Federal nursing home survey record · CMS-certified nursing home· Not a state assisted-living licensing record

SIGNATURE HEALTHCARE OF CLARKSVILLE

CLARKSVILLE, TN · 120 certified beds · Last Life Safety survey May 28, 2025

CMS Certification Number 445448 · first certified April 2002

Ownership

Operated by SIGNATURE HEALTHCARE · For profit - Limited Liability company

No change of ownership on CMS record since January 1, 2016, when the records begin.

11
Citations on file
Rolling three-year window
3
Life Safety surveys
In the same window
2
Tags cited more than once
Across separate surveys
1
Inspection & testing records
Of the citations on file

Position within TN

11 citations — more than 66% of the 303 certified nursing homes in TN. Compared within TN rather than nationally because which state a facility is in explains about 30% of the variation in citation counts between facilities, while bed count explains under 1%. State survey agencies differ far more than the buildings do. How this is calculated

Slippingmore citations at the latest survey than at its earlier surveys in the window.

The latest survey found 5 citations; the earlier surveys in the window averaged 3. With 3 surveys on file this is a direction of travel, not a conclusion.

When is the next survey likely?

The window is open now: August 2026 to February 2029. This facility’s last Life Safety survey was May 2025. Facilities in TN are typically surveyed 15–44 months after the last one (median 33), measured over 279 consecutive surveys in the last two years of CMS records.

A range the record supports, not a prediction of a date. State agencies vary widely — from about 11 months in Pennsylvania to three years in Maryland. How the window is measured

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Which alerts

Emergency preparedness

3 of the 11 citations on file are Emergency Preparedness E-tags. E-tags are cited under 42 CFR §483.73 and concern the emergency plan, training, drills, communications and supplies. Nationally about half of certified facilities have at least one. The Emergency Preparedness Index

Physical environment (health survey)

2 physical-environment citations on the health survey. Cited by the health surveyors under Appendix PP, not the Life Safety Code surveyor: equipment in safe operating condition, the call system, bed rails, pest control, hazards, the environment. Counted separately from the 11 Life Safety citations above. The Physical Environment Index

  • F-0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  • F-0880 Provide and implement an infection prevention and control program.

How that compares

Citations on file over three years

Compared with the median facility in TN, and nationally. Surveyors differ markedly between states, so the TN figure is the meaningful one.

This facility11TN median8National median11
Citations on file over three years, compared
MeasureCitations
This facility11
Median facility in TN8
Median facility nationally11

Survey history

Citations at each Life Safety survey
52018-1012019-0952025-05
Citations at each Life Safety survey
Survey dateCitations
October 9, 20185
September 6, 20191
May 28, 20255

Most-cited tags

Most-cited tags at this facility
K-09202K-02112K-09181K-02221E-00391E-00201K-07811E-00151
Most-cited tags at this facility
TagWhat the surveyor checksTimes citedLast cited
K-0920Ensure proper usage of power strips and extension cords.22019-09-06
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.22025-05-28
K-0918Have generator or other power source capable of supplying service within 10 seconds.12025-05-28
K-0222Add 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.12025-05-28
E-0039Conduct testing and exercise requirements.12018-10-09
E-0020Establish policies and procedures including evacuation.12018-10-09
K-0781Have restrictions on the use of portable space heaters.12025-05-28
E-0015Address subsistence needs for staff and patients.12018-10-09

What the citations cover

Citations by CMS category
  • Egress Deficiencies 4
  • Emergency Preparedness Deficiencies 3
  • Gas, Vacuum, and Electrical Systems Deficiencies 3
  • Miscellaneous Deficiencies 1
Citations by CMS category
CategoryCitations
Egress Deficiencies4
Emergency Preparedness Deficiencies3
Gas, Vacuum, and Electrical Systems Deficiencies3
Miscellaneous Deficiencies1

Every citation on file

As published by CMS, newest survey first. Descriptions are CMS’s own wording.

May 28, 2025 — 5 citations

Citations issued on May 28, 2025
TagWhat the surveyor checksStatus
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (June 19, 2025)
K-0222Add 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.Deficient, Provider has date of correction (June 19, 2025)
K-0223Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.Deficient, Provider has date of correction (June 19, 2025)
K-0781Have restrictions on the use of portable space heaters.Deficient, Provider has date of correction (June 19, 2025)
K-0918Have generator or other power source capable of supplying service within 10 seconds.Deficient, Provider has date of correction (June 19, 2025)

September 6, 2019 — 1 citation

Citations issued on September 6, 2019
TagWhat the surveyor checksStatus
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (October 2, 2019)

October 9, 2018 — 5 citations

Citations issued on October 9, 2018
TagWhat the surveyor checksStatus
E-0015Address subsistence needs for staff and patients.Deficient, Provider has date of correction (October 31, 2018)
E-0020Establish policies and procedures including evacuation.Deficient, Provider has date of correction (October 31, 2018)
E-0039Conduct testing and exercise requirements.Deficient, Provider has date of correction (October 31, 2018)
K-0211Keep aisles, corridors, and exits free of obstruction in case of emergency.Deficient, Provider has date of correction (October 31, 2018)
K-0920Ensure proper usage of power strips and extension cords.Deficient, Provider has date of correction (October 31, 2018)

Reflects the CMS posting of August 1, 2026. Surveys conducted in the last few months may not appear yet.