Health inspection·September 19, 2025

F 0605 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. Based on interview and record review, the facility failed to ensure free from unnecessary psychotropic medication (medications capable of affecting the minds, emotions, and behaviors) for one of three sampled resident (Resident 1) when: 1.There was no documented evidence of non-pharmacological (treatments and strategies that mange health conditions without using medications) approaches attempted before administered psychotropic medication lorazepam (used to treat for anxiety [persistent worry and fear about everyday situations]) to Resident 1;2.There was no documented evidence of side effects monitored for use of lorazepam (an unintended consequence of a medication, may be harmful) for Resident 1;3. There was no documented evidence of episodes of adequate behavior monitored for use of lorazepam for Resident 1.These above failures had the potential to place sampled resident at risk to receive unnecessary psychotropic medication.Findings:1.Review of Resident 1's face sheet (FS: a document that gives resident's information at a quick glance) indicated Resident 1 was admitted to facility on 7/9/2024. Resident 1's diagnoses indicated dementia with anxiety (loss of memory, language, problem solving and thinking abilities interfere with daily living along with irritability, agitation and restlessness).Review of Resident 1's order summary report indicated lorazepam oral concentrate (liquid)1MG (mg: milligram, unit of mass equal to one thousandth of a gram)/ 0.5 ML (ml: milliliter, unit of volume equal to one thousandth of a liter) give 0.25 ml every 6 hours as needed for agitation ., dated 6/28/2025.Review of Resident 1's electronic medication administration record (EMAR: a digital system used in healthcare settings to manage and track administration of medications to residents) for June/2025 indicated Resident 1 received lorazepam as ordered above on 6/28/2025 at 1846 and on 6/29/2025 at 1026.Further review of Resident 1's EMAR for June/2025 indicated there was no documented evidence for non-pharmacological approaches attempted before administered lorazepam on 6/28 and 6/29/2025.2.Review of Resident 1's EMAR for June/2025 indicated there was no documented evidence of monitored for side effects for lorazepam administration.3. Review of Resident 1's EMAR for June/2025 indicated there was no documented evidence for adequate behavior monitored for use of lorazepam.During an interview with facility's director of nursing (DON) on 7/1/2025 at 2:21 p.m., DON confirmed there was no documented evidence of nursing staff attempted non-pharmacological approaches before administered lorazepam, monitored side effects and adequate behavior monitored for use of lorazepam for Resident 1. DON stated license nursing staff should have attempted non-pharmacological interventions, monitored and documented side effects and adequate behavior when administered lorazepam to Resident 1.Review of facility's policy and procedure (P&P) titled, Psychotherapeutic Drug Management, dated 3/2010, the P&P indicated, The nurse shall implement non-drug interventions to modify behavior according to the care plan. Manifestations for the drug i.e. hitting others etc. Documentation shall occur each shift with the number of times this behavior has occurred. Side effects of the drug i.e. drooling, dry mouth, abnormal gait etc. Documentation of side effects shall occur each shift. 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 REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055517 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055517 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodlands Healthcare Center 14966 Terreno DE Flores Lane Los Gatos, CA 95032 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)