Woods at Lumber City of Journey LLC, The

In the surveyor’s words

From the most serious findings on record at Woods at Lumber City of Journey LLC, The, in the surveyor’s own words.

• Actual harm, isolatedF689Mar 31, 2022

  Based on record review, staff and family interviews, and review of the facility policy the facility failed to provide supervision and failed to ensure that coffee was served at a safe temperature for one of one residents (R#10) reviewed for [CONDITION(S)]. Actual harm occurred on 8/10/2021, when R#10 sustained [CONDITION(S)] to his right thigh after spilling coffee on himself when he was allowed to self-transport hot coffee via wheelchair without staff assistance. Findings include: Review of the facility policy titled, Hot Beverages Brought in from the Outside (2021) purpose identified to ensure safety when dealing with hot temperature fluids and beverages . Liquids at 135 degrees Fahrenheit or higher can cause severe burning and even blistering. […]

• No harm, potential for more than minimal, widespreadF812Aug 14, 2025

  Based on observations, staff interviews, record review, and review of the facility's policy titled, Ice Machines and Portable Ice Carts, the facility failed to ensure that one of one ice machines was clean and sanitized. This had the potential to affect 54 out of 59 residents receiving an oral diet from the kitchen.Findings include:Review of the facility's policy titled, Ice Machines and Portable Ice Carts, with revised date of 4/25/2025, Under the Policy statement revealed, It is the policy of this facility to ensure that ice machines/carts are working in proper order, cleaned, and maintained as per Federal, State, local, or facility guidance, according to manufacturer's instructions and current standards of practice. Under Policy Explanation: revealed, 1. […]

• No harm, potential for more than minimal, isolatedF656Aug 20, 2026

  Based on observation, resident and staff interviews, record review, and review of the facility's policy titled Accidents and Supervision, the facility failed to ensure supervision of resident (R) (R1) .related to elopement attempt. Specifically, the facility failed to provide watchful oversight of R1 to prevent an exit from the building unassisted from a total of three residents who wander and exit-seek. This deficient practice placed R1 at potential risk for avoidable accidents or injury, and a diminished quality of life. […]

• No harm, potential for more than minimal, isolatedF689Aug 20, 2026

  Based on interviews, record review, and policy titled, Accidents and Supervision the facility failed to ensure one of six sample residents (R) (R1) received adequate supervision outside to prevent potential accidents. s. This deficient practice had the potential to result in negative safety outcomes, such as falls, accidents and elopements.Findings Includes:A review of Policy titled, Accidents and Supervision revealed, the resident environment will remain as free of accident hazards as possible. Each resident will receive adequate supervision and assistive devices to prevent accidents. This includes. 3. Implementing interventions to reduce hazard(s) and risk(s).4. Monitoring for effectiveness and modifying interventions when necessary.Policy Explanation and Compliance Guidelines. 5. […]

• No harm, potential for more than minimal, isolatedF578Aug 14, 2025

  Based on resident and staff interviews, record review, and review of the facility's policy titled Advance Directive, the facility failed to provide residents and/or representatives written information regarding the right to accept or refuse medical or surgical treatment for two out of three Residents (R) (R9 and R33). The deficient practice had the potential to affect the resident's highest practical physical, mental, and psychosocial well-being.Finding include: Review of the facility's policy titled Advanced Directive Policy dated 3/5/2025 under the Policy statement revealed, It is the policy of this facility to support and facilitate a resident's right to request, refuse and /or discontinue medical or surgical treatment and formulate advanced directives. […]