Legacy Health and Rehabilitation of Pleasant GroveCMS ratings, inspections and fines
- Address
- 30 7th Street, Pleasant Grove, AL 35127
- CCN
- 015461
- Ownership type
- For-profit, corporation
- Certified beds
- 189
- Chain
- NHS Management
- Residents per day
- 134
- CMS flags
- No standard survey in more than 2 years
The watch list stays in this browser. After each CMS update, it shows the values that changed at the homes on the list.
CMS gives Legacy Health and Rehabilitation of Pleasant Grove an overall rating of 1 of 5 stars. The last standard survey was on 11 Feb 2022. The latest survey cycle has 8 health citations. The median for nursing homes in Alabama is 3. CMS lists no fines for this home in its penalties file.
Facilities may see a change in their overall rating for a number of reasons. Since the overall rating is based on three individual domains, a change in any one of the domains can affect the overall rating. Any new data for a nursing home could potentially change a star rating domain.
Centers for Medicare & Medicaid Services, Five-Star Quality Rating System: Technical Users' Guide, July 2026. CMS processed this record on .
Since the last CMS update
The site has no recorded change for this home. In each CMS update, the site compares the ratings, the penalties and the citations of each home.
Ratings
CMS gives each home 1 to 5 stars for health inspections, for staffing and for quality measures, and one overall rating.
| Rating (1 to 5 stars) | This home | Jefferson County median | Alabama median | US average (CMS) |
|---|---|---|---|---|
| Overall rating | 1 | 2.0 | 3.0 | 3.0 |
| Health inspection rating | 1 | 2.0 | 3.0 | 2.8 |
| Staffing rating | 4 | 3.0 | 4.0 | 2.9 |
| Quality measure rating | 2 | 3.0 | 3.0 | 3.6 |
A median is the middle value of the homes in the group: 34 homes in the county, 224 homes in the state. What the CMS star ratings measure
Citations by survey cycle
CMS keeps the last three cycles, and cycle 1 is the latest. A cycle has one standard survey. Citations from complaint and infection control inspections go into cycles of 12 months.
| Survey cycle | Standard survey | Citations | Alabama median |
|---|---|---|---|
| Cycle 1 (latest) | 11 Feb 2022 | 8 | 3 |
| Cycle 2 | 1 Jul 2019 | 5 | 2 |
| Cycle 3 | No date | 5 | 3 |
Health citations
The record of one deficiency in an inspection. One inspection can give many citations.
Scope and severity. A letter from A to L on each citation. Scope is the number of residents that the deficiency affected. Severity is the level of harm.
| Severity | Isolated | Pattern | Widespread |
|---|---|---|---|
| Immediate jeopardy to resident health or safety | J0 | K0 | L0 |
| Actual harm that is not immediate jeopardy | G0 | H0 | I0 |
| No actual harm, potential for more than minimal harm | |||
| No actual harm, potential for minimal harm | A0 | B0 |
Survey cycle 1 (latest): 8 citations
Standard survey of this cycle: .
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 11 Feb 2022 | F0553 | Allow resident to participate in the development and implementation of his or her person-centered plan of care. | D | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0584 | 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. | E | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0677 | Provide care and assistance to perform activities of daily living for any resident who is unable. | D | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0693 | Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. | D | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0758 | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | D | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0759 | Ensure medication error rates are not 5 percent or greater. | E | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0814 | Dispose of garbage and refuse properly. | F | Standard survey | 18 Mar 2022 |
| 11 Feb 2022 | F0886 | Perform COVID19 testing on residents and staff. | E | Standard survey | 18 Mar 2022 |
Survey cycle 2: 5 citations
Standard survey of this cycle: .
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 1 Jul 2019 | F0641 | Ensure each resident receives an accurate assessment. | D | Standard survey | 30 Aug 2019 |
| 1 Jul 2019 | F0656 | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | D | Standard survey | 30 Aug 2019 |
| 1 Jul 2019 | F0689 | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | D | Standard survey | 30 Aug 2019 |
| 1 Jul 2019 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard survey | 30 Aug 2019 |
| 1 Jul 2019 | F0880 | Provide and implement an infection prevention and control program. | D | Standard survey | 30 Aug 2019 |
Survey cycle 3: 5 citations
The CMS provider file has no standard survey date for this cycle.
| Survey date | F-tag | Requirement (CMS text) | Scope and severity | Survey type | Corrected |
|---|---|---|---|---|---|
| 27 Jun 2018 | F0584 | 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. | D | Standard survey | 31 Jul 2018 |
| 27 Jun 2018 | F0732 | Post nurse staffing information every day. | C | Standard survey | 31 Jul 2018 |
| 27 Jun 2018 | F0755 | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | D | Standard survey | 31 Jul 2018 |
| 27 Jun 2018 | F0812 | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | F | Standard survey | 31 Jul 2018 |
| 27 Jun 2018 | F0880 | Provide and implement an infection prevention and control program. | D | Standard survey | 31 Jul 2018 |
The requirement text is the CMS summary of the F-tag. It is not the report of the surveyor. How to read an inspection report
Penalties
A fine, or a payment denial: a period in which Medicare or Medicaid does not pay for new admissions. The CMS penalties file holds three years.
CMS lists no fine and no payment denial for this home in its penalties file.
Staffing
Hours per resident per day. The nurse hours for one resident on an average day. CMS calculates the figure from the hours that the home reports for a quarter.
| Staff | This home | Alabama median | Alabama average (CMS) |
|---|---|---|---|
| All nurse staff | 4.18 | 3.90 | 3.88 |
| Registered nurses (RN) | 0.46 | 0.60 | 0.65 |
| Licensed practical nurses (LPN) | 0.88 | 0.79 | |
| Nurse aides | 2.85 | 2.44 | |
| All nurse staff, weekends | 3.16 | 3.30 | 3.26 |
- Nurse staff turnover in a year
- 53.2%
- Nurse staff turnover, Alabama median
- 46.7%
- RN turnover in a year
- 50.0%
- Administrators who left in a year
- 1
Homes report the hours to CMS in the Payroll-Based Journal.
Quality measures
A figure that CMS calculates from the assessments of residents. One example is the percentage of long-stay residents with a fall and a major injury.
| Measure (CMS text) | Residents | This home | Alabama median | US median |
|---|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased | Long Stay | 16.4% | 11.3% | 12.6% |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | Long Stay | 0.5% | 0.7% | 0.3% |
| Percentage of long-stay residents with a urinary tract infection | Long Stay | 0.8% | 1.7% | 0.9% |
| Percentage of long-stay residents experiencing one or more falls with major injury | Long Stay | 2.6% | 2.9% | 2.8% |
| Percentage of short-stay residents who newly received an antipsychotic medication | Short Stay | 0.0% | 1.7% | 1.0% |
| Percentage of long-stay residents whose ability to walk independently worsened | Long Stay | 11.5% | 11.3% | 12.5% |
| Percentage of long-stay residents with pressure ulcers | Long Stay | 5.6% | 4.9% | 4.2% |
| Percentage of long-stay residents who received an antipsychotic medication | Long Stay | 26.1% | 20.2% | 13.4% |
For each measure in this table, CMS gives more points in the quality measure rating for a lower percentage. The site calculates the medians from the CMS file. What the CMS star ratings measure
Ownership
An organisation in the CMS ownership file. CMS records its role, for example an ownership interest, operational or managerial control, or a mortgage interest.
- Ownership type
- For-profit, corporation
- Legal business name
- Legacy Health and Rehabilitation of Pleasant Grove, LLC
- Chain
- NHS Management (43 homes in the CMS chain file)
| Organisation | Role in the CMS record | Interest | Since |
|---|---|---|---|
| Northport Holding Operations, LLC | 5% or greater direct ownership interest | 100% | 29 May 2007 |
| Capital Funding LLC | 5% or greater mortgage interest | 1 Jun 2012 | |
| Capital Funding LLC | 5% or greater security interest | 1 Jun 2012 | |
| Holding Facilities Group LLC | 5% or greater security interest | 1 Jun 2012 | |
| Pleasant Grove Health Realty LLC | 5% or greater security interest | 1 Jun 2012 | |
| Servisfirst Bank | 5% or greater security interest | 29 Aug 2018 |
The site shows organisations only. It does not show the names of persons.
Other homes in Jefferson County
| Nursing home | City | Overall rating | Citations, latest cycle | Fines | Last standard survey | |
|---|---|---|---|---|---|---|
| Caregivers of Pleasant Grove, Inc | Pleasant Grove | 1 of 5 | 5 | $0 | 11 Mar 2021 | |
| Self Skilled Nursing & Rehab | Hueytown | 1 of 5 | 11 | $0 | 18 Mar 2021 | |
| Baron House of Hueytown | Hueytown | 4 of 5 | 3 | $0 | 13 Mar 2024 | |
| Redmont Health and Rehabilitation Center | Birmingham | 3 of 5 | 4 | $0 | 27 Oct 2022 | |
| Northgate Health and Rehabilitation Center | Bessemer | 2 of 5 | 2 | $17,346 | 9 Jan 2025 | |
| Stonehaven Health and Rehabilitation Center | Bessemer | 1 of 5 | 6 | $0 | 12 Feb 2023 | |
| Birmingham Nursing and Rehabilitation Ctr LLC | Birmingham | 1 of 5 | 8 | $68,647 | 26 Jun 2024 | |
| Arlington Rehabilitation & Healthcare Center | Birmingham | 4 of 5 | 2 | $0 | 1 Apr 2021 | |
| Oak Knoll Health and Rehabilitation, LLC | Birmingham | 3 of 5 | 6 | $0 | 18 Mar 2021 | |
| Cherry Hill Rehabilitation & Healthcare Center | Birmingham | 2 of 5 | 8 | $0 | 14 Dec 2022 | |
| Diversicare of Bessemer | Bessemer | 1 of 5 | 13 | $0 | 2 Dec 2022 | |
| Civic Center Health and Rehabilitation, LLC | Birmingham | 2 of 5 | 6 | $0 | 22 Mar 2024 |
Official channels
- Care Compare record of this nursing homeMedicare.gov. The official CMS record of this home.
- Alabama Department of Public Health: filing complaintsThe complaint page of the State Survey Agency for Alabama, from the CMS list of agencies.
- Contact information for State Survey AgenciesCMS. The web address and the telephone number of the State Survey Agency of each state. These agencies investigate complaints about nursing homes.
- Filing a complaintMedicare.gov. The page names the State Survey Agency as the place for a complaint about nursing home care or facility conditions.
- Eldercare LocatorAdministration for Community Living. A public service that connects older adults and their families to local services. Telephone: 1-800-677-1116.
Cite this page
Centers for Medicare & Medicaid Services, Care Compare. Record of Legacy Health and Rehabilitation of Pleasant Grove (CCN 015461). Data processed 1 Aug 2026. Elder Care Record, https://eldercarerecord.com/facility/legacy-health-and-rehabilitation-of-pleasant-grove-pleasant-grove-al-015461/
Provenance
- Licence
- US government work, public domain
- CMS processed the data on
A program makes this page from the CMS files, and the same files always give the same text. How the site makes the figures. Report an error.
Questions
- When was Legacy Health and Rehabilitation of Pleasant Grove last inspected?
- The latest inspection with a citation in the CMS record was on 11 Feb 2022. It was a standard survey. It gave 8 citations. The standard survey before the last one was on 1 Jul 2019. CMS marks the last health inspection of this home as more than 2 years old.
- Who operates Legacy Health and Rehabilitation of Pleasant Grove?
- The CMS record gives the ownership type as for-profit, corporation. CMS lists the home in the chain NHS Management. The CMS ownership file names no organisation for operational or managerial control. This site does not show the names of persons.
- Is Legacy Health and Rehabilitation of Pleasant Grove a Special Focus Facility?
- No. The CMS provider file lists no Special Focus status for this home. CMS lists 1 home in Alabama as a Special Focus Facility and 5 as candidates.
- Where does the data on this page come from?
- The data comes from the CMS Care Compare files for nursing homes. CMS processed the files on 1 Aug 2026. The Care Compare record on Medicare.gov is the official record of the home.