Health inspection·December 5, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident is resistant to care, behaviors of yelling and hitting staff, refuses to use oxygen/equipment ordered.Administer medications as ordered. Monitor and document for effectiveness and potential adverse side effects.Monitor behavior episodes and attempt to determine underlying cause. Consider location, time of day, persons involved, and situations. Document behaviors and interventions .Approach resident in a calm manner, call by name, speak slowly, and maintain eye contact. Talk while providing care, allow time for a response, and do not rush.Provide resident with the opportunities to make decisions during ADL care, and daily routine. Encourage as much participation and interaction by the resident as possible during daily care activities. Discuss the possible outcomes of not complying with therapeutic regime.When resident refuses ADL care leave in safe environment, notify nurse, and re- approach at a later time and attempt to provide care.Psychiatric consult as indicated or ordered by the physician. During a record review of Resident #1's MD orders dated 04/14/2023 reflected: Hospice, DX: Senile Degeneration, assess pain, DNR.MD order dated 07/26/2024 reflected Vital check Q shift, Abnormal readings- Recheck in 15 m. every shift and notify MD/NP and hospice team .Morphine Sulfate (Concentrate) Oral Solution 20 MG/ML (Morphine Sulfate) Give 0.25 ml by mouth every 2 hours as needed for SOB dyspnea, pain.Morphine Sulfate (Concentrate) Oral Solution 20 MG/ML (Morphine Sulfate) Give 1 ml by mouth every 2 hours as needed for SOB, NN, pain, Dyspnea (SOB). During a record review of Resident #1's MD order dated 09/11/2024 reflected: .change O2 tubing and humidifier bottle. Inspect external O2 filter weekly (if present). Clean/change if needed. every night shifts every week for O2 use inspect external O2 filter weekly, Monitor O2 saturations, oxygen 2L via N/C for SOB, agitation PRN. During a record review of Resident #1's MD orders dated 09/18/2025, reflected an order for Ativan Oral Tablet 1 MG (Lorazepam) Give 1 tablet by mouth two times a day for anxiety and agitation. During a record review of Resident #1's 10/01/2025 MD order reflected oxygen 2 liters via N/C for SOB, agitation prn as needed for low o2 saturation, SOB. During an interview on 10/13/2025 at 11:03 AM with the Hospice RN, it was revealed that the resident had a history of refusing care and treatment. She stated that he had received new orders to address the agitation and pain, therefore it had resulted in him being more compliant with care and treatment. She stated he had an order for oxygen treatment for comfort as needed. She stated that the clinical staff notified her and the MD when the resident refused oxygen treatment. During an interview with the NP on 10/13/2025 at 1:09 PM, it was revealed that Resident #1 had an active Hospice MD order for PRN oxygen treatment. The NP stated that the nursing staff were required to follow the MD orders for treatment and care. During an interview on 10/13/2025 at 2:23 PM with the ADON, it was revealed that Resident #1 has an MD order for PRN oxygen treatment. ADON said the staff were aware of Resident #1's behavior of refusal of treatment, and they were required to document the behavior and report to the MD. During an interview on 10/13/2025 at 2:29 PM with the DON revealed that Resident #1 has an MD order for PRN oxygen treatment. She stated that resident interventions were in place to assist with treatment. She stated that the staff would provide the treatment as needed and notify ADON, DON, and MD when the resident refused.During an interview on 10/13/2025 at 2:44 PM with the RMDS and MDSC, it was revealed that Resident #1 has refused oxygen treatment and had not received treatment during the lookback period of the MDS. The MDSC stated Resident #1 received a new order on 08/13/2025 for PRN use of oxygen. The MDSC reviewed records of Resident 1's orders and TAR on her computer during the interview, and she stated that Resident #1's last oxygen treatment was on 09/13/2025. The RMDS observed reviewing Resident #1's records during the interview, and she agreed with MDSC's report of resident treatment orders and administration, despite a new MD order dated 10/01/2025 for PRN administration. However, the record review of Resident#1's TAR indicated the resident did not receive treatment in September 2025. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455606 If continuation sheet Page 2 of 3 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 12/05/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete surveyor requested a copy of the facility MDS policy protocol upon completion of the interview on 10/13/2025. The RMDS stated that the policy was forwarded to the Surveyor's email on 10/13/2025. Upon reviewing the surveyor's email, the policy was not emailed. Record review of emails received from the facility on 10/13/2025 and 10/14/2025 reflected the facility had not provided the facility's MDS policy. During an interview with the Administrator on 10/13/2025 at 3:30 PM, he stated he was aware that Resident #1 had behaviors of being resistant with care and treatment, and he expected the nursing staff to follow facility policy and MD orders for all residents. Event ID: Facility ID: 455606 If continuation sheet Page 3 of 3