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Complaint Investigation

Shannondale Of Maryville Health Care Center

September 4, 2025 · Maryville, TN · 803 Shannondale Way
Citations 3
CMS Rating 5/5
Beds 44
Provider ID 445472
Healthcare Facility
Shannondale Of Maryville Health Care Center
Maryville, TN  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

SHANNONDALE OF MARYVILLE HEALTH CARE CENTER in MARYVILLE, TN — inspection on September 4, 2025.

Found 3 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0585
Resident Rights Deficiencies

Review of the facility's Concern log revealed the facility had record of grievances from July 2024 - August 2025.

There was no log available for grievances prior to July 2024.

During an interview on 9/3/2025 at 11:44 AM, the Administrator confirmed no grievance log was available in the facility prior to July

  • The facility changed administration and ownership in June 2024.

The Administrator confirmed the grievance log was to be kept and available for review in the facility for a period of 3 years.

During an interview on 9/3/2025 at 11:48 AM, the Case Manager stated she was the current grievance official at the facility.

The Case Manager had been the grievance official since the facility changed ownership in June 2024.

The Case Manager stated she was unaware where the grievance log was prior to July 2024.

The Case Manager confirmed there was no grievance log available prior to July 2024 and that grievance logs were to be kept for a period of 3 years.

The Case Manager stated she had reached out to the former grievance official who no longer worked at the facility who was unaware where the grievance logs were located.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

445472 09/04/2025

Shannondale of Maryville Health Care Center 803 Shannondale Way Maryville, TN 37803

During an interview on 9/3/2025 at 4:45 PM, the DON stated she was unaware if the

#3's sexual abuse allegation.

The DON stated she called the local police department on 9/3/2025 and there was no police report related to Resident #3.

The DON stated the facility had contacted APS on 9/3/2025 and left a message to determine if they had been notified of the allegation.

The DON confirmed there was no documentation available at the facility to indicate law enforcement or APS had been notified of the allegation and confirmed both agencies should have been notified of the allegation and there should be evidence of the notification.

During a telephone interview on 9/4/2025 at 1:11 PM, the local police department stated they were unable to locate a report for Resident #3.

During a telephone interview on 9/4/2025 at 1:28 PM, the APS intake counselor stated she was unable to locate any reports related to Resident #3.

During a telephone interview on 9/4/2025 at 1:47 PM, the APS Supervisor stated she had checked the state and county records and there had been no reports to APS regarding Resident #3.

Medical record review revealed Resident #8 was admitted to the facility on [DATE] with diagnoses including Dementia, Major Depressive Disorder, Adjustment Disorder and Delusion Disorder.

Medical record review of Resident #8's current comprehensive care plan dated 5/30/2022 revealed .Verbally abusive behavior .Converse with others without swearing or berating .is experiencing alteration in mood AEB (as evidence by) .c/o (complaint of) people coming into room and stealing .

Each problem identified by the facility had appropriate pharmacological and non-pharmacological interventions implemented.

Review of a Psychiatric Nurse's note for Resident #8 dated 7/13/2023, revealed the resident was seen for psychiatric evaluation for .irritability, dementia, frustration previous gpsych (geri-psychiatric) admits 071323 (7/13/2023) Administration requests consult r/t (related to) ongoing lability .

Review of a quarterly Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #8 scored a 3 on the Brief Interview for Mental Status (BIMS) assessment which indicated the resident had severe cognitive impairment.

The resident required assistance from 1 or more staff members for activities of daily living (ADL's).

During an interview on 9/4/2025 at 3:16 PM, the Administrator and DON confirmed there was no investigation documentation for allegations of abuse reported to the state agency or APS for Residents #3 and #8.

The Administrator and DON were unaware what the investigations for Residents #3 and #8 included because no documentation of the investigation was retained by the previous administration.

The Administrator stated all allegations of abuse were to be reported to the state agency, law enforcement, and APS within 2 hours of allegation.

The Administrator confirmed she was unaware if the allegations had been reported because no documentation was available from the previous administration.

445472 09/04/2025

Shannondale of Maryville Health Care Center 803 Shannondale Way Maryville, TN 37803

Administrator confirmed abuse investigations were to be documented and retained in the facility.

The

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 MARYVILLE, 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 SHANNONDALE OF MARYVILLE HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.