Inspection·November 21, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete rooms were safe and clean placed residents at risk of privacy, safety, and infections.Record review of the facility's Homelike Environment policy, dated 04/24/25, reflected: A homelike environment is essential for promoting the comfort, dignity, and quality of life of residents. Respect for Individual Preferences: Recognize and honor the personal preferences and choices of each resident, including their daily routines, activities, and living arrangements. Privacy and Dignity: Ensure at residents have privacy and that their dignity is maintained at all times. This includes respecting their personal space and providing private areas for personal care and family visits. Event ID: Facility ID: 455606 If continuation sheet Page 2 of 5 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 455606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Care Center 3301 View St Fort Worth, TX 76103 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)

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain an effective pest control program to ensure the facility was free of pests for 3 of 3 hall locations (North Station, Central Station, South Station), nurse's stations, Central Station dining room and 1 of 1 biohazard closet reviewed for physical environment.The facility failed to ensure North Station, Central Station, South Station, and nurses' stations, Central Station dining room, and the biohazard closet were free from gnats. This failure could place residents at risk for the potential spread of infection, cross-contamination, and decreased quality of life. Findings included:Observation on 10/07/25 at 11:50 AM of Central Station shower room revealed gnats circling the shower room. Observation on 10/07/25 at 12:00 PM at the Central Station nursing station revealed gnats and flies flying. Interview on 10/07/25 at 12:03 PM, with Resident #2 revealed Flies and gnats are bad here. I try to keep my door closed to keep them out of my room. According to Resident #2, residents were seen swatting flies during meal times, Resident #2 stated he too spent a lot of time during the day swatting flies, which could be frustrating. Resident #2 stated he tried to always eat in his room. Observation on 10/07/25 at 12:25 PM of dining room near the Central Station revealed at least 5 gnats flying around resident tables.Observation and interview on 10/07/25 at 12:33 PM with Resident #3 revealed him with a fly swatter in his room on the South Station. When asked about gnats or flies, Resident #3 stated, There are some flies, but there seems to be a lot of gnats. I am not too bothered by them because I have a fly swatter that I use all the time. Interview and observation on 10/07/25 at 12:46 PM with CNA A revealed she observed flies and gnats all over the facility. CNA A stated today she was working on South Station CNA A stated she was ready for the roaches and flies to go! CNA A stated, I noticed several residents with fly swatters in their rooms, residents will say they are sick of the pest, the flies and gnats. CNA A stated she has reported the pest situation to the nurses, so they could log it in the Maintenance log. CNA A stated she also has reported to the Maintenance Department verbally and by logging in the maintenance log book. CNA A stated she had family members that resided in the facility, when she visited, she observed family not being able to eat without gnats and flies swarming their food, especially during meal times. CNA A stated having flies and gnats were a big problem, it made the place disgusting and unlivable. Interview on 10/07/25 at 1:40 PM with CNA B revealed she worked on the South Station and had received complaints from residents about the flies and gnats, CNA B stated, they are everywhere. CNA B stated residents have told her It's disgusting in here. CNA B stated I do not eat in the facility because it was too complicated, it's nasty. According to CNA B she was responsible for reporting to the nurse, and to the maintenance department by updating the log book. CNA B stated she had seen Pest Control come in and spray, however she did not see the vendor in the building consistently. According to CNA B, not having adequate pest control could lead to infestations and residents feeling uncomfortable in their homes. Observation and interview on 10/07/25 at 2:01 PM of the biohazard closet with CNA B located on Central Station revealed she needed to ask ADON C for the code to open the closet. Once ADON C opened the Biohazard Closet a combination of gnats and flies began flying in and out of the closet, it was revealed on the right side of the closet to have 3 closed boxes, 1 box with red bag not properly concealed. To the left of the closet an opened box with red bag that was currently being used for discarded material. There was a white plastic bag on the floor in front of the opened box. Dead flies were noted to be on the floor throughout the closet. On the top shelf revealed a sharp container with plastic bags. On the lower shelf there was a full sharp container, 20-30 dead flies, several scattered unrolled red biohazard bags. According to ADON C the nursing staff was responsible for discarding biohazards in the closet and keeping it Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455606 If continuation sheet Page 3 of 5 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 455606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Care Center 3301 View St Fort Worth, TX 76103 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)

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some clean. ADON C acknowledged the plastic bag on the floor, the dead flies, and the closet shelves in disarray. ADON C stated the closet was cleaner than it had been in the last couple of weeks. ADON C stated housekeeping recently cleaned the closet, disposing several flies and gnats. Interview on 10/07/25 at 2:19 PM with The Maintenance Director revealed there has been a big concern with gnats and flies in the facility recently. The Maintenance Director stated there was an area outside with standing water on the north side of the building, the smoke patio door open and closing and a room on the North Station that needed to be treated. The Maintenance Director stated Pest Control had been treating the facility weekly and was present this morning (10/07/25) with no recommendations. The Maintenance Director stated he was aware of the Biohazard closet being infested with gnats when it was discovered the biohazard vendor had not taken the boxes after two weeks. The Maintenance Director stated something just told him to go check the biohazard closet and that was when he discovered the gnats. According to the Maintenance Director the nursing department was responsible for keeping the closet cleaned, and if it became overwhelming the maintenance department would assist, as he was responsible for the pest control program. The Maintenance Director stated, just like a regular person, residents don't want pest flying on or around you, especially while eating.Interview on 10/07/25 at 3:06 PM with ADON D and the Infection Preventionist had taken the role of cleaning the Biohazard closet. ADON D stated she reported to the Administrator that she needed help to ensure the closet stayed clean, she stated she was then told by the Administrator and the Corporate Office the Biohazard closet was not her responsibility, but the responsibility of the nursing staff (CNAs and the Floor Nurses). ADON D stated no one stepped up to ensure the closet had remained cleaned. ADON D stated she entered the closet last Thursday and gnats were swarming. ADON D stated vendors came to pick up every two weeks, leaving at least 20 boxes to pick up. Interview on 10/07/25 at 3:27 PM with the DON revealed there was an issue was gnats due to the Biohazard closet. The DON stated the vendor was scheduled to pick up on every other Thursday. According to the DON she was notified there was an issue with the biohazard closet maybe a month ago, when she went to investigate, she observed an overwhelming number of boxes left in the closet. The DON stated she alerted the Administrator; the biohazard vendor was contacted along with pest control. The DON stated during the call with the vendor it was discovered when the vendor had come out, the driver did not take any boxes because 2 of the 20 boxes were not taped. The driver did not report this to the facility. According to the DON, the boxes should be taped by the nursing staff, staff should monitor the closet daily and alert the ADON, DON and the Administrator to see if there was a problem or if the closet is getting worse. The DON stated the biohazard vendor came out to pick up the boxes that were left. The DON stated she could not recall the exact date, but that the vendor had picked up 2-3 times since then. The DON stated that not monitoring the closet placed residents at risk of having interrupted meals as gnats are a nuisance. The DON stated Central Station nurses will be responsible for ensuring the biohazard closet is kept clean. Interview on 10/07/25 at 4:07 PM with the Administrator revealed the Biohazard vendors picked up every other Thursday. The Administrator stated staff alerted him that there was an increased amount of gnats in the halls so he called pest control to come out for treatment. The Administrator stated he did not recall the Biohazard vendor contacting him to pick up, so he went to the Biohazard closet and observed the closet to be full and in disarray. The Administrator stated after contacting the vendor it was told to him that when the vendor came out, he refused to remove the boxes because there were a few that were not taped and sealed. The Administrator advised that he had the vendor to come out and remove the boxes, housekeeping to clean and pest control to come out to spray on a weekly basis. The Administrator stated moving forward a new protocol will include purchasing a 55-gallon (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455606 If continuation sheet Page 4 of 5 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 455606 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Care Center 3301 View St Fort Worth, TX 76103 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)

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete barrels for each station which will be emptied to the biohazard closet at the end of each shift. The Administrator stated that moving forward nursing management staff would be responsible for checking the closet to ensure it was emptied and cleaned, not doing so placed residents at risk of being annoyed by the flies and gnats, and an unhealthy living space. Record review of the facility's Pest Control Program policy, dated 01/10/20, reflected: It is the policy of this facility to maintain an effective pest control program that eradicates and contains common household pests and rodents. Facility will obtain services as indicated related to issue that may arise in between scheduled visits with the outside pest service and treat as indicated. Facility will utilize a variety of methods in controlling certain seasonal pest, i.e. flies. These will involve indoor and outdoor methods that re deemed appropriate by the outside pest service and stated and federal regulations.Facility will ensure that the outside pest service also treats the exterior perimeter of the facility and any outlying buildings or structures as indicated, i.e. dumpster area. Event ID: Facility ID: 455606 If continuation sheet Page 5 of 5