Woodside Village

Inspectors wroteBased on record review and review of facility policy, the facility failed to provide appropriate supervision and/or assistance to prevent an accident for 1 of 1 discharged resident (Resident #4) who fell while ambulating. Failure to apply a gait belt around the resident's waist prior to ambulation resulted in Resident #4's fall with major injury. This citation is considered past non-compliance based on review of the corrective actions the facility implemented following the incident.

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 2 of 14 sampled residents (Resident #24 and #97) observed during cares. Failure to practice infection control standards related to enhanced barrier precautions (EBP) and hand hygiene/glove change has the potential to spread infection throughout the facility.

Inspectors wroteBased on record review, review of the facility report incident (FRI) investigation, and review of facility policy, the facility failed to ensure residents remained free from abuse for 1 of 1 sampled resident (Resident #4) who displayed physical behaviors towards another resident. Failure to protect residents from physical abuse may result in injury, fear, anxiety, and mental anguish. This citation is considered past non-compliance based on review of the corrective actions the facility implemented immediately following the incident.

Inspectors wroteBased on record review, review of the facility reported incident (FRI) investigation, and review of facility standard of care policy, the facility failed to properly utilize assistive devices necessary to prevent accidents for 1 of 1 closed record resident (Resident #7) who sustained a fall. Failure to remove the wheelchair foot pedals may have contributed to Resident #7's fall. This citation is considered past non-compliance based on review of the corrective actions the facility implemented immediately following the incident.

Inspectors wroteBased on record review, review of the facility reported incident and investigation documents, and review of facility policy, the facility failed to provide appropriate supervision and devices to prevent an accident for 1 of 9 sampled residents (Resident #87) investigated for falls. Failure to ensure staff utilized footrests properly on the wheelchair caused facial injuries to Resident #87 and placed all residents transferred via wheelchair at risk for falls and/or injury. This citation is considered past non-compliance based on review of the corrective actions the facility implemented immediately following the incident.

Inspectors wroteBased on observation, record review, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 1 of 1 sampled resident (Resident #126) observed during tracheostomy cares and 1 of 1 supplemental resident (Resident #283) observed during insulin administration. Failure to practice infection control standards related to glove use/hand hygiene has the potential to spread infection throughout the facility.

Inspectors wroteBased on information provided by the complainant, record review, review of the facility's policy and staff interview, the facility failed to notify the resident representative for 1 of 1 confidential resident (Resident A) who experienced a fall. Failure to notify the resident representative of a fall limits their ability to make informed decisions regarding medical care.

Inspectors wroteBased on record review, review of the Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User's Manual (Version 1.18.11), and staff interview, the facility failed to ensure accurate coding of the Minimum Data Set (MDS) for 1 of 26 sampled residents (Resident #103). Failure to accurately code the MDS does not allow each resident's assessment to reflect their status/needs and may affect the accurate development of a comprehensive care plan and the care provided to the residents.

Inspectors wroteBased on observation, record review, review of the facility's policy, and staff interview, the facility failed to ensure residents received adequate supervision/assistance to prevent accidents for 1 of 12 sampled residents (Resident #112) observed during stand-lift transfers. Failure to ensure proper use of a mechanical stand-lift resulted in Resident #112 experiencing pain and placed him at risk for possible accidents with/without injury.

Inspectors wroteBased on observation and staff interview, the facility failed to maintain the food preparation and service area in a sanitary manner for 1 of 3 kitchenettes (Prairieview) observed. Failure to serve food in a sanitary environment has the potential to result in contamination of food and could result in a foodborne illness. Findings Include: Observation of the Prairieview kitchenette occurred on 11/29/23 at 11:00 a.m. with an administrative dietary staff member (#9). Observation showed a tower fan with accumulated dust clumps blowing toward the food service area where staff prepared food for residents. During an interview on 11/30/23 at 8:33 a.m., an administrative dietary staff member (#9) confirmed the facility does not have a process or schedule for cleaning fans and expected them to be dust free.

Inspectors wroteBased on observation, review of facility policy, and staff interview, the facility failed to follow standards of infection control for 1 of 4 neighborhoods (Oakcrest) observed with Covid-19 outbreak, and 1 of 1 sampled residents (#60) observed with a catheter. Failure to practice infection control standards related to use of personal protective equipment (PPE), and proper care of a catheter has the potential to spread infection throughout the facility. Findings Include: PERSONAL PROTECTIVE EQUIPMENT Review of the facility policy titled Transmission-Based Precautions occurred on 11/30/23. This policy, revised July 2023, stated . Transmission-Based Precautions are initiated when a resident develops signs and symptoms of a transmissible infection . are additional measures that protect staff, visitors, and other residents from becoming infected . [...]