Woodhaven Hall at Williamsburg Landing

In the surveyor’s words

From the most serious findings on record at Woodhaven Hall at Williamsburg Landing, in the surveyor’s own words.

• Immediate jeopardy, isolatedF689Feb 27, 2026

  Based on observation, interview, record review, and policy review, the facility failed to provide supervision and ensure resident safety for two of six Residents (Resident (R)14 and R59) reviewed for elopement. As a result, R14 and R59, who had been assessed as an elopement and fall risk with moderate cognitive impairment, exited the facility without staff knowledge. R14 was found sitting in the parking of the facility next to his wheelchair with a bruised laceration under his right eye and eloped a second time. R59 also eloped from the facility two times, with one of the times being found a mile from the entrance of the facility. This had the potential to result in serious injury, harm, impairment, or death. […]

• No harm, potential for more than minimal, widespreadF812Feb 27, 2026

  Based on observation, interview, record review, and policy review, the facility failed to ensure the dish machine wash and rinse temperature was at the proper temperature to sanitize the dishes. This had the potential to affect 44 of 44 skilled nursing residents who consumed food from the kitchen. Findings include:During an observation on 02/26/26 at 12:25 PM, revealed the dishwasher wash and rinse cycle's temperature was registering 158 degrees Fahrenheit (F) for the wash cycle and 150 degrees F for the rinse cycle from the gauge on the dish machine. A second temperature monitor mounted on the wall and connected to the dish machine registered the wash cycle at 155 degrees F and 188.8 degrees F for the rinse cycle. […]

• No harm, potential for more than minimal, widespreadF886Aug 19, 2022

  Based on observation, staff interview, clinical record review, and facility documentation review, the facility staff failed to conduct COVID-19 testing in accordance with CDC (Centers for Disease Control) and CMS (Centers for Medicare & Medicaid Services) guidance/requirements for 4 out of 6 staff members, staff members #4, #5, #6, and #8, the facility staff failed to maintain documentation of COVID-19 testing occurrences and results for all facility staff, and the facility staff failed to conduct COVID-19 testing for 4 out of 4 newly admitted residents, residents #46, #57, #110, and #209. The findings included: 1. […]

• No harm, potential for more than minimal, patternF888Aug 19, 2022

  Based on staff interview and facility documentation review, the facility staff failed to implement their policy and procedure to ensure that all facility staff were fully vaccinated for COVID-19. The facility staff failed to document the COVID-19 vaccination status for 56 contracted nursing agency staff members who provided direct resident care during the months of June, July, and August 2022. The findings included: On 8/18/22, an interview was conducted with the Facility Administrator and the Infection Preventionist (IP). The IP stated that the Human Resources (HR) department was responsible for all staff COVID vaccinations. […]

• No harm, potential for more than minimal, isolatedF600Feb 27, 2026

  Based on record review, interview, and facility policy review, the facility failed to ensure residents were protected from potential abuse for one of one resident (Resident (R) 56) reviewed for an injury of unknown origin. R56 was discovered on the floor with signs and symptoms of pain and was emergently transferred to the hospital for further evaluation. There were no witnesses to the incident, and the resident did not explain the reason he was on the floor and in pain. The facility's failure to identify the incident as an injury of unknown origin caused the resident to be a possible victim of abuse.Findings include: Review of R56's printed Face Sheet, provided by the Administrator, revealed R56 was admitted to the facility's on 12/21/23 with diagnoses including dementia and… […]