Woods Health Services

In the surveyor’s words

From the most serious findings on record at Woods Health Services, in the surveyor’s own words.

• Actual harm, isolatedF684May 19, 2025

  Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) received wound (an injury to living tissue caused by a cut) care and treatment in accordance with the facility's Policies and Procedures (P&P) titled, admission Assessment and Follow Up: Role of the Nurse, when: a. Registered Nurse (RN) 1 failed to conduct a complete wound assessment (a thorough examination of both the wound itself and the resident's overall health to understand the wound's status, identify any factors hindering healing, and develop an effective treatment plan) and document Resident 1's left hip surgical wound (a cut through the skin made during surgery [a procedure to remove or repair a part of the body]) upon admission to the facility on 2/18/2025. b. […]

• Actual harm, isolatedF689Mar 11, 2024

  Based on observation, interview, and record review, the facility failed to prevent a fall for one of three sampled residents (Resident 1) who had a history of falls by failing to implement the physician (MD) order dated 1/7/2024 to place bilateral floor mats (a cushioned pad placed to absorb the force when a resident falls) on each side of the bed and a silent bed/chair alarm (a sensor pad device placed under a resident's bottom that triggers an alarm when it detected a change in pressure and was used as an early alert that a resident was trying to get out of bed or chair) for Resident 1. […]

• Actual harm, isolatedF689Dec 13, 2023

  Based on observation, interview, and record review, the facility failed to provide nursing services to prevent a fall (move downward, typically rapidly and freely without control, from a higher to a lower level) for one of three sampled residents (Resident 1), who had a history of multiple falls, by failing to: Ensure Resident 1's silent bed alarm system (an assistive electronic device that makes alerts/sounds to warn caregivers when the resident tries to get up from the bed while keeping the patient's/resident's environment free of noise/alarm sounds) was plugged into the electrical outlet and was functioning on 11/24/23. […]

• Actual harm, isolatedF580Aug 22, 2022

  Based on interview and record review, the facility failed to notify the physician for one of three sampled residents (Resident 1) who had a change in condition (COC, a sudden clinically important deviation from a patient's baseline in physical, cognitive, behavioral, or functional domains), that started on [DATE]. On [DATE] at 6:04 am, Licensed Vocational Nurse 1 (LVN 1) administered 7 units of [MEDICATION(S)] (fast-acting, insulin-a hormone that works by lowering levels of glucose/sugar in the blood) and 20 units of [MEDICATION(S)] (long-acting insulin) to Resident 1 when Resident 1 ' s blood sugar level was 59 milligram per deciliter (mg/dl a unit of measurement) {abnormally low, blood sugar level below 70 mg/dl is considered low}. […]

• Actual harm, isolatedF760Aug 22, 2022

  Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) was free from significant medication errors (causes the resident discomfort or jeopardizes the resident health and safety) according to professional standards of practice and facility ' s policy and procedure. Licensed Vocational Nurse 1 (LVN 1) administered [MEDICATION(S)] (fast-acting, insulin-a hormone that works by lowering levels of glucose/sugar in the blood) when Resident 1 ' s blood sugar level was 59 milligram per deciliter (mg/dl, a unit of measurement) [A blood sugar level below 70 mg/dl is considered low and can harm the resident). […]