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Complaint Investigation

Shelby Oaks Post Acute

Inspection Date: September 30, 2025
Total Violations 2
Facility ID 445426
Location MEMPHIS, TN
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Inspection Findings

F-Tag F0600

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Immediate Jeopardy

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

where she documented the description of the injuries. The Wound Nurse stated, I should have charted that.

During an interview on 9/22/2025 at 3:45 PM, CNA L was asked about Resident #1‘s behavior the day

before he went to the hospital. CNA L stated, .he was up in his Geri chair for a few hours, but we laid him down because he was tired and sleepy. CNA L was asked if he had fallen that day. CNA L stated, Yes, he rolled off the bed between the bed and the air conditioner, the mat would slide away from the bed, he would get on the side of the wall, but he was asleep, so we just put him back in bed. CNA L was asked if she told

the nurse. CNA L stated, No, he was care planned for being in the floor. CNA L was asked if Resident#1 acted like he was hurt. CNA L stated, No he was asleep face down when we put him back in bed. CNA L was asked why the nurse wasn't notified. CNA L stated, .they usually just tell us to put him back in the bed.

During an interview on 9/23/2025 at 1:55 PM, the DON was asked when Resident #1 was throwing himself

in the floor, where was the documentation of an occurrence report or head head-to-toe assessment, documentation the MD was notified, follow up documentation for his behaviors, and the interventions put into place were all documented in the medical record. The DON stated I don't see any documentation of that in his [Resident #1] medical record. The DON was asked if the facility provided adequate monitoring, supervision, adequate assessment and adequate interventions to keep Resident #1 safe in the facility. The DON stated Yes.those type injuries he sustained couldn't have happ

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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

09/30/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Shelby Oaks Post Acute

5070 Sanderlin Avenue Memphis, TN 38117

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)

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F-Tag F0609

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Administrator stated, The injuries could not have happened here at the facility. The Administrator was asked how he knew the injuries did not occur at the facility. The Administrator stated, .through our witness statements . The Administrator was asked since this was your resident, and the facility was considered an advocate for (Named Resident #1) why wouldn't you report the injuries. The Administrator stated, We decided to report the incident later, but there are no witnesses it occurred here. The Administrator was asked how [Named Resident #1] sustained such serious life threatening injuries. The Administrator stated, I do not know

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📋 Inspection Summary

SHELBY OAKS POST ACUTE in MEMPHIS, TN inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

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

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 MEMPHIS, 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 SHELBY OAKS POST ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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