Woodlands Nursing & Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Woodlands Nursing & Rehabilitation Center, in the surveyor’s own words.

• Immediate jeopardy, isolatedF684Feb 10, 2023

  Based on facility and emergency department record review, observation, and interviews with staff, residents, dialysis staff and contract transportation staff, the facility failed to ensure a transportation driver followed emergency protocol after Resident #1's fall from his wheelchair during van transportation. The driver failed to request emergency aid and continued driving with Resident #1 on the floor of the van. The resident had bleeding from his below the knee amputation sites and pain on his right shoulder. This situation had the high likelihood to cause serious injury and harm. This deficient practice affected 1 of 3 residents reviewed for accidents (Resident #1). […]

• Immediate jeopardy, isolatedF689Feb 10, 2023

  Based on facility and emergency department record review, observation, and interviews with staff, residents, dialysis staff and contract transportation staff, the facility failed to ensure positioning and securement was according to manufacturer's recommendations to provide a safe contract van transport. Resident #1 fell from his wheelchair when the transportation driver put on the brakes. The resident had bleeding from his below the knee amputation sites and pain on his right shoulder. This situation had the high likelihood to cause serious injury and harm. […]

• No harm, potential for more than minimal, patternF760May 7, 2024

  Based on record review and staff interviews the facility failed to administer significant medications to 4 out of 16 residents (Resident #1, #18, #21, and #48) reviewed for medication administration. The facility also failed to follow medication administration guidelines for not crushing certain medications for 1 out of 16 residents reviewed for medication administration (Resident #42). Findings included: 1a) Resident #1 was admitted originally into the facility 01/31/22 and was readmitted on [DATE] with the diagnoses of cerebral infarction, chronic systolic congestive heart failure, hypothyroidism, hypertensive heart and chronic kidney disease with heart failure, epilepsy, and type 2 diabetes mellitus. […]

• No harm, potential for more than minimal, patternF887May 7, 2024

  Based on record review and staff interviews the facility failed to maintain documentation of current Covid-19 vaccination status, eligibility screening, education, and offering of Covid-19 vaccination for facility staff. The failures regarding education, offering the vaccine, and maintaining records were found for 4 of 12 facility staff (Staff #1, Staff #2, Staff #3, and Staff #4) reviewed for infection control. The findings included: Facility Covid-19 Staff Vaccination Policy last revised 8/2023 indicated all newly hired employees will be offered the Covid-19 Vaccine. Current employees will be offered the vaccine when there is a change in the vaccine content or if they previously refused and now would like to obtain the vaccine. […]

• No harm, potential for more than minimal, patternF742Dec 1, 2022

  Based on record review, observations, and interviews with resident and staff, the facility failed to ensure residents diagnosed with Post-Traumatic Stress Disorder (PTSD) had person-centered care plans developed with individualized approaches that direct staff on how to care for their assessed needs for 2 of 3 residents (Resident #24 and Resident #52) reviewed for PTSD. The findings included: 1. Resident #24 was admitted to the facility on [DATE] with multiple diagnoses that included depression and Post Traumatic Stress Disorder (PTSD). A review of the Trauma-Informed Care and Diverse Resident Admission Assessment. […]