and national averages to see where staffing stands.
This home is ranked 83rd out of 172 homes in Tennessee for nurse hours. Total adjusted nursing hours per resident per day, combining RN, LPN, and aide time. CMS adjusts this for case-mix so facilities can be fairly compared.
| Staff type | Hours / Day / Resident | vs state avg |
|---|---|---|
|
Registered Nurse (RN)
RNs hold the highest nursing license and can assess residents, interpret test results, and direct care plans. More RN hours per day often signals stronger clinical oversight and faster response to health changes.
| 17m per day | ▼ 55% State avg: 37m per day · National avg: 41m per day |
|
LPN / LVN
Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) deliver routine hands-on care — medication administration, wound dressing, and monitoring vital signs. They work under RN supervision and make up a large share of daily bedside care.
| 1h 9m per day | ▲ 6% State avg: 1h 5m per day · National avg: 52m per day |
|
Nurse Aide
Certified Nurse Aides (CNAs) provide the most direct day-to-day assistance: bathing, dressing, feeding, and mobility. Nurse aide hours are typically the largest staffing category and directly affect residents' quality of life.
| 2h 10m per day | ■ Avg State avg: 2h 9m per day · National avg: 2h 20m per day |
|
Weekend Total Nursing
Combined nursing hours (RN + LPN + Nurse Aide) per resident per day on weekends. Staffing often drops on weekends — this figure reveals whether the facility maintains adequate coverage outside of weekday hours.
| 3h 6m per day | ▼ 8% State avg: 3h 21m per day · National avg: 3h 26m per day |
|
Physical Therapist
Hours per resident per day provided by licensed Physical Therapists (PTs) or PT Assistants. PT services help residents recover mobility after injury or illness and are especially important for post-acute (short-stay) rehabilitation.
| 3m per day | ▼ 45% State avg: 5m per day · National avg: 4m per day |
|
Weekend RN
Registered nurse hours specifically on weekends. Facilities sometimes reduce RN presence on Saturdays and Sundays — a low weekend RN figure compared to weekday hours can indicate reduced clinical oversight when most administrative staff are absent.
| 10m per day | ▼ 57% State avg: 24m per day · National avg: 28m per day |
Lower than the Tennessee average: 71.6%Four Oaks Health Care Center is administrated by Tammy Lyn Edwards.
In Tennessee, the Department of Health, Division of Health Care Facilities performs unannounced inspections and investigations to ensure facilities provide high-quality resident care.
Tennessee average 3.5
Last Health inspection on Mar 2025
Tennessee average 15.4
Tennessee average 4.39
Health citations are formal notices following inspections when they fail to comply with safety and care standards.
6 of 9 citations resulted from standard inspections; and 3 of 9 resulted from complaint investigations.
100% better than Tennessee averageTennessee average: 1.1
100% better than Tennessee averageTennessee average: 0.6
Corrected
Corrected
Corrected
Corrected
Reporting period: October 1 – December 31, 2025 (Q4 2025). Source: CMS Payroll-Based Journal report.
13% more staff per resident than Tennessee average
0% compared with Tennessee average
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Manages medical care and health needs.
All 5 RN Staff are full-time employees. No contractors work on this role.
5
Average shift length. Calculated as total hours divided by days worked and average staff per day.
9.9 hoursAssists with medical care and medications.
All 14 LPN Staff are full-time employees. No contractors work on this role.
14
Average shift length. Calculated as total hours divided by days worked and average staff per day.
9.4 hoursHelps with daily care and mobility.
All 38 CNA Staff are full-time employees. No contractors work on this role.
38
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8.5 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
Total hours from contractors
1,347 contractor hours this quarter
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
| Certified Nursing Assistant | 38 | 0 | 38 | 10,625 | 92 | 100% | 8.5 |
| Licensed Practical Nurse | 14 | 0 | 14 | 5,319 | 92 | 100% | 9.4 |
| Nurse Aide in Training | 9 | 0 | 9 | 1,108 | 65 | 71% | 8.8 |
| Registered Nurse | 5 | 0 | 5 | 1,010 | 92 | 100% | 9.9 |
| RN Director of Nursing | 2 | 0 | 2 | 934 | 70 | 76% | 7.3 |
| Mental Health Service Worker | 1 | 0 | 1 | 538 | 67 | 73% | 8 |
| Administrator | 1 | 0 | 1 | 496 | 62 | 67% | 8 |
| Dietitian | 1 | 0 | 1 | 459 | 66 | 72% | 7 |
| Other Dietary Services Staff | 2 | 0 | 2 | 441 | 59 | 64% | 7.3 |
| Speech Language Pathologist | 0 | 1 | 1 | 353 | 63 | 68% | 5.6 |
| Physical Therapy Aide | 0 | 3 | 3 | 310 | 66 | 72% | 4.7 |
| Nurse Practitioner | 1 | 0 | 1 | 279 | 35 | 38% | 8 |
| Respiratory Therapy Technician | 0 | 4 | 4 | 250 | 58 | 63% | 4.3 |
| Qualified Social Worker | 0 | 2 | 2 | 236 | 47 | 51% | 5 |
| Clinical Nurse Specialist | 1 | 0 | 1 | 209 | 27 | 29% | 7.8 |
| Physical Therapy Assistant | 0 | 4 | 4 | 197 | 61 | 66% | 3 |
Federal penalties imposed by CMS for regulatory violations, including civil money penalties (fines) and denials of payment for new Medicare/Medicaid admissions.
Source: CMS Penalties Database
No penalties in the past 3 years
No civil money penalties or payment denials were reported in the last 3 years.
These measures show how residents usually do over time at this home, based on health outcomes and preventive care.
A composite score based on pressure ulcers, falls with injury, weight loss, walking ability decline, and activities of daily living decline.
8.1
22% better than Tennessee averageTennessee average: 10.5
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
13.0
33% better than Tennessee averageTennessee average: 19.5
CMS star rating based on long-stay quality measure performance. 5 stars = significantly above average, 1 star = significantly below average.
Percent of long-stay residents whose need for help with daily activities has increased
12.4%
23% better than Tennessee averageTennessee average: 16.0%
Percent of long-stay residents whose ability to move independently worsened
10.1%
54% better than Tennessee averageTennessee average: 21.7%
Percent of low risk long-stay residents who lose control of their bowels or bladder
16.7%
20% better than Tennessee averageTennessee average: 20.7%
Percent of long-stay residents experiencing one or more falls with major injury
2.1%
42% better than Tennessee averageTennessee average: 3.7%
Percent of long-stay high risk residents with pressure ulcers
7.0%
29% worse than Tennessee averageTennessee average: 5.4%
Percent of long-stay residents with a urinary tract infection
6.1%
197% worse than Tennessee averageTennessee average: 2.1%
Percent of long-stay residents who lose too much weight
9.0%
43% worse than Tennessee averageTennessee average: 6.3%
Percent of long-stay residents who have depressive symptoms
3.3%
70% better than Tennessee averageTennessee average: 11.0%
Percent of long-stay residents who received an antipsychotic medication
13.2%
20% better than Tennessee averageTennessee average: 16.5%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
94.5%
5% better than Tennessee averageTennessee average: 89.9%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
97.1%
In line with Tennessee averageTennessee average: 94.5%
Number of hospitalizations per 1,000 long-stay resident days.
1.71
8% worse than Tennessee averageTennessee average: 1.58
Number of outpatient emergency department visits per 1,000 long-stay resident days.
1.08
31% better than Tennessee averageTennessee average: 1.57
CMS star rating based on short-stay quality measure performance. 5 stars = much above average, 1 star = much below average.
Percent of short-stay residents assessed and appropriately given the pneumococcal vaccine
79.0%
In line with Tennessee averageTennessee average: 79.7%
Percent of short-stay residents who newly received an antipsychotic medication
1.5%
12% better than Tennessee averageTennessee average: 1.7%
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
81.7%
In line with Tennessee averageTennessee average: 79.8%
Percentage of short-stay residents who were re-hospitalized after their nursing home admission.
25.4%
14% worse than Tennessee averageTennessee average: 22.2%
Percentage of short-stay residents who had an outpatient emergency department visit.
8.3%
26% better than Tennessee averageTennessee average: 11.2%
Percentage of SNF residents who experience falls with major injury during their stay.
0.0%
100% better than Tennessee averageTennessee average: 0.8%
Percentage of residents at or above expected ability to care for themselves at discharge.
42.4%
21% worse than Tennessee averageTennessee average: 53.7%
Rate of successful return to home or community from a skilled nursing facility.
47.5%
6% worse than Tennessee averageTennessee average: 50.6%
Quality measures are calculated from Minimum Data Set (MDS) assessments. For most measures, lower percentages indicate better care quality.
17% of new residents, usually for short-term rehab.
65% of new residents, often for short stays.
19% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
45Residents meet regularly to discuss policies, care quality, and activities
Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.
Data sourced from CMS Long-Term Care Facility Characteristics quarterly report. Payer mix reflects the current resident census by primary payment source.
Historical financial and operational data for Four Oaks Health Care Center based on CMS SNF Cost Reports.
The portion of the home's budget spent on staff, including nurses, caregivers, and other employees who support care and operations.
Rank #155 / 176Payroll — State benchmarkedThis home is ranked 155th out of 176 homes in Tennessee for payroll. Shows total annual staff payroll benchmarked to the Tennessee average. Higher payroll investment relative to peers often signals better staffing and less reliance on cheaper contract labor.Click the rank badge to see the full State ranking.Click here to see the full State ranking.
All remaining costs needed to run the home, such as food, utilities, building maintenance, supplies and administrative expenses.
Most residents stay long-term, while a smaller portion are admitted for short-term rehab.
0.0 miles from city center
Estimated distance in miles from Jonesborough's city center to Four Oaks Health Care Center's address, calculated via Google Maps.
Add your location
Four Oaks Health Care Center is located in Jonesborough, Tennessee.
Here are the financial assistance programs available to residents in Tennessee.
The legal owner and operator of Four Oaks Health Care Center is Four Oaks Operating Group, LLC.
Four Oaks Health Care Center has a walk score of 53. Moderately walkable. Some errands can be accomplished on foot, with a mix of nearby amenities.
According to TN state health department records, Four Oaks Health Care Center's license number is 00000292.
Four Oaks Health Care Center's occupancy is 62%.
Tammy Lyn Edwards is the administrator of Four Oaks Health Care Center.
Four Oaks Health Care Center has 26 beds.
Yes — there are 3 photos of Four Oaks Health Care Center in the photo gallery on this page.
Care Cost Calculator: See Prices in Your Area
Nursing Home Data Explorer
Don’t Wait Too Long: 7 Red Flag Signs Your Parent Needs Assisted Living Now
The True Cost of Assisted Living in 2025 – And How Families Are Paying For It
Understanding Senior Living Costs: Pricing Models, Discounts & Financial Assistance
Thank you for your interest!
Our team will be in touch shortly to help with next steps.
