Dadeville Healthcare Center
351 North East Street, Dadeville, AL 36853 · For profit - Limited Liability company · 144 certified beds · (256) 825-9244 Medicare & Medicaid certified
The public record raises real questions here. Weigh the concerns below carefully.
- no federal fines or payment denials on record
- a high payroll-based staffing rating (5/5)
- lower-than-typical staff turnover (34% vs 45% nationally) — better care continuity
- it has a citation for its abuse-prevention policies, restraint use, or reporting and investigating of allegations (F0609) — cited below the harm level, meaning inspectors found the process wanting but did not find a resident harmed
- a high number of inspection citations overall (16) — worth reading through, though larger and more-often-surveyed homes tend to accrue more lower-severity tags
- its payroll-based staffing score sits well above its independent inspection score
- its independent health-inspection rating is low (2/5)
- its facility-reported quality-measure rating is low (2/5)
- about 20% of its spending goes to commonly-owned related companies
- its last standard health inspection was over 5 years ago — the star rating may not reflect current conditions
One thing this read cannot see: what residents and families actually experience day to day. Public data misses the feel of a place — visit unannounced, ideally at a mealtime or on a weekend, talk to staff and families, and ask your tour questions.
A plain-English summary of the public record below — not a rating, ranking, or recommendation. We take no money from any facility.
| Health inspectionSurveyor-assigned, ranked within your stateInspector-verified | 2 of 5 |
| StaffingFrom payroll records (PBJ) | 5 of 5 |
| Quality measuresSelf-reported by the facility | 2 of 5 |
Worth a closer look. This home's staffing rating runs 3 stars above its independent health-inspection score. The inspection is done by state surveyors; the staffing score rests on the facility's own payroll (PBJ) submissions — so a gap this large is worth reading the inspection record for.
Location & what’s nearby
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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.
Quality measures — how residents actually fare
| Overall quality measures | 2 of 5 |
| Long-stay residentspeople who live here | 4 of 5 |
| Short-stay residentsrehab / post-hospital | 1 of 5 |
Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.
Trend — is this home getting better or worse?
Over 2025-02 to 2026-06, this home’s CMS overall rating improved from 1 to 3 stars. From monthly CMS archive snapshots.
Horizontal axis runs 2025-02 to 2026-06. That is where CMS’s monthly archive ends, so the right-hand edge of each line is that month — not today.
See all quality measures vs. state & national benchmarks
| Measure | This home | State avg | Typical state | vs typical state |
|---|---|---|---|---|
| Long-stay residents whose need for help with daily activities increased | 11.0% | 12.0% | 15.4% | better |
| Long-stay residents who lose too much weight | 2.5% | 5.4% | 5.4% | better |
| Long-stay residents with a catheter left in their bladder | 1.0% | 1.0% | 0.9% | worse |
| Long-stay residents with a urinary tract infection | 1.3% | 2.4% | 2.0% | better |
| Long-stay residents with depressive symptoms | 0.6% | 1.4% | 6.5% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents who were physically restrained | 0.0% | 0.6% | 0.1% | better than state‡ — see note marked double-dagger below the table |
| Long-stay residents with falls causing major injury | 3.4% | 3.3% | 3.3% | typical |
| Long-stay residents whose ability to walk worsened | 8.2% | 12.1% | 16.1% | better |
| Long-stay residents on antianxiety or hypnotic medication | 18.9% | 24.5% | 18.9% | typical |
| Long-stay residents given the seasonal flu vaccine | 99.0% | 94.8% | 95.3% | typical |
| Long-stay residents with pressure ulcers | 5.0% | 5.4% | 4.7% | typical |
| Long-stay residents with worsening bladder/bowel control | 15.0% | 12.8% | 21.2% | better |
| Long-stay residents who got an antipsychotic medication§ — see the note below the table | 28.3% | 21.2% | 17.1% | worse |
| Short-stay residents who newly got an antipsychotic medication | 0.9% | 2.0% | 1.4% | better |
| Short-stay residents given the seasonal flu vaccine | 81.8% | 80.3% | 79.4% | typical |
| Short-stay residents rehospitalized after admission | 30.2% | 24.8% | 22.6% | worse |
| Short-stay residents with an outpatient ER visit | 9.0% | 11.3% | 12.0% | better |
| Long-stay hospitalizations per 1,000 resident days | 1.79 | 1.96 | 1.67 | typical |
| Long-stay outpatient ER visits per 1,000 resident days | 1.69 | 1.70 | 1.80 | typical |
‡ On this measure the state average is at least twice (or half) the typical state — a gap that size is usually how the state codes and reports the measure, not how its homes actually perform. Against a benchmark this state does not sit on, a “vs typical state” verdict would mostly be measuring the state, so we compare this home with its own state instead and show both averages.
§ Antipsychotics carry an FDA boxed warning — they raise the risk of death in older people with dementia-related psychosis, and are not approved for that use. So this measure is partly a read on whether a home sedates residents instead of staffing for them. But read a low rate carefully in both directions: CMS excludes residents coded with schizophrenia (and Tourette's or Huntington's) from this measure, and federal auditors have found implausible increases in schizophrenia coding since the measure was published — so a very low rate can reflect recoding rather than less prescribing. Ask the home what share of its residents carry a schizophrenia diagnosis, and how it handles behavioral symptoms without medication.
CMS quality measures, as Care Compare shows them. For most rows lower is better (fewer falls, ulcers, hospitalizations); vaccination rates are the exception. Not every row is risk-adjusted. CMS adjusts some measures for resident mix, but falls with major injury, antipsychotic use, physical restraints and the vaccination rates are unadjusted rates — so a home caring for heavier or more behaviorally complex residents can look worse on them without providing worse care. The “typical state” column is the median of the 50 state averages — not a national average of all homes. We use it because a plain average across homes is pulled badly off course by a few states’ reporting habits (long-stay depressive symptoms is the clearest case: Illinois codes it several times higher than most states, which alone lifted the all-homes figure to about twice what a typical state records). The median of state averages resists that — but it does weigh every state equally, so a large state counts no more than a small one, and it is a benchmark of our construction rather than a CMS-published figure. better/worse means the home differs from that benchmark by more than 10% of it; closer than that reads typical. CMS does not publish how many residents each measure covers, and the counts are often small — a single resident can move a rate by several points — so treat small gaps as noise. These come from data the facility reports, so weigh them against the independent inspection record above.
Short-stay rehab — if you are coming here from a hospital
Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.
30.5% of the Medicare patients who left this home got back to the community and stayed there for at least 31 days — CMS rates that worse than the national rate. This is CMS’s risk-adjusted rate over 37 Medicare stays in Oct 2022–Sep 2024, and CMS’s own comparison — not ours.
Therapy staffing: this home’s payroll records show 0.14 therapist hours per resident per day in 2026Q1 — more than 10% of the 13,892 homes that report any therapy hours at all.
Weekend therapy: weekend therapy hours are 12% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.
This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.
See every short-stay measure CMS publishes for this home
| Measure | This home | U.S. median | Period covered | CMS’s call |
|---|---|---|---|---|
| Got home and stayed homeRate of successful return to home or community from a SNF | 30.5%CMS range 21.5–44.3 | 51.5% | Oct 2022–Sep 2024 | worse than U.S. |
| Went back to hospitalRate of potentially preventable hospital readmissions 30 days after discharge from a SNF | 10.2%CMS range 6.4–17.2 | 10.7% | Oct 2022–Sep 2024 | no different from U.S. |
| Met the expected recoveryPercentage of residents who are at or above an expected ability to care for themselves and move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Self-care at dischargePercentage of residents who are at or above an expected ability to care for themselves at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Moving around at dischargePercentage of residents who are at or above an expected ability to move around at discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication problems followed upPercentage of residents whose medications were reviewed and who received follow-up care when medication issues were identified | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the next providerPercentage of residents where the SNF provided a current medication list to the next health care setting | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medication list to the familyPercentage of residents where the SNF provided a current medication list to the resident, family, and/or caregiver at final discharge | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Falls with major injuryPercentage of SNF residents who experience one or more falls with major injury during their SNF stay | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| New or worsened pressure ulcersPercentage of residents with pressure ulcers/pressure injuries that are new or worsened | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Infections that led to hospitalPercentage of infections residents got during their SNF stay that resulted in hospitalization | not reported — The number of residents or resident stays is too small to report. Call the facility to discuss this quality measure. | — | ||
| Medicare spending per stayMedicare Spending Per Beneficiary (MSPB) for residents in SNFs | 0.71 | 1.02 | Oct 2022–Sep 2024 | CMS makes no comparison for this measure |
From the CMS Skilled Nursing Facility Quality Reporting Program — Medicare short-stay outcomes, which is a different dataset from the long-stay quality measures above and describes a different set of residents. Where CMS risk-adjusts a measure we show its adjusted rate, and the CMS range beside it is the confidence interval CMS publishes: a home whose range is wide is a home with few stays, where one patient moves the number several points. Read the period column. These measures do not share a window — the claims-based ones (getting home, readmission, spending) lag by a year or more, because a stay has to finish and its claims settle before it can be counted. CMS’s call is CMS’s, not ours: it is the only place anyone tests whether this home differs from the national rate at all, and most homes on most measures do not. Two caveats on it. CMS tests only three of these measures — getting home, readmission, and infections that led to hospital; on the other nine it publishes a rate and no comparison, and rather than compute a verdict CMS declined to make, we say so in the column. And on readmission almost every home in the country lands on “no different”, so that row separates homes far less than getting-home does — which is why met the expected recovery, a measure CMS does not test but which spreads across the whole range, is called out above the table rather than left in this list. The U.S. median column is our own, taken across every home CMS publishes that measure for in this same file; it is not a CMS-published benchmark. Homes CMS gives no rate for are left out of it rather than counted as zero. Medicare spending per stay is a ratio, not a percentage — 1.00 means this home’s Medicare spending for a stay matched the national figure CMS compares it against, and it measures cost to Medicare, not quality of care.
Staffing
How full it usually is: this home is certified for 144 beds and averages 101.0 residents a day — about 70% occupied, or roughly 43 beds typically open. It usually has some room. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.
Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 4.41 hrs/resident/day is at or above the 3.48-hour benchmark and RN staffing of 0.65 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 2.96 is at or above the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.
Weekend coverage: total nurse staffing is 3.73 hrs/resident/day on weekends vs 4.69 on weekdays — 20% thinner on weekends — a notable drop. RN hours go from 0.82 to 0.21 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)
This home’s total nursing-staff turnover of 34% is below the national median of 45%.
Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.
Inspection trend
Deficiencies are more than at the previous inspection — worsening. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.
This trend is not current. The most recent of these two inspections was over 5 years ago; the arrow describes what inspectors found then, not what the home is like now.
Inspection deficiencies
State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.
Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.
16 citations, most serious first. The 10 most serious are shown; the remaining 6 are one tap away and print in full.
- Potential for harm · E2021-04-22 · tag F0688 — failed to keep residents mobile / prevent decline — patternProvide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observations, interviews, record review, and policy review, the facility failed to provide services to three of eight residents (Resident Identifier (RI) #67, #11, and #73) reviewed for limitations in range of motion (ROM) in a total sample of 23. The facility failed to assess residents with ROM impairments and provide services to maintain function or prevent declines. In addition, the facility failed to implement established restorative programs for residents with programs in place. Findings include: A policy for the Functional Maintenance Plan (FMP)/Restorative Nursing was requested. The Rehab Nurse, Employee Identifier (EI) #4, brought a policy to the surveyor dated 04/21/21. EI #4 stated she just wrote the policy; there was no policy previously. Review of the policy revealed therapy staff would give the FMP to the restorative nurse who would initiate the plan as recommended on the FMP. The policy read, After approx (approximately) 2 weeks the nurse will forward the FMP to the therapy department…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2021-04-22 · tag F0761 — failed to label and store drugs safely — patternEnsure 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.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation and interviews, the facility failed to keep medications under safe and secure storage with limited access and under direct observation of authorized staff for one of six medication carts observed. In addition, the facility failed to ensure insulin vials and pens were dated when opened for four of six medication carts observed which affected six of 21 residents identified by the facility as having used insulin. Findings include: 1. Review of an undated facility policy titled, Administration of Medications, revealed .Medication carts shall be kept in sight or locked whenever back is turned or away from the cart .No one shall have access to drugs in the medication carts except the licensed nurses for that specific unit . On 04/19/21 at 12:45 PM, an observation of the medication cart on Hall Two Long-Term Care (LTC) was observed unlocked. The licensed nurse was away from the cart and there was no licensed nurse on the hall. During a continuous observation of the medication cart from 12:45 PM to 1:16 PM, the medication cart remained unlocked. During an observation…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · E2021-04-22 · tag F0880 — failed to prevent and control infections — patternProvide and implement an infection prevention and control program.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on observation, interview, and record review, the facility failed to ensure three of three residents (Resident Identifier (RI) #28, RI #50 and RI #282) reviewed for oxygen (O2) therapy in a sample of 23 residents received O2 therapy with equipment that was cleaned and stored in a way to prevent possible contamination. The concentrators had dusty filters and the nasal cannulas were not dated to indicated when the tubing had been changed and the nasal cannulas were not placed in a bag when not in use. This deficient practice had the potential to allow residents to receive therapy with equipment that was not stored properly between uses and increased their risk of infection and/or illness. Findings include: Review of undated maintenance instructions revealed on page 25, under 7.3 Cleaning the Cabinet Filter .1. Remove the filter and clean as needed. Environmental conditions that may require more frequent inspection and cleaning of the filter include but are not limited to high dust, air pollutions, etc. 2. Clean the cabinet filter with a vacuum cleaner or wash with a mild liquid…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-22 · tag F0550 — failed to protect resident dignity and rights — isolatedHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to provide dignity in toileting for one of 23 sampled residents (Resident Identifier (RI) #8). The facility staff failed to provide RI #8 with interventions, such as assisting to the bathroom, a bedside commode, or bed pan, to remain continent but instead provided adult briefs for bowel and bladder function. Findings include: Review of the admission Record located in the paper medical chart revealed RI #8 was originally admitted to the facility on [DATE]. RI #8 was discharged back to the assisted living and was readmitted to the facility on [DATE] and on 10/16/20 after receiving care at the hospital for fractures. On 04/19/21 at 3:16 PM, RI #8 was observed lying in bed. This surveyor interviewed RI #8 who stated he/she wore a diaper, so he/she didn't have to get up to go to the bathroom. RI #8 stated, he/she had been continent, and it was awful being incontinent and having to wear an adult incontinence brief, but he/she was used to wearing…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-22 · tag F0623 — isolatedProvide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on record review and interview, the facility failed to provide written notice of a transfer for one of one resident (Resident Identifier (RI) #31) reviewed for hospital transfers to the resident and the resident representative when the resident was transferred to the hospital; and failed to notify the State office of the Ombudsman of resident transfers. Findings include: Review of RI #31's Face Sheet, dated 02/05/21, located in RI #31's paper medical record, showed a facility admission date of 10/26/20 and a re-admission date of 02/05/21. Review of RI #31's nursing Progress Notes, dated 01/31/21 at 11:45 AM, located in RI #31's paper record under the nurses notes tab, revealed Res [resident] still has had no results from Lactulose on 01/29/21 or MOM [Milk of Magnesia] + senna syrup on 01/30/21 . PC [placed call] to . CRNP [Certified Registered Nurse Practitioner], order received . to send to (local hospital) ER (Emergency Room) for eval [evaluation] of positive ABD [abdominal] x-ray for ileus. Review of RI #31's nursing Progress Notes, dated 01/31/21 at 12:35 PM, located in RI…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-22 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolatedEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to have an effective system to identify safety risks related to side rails for one of one resident (Resident Identifier (RI) #11) reviewed for side rails. The facility failed to ensure the correct assessed side rail was utilized to prevent potential accidents hazards. Findings include: Review of the admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 01/28/21, Resident Identifier (RI) #11 was admitted to the facility on [DATE] with diagnoses which included seizures and a fracture of the left leg. This MDS showed RI #11 was cognitively intact for daily decision-making skills and required extensive assistance with bed mobility and transfers. Review of the Care Plans, located in the paper medical chart under the care plan tab, revealed a Risk for Falls care plan, dated 01/21/21, with an approach for side rails up x 2 for turning and repositioning. Review of the Physicians Orders, dated 01/21/21 and located in the paper…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2021-04-22 · tag F0758 — failed to limit and justify psychotropic drugs — isolatedImplement 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.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, record review, and policy review, the facility failed to ensure one out of five residents reviewed for unnecessary medications (Resident Identifier (RI)# 47) had a medication regimen free of unnecessary medications. The resident was prescribed as needed (PRN) antipsychotic medication without a stop order and without a physician re-evaluation after 14 days. Findings include: Review of the facility's Anti-Psychotic Drugs policy (undated) revealed antipsychotic medication would be used only when it was necessary to treat a specific condition. The only guidance regarding PRN antipsychotic medications was, PRN anti-psychotic drugs should not be used more than five (5) times in any seven (7) day period without a review of the resident's condition by a physician. The requirement for a PRN antipsychotic prescription of no more than 14 days and the requirement for Physician reassessment was not included in the policy. Review of the admission Face Sheet, dated 01/29/21 and located in the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2019-02-14 · tag F0609 — failed to report abuse allegations — isolatedTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interview and a review of the facility policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, the facility failed to ensure an allegation of abuse, involving Resident Identifier (RI) #155, was reported to the State Agency (SA). This affected one of three sampled residents reviewed for abuse. A review of a facility policy titled, Abuse, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, with an effective date of 11/28/2016, revealed: PURPOSE: To ensure the safety and well-being of each resident, the facility will promote and protect the rights of each resident.VII. REPORTING /RESPONSE A. In response to allegations of abuse . are reported immediately, but not later than 2 hours after the allegation is made . to other officials (including to the State Survey Agency .). On 08/16/2018 the State Agency received a complaint from a family member of RI #155. The family member reported that she spoke to the owner and ( Employee Identifier #5 ) alleging that RI #155 was mistreated by a male…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · F2018-01-04 · tag F0730 — widespreadObserve each nurse aide's job performance and give regular training.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interviews, record review, and review of annual Certified Nursing Assistant (CNA) competency/performance review documentation, the facility failed to ensure a system was in place to assess CNAs performance at least once every twelve months. This affected three of three CNAs reviewed and had the potential to affect all 86 residents residing in the facility. Findings include: On at 01/03/18 at 11:18 AM Employee Identifier (EI) #4, Director of Nursing Assistant, provided information related to yearly Certified Nursing Assistant (CNA) competencies. This documentation included a page from the Facility Assessment indicating the facility would conduct and document annual competency reviews. Also included were QAPI (Quality Assurance Process Improvement)Committee Minutes dated 11/17/2017. These minutes indicated staff would be inserviced on the need for annual training. They also indicated annual skills check-offs would start on 01/01/2018. When asked for annual competencies on EI #s 5, 6, and 7, CNAs, the facility was only able to provide pericare/incontinence care sign-offs for…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2018-01-04 · tag F0582 — isolatedGive residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
What the surveyor found here — an excerpt from the official record, may be distressing
Based on interviews, review of the Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS-10095 and Form Instructions Advance Beneficiary Notice of Noncoverage (ABN), and review of Resident Indentifer (RI)# 54's beneficiary notifications, the facility failed to ensure Resident #54 and/or the resident representative were issued beneficiary liability notices at least two days prior to the end of Medicare Part A covered days. This affected one of three residents reviewed for liability notices. Findings include: On 01/02/18 at 5:38 PM the facility Administrator stated the facility did not have a policy addressing NOMNC or SNFABNs. Review of the Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS-10095 revealed the following: When to Deliver the NOMNC A Medicare health provider must give an advance, completed copy of the Notice of Medicare Non-Coverage (NOMNC) to enrollees receiving skilled nursing .no later than two days before the termination of services . Review of the Form Instructions Advance Beneficiary Notice of Noncoverage (ABN) revealed the…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
Show the remaining 6 citations
- Potential for harm · D2018-01-04 · tag F0635 — isolatedProvide doctor's orders for the resident's immediate care at the time the resident was admitted.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interviews, and review of facility's Resident admission Checklist, the facility failed to ensure Resident Indentifer (RI)# 88 had orders in place from the time of admission, addressing the need for oxygen. This affected one of 21 residents for whom physician's orders were reviewed Findings include: Review of the facility's Resident admission Checklist revealed upon admission all admission orders should be transcribed and the chart contents should be verified, including admission orders, history and physical, and all physician's orders. RI# 88 was admitted to the facility on [DATE] with diagnoses of Acute Diastolic Congestive Heart Failure, Left Ventricular Failure, Chronic Kidney Disease Stage 3, and Paroxysmal Atrial Fibrillation. A review of hospital records prior to RI# 88's admission to the facility, dated 9/8/2017, indicated RI# 88 reported using oxygen while at home, and documented the resident used a flow rate of 2 L/min (liters per minute). A review of RI# 88's Nurses Notes…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2018-01-04 · tag F0637 — isolatedAssess the resident when there is a significant change in condition
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews, the facility failed to ensure a Significant Change in Status Minimum Data Set (MDS) Assessment was initiated after a decline in two areas, indwelling urinary catheter and pressure ulcer. This affected Resident Identifier (RI) #72one of 21 residents for whom MDS assessments were reviewed. Findings include: Resident Identifier (RI) #72 was admitted to the facility on [DATE], and discharged on 11/23/17. On 11/27/17, RI #72 was readmitted to the facility with the following diagnosis including Sepsis, Hypertension, and Stage III pressure ulcer A review of the most recent Quarterly MDS with an assessment reference date of 10/ 08/2017, revealed in section H, the resident was incontinent of bowel and bladder and used no appliances. Also in Section M on the MDS the resident was identified as at risk of developing pressure ulcers but at the time of this assessment no pressure ulcer was identified. Employee identifier (EI) #10 Registered Nurse (RN) MDS Coordinator, was interviewed on…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2018-01-04 · tag F0656 — failed to write and follow a full care plan — isolatedDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews, the facility failed to ensure: 1) Resident Identifier (RI) #35's dialysis care plan approach to monitor fluid intake was implemented; 2) A care plan was developed to address RI #72's catheter. These failures affected 2 of 21 residents for whom care plans were reviewed. Findings include: 1. RI #35 was admitted to the facility on [DATE], and readmitted on [DATE], with diagnoses including Type Two Diabetes, and End Stage Renal Disease. A review of RI #35's Quarterly Minimum Data Set with an Assessment Reference Date of 10/29/2017 revealed his brief interview for mental score was a 15 indicated the resident was cognitively intact. Also in section O of the MDS the resident was identified as requiring treatment for Dialysis. A review of the physician orders dated December 2017, revealed the resident goes out of the facility for dialysis three days a week on Monday , Wednesday, and Friday, and was on a 1500 cubit centimeters(cc) fluid restriction. A review of the resident medical…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2018-01-04 · tag F0658 — failed to meet professional standards of care — isolatedEnsure services provided by the nursing facility meet professional standards of quality.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interviews, and review of [NAME] and [NAME], Fundamentals of Nursing, EIGHTH EDITION, the facility failed to ensure staff completed an order for O2 (oxygen) saturations every shift for five days from 9/27-10/1/2017. This affected one of 21 residents for whom physician's orders were reviewed. Findings include: Review of [NAME] and [NAME]'s 'Fundamentals of Nursing, Eighth Edition, copyright 2013, revealed the following: . Chapter 23 Legal Implications in Nursing Practice . Health Care Providers' Orders. The health care provider (physician .) is responsible for directing medical treatment. Nurses follow health care providers' orders unless they believe the orders are in error or harm patients. Resident # 88 was admitted to the facility on [DATE] with diagnoses of Acute Diastolic Congestive Heart Failure, Left Ventricular Failure, Chronic Kidney Disease Stage 3, and Paroxysmal Atrial Fibrillation. Review of Resident # 88's Physician Orders revealed a written order dated 9/27/2017 to monitor…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2018-01-04 · tag F0698 — failed to provide proper dialysis care — isolatedProvide safe, appropriate dialysis care/services for a resident who requires such services.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review and interviews, the facility failed to ensure staff monitored Resident #35's fluid intake, a resident dependent on hemodialysis with orders for fluid restriction. This affected one of three residents reviewed for Dialysis. Findings include: RI #35 was admitted to the facility on [DATE], and readmitted on [DATE], with diagnoses including Type Two Diabetes, and End Stage Renal Disease. A review of RI #35's Quarterly Minimum Data Set with an Assessment Reference Date of 10/29/2017 revealed his brief interview for mental score was a 15 indicated the resident was cognitively intact. Also in section O of the MDS the resident was identified as requiring treatment for Dialysis. A review of the physician orders dated December 2017, revealed the resident goes out of the facility for Dialysis three days a week on Monday , Wednesday, and Friday, and was on a 1500 cubit centimeter (cc) fluid restriction. 01/04/18 10:22 AM an interview with Employee identifier (EI) 11, how do you know how much fluid RI…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Potential for harm · D2018-01-04 · tag F0842 — failed to keep accurate, complete medical records — isolatedSafeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
What the surveyor found here — an excerpt from the official record, may be distressing
NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on record review, interviews, and review of [NAME] and [NAME], Fundamentals of Nursing, EIGHTH EDITION, the facility failed to ensure nursing staff documented in Resident #88's medical record that the resident collapsed while being assisted to the bathroom on [DATE]. Further, nursing staff did not document their response to Resident #88, including resuscitation efforts, or the subsequent need to transfer him/her to the hospital. This affected one of 21 residents for whom medical records were reviewed. Findings include: Review of [NAME] and [NAME]'s 'Fundamentals of Nursing, Eighth Edition, copyright 2013, revealed the following: .Chapter 26 Documentation and Informatics . GUIDELINES FOR QUALITY DOCUMENTATION AND REPORTING High-quality documentation and reporting are necessary to enhance efficient, individualized patient care. Quality documentation and reporting have five important characteristics: they are factual, accurate, complete, current, and organized . Resident # 88 was admitted to the facility on…
This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.
- Long-Term Care Ombudsman — a free, confidential advocate for the resident. They act only with the resident’s consent and work to resolve the problem. Find yours at theconsumervoice.org/get_help.
- Adult Protective Services — the state agency that investigates suspected abuse, neglect, or exploitation of a vulnerable adult. Not sure of your state’s APS number? The federal Eldercare Locator will route you: 1-800-677-1116 or eldercare.acl.gov.
- State survey agency — the regulator that licenses and inspects the home. Every state has an official nursing-home complaint line and most take complaints online; the Ombudsman or Eldercare Locator can connect you.
Fines & penalties
No federal fines in the current CMS record.
Part of a chain
This home belongs to PRIME HEALTH CARE ENTERPRISES — 5 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →
| Rating | This home | Chain avg | |
|---|---|---|---|
| Overall | 3 of 5 | 4.0 | -1.0 vs chain |
| Health inspection | 2 of 5 | 3.8 | -1.8 vs chain |
| Staffing | 5 of 5 | 4.0 | +1.0 vs chain |
| Quality measures | 2 of 5 | 2.4 | -0.4 vs chain |
The other 4 homes this chain runs (chain average 4.0★, per CMS)
A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.
Who owns this facility
| Owner / manager | Type | Role | Share | Since |
|---|---|---|---|---|
| PRIME HEALTH CARE ENTERPRISES, INC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST; OPERATIONAL/MANAGERIAL CONTROL | NO PERCENTAGE PROVIDED | since 01/01/2004 |
| PRIME HEALTHCARE ENTERPRISE LLC | Organization | 5% OR GREATER DIRECT OWNERSHIP INTEREST | NO PERCENTAGE PROVIDED | since 05/28/2004 |
| SERVISFIRST BANK | Organization | 5% OR GREATER MORTGAGE INTEREST | — | since 03/28/2012 |
| PRIME MANAGEMENT, LLC | Organization | OPERATIONAL/MANAGERIAL CONTROL | — | since 11/18/2003 |
| STEPHENSON, VICKY | Individual | OPERATIONAL/MANAGERIAL CONTROL | — | since 05/01/2016 |
CMS files one row per role, so the 6 rows in the source record cover these 5 parties — each is shown once here with every role it holds. Nothing is omitted.
4 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.
Follow the money — this home’s finances
Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.
About 71% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $2.0M paid to related parties — landlords or management companies under common ownership — equal to about 20% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals.
Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2024. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.
Cost & finances
Straight from this home’s Medicare cost report (CMS, FY2024). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.
What families pay in AL
This is a Medicare- and Medicaid-certified nursing home, so it can accept Medicaid for long-term care — like nearly all U.S. nursing homes. The private-pay figures below are what families without Medicaid pay; once a resident qualifies for Medicaid, out-of-pocket cost for covered nursing-home care is typically close to $0 (almost all of their income goes to the home as their share of the cost; they keep a small personal needs allowance — for clothing, haircuts, a phone — and Medicaid pays the rest). The amount of that allowance is set by each state. Confirm Medicaid-bed availability with the home, and see the Alabama Medicaid page.
Median private-pay cost, CareScout (Genworth) 2025 Cost of Care Survey — a regional midpoint, not any single community’s rate. Private rooms and higher care levels cost more; ask for a current quote. Project your own in the cost-of-care planner.
Every figure above is reproduced from the CMS Provider Data Catalog (a public record), from the CMS extract processed 2026-08-01 — CMS provider number 015166. CMS refreshes its data monthly, and the star rating rests on the last standard inspection — dated 2021-04-22, which can lag current conditions. Staffing hours are CMS PBJ CY2026Q1 (Jan–Mar 2026). Check this record against the government’s own page for it: this home on Medicare Care Compare ↗ — the authoritative source, and the place to confirm anything here before you act on it. How we present it →
Not a government site. Eldercare Lens is not affiliated with, endorsed by, or authorized by the Centers for Medicare & Medicaid Services (CMS), Medicare, or any government agency. The star ratings, citations, and inspection wording on this page are reproduced from the public CMS record; the plain-English summaries, tiers, and comparisons around them are ours. We do not speak for CMS, and CMS has not reviewed this page. For the official record, go to Medicare Care Compare. How we’re funded →
Are you this operator? If the record here is out of date, or misses what you have since fixed, tell us and we will look: hello@eldercarelens.com. We reproduce the public CMS record and cannot change what it says — corrections to the underlying data go through CMS and your state survey agency — but we will correct anything we have got wrong about it, and we will say so on the page.