The federal government has ended its Medicare/Medicaid provider agreement with the John M. Reed Health & Rehabilitation nursing home in Limestone, citing numerous patient care deficiencies.

The federal government formally terminated its Medicare/Medicaid provider agreement with the John M. Reed Health & Rehabilitation facility in Limestone on Nov. 28 following a detailed review noting deficiencies that could potentially affect the health of residents, placing some in "immediate jeopardy."

Deficiencies found at the facility at 124 John Reed Home Road were identified during a complaint investigation started on Oct. 14 and during a joint rectification and licensure survey started on Nov. 2.

"The Centers for Medicare and Medicaid Services has determined that [Reed] is not in compliance with the requirements for participation. The Medicare/Medicaid program will not make payment for in-patient nursing services to residents who are admitted after Nov. 28," according to a public notice published in The Greeneville Sun.

For residents admitted before Nov. 28, "payment may continue for a maximum of 30 days for nursing services," the notice states.

The state Department of Health served as the state survey agency for the federal Centers for Medicare and Medicaid Services, a division of the Department of Health & Human Services.


The survey revealed a series of "deficient practices" at the facility. Among its conclusions were that the facility failed to:

* "recognize concerns and implement interventions in the area of quality of care."

* "ensure timely incontinence care and repositioning."

* "prevent traumatic penile and urethral injuries."

* "prevent avoidable pressure ulcers and excoriation."

* prevent "repeated urinary tract infections."

* "administer antibiotics as ordered by the physician."

* "maintain dignity by ensuring residents are dressed in their own personal clothing."

In the area of nursing services, the John M. Reed Home "failed to recognize concerns and implement interventions."

"The facility failed to ensure nursing staff to repeatedly meet the needs of the residents," the survey stated.

In one instance, a housekeeper who is not a certified nursing assistant told survey interviewers that she checked vital signs of patients one night in November due to a staffing shortage.

The employee "confirmed she is assigned or pulled to work the floor when the facility is short of CNAs."

There are several instances noted of patients who developed sacral pressure ulcers "from untimely incontinence care and repositioning, and (not addressing) avoidable urinary tract and pressure ulcer infections" in some patients, according to the survey.

The facility also "failed to prevent repeated medication errors by not transcribing and administering medications for infectious processes, as ordered."


The state recertification and licensure survey found a series of potentially dangerous building and maintenance deficiencies in the Reed facility.

A fire alarm system in the building was not properly maintained. An annual fire alarm report conducted on Oct. 9 "revealed three of four alarm system batteries failed testing and had not yet been replaced," the survey stated.

Other survey findings included:

* The facility failed to ensure that sprinkler system control valves were provided with electronic supervisory tamper switches.

* Combustible floral arrangements and decorations were not treated with fire retardant material. Items on some residents' doors were also not treated with fire retardant material.

* Generators, which are required to be inspected weekly and exercised under load for 30 minutes per month, had not had annual maintenance work done since February 2014.

The findings were verified by the facility maintenance supervisor and acknowledged by the administrator during an exit conference on Nov. 2, according to the state Department of Health survey.

The facility has appeal rights which are outlined in the CMS notice of termination letter to the facility, state officials said.

The John Reed facility is operated by New Beginnings Care LLC, based in Hixson, Tenn.

New Beginnings "is a multipurpose healthcare company focused on providing the best care and services to those in need of long-term care," according to the New Beginnings website,

Inquiries about the notice and CMS survey were referred to Terry Walker, a regional administrator for New Beginnings. Walker did not return several calls seeking comment.


The board of directors of the John M. Reed Home issued a statement on Wednesday. It described New Beginnings as "the management company leasing the facility."

The not-for-profit John M. Reed Home is operated by the board, which consists of community members and members of the Church of the Brethren.

"The board was in the process of ending the lease agreement with the management company and regaining control of the facility when this action took place against the management company," the statement said.

It said that under the terms of the notice, Medicaid and Medicare patients will have to be moved from the facility over the next 30 days, and no new Medicaid and Medicare patients "can be accepted until the board can regain control of the facility, re-apply for acceptance into the Medicaid and Medicare programs and be approved."

The action will not affect private-pay and assisted living residents who will remain at the John M. Reed Home, the statement said.

The John M. Reed facility "has been taking care of people in this community in need of assisted living and nursing home services from our area for 51 years," the statement said.

It is licensed for 63 beds, although the exact number of patients at the facility today was unclear.

"The John M. Reed board recognizes the importance of this facility in the Limestone community and pledges to work with CMS and the state of Tennessee to keep the facility open to other patients and to regain Medicaid and Medicare certification as quickly as possible," it said.

The board of directors "acknowledges and appreciates the assistance of local and state governmental representatives and elected officials as they move forward in this process," the statement concludes.

State Department of Health spokeswoman Shelley Walker said that the facility surveys were conducted by state inspectors.

"The state regulations for the facility mirror federal regulations, and we use the CMS forms to report findings. We are awaiting the submission of an acceptable plan of correction from the facility," Walker said in an email response to questions.

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