F 0627
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for
a safe transfer/discharge.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to permit a resident to return to the facility after being
hospitalized or placed on therapeutic leave for 1 of 3 residents (Resident #1) reviewed for bed hold. The
facility failed to re-admit Resident #1 after he was hospitalized for having shortness of breath. Emergency
services attempted to return Resident #1 on 12/18/25 and again on 12/19/25, and the facility sent him back
to the hospital. This failure could place residents at risk of not getting the care and services required.
Findings included:Record review of Resident #1's nursing home discharge MDS, dated [DATE], reflected
Resident #1 was a [AGE] year-old male who was admitted to the facility originally on 08/18/21, readmitted
[DATE] and again on 12/09/25. Resident #1's diagnoses included diabetes mellitus (high blood sugar
levels), chronic respiratory failure with hypoxia (not having enough oxygen in the blood), chronic obstructive
pulmonary disease (group of lung diseases that obstruct airflow and make breathing difficult), major
depressive disorder (pervasive low mood, low self-esteem, and loss of interest or pleasure), end stage
renal disease (kidney failure), morbid obesity (body mass index of 40 or higher), other seizures (sudden
burst of electrical activity in the brain). The MDS reflected Resident #1 was dependent on staff with all
activities of daily living skills. Also, the MDS Discharge Assessment did not indicate if a return was
anticipated or not anticipated. Record review of Resident #1's current care plan reflected Resident #1 was
Resistant to Care and at risk for injury, a decline in functional abilities, and not having their needs met in a
timely manner. Resistance is related to: Resident refused dialysis care, refused medications/care, Resident
refused/delays diabetic care, Resident frequently refuses incontinent care/wear brief, refused to wear
clothes. Goal: Resident will maintain highest level of independence and not experience a decline in
functional abilities. Resistance behaviors will not interfere with ADLs being met in a timely manner on a
daily basis. Interventions included Use the Buddy System when interacting with Resident #1. Monitor
behavior episodes and attempt to determine underlying cause. Consider location, time of day, persons
involved, and situations. Document behaviors and interventions in behavior log. Give a clear explanation of
daily care activities prior to and as they occur during each contact. Encourage as much participation and
interaction by the resident as possible. Provide resident with opportunities to make decisions during ADL
cares and daily routine. If possible, negotiate a time for ADLs so that the resident participates in the
decision making process and return at a time when resident is more likely to be compliant with receiving
assistance with ADLs. Discuss the possible outcomes of not complying with therapeutic regimen.Record
review of Resident #1's undated care plan reflected Resident #1 had Congestive Heart Failure. Goal:
Resident will be free from complications related to Congested Heart Failure. Interventions included Give
cardiac medications as ordered. Monitor/document/report to Physician PRN any signs and symptoms of
Congestive Heart Failure: dependent edema of legs and feet, periorbital edema (accumulation of fluid to
lower extremities), shortness
(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 8
Event ID:
455606
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
12/22/2025
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 0627
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
of breath on exertion, cool skin, dry cough, distended neck veins, weakness, weight gain unrelated to
intake, crackles and wheezes upon auscultation (to listen to the sounds of the lungs with stethoscope) of
the lungs, Orthopnea (shortness of breath when lying down), weakness and/or fatigue, increased heart rate
(tachycardia) lethargy and disorientation. Oxygen therapy per physicians orders. Vital signs as
needed.Record review of Resident #1's undated care plan reflected Resident #1 had a diagnosis of
diabetes and is at risk for unstable blood sugars and abnormal lab results. Goal: Resident will be free from
the signs and symptoms of hyper/hypoglycemia (high/low blood sugar). Interventions included Administer
diabetic medications as ordered by the physician. Monitor for adverse reactions and report abnormal as
detected. Provide therapeutic diet as ordered. Monitor blood Sugar as ordered by physician. Administer
sliding scale insulin if ordered. For any blood sugars not within the acceptable parameters as dictated by
the physician, document and notify the physician. Monitor for signs and symptoms of hyperglycemia such
as: Reduced appetite, increased thirst, urinary frequency, weight loss, fatigue, nausea, vomiting, dry skin,
muscle cramps, Kussmaul breathing (deep, labored breathing pattern), acetone breath (smells fruity),
stupor (mental condition marked by absence of spontaneous movement), and coma. Document and report
to the physician as needed.Record review of Resident #1's undated care plan reflected Resident #1 had
dialysis. Resident #1 received dialysis related to renal failure and is at risk of the potential complications of
dialysis related to End Stage Renal Disease. Goal: Resident will have no complications from routine
dialysis. Interventions included Encourage resident to attend scheduled dialysis appointments.
Hemodialysis treatments are to be performed on the following days of the week: Tuesday, Thursday,
Saturday. Obtain vital signs and weight per protocol. Report significant changes in pulse, respirations, and
blood pressure to the physician. Do not draw blood or take blood pressure readings on any arm containing
an Arteriovenous fistula (arteriovenous fistula is an abnormal connection between an artery and a vein).
Arteriovenous shunt (surgical connection that allow blood to flow directly from a high-pressure artery into a
lower-pressure vein): Auscultate shunt site for bruit and palpate for thrill (to listen for swishing or whooshing
sounds) as ordered. Notify physician for absence of bruit/thrill. Monitor dialysis dressing and change as
ordered. Report abnormal bleeding to the physician. Monitor/document/report to physician any signs or
symptoms of infection at the access site such as redness, swelling, warmth, pain, or purulent drainage
(thick, pus-like fluid that indicate infection). In case of dislodgment of dialysis access device to Right side of
neck, apply pressure to prevent bleeding, call emergency services, and notify physician.Record review of
Resident #1's undated care plan reflected Resident #1 had Discharge Plans, LTC: Resident #1 is in the
facility for long-term care placement as a result of a continued need for the services of skilled nursing staff
as evidenced by an inability to provide selfcare and discharge planning is not needed. Either the family or
the resident has requested that questions regarding return to the community only be asked on
comprehensive assessments. Goal: Resident and family's wish would be honored. Interventions included
Observe for change in conditions that may affect long-term care goals and notify the physician and
responsible party as needed. Discuss the need for continuing long-term care placement with the resident or
family as indicated or requested. Encourage and allow the resident or family to discuss feelings and
concerns regarding long-term care placement. Discuss with the resident or family the level of care that
would be needed to safely return to an assisted living facility, group home, or the community when indicated
or requested.Record review of Resident #1's progress note written by RN E on 12/16/25 at 2:43 PM
reflected Data: Resident refusing to go to dialysis - using profanity words being disrespectful to staff.
residents continue to refuse care daily and frequently. RN encouraged resident to go to dialysis and follow
current medical care
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455606
If continuation sheet
Page 2 of 8
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
12/22/2025
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 0627
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
plan. Resident denies any increased pain or discomfort at this time. Resident allowed staff to clean him but
refused to transfer to stretcher for dialysis. Action: continue to encourage resident to complete his care plan.
Response: resident states he does not want to do anything right now and will most likely call the state
again. No abuse or neglect has been noted.Record review of Resident #1's progress note written by RN F
on 12/16/25 at 10:54 PM reflected Data: While this writer was on break, the resident called 911 requesting
a breathing treatment. Another nurse assessed the resident, confirmed the request, and administered the
breathing treatment as ordered. This writer talked with a resident and educated the resident if he needed
anything ask the staff first.Record review of Resident #1's progress note written by RN E on 12/17/25 at
9:05 AM reflected Data: Resident has new order to transport resident to hospital.Record review of Resident
#1's progress note written by the Administrator on 12/19/25 at 12:40 PM reflected Resident initiated
discharge on [DATE] to hospital. Resident had previously stated he did not feel safe in the facility and did
not want to remain in the facility. Facility followed resident's wishes with discharge. MD agreed with resident
discharge.Record review of the facility's current resident roster, dated 12/22/25, reflected Resident #1 was
not listed as a resident currently in the facility or listed as a resident in the hospital.Interview on 12/22/25 at
10:21 AM with the Emergency Medical Technician revealed she received a call to transport Resident #1
from the hospital back to his home, a nursing facility, accompanied by the police due to this being Resident
#1's second attempt to reenter the facility. The Emergency Medical Technician stated the facility had
refused Resident #1 twice, and she did not understand why because Resident #1 needed assistance with
all of his care. The Emergency Medical Technician stated she entered the facility to gather discharge
paperwork but was given the runaround and never received any documentation regarding a safe discharge.
The Emergency Medical Technician stated she was told by facility staff that the facility was not refusing
Resident #1, but Resident #1 refused care and was rude and disrespectful to staff, and they would not
allow Resident #1 to enter the facility. The Emergency Medical Technician stated Resident #1 expressed to
her that he would have to return to the hospital because he could not do anything for himself. The
Emergency Medical Technician voiced Resident #1 did not have a safe discharge placing him at risk of
being homeless and without medical care. Interview on 12/22/25 at 12:32 PM with Hospital Staff revealed
Resident #1 entered the hospital due to needing dialysis, Resident #1 received dialysis and was sent back
to the nursing home on [DATE] and again on 12/19/25. The Hospital Staff stated Resident #1 returned to
the hospital and was admitted on [DATE] due to the nursing home facility rejecting him. The Hospital Staff
stated Resident #1 was currently admitted in the hospital. The Hospital Staff stated she reached out to the
facility to assist with his return and was told Resident #1 will not be allowed back to the facility. According to
the Hospital Staff, the facility was placing Resident #1 at risk of an unsafe discharge, and it was the facility's
responsibility to allow him to return until he was able to relocate to an alternative placement to
accommodate his care needs. Interview on 12/22/25 at 2:34 PM with the Ombudsman revealed she had
received a call from Resident #1 reporting that he had attempted to return to the facility after a hospital stay,
however the facility was rejecting his return. The Ombudsman stated she had not received any notice or
documentation from the facility on his discharge, so she reached out to the Administrator. According to the
Ombudsman, The Administrator acknowledged Resident #1 went out to the hospital and would not be
allowed to return. The Ombudsman shared there was a Care Plan meeting completed in November 2025,
which did not disclose any concerns regarding his stay in the facility. The Ombudsman stated she
expressed concern with the Administrator and advised Resident #1 should be allowed to return to his
home, however the Administrator was adamant that Resident #1 was not allowed to return
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455606
If continuation sheet
Page 3 of 8
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
12/22/2025
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 0627
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
to the facility. The Ombudsman stated not allowing Resident #1 to return to the facility placed him at risk of
not having a safe discharge. Interview on 12/22/25 at 3:00 PM with Resident #1 revealed he was sent to the
hospital on [DATE] due to shortness of breath. Resident #1 stated he had missed dialysis and needed to
have fluid removed, which was completed at the hospital. Resident #1 stated upon his return to the nursing
home facility, the Administrator came outside voicing he was denied reentry. Resident #1 stated he was
taken back to the hospital. Resident #1 stated the hospital discharged him twice to return to the facility,
however, was rejected by the Administrator to return. Resident #1 stated he expected to return to the facility
because he had no other place to go. Resident #1 voiced that the facility had tried relocating him, however
his referrals were all denied. Resident #1 stated he was currently admitted to the hospital, and according to
Resident #1 the Administrator was trying to kick him out of the facility with no place to go. Interview on
12/22/25 at 3:25 PM with RN F revealed she worked closely with Resident #1, he was always agitated with
staff, would refuse care, medication and often refused dialysis. According to RN B, Resident #1 would call
emergency medical services when he felt uncomfortable or wanted to be seen at the hospital. RN B stated
she was not aware of him being discharged from the facility. RN B stated Resident #1 had not voiced
feeling unsafe in the facility and anticipated his return. Interview on 12/22/25 at 3:35 PM with RN E revealed
Resident #1 was sent to the hospital on [DATE] due to having shortness of breath and chest pain. RN A
stated Resident #1 did not say anything about him not returning to the facility and she did not complete any
discharge paperwork. RN A stated she was not aware that Resident #1 was not allowed to return to the
facility. RN A stated not allowing Resident #1 to return to the facility would place him at risk of not having a
safe place for care . Interview on 12/22/25 at 4:35 PM with the ADON revealed she was aware Resident #1
had been sent to the hospital on [DATE] due to shortness of breath and chest pain. The ADON stated staff
and the Nurse Practitioner were working with him to assess his breathing and pain, however Resident #1
voiced if they did not call emergency services for him, he would call emergency services himself. The
ADON stated hospital documentation was provided to emergency services upon his exit from the facility,
and she anticipated Resident #1 was to return to the facility. The ADON voiced she understood that
Resident #1 was unhappy and wanted to eventually relocate. The ADON stated on 12/19/25 she was in the
building, and heard from an unknown staff member that Resident #1 had returned to the facility however
the Administrator refused to allow him to return. The ADON stated Resident #1 had voiced that he was
thinking about relocating to another facility that had inhouse dialysis, but she had heard that referral was
denied. According to the ADON, nursing staff would be responsible for completing discharge
documentation which would include resident discharge summary, medication list with instructions and
where they are discharging to. According to the ADON Resident #1 had not been properly discharged . The
ADON stated not allowing Resident #1 to return to the facility placed him at risk of not having a safe place
to live with the care he needed. Interview on 12/22/25 at 5:00 PM with the Administrator revealed on
12/13/25 Resident #1 was involved in a Priority 1 Health and Human Services investigation which he
alleged he did not feel safe residing in the facility. The Administrator stated this led to her creating her own
investigation, finding that Resident #1 would refuse his medications, activities of daily living care, and
dialysis treatment along with being rude and abusive towards staff. The Administrator stated she was aware
of Resident #1 being sent out to the hospital for shortness of breath and chest pain. According to the
Administrator, she discussed her investigation findings with her corporate office, and it was then decided
that Resident #1 would not be readmitted to the facility after his hospital stay. The Administrator explained
that Resident #1 was brought to the facility by Emergency Medical Technician and the
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455606
If continuation sheet
Page 4 of 8
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
12/22/2025
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 0627
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
police on 12/19/25 which she then explained Resident #1 had voiced not feeling safe and his want to
relocate therefore the facility would be supporting and honoring his wishes . The Administrator stated she
understood not allowing Resident #1 to readmit to the facility placed him at risk for an improper discharge.
According to the Administrator Resident #1 did not have a proper discharge and he was not going to be
allowed to return to the facility. Record review of facility policy dated 12/06/16 titled Discharge Planning did
not address allowing residents to return after a hospital visit and reflected: Anticipated Outcome: The
resident will receive medically related social services means services provided by the facility's staff to assist
residents in maintaining or improving their ability to manage their everyday physical, mental, and
psychosocial needs. Including discharge planning services (e.g., helping to place a resident on a waiting list
for community congregate living, arranging intake for home care services for residents returning home,
assisting with transfer arrangements to other facilities).Fundamental InformationSocial Service must
develop and implement an effective discharge planning process that focuses on the resident's discharge
goals, the preparation of residents to be active partners and effectively transition them to post-discharge
care, and the reduction of factors leading to preventable readmissions. The facility's discharge planning
process must be consistent with the discharge rights of a resident.Document, completed on a timely basis
based on the resident's needs, and included in the clinical record, the evaluation of the resident's discharge
needs and discharge plan.The results of the evaluation must be discussed with the resident or resident's
representative.All relevant resident information must be incorporated into the discharge plan to facilitate its
implementation and to avoid unnecessary delays in the discharge or transfer.Discharge
SummaryPost-discharge plan of care that is developed with the participation of the resident and, with the
resident's consent, the resident representative(s), which will assist the resident to adjust to his or her new
living environment.The post-discharge plan of care must indicate where the individual plans to reside, any
arrangements that have been made for the resident's follow up care and any post-discharge medical and
non-medical services.
Event ID:
Facility ID:
455606
If continuation sheet
Page 5 of 8
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
12/22/2025
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 0656
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Develop and implement a complete care plan that meets all the resident's needs, with timetables and
actions that can be measured.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interviews and record reviews, the facility failed to develop and implement a comprehensive
person-centered care plan for each resident that describes the services that are to be furnished to attain or
maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 resident of 8
residents (Resident #2) reviewed for care plans.The facility failed to address Resident #2's wound, and her
non-compliance with care in her care plan.This failure could place residents at risk of not receiving the care
they require. Findings included:Record review of Resident #2's quarterly MDS, dated [DATE], revealed
Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included a
stroke that affected her left side, poor circulation, and nicotine dependence. Her BIMS score was 11,
indicating she was moderately cognitively impaired. Her Functional Abilities assessment revealed she was
totally dependent on staff for her ADLs. She had no pressure ulcers according to her Skin Conditions
assessment. Record review of Resident #2's care plan, dated 10/06/25, revealed she had cognitive
impairment, had an ADL self-care deficit, she was at risk of developing pressure ulcers, and she had fragile
skin. It did not address the resident's Arterial wound (wound to leg caused by poor blood flow) or her
non-compliance with care. Record review of Resident #2's Skin Issue assessment, dated 10/28/25,
revealed she had developed an Arterial wound to her left outer ankle. Her assessment on 12/12/25
revealed the wound was larger and had poor healing. Record review of Resident #2's wound physician's
note on 12/10/25 revealed the resident had poor healing related to her smoking and failure to offload
pressure to the wound. His measurements revealed the wound was larger than it was initially. In an
interview on 12/22/25 at 1:46 PM CNA-A stated Resident #2 did not like getting out of bed. Her. hHer family
would get her up when they came to visit, but otherwise the resident stayed in bed. Staff would try to
position the resident on her right side to take pressure off her wound, but the resident would eventually
make it back to her backside and tuck her left foot under her right leg. She stated staff tried using pillows to
keep the left foot clear of the right leg, but the resident would work the pillow out. In an interview on
12/22/25 at 2:30 PM LVN-B stated Resident #2 rarely got out of bed. Her family would take her out to
smoke and sit in the common area to visit when they were there, otherwise the resident wanted to stay in
bed. LVN-B stated the staff tried multiple things to keep pressure off the resident's wound, but she would
eventually get her foot under her other leg. She stated the resident was educated multiple times about
offloading pressure. In an interview on 12/22/25 at 4:55 PM the Wound Care Nurse stated the resident was
seen weekly by the wound care physician, had daily dressing changes, and her wound continued to
deteriorate. The resident was educated about offloading pressure, and she would say That's what you say
(meaning she did not believe what she was being told) and continue to be non-compliant. In an interview on
12/22/25 at 4:35 PM the ADON stated she was responsible for keeping care plans updated on the South
Hall residents. She stated she was new to the position and facility and was trying to catch up. She stated
the admitting nurse created the baseline care plan, the MDS nurses added more detail to it after their
assessment, and then the ADONs kept the care plan updated with changes. Review of the facility's policy
Comprehensive Care Plans, dated 02/10/21, reflected: It is the policy of this facility to develop and
implement a comprehensive person-centered care plan for each resident, consistent with resident rights,
that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and
psychosocial needs that are identified in the resident's comprehensive assessment. 3. The comprehensive
care plan will describe, at a minimum, the following: a. The services that are to be furnished to attain or
maintain the resident's
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455606
If continuation sheet
Page 6 of 8
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
12/22/2025
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 0656
highest practicable physical, mental, and psychosocial well-being.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455606
If continuation sheet
Page 7 of 8
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
12/22/2025
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 0914
Provide bedrooms that don't allow residents to see each other when privacy is needed.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, interviews, and record review, the facility failed to ensure full visual privacy for each resident
in 6 rooms of 30 rooms (Rooms # 12, # 15, #23, # 71, #72 and #77) reviewed for privacy. The facility failed
to maintain functional window blinds to provide privacy for the residents of Rooms #12, # 15, #23, # 71, #72
and #77. This failure could place residents at risk for exposure and decreased sense of dignity. Findings
included:Observation on 12/22/25 at 9:45 AM in room [ROOM NUMBER] revealed the window blinds had 8
slats that were broken, allowing visualization of the bed from outside the facility. Observation on 12/22/25 at
9:53 AM in room [ROOM NUMBER] revealed the window blinds had 4 slats that were broken, allowing
visualization of the bed from outside the facility.Observation and interview on 12/22/25 at 10:00 AM in
Room # 77 revealed the window blinds had 12 slats that were broken, allowing visualization of the bed from
outside the facility. The resident stated the blinds had been broken a long time, stating the needed to be
replaced for privacy. Observation on 12/22/25 at 10:25 AM in room [ROOM NUMBER] revealed the window
blinds had 10 broken slats, allowing visualization of the bed from outside the facility. Observation and
interview on 12/22/25 at 10:30 AM in room [ROOM NUMBER] revealed the window blinds had 7 broken
slats, allowing visualization of the bed from outside the facility. The resident did not like the broken blinds,
stating it let people see in. Observation on 12/22/25 at 11:00 AM in room [ROOM NUMBER] revealed the
window blinds had 12 broken slats, allowing visualization of the bed from outside the facility. In an interview
on 12/22/25 at 11:54 AM, MA-C stated any repairs needed to the resident rooms were entered into the
Maintenance Logbook, located at each nurses' station, for maintenance to address. She was unaware of
any blinds in need of replacement. In an interview on 12/22/25 at 11:58 AM, LVN-D stated anything that
needed to be fixed in the resident rooms was written in the Maintenance Logbook or told directly to the
Maintenance Director. She was unaware of any blinds that needed to be replaced. Record review on
12/22/25 at 12:00 PM of Maintenance Logbooks for all three stations, revealed no requests for blind
repair/replacement. In an interview on 12/22/25 at 5:00 PM, the Maintenance Director stated he was
responsible for making repairs to the physical plant. He stated staff had been educated on the process of
entering any repair requests in the logbook. He stated he checks the books the first thing in the morning,
and then several times throughout the day. He stated he tries to make a sweep of all the rooms once a
month, looking for things that need to be addressed, but he relies heavily on the staff to alert him about
repairs needed. He was unaware there were blinds that needed replacement, he stated he has
replacements in stock and would get them replaced. Record review of the facility's policy Homelike
Environment, dated 04/24/25, reflected: .A homelike environment is essential for promoting the comfort,
dignity, and quality of life of residents. 2. Privacy and Dignity: Ensure that 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.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
455606
If continuation sheet
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