Willow Valley Center For Nursing And Rehabilitatio
Inspection Findings
F-Tag F0565
Federal health inspectors cited Willow Valley Center for Nursing and Rehabilitatio in Winston-Salem, NC for a deficiency under regulatory tag F-F0565 during a standard health inspection conducted on 2025-08-29.
Category: Resident Rights Deficiencies
The facility was found deficient in the following area: Honor the resident's right to organize and participate in resident/family groups in the facility.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Willow Valley Center for Nursing and Rehabilitatio.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-24.
F-Tag F0585
F 0585
October 2024. She stated that she was not made aware of the federal requirement of notifying a complainant in writing of the conclusion and resolution of his/her reported grievance.
Level of Harm - Potential for minimal harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
08/29/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Willow Valley Center for Nursing and Rehabilitatio
1900 W 1st Street Winston-Salem, NC 27104
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0646
Federal health inspectors cited Willow Valley Center for Nursing and Rehabilitatio in Winston-Salem, NC for a deficiency under regulatory tag F-F0646 during a standard health inspection conducted on 2025-08-29.
Category: Resident Assessment and Care Planning Deficiencies
The facility was found deficient in the following area: Notify the appropriate authorities when residents with MD or ID services has a significant change in condition.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Willow Valley Center for Nursing and Rehabilitatio.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-24.
F-Tag F0677
F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, record review, and staff interviews, the facility failed to ensure residents were provided clean footwear for 1 of 5 residents dependent on staff for Activities of Daily Living (ADL) care (Resident #4).
Findings Included: Resident #4 was admitted to the facility on [DATE REDACTED] with diagnoses that included Dementia and enlarged prostate gland with an indwelling catheter. The Quarterly Minimum Data Set (MDS) assessment dated [DATE REDACTED] revealed Resident #4 was assessed as severely cognitively impaired with no behaviors or rejection of care. Resident #4 was assessed as requiring substantial / maximum assistance for toileting hygiene and partial / moderate assistance personal hygiene. The care plan dated 7/3/25 revealed Resident #4 was care planned for ADL self-care deficit related to Dementia. The goal indicated Resident #4 will maintain current level of function through the review date. Interventions included provide sponge bath when a full bath or shower cannot be tolerated and make sure shoes are comfortable and not slippery.
During an observation on 8/25/25 at 11:20am, Resident #4 was observed walking from his bedroom towards writer. Resident approached writer wearing yellow socks with purple stripes. Both socks were saturated with a liquid substance. Resident #4 wore plaid pajama pants that were saturated with a liquid substance down the back of his right pants leg. Visible wet footprints were coming from the resident's room door. At the foot of the residents' bed on the floor a small wet area was observed with multiple wet footprints surrounding the area. During an observation on 8/26/25 at 9:30am, Resident #4 was observed lying in bed
on his left side wearing a hospital gown and yellow socks with two purple stripes with light brown stains on
the bottom of both socks. During an observation on 8/26/25 at 11:25am, Resident #4 was observed lying in bed on his back with his legs crossed at the feet wearing yellow socks with two purple stripes with light brown stains on the bottom of both socks. During an observation on 8/27/25 at 8:40am, Resident #4 was observed wearing gray sweatpants with gray nonskid footies. During an interview on 8/27/25 at 9:10am, Nursing Assistant (NA) #1, indicated she was assigned to the resident. NA #1 further indicated she applied
the yellow socks with purple stripes on Resident #4 the morning of 8/25/25. She stated she was not assigned to the resident on 8/26/25. NA #1 also indicated she removed the same yellow socks with purple strips she applied to the resident the morning of 8/25/25 the morning of 8/27/25. During an interview on 8/27/24 at 9:20am, Medication Aide (MA) #1, indicated Resident #4 normally lets staff groom him. She indicated the resident wore a leg bag because of his catheter. During an interview on 8/27/25 at 9:40am,
the Unit Manager #1 indicated Resident #4 would mess with his leg bag sometimes. She indicated frequent checks were implemented to ensure Resident #4 was not disconnecting his leg bag from the catheter. Unit Manager #1 stated she was not aware the resident wore the same yellow socks with purple stripes from 8/25/25 through 8/27/25. She stated NA #2 told her she changed the residents' socks on 8/26/25. During an
interview on 8/27/25 at 10:00am, NA #2 indicated she put gray socks on Resident #4 on 8/26/25. She stated she could not remember what socks he had on prior to her getting him dressed after lunch. She indicated she put the soiled clothing in a bag and placed it in the soil linen room. During an interview on 8/29/25 at 10:17am, the Assistant Director of Nursing (ADON) indicated staff were instructed to replace the resident's socks as needed. The ADON indicated he did not know why Resident #4 would have the same socks on for multiple days in a row. The ADON stated he would follow up with the unit manager and reinforce the importance of proper footwear to the unit staff.
Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
F-Tag F0812
Federal health inspectors cited Willow Valley Center for Nursing and Rehabilitatio in Winston-Salem, NC for a deficiency under regulatory tag F-F0812 during a standard health inspection conducted on 2025-08-29.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Willow Valley Center for Nursing and Rehabilitatio.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-23.
F-Tag F0814
Federal health inspectors cited Willow Valley Center for Nursing and Rehabilitatio in Winston-Salem, NC for a deficiency under regulatory tag F-F0814 during a standard health inspection conducted on 2025-08-29.
Category: Nutrition and Dietary Deficiencies
The facility was found deficient in the following area: Dispose of garbage and refuse properly.
Scope/Severity Level F: widespread, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 7 deficiencies cited during this inspection of Willow Valley Center for Nursing and Rehabilitatio.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-23.
F-Tag F0880
Federal health inspectors cited Willow Valley Center for Nursing and Rehabilitatio in Winston-Salem, NC for a deficiency under regulatory tag F-F0880 during a standard health inspection conducted on 2025-08-29.
Category: Infection Control Deficiencies
The facility was found deficient in the following area: Provide and implement an infection prevention and control program.
Scope/Severity Level J: isolated, immediate jeopardy to resident health or safety.
This represents an immediate jeopardy situation, the most serious level of deficiency.
This was one of 7 deficiencies cited during this inspection of Willow Valley Center for Nursing and Rehabilitatio.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-24.
Willow Valley Center for Nursing and Rehabilitatio in Winston-Salem, NC inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Winston-Salem, NC, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Willow Valley Center for Nursing and Rehabilitatio or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.