Willow Woods Rehabilitation and Nursing

In the surveyor’s words

From the most serious findings on record at Willow Woods Rehabilitation and Nursing, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880May 11, 2021

  Based on the unprecedented global pandemic that resulted in the Presidential declaration of a State of National Emergency dated 03/13/20, review of the facility's Coronavirus (COVID-19) policy, review of the facility's handwashing policy, review of Centers for Disease Control and Prevention (CDC) guidelines, observations, interviews, and record review the facility failed to implement appropriate infection control practices related to use of personal protective equipment (PPE) for residents on COVID-19 isolation precautions, failed to conduct appropriate screening upon entering the facility and failed to perform hand hygiene. This resulted in Immediate Jeopardy on 04/30/21 at 4:00 A.M. […]

• Immediate jeopardy, isolatedF689Mar 6, 2023

  Based on observation, medical record review, Self-Reported Incident review, camera footage review, interviews, review of the local police report, witness statement review, review of historical local weather, and facility policy review, the facility failed to provide adequate supervision to prevent one resident (Resident #2), who had a court appointed guardian, memory impairment, history of traumatic brain injury (TBI), and diagnosis of vascular dementia from elopement from the facility. This resulted in Immediate Jeopardy and the potential for serious life-threatening harm, injury and/or death when on 02/20/23 at 2:26 P.M. Resident #2 exited the facility without staff knowledge via a first floor secured window. […]

• Actual harm, isolatedF600Dec 31, 2024

  Based on observation, record review, review of a facility Self-Reported Incident (SRI) and investigation, review of a police report, facility policy review and interview, the facility failed to protect Resident #2's right to be free from physical abuse by Resident #44. Actual harm occurred on 11/28/24 when Resident #2, who was alert and oriented, was punched in the face by Resident #44, who had known aggressive behaviors towards others, during an unprovoked incident while Resident #2 was laying in his bed, sustaining a hematoma to the right eye area and bruising to his right upper arm. Resident #2 was taken to the hospital emergency department for evaluation, diagnosed with a facial hematoma and returned to the facility. […]

• Actual harm, isolatedF689Dec 31, 2024

  THE FOLLOWING DEFICIENCY REPRESENTS AN INCIDENT OF PAST NON-COMPLIANCE THAT WAS SUBSEQUENTLY CORRECTED PRIOR TO THIS SURVEY Based on record review, interview and review of facility policy, the facility failed to provide adequate supervision and/or intervention to prevent Resident #64 from sustaining a burn to his abdomen. This affected one resident (#64) of four residents who were reviewed for accidents. The facility census was 71. Actual harm occurred on 11/03/24 when Resident #64, who had severe cognitive impairment, was found in his room with a cigarette lighter (belonging to Resident #85) and his clothing smoldering subsequently sustaining a second-degree burn (an injury that affects both the outer layer of skin or epidermis and part of the underlying layer called the dermis) to his… […]

• Actual harm, isolatedF600Jan 23, 2023

  Based on review of medical records, review of the facility Self- Reported Incident (SRI) and SRI investigation, review of the facility abuse policy and interviews with staff, the facility failed to provide adequate supervision to protect Resident #84 from physical abuse inflicted by cognitively intact Resident #43. Actual harm occurred when Resident #84 was struck in the face by Resident #43 causing a half inch laceration to Resident #84's left eyebrow. This affected one resident (Resident #84) of three residents reviewed for abuse/neglect and it had the potential to affect all 18 residents on the Maple/secured unit. […]