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CUMBERLAND VILLAGE CARE Inspection Report, Violations & Safety Grade (LAFOLLETTE, Tennessee)

136 DAVIS LANE, LAFOLLETTE, Tennessee 37766

Phone: 4235620760

CMS Overall:5/5

Overview & Bed Count

Certified Beds
182
Avg Residents/Day
152.4
Ownership
For profit - Limited Liability company
Provider Type
Medicare and Medicaid
County
Campbell
Sprinkler Systems
Yes
Special Focus
None
Abuse Icon
No

CMS Star Ratings

Overall5/5
Health4/5
Staffing2/5
Quality5/5

Nurse Staffing Check

MetricThis FacilityTennessee AvgDifference
RN Hours per Resident per Day0.500.60-0.10
Total Nurse Hours per Resident per Day3.233.82-0.59
CMS Staffing Rating2/52.5/5-
Nursing Staff Turnover22.8%48.6%-

Health Citation History

16 health citations on record

DateCategoryDescriptionSeverity
2025-01-30Environmental DeficienciesKeep all essential equipment working safely.E – Moderate Harm Potential
2025-01-14Nutrition and Dietary DeficienciesProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.E – Moderate Harm Potential
2025-01-14Quality of Life and Care DeficienciesProvide safe, appropriate dialysis care/services for a resident who requires such services.D – Moderate Harm Potential
2025-01-14Nutrition and Dietary DeficienciesDispose of garbage and refuse properly.D – Moderate Harm Potential
2025-01-14Infection Control DeficienciesProvide and implement an infection prevention and control program.D – Moderate Harm Potential
2024-10-23Quality of Life and Care DeficienciesProvide appropriate treatment and care according to orders, resident’s preferences and goals.D – Moderate Harm Potential
2024-09-11Freedom from Abuse, Neglect, and Exploitation DeficienciesProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.D – Moderate Harm Potential
2024-09-11Quality of Life and Care DeficienciesProvide appropriate treatment and care according to orders, resident’s preferences and goals.D – Moderate Harm Potential
2021-10-20Resident Assessment and Care Planning DeficienciesSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.D – Moderate Harm Potential
2019-10-29Pharmacy Service DeficienciesEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.F – Moderate Harm Potential
2019-10-29Nutrition and Dietary DeficienciesDispose of garbage and refuse properly.F – Moderate Harm Potential
2019-10-29Resident Rights DeficienciesAllow residents to self-administer drugs if determined clinically appropriate.D – Moderate Harm Potential
2019-10-29Quality of Life and Care DeficienciesProvide care and assistance to perform activities of daily living for any resident who is unable.D – Moderate Harm Potential
2019-10-29Quality of Life and Care DeficienciesProvide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.D – Moderate Harm Potential
2019-10-29Administration DeficienciesArrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.D – Moderate Harm Potential
2019-10-29Infection Control DeficienciesProvide and implement an infection prevention and control program.D – Moderate Harm Potential

Fire Safety Citation History

10 fire safety citations on record

DateCategoryDescriptionSeverity
2025-01-14Smoke DeficienciesHave approved installation, maintenance and testing program for fire alarm systems.F – Moderate Harm Potential
2025-01-14Smoke DeficienciesInspect, test, and maintain automatic sprinkler systems.F – Moderate Harm Potential
2025-01-14Services DeficienciesEnsure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.F – Moderate Harm Potential
2025-01-14Gas, Vacuum, and Electrical Systems DeficienciesHave generator or other power source capable of supplying service within 10 seconds.F – Moderate Harm Potential
2025-01-14Smoke DeficienciesInstall corridor and hallway doors that block smoke.E – Moderate Harm Potential
2025-01-14Smoke DeficienciesProvide properly protected cooking facilities.D – Moderate Harm Potential
2025-01-14Services DeficienciesHave properly installed electrical wiring and gas equipment.D – Moderate Harm Potential
2019-10-29Miscellaneous DeficienciesTo conduct inspection, testing and maintenance of fire doors by qualified individuals.F – Moderate Harm Potential
2019-10-29Construction DeficienciesUse approved construction type or materials.E – Moderate Harm Potential
2019-10-29Egress DeficienciesAdd 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.D – Moderate Harm Potential

Total Penalties & Fines

$18,769
Total Fine Amount (CMS)
1
Number of Fines
1
Total Penalties
DateTypeFine AmountPayment Denial
2024-09-11Fine$18,769-

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