Willow Valley Center For Nursing And Rehabilitatio

During a telephone interview on 8/28/25 at 8:56 a.m., Resident #225's RP indicated the facility frequently did not communicate with him when he had concerns about the resident's care. He had filed grievances with Social Services, but the facility did not follow-up with him.

During an interview on 8/29/25 at 1:05 p.m., the facility's Director of Social Services revealed she began working at the facility in January

• She stated after reviewing the notebook of copies of Grievance Response Letters maintained by

the previous Director of Social Services, the letters sent to the complainants were discontinued after 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.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

345092 08/29/2025

Willow Valley Center for Nursing and Rehabilitatio 1900 W 1st Street Winston-Salem, NC 27104

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.

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.

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.

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.

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.