01 / INSPECTION LEDGER
Survey cycles in this release
| Cycle | Health date | Health deficiencies | Fire date | Fire deficiencies |
|---|---|---|---|---|
| Cycle 1 | 2026-02-27 | 0 | 2026-02-27 | 18 |
| Cycle 2 | 2019-11-06 | 4 | 2019-11-06 | 7 |
| Cycle 3 | 2018-12-05 | 5 | 2018-12-05 | 4 |
CMS CCN 4451712026-08-01 PROCESSING DATE
NURSING HOME PUBLIC RECORD
The Waters Of Shelbyville, Llc
835 Union Street · Shelbyville, TN 37160 · Bedford County
Certified beds96CMS provider file
Recent citation rows38current CMS citation release
Penalty rows0current 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
38 rows in the current release
1 rows carry G–L scope/severity codes; 1 carry J–L. 3 tag codes appear on more than one survey date. These counts describe citation rows, not residents or incidents.
2026-02-27 · FIREE0004Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Develop and maintain an Emergency Preparedness Program (EP).
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0006Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct risk assessment and an All-Hazards approach.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0015Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Address subsistence needs for staff and patients.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0020Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish policies and procedures including evacuation.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0025Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Create arrangements with other facilities to receive patients.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0026Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Establish roles under a Waiver declared by secretary.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0030Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
List the names and contact information of those in the facility.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0039Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Conduct testing and exercise requirements.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREE0041Severity D · isolated; potential for more than minimal harm
Emergency Preparedness Deficiencies
Implement emergency and standby power systems.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0225Severity D · isolated; potential for more than minimal harm
Egress Deficiencies
Have stairways and smokeproof enclosures used as exits that meet safety requirements.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0321Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0345Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Have approved installation, maintenance and testing program for fire alarm systems.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0353Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Inspect, test, and maintain automatic sprinkler systems.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0361Severity D · isolated; potential for more than minimal harm
Smoke Deficiencies
Ensure that waiting areas, nurse’s stations, gift shops, and cooking facilities, open to the corridor are properly protected.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0521Severity D · isolated; potential for more than minimal harm
Services Deficiencies
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0741Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0761Severity D · isolated; potential for more than minimal harm
Miscellaneous Deficiencies
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Correction field: Deficient, Provider has date of correction · 2026-04-092026-02-27 · FIREK0921Severity D · isolated; potential for more than minimal harm
Gas, Vacuum, and Electrical Systems Deficiencies
Ensure that testing and maintenance of electrical equipment is performed.
Correction field: Deficient, Provider has date of correction · 2026-04-092023-11-29 · HEALTHF0684Severity D · isolated; potential for more than minimal harm
Quality of Life and Care Deficiencies
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Correction field: Deficient, Provider has date of correction · 2024-01-11 · complaint2023-11-29 · 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 · 2024-01-11 · complaint2019-11-06 · 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 · 2019-12-092019-11-06 · HEALTHF0658Severity D · isolated; potential for more than minimal harm
Resident Assessment and Care Planning Deficiencies
Ensure services provided by the nursing facility meet professional standards of quality.
Correction field: Deficient, Provider has date of correction · 2019-12-092019-11-06 · 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: Past Non-Compliance · 2019-08-202019-11-06 · HEALTHF0812Severity E · pattern; potential for more than minimal harm
Nutrition and Dietary Deficiencies
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Correction field: Deficient, Provider has date of correction · 2019-12-0903 / 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 |
|---|---|---|---|
| No penalty row appeared in the August 2026 penalties file. | |||
04 / OWNERSHIP DISCLOSURES
Who appears in the CMS file
- A&F REALTY LLCOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST20% · since 08/01/2016
- GUBIN ENTERPRISES LIMITED PARTNERSHIPOrganization · 5% OR GREATER DIRECT OWNERSHIP INTEREST40% · since 08/01/2016
- TACKETT, THOMASIndividual · W-2 MANAGING EMPLOYEENOT APPLICABLE · since 05/16/2019
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 hours3.14per resident day
RN hours0.32per resident day
Weekend nurse hours2.67per resident day
Staff turnover52.5%CMS reported field
06 / LOCAL RECORDS
Open the Tennessee ledger →Other published facilities nearby
No second facility in the same city met the directory rule.