2 health deficiencies
Top issue: Infection Control (1 deficiency)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Huntsville, AL
4-star overall rating with 4-star inspections with 2 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
12000 Turnmeyer Drive, Huntsville, AL
(256) 881-6717
Overall
4 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Beds
56
Certified beds
Average residents
54
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
2005-07-15
CMS approved date
Coverage
Medicare
Participation flags
Changed ownership
No
Within the last 12 months
Family council
Yes
Resident and family council reported
Sprinklers
Yes
Automatic sprinklers in all required areas
Staffing
RN hours / resident day
0.68
Registered nurse staffing · state 0.64 · national 0.68
LPN hours / resident day
0.82
Licensed practical nurse staffing · state 0.78 · national 0.87
Aide hours / resident day
2.99
Nurse aide staffing · state 2.50 · national 2.35
Total nurse hours
4.49
All reported nurse hours · state 3.91 · national 3.89
Licensed hours
1.50
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
3.62
Weekend nurse staffing · state 3.29 · national 3.43
Weekend RN hours
0.43
Weekend registered nurse coverage · state 0.36 · national 0.47
Physical therapist
0.16
Reported PT staffing · state 0.04 · national 0.07
Adjusted RN hours
0.77
CMS adjusted RN staffing hours
Adjusted total hours
5.07
CMS adjusted total nurse staffing hours
Case-mix index
1.21
Higher values indicate more complex resident acuity
RN turnover
30%
Annual RN turnover · state 42% · national 45%
Total nurse turnover
37%
Annual nurse turnover · state 49% · national 46%
SNF VBP
Program rank
288
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
74.44
Composite VBP score used to determine payment impact.
Payment multiplier
1.0243
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
Readmission
5.90
Baseline 16.99% · Performance 18.70% · Measure score 5.90 · Achievement 5.90 · Improvement 0
Healthcare-associated infections
8.01
Baseline 5.58% · Performance 5.44% · Measure score 8.01 · Achievement 8.01 · Improvement 1.88
Total nurse turnover
8.36
Performance 29.51% · Measure score 8.36 · Achievement 8.36 · This facility did not have sufficient data to calculate a baseline period measure result.
Adjusted total nurse staffing
7.51
Baseline 4.89 hours · Performance 5.21 hours · Measure score 7.51 · Achievement 7.51 · Improvement 3.17
SNF QRP
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 12.78% |
10.72%
2.1 pts worse
|
No Different than the National Rate · Eligible stays 248 · Observed rate 11.29% · Lower 95% interval 9.53% |
| Discharge to community | 53.65% |
50.57%
3.1 pts better
|
No Different than the National Rate · Eligible stays 215 · Observed rate 53.49% · Lower 95% interval 48.72% |
| Medicare spending per beneficiary | 0.67 |
1.02
0.3 pts better
|
|
| Drug regimen review with follow-up | 83.85% |
95.27%
11.4 pts worse
|
Numerator 109 · Denominator 130 |
| Falls with major injury | 0.77% |
0.77%
About the same
|
Numerator 1 · Denominator 130 |
| Discharge self-care score | 51% |
53.69%
2.7 pts worse
|
Numerator 51 · Denominator 100 |
| Discharge mobility score | 43% |
50.94%
7.9 pts worse
|
Numerator 43 · Denominator 100 |
| Pressure ulcers or injuries, new or worsened | 1.54% |
2.29%
0.8 pts better
|
Numerator 2 · Denominator 130 · Adjusted rate 1.45% |
| Healthcare-associated infections requiring hospitalization | 5.44% |
7.12%
1.7 pts better
|
No Different than the National Rate · Eligible stays 140 · Observed rate 2.14% · Lower 95% interval 2.95% |
| Staff COVID-19 vaccination coverage | 3.48% |
8.2%
4.7 pts worse
|
Numerator 4 · Denominator 115 |
| Staff flu vaccination coverage | 18.26% |
42%
23.7 pts worse
|
Numerator 21 · Denominator 115 |
| Discharge function score | 63% |
56.45%
6.5 pts better
|
Numerator 63 · Denominator 100 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 41 · Denominator 41 |
| Transfer of health information to patient | 98.21% |
96.28%
1.9 pts better
|
Numerator 55 · Denominator 56 |
| Resident COVID-19 vaccinations up to date | 23.08% |
25.2%
2.1 pts worse
|
Numerator 15 · Denominator 65 |
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.6 |
2.0
0.4 pts better
|
1.9
0.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 1.6 · Observed 1.5 · Expected 1.8 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 0.5 |
1.8
1.3 pts better
|
1.8
1.3 pts better
|
Long Stay · 20240701-20250630 · Adjusted 0.5 · Observed 0.5 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.5% |
91.3%
8.2 pts better
|
93.4%
6.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 97.9% · Q3 100.0% · Q4 100.0% · 4Q avg 99.5% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 98.0% |
94.8%
3.2 pts better
|
95.5%
2.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 98.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 8.6% |
3.4%
5.2 pts worse
|
3.3%
5.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 6.5% · Q2 12.8% · Q3 8.9% · Q4 6.4% · 4Q avg 8.6% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 0.0% |
1.3%
1.3 pts better
|
11.4%
11.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents who lose too much weight | 7.2% |
5.3%
1.9 pts worse
|
5.4%
1.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 5.6% · Q2 2.7% · Q3 9.8% · Q4 10.3% · 4Q avg 7.2% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 24.4% |
24.9%
0.5 pts better
|
19.6%
4.8 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 18.4% · Q2 26.3% · Q3 26.2% · Q4 26.2% · 4Q avg 24.4% |
| Percentage of long-stay residents who received an antipsychotic medication | 17.7% |
22.8%
5.1 pts better
|
16.7%
1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 35.0% · Q2 13.6% · Q3 12.0% · Q4 13.8% · 4Q avg 17.7% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.6%
0.6 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | 32.6% |
14.8%
17.8 pts worse
|
16.3%
16.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · 4Q avg 32.6% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 20.5% |
13.4%
7.1 pts worse
|
14.9%
5.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 21.6% · Q2 13.5% · Q3 22.0% · Q4 24.4% · 4Q avg 20.5% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.4% |
1.3%
0.9 pts better
|
1.0%
0.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.6% · Q2 0.0% · Q3 0.0% · Q4 0.0% · 4Q avg 0.4% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 2.8% |
2.6%
0.2 pts worse
|
1.7%
1.1 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.3% · Q2 4.3% · Q3 4.5% · Q4 0.0% · 4Q avg 2.8% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 31.3% |
13.5%
17.8 pts worse
|
19.8%
11.5 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 36.8% · Q2 33.1% · Q3 30.7% · Q4 24.6% · 4Q avg 31.3% |
| Percentage of long-stay residents with pressure ulcers | 7.1% |
5.7%
1.4 pts worse
|
5.1%
2 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 9.6% · Q2 8.8% · Q3 4.3% · Q4 5.5% · 4Q avg 7.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 100.0% |
84.3%
15.7 pts better
|
81.7%
18.3 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 100.0% · 4Q avg 100.0% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 16.0% |
11.5%
4.5 pts worse
|
12.0%
4 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 16.0% · Observed 13.8% · Expected 9.6% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.8% |
2.1%
0.3 pts better
|
1.6%
0.2 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 4.5% · Q2 2.2% · Q3 0.0% · Q4 0.0% · 4Q avg 1.8% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 87.0% |
80.3%
6.7 pts better
|
79.7%
7.3 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 87.0% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 34.2% |
24.5%
9.7 pts worse
|
23.9%
10.3 pts worse
|
Short Stay · 20240701-20250630 · Adjusted 34.2% · Observed 26.6% · Expected 18.6% · Used in QM five-star |
Survey summary
Top issue: Infection Control (1 deficiency)
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Top issue: Quality of Life and Care (1 deficiency)
1 fire-safety deficiencies
Top issue: Egress (1 deficiency)
No concentrated health issue counts in this cycle.
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Fire safety
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2022-03-28
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-03-28
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2022-03-28
Fire Safety
Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
Corrected 2019-06-27
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2018-06-15
Inspection history
Health
Provide and implement an infection prevention and control program.
Corrected 2022-03-23
Health
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.
Corrected 2022-03-23
Health
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Corrected 2019-07-05
Penalties and ownership
Operational/Managerial Control · Organization
Operational/Managerial Control · Individual
Corporate Officer · Individual
Corporate Director · Individual
Corporate Officer · Individual
Corporate Officer · Individual
W-2 Managing Employee · Individual
5% Or Greater Direct Ownership Interest · Organization
5% Or Greater Indirect Ownership Interest · Organization
5% Or Greater Direct Ownership Interest · Organization
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