How assisted living is licensed in Knoxville and East Tennessee

Which agency licenses assisted living in Knoxville, Tennessee?

The Tennessee Health Facilities Commission (HFC) licenses every assisted living building in Knoxville and the surrounding counties; the legal term is Assisted-Care Living Facility, or ACLF, and the standards are in Tenn. Comp. R. & Regs. chapter 0720-26.

The HFC took over this work in 2022. Public Chapter 1119 merged the old Health Services and Development Agency with the Department of Health's Office of Health Care Facilities into one independent commission, and the facility rules were renumbered from chapter 1200-08 to chapter 0720 on July 1 of that year. Older brochures that mention “the Department of Health” are describing the same function under its previous home. The HFC is also the agency CMS relies on to survey Medicare- and Medicaid-certified providers in Tennessee.

Knox County, the City of Knoxville, Farragut, Maryville, Oak Ridge and the other local governments in the region do not license care settings. Codes and zoning apply to the building, but the right to accept residents comes only from the state license.

What makes a building an assisted-care living facility under Tennessee law?

An ACLF is a building, complex or distinct part of one that takes in primarily aged persons for domiciliary care and services, and “primarily aged” means at least 51% of residents are 62 or older (0720-26-.02(7) and (34)).

In practice an ACLF supplies housing, meals, protective oversight and non-medical help with bathing, dressing and similar daily tasks, and it may administer medications people usually take on their own. It can also arrange any medical service a person could get in a private home: visiting nurses, therapy, podiatry, medical equipment and hospice. Tennessee keeps one assisted living license rather than tiers, and a building with a locked dementia area reports those beds as secured beds inside the same license.

The October 2026 bed report lists 57 licensed ACLFs in Knox, Blount, Anderson, Loudon, Sevier, Roane and Union counties with 4,032 licensed beds, 1,133 of them secured; 33 are in Knox County.

How much is an ACLF license fee in Tennessee, and why should families care?

The annual fee is set by licensed beds, from $1,040 for a building under 25 beds up to $2,860 at 175 to 199 beds, plus $200 for every 25 beds over 199 (0720-26-.04(1)).

Because operators pay by the bed and may not house more residents than the license allows, the licensed-bed figure on the state's bed report is a dependable measure of a building's size. Licenses expire each year on the anniversary of their first issue; a building that lets one lapse for more than 60 days has to reapply and pass a new inspection. A license also belongs to one operator at one address, so a sale or move requires a new application. That is why some HFC orders mention a “contingent change of ownership.”

Who has to run a Tennessee ACLF, and what qualifies them?

Each ACLF needs an administrator certified by the state licensing board, or a Tennessee-licensed nursing home administrator, who is at least 21, has a high school diploma or GED, has passed a criminal background check, has no conviction for abusing or neglecting a vulnerable adult, and completes 24 classroom hours of continuing education every two years (0720-26-.03(9)).

The operator must also designate someone to act when the administrator is away, keep an alert and awake responsible attendant on duty around the clock, have a licensed nurse available as needed, and use a qualified dietitian on staff or as a consultant (0720-26-.06(1)). Nobody on the state abuse registry may be hired. When you ask who is accountable at a Knoxville community, expect the certified administrator's name and, where one exists, the management company that HFC's listing shows.

How often must Tennessee inspect an ACLF?

Rule 0720-26-.05(1) requires an unannounced inspection within 15 months of the previous one, and as often as needed to protect residents; surveyors may enter at any time and must be given every required record.

When surveyors cite deficiencies, the operator gets a written statement and ten days to return a plan of correction saying what will be fixed, by when, and how it will be monitored so it does not recur (0720-26-.05(2)). Missing that deadline is itself grounds for discipline. Our facility pages repeat the “date of last survey” exactly as HFC's public listing shows it. Some of those dates are older than 15 months; that is a prompt to ask the building for its newest survey, not evidence of a skipped inspection, because the listing is not always updated promptly.