Federal inspectors found the violations during a December complaint investigation at Woodstock Valley Health and Rehabilitation on South Main Street. The facility failed to follow basic respiratory care protocols for Resident 110, who had been using an incentive spirometer without proper medical authorization.
Incentive spirometers help patients take slow, deep breaths to keep lungs healthy after surgery or during illnesses like pneumonia. The devices require physician orders specifying how often patients should use them.
On December 1 at 1:44 p.m., inspectors observed the resident sitting up in bed with the spirometer on her nightstand. The mouthpiece sat completely uncovered.
The resident told inspectors she had been using the device regularly. Staff never provided a cover for it.
"Nurses should obtain a physician's order for an incentive spirometer and the order should include how often the resident should use it," Licensed Practical Nurse 1 told inspectors during a December 1 interview. "Nurses would not know that a resident is supposed to use an incentive spirometer unless there was an order."
The same nurse explained that infection control protocols require storing the devices in plastic bags when not in use.
Yet a review of the resident's medical records revealed no physician's order for the spirometer. Her admission assessment documented that she was alert and oriented to person, place, time and situation, but contained no respiratory care directives.
The facility's admission minimum data set assessment for the resident remained incomplete at the time of inspection.
When inspectors informed facility leadership about the violations on December 2, three administrators acknowledged the concerns: the President of Operations, the traveling Director of Nursing, and the acting Director of Nursing.
The facility could not produce any written policy regarding incentive spirometer use or storage.
Leaving medical devices uncovered creates infection risks, particularly for respiratory equipment that patients place directly in their mouths. Contaminated spirometers can introduce bacteria into already vulnerable respiratory systems.
The violation occurred despite clear medical protocols. Healthcare providers typically recommend incentive spirometers for post-surgical patients or those with lung conditions to prevent complications like pneumonia or collapsed lung segments.
Without physician orders, nursing staff cannot properly monitor patient progress or ensure appropriate usage frequency. The devices require specific breathing techniques and timing that medical professionals must prescribe based on individual patient needs.
The resident's case illustrates broader care coordination failures. Her incomplete admission assessment suggests systematic problems with initial medical evaluations and treatment planning.
Licensed Practical Nurse 1's comments during the inspection revealed that staff understood the proper protocols. The nurse correctly identified that physician orders were mandatory and that infection control required protective storage.
Yet these standards were not implemented for Resident 110.
Federal inspectors classified the violation as causing minimal harm or potential for actual harm. The citation fell under regulations requiring facilities to provide safe and appropriate respiratory care when needed.
The inspection occurred in response to a complaint, though the specific nature of that complaint was not detailed in the report. Complaint investigations typically focus on immediate safety concerns reported by residents, families, or staff members.
Woodstock Valley Health and Rehabilitation operates as a skilled nursing facility in Virginia's Shenandoah County. The December inspection examined 14 residents in the survey sample, finding respiratory care failures affecting one patient.
The facility's inability to produce relevant policies during the inspection raised additional questions about staff training and procedural guidance. Written protocols help ensure consistent care delivery and regulatory compliance across nursing shifts.
Resident 110 continued using the uncovered spirometer throughout the inspection period. The device remained on her nightstand, mouthpiece exposed, as inspectors documented the violations.
The case demonstrates how seemingly minor protocol failures can compromise patient safety in nursing home settings. Respiratory equipment requires the same infection control standards as other medical devices, particularly when shared or stored in patient rooms.
No additional information was provided before inspectors completed their exit interview with facility administrators.
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
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