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Health Inspection Summary

Althea Woodland Nursing Home

1000 Daleview Drive

Silver Spring, MD 20901

(301) 434-2646

Deficiency Category	Inspection Date: 4/9/21 Complaint Reporting Period: 5/1/24 - 4/30/25	Inspection Date: 7/11/19 Complaint Reporting Period: 5/1/23 - 4/30/24	Inspection Date: 6/22/18 Complaint Reporting Period: 5/1/22 - 4/30/23
Freedom from Abuse, Neglect, and Exploitation Deficiencies	0	0	0
Quality of Life and Care Deficiencies	1	1	3
Infection Control Deficiencies	0	1	1
Resident Assessment and Care Planning Deficiencies	2	3	4
Nursing and Physician Services Deficiencies	0	1	0
Resident Rights Deficiencies	2	0	5
Nutrition and Dietary Deficiencies	0	1	1
Pharmacy Service Deficiencies	1	2	1
Environmental Deficiencies	0	1	0
Administration Deficiencies	0	0	1

Detailed result for inspection on 4/9/21

Date of last standard health inspection:	4/9/21Read the full report (PDF)
Date(s) of complaint inspection(s) between 5/1/24 - 4/30/25	8/2/24Read the full report (PDF)
Date(s) of infection control inspection(s) between 5/1/24 - 4/30/25	No infection control inspections
Total number of Health Deficiencies for this nursing home:	6
Average number of Health Deficiencies in Maryland:	19.3
Average number of Health Deficiencies in the United States:	9.6

Freedom from Abuse, Neglect, and Exploitation Deficiencies
No Freedom from Abuse, Neglect, and Exploitation Deficiencies were found during this inspection period.

Quality of Life and Care Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Provide appropriate treatment and care according to orders, resident’s preferences and goals.	4/9/21	6/7/21	2 - Minimal harm or potential for actual harm	Few

Infection Control Deficiencies
No Infection Control Deficiencies were found during this inspection period.

Resident Assessment and Care Planning Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted	4/9/21	6/7/21	2 - Minimal harm or potential for actual harm	Few
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.	8/2/24	10/22/24	2 - Minimal harm or potential for actual harm	Few

Nursing and Physician Services Deficiencies
No Nursing and Physician Services Deficiencies were found during this inspection period.

Resident Rights Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.	8/2/24	10/22/24	2 - Minimal harm or potential for actual harm	Few
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.	8/2/24	10/22/24	2 - Minimal harm or potential for actual harm	Few

Nutrition and Dietary Deficiencies
No Nutrition and Dietary Deficiencies were found during this inspection period.

Pharmacy Service Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.	4/9/21	6/7/21	2 - Minimal harm or potential for actual harm	Few

Environmental Deficiencies
No Environmental Deficiencies were found during this inspection period.

Administration Deficiencies
No Administration Deficiencies were found during this inspection period.

Detailed result for inspection on 7/11/19

Date of last standard health inspection:	7/11/19Read the full report (PDF)
Date(s) of complaint inspection(s) between 5/1/23 - 4/30/24	No complaint inspections
Date(s) of infection control inspection(s) between 5/1/23 - 4/30/24	No infection control inspections
Total number of Health Deficiencies for this nursing home:	10
Average number of Health Deficiencies in Maryland:	14.5
Average number of Health Deficiencies in the United States:	9.5

Freedom from Abuse, Neglect, and Exploitation Deficiencies
No Freedom from Abuse, Neglect, and Exploitation Deficiencies were found during this inspection period.

Quality of Life and Care Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few

Infection Control Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Provide and implement an infection prevention and control program.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few

Resident Assessment and Care Planning Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.	7/11/19	9/10/19	1 - Potential for minimal harm	Some

Nursing and Physician Services Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Observe each nurse aide's job performance and give regular training.	7/11/19	9/10/19	1 - Potential for minimal harm	Many

Resident Rights Deficiencies
No Resident Rights Deficiencies were found during this inspection period.

Nutrition and Dietary Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Ensure each resident receives and the facility provides drinks consistent with resident needs and preferences and sufficient to maintain resident hydration.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few

Pharmacy Service Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Few

Environmental Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.	7/11/19	9/10/19	2 - Minimal harm or potential for actual harm	Some

Administration Deficiencies
No Administration Deficiencies were found during this inspection period.

Detailed result for inspection on 6/22/18

Date of last standard health inspection:	6/22/18Read the full report (PDF)
Date(s) of complaint inspection(s) between 5/1/22 - 4/30/23	No complaint inspections
Date(s) of infection control inspection(s) between 5/1/22 - 4/30/23	No infection control inspections
Total number of Health Deficiencies for this nursing home:	16
Average number of Health Deficiencies in Maryland:	12.1
Average number of Health Deficiencies in the United States:	8.8

Freedom from Abuse, Neglect, and Exploitation Deficiencies
No Freedom from Abuse, Neglect, and Exploitation Deficiencies were found during this inspection period.

Quality of Life and Care Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Provide appropriate treatment and care according to orders, resident’s preferences and goals.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few
Provide activities to meet all resident's needs.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few

Infection Control Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Provide and implement an infection prevention and control program.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few

Resident Assessment and Care Planning Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted	6/22/18	8/21/18	1 - Potential for minimal harm	Some
PASARR screening for Mental disorders or Intellectual Disabilities	6/22/18	8/21/18	1 - Potential for minimal harm	Some
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Some

Nursing and Physician Services Deficiencies
No Nursing and Physician Services Deficiencies were found during this inspection period.

Resident Rights Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.	6/22/18	8/21/18	1 - Potential for minimal harm	Some
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.	6/22/18	8/21/18	1 - Potential for minimal harm	Some
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few
Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide.	6/22/18	8/21/18	1 - Potential for minimal harm	Some
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Some

Nutrition and Dietary Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few

Pharmacy Service Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Few

Environmental Deficiencies
No Environmental Deficiencies were found during this inspection period.

Administration Deficiencies
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Have a plan that describes the process for conducting QAPI and QAA activities.	6/22/18	8/21/18	2 - Minimal harm or potential for actual harm	Some

Complaints and facility-reported incidents in the past 3 years
Inspectors determined that the nursing home failed to:	Inspection Date	Date of Correction	Level of Harm (Least to most)	Residents Affected (Few, Some, Many)
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.	8/2/24	10/22/24	2 - Minimal harm or potential for actual harm	Few
Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.	8/2/24	10/22/24	2 - Minimal harm or potential for actual harm	Few
Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.	8/2/24	10/22/24	2 - Minimal harm or potential for actual harm	Few

Infection control inspection deficiencies in the past 3 years
This nursing home has not had any infection control inspections in the past 3 years.

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