Woodside Village
WOODSIDE VILLAGE in GRAND FORKS, ND — inspection on December 22, 2025.
Found 2 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 for residents affected by the deficient practice as follows:Immediate Actions Taken:* Staff intervened and separated the two residents to prevent further escalation and assessed for injury. No injuries noted. * Other residents in vicinity redirected to ensure safety.* Incident reported to charge nurse and on-call administration.
Report made to the North Dakota Department of Health and Human Services on 09/14/25. * Responsible parties of both residents and the Medical Doctor on-call notified of the incident on 09/14/25 by the charge nurse.* Both residents monitored the remainder of the day.
Follow-Up Actions: * Completed initial meeting and investigation of incident on 09/15/25* Documented 72-hour status monitoring of both residents in electronic medical record system.* Resident #4 and #7's care plans reviewed and revised on 09/15/25. * Psychiatric Nurse Practitioner continues to conduct health consultations/medication reviews for both residents.
Provider saw both residents on scheduled provider rounds on 09/17/25. * Staff education provided on 09/19/25 to the dementia unit staff on de-escalation strategies for dementia behaviors and resident-to-resident altercations.* Registered Nurse Care Coordinator provided information concerning therapeutic response techniques at the neighborhood Quality of Care meeting on 09/25/25.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
12/22/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Woodside Village
4000 24th Ave S Grand Forks, ND 58201
SUMMARY STATEMENT OF DEFICIENCIES
Based on record review, review of the facility reported incident (FRI) investigation, and review of facility standard of care policy, the facility failed to properly utilize assistive devices necessary to prevent accidents for 1 of 1 closed record resident (Resident #7) who sustained a fall.
Failure to remove the wheelchair foot pedals may have contributed to Resident #7's fall.
This citation is considered past non-compliance based on review of the corrective actions the facility implemented immediately following the incident.
Findings include:
Review of the facility Standards of Care occurred on 12/22/25.
This form, dated 10/06/25 stated, .
Foot pedals will be used for all residents being transported for extended distances and removed when stationary or unless Care Planned.
Review of Resident #7s medical record occurred on 12/22/25.
The care plan, dated 11/04/25, stated, Ambulation: I need assist of 1 with a gait belt, hand held assist.
Review of the FRI investigation, dated 11/05/25, stated, At approximately 7:50 AM CNA [certified nurse aide] [CNA #1] brought [Resident #7] to the dining room table in a wheelchair. [CNA #1] left [Resident #7] at the table with wheelchair pedals in place and then returned to the residents room down the hall to retrieve a bag of garbage. On his way to throw the garbage he stopped to speak to the RN [registered nurse] [nurse name].
In [CNA #1] written report of the incident, he indicated that on the wheelchair pedals there was a sticker that stated pedals stay on at all times. [Nurse name] confirmed that [CNA #1] had asked her about this and she clarified to [CNA #1] that the pedals should be removed. [CNA #1] did not return to [Resident #7] to remove the wheelchair pedals, instead walking to the utility room to discard the garbage. As [CNA #1] was returning toward the dining room, [Resident #7] stood up and fell, striking the back of his head on a dining room chair. [Resident #7] had been hospitalized for pneumonia and returned to our facility on 11/4/25.
The wheelchair was left in his room as it was used to transport him back from the hospital.
Based on the following information, non-compliance at F-F689 is considered past non-compliance.
The facility implemented corrective actions for residents affected by the deficient practice as follows:*The nurse immediately assessed Resident #7.*Completed an investigation related to Resident #7's fall. *Resident #7's primary decision maker and physician notified. *Monitoring of Resident #7 for any signs of injury, distress or change in condition. *Incident reported to the Department of Health and Human Services. *CNA (#1) terminated on 11/11/25. *Resident #7's care plan reviewed. *Staff education provided on 11/05/25 regarding foot pedals removed from wheelchair when resident is stationary.*Wheelchair positioning audits completed.
Facility ID:
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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.