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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.
Nhc Healthcare, Smithville is a 114-bed skilled nursing facility in Smithville, Tennessee, offering short-term rehabilitation, long-term care, memory care, and respite care. It is operated by Ryan Vaden. Located on Fisher Avenue in De Kalb County and accepts Medicare, Medicaid, and private pay. About 44% of new admissions arrive for post-acute rehabilitation, giving the facility a mix of short- and long-stay residents with a 110-day average length of stay.
CMS rates the facility at 3 stars overall. Over the past eight years, NHC HealthCare Smithville recorded 10 total health citations — ranking 57th out of 176 Tennessee skilled nursing facilities, well below the state average of 15.4. Citations per inspection averaged 3.33, also below the Tennessee mean of 4.39.
Seven of the 10 citations followed complaint investigations, and the facility carries $229,000 in cumulative federal fines, placing it 171st out of 177 fined Tennessee facilities — 165% above the state average for fine amounts. One payment denial has also been issued, roughly double the Tennessee norm.
The facility’s staffing averages 3 hours 31 minutes of total nursing care per resident per day, modestly below Tennessee’s average of 3 hours 40 minutes. Rehabilitation services are available on-site, and the facility provides 24-hour staffing along with a beauty and barber shop, outdoor relaxation area, and daily activities programming. A secured memory care unit supports residents with dementia.
NHC HealthCare’s rehabilitation capacity and mixed payer profile make it suitable for both post-acute Medicare stays and long-term Medicaid residency in the Smithville and DeKalb County area. Memory care availability also extends its reach to residents in the earlier through mid-stages of dementia who require structured supervision.
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 69th 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.
| 32m per day | ▼ 13% 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.
| 51m per day | ▼ 22% 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 24m per day | ▲ 12% 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 19m per day | ■ Avg 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.
| 4m per day | ▼ 27% 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.
| 19m per day | ▼ 22% State avg: 24m per day · National avg: 28m per day |
Similar to the Tennessee average: 71.6%NHC HealthCare, Smithville is administrated by Ryan Vaden.
Key information about the people who lead and staff this community.
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 Feb 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.
3 of 10 citations resulted from standard inspections; and 7 of 10 resulted from complaint investigations.
82% worse than Tennessee averageTennessee average: 1.1
67% worse 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.
16% fewer 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 14 RN 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.
8.4 hoursAssists with medical care and medications.
All 20 LPN Staff are full-time employees. No contractors work on this role.
20
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 54 CNA Staff are full-time employees. No contractors work on this role.
54
Average shift length. Calculated as total hours divided by days worked and average staff per day.
8 hours
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
This data comes from the CMS Payroll-Based Journal report covering October 1 – December 31, 2025.
| Certified Nursing Assistant | 54 | 0 | 54 | 15,764 | 92 | 100% | 8 |
| Licensed Practical Nurse | 20 | 0 | 20 | 6,456 | 92 | 100% | 9.4 |
| Nurse Aide in Training | 10 | 0 | 10 | 2,622 | 92 | 100% | 9.1 |
| Registered Nurse | 14 | 0 | 14 | 2,620 | 92 | 100% | 8.4 |
| Clinical Nurse Specialist | 3 | 0 | 3 | 1,047 | 68 | 74% | 7.7 |
| Dental Services Staff | 1 | 0 | 1 | 561 | 59 | 64% | 9.5 |
| Mental Health Service Worker | 1 | 0 | 1 | 556 | 63 | 68% | 8.8 |
| Dietitian | 1 | 0 | 1 | 480 | 62 | 67% | 7.7 |
| Administrator | 1 | 0 | 1 | 472 | 59 | 64% | 8 |
| Physical Therapy Assistant | 1 | 0 | 1 | 467 | 60 | 65% | 7.8 |
| Respiratory Therapy Technician | 3 | 0 | 3 | 466 | 62 | 67% | 7.4 |
| Other Dietary Services Staff | 1 | 0 | 1 | 438 | 56 | 61% | 7.8 |
| Nurse Practitioner | 1 | 0 | 1 | 428 | 54 | 59% | 7.9 |
| Speech Language Pathologist | 2 | 0 | 2 | 330 | 54 | 59% | 6.1 |
| Occupational Therapy Aide | 1 | 0 | 1 | 150 | 26 | 28% | 5.8 |
| Qualified Social Worker | 1 | 0 | 1 | 38 | 11 | 12% | 3.4 |
| Occupational Therapy Assistant | 0 | 1 | 1 | 12 | 3 | 3% | 4 |
| Medical Director | 0 | 4 | 4 | 3 | 3 | 3% | 0.5 |
Includes penalties issued in 2024
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 (Data as of Jan 2026)
165% higher than Tennessee averageTennessee average: $86K
43% fewer fines than Tennessee averageTennessee average: 1.7
Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed.
1
96% more payment denials than Tennessee averageTennessee average: 0.5
Penalties are imposed by CMS for violations of federal nursing home regulations.
2 penalties in the past 3 years
Multiple penalties were reported in the last 3 years.
Fines imposed for noncompliance, which can be assessed per day or per instance of violation.
Apr 11, 2024
Serious action where Medicare and/or Medicaid temporarily stops payments for new residents until issues are fixed.
Apr 11, 2024Last updated: Jan 2026
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.
3.7
65% better than Tennessee averageTennessee average: 10.5
A composite score based on activities of daily living decline, walking ability decline, and incontinence.
11.3
42% 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
8.9%
45% better than Tennessee averageTennessee average: 16.0%
Percent of long-stay residents whose ability to move independently worsened
4.5%
79% better than Tennessee averageTennessee average: 21.7%
Percent of low risk long-stay residents who lose control of their bowels or bladder
20.6%
In line with Tennessee averageTennessee average: 20.7%
Percent of long-stay residents experiencing one or more falls with major injury
3.2%
13% better than Tennessee averageTennessee average: 3.7%
Percent of long-stay high risk residents with pressure ulcers
0.4%
92% better than Tennessee averageTennessee average: 5.4%
Percent of long-stay residents with a urinary tract infection
1.1%
49% better than Tennessee averageTennessee average: 2.1%
Percent of long-stay residents who lose too much weight
1.5%
77% better than Tennessee averageTennessee average: 6.3%
Percent of long-stay residents who have depressive symptoms
6.6%
40% better than Tennessee averageTennessee average: 11.0%
Percent of long-stay residents who received an antipsychotic medication
10.0%
40% better than Tennessee averageTennessee average: 16.5%
Percent of long-stay residents assessed and appropriately given the pneumococcal vaccine
100.0%
11% better than Tennessee averageTennessee average: 89.9%
Percent of long-stay residents assessed and appropriately given the seasonal influenza vaccine
100.0%
6% better than Tennessee averageTennessee average: 94.5%
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
100.0%
26% better than Tennessee averageTennessee average: 79.7%
Percent of short-stay residents who newly received an antipsychotic medication
0.0%
100% better than Tennessee averageTennessee average: 1.7%
Percent of short-stay residents assessed and appropriately given the seasonal influenza vaccine
100.0%
25% better than Tennessee averageTennessee average: 79.8%
Percentage of short-stay residents who were re-hospitalized after their nursing home admission.
12.9%
42% better than Tennessee averageTennessee average: 22.2%
Percentage of short-stay residents who had an outpatient emergency department visit.
11.9%
6% worse than Tennessee averageTennessee average: 11.2%
Percentage of SNF residents who experience falls with major injury during their stay.
2.2%
182% worse than Tennessee averageTennessee average: 0.8%
Percentage of residents at or above expected ability to care for themselves at discharge.
53.3%
In line with Tennessee averageTennessee average: 53.7%
Rate of successful return to home or community from a skilled nursing facility.
61.3%
21% better 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.
44% of new residents, usually for short-term rehab.
6% of new residents, often for short stays.
49% of new residents, often for long-term daily care.
Source: CMS Long-Term Care Facility Characteristics (Data as of Jan 2026)
Total residents
82Residents meet regularly to discuss policies, care quality, and activities
State-approved Nurse Aide Training and Competency Evaluation Program on-site
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 NHC HealthCare, Smithville 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 #95 / 176Payroll — State benchmarkedThis home is ranked 95th 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 for extended periods and receive ongoing daily care.
0.0 miles from city center
Estimated distance in miles from Smithville's city center to NHC HealthCare, Smithville's address, calculated via Google Maps.
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NHC HealthCare, Smithville is located in Smithville, Tennessee.
Here are the financial assistance programs available to residents in Tennessee.
NHC HealthCare, Smithville is in the Middle Tennessee neighborhood of Smithville.
NHC HealthCare, Smithville 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, NHC HealthCare, Smithville's license number is 00000071.
NHC HealthCare, Smithville's occupancy is 74%.
Ryan Vaden is the administrator of NHC HealthCare, Smithville.
NHC HealthCare, Smithville has 114 beds.
Yes — there are 15 photos of NHC HealthCare, Smithville in the photo gallery on this page.
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