Cycle 1
Health 2021-05-06 · Fire 2021-05-06
0 health deficiencies
No concentrated health issue counts in this cycle.
0 fire-safety deficiencies
No concentrated fire-safety issue counts in this cycle.
Fayette, AL
Fayette Medical Center Long Term Care Unit
5-star overall rating with 4-star inspections
1653 Temple Avenue North, Fayette, AL
(205) 932-5966
Overall
5 / 5
CMS overall stars
Health inspections
4 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
122
Certified beds
Average residents
99
Average occupied residents
Ownership
Government
Publicly displayed owner type
Chain
No chain reported
Operator or chain grouping
Approved since
1977-04-01
CMS approved date
Coverage
Medicare + Medicaid
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
Hospital-based
Yes
CMS reports the provider resides in a hospital
Staffing
Hours and turnover
RN hours / resident day
0.93
Registered nurse staffing · state 0.64 · national 0.68
LPN hours / resident day
1.02
Licensed practical nurse staffing · state 0.78 · national 0.87
Aide hours / resident day
2.45
Nurse aide staffing · state 2.50 · national 2.35
Total nurse hours
4.41
All reported nurse hours · state 3.91 · national 3.89
Licensed hours
1.95
RN + LPN hours · state 1.42 · national 1.54
Weekend hours
3.83
Weekend nurse staffing · state 3.29 · national 3.43
Weekend RN hours
0.59
Weekend registered nurse coverage · state 0.36 · national 0.47
Physical therapist
0.00
Reported PT staffing
Adjusted RN hours
1.03
CMS adjusted RN staffing hours
Adjusted total hours
4.87
CMS adjusted total nurse staffing hours
Case-mix index
1.24
Higher values indicate more complex resident acuity
RN turnover
11%
Annual RN turnover · state 42% · national 45%
Total nurse turnover
28%
Annual nurse turnover · state 49% · national 46%
SNF VBP
Value-based purchasing
Program rank
1,245
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
58.44
Composite VBP score used to determine payment impact.
Payment multiplier
1.0137
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
3.78
Baseline 18.02% · Performance 19.68% · Measure score 3.78 · Achievement 3.78 · Improvement 0
Healthcare-associated infections
5.45
Baseline 6.46% · Performance 6.21% · Measure score 5.45 · Achievement 5.45 · Improvement 1.23
Total nurse turnover
7.76
Baseline 28.57% · Performance 31.96% · Measure score 7.76 · Achievement 7.76 · Improvement 0
Adjusted total nurse staffing
6.39
Baseline 4.99 hours · Performance 4.90 hours · Measure score 6.39 · Achievement 6.39 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.09% |
10.72%
1.6 pts better
|
No Different than the National Rate · Eligible stays 78 · Observed rate 3.85% · Lower 95% interval 6.13% |
| Discharge to community | 39.8% |
50.57%
10.8 pts worse
|
No Different than the National Rate · Eligible stays 57 · Observed rate 31.58% · Lower 95% interval 29.91% |
| Medicare spending per beneficiary | 0.8 |
1.02
0.2 pts better
|
|
| Drug regimen review with follow-up | 100% |
95.27%
4.7 pts better
|
Numerator 56 · Denominator 56 |
| Falls with major injury | 0% |
0.77%
0.8 pts better
|
Numerator 0 · Denominator 56 |
| Discharge self-care score | 23.4% |
53.69%
30.3 pts worse
|
Numerator 11 · Denominator 47 |
| Discharge mobility score | 48.94% |
50.94%
2 pts worse
|
Numerator 23 · Denominator 47 |
| Pressure ulcers or injuries, new or worsened | 1.79% |
2.29%
0.5 pts better
|
Numerator 1 · Denominator 56 · Adjusted rate 1.55% |
| Healthcare-associated infections requiring hospitalization | 6.21% |
7.12%
0.9 pts better
|
No Different than the National Rate · Eligible stays 47 · Observed rate 2.13% · Lower 95% interval 3.07% |
| Staff COVID-19 vaccination coverage | 0.64% |
8.2%
7.6 pts worse
|
Numerator 1 · Denominator 156 |
| Staff flu vaccination coverage | 89.62% |
42%
47.6 pts better
|
Numerator 190 · Denominator 212 |
| Discharge function score | 29.79% |
56.45%
26.7 pts worse
|
Numerator 14 · Denominator 47 |
| Transfer of health information to provider | 100% |
95.95%
4 pts better
|
Numerator 23 · Denominator 23 |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 1 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | 35.71% |
25.2%
10.5 pts better
|
Numerator 10 · Denominator 28 |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 2.1 |
2.0
0.1 pts worse
|
1.9
0.2 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.1 · Observed 1.8 · Expected 1.6 · Used in QM five-star |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.0 |
1.8
0.2 pts worse
|
1.8
0.2 pts worse
|
Long Stay · 20240701-20250630 · Adjusted 2.0 · Observed 1.8 · Expected 1.5 · Used in QM five-star |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 99.7% |
91.3%
8.4 pts better
|
93.4%
6.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 100.0% · Q2 100.0% · Q3 100.0% · Q4 98.9% · 4Q avg 99.7% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
94.8%
5.2 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 100.0% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 10.2% |
3.4%
6.8 pts worse
|
3.3%
6.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 8.1% · Q2 11.8% · Q3 11.1% · Q4 9.9% · 4Q avg 10.2% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 1.8% |
1.3%
0.5 pts worse
|
11.4%
9.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.5% · Q2 1.2% · Q3 2.4% · Q4 1.2% · 4Q avg 1.8% |
| Percentage of long-stay residents who lose too much weight | 6.7% |
5.3%
1.4 pts worse
|
5.4%
1.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 9.6% · Q2 4.7% · Q3 4.1% · Q4 8.0% · 4Q avg 6.7% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 20.9% |
24.9%
4 pts better
|
19.6%
1.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 23.0% · Q2 22.5% · Q3 19.7% · Q4 18.4% · 4Q avg 20.9% |
| Percentage of long-stay residents who received an antipsychotic medication | 14.9% |
22.8%
7.9 pts better
|
16.7%
1.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 17.2% · Q2 13.1% · Q3 15.8% · Q4 13.3% · 4Q avg 14.9% · 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 | 11.0% |
14.8%
3.8 pts better
|
16.3%
5.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 14.6% · Q2 2.9% · Q3 20.7% · Q4 5.0% · 4Q avg 11.0% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 13.4% |
13.4%
About the same
|
14.9%
1.5 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 16.9% · Q2 12.7% · Q3 16.4% · Q4 7.5% · 4Q avg 13.4% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 1.7% |
1.3%
0.4 pts worse
|
1.0%
0.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.7% · Q2 3.3% · Q3 0.0% · Q4 1.1% · 4Q avg 1.7% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 0.9% |
2.6%
1.7 pts better
|
1.7%
0.8 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.4% · Q2 0.0% · Q3 1.1% · Q4 0.0% · 4Q avg 0.9% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 14.2% |
13.5%
0.7 pts worse
|
19.8%
5.6 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 17.2% · Q2 15.9% · Q3 10.3% · Q4 13.4% · 4Q avg 14.2% |
| Percentage of long-stay residents with pressure ulcers | 2.2% |
5.7%
3.5 pts better
|
5.1%
2.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.3% · Q2 2.5% · Q3 1.0% · Q4 3.0% · 4Q avg 2.2% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 91.5% |
84.3%
7.2 pts better
|
81.7%
9.8 pts better
|
Short Stay · 2024Q4-2025Q3 · Q1 85.2% · Q2 93.3% · Q3 92.5% · Q4 93.3% · 4Q avg 91.5% |
| Percentage of short-stay residents who had an outpatient emergency department visit | 10.2% |
11.5%
1.3 pts better
|
12.0%
1.8 pts better
|
Short Stay · 20240701-20250630 · Adjusted 10.2% · Observed 11.1% · Expected 12.2% · Used in QM five-star |
| Percentage of short-stay residents who newly received an antipsychotic medication | 0.0% |
2.1%
2.1 pts better
|
1.6%
1.6 pts better
|
Short Stay · 2024Q4-2025Q3 · Q3 0.0% · Q4 0.0% · 4Q avg 0.0% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 90.9% |
80.3%
10.6 pts better
|
79.7%
11.2 pts better
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 90.9% |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 10.3% |
24.5%
14.2 pts better
|
23.9%
13.6 pts better
|
Short Stay · 20240701-20250630 · Adjusted 10.3% · Observed 11.1% · Expected 25.7% · Used in QM five-star |
Survey summary
Recent inspection cycles
Cycle 2
Health 2019-04-11 · Fire 2019-04-11
3 health deficiencies
Top issue: Infection Control (1 deficiency)
2 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Cycle 3
Health 2018-04-12 · Fire 2018-04-12
7 health deficiencies
Top issue: Nutrition and Dietary (2 deficiencies)
1 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (1 deficiency)
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2019-04-11
K321 · Smoke Deficiencies
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2019-05-04
D · Potential for more than minimal harm
2019-04-11
K374 · Smoke Deficiencies
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2019-05-04
D · Potential for more than minimal harm
2018-04-12
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2018-05-22
Inspection history
Recent health citations
F · Potential for more than minimal harm
2019-04-11
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2019-05-14
D · Potential for more than minimal harm
2019-04-11
F583 · Resident Rights Deficiencies
Health
Keep residents' personal and medical records private and confidential.
Corrected 2019-05-14
D · Potential for more than minimal harm
2019-04-11
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2019-05-14
F · Potential for more than minimal harm
2018-04-12
F812 · Nutrition and Dietary Deficiencies
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2018-05-17
D · Potential for more than minimal harm
2018-04-12
F658 · Resident Assessment and Care Planning Deficiencies
Health
Ensure services provided by the nursing facility meet professional standards of quality.
Corrected 2018-05-17
D · Potential for more than minimal harm
2018-04-12
F677 · Quality of Life and Care Deficiencies
Health
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected 2018-05-17
D · Potential for more than minimal harm
2018-04-12
F693 · Quality of Life and Care Deficiencies
Health
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Corrected 2018-05-17
D · Potential for more than minimal harm
2018-04-12
F755 · Pharmacy Service Deficiencies
Health
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected 2018-05-17
D · Potential for more than minimal harm
2018-04-12
F810 · Nutrition and Dietary Deficiencies
Health
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Corrected 2018-05-17
D · Potential for more than minimal harm
2018-04-12
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2018-05-17
Penalties and ownership
What sits behind the stars
Ownership
Bedwell, Joe
W-2 Managing Employee · Individual
Clark, Rodney
W-2 Managing Employee · Individual
Claytor, Brian
Corporate Officer · Individual
Colquitt, Joseph
Corporate Officer · Individual
Dobbins, Alex
W-2 Managing Employee · Individual
Gay, David
Corporate Officer · Individual
Harrison, James
Corporate Officer · Individual
Hudson, David
Corporate Officer · Individual
Standeffer, Lewis
Corporate Director · Individual
The Dch Health Care Authority
Operational/Managerial Control · Organization
Nearby options
Other facilities in reach
#1
Diversicare Of Winfield
Winfield, AL
4-star overall rating with 4-star inspections with 2 recent health deficiencies
#2
Sunset Manor
Guin, AL
4-star overall rating with 3-star inspections with 2 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
#3
Generations Of Vernon, LLC
Vernon, AL
1-star overall rating with 2-star inspections
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