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Nursing HomeMedicaid Investigative

Tri State Health and Rehabilitation Center

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

600 Shawanee Rd, Harrogate, TN 37752116 bedsLicensed & Active
1/5
Medicare
Inspection
Quality
Staffing
Google rating
4.6/5

based on 78 Google reviews

5
4
3
2
1
Tri State Health and Rehabilitation Center Nursing Home in Harrogate, TN — Street View
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4/ 10
moderate Risk

Quality Concerns Identified

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

  • Abuse citation on record
  • Low overall rating (1/5 stars)

Bottom 25% in TN · Meets national RN staffing standard · Worst in THE ENSIGN GROUP chain · $14,852 in fines · Abuse citation

Source: Medicare data

What this means for your family

This facility is highly regarded for its physical therapy and social activities, which can be great for short-term recovery. However, there are serious, recurring reports regarding lack of communication during medical emergencies and unprofessional management. We strongly recommend that you visit during off-hours and ask the administrator specifically about their protocol for notifying families of falls or changes in condition.

Google Reviews

Google Reviews

78 reviews on Google
Tri State Health and Rehabilitation Center receives a high volume of positive feedback, particularly regarding the friendliness of the staff and the effectiveness of their therapy department. However, there is a concerning pattern of negative reviews from family members citing serious lapses in patient safety, poor communication during medical incidents, and unprofessional conduct by management. Families should weigh the praise for the facility's atmosphere against these significant reports of neglect and lack of transparency.

Quality Themes

Tap a score for details
Food10.0Staff6.0Clean9.0Activities9.0MedsN/AMemoryN/AComms3.0ValueN/A

Strengths

  • Warm, friendly nursing and support staff
  • Effective physical therapy department
  • Clean and well-maintained facility
  • Engaging activities and social events

Concerns

  • Lack of communication regarding patient falls and injuries (mentioned by 2 reviewers)
  • Understaffing leading to slow call light response times (mentioned by 2 reviewers)
  • Unprofessional or rude management/administrative behavior (mentioned by 2 reviewers)

Rating Trends

Tap a year to see what changed

234'15(1)'18(5)'20(2)'22(4)'24(4)'25(8)

Distribution · 83 analyzed

5
72
4
1
3
1
2
1
1
8
45 reviews posted between Jan 15, 2019Jan 26, 2019 · 45 were 5-star
31 reviews posted between Jan 21, 2019Jan 26, 2019 · 31 were 5-star

How They Respond to Reviews

0%response rate

Questions for Your Tour

  • 1We've heard wonderful things about the physical therapy department here; could you tell us more about how the therapists work with residents to regain their mobility?
  • 2How does the nursing team ensure that families are kept fully informed and updated immediately if a resident has a fall or a change in their health status?
  • 3With the high praise for your social events, what kind of daily activities or group outings do you have planned for the residents this month?
  • 4How do you manage call light response times during the night or during shift changes to ensure residents get help quickly?
  • 5What is the protocol for handling a medical emergency after hours, and how is the on-call physician notified?
  • 6We noticed some mentions of great support staff here; how do you foster that warm and friendly culture among your care team?

Personalized based on this facility's data


Key Review Excerpts

I came in one day to find blood on her sheets and went to find her at the nurses station. I asked why there is blood on my moms sheets and the her nurse said she had fell and had a skin tear on her arm when I looked I noticed her wrist was broken so badly it was deformed looking. They never apologized, no phone call that she fell, not one word from them.

Long-term resident's family · 2022☆☆☆☆

When I voiced my concerns with the DON about call light times due to lack of staff and my grandma needing to use the restroom she was very rude with me and talked badly about the staff she had. It’s very unprofessional.

Memory care family member · 2024☆☆☆☆

The staff at Tristate, keep our Dad well groomed and looking sharp. The physical therapy department worked with Dad to help him

Long-term resident's family · 2018★★★★★
Source: 78 Google reviews

Staffing

Staffing Hours

per resident/day · Medicare 2026
RN Hours
0.72hrs
96%
Registered nurses for medical care
Total Nursing
3.79hrs
92%
All nurses + aides combined
Staff Turnover
37%
Lower is better (< 30% = good)
RN Turnover
39%
Lower is better (< 30% = good)

Both RN and total nursing hours are below national benchmarks. This can mean less clinical attention per resident, so ask about their staffing plan.

Quality Measures

Quality Measures

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

Medicare Rating
4/ 5
Better Than Avg

13

measures

Worse Than Avg

3

measures

Mixed Results

1

measures

Long-Stay Residents
💊

Residents on anti-anxiety or sleep medication

↓ Lower is better
This Facility39.8%
Worse than Avg
Here
39.8%
US
19.5%
TN
31.9%
Claiborne
30.8%
😔

Residents with depression symptoms

↓ Lower is better
This Facility12.5%
Mixed vs Avgs
Here
12.5%
US
12.1%
TN
12.9%
Claiborne
1.2%

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

💉

Residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
93.4%
TN
89.5%
Claiborne
93.4%
🛏️

Residents needing more daily help over time

↓ Lower is better
This Facility10.9%
Better than Avg
Here
10.9%
US
14.4%
TN
14.6%
Claiborne
21.1%
💊

Residents on antipsychotic medication

↓ Lower is better
This Facility13.8%
Better than Avg
Here
13.8%
US
15.5%
TN
16.9%
Claiborne
23.5%
🚶

Residents whose walking got worse

↓ Lower is better
This Facility23.6%
Worse than Avg
Here
23.6%
US
15.3%
TN
18.5%
Claiborne
22.6%
Short-Stay Residents (Rehab / Post-Acute)
💉

Short-stay residents vaccinated for pneumonia

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
81.8%
TN
79.4%
Claiborne
75.2%
💉

Short-stay residents vaccinated for the flu

↑ Higher is better
This Facility100.0%
Better than Avg
Here
100.0%
US
79.8%
TN
79.8%
💊

Short-stay residents newly given antipsychotics

↓ Lower is better
This Facility1.5%
Better than Avg
Here
1.5%
US
1.6%
TN
1.6%
Claiborne
3.0%
Source: Medicare quality measures

US average from Medicare published data

Inspection History

Medicare Inspection History

3-year lookback · Medicare 2026

4deficiencies
2penalties
Near state avg (5.9)
9 complaint-triggered
$14,852 in fines

Families filed complaints that triggered a recent inspection revealing serious concerns about nursing staff competency, care planning, and resident protection from abuse, with management and quality assurance issues also cited. The facility has recurring problems with fire safety systems and general care quality across multiple surveys. While the facility reports correcting these deficiencies, the pattern of complaint-driven inspections and repeated safety violations warrants careful consideration before choosing this facility.

Dec 17, 2025Routine
7
0345Potential for harm · WidespreadCorrected

Smoke Deficiencies

Have approved installation, maintenance and testing program for fire alarm systems.

0353Potential for harm · WidespreadCorrected

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

0918Potential for harm · WidespreadCorrected

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

0684Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

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.

0521Potential for harm · IsolatedCorrected

Services Deficiencies

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Dec 17, 2025Complaint
1
0602Potential for harm · IsolatedResolved (past non-compliance)

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from the wrongful use of the resident's belongings or money.

Sep 26, 2024Complaint
8
0678Immediate jeopardy · PatternCorrected

Quality of Life and Care Deficiencies

Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives.

0726Immediate jeopardy · PatternCorrected

Nursing and Physician Services Deficiencies

Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

0835Immediate jeopardy · PatternCorrected

Administration Deficiencies

Administer the facility in a manner that enables it to use its resources effectively and efficiently.

0837Immediate jeopardy · PatternCorrected

Administration Deficiencies

Establish a governing body that is legally responsible for establishing and implementing policies for managing and operating the facility and appoints a properly licensed administrator responsible for managing the facility.

0867Immediate jeopardy · PatternCorrected

Administration Deficiencies

Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.

0656Potential for harm · PatternCorrected

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.

0842Potential for harm · PatternCorrected

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.

0600Potential for harm · IsolatedCorrected

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Aug 16, 2023Routine
5
0693Potential for harm · IsolatedCorrected

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.

0812Potential for harm · IsolatedCorrected

Nutrition and Dietary Deficiencies

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

0363Potential for harm · IsolatedCorrected

Smoke Deficiencies

Install corridor and hallway doors that block smoke.

0700Potential for harm · IsolatedCorrected

Miscellaneous Deficiencies

Meet requirements for operating features, such as evacuation plans, fire drills, smoking regulations, draperies, decorations and the inspection, testing and maintenance of fire doors.

0754Potential for harm · IsolatedCorrected

Miscellaneous Deficiencies

Provide properly sized and located linen or trash receptacles.

Dec 10, 2019Routine
2
0761Potential for harm · WidespreadCorrected

Miscellaneous Deficiencies

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

0695Potential for harm · IsolatedCorrected

Quality of Life and Care Deficiencies

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

Federal Penalties

Fine

Sep 26, 2024

$7,426

Fine

Sep 26, 2024

$7,426

Ownership & Operations

Who Operates This Facility

Owner / Operator

Tri State Health and Rehabilitation Center

Organization Type

for profit

Chain Affiliation

Chain Name

The Ensign Group

Chain Size

342 facilities nationwide

Chain avg rating: 3.2/5 · Rank 328 of 328 (Worst)

Ownership & Management

Owners

Rocky Top Healthcare LLC

Owner · Organization

100%

Key personnel

Abbott, SwatiOfficer / DirectorAgwunobi, JohnOfficer / DirectorAlbrechtsen, TylerOfficer / DirectorBlouin, AnnOfficer / DirectorChristensen, ChristopherOfficer / Director
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 4 nearby facilities within 10 miles that may offer a stronger care environment. We encourage families to compare options carefully.

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