Deficiencies (last 4 years)
Deficiencies (over 4 years)
1.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
59% better than Tennessee average
Tennessee average: 4.4 deficiencies/year
Deficiencies per year
4
3
2
1
0
Inspection Report
Enforcement
Deficiencies: 2
Date: Feb 26, 2025
Visit Reason
This document is a Consent Order issued by the Tennessee Health Facilities Commission regarding enforcement action against Shelby Gardens, LLC, an assisted care living facility, for violations under prior ownership and failure to comply with safety and plan of care requirements.
Findings
The Commission found multiple deficiencies related to failure to provide safety to residents, failure to maintain and update plans of care, and failure to implement approved plans of correction. These violations occurred under prior ownership and resulted in civil monetary penalties.
Deficiencies (2)
Failure to provide safety while in the assisted care living facility, including risks such as falls and sharp hazards.
Failure to maintain, revise, and update the Plan of Care for each resident as required.
Report Facts
Civil Monetary Penalty: 2000
Civil Monetary Penalty: 2000
Total Civil Monetary Penalties: 4000
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Daniel M. Hamister | Successor Manager | Signed as Authorized Representative of Shelby Gardens, LLC. |
| Jeremy J. Gourley | Senior Associate General Counsel | Signed on behalf of the Health Facilities Commission. |
Inspection Report
Enforcement
Deficiencies: 1
Date: Feb 29, 2024
Visit Reason
The inspection was conducted due to findings of medication errors and failure to complete a thorough medication regimen review for Resident #5, leading to disciplinary action against the facility.
Findings
Surveyors found that the facility failed to provide correct medication therapy to Resident #5 from October through December 2023, resulting in an emergency room visit. The facility admitted to a medication error and performed a Root Cause Analysis to address the issue.
Deficiencies (1)
Tenn. Comp. R. and Regs. 0720-18-.06(6)(a) Basic Services: The nursing home failed to provide pharmaceutical services that meet the needs of residents, resulting in a medication error for Resident #5.
Report Facts
Civil Monetary Penalty: 1500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brandy Grindstaff | Executive Director | Signed as authorized representative of the facility. |
| Jeremy Gourley | Senior Associate General Counsel | Legal counsel for the Health Facilities Commission involved in the consent order. |
| Director of Nursing | Admitted to surveyors the medication misunderstanding regarding Resident #5. |
Inspection Report
Enforcement
Deficiencies: 2
Date: Jun 8, 2023
Visit Reason
The document is a Consent Order issued by the Tennessee Board for Licensing Health Care Facilities regarding violations found at Shelby Gardens Place Assisted Care Living Facility. The enforcement action follows a review and investigation of the facility's compliance with regulations.
Findings
The facility was found to have violated regulations related to resident safety and care planning, specifically regarding elopement risk and the development and updating of plans of care. The investigation revealed lack of appropriate interventions and documentation for a resident with elopement risk and confusion/dementia.
Deficiencies (2)
Tenn. Comp. R. and Reg. 0720-26-.07(a)(2) was violated as the facility failed to provide safety for residents, evidenced by a resident eloping through an unlocked door and sustaining injuries.
Tenn. Comp. R. and Regs. 0720-26-.12(5)(a) was violated as the facility did not develop or update a plan of care for the resident with elopement risk and confusion.
Report Facts
Civil Monetary Penalty: 6000
Dates of elopement risk evaluation form: April 21, 2023
Date of elopement incident: April 27, 2023
Date of surveyor review: June 8, 2023
Date of telephone interview: June 12, 2023
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Jeremy Gourley | Senior Associate General Counsel | Signed the Consent Order on behalf of the Health Facilities Commission. |
| Rodney Baker | Executive Director | Signed the Consent Order as Authorized Representative. |
Inspection Report
Annual Inspection
Deficiencies: 2
Date: Oct 15, 2018
Visit Reason
An annual licensure survey was conducted at Shelby Gardens Place to assess compliance with health, safety, and welfare regulations for residents.
Findings
Deficiencies were cited related to failure to follow prescribed therapeutic diets for residents with diabetes and hypertension. A revisit survey on 2018-12-31 found that the facility had corrected the cited deficiencies and was back in compliance.
Deficiencies (2)
The facility failed to follow prescribed therapeutic diets for Residents #1, 2, 3, and 6, including diabetic and low sodium diets. Interviews revealed residents were on regular diets despite physician orders and dietary documentation was lacking.
The facility was recited for failure to implement its plan of corrections related to prescribed therapeutic diets for Residents #1, 2, and 3.
Report Facts
Civil monetary penalties: 1500
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Kathy Garbus | Administrator | Signed as Respondent for Shelby Gardens Place. |
| Caroline R. Tippens | Assistant General Counsel | Signed on behalf of Tennessee Department of Health. |
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