Tri State Health and Rehabilitation Center

Nursing Home & Skilled Nursing · Harrogate, TN

CMS overall rating

Tri State Health and Rehabilitation Center

Nursing Home & Skilled Nursing · Harrogate, TN

CMS overall rating

600 Shawanee Road, Harrogate, TN 37752 View map

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Tri State Health and Rehabilitation Center accepts Medicaid, Medicare, and private pay.

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Tri State Health and Rehabilitation Center accepts Medicaid, Medicare, and private pay.

Overview of Tri State Health and Rehabilitation Center

Tri-State Health and Rehabilitation Center in Harrogate, TN, is a nursing home that offers long-term care, short-term rehabilitation, memory support, expert nursing, and respite stays. Serving the region since July 1992, this long-standing provider is owned by Raven Lake Healthcare Inc., with Magen Ann Smith acting as administrator under the larger Ensign Services network umbrella. Admitting individuals who rely on Medicare, Medicaid, or private funds, the community currently holds a 1-star quality score from CMS. An active monthly calendar, religious services, a signature “Stay Active” wellness framework, and 24-hour care via on-staff doctors, credentialed nurses, and certified aides are also provided.

A primary differentiator for this neighborhood is its exceptional allocation of registered nurse hours. The data indicate that registered nurses spend an average of 45 minutes of direct attention on each resident daily, beating the Tennessee state norm of 37 minutes by 22% and comfortably passing the national benchmark of 41 minutes. This robust staffing metric leads all other personnel data categories. Certified nursing assistants, licensed practical nurses, and registered nurses all completed their 91-day cycles with unbroken 100% shift coverage. The local workforce additionally includes respiratory therapists, dental practitioners, speech therapists, and nurse practitioners. Total adjusted nursing attention equals 3 hours and 16 minutes per resident every day, though licensed practical nurse and nursing assistant hours track slightly under state medians. Crucially for families prioritizing rehabilitation, physical therapist availability averages 3 minutes per resident daily, a 40% reduction when measured against the state average of 5 minutes.

Regulatory records from the Tennessee Department of Health document 4 total evaluations throughout a seven-year period, resulting in 12 health deficiencies. Significantly, 8 of these 12 citations grew out of specific complaint investigations rather than routine annual reviews, a pattern pointing toward a heavily complaint-driven oversight dynamic. Of the 12 deficiencies, 5 reached a critical tier of severity, with zero serious, 7 moderate, and 0 minor marks. The most recent state overview from September 26, 2024, uncovered 3 critical administrative citations and 1 moderate citation regarding abuse or neglect, all of which are now officially marked as resolved. Broadly sorted, quality of life issues and administrative oversight combined for half the total findings with 3 citations each, while infection control and abuse themes contributed 1 apiece. Third-party channels show 4 verified complaints alongside a single civil monetary penalty in recent cycles.

Since it represents the only skilled nursing choice in Harrogate, the community draws heavily from a short-stay demographic. Private insurance accounts for 64% of arrivals, typically involving stays lasting one to two months, while Medicare admissions for post-acute rehabilitation comprise 26% of the base, holding a similar one-to-two-month duration. Total occupancy hovers around 75.3%, trailing the statewide average.

For those seeking localized medical care along the tri-state borders of Tennessee, Kentucky, and Virginia, Tri-State Health and Rehabilitation Center offers families a localized care choice with an entirely permanent, employee-only nursing staff and strong registered nurse availability for older adults.

Facility Direct Line (423) 869-5376 contact-TriState@ensignservices.net

Quality ratings

Measured by Centers for Medicare & Medicaid Services (CMS)

Staffing hours breakdown

Hours per resident per day — compared to state averages

Total nursing care / resident

3h 16m per day

vs avg

3 of 6 metrics below state avg

Standout metric Registered Nurse (RN) is +16% above state avg

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.	43m per day	▲ 16% 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.	53m per day	▼ 19% 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 12m 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 17m 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.	2m per day	▼ 51% 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	▼ 20% State avg: 24m per day · National avg: 28m per day

Capacity and availability

82 days

116-bed community

A larger shared setting that may offer more common spaces and organized community services.

34 years in operation

A longer operating history, which may indicate experience navigating regulations and delivering ongoing care.

Walk Score: 47 / 100

Somewhat walkable. A few nearby services may be reachable on foot, but most trips require transportation.

About this community

Occupancy

Occupancy rate

75%

Higher than the Tennessee average: 71.6%

Occupied beds

87 / 116

Average occupied beds in Tennessee homes 82 beds

Facility TypeNursing Home

IssuanceJuly 1, 1992

ExpirationAugust 1, 2026 Expires in 28 days

License Number00000038

Tri State Health and Rehabilitation Center is administered by Magen Ann Smith.

Owner NameRaven Lake Healthcare Inc

Accept Medicaid

Accept Medicare

Rehabilitation Services

Doctor on Staff

24-Hour Staffing

Activities

Religious Services

Get floorplan photos & videos Schedule a home tour Get detailed pricing Check availability Get brochure

Since 2019 · 7 years of data 1 citation

Inspection Scorecard This scorecard compares key inspection, citation, and complaint metrics at this facility against the Tennessee state average. Metrics rated ≥15% worse than average are highlighted in red; those ≥15% better are highlighted in green.

Since 2019 vs. Tennessee state average

Overall vs. TN average

Latest Inspection August 16, 2023

Citations Citations are formal regulatory issues recorded during state inspections.	This Facility	TN Average	vs. TN Avg
Total citations Formal regulatory issues recorded by inspectors across all inspection types.	1	4	This facility has 75% fewer total citations than a typical Tennessee assisted living residence (1 vs. TN avg 4).↓ 75% better
Citations per year Average citations per year since 2019.	0.1	0.6	This facility has 83% fewer citations per year than a typical Tennessee assisted living residence (0.1 vs. TN avg 0.6).↓ 83% better

Show Inspection Reports

Inspections since 2019

Total health inspections 4

State average N/A

Last Health inspection on Sep 2024

Total health citations

State average N/A

Citations per inspection

State average N/A

Health citations are formal notices following inspections when they fail to comply with safety and care standards.

4 of 12 citations resulted from standard inspections; and 8 of 12 resulted from complaint investigations.

Breakdown of citation severity (last 7 years)

Critical health citations

In line with State average

State average: N/A

Serious health citations

In line with State average

State average: N/A

5 critical citations State average: N/A

0 serious citations State average: N/A

7 moderate citations State average: N/A

0 minor citations State average: N/A

Citations history (last 7 years)

Abuse/Neglect moderate citation Sep 26, 2024

Corrected

Administration critical citation Sep 26, 2024

Corrected

Administration critical citation Sep 26, 2024

Corrected

Administration critical citation Sep 26, 2024

Corrected

Top deficiency categories

Quality of Life & Care 3 deficiencies (25%)

Administration 3 deficiencies (25%)

Infection Control 1 deficiency (8%)

Abuse, Neglect & Exploitation 1 deficiency (8%)

Total staff 109

Employees 109

Contractors 0

Staff to resident ratio 1.31 : 1

0% compared with State average

State average ratio: 0 : 0

Avg staff/day 48

Average shift 8.8 hours

0% compared with State average

State average: 0 hours

Total staff hours (quarter) 38,991

Nursing staff breakdown

9.5 hours

9.4 hours

9.3 hours

Contractor staffing

Total hours from contractors 0% — all staff are direct employees this quarter

Staff by category


Certified Nursing Assistant	48	48	18,307	92	100%	9.3
Licensed Practical Nurse	15	15	7,337	92	100%	9.4
Registered Nurse	17	17	3,737	92	100%	9.5
Clinical Nurse Specialist	5	5	1,700	66	72%	8.9
Speech Language Pathologist	4	4	1,578	68	74%	6.6
Other Dietary Services Staff	5	5	1,433	92	100%	7.3
Dental Services Staff	3	3	1,295	70	76%	7.5
Physical Therapy Aide	3	3	981	71	77%	7.3
Physical Therapy Assistant	2	2	860	67	73%	7.1
Nurse Practitioner	1	1	540	60	65%	9
Administrator	1	1	496	62	67%	8
Qualified Social Worker	2	2	385	64	70%	5.9
Respiratory Therapy Technician	3	3	342	60	65%	5.6

48 Certified Nursing Assistant

% of Days 100%

15 Licensed Practical Nurse

% of Days 100%

17 Registered Nurse

% of Days 100%

5 Clinical Nurse Specialist

% of Days 72%

4 Speech Language Pathologist

% of Days 74%

5 Other Dietary Services Staff

% of Days 100%

3 Dental Services Staff

% of Days 76%

3 Physical Therapy Aide

% of Days 77%

2 Physical Therapy Assistant

% of Days 73%

1 Nurse Practitioner

% of Days 65%

1 Administrator

% of Days 67%

2 Qualified Social Worker

% of Days 70%

3 Respiratory Therapy Technician

% of Days 65%

View All Staffing Data

Total fines amount $15K

83% lower than State average

State average: $86K

Number of fines 2

15% more fines than State average

State average: 1.7

Payment Denials 0

100% fewer payment denials than State average

State average: 0.5

Fines amount comparison

This facility $15K

State average $86K

Penalty History

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.

Civil Money Penalty Sep 26, 2024

$7K

Civil Money Penalty Sep 26, 2024

$7K

Last updated: Jan 2026

High-risk clinical events score 10.5

In line with State average

State average: 10.5

Functional decline score 24.4

25% worse than State average

State average: 19.5

Long-stay resident measures

Above average

Need for Help with Daily Activities Increased 10.6%

34% better than State average

State average: 16.0%

Walking Ability Worsened 35.5%

63% worse than State average

State average: 21.7%

Low Risk Residents with Bowel/Bladder Incontinence 27.0%

30% worse than State average

State average: 20.7%

Falls with Major Injury 2.4%

35% better than State average

State average: 3.7%

High Risk Residents with Pressure Ulcers 3.2%

41% better than State average

State average: 5.4%

Urinary Tract Infection 1.0%

51% better than State average

State average: 2.1%

Lost Too Much Weight 0.8%

87% better than State average

State average: 6.3%

Depressive Symptoms 4.9%

55% better than State average

State average: 11.0%

Antipsychotic Use 7.3%

56% better than State average

State average: 16.5%

Pneumococcal Vaccine 100.0%

11% better than State average

State average: 89.9%

Influenza Vaccine 100.0%

6% better than State average

State average: 94.5%

Hospitalizations per 1,000 days 0.91

42% better than State average

State average: 1.58

ED visits per 1,000 days 3.20

104% worse than State average

State average: 1.57

Short-stay resident measures

Above average

Pneumococcal Vaccine 99.8%

25% better than State average

State average: 79.7%

Antipsychotic medication increase 1.2%

32% better than State average

State average: 1.7%

Influenza Vaccine 100.0%

25% better than State average

State average: 79.8%

Re-hospitalized after SNF stay 17.2%

23% better than State average

State average: 22.2%

Emergency department visits 18.2%

63% worse than State average

State average: 11.2%

Falls with major injury 0.0%

100% better than State average

State average: 0.8%

Ability to care for self at discharge 60.6%

13% better than State average

State average: 53.7%

Successful return to home or community 50.3%

In line with State average

State average: 50.6%

Breakdown by payment type

Medicare

26% of new residents, usually for short-term rehab.

Typical stay 1 - 2 months

Private pay

64% of new residents, often for short stays.

Typical stay 1 - 2 months

Medicaid

10% of new residents, often for long-term daily care.

Typical stay 1 - 2 years

Total residents 83

Medicare

9.6% of residents

Medicaid

62.7% of residents

Private pay or other

27.7% of residents

Programs & Services

Residents Group

Residents meet regularly to discuss policies, care quality, and activities

Nurse Aide Training

State-approved Nurse Aide Training and Competency Evaluation Program on-site

Active Resident Council

Organized group of residents that meets regularly to discuss facility policies, quality of life, and activities.

Financial Trends

Historical financial and operational data for Tri State Health and Rehabilitation Center from 2011–2023, based on CMS SNF Cost Reports.

Key figures below are for fiscal year ending in 12/2023.

Occupancy Rate 75.3% ↑ 9.6pp vs 2022

Net Patient Income $290.6K ↑ ~$1.5M vs 2022

Payroll Costs $5.7M ↑ ~$254.3K vs 2022

Operating Margin 2.9% ↑ 17.4pp vs 2022

Financial Performance

Net patient revenue Operating expenses Net patient income

Salaries Wage Costs Contract Labor

Medicare Medicaid Private Pay/Other

Metric	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
Occupancy %	80.4%	84.4%	81.8%	74.8%	75.1%	72.9%	73.8%	79.4%	79.6%	67.5%	62.3%	65.8%	75.3%
Beds	116	116	116	116	116	116	116	116	116	116	116	116	116
Net Income	$363,655	-$38,081	$613,753	$198,179	$85,800	-$241,906	$235,214	-$122,970	$1,263,419	$246,226	$1,146,594	-$973,746	$1,119,743
Gross Revenue	$7,582,375	$8,091,105	$8,800,868	$8,761,461	$8,565,287	$8,389,535	$8,544,153	$11,085,313	$13,044,521	$10,908,964	$10,728,346	$12,644,513	$14,537,839
Operating Expenses	$6,945,137	$6,951,242	$6,995,942	$6,963,689	$7,074,505	$7,061,585	$7,215,037	$8,200,260	$7,987,553	$8,444,329	$8,122,551	$9,170,825	$9,688,835
Net Patient Income	$487,856	$33,993	$644,712	$377,228	$158,880	$74,429	$353,531	$413,078	$1,255,498	$373,648	-$581,309	-$1,163,634	$290,649
Net Patient Revenue	$7,432,993	$6,985,235	$7,640,654	$7,340,917	$7,233,385	$7,136,014	$7,568,568	$8,613,338	$9,243,051	$8,817,977	$7,541,242	$8,007,191	$9,979,484
Payroll Costs	$3,889,085	$3,930,851	$3,915,801	$3,880,691	$3,932,763	$3,894,437	$3,866,696	$4,544,871	$4,429,898	$4,635,494	$4,394,642	$5,455,217	$5,709,484
Operating Margin %	6.6%	0.5%	8.4%	5.1%	2.2%	1.0%	4.7%	4.8%	13.6%	4.2%	-7.7%	-14.5%	2.9%
Medicare %	22.7%	18.8%	21.0%	20.8%	16.4%	13.8%	13.6%	15.8%	14.3%	18.4%	13.8%	13.5%	10.5%
Medicaid %	0.0%	6.9%	6.1%	9.2%	5.9%	4.9%	4.0%	67.4%	69.2%	63.3%	61.3%	57.6%	60.7%
Private %	77.3%	74.3%	72.8%	70.0%	77.6%	81.3%	82.4%	16.8%	16.4%	18.3%	25.0%	28.9%	28.7%
Net Patient Revenue/Day	$218	$195	$221	$232	$228	$231	$242	$256	$274	$308	$286	$288	$313
Cost/Day	$204	$194	$202	$220	$223	$228	$231	$244	$237	$295	$308	$329	$304
Avg Length of Stay	453.6 days	119.1 days	121.9 days	100.3 days	122.3 days	114.6 days	94.7 days	78.9 days	104.4 days	95.9 days	100.3 days	71.6 days	82.4 days

Finances and operations

Based on CMS SNF Cost Report for fiscal year ending in 12/2023.

Net patient revenue

$10.0M

Net patient income

$290.6K

For-profit LLC

Net patient revenue

$10.0M

Net patient income

$290.6K

Other income

$829.1K

Payroll costs

$5.7M 57.2% of net patient revenue

Other operating costs

$4.0M

Total costs

$9.7M

TYPE OF STAY

Primarily short stays

Residents typically stay for brief periods, with frequent admissions and discharges throughout the year.

Most new residents arrive under private pay (64% of admissions), and a typical private pay stay runs around 1 - 2 months.

Coverage residents most often arrive under.

Medicare 26%

Private pay 64%

Medicaid 10%

Coverage residents most often leave under.

Medicare 20%

Private pay 61%

Medicaid 19%

0.0 miles from city center Estimated distance in miles from Harrogate's city center to Tri State Health and Rehabilitation Center's address, calculated via Google Maps.

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The information below is reported by the Tennessee Department of Health, Division of Health Care Facilities.


The Heritage at Brentwood	NH AL IL MC SNF	Brentwood	-	66	A+	7	1 Bed / 2 Bed / 3 Bed
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Ben Atchley Tennessee State Veterans‘ Home	NH SNF	Knoxville	-	140	-	7	-
The Health Center at Standifer Place	NH ADC AL HC HOS IL MC SNF	Chattanooga (Walker Road)	-	125	A+	38	-
Tri State Health and Rehabilitation Center	NH SNF	Harrogate	-	116	-	47	-

Nursing Home Explorer

Who is the owner of Tri State Health and Rehabilitation Center?

Tri State Health and Rehabilitation Center is legally operated by Raven Lake Healthcare Inc, and administered by Magen Ann Smith.

Is Tri State Health and Rehabilitation Center in a walkable area?

Tri State Health and Rehabilitation Center has a walk score of 47. Somewhat walkable. A few nearby services may be reachable on foot, but most trips require transportation.

What is the license number of Tri State Health and Rehabilitation Center?

According to TN state health department records, Tri State Health and Rehabilitation Center's license number is 00000038.

When does Tri State Health and Rehabilitation Center's license expire?

According to TN state health department records, Tri State Health and Rehabilitation Center's license expires on August 1, 2026.

What is the occupancy rate at Tri State Health and Rehabilitation Center?

Tri State Health and Rehabilitation Center's occupancy is 75%.

Does Tri State Health and Rehabilitation Center operate as a for-profit or non-profit?

Tri State Health and Rehabilitation Center is registered as a for-profit in TN.

Who is the administrator of Tri State Health and Rehabilitation Center?

Magen Ann Smith is the administrator of Tri State Health and Rehabilitation Center.

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Tri State Health and Rehabilitation Center

Overview of Tri State Health and Rehabilitation Center

Quality ratings

Staffing hours breakdown

Capacity and availability

About this community

Occupancy

License Details

Ownership & Operating Entity

Payment & Insurance

Therapy & Rehabilitation

Staffing & Medical

Amenities & Lifestyle

Contact Tri State Health and Rehabilitation Center

Inspection History

Inspection Scorecard This scorecard compares key inspection, citation, and complaint metrics at this facility against the Tennessee state average. Metrics rated ≥15% worse than average are highlighted in red; those ≥15% better are highlighted in green.

Citations Citations are formal regulatory issues recorded during state inspections.

Health Inspection History

Inspections since 2019

Breakdown of citation severity (last 7 years)

Citations history (last 7 years)

Staffing Data

Nursing staff breakdown

Registered Nurse

Licensed Practical Nurse

Certified Nursing Assistant

Contractor staffing

Staff by category

48 Certified Nursing Assistant

15 Licensed Practical Nurse

17 Registered Nurse

5 Clinical Nurse Specialist

4 Speech Language Pathologist

5 Other Dietary Services Staff

3 Dental Services Staff

3 Physical Therapy Aide

2 Physical Therapy Assistant

1 Nurse Practitioner

1 Administrator

2 Qualified Social Worker

3 Respiratory Therapy Technician

Penalties and fines

Fines amount comparison

Fines amount comparison

Penalty History

Quality of care over time

Long-stay resident measures

Short-stay resident measures

Breakdown by payment type

Medicare

Private pay

Medicaid

Facility Characteristics

Programs & Services

Residents Group

Nurse Aide Training

Active Resident Council

Financial Trends

Financial Performance

Payroll & Labor Costs

Payer Mix (percentage)

Finances and operations

Who this home usually serves

Primarily short stays

Admissions

Discharges

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