Birmingham Nursing And Rehabilitation Ctr Llc

F 0578 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

(including covering the mouth or pinching the nose to force a resident to take medication). A Quality Assurance Meeting held on 10/24/25 to review F-tag 578, 600, 607, 609, 835, and 837 at scope and severity level IJ. Members attending the QAPI meeting: Administrator, Human Resources, Clinical Operations Nurse, QA Nurse, [NAME] President of Operations, Medical Director, and Director of Nursing.

After receiving education (on 10/24/25 for the Administrator, DON, and [NAME] President of Operations by

the [NAME] President of Clinical Services) related to abuse and covering the mouth and pinching the nose of a resident in order to prevent them from spitting out medication, the QAPI team reviewed the allegation of abuse of RI #1 by LPN #5 and the allegation was substantiated. It was determined at this meeting: The Abuse Prevention Policy will be educated to the entire staff emphasizing that any act of coercion or force (forcefully/making resident take medication against his/her will) is considered abuse. Abuse must be reported immediately to the abuse coordinator. Resident cannot be left alone in a potential abuse situation/unsafe situation, stay with resident, intervene, and call for help; Medication Administration Policy, residents right to refuse medication, supervisor/staff follow-up after receiving resident information that could be considered abuse. All residents would be educated on Resident's Rights. The DON reported to the ABON on 10/28/2025 that the allegation of abuse of RI #1 by LPN #5 was substantiated. 5. Date of CompletionThe immediacy corrective actions were completed by [10/28/25].Education was completed [10/28/25]. ************************************************** After reviewing the facility's immediate actions and information provided in their Removal Plan, interviewing staff and verifying the corrective actions had been implemented the Immediate Jeopardy was removed on 10/29/2025. The scope/severity level of F-F578 was lowered to the lower severity of no actual harm with a potential for more than minimal harm that was not immediate jeopardy, to allow the facility time to monitor and/or revise their corrective actions as necessary to achieve substantial compliance.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Birmingham Nursing and Rehabilitation Ctr LLC

1000 Dugan Avenue Birmingham, AL 35214

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety

DON and Weekend Supervisor observed 5 nurses pass 5 resident's medication on 10/25/25, to ensure compliance with resident rights and medication administration procedures. No issues or concerns were identified with medication administration or the resident's right to refuse medication (including covering the mouth or pinching the nose to force a resident to take medication).

A Quality Assurance Meeting held on 10/24/25 to review F-tag 578, 600, 607, 609, 835, and 837 at scope[

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Birmingham Nursing and Rehabilitation Ctr LLC

1000 Dugan Avenue Birmingham, AL 35214

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Operations, the [NAME] President of Operations will guide the facility Administrator on how to implement

the abuse policy to identify abuse and protect residents from perpetrators of abuse. A Quality Assurance Meeting held on 10/24/25 to review F-tag 578, 600, 607, 609, 835, and 837 at scope and severity level IJ.

Members attending the QAPI meeting: Administrator, Human Resources, Clinical Operations Nurse, QA Nurse, [NAME] President of Operations, Medical Director, and Director of Nursing. After receiving education (on 10/24/25 for the Administrator, DON, and [NAME] President of Operations by the [NAME] President of Clinical Services) related to abuse and covering the mouth and pinching the nose of a resident to prevent them from spitting out medication, the QAPI team reviewed the allegation of abuse of RI #1 by LPN #5 and

the allegation was substantiated. It was determined at this meeting: The Abuse Prevention Policy will be educated to the entire staff emphasizing that any act of coercion or force (forcefully/making resident take medication against his/her will) is considered abuse. Abuse must be reported immediately to the abuse coordinator. Resident cannot be left alone in a potential abuse situation/unsafe situation, stay with resident, intervene, and call for help; Medication Administration Policy, residents right to refuse medication, supervisor/staff follow-up after receiving resident information that could be considered abuse. All residents would be educated on Resident's Rights. The DON reported to the ABON on 10/28/2025 that the allegation of abuse of RI #1 by LPN #5 was substantiated.5. Date of CompletionThe immediacy corrective actions were completed by [10/28/25]. Education was completed [10/28/25]. ********************************************* After reviewing the facility's immediate actions and information provided in their Removal Plan, interviewing staff and verifying the corrective actions had been implemented the Immediate Jeopardy was removed on 10/29/2025. The scope/severity level of F-F607 was lowered to no actual harm with a potential for more than minimal harm that was not immediate jeopardy, to allow the facility time to monitor and/or revise their corrective actions as necessary to achieve substantial compliance.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Birmingham Nursing and Rehabilitation Ctr LLC

1000 Dugan Avenue Birmingham, AL 35214

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

employees off each shift to interview to ensure staff recognizes and knows whom and how to report immediately, and understand protection for residents. The staff were asked if they understood abuse-when to report and whom to report, reporting timely, protecting the resident/intervene when the resident could be at risk and call for help. 9 out of 9 employees answered the questions correctly. These interviews will occur weekly going forward. A Quality Assurance Meeting held on 10/24/25 to review F-tag 578, 600, 607, 609, 835, and 837 at scope and severity level IJ. Members attending the QAPI meeting: Administrator, Human Resources, Clinical Operations Nurse, QA Nurse, [NAME] President of Operations, Medical Director, and Director of Nursing. After receiving education (on 10/24/25 for the Administrator, DON, and [NAME] President of Operations by the [NAME] President of Clinical Services) related to abuse and covering the mouth and pinching the nose of a resident in order to prevent them from spitting out medication, the QAPI team reviewed the allegation of abuse of RI #1 by LPN #5 and the allegation was substantiated. It was determined at this meeting: The Abuse Prevention Policy will be educated to the entire staff emphasizing that any act of coercion or force (forcefully/making resident take medication against his/her will) is considered abuse. Abuse must be reported immediately to the abuse coordinator. Resident cannot be left alone in a potential abuse situation/unsafe situation, stay with resident, intervene, and call for help; Medication Administration Policy, residents right to refuse medication, supervisor/staff follow-up after receiving resident information that could be considered abuse. All residents would be educated on Resident's Rights. The DON reported to the ABON on 10/28/2025 that the allegation of abuse of RI #1 by LPN #5 was substantiated.5. Date of CompletionThe immediacy corrective actions were completed by [10/28/25].Education was completed [10/28/25]. ************************************************ After reviewing

the facility's immediate actions and information provided in their Removal Plan, interviewing staff and verifying the corrective actions had been implemented the Immediate Jeopardy was removed on 10/29/2025. The scope/severity level of F-F609 was lowered to the lower severity of no actual harm with a potential for more than minimal harm that was not immediate jeopardy, to allow the facility time to monitor and/or revise their corrective actions as necessary to achieve substantial compliance.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Birmingham Nursing and Rehabilitation Ctr LLC

1000 Dugan Avenue Birmingham, AL 35214

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0740 Level of Harm - Minimal harm or potential for actual harm

signs from RI #78. The Adm said the incident was investigated and taken to QAPI and the root cause analysis was performed. The ADM said they determined the root cause to be environmental, including television noise, music and overall stimulation, and therefore implemented a quiet time during meals.

Review of RI #78's medical record did not reveal any interventions or actions were put in place to routinely supervise RI #78 to protect residents in the facility from being abused by RI #78.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Birmingham Nursing and Rehabilitation Ctr LLC

1000 Dugan Avenue Birmingham, AL 35214

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

and call for help; Medication Administration Policy, residents right to refuse medication, supervisor/staff follow-up after receiving resident information that could be considered abuse. All residents would be educated on Resident's Rights. The DON reported to the ABON on 10/28/2025 that the allegation of abuse of RI #1 by LPN #5 was substantiated.5. Date of CompletionThe immediacy corrective actions were completed by [10/28/25].Education was completed [10/28/25]******************************************************** After reviewing the facility's immediate actions and information provided in their Removal Plan, interviewing staff and verifying the corrective actions had been implemented the Immediate Jeopardy was removed on 10/29/2025. The scope/severity level of F-F835 was lowered to the lower severity of no actual harm with a potential for more than minimal harm that was not immediate jeopardy, to allow the facility time to monitor and/or revise their corrective actions as necessary to achieve substantial compliance.

Event ID:

Facility ID:

If continuation sheet