The Waters of Springfield LLC
704 5th Avenue East, Springfield, TN 37172 · Robertson County · 66 certified beds · avg 47 residents/day · certified since Oct 7, 2005
Part of chain: INFINITY HEALTHCARE CONSULTING (69 facilities, chain avg rating 2.0★)
What health inspectors found (on-site government inspections — the most independent evidence available)
Health inspection rating: ★☆☆☆☆1/5 · CMS overall rating: 1/5
The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.
Most serious findings (actual harm or immediate jeopardy)
▲ Immediate jeopardy, one-off · Feb 23, 2026 · F-0678 · triggered by a complaint
The facility did not provide basic life support, such as CPR, before emergency medical help arrived — care that's required when it matches the doctor's orders and the resident's own written wishes.
Why it matters: In a cardiac or breathing emergency, failure to start CPR promptly can be the difference between life and death.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: Feb 27, 2026 (Deficient, Provider has date of correction)
▲ Immediate jeopardy, one-off · Oct 19, 2023 · F-0689 · triggered by a complaint
The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls.
Why it matters: This is one of the most common citations and directly relates to falls and injuries, which can be devastating for older adults.
Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.
Corrected: Aug 7, 2022 (Past Non-Compliance)
All citations in the current public record (20)
CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.
| Date | Severity | What the facility was cited for |
|---|---|---|
| Feb 23, 2026 | ▲ J · Immediate jeopardy, one-off | The facility did not provide basic life support, such as CPR, before emergency medical help arrived — care that's required when it matches the doctor's orders and the resident's own written wishes. · from a complaint |
| May 20, 2025 | E · Potential for harm, repeated | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| May 20, 2025 | D · Potential for harm, one-off | The facility did not honor residents' right to form and take part in resident or family groups, such as a resident council. |
| May 20, 2025 | D · Potential for harm, one-off | The facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. |
| May 20, 2025 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. |
| Jul 25, 2024 | F · Potential for harm, facility-wide | The facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards. |
| Jul 25, 2024 | E · Potential for harm, repeated | The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint |
| Jul 25, 2024 | D · Potential for harm, one-off | The facility did not give residents proper notice about what Medicare or Medicaid covers, or about charges the resident might owe for services that aren't covered. |
| Jul 25, 2024 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Jul 25, 2024 | D · Potential for harm, one-off | The facility did not help a resident get vision and hearing services — such as eye exams, glasses, hearing tests, or hearing aids. |
| Oct 19, 2023 | ▲ J · Immediate jeopardy, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint |
| Oct 19, 2023 | D · Potential for harm, one-off | The facility did not protect residents from misuse of their belongings or money — this is called misappropriation, and it includes theft or improper use of a resident's property or funds. · from a complaint |
| Oct 19, 2023 | D · Potential for harm, one-off | The facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint |
| Oct 19, 2023 | D · Potential for harm, one-off | The facility's medication error rate was 5 percent or higher — meaning too many doses were given incorrectly, such as the wrong drug, dose, or time. · from a complaint |
| Oct 19, 2023 | D · Potential for harm, one-off | The facility did not have a written plan describing how it runs its quality improvement program — the ongoing process of finding problems in care and fixing them. · from a complaint |
| Oct 19, 2023 | D · Potential for harm, one-off | The facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint |
| Jul 8, 2021 | D · Potential for harm, one-off | The facility did not provide a safe, clean, comfortable, and homelike environment, including safe support for residents' daily living needs. |
| Jul 8, 2021 | D · Potential for harm, one-off | The facility did not develop or follow a complete care plan for each resident — the written roadmap covering all of a resident's needs, with measurable goals and timelines. |
| Jul 8, 2021 | D · Potential for harm, one-off | The facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. |
| Jul 8, 2021 | D · Potential for harm, one-off | The facility did not observe each nurse aide's job performance or provide regular training as required. |
Inspection trend by year
Citations from standard inspections stayed about the same across the last two inspection cycles (5 → 4).
| Year | Citations | Serious (G–L) | Worst severity that year |
|---|---|---|---|
| 2021 | 4 | 0 | D |
| 2023 | 6 | 1 | J ▲ |
| 2024 | 5 | 0 | F |
| 2025 | 4 | 0 | E |
| 2026 | 1 | 1 | J ▲ |
Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.
Fines and enforcement (last 3 years)
2 fines totaling $26,407.
| Date | Type | Amount / length |
|---|---|---|
| Feb 23, 2026 | Fine | $16,985 |
| Oct 19, 2023 | Fine | $9,422 |
Nurse staffing (from payroll records, adjusted for how much care residents need)
| Measure | This facility | Tennessee avg | U.S. avg | Where it stands |
|---|---|---|---|---|
| Total nurse staffing (hours per resident per day) | 2.33 | 3.62 | 3.95 | bottom 1% in Tennessee; bottom 2% in the U.S. |
| Registered Nurse hours | 0.52 | 0.57 | 0.69 | top 49% in Tennessee; bottom 41% in the U.S. |
| Weekend total nurse staffing | 2.08 | 3.15 | 3.50 | bottom 1% in Tennessee; bottom 2% in the U.S. |
| Weekend RN hours (not acuity-adjusted) | 0.69 | 0.39 | 0.48 | top 7% in Tennessee; top 17% in the U.S. |
| Total nursing staff turnover (%) | 63.0 | 48.9 | 45.8 | bottom 14% in Tennessee; bottom 12% in the U.S. |
| RN turnover (%) | 44.4 | 43.2 | 42.9 | bottom 45% in Tennessee; bottom 45% in the U.S. |
Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 2.90, RN 0.65, weekend 2.59. Staffing rating: 1/5.
Self-reported quality measures
Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.
Quality measures rating: 4/5 · long-stay residents: 5/5 · short-stay residents: 2/5
Who owns this facility
For profit - Limited Liability company
| Owner / manager | Type | Role | Stake | Since |
|---|---|---|---|---|
| A&f Realty LLC | Organization | 5% or Greater Direct Ownership Interest | 20% | 08/01/2016 |
| Gubin Enterprises Limited Partnership | Organization | 5% or Greater Direct Ownership Interest | 40% | 08/01/2016 |
| Welsh, Benton | Individual | W-2 Managing Employee | NOT APPLICABLE | 08/05/2020 |
Questions to ask on your visit
Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.
- "Are staff on every shift trained and certified in CPR, and how do they know each resident's resuscitation wishes?"
- "What is your falls rate, and what specific steps do you take to prevent falls and supervise residents at risk?"
- "What did your most recent kitchen inspection find, and can I see how food is stored and prepared?"
- "Does your facility have an active resident council, and how does management respond to its concerns?"
- "How many aides are on each shift, and how do you make sure every resident gets timely help with bathing, dressing, and meals?"
- "Who leads your infection prevention program, and how do you make sure staff follow practices like hand hygiene every day?"
- "Tell me about this abuse or neglect citation — what happened, and what specific changes did you make afterward?"
- "Before any service that isn't covered by Medicare or Medicaid, how will you notify us and get our agreement?"
- "What is your current ratio of nursing staff to residents on day, evening, and weekend shifts?"
- "Can I see the results and plan of correction from your most recent state inspection?"
Nearby facilities (within 20 miles)
| Facility | Distance | City | Overall | Inspection | Flags |
|---|---|---|---|---|---|
| NHC Healthcare, Springfield | 0.3 mi | Springfield, TN | ★★☆☆☆ | 1/5 | abuse |
| Stoneridge Health Care, LLC | 9.5 mi | Goodlettsville, TN | ★★☆☆☆ | 3/5 | |
| White House Health Care INC | 10.6 mi | White House, TN | ★★★★★ | 5/5 | |
| Alta Heights Post Acute | 16.4 mi | Goodlettsville, TN | ★★★★☆ | 4/5 | |
| Whites Creek Wellness and Rehabilitation Center | 18.9 mi | Whites Creek, TN | ★★★☆☆ | 3/5 | |
| Riverview Post Acute | 19.1 mi | Ashland City, TN | ★★☆☆☆ | 3/5 | |
| Creekside Center for Rehabilitation and Healing | 19.2 mi | Madison, TN | ★★★★☆ | 4/5 | |
| NHC Healthcare, Hendersonville | 19.2 mi | Hendersonville, TN | ★★★☆☆ | 3/5 | |
| Signature Healthcare of Clarksville | 19.9 mi | Clarksville, TN | ★★☆☆☆ | 2/5 |
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Facility data as of CMS processing date 2026-08-01. CCN 445480.