SNF
Antioch TN Opco, LLC
CCN: 445170 · ANTIOCH, TN 37013 · Davidson County
SFF Candidate Abuse citation flag Inspection > 2 years ago
Overview
- Address
- 500 HICKORY HOLLOW TERRACE, ANTIOCH, TN 37013
- Phone
- 6157317130
- Certified beds
- 110
- Avg daily residents
- 75 (68% of beds filled)
- Ownership
- For-profit corporation
- Provider type
- Medicare and Medicaid
- Medicare/Medicaid since
- 1985-01-16
- Setting
- Urban
1 /5
★★★★★
CMS Overall Rating
CMS 5-Star Ratings
CMS rates every Medicare/Medicaid-certified nursing home on four domains. The Overall rating is driven primarily by Health Inspection results, then adjusted up or down by Staffing and Quality Measures.
Health Inspections
CMS weights three inspection cycles to compute the Health Inspection rating: the most recent (50%), the second most recent (33%), and the oldest (17%). Each standard-survey deficiency is assigned a score based on scope and severity; complaint-survey findings and revisit scores are added to produce the cycle total.
| Cycle | Date | Total defs. | Standard | Complaint | Deficiency score | Revisits | Total score |
|---|---|---|---|---|---|---|---|
| Cycle 1 (most recent) | 2023-08-02 | 17 | 14 | 17 | 442 | 2 | 663 |
| Cycle 2/3 (prior) | 2019-05-02 | 2 | 2 | 0 | 20 | 1 | 20 |
Total weighted health score
502.3
lower is better
Deficiencies (28)
Individual survey findings. Scope/severity uses the CMS A–L matrix: letters further down the alphabet indicate greater harm and wider scope, up through J–L (immediate jeopardy).
18 D/E/F Actual harm — potential for minor
5 G/H/I Actual harm
5 J/K/L Immediate jeopardy
| Tag | Description | Scope/Severity | Survey date | Corrected |
|---|---|---|---|---|
| 0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | J | 2025-10-09 | 2025-11-18 |
| 0610 | Respond appropriately to all alleged violations. | J | 2025-10-09 | 2025-11-18 |
| 0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | J | 2025-10-09 | 2025-11-18 |
| 0550 | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | D | 2023-08-02 | 2023-08-23 |
| 0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | D | 2023-08-02 | 2023-08-23 |
| 0583 | Keep residents' personal and medical records private and confidential. | D | 2023-08-02 | 2023-08-23 |
| 0584 | 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. | E | 2023-08-02 | 2023-08-23 |
| 0625 | Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. | D | 2023-08-02 | 2023-08-23 |
| 0641 | Ensure each resident receives an accurate assessment. | D | 2023-08-02 | 2023-08-23 |
| 0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | E | 2023-08-02 | 2023-08-23 |
| 0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | 2023-08-02 | 2023-08-23 |
| 0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | J | 2023-08-02 | 2023-08-23 |
| 0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | 2023-08-02 | 2023-08-23 |
| 0851 | Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. | D | 2023-08-02 | 2023-08-23 |
| 0865 | Have a plan that describes the process for conducting QAPI and QAA activities. | J | 2023-08-02 | 2023-08-23 |
| 0880 | Provide and implement an infection prevention and control program. | F | 2023-08-02 | 2023-08-23 |
| 0882 | Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home. | F | 2023-08-02 | 2023-08-23 |
| 0803 | Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. | F | 2019-05-02 | 2019-05-23 |
| 0804 | Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. | D | 2019-05-02 | 2019-05-22 |
| 0578 | 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. | D | 2018-04-18 | 2018-05-04 |
| 0580 | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | G | 2018-04-18 | 2018-05-04 |
| 0600 | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | G | 2018-04-18 | 2018-05-04 |
| 0641 | Ensure each resident receives an accurate assessment. | D | 2018-04-18 | 2018-05-04 |
| 0655 | Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted | G | 2018-04-18 | 2018-05-04 |
| 0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | G | 2018-04-18 | 2018-05-04 |
| 0697 | Provide safe, appropriate pain management for a resident who requires such services. | G | 2018-04-18 | 2018-05-04 |
| 0758 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | 2018-04-18 | 2018-05-04 |
| 0800 | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | F | 2018-04-18 | 2018-05-04 |
Penalties (3)
Fines issued
2
last 3 years
Total fines
$167,771
Payment denials
1
| Date | Type | Fine amount |
|---|---|---|
| 2023-10-10 | Fine | $7,342 |
| 2023-07-24 | Fine | $160,429 |
| 2023-07-24 | Payment Denial | — |
Source: CMS Nursing Home Penalties.
Financial Health (FY 2023)
Payer mix (share of resident days)
Medicare 1.4% Medicaid 88.0% Other 10.6%
Operating performance
Operating Margin
-52.4%
Total Margin
-40.2%
Occupancy Rate
60.1%
Revenue & costs
Net Patient Revenue
$6.4M
Total Costs
$454K
Net Income
-$2.8M
Balance sheet
Total Assets
-$659K
Total Liabilities
$5.3M
Fund Balance
-$6.0M
Source: CMS SNF Cost Report (FY 2023). Cost report data lags by ~2 years.
Ownership & Corporate Structure
Owner / manager individuals (5)
| Name | Role | Association |
|---|---|---|
| VALDOMAR, CELIA | 5% OR GREATER DIRECT OWNERSHIP INTEREST | since 08/06/1986 |
| SANTOS, ARMANDO | OPERATIONAL/MANAGERIAL CONTROL | since 09/01/2009 |
| BRYDON, JOSEPHINE | CORPORATE OFFICER | since 12/01/2009 |
| GLENWRIGHT, DEBORAH | CORPORATE OFFICER | since 12/01/2009 |
| SANTOS, ARMANDO | CORPORATE OFFICER | since 01/01/2018 |
Source: CMS Nursing Home Ownership. Percent ownership is rarely disclosed — CMS only requires it for specific roles.
Facility Features
- CCRC
- No
- Hospital-based
- No
- Resident / family council
- Resident
- Sprinkler systems
- Yes
- Special focus status
- SFF Candidate
- Abuse citation flag
- Yes — last 2 cycles
Methodology & sources
- Nursing Home Provider Info (
nh-provider-info), vintage 2026, downloaded 2026-04-14 , 14,703 rows. - Nursing Home Penalties (
nh-penalties), vintage 2026, downloaded 2026-04-14 , 16,915 rows. - Nursing Home Health Deficiencies (
nh-deficiencies), vintage 2026, downloaded 2026-04-14 , 418,972 rows. - Nursing Home Ownership (
nh-ownership), vintage 2026, downloaded 2026-04-14 , 160,393 rows. - Skilled Nursing Facility Cost Report (
snf-cost-report), vintage 2023, downloaded 2026-04-14 , 14,120 rows.
All Data
Every labeled field shipped for this facility by CMS. No national median or percentile context is available for SNFs in the current release.
Show 111 rows
| Source | Metric | Value | Raw key |
|---|---|---|---|
| Cost Report | fiscal_year | 2,023 | fiscal_year |
| Cost Report | Medicaid Day Share (%) | 88.0% | metrics.medicaid_day_share |
| Cost Report | Medicare Day Share (%) | 1.4% | metrics.medicare_day_share |
| Cost Report | Net Income ($) | $-2,812,342 | metrics.net_income |
| Cost Report | Net Patient Revenue ($) | $6,432,185 | metrics.net_patient_revenue |
| Cost Report | Occupancy Rate (%) | 60.1% | metrics.occupancy_rate |
| Cost Report | Operating Margin (%) | -52.4% | metrics.operating_margin |
| Cost Report | Total Assets ($) | $-659,047 | metrics.total_assets |
| Cost Report | Total Costs ($) | $454,457 | metrics.total_costs |
| Cost Report | Total Fund Balances ($) | $-5,988,809 | metrics.fund_balance |
| Cost Report | Total Liabilities ($) | $5,329,762 | metrics.total_liabilities |
| Cost Report | Total Margin (%) | -40.2% | metrics.total_margin |
| Provider Information | Abuse Icon | Y | Abuse Icon |
| Provider Information | Adjusted LPN Staffing Hours per Resident per Day | — | Adjusted LPN Staffing Hours per Resident per Day |
| Provider Information | Adjusted Nurse Aide Staffing Hours per Resident per Day | — | Adjusted Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Adjusted RN Staffing Hours per Resident per Day | — | Adjusted RN Staffing Hours per Resident per Day |
| Provider Information | Adjusted Total Nurse Staffing Hours per Resident per Day | — | Adjusted Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Adjusted Weekend Total Nurse Staffing Hours per Resident per Day | — | Adjusted Weekend Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Administrator turnover footnote | 26 | Administrator turnover footnote |
| Provider Information | Automatic Sprinkler Systems in All Required Areas | Yes | Automatic Sprinkler Systems in All Required Areas |
| Provider Information | Average Number of Residents per Day | 75.3 | Average Number of Residents per Day |
| Provider Information | Average Number of Residents per Day Footnote | — | Average Number of Residents per Day Footnote |
| Provider Information | Case-Mix LPN Staffing Hours per Resident per Day | — | Case-Mix LPN Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Nurse Aide Staffing Hours per Resident per Day | — | Case-Mix Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Case-Mix RN Staffing Hours per Resident per Day | — | Case-Mix RN Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Total Nurse Staffing Hours per Resident per Day | — | Case-Mix Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day | — | Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Chain Average Health Inspection Rating | — | Chain Average Health Inspection Rating |
| Provider Information | Chain Average Overall 5-star Rating | — | Chain Average Overall 5-star Rating |
| Provider Information | Chain Average QM Rating | — | Chain Average QM Rating |
| Provider Information | Chain Average Staffing Rating | — | Chain Average Staffing Rating |
| Provider Information | Chain ID | — | Chain ID |
| Provider Information | Chain Name | — | Chain Name |
| Provider Information | City/Town | ANTIOCH | City/Town |
| Provider Information | CMS Certification Number (CCN) | 445170 | CMS Certification Number (CCN) |
| Provider Information | Continuing Care Retirement Community | N | Continuing Care Retirement Community |
| Provider Information | County/Parish | Davidson | County/Parish |
| Provider Information | Date First Approved to Provide Medicare and Medicaid Services | 1985-01-16 | Date First Approved to Provide Medicare and Medicaid Services |
| Provider Information | Geocoding Footnote | — | Geocoding Footnote |
| Provider Information | Health Inspection Rating | 1 | Health Inspection Rating |
| Provider Information | Health Inspection Rating Footnote | — | Health Inspection Rating Footnote |
| Provider Information | Latitude | 36.0515 | Latitude |
| Provider Information | Legal Business Name | EBENEZER HOME OF TENNESSEE INC | Legal Business Name |
| Provider Information | Location | 500 HICKORY HOLLOW TERRACE,ANTIOCH,TN,37013 | Location |
| Provider Information | Long-Stay QM Rating | 4 | Long-Stay QM Rating |
| Provider Information | Long-Stay QM Rating Footnote | — | Long-Stay QM Rating Footnote |
| Provider Information | Longitude | -86.647 | Longitude |
| Provider Information | Most Recent Health Inspection More Than 2 Years Ago | Y | Most Recent Health Inspection More Than 2 Years Ago |
| Provider Information | Number of administrators who have left the nursing home | — | Number of administrators who have left the nursing home |
| Provider Information | Number of Certified Beds | 110 | Number of Certified Beds |
| Provider Information | Number of Citations from Infection Control Inspections | — | Number of Citations from Infection Control Inspections |
| Provider Information | Number of Facilities in Chain | — | Number of Facilities in Chain |
| Provider Information | Number of Fines | 2 | Number of Fines |
| Provider Information | Number of Payment Denials | 1 | Number of Payment Denials |
| Provider Information | Nursing Case-Mix Index | — | Nursing Case-Mix Index |
| Provider Information | Nursing Case-Mix Index Ratio | — | Nursing Case-Mix Index Ratio |
| Provider Information | Overall Rating | 1 | Overall Rating |
| Provider Information | Overall Rating Footnote | — | Overall Rating Footnote |
| Provider Information | Ownership Type | For profit - Corporation | Ownership Type |
| Provider Information | Physical Therapist Staffing Footnote | 23 | Physical Therapist Staffing Footnote |
| Provider Information | Processing Date | 2026-03-01 | Processing Date |
| Provider Information | Provider Address | 500 HICKORY HOLLOW TERRACE | Provider Address |
| Provider Information | Provider Changed Ownership in Last 12 Months | N | Provider Changed Ownership in Last 12 Months |
| Provider Information | Provider Name | Antioch TN Opco, LLC | Provider Name |
| Provider Information | Provider Resides in Hospital | N | Provider Resides in Hospital |
| Provider Information | Provider SSA County Code | 180 | Provider SSA County Code |
| Provider Information | Provider Type | Medicare and Medicaid | Provider Type |
| Provider Information | QM Rating | 4 | QM Rating |
| Provider Information | QM Rating Footnote | — | QM Rating Footnote |
| Provider Information | Rating Cycle 1 Health Deficiency Score | 442 | Rating Cycle 1 Health Deficiency Score |
| Provider Information | Rating Cycle 1 Health Revisit Score | 221 | Rating Cycle 1 Health Revisit Score |
| Provider Information | Rating Cycle 1 Number of Complaint Health Deficiencies | 17 | Rating Cycle 1 Number of Complaint Health Deficiencies |
| Provider Information | Rating Cycle 1 Number of Health Revisits | 2 | Rating Cycle 1 Number of Health Revisits |
| Provider Information | Rating Cycle 1 Number of Standard Health Deficiencies | 14 | Rating Cycle 1 Number of Standard Health Deficiencies |
| Provider Information | Rating Cycle 1 Standard Survey Health Date | 2023-08-02 | Rating Cycle 1 Standard Survey Health Date |
| Provider Information | Rating Cycle 1 Total Health Score | 663 | Rating Cycle 1 Total Health Score |
| Provider Information | Rating Cycle 1 Total Number of Health Deficiencies | 17 | Rating Cycle 1 Total Number of Health Deficiencies |
| Provider Information | Rating Cycle 2 Number of Standard Health Deficiencies | 2 | Rating Cycle 2 Number of Standard Health Deficiencies |
| Provider Information | Rating Cycle 2 Standard Health Survey Date | 2019-05-02 | Rating Cycle 2 Standard Health Survey Date |
| Provider Information | Rating Cycle 2/3 Health Deficiency Score | 20 | Rating Cycle 2/3 Health Deficiency Score |
| Provider Information | Rating Cycle 2/3 Health Revisit Score | 0 | Rating Cycle 2/3 Health Revisit Score |
| Provider Information | Rating Cycle 2/3 Number of Complaint Health Deficiencies | 0 | Rating Cycle 2/3 Number of Complaint Health Deficiencies |
| Provider Information | Rating Cycle 2/3 Number of Health Revisits | 1 | Rating Cycle 2/3 Number of Health Revisits |
| Provider Information | Rating Cycle 2/3 Total Health Score | 20 | Rating Cycle 2/3 Total Health Score |
| Provider Information | Rating Cycle 2/3 Total Number of Health Deficiencies | 2 | Rating Cycle 2/3 Total Number of Health Deficiencies |
| Provider Information | Registered Nurse hours per resident per day on the weekend | — | Registered Nurse hours per resident per day on the weekend |
| Provider Information | Registered Nurse turnover | — | Registered Nurse turnover |
| Provider Information | Registered Nurse turnover footnote | 26 | Registered Nurse turnover footnote |
| Provider Information | Reported Licensed Staffing Hours per Resident per Day | — | Reported Licensed Staffing Hours per Resident per Day |
| Provider Information | Reported LPN Staffing Hours per Resident per Day | — | Reported LPN Staffing Hours per Resident per Day |
| Provider Information | Reported Nurse Aide Staffing Hours per Resident per Day | — | Reported Nurse Aide Staffing Hours per Resident per Day |
| Provider Information | Reported Physical Therapist Staffing Hours per Resident Per Day | — | Reported Physical Therapist Staffing Hours per Resident Per Day |
| Provider Information | Reported RN Staffing Hours per Resident per Day | — | Reported RN Staffing Hours per Resident per Day |
| Provider Information | Reported Staffing Footnote | 23 | Reported Staffing Footnote |
| Provider Information | Reported Total Nurse Staffing Hours per Resident per Day | — | Reported Total Nurse Staffing Hours per Resident per Day |
| Provider Information | Short-Stay QM Rating | — | Short-Stay QM Rating |
| Provider Information | Short-Stay QM Rating Footnote | 2 | Short-Stay QM Rating Footnote |
| Provider Information | Special Focus Status | SFF Candidate | Special Focus Status |
| Provider Information | Staffing Rating | 1 | Staffing Rating |
| Provider Information | Staffing Rating Footnote | 23 | Staffing Rating Footnote |
| Provider Information | State | TN | State |
| Provider Information | Telephone Number | 6157317130 | Telephone Number |
| Provider Information | Total Amount of Fines in Dollars | 167771.00 | Total Amount of Fines in Dollars |
| Provider Information | Total number of nurse staff hours per resident per day on the weekend | — | Total number of nurse staff hours per resident per day on the weekend |
| Provider Information | Total Number of Penalties | 3 | Total Number of Penalties |
| Provider Information | Total nursing staff turnover | — | Total nursing staff turnover |
| Provider Information | Total nursing staff turnover footnote | 26 | Total nursing staff turnover footnote |
| Provider Information | Total Weighted Health Survey Score | 502.250 | Total Weighted Health Survey Score |
| Provider Information | Urban | Y | Urban |
| Provider Information | With a Resident and Family Council | Resident | With a Resident and Family Council |
| Provider Information | ZIP Code | 37013 | ZIP Code |