Monroeville, AL

Monroe Manor Health & Rehabilitation Center

4-star overall rating with 4-star inspections with 1 recent health deficiencies with 1 fire-safety deficiencies in the latest cycle

236 West Claiborne Street, Monroeville, AL

(251) 575-2648

Compare this facility

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

Facility snapshot

Beds

84

Certified beds

Average residents

71

Average occupied residents

Ownership

For-Profit

Publicly displayed owner type

Chain

Ball Healthcare Services

Operator or chain grouping

Approved since

1988-01-07

CMS approved date

Coverage

Medicare + Medicaid

Participation flags

Chain footprint

10 facilities

Chain averages 3 overall / 3 health / 3 staffing / 3 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

0.68

Registered nurse staffing · state 0.64 · national 0.68

LPN hours / resident day

1.09

Licensed practical nurse staffing · state 0.78 · national 0.87

Aide hours / resident day

2.37

Nurse aide staffing · state 2.50 · national 2.35

Total nurse hours

4.14

All reported nurse hours · state 3.91 · national 3.89

Licensed hours

1.77

RN + LPN hours · state 1.42 · national 1.54

Weekend hours

3.41

Weekend nurse staffing · state 3.29 · national 3.43

Weekend RN hours

0.33

Weekend registered nurse coverage · state 0.36 · national 0.47

Physical therapist

0.01

Reported PT staffing · state 0.04 · national 0.07

Adjusted RN hours

0.74

CMS adjusted RN staffing hours

Adjusted total hours

4.53

CMS adjusted total nurse staffing hours

Case-mix index

1.25

Higher values indicate more complex resident acuity

RN turnover

25%

Annual RN turnover · state 42% · national 45%

Total nurse turnover

26%

Annual nurse turnover · state 49% · national 46%

SNF VBP

Value-based purchasing

Program rank

4,268

Lower is better among SNFs in the FY 2026 VBP program.

Performance score

40.64

Composite VBP score used to determine payment impact.

Payment multiplier

0.9936

Above 1.000 increases Medicare payment; below 1.000 reduces it.

Program components

How the VBP score is built

Readmission

2

Baseline 19.00% · Performance 20.51% · Measure score 2 · Achievement 2 · Improvement 0

Healthcare-associated infections

3.74

Baseline 6.34% · Performance 6.72% · Measure score 3.74 · Achievement 3.74 · Improvement 0

Total nurse turnover

7.54

Baseline 22.86% · Performance 32.88% · Measure score 7.54 · Achievement 7.54 · Improvement 0

Adjusted total nurse staffing

2.98

Baseline 4.47 hours · Performance 3.92 hours · Measure score 2.98 · Achievement 2.98 · Improvement 0

SNF QRP

Medicare quality reporting measures

Measure	Facility	National	Note
Potentially preventable 30-day readmission	9.43%	10.72% 1.3 pts better	No Different than the National Rate · Eligible stays 65 · Observed rate 4.62% · Lower 95% interval 6.16%
Discharge to community	58.56%	50.57% 8 pts better	No Different than the National Rate · Eligible stays 50 · Observed rate 56% · Lower 95% interval 46.05%
Medicare spending per beneficiary	0.85	1.02 0.2 pts better
Drug regimen review with follow-up	70.97%	95.27% 24.3 pts worse	Numerator 22 · Denominator 31
Falls with major injury	0%	0.77% 0.8 pts better	Numerator 0 · Denominator 31
Discharge self-care score	50%	53.69% 3.7 pts worse	Numerator 10 · Denominator 20
Discharge mobility score	45%	50.94% 5.9 pts worse	Numerator 9 · Denominator 20
Pressure ulcers or injuries, new or worsened	0%	2.29% 2.3 pts better	Numerator 0 · Denominator 31 · Adjusted rate 0%
Healthcare-associated infections requiring hospitalization	6.72%	7.12% 0.4 pts better	No Different than the National Rate · Eligible stays 30 · Observed rate 3.33% · Lower 95% interval 3.11%
Staff COVID-19 vaccination coverage	0.93%	8.2% 7.3 pts worse	Numerator 1 · Denominator 107
Staff flu vaccination coverage	10.2%	42% 31.8 pts worse	Numerator 15 · Denominator 147
Discharge function score	55%	56.45% 1.5 pts worse	Numerator 11 · Denominator 20
Transfer of health information to provider	Not Available	95.95%	Numerator Not Available · Denominator 15 · Too few residents or stays to report publicly.
Transfer of health information to patient	Not Available	96.28%	Numerator Not Available · Denominator 2 · Too few residents or stays to report publicly.
Resident COVID-19 vaccinations up to date	Not Available	25.2%	Numerator Not Available · Denominator 15 · Too few residents or stays to report publicly.

Quality measures

Resident outcomes and process scores

Measure	Facility	State	National	Note
Number of hospitalizations per 1000 long-stay resident days	1.8	2.0 0.2 pts better	1.9 0.1 pts better	Long Stay · 20240701-20250630 · Adjusted 1.8 · Observed 1.6 · Expected 1.7 · 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	63.4%	91.3% 27.9 pts worse	93.4% 30 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 45.7% · Q2 67.6% · Q3 70.6% · Q4 70.0% · 4Q avg 63.4%
Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine	81.7%	94.8% 13.1 pts worse	95.5% 13.8 pts worse	Long Stay · 2024Q3-2025Q2 · 4Q avg 81.7%
Percentage of long-stay residents experiencing one or more falls with major injury	1.8%	3.4% 1.6 pts better	3.3% 1.5 pts better	Long Stay · 2024Q4-2025Q3 · Q1 0.0% · Q2 0.0% · Q3 2.9% · Q4 4.3% · 4Q avg 1.8% · Used in QM five-star
Percentage of long-stay residents who have depressive symptoms	2.8%	1.3% 1.5 pts worse	11.4% 8.6 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.6% · Q2 0.0% · Q3 4.8% · Q4 1.6% · 4Q avg 2.8%
Percentage of long-stay residents who lose too much weight	6.9%	5.3% 1.6 pts worse	5.4% 1.5 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 8.8% · Q2 5.2% · Q3 8.6% · Q4 5.1% · 4Q avg 6.9%
Percentage of long-stay residents who received an antianxiety or hypnotic medication	11.3%	24.9% 13.6 pts better	19.6% 8.3 pts better	Long Stay · 2024Q4-2025Q3 · Q1 11.7% · Q2 13.6% · Q3 13.3% · Q4 6.7% · 4Q avg 11.3%
Percentage of long-stay residents who received an antipsychotic medication	27.6%	22.8% 4.8 pts worse	16.7% 10.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 30.0% · Q2 25.5% · Q3 28.0% · Q4 27.1% · 4Q avg 27.6% · 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	17.2%	14.8% 2.4 pts worse	16.3% 0.9 pts worse	Long Stay · 2024Q4-2025Q3 · 4Q avg 17.2% · Used in QM five-star
Percentage of long-stay residents whose need for help with daily activities has increased	16.8%	13.4% 3.4 pts worse	14.9% 1.9 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 12.5% · Q2 10.9% · Q3 24.5% · Q4 18.8% · 4Q avg 16.8% · Used in QM five-star
Percentage of long-stay residents with a catheter inserted and left in their bladder	3.3%	1.3% 2 pts worse	1.0% 2.3 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 2.8% · Q2 4.3% · Q3 2.5% · Q4 3.5% · 4Q avg 3.3% · Used in QM five-star
Percentage of long-stay residents with a urinary tract infection	1.9%	2.6% 0.7 pts better	1.7% 0.2 pts worse	Long Stay · 2024Q4-2025Q3 · Q1 3.0% · Q2 3.0% · Q3 0.0% · Q4 1.4% · 4Q avg 1.9% · Used in QM five-star
Percentage of long-stay residents with new or worsened bowel or bladder incontinence	14.0%	13.5% 0.5 pts worse	19.8% 5.8 pts better	Long Stay · 2024Q4-2025Q3 · Q1 6.9% · Q2 7.0% · Q3 15.7% · Q4 25.8% · 4Q avg 14.0%
Percentage of long-stay residents with pressure ulcers	2.7%	5.7% 3 pts better	5.1% 2.4 pts better	Long Stay · 2024Q4-2025Q3 · Q1 4.0% · Q2 2.7% · Q3 1.4% · Q4 2.6% · 4Q avg 2.7% · Used in QM five-star
Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine	21.8%	84.3% 62.5 pts worse	81.7% 59.9 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 10.6% · Q2 19.6% · Q3 15.9% · Q4 53.6% · 4Q avg 21.8%
Percentage of short-stay residents who had an outpatient emergency department visit	11.4%	11.5% 0.1 pts better	12.0% 0.6 pts better	Short Stay · 20240701-20250630 · Adjusted 11.4% · Observed 13.3% · Expected 13.0% · Used in QM five-star
Percentage of short-stay residents who newly received an antipsychotic medication	1.7%	2.1% 0.4 pts better	1.6% 0.1 pts worse	Short Stay · 2024Q4-2025Q3 · Q1 3.2% · Q2 2.6% · Q3 0.0% · Q4 0.0% · 4Q avg 1.7% · Used in QM five-star
Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine	28.8%	80.3% 51.5 pts worse	79.7% 50.9 pts worse	Short Stay · 2024Q3-2025Q2 · 4Q avg 28.8%
Percentage of short-stay residents who were rehospitalized after a nursing home admission	21.8%	24.5% 2.7 pts better	23.9% 2.1 pts better	Short Stay · 20240701-20250630 · Adjusted 21.8% · Observed 23.3% · Expected 25.5% · Used in QM five-star

Survey summary

Recent inspection cycles

Cycle 1 Health 2019-12-05 · Fire 2019-12-05

1 health deficiencies

Top issue: Infection Control (1 deficiency)

1 fire-safety deficiencies

Top issue: Services (1 deficiency)

Cycle 2 Health 2018-11-01 · Fire 2018-11-01

3 health deficiencies

Top issue: Infection Control (1 deficiency)

2 fire-safety deficiencies

Top issue: Smoke (2 deficiencies)

Cycle 3 Health 2017-10-05 · Fire 2017-10-05

5 health deficiencies

Top issue: Quality of Life and Care (2 deficiencies)

3 fire-safety deficiencies

Top issue: Smoke (3 deficiencies)

Fire safety

Fire-safety citations

E · Potential for more than minimal harm 2019-12-05

K521 · Services Deficiencies

Fire Safety

Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.

Corrected 2019-12-17

D · Potential for more than minimal harm 2018-11-01

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 2018-11-30

D · Potential for more than minimal harm 2018-11-01

K351 · Smoke Deficiencies

Fire Safety

Install an approved automatic sprinkler system.

Corrected 2018-11-30

D · Potential for more than minimal harm 2017-10-05

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 2017-11-08

D · Potential for more than minimal harm 2017-10-05

K353 · Smoke Deficiencies

Fire Safety

Inspect, test, and maintain automatic sprinkler systems.

Corrected 2017-11-08

D · Potential for more than minimal harm 2017-10-05

K355 · Smoke Deficiencies

Fire Safety

Properly select, install, inspect, or maintain portable fire extinguishes.

Corrected 2017-11-08

Inspection history

Recent health citations

D · Potential for more than minimal harm 2019-12-05

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2020-01-09

E · Potential for more than minimal harm 2018-11-01

F658 · Resident Assessment and Care Planning Deficiencies

Health

Ensure services provided by the nursing facility meet professional standards of quality.

Corrected 2018-11-30

E · Potential for more than minimal harm 2018-11-01

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 2018-11-30

E · Potential for more than minimal harm 2018-11-01

F880 · Infection Control Deficiencies

Health

Provide and implement an infection prevention and control program.

Corrected 2018-11-30

D · Potential for more than minimal harm 2017-10-05

F281 · Quality of Life and Care Deficiencies

Health

Ensure services provided by the nursing facility meet professional standards of quality.

Corrected 2017-11-07

D · Potential for more than minimal harm 2017-10-05

F282 · Quality of Life and Care Deficiencies

Health

Provide care by qualified persons according to each resident's written plan of care.

Corrected 2017-11-07

D · Potential for more than minimal harm 2017-10-05

F329 · Pharmacy Service Deficiencies

Health

Ensure that each resident's 1) entire drug/medication regimen is free from unnecessary drugs; and 2) is managed and monitored to achieve highest level of well-being.

Corrected 2017-11-07

D · Potential for more than minimal harm 2017-10-05

F441 · Environmental Deficiencies

Health

Have a program that investigates, controls and keeps infection from spreading.

Corrected 2017-11-07

D · Potential for more than minimal harm 2017-10-05

F503 · Administration Deficiencies

Health

Ensure laboratory services, blood blanks and transfusion services provided on site meet requirements for certified laboratories; or have an agreement to obtain services from an offsite laboratory, that meets the same requirements.

Corrected 2017-11-07

Penalties and ownership