Cumberland Village Genesis Healthcare

MEDICARE CERTIFIED

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Cumberland Village Genesis Healthcare was recognized and ceritified in 1992 by Centers for Medicare & Medicaid Services as one of model nursing home providers promoting health and improving quality of life. Cumberland Village Genesis Healthcare which is located in 136 Davis Lane LaFollette, is scientifically measured and assessed by Centers for Medicare & Medicaid Services and is shown to provide good nursing home services or products under the Medicare program. Cumberland Village Genesis Healthcare is being offered ceritified services and products in Tennessee.

  136 Davis Lane
       LaFollette, TN 37766

  (423) 562-0760

County: Campbell
Federal Provider Number: 445276

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Participates in: Medicare And Medicaid
Certified Date: Wednesday, January 15, 1992 (33 years certified)
Certified Agency: Centers for Medicare & Medicaid Services
Legal Business Name: Sunbridge Regency - Tennessee, Inc.
Ownership Type: For Profit - Corporation
Provider Changed Ownership in Last 12 Months: No

Type	Name	Role Description
Organization	Gen Management Llc	5% Or More Ownership Interest
Organization	Gazelle Gen Llc	5% Or More Ownership Interest
Organization	Fc-Gen Operations Investment Llc	5% Or More Ownership Interest
Organization	Donna Reis 1995 Fam Tr	5% Or More Ownership Interest
Organization	Barclays Bank Plc	5% Or Greater Security Interest
Organization	Gen Operations I Llc	5% Or More Ownership Interest
Organization	Gen Operations Ii, Llc	5% Or More Ownership Interest
Organization	General Electric Capital Corporation	5% Or Greater Security Interest
Organization	Genesis Healthcare Llc	5% Or More Ownership Interest
Organization	Genesis Healthcare Llc	Operational/managerial Control
Organization	Ghc Holdings Ii Llc	5% Or More Ownership Interest
Organization	Hccf Management Group Xi Llc	5% Or More Ownership Interest
Organization	Senior Care Genesis Llc	5% Or More Ownership Interest
Organization	Senior Care Holdings, Llc	5% Or More Ownership Interest
Organization	Sl Gen Llc	5% Or More Ownership Interest
Organization	Sun Healthcare Group, Inc.	Operational/managerial Control
Organization	Sunbridge Healthcare Llc	5% Or More Ownership Interest
Organization	Sunbridge Regency - Tennessee, Inc.	5% Or More Ownership Interest
Organization	Zac Properties Xi Llc	5% Or More Ownership Interest
Person	Stephen Young	Director/officer
Person	Joseph Wilks	Director/officer
Person	Arnold Whitman	Director/officer
Person	Arnold Whitman	5% Or More Ownership Interest
Person	David Stordy	Director/officer
Person	Kenneth Silverwood	Director/officer
Person	Michael Sherman	Operational/managerial Control
Person	Michael Sherman	Director/officer
Person	Logan Sexton	Director/officer
Person	Norman Schueftan	Director/officer
Person	Israel Rosenblum	Director/officer
Person	Jerrald Roles	Director/officer
Person	Robert Reitz	Operational/managerial Control
Person	Robert Reitz	Director/officer
Person	David Reis	Director/officer
Person	Joanne Reifsnyder	Director/officer
Person	Kelly Priegnitz	Director/officer
Person	Jeanne Phillips	Director/officer
Person	Garry Pezzano	Director/officer
Person	Kirk Pagett	Director/officer
Person	Lawrence Newman	Director/officer
Person	Isaac Neuberger	Director/officer
Person	Michael Montevideo	Director/officer
Person	William Mathies	Director/officer
Person	Joseph Mason	Operational/managerial Control
Person	Joseph Mason	Director/officer
Person	Laurence Lane	Director/officer
Person	Bennett Hoffman	Director/officer
Person	Daniel Hirschfeld	Director/officer
Person	Charles Herman	Operational/managerial Control
Person	Charles Herman	Director/officer
Person	Robert Hartman	Director/officer
Person	Robert Hartman	5% Or More Ownership Interest
Person	George Hager	Operational/managerial Control
Person	George Hager	Director/officer
Person	Rob Flowers	W-2 Managing Employee
Person	Steven Fishman	Director/officer
Person	Steven Fishman	5% Or More Ownership Interest
Person	Christina Firth	Director/officer
Person	Jan Edwards	Director/officer
Person	Joseph Dvorak	Director/officer
Person	Thomas Divittorio	Operational/managerial Control
Person	Thomas Divittorio	Director/officer
Person	Keith Davis	Operational/managerial Control
Person	Keith Davis	Director/officer
Person	Richard Castor	Director/officer
Person	Joseph Bourne	Director/officer
Person	David Bertha	Director/officer
Person	Michael Berg	Operational/managerial Control
Person	Michael Berg	Director/officer
Person	Jeffrey Berenbach	Operational/managerial Control
Person	Jeffrey Berenbach	Director/officer
Person	Brian Beckwith	Director/officer
Person	David Almquist	Operational/managerial Control
Person	David Almquist	Director/officer

Provider Resides in Hospital: No
Number of Federally Certified Beds: 182
Number of Residents in Federally Certified Beds: 166 (92% occupied)
Continuing Care Retirement Community: No
Special Focus Facility: No
With a Resident and Family Council: Both
Automatic Sprinkler Systems in All Required Areas: Yes

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0283 (Provide proper discharge planning and communication, of the resident's health status and summary of )
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0315 (Ensure that each resident who enters the nursing home without a catheter is not given a catheter, un)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0280 (Allow residents the right to participate in the planning or revision of care and treatment.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0514 (Keep accurate, complete and organized clinical records on each resident that meet professional stand)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0157 (Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decl)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0279 (Develop a complete care plan that meets all the resident's needs, with timetables and actions that c)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 23, 2013
Survey Type: Health
Deficiency: F0441 (Have a program that investigates, controls and keeps infection from spreading.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, November 25, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, October 22, 2013
Survey Type: Fire Safety
Deficiency: K0047 (Properly located and lighted "Exit" signs.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 1, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, October 22, 2013
Survey Type: Fire Safety
Deficiency: K0062 (Automatic sprinkler systems that have been maintained in working order.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Thursday, December 12, 2013
The inspection cycle of deficiency: 1 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 10, 2012
Survey Type: Health
Deficiency: F0282 (Provide care by qualified persons according to each resident's written plan of care.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, October 26, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 10, 2012
Survey Type: Health
Deficiency: F0272 (Conduct initial and periodic assessments of each resident's functional capacity.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, October 26, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, October 10, 2012
Survey Type: Health
Deficiency: F0315 (Ensure that each resident who enters the nursing home without a catheter is not given a catheter, un)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, October 26, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Monday, October 8, 2012
Survey Type: Fire Safety
Deficiency: K0144 (Weekly inspections and monthly testing of generators.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 2, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Monday, October 8, 2012
Survey Type: Fire Safety
Deficiency: K0021 (Exit doors that are held open by devices that will automatically close on the activation of a fire a)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 2, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Monday, October 8, 2012
Survey Type: Fire Safety
Deficiency: K0067 (Heating and ventilation systems that have been properly installed according to the manufacturer's in)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 2, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Monday, October 8, 2012
Survey Type: Fire Safety
Deficiency: K0050 (Record of quarterly fire drills for each shift under varying conditions.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 2, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Monday, October 8, 2012
Survey Type: Fire Safety
Deficiency: K0018 (Corridor and hallway doors that block smoke.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 2, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Monday, October 8, 2012
Survey Type: Fire Safety
Deficiency: K0062 (Automatic sprinkler systems that have been maintained in working order.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, November 2, 2012
The inspection cycle of deficiency: 2 (the deficiency was found on a standard inspection)

Survey Date: Tuesday, December 20, 2011
Survey Type: Health
Deficiency: F0159 (Properly hold, secure, and manage each resident's personal money which is deposited with the nursing)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Friday, December 30, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a complaint inspection)

Survey Date: Wednesday, March 30, 2011
Survey Type: Health
Deficiency: F0371 (Store, cook, and serve food in a safe and clean way.)
Scope Severity Code: F
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, April 18, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, March 30, 2011
Survey Type: Health
Deficiency: F0441 (Have a program that investigates, controls and keeps infection from spreading.)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, April 18, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a standard inspection)

Survey Date: Wednesday, March 30, 2011
Survey Type: Health
Deficiency: F0322 (Give proper treatment to residents with feeding tubes to prevent problems (such as aspiration pneumo)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, April 18, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a standard inspection)

Survey Date: Monday, March 28, 2011
Survey Type: Fire Safety
Deficiency: K0025 (Walls that prevent smoke from passing through and would resist fire for at least one hour.)
Scope Severity Code: E
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, April 18, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a standard inspection)

Survey Date: Monday, March 28, 2011
Survey Type: Fire Safety
Deficiency: K0021 (Exit doors that are held open by devices that will automatically close on the activation of a fire a)
Scope Severity Code: D
Deficiency Corrected: Deficient, Provider Has Date Of Correction
Date the deficiency was corrected: Monday, April 18, 2011
The inspection cycle of deficiency: 3 (the deficiency was found on a standard inspection)

Number of Facility Reported Incidents: 0
Number of Substantiated Complaints: 0
Number of Fines: 0
Number of Payment Denials: 0
Total Number of Penalties: 0
Total Amount of Fines in Dollars: USD 0

This data allows consumers to compare information about nursing homes. Information here is not an endorsement or advertisement for any nursing home and should be considered carefully. Use it with other information you gather about nursing homes facilities. Talk to your doctor or other health care provider about this.

This data was updated by using data source from Centers for Medicare and Medicaid Services (CMS) which is publicized on Wednesday, October 1, 2014. If you found out that something incorrect and want to change it, please follow this Update Data guide.

The Five Star Quality Rating System is not a substitute for visiting the nursing home. This system can give you important information, help you compare nursing homes by topics you consider most important, and help you think of questions to ask when you visit the nursing home. Use the Five-Star ratings together with other sources of information.

items	rating
Health Inspection Rating	(3 out of 5 stars)
Quality Rating	(4 out of 5 stars)
Staffing Rating	(3 out of 5 stars)
RN Staffing Rating	(3 out of 5 stars)
Overall Rating	(3 out of 5 stars)

Nursing homes vary in the quality of care and services they provide to their residents. Reviewing health inspection results, staffing data, and quality measure data are three important ways to measure nursing home quality. This information gives you a "snap shot" of the care individual nursing home give.

Patients experiences	Provider	State	Nation
Percent of High Risk Long Stay Residents With Pressure Ulcers	N/A	5%	6%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury	N/A	4%	3%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain	N/A	6%	8%
Percent of Long Stay Residents Who Were Physically Restrained	N/A	3%	1%
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased	N/A	16%	16%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder	N/A	3%	3%
Percent of Long Stay Residents With a Urinary Tract Infection	N/A	8%	6%
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain	N/A	17%	19%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened	N/A	1%	1%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine	N/A	94%	94%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine	N/A	94%	94%
Percent of Long Stay Residents Who Have Depressive Symptoms	N/A	3%	6%
Percent of Long Stay Residents Who Lose Too Much Weight	N/A	8%	7%
Percent of Long Stay Residents Who Received an Antipsychotic Medication	N/A	23%	20%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder	N/A	48%	44%
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine	N/A	83%	83%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication	N/A	3%	2%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine	N/A	85%	84%

N/A

Data not available.

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