Woodstock Valley Health: Wound Tracking Gap - VA
That gap, documented during a September 2025 complaint inspection at Woodstock Valley Health and Rehabilitation, sits at the center of a deficiency cited by federal inspectors under the care planning tag F0656.
The director of nursing, identified in the inspection report as ASM #2, described the breakdown plainly. The former assistant director of nursing had kept a log sheet, tracking pressure injuries and measuring them weekly. When that person stepped down, the log went with her. The wound care nurse practitioner who had visited weekly to assess residents, measure injuries, and adjust treatments also stopped coming. The electronic medical record system had an assessment tool that staff could have used to fill the gap. It went unused.
"There had been a lapse," the director of nursing told inspectors on September 24, 2025.
The facility had a new doctor who started the week before the inspection. That was the recovery plan she described.
LPN #2, a night shift nurse interviewed during the inspection, said she was not fully certain what the current process even was. If a new wound was reported to her, she said, she would ask a nurse trained in wounds to measure it and refer it to the physician. Whether that nurse was measuring existing wounds on any regular schedule, the inspection report does not say. What the report does say is that the weekly tracking system, the one that existed before the staffing changes, was gone.
One resident, identified as R6, was specifically flagged. The director of nursing told inspectors that R6 was non-compliant with repositioning and tended to lie flat on her back or on her left side. Pressure injuries develop when sustained weight compresses tissue against bone, and residents who resist repositioning face elevated risk. Whether R6 had an active pressure injury, and whether it had been measured during the period the tracking lapsed, is not stated in the report.
The facility administrator, ASM #1, was notified of the concern on September 25, 2025, the day before the inspection closed. No additional information was provided before inspectors left.
The deficiency was classified as minimal harm or potential for actual harm, affecting some residents. That classification sits near the lower end of the federal harm scale, but it describes a system failure rather than a single missed treatment. Pressure injuries can develop quickly in residents with limited mobility, and wounds that go unmeasured can go undetected as they worsen.
What the inspection captures is a facility that knew its oversight structure had collapsed and had not rebuilt it. The director of nursing did not say the lapse was brief. She said there was a gap. She said a new doctor had started last week. She did not say wound assessments had resumed on any defined schedule.
The nurse practitioner who used to come weekly, the one who measured wounds and adjusted treatments, was simply no longer there. Nobody had replaced her function.
For R6, who tends to lie on her back, on her left side, and who does not reposition herself, the weeks without a functioning tracking system were weeks without anyone formally measuring what was happening to her skin.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Woodstock Valley Health and Rehabilitation from 2025-09-26 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 27, 2026 · Our methodology
Woodstock Valley Health and Rehabilitation in WOODSTOCK, VA was cited for violations during a health inspection on September 26, 2025.
The director of nursing, identified in the inspection report as ASM #2, described the breakdown plainly.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.