Antioch Tn Opco, Llc
Inspection Findings
F-Tag F0600
F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
(BOM), Medical Records, Rehabilitation Manager, and Nursing Scheduler. This was also participated by the VP of Clinical Services, Chief of Operations and Regional Regulatory Compliance Officer. The QAPI team discussed the reason Resident #2 was transferred to the hospital on 7/2/24 and the admission reports of foreign bodies found within her abdomen. The leadership team also discussed the facility actions and systemic changes which were implemented to prevent the recurrence of similar incidents. The facility actions as specified in the plans of removal which includes but are not limited to: a) Review of potential admissions (referrals) by the admission staff, DON or her designee prior to admissions b) Development of care plan upon admission to address any identified risk from review of documents, such as hospital records and other documents which provided information about the potential admissions medical and psychiatric history c) Care plan review of all current residents to ensure that any identified behaviors are addressed with person-centered interventions 2. Huddle Meeting: The DON (director of nursing) conducted a huddle meeting on 9/29/25 with the nursing staff to identify any resident who may have similar behavior like Resident #2, a vulnerable, cognitively impaired resident with a behavioral history of eating non-food items including the ingestion of metal objects. The DON will review the clinical huddle meeting records daily to identify any concern related to resident's behavior to ensure that the behaviors are care planned with person-centered interventions. 3. Care Plan review: The clinical leadership team (DON, UM - Unit Manager, SDC - staff development coordinator, MDS - minimum data set Nurse), SSD (social service director, VPCS (Vice President of Clinical Services), and VPBM (Vice President of Behavior Management & Resident Quality of Life) reviewed all care plans of current residents to ensure that all behaviors are care planned with person-centered interventions. This action item will be completed on or before 10/06/2
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Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Antioch TN Opco, LLC
500 Hickory Hollow Terrace Antioch, TN 37013
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0610
F 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
QAPI meetings: Monthly QAPI will also be held. The meeting will be attended by the QAPI team members which includes but are not limited to the Facility Medical Director, Administrator, DON, ADON, UM (unit manager), Social Services Director, MDS Nurse, Maintenance Director, Dietary Manager, Infection Control/SDC, Activities Director, Rehab Manager, RD (registered dietician) and Business office Manager.
The QAPI team will meet monthly and discuss facility actions related to investigation of abuse or neglect which has the likelihood to cause serious injury, serious harm, serious impairment or death. During QAPI meetings, the QAPI team will determine the need for additional interventions or corrective actions, based
on the results of observation, and other monitoring activities. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: 10/06/25
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If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/09/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Antioch TN Opco, LLC
500 Hickory Hollow Terrace Antioch, TN 37013
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0689
F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
documentation which are being reviewed includes but is not limited to:? ? a) Nurses Notes? ? b) Incidents? ? c) New physician orders? ? d) Events/Incidents in the electronic health records? ? e) Review of new admissions for elopement risk assessments and ensure appropriate care plan interventions have been implemented and the elopement books have been updated as applicable.? ? f) Nurses' notes for the previous 24 hours to ensure if any new/worsening exit seeking behaviors was noted and if so, the behaviors are care planned, and interventions are implemented as applicable? ? During unit observation rounds, the DON/ SDC/ Unit Manager/ Administrator will also observe for any new or worsening exit seeking/wandering behaviors and to ensure care plans interventions are being followed. This will be completed during the week (Mondays - Fridays).? During the weekends, the nurse supervisor and/or MOD (manager on duty) will complete the review of the above-mentioned documents and will also conduct unit observations to observe for any new or worsening exit seeking/wandering behaviors and to ensure care plans interventions are being followed.? ?? Any concern identified will be addressed immediately. The DON or Administrator will also be notified of the concern. Additional interventions will be implemented, if necessary, by the direction of the DON or the Administrator.? ? 9. Review of new admissions & re-admissions:? ? New admissions will be reviewed by the SSD/ DON/ Unit Manager, SDC (staff development coordinator) or MDS Nurse for elopement risk. Any new admission/ re-admission who are identified as being at risk fo
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Antioch TN Opco, LLC in ANTIOCH, TN inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in ANTIOCH, TN, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Antioch TN Opco, LLC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.