Health inspection·March 14, 2024

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to establish and implement policies addressing resident admission to the facility for one (Resident #1) of three residents reviewed for admissions. The facility failed to provide Resident #1 with an admission packet upon admission. This failure could affect residents by placing them at risk for not being aware of what services the facility is providing. Findings included: Review of Resident #1's facesheet printed on 03/14/24 revealed the resident was a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included cerebral infarction (heart attack), aphagia (difficulty speaking), muscle weakness, dysphagia (difficulty swallowing), need for assistance for personal care, and seizures. Review of Resident #1's progress notes revealed she was discharged from the facility on 02/05/24. Interview on 03/13/24 at 10:25 AM with Resident #1's family revealed when Resident #1 was admitted to the facility, they were not asked to fill out any type of admission paperwork or given any paperwork from anyone . Interview on 03/14/24 at 2:12 PM with the BOM revealed she began working at the facility on 02/05/24 and things in the business office were a mess. The BOM said admission paperwork had not been completed for some of the residents by the previous BOM. She further stated Resident #1 did not have any admission paperwork in her file. She stated they were trying to go back and complete things that had not been done and she was now making sure all new residents has admission paperwork and was trying to complete the paperwork on the residents that did not have any. Interview on 03/14/24 at 3:24 PM with the Administrator revealed she began working at the facility on 02/05/24. She stated she was not aware admission paperwork had not been completed for some residents by the previous BOM. The Administrator said the admission packet contained financial information such as the transition from Medicare and Medicaid. Other things included in the packet included, resident rights, and who to contact in case they had a grievance. The Administrator further stated it was important to residents/responsible parties to have the admission packet because it gave residents/responsible parties financial information to ensure they were being billed correctly. (continued on next page) 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: 455572 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 455572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wedgewood Nursing Home 6621 Dan Danciger Rd Fort Worth, TX 76133 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)