Birmingham Nursing and Rehabilitation Ctr LLC

Inspectors wroteBased on interviews, record reviews, review of a facility policy titled, ABUSE PREVENTION, review of Facility Reported Incidents (FRIs) received by the State Agency and review of the facility's investigative files, the facility failed to ensure residents in the facility were free from physical abuse perpetrated by other residents. The facility failed to protect (RI) #119's right to be free from physical abuse perpetrated by RI #78, a resident with a known history of Chronic Delusions, Psychosis, Restlessness, Agitation, and Dementia with Behavioral Disturbance. RI #78 was witnessed walking across the dining room and hit RI #119 in the right upper arm on 06/12/2025. The facility failed to assess and determine the level of staff supervision needed for RI #78, before and after the abuse, to prevent RI #78 from abusing others. [...]

Inspectors wroteBased on observations, interviews, record review, review of Facility Reported Incidents (FRI), review of the facility investigative files, review of a facility policy titled Abuse Prevention and review of a facility policy titled Behavior Management and Psychopharmacological Medication Monitoring Protocol, the facility failed to provide adequate supervision and ensure appropriate interventions were developed to manage RI #78's psychosis/delusional behaviors and ensure safety of residents in the facility. Because RI #78, a resident with a known history of chronic delusions/psychosis/restlessness/agitation, was not adequately supervised by staff, RI #78 hit RI #119 in the left shoulder on 06/12/25 and hit RI #13 on the left shoulder on 09/15/2025. This was discovered during investigations of abuse. [...]

Inspectors wroteBased on observation, interviews, record review, review of a facility policy titled MEDICATION ADMINISTRATION - GENERAL GUIDELINES, review of the RESIDENT BILL OF RIGHTS and review of a Facility Reported Incident (FRI) received by the State Agency, the facility failed to protect Resident Identifier (RI) #1's right to refuse care and treatment on 09/19/2025 when Licensed Practical Nurse (LPN) #5 administered medication to RI #1 and placed his hand over RI #1's mouth and pinched RI #1's nose to prevent RI #1 from spitting out the medication, which was physically and mentally abusive to RI #1. The Certified Nursing Assistant (CNA) witness said, LPN #5 told RI #1 he/she was going to take the medications, and RI #1's face turned red as RI #1 struggled and pushed his/her head from side to side in response to LPN #5's force. [...]

Inspectors wroteBased on observation, interviews, record review, review of a facility policy titled ABUSE PREVENTION, review of a Facility Reported Incident (FRI) received by the State Agency, and review of a facility investigative file, the facility failed to ensure residents in the facility were free from physical and mental abuse perpetrated by staff. Specifically:The facility failed to ensure Resident Identifier (RI) #1 was free from abuse perpetrated by Licensed Practical Nurse (LPN) #5 on 09/19/2025 at approximately 8:45 AM when Certified Nursing Assistant (CNA) #8 witnessed LPN #5 physically abuse RI #1 when he placed his hand and a paper towel over RI #1's mouth and he pinched RI #1's nose, while telling RI #1 they were going to take medication. [...]

Inspectors wroteBased on observation, interviews, record review and review of a facility policy titled ABUSE PREVENTION, the facility failed to implement their abuse policy and take appropriate actions to protect Resident Identifier (RI) #1 from abuse on 09/19/2025 after Licensed Practical Nurse (LPN) #5 physically and mentally abused RI #1 and LPN #5 was observed during the survey on 10/21/2025 continuing to administer medications to residents, placing residents at risk of being abused by LPN #5. Certified Nursing Assistant (CNA) #8 who witnessed LPN #5 abuse RI #1 on 09/19/2025 at approximately 8:47 AM failed to ensure RI #1 was protected from LPN #5 after he placed his hand over RI #1's nose and mouth to force RI #1 to swallow medications, placing RI #1 at risk of aspiration of the medications and being fearful. CNA #8 left RI #1's room leaving RI #1 alone with LPN #5. [...]

Inspectors wroteBased on interviews, review of the Administrator's (ADM) and Director of Nursing (DON) Job Responsibilities, and review of the facility's ABUSE PREVENTION policy, the facility's ADM and DON failed to provide oversight and guidance to facility staff to ensure the facility's abuse policy was implemented to identify abuse, report suspected abuse, and take corrective actions to protect residents following an incident of abuse. On 09/19/2025 Resident Identifier (RI) #1 was abused by Licensed Practical Nurse (LPN) #5 when LPN #5 placed his hand over RI #1's mouth and pinched RI #1's nose to prevent RI #1 from spitting out medication during medication administration. Two staff reported that RI #1's face was red after the incident. The Certified Nursing Assistant (CNA) who witnessed the incident left RI #1 alone with LPN #5 at the time of the abuse and failed to report immediately. [...]

Inspectors wroteBased on observations, interviews, record review, review of Facility Reported Incidents (FRI), review of the facility investigative files, review of a facility policy titled Abuse Prevention and review of a facility policy titled Behavior Management and Psychopharmacological Medication Monitoring Protocol, the facility failed to provide adequate supervision and ensure appropriate interventions were developed to manage RI #78's psychosis/delusional behaviors and ensure safety of residents in the facility. Because RI #78, a resident with a known history of chronic delusions/psychosis/restlessness/agitation, was not adequately supervised by staff, RI #78 hit RI #119 in the left shoulder on 06/12/25 and hit RI #13 on the left shoulder on 09/15/2025. This was discovered during investigations of abuse. [...]

Inspectors wroteBased on observations, interviews, and facility policies titled Procedure for Infection Control for Laundry Department, and CONTACT PRECAUTIONS, the facility failed to ensure: 1)The north hall clean linen closet was clean and free from contaminants. This deficient practice had the potential to affect one of two linen closets observed. 2) Resident's laundry was handled in a manner to prevent the spread of infection. This deficient practice had the potential to affect 129 of 129 residents in the facility. 3) A staff member implemented Enhanced Barrier Precautions as indicated when providing care to Resident Identifier (RI) #8. This deficient practice affected Resident Identifier (RI) #8, one of one resident reviewed for transmission-based precautions.

Inspectors wroteBased on interviews, record review, review of a facility policy titled ABUSE PREVENTION, review of a Facility Reported Incident (FRI) submitted by the facility to the State Agency, and review of the facility's investigative file, the facility failed to ensure Resident Identifier (RI) #3 and RI #4 were free from physical abuse. On 01/26/2025, Certified Nursing Assistant (CNA) was transferring RI #3 back to the room when RI #4 hit RI #3 and they got into a physical altercation. This deficient practice affected RI #3 and RI #4, two of four residents sampled for abuse. This deficiency was cited as a result of the investigation of complaint/report number AL00050195.

Inspectors wroteBased on interviews, medical record review and review of a facility policy titled, Behavior Management and Psychopharmacological Medication Monitoring Protocol, review of Facility Reported Incidents (FRIs) received by the Alabama State Survey Agency, and review of the facility's investigative file, the facility failed to ensure appropriate interventions were developed to manage Resident Identifier (RI) #2's wandering behaviors and ensure residents' safety. This deficient practice affected RI #2, one of four residents sampled for behaviors. This deficiency was cited as a result of the investigation of complaint/report number AL00049492.

Inspectors wroteBased on observations, interviews, and resident record review, the facility failed to ensure Resident Identifier (RI) #26's nebulizer mask was in a storage bag and dated. This affected RI #26, one of two residents sampled for Respiratory Care.

Inspectors wroteBased on interviews, record review, review of the of facility policies ABUSE PREVENTION, and HUMAN RESOURCES MANAGEMENT POLICY AND PROCEDURES and the Alabama Department of Public health's (ADPH) Online Reporting System, the facility failed to ensure Resident Identifier (RI) #1 was free from misappropriation of funds from his/her personal funds. On 05/28/2024 the facility administrator was informed by the Business Office Manager (BOM) that RI #1 reported he/she had loaned Certified Nursing Assistant (CNA) #1 $250.00, and he/she had not been paid back as intended on 05/24/2024 and that today CNA #1 had told him/her it would be June 7, 2024 before she could repay the loan. This was cited as a result of investigation of complaint/report number AL00048072, and affected one of three residents reviewed for misappropriation of resident property. Findings Include: [...]

Inspectors wroteBased on observations, interviews, residents' record review, the Center for Disease Control (CDC) Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, and facility policies titled, Standard Precautions and ENTERAL TUBE MEDICATION ADMINISTRATION PROCEDURES the facility failed to ensure: 1) a Registered Nurse (RN) used technique to prevent contamination while preparing and administering medications to Resident Identifier (RI) #24 and RI #44; 2) an RN followed Standard Precautions when she picked up an alcohol swab with blood on it without wearing gloves; [...]

Inspectors wroteBased on observations, interviews, record review and review of RESIDENT BILL OF RIGHTS, the facility failed to accommodate the needs of Resident Identifier (RI) #103 by failing to ensure the call light was accessible on three of four days of the survey. This affected RI #103, one of 25 sampled residents. Findings Include: Review of RESIDENT BILL OF RIGHTS, dated 01/2023, documented: . Facility residents shall have the right to: . 10. Reside and receive services in the facility with reasonable accommodation of resident needs and preferences . RI #103 was admitted to the facility on [DATE] with a diagnosis to include Spastic Quadriplegic Cerebral Palsy. On 01/22/2024 at 3:47 PM, during initial tour surveyor observed RI #103 sitting in a Geri-chair (Geriatric Chair) while the call light was behind RI #103 on the side of the bed. The call light was not in reach. [...]

Inspectors wroteBased on observations, interviews, record review, and the facility policy titled FINGERNAILS/TOENAILS CARE the facility failed to provide assistance with activities of daily living (ADLs) to ensure good grooming for a dependent resident, Resident Identifier (RI) #73. Specifically, the facility failed to ensure RI #73's fingernails were clean. This affected one of 25 sampled residents.

Inspectors wroteBased on observations, interviews, resident record review, and the facility policy titled Oxygen Therapy, the facility failed to ensure Resident Identifier (RI) #11 received oxygen (O2) at the physician prescribed rate of two liters per minute (2 l/m). On 01/22/2024 and 01/23/2024, RI #11 was observed receiving O2 at a rate of four (4) l/m. This affected one of one resident sampled for respiratory care. Findings Include: Review of facility policy titled Oxygen Therapy dated 08/2014, documented: Policy: Oxygen (O2) is administered to promote adequate oxygenation and provide relief of symptoms of respiratory distress . PROCEDURE: 1. Oxygen therapy is to be provided under the direction of a written physicians order. 4. Adjust delivery rate as ordered. RI #11 was admitted to the facility 08/14/2014 and readmitted on [DATE] with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD). [...]

Inspectors wroteBased on observation, interview, the facility policies for Menu Planning and Requirements and Menu Substitutions or Changes and Approval, and the facility menus and production sheets for Spring/Summer (S/S) 2023 Menu, Week 1, Day 2 and Day 3; the following menu discrepancies were observed: • Four ounces of Chicken & Dumplings instead of six ounces were served to residents on Regular diets for Supper on Monday, 08/14/2023. • The Puree Diet menu for the Supper meal on Monday, 08/14/2023 for the S/S 2023 Menu, Week 1, Day 2 listed Seasoned Spinach for the vegetable, not Pureed Spinach. The production sheet for that meal also listed Seasoned Spinach, not Pureed Spinach, • Capri Vegetables were served instead of [NAME] Beans for Lunch on Tuesday, 08/15/2023 for residents on Regular, Mechanical Soft, and Puree diets. [...]

Inspectors wroteBased on observation, interview, the 2022 United States (U.S.) Food and Drug Administration (FDA) Food Code, and the facility's policies for Dishwashing: Machine Operation, Proper Handwashing and Glove Use, and Handwashing; the facility failed to prevent the potential for cross contamination on 08/13/2023 when Employee Identifier (EI) #8, a PM Aide, failed to wash hands during dishwashing when going from handling dirty dishes to clean ones. This had the potential to affect 122 of 122 residents receiving meals from the facility's kitchen. Findings Include: The facility's policy for Dishwashing: Machine Operation dated 2016, documented the following: Guideline: The Food and Nutrition Services staff shall maintain the operation of the dishwashing machine according to established procedure . [...]

Inspectors wroteBased on observations, interviews and record review, the facility failed to ensure staff did not stand while feeding Resident Identifier (RI) #63 the breakfast and lunch meals on 08/14/2023. This deficient practice affected RI #63, one of one resident observed requiring assistance at meal time. Findings Include: RI #63 was admitted to the facility on [DATE], with diagnoses to include Vascular Dementia and Alzheimer's Disease. RI #63's quarterly Minimum Data Set (MDS) assessment with an Assessment Reference Date (ARD) of 05/26/2023, assessed RI #63 with a Brief Interview for Mental Status (BIMS) score of three which indicated RI #63 had severely impaired cognitive skills for daily decision making; and RI #63 required one person assist with eating. On 08/14/2023 at 8:33 AM, RI #63 was observed being fed the breakfast meal by Employee Identifier (EI) #5, a Certified Nursing Assistant (CNA). [...]

Inspectors wroteBased on observations and interviews, the facility failed to ensure Employee Identifier (EI) #6, a Certified Nursing Assistant (CNA), washed or sanitized her hands during the delivery of the dinner meal trays on 08/13/2023. This affected the residents in Room Locators (RL) #'s 1-4, on one of two units at the facility. Findings Include: On 08/13/2023 at 6:11 PM, the dinner meal cart was delivered to the North Hall where RL #1-#4 were located. On 08/13/2023 at 06:13 PM, EI #6 entered RL #1 with a dinner tray. EI #6 was not observed to sanitize her hands before removing the tray from the meal cart. On 08/13/2023 at 6:14 PM, EI #6 went back to the meal cart, and did not sanitizer her hands when exiting RL #1. EI #6 went to the meal cart, removed another tray and took it into RL #1. EI #6 did not sanitize her hands before removing the dinner tray from the meal cart. [...]