Woodbury Health Care Center: Lymphedema Care Denied - MN
The woman, identified in inspection records as R1, had used compression pumps at home and at a prior facility before her admission to Woodbury Health Care Center. She knew how to operate them. When inspectors interviewed the facility's physical therapist in May, the therapist said R1 could demonstrate correct use of the pumps, show she understood the settings, and prove she could turn the power off and unzip the compression sleeves if she needed to. She did all of that. She still wasn't allowed to use them.
The director of nursing initially blocked the pumps because the nursing department wasn't familiar with them. Then, after R1 demonstrated she could operate them safely, the director blocked them again, this time over concern that R1 might not be able to shut the pump off in an emergency. R1 had already demonstrated that she could. The physical therapist told inspectors the therapy department spent weeks trying to eliminate the barriers to using the pumps. They were just not allowed.
R1's hospital discharge orders had specified physical therapy for lymphedema treatment. The facility's own admissions coordinator acknowledged during the inspection that the facility should not have admitted R1 if compression pump orders were in place and the staff couldn't manage the treatments. The physical therapist was blunter: the trained lymphedema therapist was only on site twice a week, and R1 had just come from the hospital. Twice a week wasn't enough.
So the care fell to whoever would do it. The therapy department handled what it could. Nursing staff placed bandages and ACE wraps on R1's legs, despite having no training in lymphedema care. R1's husband managed the compression pumps on the days he came in, which was every other day, because facility staff would not. A registered nurse told inspectors on May 26 that R1 had no care plan for lymphedema because nursing staff wasn't trained for it.
The director of nursing, interviewed the same day, said she was unsure when the therapy department had transferred responsibility for R1's lymphedema care to nursing. She didn't know the date. She said there had been a six-to-seven-day delay before therapy completed the assessment to confirm R1 and her husband could use the pumps safely, and acknowledged that delay was too long. Therapy cleared R1 to use the pumps on March 25. A note from April 22 indicated a physical therapist had again documented that R1 would benefit from using them, suggesting they still weren't consistently in use nearly a month after clearance. The director said she wasn't sure why that note existed, and wasn't sure whether the pumps were actually being used at that point.
She did say one thing clearly. The delay in lymphedema pump therapy could have contributed to R1's legs swelling more.
When inspectors requested a facility policy on lymphedema care, none was provided.
The physical therapist described what lymphedema does when it isn't managed: R1's legs got very large with fluid. The pumps were designed to push that fluid out. Without them, or without consistent trained care, the fluid stayed.
R1's husband had been paying for a service the facility collected payment for and then declined to deliver. He kept showing up anyway, every other day, to do the work himself.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Woodbury Health Care Center from 2026-05-26 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: August 14, 2026 · Our methodology
WOODBURY HEALTH CARE CENTER in WOODBURY, MN was cited for violations during a health inspection on May 26, 2026.
She still wasn't allowed to use them.
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.