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Nursing HomeMedicaid Investigative

Spring Gate Rehab & Healthcare Center

Below-average Medicare ratings — review the inspection history and ask the administrator about recent corrections before visiting.

3909 Covington Pike, Sunset Trace · Memphis, TN 38135206 bedsLicensed & Active
2/5
Medicare
Inspection
Quality
Staffing
Google rating
4.0/5

based on 211 Google reviews

5
4
3
2
1

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5/ 10
high Risk

Quality Concerns Identified

Medicare inspection and quality data reveal areas that families should carefully evaluate before choosing this facility.

  • Low overall rating (1/5 stars)
  • Low staffing rating (2/5 stars)
  • Above-median deficiencies (26 vs median 5.0)
  • High staff turnover (58%)

Bottom 25% in TN · Below recommended RN staffing · Above recommended total nurse staffing · Worst in PRESTIGE ADMINISTRATIVE SERVICES chain · $128,974 in fines

Source: Medicare data

What this means for your family

While recent reviews show an effort to improve facility aesthetics and front-desk hospitality, the recurring, high-severity reports of medical neglect and hygiene failures are deeply concerning. If you choose this facility, it is essential to conduct frequent, unannounced visits and maintain a very active role in your loved one's daily care and medical oversight.

Google Reviews

Google Reviews

211 reviews on Google
Spring Gate Rehab & Healthcare Center receives highly polarized feedback, with many visitors praising the cleanliness and friendly front-desk staff, while others report severe neglect. Families have raised critical concerns regarding patient hygiene, the development of bedsores, and poor communication from nursing leadership. While some long-term residents and their families report positive experiences, the frequency of serious allegations regarding patient safety makes this a facility that requires extreme caution and frequent, unannounced visits.

Quality Themes

Tap a score for details
Food2.0Staff5.0Clean6.0Activities7.0Meds2.0Memory3.0Comms2.0ValueN/A

Strengths

  • Friendly and welcoming front desk staff
  • Clean and well-maintained facility environment
  • Helpful and compassionate individual nursing staff
  • Efficient check-in and visitor management process

Concerns

  • Neglect leading to severe bedsores and open wounds (mentioned by 10 reviewers)
  • Poor communication from nursing and administrative staff (mentioned by 7 reviewers)
  • Understaffing leading to slow response times for call lights (mentioned by 6 reviewers)
  • Hygiene issues including failure to bathe patients or change linens (mentioned by 5 reviewers)
  • Theft of personal belongings (mentioned by 3 reviewers)

Rating Trends

Tap a year to see what changed

2343.0'18(10)2.02.0'20(6)3.44.3'22(12)4.04.5'24(51)3.9'25(56)

Distribution · 167 analyzed

5
103
4
21
3
8
2
0
1
35

How They Respond to Reviews

80%response rate

This facility actively engages with reviewer feedback.

Questions for Your Tour

  • 1Given the facility's size of 206 residents, how do you ensure consistent, personalized attention for each resident to prevent issues like skin breakdown and ensure regular hygiene?
  • 2I noticed that communication is a high priority for your management team based on your active response rate to feedback; what specific protocols are in place to keep families updated on changes in their loved one's health or care plan?
  • 3With the current staffing levels, what is the average response time for call lights, and how do you prioritize urgent needs during peak hours?
  • 4How does your nursing team manage medication administration and documentation to ensure accuracy and safety for residents?
  • 5What measures are in place to safeguard residents' personal belongings and ensure that their living spaces remain secure?
  • 6Could you walk me through your process for addressing family concerns or grievances, and how do you ensure these issues are resolved in a timely manner?

Personalized based on this facility's data


Key Review Excerpts

I can understand some worn out areas due to the facility being older but look like they were doing some upgrading the music was going and the patients were smiling and the staff spoke as we passed by I was pleasantly pleased on the Tour

Family member of prospective resident · 2025★★★★

My mother was transferred to this location for rehabilitation for a trachea. She was not allowed to drink due to a swallow test that needed to be done .She was not on IV fluids . Two weeks after she arrived, we finally got them to schedule it, but it was too late, and she never made the appointment.

Long-term resident's family · 2024☆☆☆☆

I just want to give thanks to the new Administrator, Kristian. She is always pleasant and welcoming family members to Spring Gate. Her reassurance, leadership, and changes has given me a piece of mind in knowing that my Loved One will be taken care of.

Family member · 2025★★★★
Source: 211 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.82hrs
OK
Registered nurses for medical care
Total Nursing
4.26hrs
OK
All nurses + aides combined
Staff Turnover
59%
Lower is better (< 30% = good)
RN Turnover
81%
Lower is better (< 30% = good)

This facility meets the national staffing benchmarks. Higher staffing is linked to fewer falls and better day-to-day care.

Quality Measures

Quality Measures

Resident outcomes compared with national, state, and local averages · 17 measures

Medicare Rating
5/ 5
Better Than Avg

11

measures

Worse Than Avg

6

measures

Long-Stay Residents
💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility57.6%
Worse than Avg
Here
57.6%
US
93.4%
TN
89.5%
Shelby
86.9%
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility9.5%
Better than Avg
Here
9.5%
US
19.5%
TN
31.9%
Shelby
23.1%
😔

Residents with depression symptoms

↓ Lower is better
This Facility0.0%
Better than Avg
Here
0.0%
US
12.1%
TN
12.9%
Shelby
13.7%

Highly dependent on how each facility screens and codes depressive symptoms, so it varies widely between facilities.

🚶

Residents whose walking got worse

↓ Lower is better
This Facility6.6%
Better than Avg
Here
6.6%
US
15.3%
TN
18.5%
Shelby
16.7%
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility5.0%
Better than Avg
Here
5.0%
US
14.4%
TN
14.6%
Shelby
13.5%
🩹

Residents with pressure sores (bedsores)

↓ Lower is better
This Facility14.4%
Worse than Avg
Here
14.4%
US
4.9%
TN
5.2%
Shelby
6.0%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility13.7%
Worse than Avg
Here
13.7%
US
81.8%
TN
79.4%
Shelby
73.5%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility31.8%
Worse than Avg
Here
31.8%
US
79.7%
TN
79.8%
Shelby
69.2%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility1.5%
Better than Avg
Here
1.5%
US
1.6%
TN
1.6%
Shelby
1.8%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

23deficiencies
3penalties
Well above state avg (5.9)
22 complaint-triggered
$128,974 in fines

Spring Gate has concerning complaint patterns with families filing reports that triggered multiple investigations, including recent safety hazards and neglect reporting issues. The facility shows persistent problems with safety supervision, care planning, and medication management across multiple years, with the same safety deficiency recurring from 2019 through 2025. While all violations report correction dates, the repeated nature of core safety issues warrants careful consideration during any visit.

Apr 30, 2025Complaint
8
0689Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0689Immediate jeopardy · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0656Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0842Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

0656Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0842Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.

Oct 16, 2024Routine
19
0690Actual harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.

0812Potential for harm · PatternCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0641Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Ensure each resident receives an accurate assessment.

0561Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.

0578Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

0645Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

PASARR screening for Mental disorders or Intellectual Disabilities

0657Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

0677Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide care and assistance to perform activities of daily living for any resident who is unable.

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide safe and appropriate respiratory care for a resident when needed.

0847Potential for harm · IsolatedCorrected

Administration Deficiencies

Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.

0211Potential for harm · IsolatedCorrected

Egress Deficiencies

Keep aisles, corridors, and exits free of obstruction in case of emergency.

0222Potential for harm · IsolatedCorrected

Egress Deficiencies

Add 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.

0321Potential for harm · IsolatedCorrected

Smoke Deficiencies

Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.

0324Potential for harm · IsolatedCorrected

Smoke Deficiencies

Provide properly protected cooking facilities.

0353Potential for harm · IsolatedCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0741Potential for harm · IsolatedCorrected

Miscellaneous Deficiencies

Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

0761Potential for harm · IsolatedCorrected

Miscellaneous Deficiencies

To conduct inspection, testing and maintenance of fire doors by qualified individuals.

0920Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure proper usage of power strips and extension cords.

0923Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have proper medical gas storage and administration areas.

Oct 16, 2024Complaint
14
0689Actual harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0584Potential for harm · WidespreadCorrected

Resident Rights Deficiencies

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

0693Potential for harm · PatternCorrected

Quality of Life and Care Deficiencies

Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

0712Potential for harm · PatternCorrected

Nursing and Physician Services Deficiencies

Ensure that the resident and his/her doctor meet face-to-face at all required visits.

0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0557Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

0580Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

0609Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

0610Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Respond appropriately to all alleged violations.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0732Potential for harm · IsolatedCorrected

Nursing and Physician Services Deficiencies

Post nurse staffing information every day.

0761Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

0791Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide or obtain dental services for each resident.

0550Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Sep 24, 2021Routine
5
0880Potential for harm · PatternCorrected

Infection Control Deficiencies

Provide and implement an infection prevention and control program.

0554Potential for harm · IsolatedCorrected

Resident Rights Deficiencies

Allow residents to self-administer drugs if determined clinically appropriate.

0657Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

0686Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Oct 3, 2019Routine
7
0812Potential for harm · WidespreadCorrected

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

0656Potential for harm · IsolatedCorrected

Resident Assessment and Care Planning Deficiencies

Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

0689Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

0761Potential for harm · IsolatedCorrected

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

0353Potential for harm · IsolatedCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0741Potential for harm · IsolatedCorrected

Miscellaneous Deficiencies

Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.

0920Potential for harm · IsolatedCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Ensure proper usage of power strips and extension cords.

Federal Penalties

Fine

Apr 30, 2025

$50,749

Fine

Oct 16, 2024

$78,225

Payment Denial

Oct 16, 2024

50-day denial

Ownership & Operations

Who Operates This Facility

Owner / Operator

Spring Gate Rehab & Healthcare Center

Organization Type

for profit

Chain Affiliation

Chain Name

Prestige Administrative Services

Chain Size

9 facilities nationwide

Chain avg rating: 2.2/5 · Rank 8 of 9 (Worst)

Ownership & Management

Owners

B&y Healthcare S CORP

Owner · Organization

50%

Cody Healthcare S CORP

Owner · Organization

50%

B&y Trust

Owner (parent company) · Organization

50%

Craig Flashner 2007 Trust

Owner (parent company) · Organization

50%

Key personnel

Norcross, RobertContracted Managing EmployeeRogers, StaceyContracted Managing EmployeeKirk, KristineW-2 Managing EmployeeFlashner, CraigOfficer / DirectorNorthpoint Regional LLCManager
Source: Medicare provider data

Contact

Get in Touch

Contact this facility directly and verify the details that matter most to your family.

References & Resources

EveryPlace is a research directory. Facility information is compiled from public sources — Medicare.gov, state licensing portals, Google Places, and publicly available street-level imagery. Listings do not constitute endorsement, recommendation, or advertisement, and we do not accept payment for placement. Families should verify all details directly with the facility and the original sources linked above before making any care decisions. See our Research Policy for our editorial standards, correction process, and image-removal policy.

Safer Alternatives Nearby

Based on current clinical data, we identified 6 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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