01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2025-05-28 | 6 | 2025-05-28 | 5 |
| Cycle 2 | 2019-09-06 | 1 | 2019-09-06 | 1 |
| Cycle 3 | 2018-10-09 | 0 | 2018-10-09 | 5 |
CMS CCN 4454482026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
Signature Healthcare Of Clarksville
198 Old Farmer Road · Clarksville, TN 37043 · Montgomery County
Certified beds120CMS provider file
Recent citation rows18current CMS citation release
Penalty rows1current CMS penalties file
Read this record carefully.
The citation files cover the three most recent standard inspections plus qualifying complaint and infection-control inspections in the prior three years. A correction date is a CMS field; this site does not independently verify conditions. Absence from a file is not proof that no issue exists.
02 / CITATION DETAIL
18 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 2 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2025-05-28 · HEALTHF0550Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · HEALTHF0569Severity D · isolated; potential for more than minimal harm
Resident Rights Deficiencies
Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · HEALTHF0609Severity D · isolated; potential for more than minimal harm
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · HEALTHF0689Severity J · isolated immediate jeopardy
Quality of Life and Care Deficiencies
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · HEALTHF0695Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide safe and appropriate respiratory care for a resident when needed.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · HEALTHF0880Severity D · isolated; potential for more than minimal harm
Infection Control Deficiencies
Provide and implement an infection prevention and control program.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · FIREK0211Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · FIREK0222Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · FIREK0223Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · FIREK0781Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
Have restrictions on the use of portable space heaters.
Correction field: Deficient, Provider has date of correction · 2025-06-192025-05-28 · FIREK0918Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Have generator or other power source capable of supplying service within 10 seconds.
Correction field: Deficient, Provider has date of correction · 2025-06-192019-09-06 · HEALTHF0759Severity D · isolated; potential for more than minimal harm
Pharmacy Service Deficiencies
Ensure medication error rates are not 5 percent or greater.
Correction field: Deficient, Provider has date of correction · 2019-10-022019-09-06 · FIREK0920Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2019-10-022018-10-09 · FIREE0015Severity C · widespread; potential for minimal harm
Emergency Preparedness Deficiencies
Address subsistence needs for staff and patients.
Correction field: Deficient, Provider has date of correction · 2018-10-312018-10-09 · FIREE0020Severity C · widespread; potential for minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures including evacuation.
Correction field: Deficient, Provider has date of correction · 2018-10-312018-10-09 · FIREE0039Severity C · widespread; potential for minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2018-10-312018-10-09 · FIREK0211Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Correction field: Deficient, Provider has date of correction · 2018-10-312018-10-09 · FIREK0920Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure proper usage of power strips and extension cords.
Correction field: Deficient, Provider has date of correction · 2018-10-3103 / ENFORCEMENT FILE
Penalties reported by CMS
Fine amounts and payment-denial days are shown exactly as aggregated from the current penalties file. They do not imply an unpaid balance.
| Date | Type | Fine amount | Payment-denial days |
|---|---|---|---|
| 2025-05-28 | Fine | $63,105 | 0 |
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- LP RE I HOLDINGS LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST100% · since 11/01/2007
- JJLA LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 11/01/2007
- LPSNF LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 11/01/2007
- SHC LP HOLDINGS II LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 07/01/2012
- SPRING HOLDINGS, LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 05/01/2018
- WHEATEN LLCOrganization · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 11/01/2007
- STEIER III, ELMERIndividual · 5% OR GREATER INDIRECT OWNERSHIP INTERESTNO PERCENTAGE PROVIDED · since 11/01/2007
- CRIDER, BENJAMINIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 01/16/2024
- HARRISON, JOHNIndividual · CORPORATE OFFICERNOT APPLICABLE · since 11/01/2007
Names and roles are self-reported CMS disclosure fields. Exact-name pages do not prove that similarly named people or organizations are the same entity.
05 / CMS STAFFING FIELDS
Reported hours and turnover
Staffing fields are provider-reported and case-mix context matters. CMS applies footnotes and exclusions not reproduced as a new score here.
Total nurse hours3.88per resident day
RN hours0.83per resident day
Weekend nurse hours3.03per resident day
Staff turnover76.0%CMS reported field
06 / LOCAL RECORDS
Open the Clarksville ledger →Other published facilities nearby
Ahava Healthcare Of Clarksville122 beds · CMS overall 2/517 citation rowsBrigadier General Wendell H Gilbert Tn State Veter108 beds · CMS overall 3/58 citation rowsPark Meadows Post Acute113 beds · CMS overall 2/523 citation rowsSpring Meadows Health And Rehabilitation121 beds · CMS overall 2/540 citation rows