Jefferson Park at White Pine — nursing home in White Pine, TN

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 30 CMS-certified beds (not state-licensed beds)
Licensed beds: State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead.
Average residents per day: 29.1 CMS, MDS-derived
CMS Certification Number: 445542
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Oct 25, 2023
Ownership type: Government - County
Operator (legal business name): Jefferson County Nursing Home
CMS chain: Not part of a CMS-reported chain
Phone: (865) 327-4100
Resident & family council: Resident
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

Inspection record · CMS window

Verified

Inspections

4

latest May 28, 2026

Citations

9

4 health · 5 fire

Harm or worse

0

no immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D4	E2	F1
Minimal	A·	B1	C1

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

0

$0

Payment denials

0

Latest

—

Federal certification

Federal · CMS

Authority: Centers for Medicare & Medicaid Services (CMS), surveyed by the state survey agency
CCN: 445542
Program: Medicare and Medicaid
Medicare (SNF): Certified
Medicaid (NF): Certified
Certified beds: 30
First approved: Oct 25, 2023
Located in a hospital: No
Status: Active CMS certification as of CMS release Oct 1, 2026
Evidence: Verified

State license

State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead. State coverage for Tennessee.

Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

Date	Domain	Survey types	Citations	Most severe	Open
May 28, 2026	Fire safety	Fire Safety Standard	5	Potential harm	—	Open →
May 28, 2026	Health	Health Complaint, Health Standard	4	Potential harm	—	Open →
Oct 24, 2023	Fire safety	Fire Safety Standard	0	No citations	—	Open →
Oct 24, 2023	Health	Health Standard	0	No citations	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

No fines or payment denials in the CMS Penalties file for this CCN.

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D4	E2	F1
Minimal	A·	B1	C1

By concept

Date	Tag	Deficiency	Scope / severity	Correction	Flags
May 28, 2026	K-0324	Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 30, 2026
May 28, 2026	K-0353	Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 30, 2026
May 28, 2026	K-0712	Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Jun 30, 2026
May 28, 2026	K-0911	Meet requirements for the installation and maintenance of electrical systems. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 30, 2026
May 28, 2026	K-0923	Have proper medical gas storage and administration areas. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Jun 30, 2026
May 28, 2026	F-0761	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. Pharmacy Service Deficiencies · Medication management	E · Potential harm Pattern	Corrected Jun 30, 2026
May 28, 2026	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Corrected Jun 30, 2026	Complaint
May 28, 2026	F-0656	Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care	C · Minimal Widespread	Corrected Jun 30, 2026
May 28, 2026	F-0851	Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Administration Deficiencies · Administration & records	B · Minimal Pattern	Corrected Jun 30, 2026

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Five-Star ratings

Federal · CMS

Overallstate 3.1

Health inspectionsstate 3

Staffingstate 2.5

Quality measuresstate 3.7

Long-stay QM

Short-stay QM

CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.

Nurse staffing · hours per resident per day

Total nurse staffing5.66

State avg 3.82US avg 3.90

Registered nurse (RN)0.47

State avg 0.60US avg 0.69

Licensed practical nurse1.50

State avg 1.08US avg 0.86

Nurse aide3.69

State avg 2.14US avg 2.35

Weekend total nurse5.34

State avg 3.32US avg 3.43

Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 6.04 (case-mix index 1.31).

Staff turnover

Total nursing staff turnover41.5%

State avg 48.6%US avg 45.3%

Registered nurse turnover83.3%

State avg 43.2%US avg 42.5%

Administrators who left0

State avg 1US avg 1

Health survey score

Cycle 1 standard survey: May 28, 2026
Cycle 1 health score: 16
Total weighted score: 12

Operating entity

Jefferson County Nursing Home

CMS legal business name of the certified provider. Operates 3 facilities.

VerifiedLinked by exact legal name

CMS chain

Not part of a CMS-reported chain.

Ownership disclosures

Disclosures

3

Organizations

0

Individuals

3

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Roger Mynatt	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Jan 2, 1992
Mark Potts	Individual	Corporate officer / director	CORPORATE DIRECTOR	not provided	Aug 23, 2018
Roger Mynatt	Individual	Managing employee	W-2 MANAGING EMPLOYEE	not provided	Jan 2, 1992

Other facilities operated by Jefferson County Nursing Home

All 2 →

Facility	Beds	CMS overall	Last inspection	Citations (window)	Fines
Jefferson County Nursing Home 910 Main Street, Fayette, MS 39069 CCN 255164	60		Jul 30, 2026	10	—
Jefferson County Nursing Home 914 Industrial Park Rd, Dandridge, TN 37725 CCN 445473	160		Dec 12, 2025	25	—

No building or property record is linked to this facility yet. Parcel, assessor and building-permit joins will be added only where a valid site match exists.

Coordinates as published by CMS (geocoding footnote 22).

Address: 407 Laura Lee Dr, White Pine, TN 37890
ZIP: 37890
County: Jefferson County FIPS 47089
State: Tennessee
Urban / rural (CMS): Urban

Within ~25 km

Nearby nursing homes

Facility	Distance	Beds	CMS overall	Last inspection	Citations (window)	Fines
Newport Tn Opco LLC 135 Generation Drive, Newport, TN 37821 CCN 445504	9.8 km	150		Aug 20, 2025	282 harm	—
Tennova Newport Convalescent Center 450 College St, Newport, TN 37821 CCN 44E132	12.8 km	56		Jun 18, 2026	13	—

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	445542	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	445542	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026

Record-level source links for CCN 445542

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction