Cycle 1
Health 2022-05-17 · Fire 2022-05-17
3 health deficiencies
Top issue: Infection Control (1 deficiency)
2 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Huntsville, AL
Willowbrooke Ct Skilled Care Ctr At Magnolia Trace
5-star overall rating with 3-star inspections with 3 recent health deficiencies with 2 fire-safety deficiencies in the latest cycle
One Crown Circle, Huntsville, AL
(256) 261-1602
Overall
5 / 5
CMS overall stars
Health inspections
3 / 5
Survey and complaint cycles
Staffing
5 / 5
RN + nurse staffing
Quality measures
5 / 5
Resident outcomes and process measures
Quick facts
Facility snapshot
Beds
59
Certified beds
Average residents
16
Average occupied residents
Ownership
Non-Profit
Publicly displayed owner type
Chain
Acts Retirement-Life Communities
Operator or chain grouping
Approved since
2003-03-18
CMS approved date
Coverage
Medicare
Participation flags
Staffing
Hours and turnover
RN hours / resident day
1.35
Registered nurse staffing
LPN hours / resident day
0.46
Licensed practical nurse staffing
Aide hours / resident day
2.45
Nurse aide staffing
Weekend hours
3.81
Weekend nurse staffing
RN turnover
25%
Annual RN turnover
Total nurse turnover
18%
Annual nurse turnover
Quality measures
Resident outcomes and process scores
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| 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 |
| Percentage of short-stay residents who had an outpatient emergency department visit | 6.0% |
11.5%
5.5 pts better
|
12.0%
6 pts better
|
Short Stay · 20240701-20250630 |
| Percentage of short-stay residents who newly received an antipsychotic medication | 1.6% |
2.1%
0.5 pts better
|
1.6%
About the same
|
Short Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents who were assessed and appropriately given the seasonal influenza vaccine | 98.7% |
80.3%
18.4 pts better
|
79.7%
19 pts better
|
Short Stay · 2024Q3-2025Q2 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 19.4% |
24.5%
5.1 pts better
|
23.9%
4.5 pts better
|
Short Stay · 20240701-20250630 |
Survey summary
Recent inspection cycles
Cycle 2
Health 2019-10-17 · Fire 2019-10-17
1 health deficiencies
Top issue: Infection Control (1 deficiency)
4 fire-safety deficiencies
Top issue: Egress (2 deficiencies)
Cycle 3
Health 2018-10-11 · Fire 2018-10-11
0 health deficiencies
No concentrated health issue counts in this cycle.
3 fire-safety deficiencies
Top issue: Smoke (2 deficiencies)
Fire safety
Fire-safety citations
E · Potential for more than minimal harm
2022-05-17
K363 · Smoke Deficiencies
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2022-05-26
D · Potential for more than minimal harm
2022-05-17
K311 · Smoke Deficiencies
Fire Safety
Have an enclosure around a vertical opening shaft.
Corrected 2022-05-26
F · Potential for more than minimal harm
2019-10-17
K712 · Miscellaneous Deficiencies
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2019-11-25
D · Potential for more than minimal harm
2019-10-17
K222 · Egress Deficiencies
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 2019-11-25
D · Potential for more than minimal harm
2019-10-17
K232 · Egress Deficiencies
Fire Safety
Have corridors or aisles that are unobstructed and are at least 8 feet in width.
Corrected 2019-11-25
D · Potential for more than minimal harm
2019-10-17
K920 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2019-11-25
D · Potential for more than minimal harm
2018-10-11
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 2018-11-07
D · Potential for more than minimal harm
2018-10-11
K353 · Smoke Deficiencies
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2018-11-07
D · Potential for more than minimal harm
2018-10-11
K918 · Gas, Vacuum, and Electrical Systems Deficiencies
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2018-11-07
Inspection history
Recent health citations
F · Potential for more than minimal harm
2022-05-17
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 2022-06-20
D · Potential for more than minimal harm
2022-05-17
F641 · Resident Assessment and Care Planning Deficiencies
Health
Ensure each resident receives an accurate assessment.
Corrected 2022-06-20
D · Potential for more than minimal harm
2022-05-17
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2022-06-20
E · Potential for more than minimal harm
2019-10-17
F880 · Infection Control Deficiencies
Health
Provide and implement an infection prevention and control program.
Corrected 2019-11-20
Penalties and ownership
What sits behind the stars
Ownership
Acts Retirement Services, Inc
5% Or Greater Direct Ownership Interest · Organization
Acts Management Services, Inc.
Operational/Managerial Control · Organization
Acts Retirement Services, Inc
Operational/Managerial Control · Organization
Ahern, Susan
Corporate Officer · Individual
Ahern, Susan
W-2 Managing Employee · Individual
Allmond, Susan
Corporate Director · Individual
Christiansen, Karen
Corporate Officer · Individual
Christiansen, Karen
W-2 Managing Employee · Individual
Clemens, Thomas
Corporate Director · Individual
Detweiler, Harold
Corporate Director · Individual
Dunn, Thomas
Corporate Director · Individual
Esterhai, John
Corporate Director · Individual
Esterhai, John
Corporate Officer · Individual
Evans, Robert
Corporate Director · Individual
Fox, Glenn
Corporate Officer · Individual
Fox, Glenn
W-2 Managing Employee · Individual
Gerner, Elric
Corporate Director · Individual
Gerner, Elric
Corporate Officer · Individual
Grant, Gerald
Corporate Director · Individual
Grant, Gerald
Corporate Officer · Individual
Grant, Gerald
W-2 Managing Employee · Individual
Kelly, Michael
Corporate Director · Individual
Kelly, Michael
Corporate Officer · Individual
Kulathum, Dilip
Corporate Director · Individual
Kulathum, Dilip
Corporate Officer · Individual
Lammers, John
Corporate Director · Individual
Lawson, Daniel
Corporate Director · Individual
Marr, Larry
Corporate Director · Individual
Mashner, Marvin
Corporate Director · Individual
Valdivia, Peggy
Corporate Officer · Individual
Valdivia, Peggy
W-2 Managing Employee · Individual
Worth, James
Corporate Director · Individual
Nearby options
Other facilities in reach
#1
Huntsville Health & Rehabilitation, LLC
Huntsville, AL
4-star overall rating with 3-star inspections with 2 recent health deficiencies with 5 fire-safety deficiencies in the latest cycle
#2
Rocket City Rehabilitation And Healthcare Center
Huntsville, AL
1-star overall rating with 1-star inspections with 12 recent health deficiencies with 3 fire-safety deficiencies in the latest cycle
#3
Diversicare Of Big Springs
Huntsville, AL
4-star overall rating with 4-star inspections with 2 recent health deficiencies
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