Cycle 1
Health 2025-11-18 · Fire 2024-07-11
5 health deficiencies
Top issue: Administration (1 deficiency)
4 fire-safety deficiencies
Top issue: Construction (1 deficiency)
Thomasville, NC
Magnolia Gardens Center for Nursing and Rehabilita
2-star overall rating with 2-star inspections with $16,153 in total fines with 5 recent health deficiencies with 4 fire-safety deficiencies in the latest cycle
1028 Blair Street, Thomasville, NC
(336) 472-7771
Overall
2 / 5
CMS overall stars
Health inspections
2 / 5
Survey and complaint cycles
Staffing
2 / 5
RN + nurse staffing
Quality measures
2 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
120
Certified beds
Average residents
100
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Alliance Health Group
Operator or chain grouping
Approved since
2002-10-31
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Chain footprint
10 facilities
Chain averages 1 overall / 2 health / 2 staffing / 2 quality stars
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
Hours and turnover
RN hours / resident day
0.43
Registered nurse staffing · state 0.59 · national 0.68
LPN hours / resident day
0.89
Licensed practical nurse staffing · state 0.87 · national 0.87
Aide hours / resident day
2.05
Nurse aide staffing · state 2.33 · national 2.35
Total nurse hours
3.37
All reported nurse hours · state 3.78 · national 3.89
Licensed hours
1.32
RN + LPN hours · state 1.45 · national 1.54
Weekend hours
2.94
Weekend nurse staffing · state 3.34 · national 3.43
Weekend RN hours
0.10
Weekend registered nurse coverage · state 0.38 · national 0.47
Physical therapist
0.03
Reported PT staffing · state 0.09 · national 0.07
Adjusted RN hours
0.46
CMS adjusted RN staffing hours
Adjusted total hours
3.59
CMS adjusted total nurse staffing hours
Case-mix index
1.28
Higher values indicate more complex resident acuity
RN turnover
40%
Annual RN turnover · state 48% · national 45%
Total nurse turnover
54%
Annual nurse turnover · state 50% · national 46%
SNF VBP
Value-based purchasing
Program rank
10,834
Lower is better among SNFs in the FY 2026 VBP program.
Performance score
18.93
Composite VBP score used to determine payment impact.
Payment multiplier
0.9821
Above 1.000 increases Medicare payment; below 1.000 reduces it.
Program components
How the VBP score is built
Readmission
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Healthcare-associated infections
Not reported
This facility did not meet this measure's case minimum policy requirement and therefore no measure data is publicly reported.
Total nurse turnover
2.18
Baseline 67.39% · Performance 56.00% · Measure score 2.18 · Achievement 1.88 · Improvement 2.18
Adjusted total nurse staffing
1.61
Baseline 3.60 hours · Performance 3.54 hours · Measure score 1.61 · Achievement 1.61 · Improvement 0
SNF QRP
Medicare quality reporting measures
| Measure | Facility | National | Note |
|---|---|---|---|
| Potentially preventable 30-day readmission | 9.96% |
10.72%
0.8 pts better
|
No Different than the National Rate · Eligible stays 36 · Observed rate 8.33% · Lower 95% interval 6.2% |
| Discharge to community | 44.79% |
50.57%
5.8 pts worse
|
No Different than the National Rate · Eligible stays 30 · Observed rate 30% · Lower 95% interval 31.11% |
| Medicare spending per beneficiary | 0.6 |
1.02
0.4 pts better
|
|
| Drug regimen review with follow-up | Not Available |
95.27%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
| Falls with major injury | Not Available |
0.77%
|
Numerator Not Available · Denominator 19 · Too few residents or stays to report publicly. |
| Discharge self-care score | Not Available |
53.69%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Discharge mobility score | Not Available |
50.94%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Pressure ulcers or injuries, new or worsened | Not Available |
2.29%
|
Numerator Not Available · Denominator 19 · Adjusted rate Not Available · Too few residents or stays to report publicly. |
| Healthcare-associated infections requiring hospitalization | Not Available |
7.12%
|
Not Available · Eligible stays 14 · Observed rate Not Available · Lower 95% interval Not Available · Too few residents or stays to report publicly. |
| Staff COVID-19 vaccination coverage | 0% |
8.2%
8.2 pts worse
|
Numerator 0 · Denominator 111 |
| Staff flu vaccination coverage | 3.91% |
42%
38.1 pts worse
|
Numerator 7 · Denominator 179 |
| Discharge function score | Not Available |
56.45%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
| Transfer of health information to provider | Not Available |
95.95%
|
Numerator Not Available · Denominator 5 · Too few residents or stays to report publicly. |
| Transfer of health information to patient | Not Available |
96.28%
|
Numerator Not Available · Denominator 8 · Too few residents or stays to report publicly. |
| Resident COVID-19 vaccinations up to date | Not Available |
25.2%
|
Numerator Not Available · Denominator 10 · Too few residents or stays to report publicly. |
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 96.1% |
91.5%
4.6 pts better
|
93.4%
2.7 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 97.8% · Q2 96.6% · Q3 95.6% · Q4 94.5% · 4Q avg 96.1% |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 93.8% |
94.1%
0.3 pts worse
|
95.5%
1.7 pts worse
|
Long Stay · 2024Q3-2025Q2 · 4Q avg 93.8% |
| Percentage of long-stay residents experiencing one or more falls with major injury | 4.2% |
3.6%
0.6 pts worse
|
3.3%
0.9 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 2.2% · Q2 5.7% · Q3 4.4% · Q4 4.4% · 4Q avg 4.2% · Used in QM five-star |
| Percentage of long-stay residents who have depressive symptoms | 3.0% |
4.8%
1.8 pts better
|
11.4%
8.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 2.3% · Q2 5.1% · Q3 2.3% · Q4 2.4% · 4Q avg 3.0% |
| Percentage of long-stay residents who lose too much weight | 2.5% |
7.2%
4.7 pts better
|
5.4%
2.9 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 1.2% · Q2 3.8% · Q3 1.2% · Q4 3.7% · 4Q avg 2.5% |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 40.6% |
21.6%
19 pts worse
|
19.6%
21 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 43.9% · Q2 34.6% · Q3 37.5% · Q4 45.8% · 4Q avg 40.6% |
| Percentage of long-stay residents who received an antipsychotic medication | 37.0% |
15.0%
22 pts worse
|
16.7%
20.3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 33.3% · Q2 37.0% · Q3 37.3% · Q4 39.7% · 4Q avg 37.0% · Used in QM five-star |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.0%
About the same
|
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 | 32.9% |
21.5%
11.4 pts worse
|
16.3%
16.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 30.3% · Q2 33.0% · Q3 37.0% · Q4 30.4% · 4Q avg 32.9% · Used in QM five-star |
| Percentage of long-stay residents whose need for help with daily activities has increased | 24.6% |
16.8%
7.8 pts worse
|
14.9%
9.7 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 15.8% · Q2 21.6% · Q3 25.6% · Q4 34.6% · 4Q avg 24.6% · Used in QM five-star |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.6% |
0.9%
0.3 pts better
|
1.0%
0.4 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 1.7% · Q4 0.7% · 4Q avg 0.6% · Used in QM five-star |
| Percentage of long-stay residents with a urinary tract infection | 1.4% |
2.6%
1.2 pts better
|
1.7%
0.3 pts better
|
Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 2.3% · Q3 0.0% · Q4 3.3% · 4Q avg 1.4% · Used in QM five-star |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 30.4% |
21.2%
9.2 pts worse
|
19.8%
10.6 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 28.3% · Q2 37.0% · Q3 20.5% · Q4 35.8% · 4Q avg 30.4% |
| Percentage of long-stay residents with pressure ulcers | 8.1% |
6.0%
2.1 pts worse
|
5.1%
3 pts worse
|
Long Stay · 2024Q4-2025Q3 · Q1 8.0% · Q2 6.6% · Q3 9.4% · Q4 8.4% · 4Q avg 8.1% · Used in QM five-star |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 72.5% |
79.9%
7.4 pts worse
|
81.7%
9.2 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 56.1% · Q2 69.0% · Q3 82.5% · Q4 77.3% · 4Q avg 72.5% |
| Percentage of short-stay residents who newly received an antipsychotic medication | 5.8% |
1.5%
4.3 pts worse
|
1.6%
4.2 pts worse
|
Short Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 6.0% · Q3 6.2% · Q4 6.9% · 4Q avg 5.8% · Used in QM five-star |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 66.0% |
78.1%
12.1 pts worse
|
79.7%
13.7 pts worse
|
Short Stay · 2024Q3-2025Q2 · 4Q avg 66.0% |
Survey summary
Recent inspection cycles
Cycle 2
Health 2024-07-11 · Fire 2023-07-20
6 health deficiencies
Top issue: Resident Rights (3 deficiencies)
13 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (4 deficiencies)
Cycle 3
Health 2023-07-20 · Fire 2022-09-01
8 health deficiencies
Top issue: Resident Rights (3 deficiencies)
3 fire-safety deficiencies
Top issue: Gas and Vacuum and Electrical Systems (2 deficiencies)
Fire safety
Fire-safety citations
D · Potential for more than minimal harm
2024-07-11
K161 · Construction Deficiencies
Fire Safety
Use approved construction type or materials.
Corrected 2024-09-27
D · Potential for more than minimal harm
2024-07-11
K211 · Egress Deficiencies
Fire Safety
Keep aisles, corridors, and exits free of obstruction in case of emergency.
Corrected 2024-09-27
D · Potential for more than minimal harm
2024-07-11
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2024-09-27
D · Potential for more than minimal harm
2024-07-11
K521 · Services Deficiencies
Fire Safety
Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Corrected 2024-09-27
F · Potential for more than minimal harm
2023-07-20
K161 · Construction Deficiencies
Fire Safety
Use approved construction type or materials.
Corrected 2023-10-26
F · Potential for more than minimal harm
2023-07-20
K291 · Egress Deficiencies
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-10-26
F · Potential for more than minimal harm
2023-07-20
K511 · Services Deficiencies
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-10-26
F · Potential for more than minimal harm
2023-07-20
K700 · Miscellaneous Deficiencies
Fire Safety
Meet requirements for operating features, such as evacuation plans, fire drills, smoking regulations, draperies, decorations and the inspection, testing and maintenance of fire doors.
Corrected 2023-10-26
F · Potential for more than minimal harm
2023-07-20
K914 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure receptacles at patient bed locations and where general anesthesia is administered, are tested after initial installation, replacement or servicing.
Corrected 2023-10-26
F · Potential for more than minimal harm
2023-07-20
K916 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have a battery powered remote alarm panel in a location accessible by operating personnel.
Corrected 2023-10-26
E · Potential for more than minimal harm
2023-07-20
K347 · Smoke Deficiencies
Fire Safety
Properly provide smoke detection systems in areas open to corridors.
Corrected 2023-10-26
E · Potential for more than minimal harm
2023-07-20
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2023-10-26
E · Potential for more than minimal harm
2023-07-20
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2023-10-26
D · Potential for more than minimal harm
2023-07-20
K111 · Construction Deficiencies
Fire Safety
Satisfy building requirements after a repair, renovation, modification, or change of user/occupancy.
Corrected 2023-10-26
D · Potential for more than minimal harm
2023-07-20
K364 · Smoke Deficiencies
Fire Safety
Install properly constructed windows in hallway walls or doors.
Corrected 2023-10-26
D · Potential for more than minimal harm
2023-07-20
K374 · Smoke Deficiencies
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2023-10-26
D · Potential for more than minimal harm
2023-07-20
K911 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Meet requirements for the installation and maintenance of electrical systems.
Corrected 2023-10-26
D · Potential for more than minimal harm
2022-09-01
K161 · Construction Deficiencies
Fire Safety
Use approved construction type or materials.
Corrected 2022-11-20
D · Potential for more than minimal harm
2022-09-01
K921 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure that testing and maintenance of electrical equipment is performed.
Corrected 2022-11-20
D · Potential for more than minimal harm
2022-09-01
K923 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have proper medical gas storage and administration areas.
Corrected 2022-11-20
Inspection history
Recent health citations
F · Potential for more than minimal harm
2025-11-18
F727 · Nursing and Physician Services Deficiencies
Health
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
Corrected 2025-11-24
D · Potential for more than minimal harm
2025-11-18
F657 · Resident Assessment and Care Planning Deficiencies
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2025-11-24
D · Potential for more than minimal harm
2025-11-18
F849 · Administration Deficiencies
Health
Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.
Corrected 2025-11-24
J · Immediate jeopardy
2025-07-18
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Not marked corrected
D · Potential for more than minimal harm
2025-03-06
F607 · Freedom from Abuse, Neglect, and Exploitation Deficiencies
Health
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Corrected 2025-02-22
D · Potential for more than minimal harm
2024-07-11
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2024-08-02
E · Potential for more than minimal harm
2024-05-21
F550 · Resident Rights Deficiencies
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2024-06-11
E · Potential for more than minimal harm
2024-05-21
F565 · Resident Rights Deficiencies
Health
Honor the resident's right to organize and participate in resident/family groups in the facility.
Corrected 2024-06-11
E · Potential for more than minimal harm
2024-05-21
F867 · Administration Deficiencies
Health
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected 2024-06-11
D · Potential for more than minimal harm
2024-05-21
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2024-06-11
D · Potential for more than minimal harm
2024-05-21
F689 · Quality of Life and Care Deficiencies
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-06-11
D · Potential for more than minimal harm
2023-07-20
F558 · Resident Rights Deficiencies
Health
Reasonably accommodate the needs and preferences of each resident.
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F582 · Resident Rights Deficiencies
Health
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F584 · Resident Rights Deficiencies
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F637 · Resident Assessment and Care Planning Deficiencies
Health
Assess the resident when there is a significant change in condition
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F656 · Resident Assessment and Care Planning Deficiencies
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F690 · Quality of Life and Care Deficiencies
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F808 · Nutrition and Dietary Deficiencies
Health
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
Corrected 2023-08-17
D · Potential for more than minimal harm
2023-07-20
F867 · Administration Deficiencies
Health
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected 2023-08-17
Penalties and ownership
What sits behind the stars
$16,153
2025-07-18
Fine
Fine · fine $16,153
Fine
Ownership
Alignment Holdco LLC
5% Or Greater Direct Ownership Interest · Organization
Alliance Health Group LLC
Operational/Managerial Control · Organization
Coalition Group LLC
5% Or Greater Indirect Ownership Interest · Organization
Emanuel, Yosef
5% Or Greater Indirect Ownership Interest · Individual
Emanuel, Yosef
Corporate Officer · Individual
Parker, Eric
Operational/Managerial Control · Individual
Nearby options
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#2
Piedmont Crossing
Thomasville, NC
5-star overall rating with 5-star inspections with 2 recent health deficiencies
#3
Westchester Manor at Providence Place
High Point, NC
3-star overall rating with 3-star inspections with $8,018 in total fines with 5 recent health deficiencies with 8 fire-safety deficiencies in the latest cycle
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