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Complaint Investigation

Woodside Village

January 8, 2025 · Grand Forks, ND · 4000 24th Ave S
Citations 1
CMS Rating 5/5
Beds 138
Provider ID 355112
Healthcare Facility
Woodside Village
Grand Forks, ND  ·  View full profile →
Inspection Summary

WOODSIDE VILLAGE in GRAND FORKS, ND — inspection on January 8, 2025.

Found 1 citation. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

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Inspection Findings

FF689
Minimal harm or 40488 Few affected

Review of the facility policy titled Insulin Pen Injections occurred on 01/08/25.

This policy, dated January 2023, stated, .

Technique .

Gather equipment .

Perform hand hygiene .

Preparing insulin pen .

Apply clean gloves .

Select appropriate site .

Administer injection.

- Review of Resident #126's medical record occurred on all days of survey.

The record identified a tracheostomy, enhanced barrier precautions, and a recent Influenza A infection.

Observation on 01/09/25 at 11:38 a.m. showed a staff nurse (#5) applied a gown and gloves, prepared for the sterile portion of Resident #126's tracheostomy cares, and handed the resident a paper napkin to cough into during care.

The nurse (#5) completed the sterile portion of the care, removed the sterile gloves, performed hand hygiene, and applied clean gloves to complete the non-sterile portion of the care.

The nurse removed the used paper napkin from Resident #126's hands, cleansed the ostomy site with cotton swabs and a solution of peroxide and saline, and threw the cotton swabs into the garbage.

The nurse (#5) handed the same used paper napkin to the resident, and with the same gloves, touched many items in the resident's room, then removed the gown and gloves, performed hand hygiene, and exited the room.

The nurse (#5) failed to remove the soiled gloves, perform hand hygiene, and apply new gloves before moving on to other tasks.

During an interview on 01/08/25 at 2:35 p.m., two administrative nurses (#6 and #7) stated they expected staff to remove their contaminated gloves and perform hand hygiene before moving on to other tasks.

- Review of Resident #283's medical record occurred on 01/08/25.

Physician's orders showed Insulin Glargine 12 units and Novolog 3 units sub-cutaneous injections daily.

Observation on 01/08/25 at 8:41 a.m. showed a nurse (#4) performed hand hygiene and without applying gloves, administered Resident #283's insulin injections.

355112

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 355112 B.

Wing 01/08/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Woodside Village 4000 24th Ave S Grand Forks, ND 58201

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 GRAND FORKS, ND, (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 WOODSIDE VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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