The Administrator at Axiom Gardens of Nashville admitted during a December inspection that certified nursing assistants fell far short of the federally mandated 12 hours of continuing education. "I have to be honest, that is all we have for the CNA in-services/education for the past year," the Administrator told inspectors.
The training shortfall affected assistants with experience ranging from recent hires to veterans with more than 25 years on the job.
V32, hired in 2011, received just one hour of education in 2025. V33, who started working at the facility in 2002, got two hours. V34, hired in 2018, also received only one hour of training for the year.
V35, employed since 1999, completed two hours of education. V36, hired in 2019, had no education documented for the entire year. V37, who started in late 2019, received 2.5 hours of training.
The Administrator explained that most training sessions lasted just 30 minutes, except for a wound care course that ran one hour. When pressed by inspectors, she acknowledged the obvious gap: "CNAs are supposed to have 10 or 12 hours of continuing education per year."
The Director of Nursing joined the conversation and agreed with the Administrator's assessment. Both confirmed that all six nursing assistants failed to meet the annual education requirement.
Federal regulations require the training to ensure nursing assistants can properly care for residents and understand critical safety protocols. The education must cover infection control, abuse prevention, emergency procedures, and resident rights.
The facility's own written policy, dated October 2022, commits to providing comprehensive staff education "in accordance with State and Federal regulations." The policy specifically requires annual training in eight areas, including infection prevention, fire safety, abuse prevention, accident prevention, resident rights, and federal regulations governing long-term care facilities.
But the policy exists only on paper.
When inspectors asked about dementia training, the Administrator said she thought the facility provided it in February 2025 but couldn't locate attendance records. The facility's policy requires dementia training within 60 days of hire and annually thereafter.
"We are not doing that," the Administrator admitted when asked if new employees receive dementia training within the required timeframe.
The policy mandates that nursing assistants employed for 12 months or longer must undergo performance reviews every year and receive regular education based on those reviews. The facility failed to demonstrate this was happening.
The training deficiency puts all residents at risk. Nursing assistants provide the majority of hands-on care in nursing homes, helping residents with daily activities like bathing, dressing, eating, and moving safely. Without proper ongoing education, assistants may not recognize signs of infection, understand how to prevent falls, or know how to respond to medical emergencies.
The facility operates under new management as of November 1, 2025, but the training records show the education shortfall predated the ownership change. The Administrator's hire date list documented when each nursing assistant originally started working at the facility, with employment spanning more than two decades.
V35 has worked at the facility since 1999 but received only two hours of education in 2025. V33 started in 2002 and got the same amount. These longtime employees, who likely provide training guidance to newer staff, fell dramatically short of continuing education requirements.
The inspection occurred on December 24, 2025, as part of a complaint investigation. Inspectors classified the violation as having "minimal harm or potential for actual harm" but noted it affected "many" residents - in this case, all 60 people living at the facility.
The facility's daily census report confirmed 60 residents were receiving care from nursing assistants who lacked adequate training.
The Administrator's candid admissions during the inspection revealed a facility operating without basic compliance systems. Her inability to locate dementia training records and acknowledgment that new employees don't receive required education within 60 days of hire demonstrated systemic failures in staff preparation.
The violation occurred despite the facility having a detailed written education policy that clearly outlined requirements. The policy called for annual review by the quality assurance committee and revision as needed, but the inspection findings suggest this oversight wasn't happening.
Most concerning was V36's complete lack of documented education. This nursing assistant, hired in 2019, received no training at all during 2025 according to facility records. Federal inspectors found no evidence this person had learned updated protocols for infection control, emergency procedures, or abuse prevention.
The training gap affects residents who depend on nursing assistants for essential daily care. These staff members help residents eat, bathe, use the bathroom, and move around safely. They're often the first to notice changes in a resident's condition or signs of distress.
Without proper education, nursing assistants may miss early warning signs of serious medical problems, fail to follow infection control protocols, or respond inappropriately to behavioral symptoms in residents with dementia.
The facility's failure to provide dementia training within 60 days of hire is particularly troubling given the high prevalence of cognitive impairment among nursing home residents. Dementia training teaches staff how to communicate effectively with confused residents, manage challenging behaviors safely, and recognize when someone is experiencing distress.
The Administrator's honest assessment - "I have to be honest, that is all we have" - revealed a facility that wasn't tracking or ensuring compliance with basic federal requirements for staff preparation.
The inspection found a nursing home where written policies existed but weren't implemented, where training records were incomplete or missing, and where the Administrator openly acknowledged failures to meet federal standards.
Sixty residents continue receiving care from nursing assistants who missed most of their required annual education, with one receiving none at all.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Axiom Gardens of Nashville from 2025-12-24 including all violations, facility responses, and corrective action plans.