Woodside Village
WOODSIDE VILLAGE in GRAND FORKS, ND — inspection on January 8, 2025.
Found 3 citations. 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.
Inspection Findings
facility implemented corrective actions to ensure the deficient practice does not recur by:
* Completed an investigation on 09/13/24, including an interview with the CNA #8 who transferred
* Determined the CNA #8 provided wheelchair transport to Resident #87 without the foot pedals in the proper position. * Placed CNA #8 on administrative leave on 09/10/24 until further investigation and education was provided. * Email education to all staff, dated 09/10/24, stated, Foot pedals or leg rests always need to be used when pushing a resident in a wheelchair. It is never acceptable to allow a resident's feet to dangle when pushing them, not even for a short distance. * Memo dated 09/13/24 addressed to all staff, stated, ANYTIME a resident is being pushed in their wheelchair the foot pedals MUST BE ON. * CNA #8 and all other nursing staff signed rosters indicating review and understanding of the 09/13/24 memo. * The charge nurses were responsible for reviewing education provided in the 09/13/24 memo after the 09/07/24 fall. * Continue weekly quality assurance audits to ensure resident safety during wheelchair transport.
355112 01/08/2025
Woodside Village 4000 24th Ave S Grand Forks, ND 58201
Review of the facility policy titled Handwashing/Hand Hygiene occurred on 01/08/25.
This policy, dated October 2024, stated, .
Hand hygiene is indicated .
After contact with blood, body fluids or contaminated surfaces; After touching a resident; After touching the resident's environment .
The use of gloves does not replace hand washing/hygiene.
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.
During an interview on 01/08/25 at 4:53 p.m., an administrative staff member (#2) confirmed she expected nurses to wear gloves while administering an injection.
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
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.