SNF

GALLERIA WOODS SKILLED NURSING FACILITY

CCN: 015459 · BIRMINGHAM, AL 35244 · Jefferson County

⚠ Inspection > 2 years ago ℹ CCRC

Overview

Address
3850 GALLERIA WOODS DRIVE, BIRMINGHAM, AL 35244
Phone
2059857537
Certified beds
30
Avg daily residents
26 (86% of beds filled)
Ownership
For-profit corporation
Provider type
Medicare
Medicare/Medicaid since
2007-02-16
Setting
Urban
3 /5
★★★★★
CMS Overall Rating

CMS 5-Star Ratings

CMS rates every Medicare/Medicaid-certified nursing home on four domains. The Overall rating is driven primarily by Health Inspection results, then adjusted up or down by Staffing and Quality Measures.

Overall Rating
Composite of Health Inspection, Staffing, and Quality Measures.
★★★★★ 3/5
Health Inspection
Based on the three most recent standard surveys, with more weight on recent results.
★★★★★ 2/5
Staffing
Weighted combination of RN and total nurse staffing hours per resident per day, case-mix adjusted.
★★★★★ 4/5
Quality Measures
15 resident-level quality measures split between long-stay and short-stay (post-acute) residents.
★★★★★ 5/5
Quality Measures breakdown
Long-Stay Quality Measures ★★★★★ 5/5
Short-Stay Quality Measures ★★★★★ 4/5

Staffing & Workforce

Direct-care staffing is the strongest operational driver of quality in nursing homes. Values are hours per resident per day, derived from payroll-based journal (PBJ) submissions. "Case-mix" adjusts for resident acuity; "Adjusted" is the CMS rating-input value.

Role Reported Case-mix expected Adjusted Federal floor
Total nurse
All nursing staff combined: RN + LPN + Aide
 4.52 3.14 5.55 ≥ 3.48
Registered Nurse (RN)
Licensed RN hours. Strongest driver of clinical outcomes.
 1.09 0.55 1.34 ≥ 0.55
Licensed Practical Nurse (LPN)
LPN/LVN hours. Often handles medication administration.
 0.96 0.70 1.17 —
Nurse aide
CNA hours. Bulk of direct resident care — bathing, feeding, mobility.
 2.47 1.90 3.04 —
Licensed (RN + LPN)
Combined licensed nurse coverage.
 2.05 — — —
Physical therapist
Rehabilitation therapist hours — important for post-acute / rehab admissions.
 0.13 — — —

Federal minimums (phasing in under the CMS 2024 minimum staffing rule) shown for reference. RN: 0.55 hrs/resident/day. Total nurse: 3.48 hrs/resident/day.

Weekend staffing

Total nurse (weekend)
4.07
hrs / resident / day
RN (weekend)
0.78
hrs / resident / day
Total nurse (adjusted, weekend)
5.00
hrs / resident / day

Weekend under-staffing is a common quality-of-care concern — adverse events are more frequent when licensed coverage drops.

Staff turnover

Total nursing staff turnover
63.9%
annual
RN turnover
54.5%
annual
Administrators departed
0
last 12 months

Resident acuity

Nursing Case-Mix Index
1.11
near national average
Case-Mix Index Ratio
0.81
facility / state ratio

Health Inspections

CMS weights three inspection cycles to compute the Health Inspection rating: the most recent (50%), the second most recent (33%), and the oldest (17%). Each standard-survey deficiency is assigned a score based on scope and severity; complaint-survey findings and revisit scores are added to produce the cycle total.

Cycle Date Total defs. Standard Complaint Deficiency score Revisits Total score
Cycle 1 (most recent) 2021-12-16 4 4 0 40 1 40
Cycle 2/3 (prior) 2019-04-11 3 3 0 24 1 24
Total weighted health score
36.0
lower is better
Infection-control citations
0
last cycle

Deficiencies (10)

Individual survey findings. Scope/severity uses the CMS A–L matrix: letters further down the alphabet indicate greater harm and wider scope, up through J–L (immediate jeopardy).

10 D/E/F Actual harm — potential for minor
Tag Description Scope/Severity Survey date Corrected
0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. D 2021-12-16 2022-01-12
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F 2021-12-16 2022-01-12
0814 Dispose of garbage and refuse properly. D 2021-12-16 2022-01-12
0880 Provide and implement an infection prevention and control program. F 2021-12-16 2022-01-12
0690 Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. D 2019-04-11 2019-05-03
0761 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. D 2019-04-11 2019-05-03
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F 2019-04-11 2019-05-03
0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. D 2018-05-17 2018-06-06
0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. D 2018-05-17 2018-06-06
0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. F 2018-05-17 2018-06-06

Financial Health (FY 2023)

Operating performance

Total Margin
10.8%
Occupancy Rate
88.5%
Cost per Resident Day
$32

Revenue & costs

Net Patient Revenue
$4.0M
Total Costs
$563K
Net Income
$1.6M

Balance sheet

Total Assets
$26.4M
Total Liabilities
$35.9M
Fund Balance
-$9.4M
Current Ratio
0.59

Source: CMS SNF Cost Report (FY 2023). Cost report data lags by ~2 years.

Ownership & Corporate Structure

Chain: HEALTHPEAK PROPERTIES, INC.

Chain ID
261
Facilities in chain
15
Legal business name
CCRC OPCO-GALLERIA WOODS, LLC
Chain-average star ratings (for peer context)
Overall
3.3
Health
3.0
Staffing
3.9
QM
3.7

Owner / manager organizations (8)

Organization Role Association
CCRC OPCO VENTURES LLC 5% OR GREATER DIRECT OWNERSHIP INTEREST since 08/29/2014
CCRC PROPCO VENTURES, LLC 5% OR GREATER DIRECT OWNERSHIP INTEREST since 02/01/2020
HCP S-H 2014 MEMBER LLC 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 02/01/2020
HEALTHPEAK OP LLC 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 02/10/2023
HEALTHPEAK PROPERTIES INC 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 02/01/2020
S-H 2014 OPCO TRS INC 5% OR GREATER INDIRECT OWNERSHIP INTEREST since 02/01/2020
LIFE CARE SERVICES LLC OPERATIONAL/MANAGERIAL CONTROL since 02/01/2020
ARC GALLERIA WOODS INC 5% OR GREATER SECURITY INTEREST since 08/31/2014

Owner / manager individuals (2)

Name Role Association
GILSTRAP, JODY OPERATIONAL/MANAGERIAL CONTROL since 01/01/2025
SULLIVAN, LYNDA OPERATIONAL/MANAGERIAL CONTROL since 08/29/2014

Source: CMS Nursing Home Ownership. Percent ownership is rarely disclosed — CMS only requires it for specific roles.

Facility Features

CCRC
Yes
Hospital-based
No
Resident / family council
Resident
Sprinkler systems
Yes
Abuse citation flag
No
Methodology & sources

Full methodology →

All Data

Every labeled field shipped for this facility by CMS. No national median or percentile context is available for SNFs in the current release.

Download CSV

Show 111 rows
Source Metric Value Raw key
Cost Report Cost per Resident Day ($) $32 metrics.cost_per_resident_day
Cost Report Current Ratio 0.59 metrics.current_ratio
Cost Report fiscal_year 2,023 fiscal_year
Cost Report Medicare Day Share (%) 6.3% metrics.medicare_day_share
Cost Report Net Income ($) $1,620,052 metrics.net_income
Cost Report Net Patient Revenue ($) $4,024,709 metrics.net_patient_revenue
Cost Report Occupancy Rate (%) 88.5% metrics.occupancy_rate
Cost Report Total Assets ($) $26,417,657 metrics.total_assets
Cost Report Total Costs ($) $563,448 metrics.total_costs
Cost Report Total Fund Balances ($) $-9,447,480 metrics.fund_balance
Cost Report Total Liabilities ($) $35,865,137 metrics.total_liabilities
Cost Report Total Margin (%) 10.8% metrics.total_margin
Provider Information Abuse Icon N Abuse Icon
Provider Information Adjusted LPN Staffing Hours per Resident per Day 1.17270 Adjusted LPN Staffing Hours per Resident per Day
Provider Information Adjusted Nurse Aide Staffing Hours per Resident per Day 3.03815 Adjusted Nurse Aide Staffing Hours per Resident per Day
Provider Information Adjusted RN Staffing Hours per Resident per Day 1.34367 Adjusted RN Staffing Hours per Resident per Day
Provider Information Adjusted Total Nurse Staffing Hours per Resident per Day 5.55452 Adjusted Total Nurse Staffing Hours per Resident per Day
Provider Information Adjusted Weekend Total Nurse Staffing Hours per Resident per Day 5.00289 Adjusted Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Administrator turnover footnote — Administrator turnover footnote
Provider Information Automatic Sprinkler Systems in All Required Areas Yes Automatic Sprinkler Systems in All Required Areas
Provider Information Average Number of Residents per Day 25.9 Average Number of Residents per Day
Provider Information Average Number of Residents per Day Footnote — Average Number of Residents per Day Footnote
Provider Information Case-Mix LPN Staffing Hours per Resident per Day 0.69788 Case-Mix LPN Staffing Hours per Resident per Day
Provider Information Case-Mix Nurse Aide Staffing Hours per Resident per Day 1.89669 Case-Mix Nurse Aide Staffing Hours per Resident per Day
Provider Information Case-Mix RN Staffing Hours per Resident per Day 0.55009 Case-Mix RN Staffing Hours per Resident per Day
Provider Information Case-Mix Total Nurse Staffing Hours per Resident per Day 3.14466 Case-Mix Total Nurse Staffing Hours per Resident per Day
Provider Information Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day 2.77169 Case-Mix Weekend Total Nurse Staffing Hours per Resident per Day
Provider Information Chain Average Health Inspection Rating 3.0 Chain Average Health Inspection Rating
Provider Information Chain Average Overall 5-star Rating 3.3 Chain Average Overall 5-star Rating
Provider Information Chain Average QM Rating 3.7 Chain Average QM Rating
Provider Information Chain Average Staffing Rating 3.9 Chain Average Staffing Rating
Provider Information Chain ID 261 Chain ID
Provider Information Chain Name HEALTHPEAK PROPERTIES, INC. Chain Name
Provider Information City/Town BIRMINGHAM City/Town
Provider Information CMS Certification Number (CCN) 015459 CMS Certification Number (CCN)
Provider Information Continuing Care Retirement Community Y Continuing Care Retirement Community
Provider Information County/Parish Jefferson County/Parish
Provider Information Date First Approved to Provide Medicare and Medicaid Services 2007-02-16 Date First Approved to Provide Medicare and Medicaid Services
Provider Information Geocoding Footnote — Geocoding Footnote
Provider Information Health Inspection Rating 2 Health Inspection Rating
Provider Information Health Inspection Rating Footnote — Health Inspection Rating Footnote
Provider Information Latitude 33.3686 Latitude
Provider Information Legal Business Name CCRC OPCO-GALLERIA WOODS, LLC Legal Business Name
Provider Information Location 3850 GALLERIA WOODS DRIVE,BIRMINGHAM,AL,35244 Location
Provider Information Long-Stay QM Rating 5 Long-Stay QM Rating
Provider Information Long-Stay QM Rating Footnote — Long-Stay QM Rating Footnote
Provider Information Longitude -86.817 Longitude
Provider Information Most Recent Health Inspection More Than 2 Years Ago Y Most Recent Health Inspection More Than 2 Years Ago
Provider Information Number of administrators who have left the nursing home 0 Number of administrators who have left the nursing home
Provider Information Number of Certified Beds 30 Number of Certified Beds
Provider Information Number of Citations from Infection Control Inspections 0 Number of Citations from Infection Control Inspections
Provider Information Number of Facilities in Chain 15 Number of Facilities in Chain
Provider Information Number of Fines 0 Number of Fines
Provider Information Number of Payment Denials 0 Number of Payment Denials
Provider Information Nursing Case-Mix Index 1.11401 Nursing Case-Mix Index
Provider Information Nursing Case-Mix Index Ratio 0.80863 Nursing Case-Mix Index Ratio
Provider Information Overall Rating 3 Overall Rating
Provider Information Overall Rating Footnote — Overall Rating Footnote
Provider Information Ownership Type For profit - Corporation Ownership Type
Provider Information Physical Therapist Staffing Footnote — Physical Therapist Staffing Footnote
Provider Information Processing Date 2026-03-01 Processing Date
Provider Information Provider Address 3850 GALLERIA WOODS DRIVE Provider Address
Provider Information Provider Changed Ownership in Last 12 Months N Provider Changed Ownership in Last 12 Months
Provider Information Provider Name GALLERIA WOODS SKILLED NURSING FACILITY Provider Name
Provider Information Provider Resides in Hospital N Provider Resides in Hospital
Provider Information Provider SSA County Code 360 Provider SSA County Code
Provider Information Provider Type Medicare Provider Type
Provider Information QM Rating 5 QM Rating
Provider Information QM Rating Footnote — QM Rating Footnote
Provider Information Rating Cycle 1 Health Deficiency Score 40 Rating Cycle 1 Health Deficiency Score
Provider Information Rating Cycle 1 Health Revisit Score 0 Rating Cycle 1 Health Revisit Score
Provider Information Rating Cycle 1 Number of Complaint Health Deficiencies 0 Rating Cycle 1 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 1 Number of Health Revisits 1 Rating Cycle 1 Number of Health Revisits
Provider Information Rating Cycle 1 Number of Standard Health Deficiencies 4 Rating Cycle 1 Number of Standard Health Deficiencies
Provider Information Rating Cycle 1 Standard Survey Health Date 2021-12-16 Rating Cycle 1 Standard Survey Health Date
Provider Information Rating Cycle 1 Total Health Score 40 Rating Cycle 1 Total Health Score
Provider Information Rating Cycle 1 Total Number of Health Deficiencies 4 Rating Cycle 1 Total Number of Health Deficiencies
Provider Information Rating Cycle 2 Number of Standard Health Deficiencies 3 Rating Cycle 2 Number of Standard Health Deficiencies
Provider Information Rating Cycle 2 Standard Health Survey Date 2019-04-11 Rating Cycle 2 Standard Health Survey Date
Provider Information Rating Cycle 2/3 Health Deficiency Score 24 Rating Cycle 2/3 Health Deficiency Score
Provider Information Rating Cycle 2/3 Health Revisit Score 0 Rating Cycle 2/3 Health Revisit Score
Provider Information Rating Cycle 2/3 Number of Complaint Health Deficiencies 0 Rating Cycle 2/3 Number of Complaint Health Deficiencies
Provider Information Rating Cycle 2/3 Number of Health Revisits 1 Rating Cycle 2/3 Number of Health Revisits
Provider Information Rating Cycle 2/3 Total Health Score 24 Rating Cycle 2/3 Total Health Score
Provider Information Rating Cycle 2/3 Total Number of Health Deficiencies 3 Rating Cycle 2/3 Total Number of Health Deficiencies
Provider Information Registered Nurse hours per resident per day on the weekend 0.78085 Registered Nurse hours per resident per day on the weekend
Provider Information Registered Nurse turnover 54.5 Registered Nurse turnover
Provider Information Registered Nurse turnover footnote — Registered Nurse turnover footnote
Provider Information Reported Licensed Staffing Hours per Resident per Day 2.04954 Reported Licensed Staffing Hours per Resident per Day
Provider Information Reported LPN Staffing Hours per Resident per Day 0.95515 Reported LPN Staffing Hours per Resident per Day
Provider Information Reported Nurse Aide Staffing Hours per Resident per Day 2.47453 Reported Nurse Aide Staffing Hours per Resident per Day
Provider Information Reported Physical Therapist Staffing Hours per Resident Per Day 0.12705 Reported Physical Therapist Staffing Hours per Resident Per Day
Provider Information Reported RN Staffing Hours per Resident per Day 1.09440 Reported RN Staffing Hours per Resident per Day
Provider Information Reported Staffing Footnote — Reported Staffing Footnote
Provider Information Reported Total Nurse Staffing Hours per Resident per Day 4.52407 Reported Total Nurse Staffing Hours per Resident per Day
Provider Information Short-Stay QM Rating 4 Short-Stay QM Rating
Provider Information Short-Stay QM Rating Footnote — Short-Stay QM Rating Footnote
Provider Information Special Focus Status — Special Focus Status
Provider Information Staffing Rating 4 Staffing Rating
Provider Information Staffing Rating Footnote — Staffing Rating Footnote
Provider Information State AL State
Provider Information Telephone Number 2059857537 Telephone Number
Provider Information Total Amount of Fines in Dollars 0.00 Total Amount of Fines in Dollars
Provider Information Total number of nurse staff hours per resident per day on the weekend 4.07478 Total number of nurse staff hours per resident per day on the weekend
Provider Information Total Number of Penalties 0 Total Number of Penalties
Provider Information Total nursing staff turnover 63.9 Total nursing staff turnover
Provider Information Total nursing staff turnover footnote — Total nursing staff turnover footnote
Provider Information Total Weighted Health Survey Score 36.000 Total Weighted Health Survey Score
Provider Information Urban Y Urban
Provider Information With a Resident and Family Council Resident With a Resident and Family Council
Provider Information ZIP Code 35244 ZIP Code