Inspection·December 23, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to ensure that all drugs and biologicals were accurately dispensed and administered to meet the needs of each resident when 1 (Resident #5) of 3 residents were reviewed for pharmaceutical services. The facility failed to ensure Resident #5 did not miss a dose of antibiotic medication that was to be administered on 12/21/24. This failure could place residents at risk of not receiving their medications as ordered by their physician. Review of Resident #5's Face Sheet, dated 12/23/24, reflected Resident #5 admitted [DATE] with paraplegia (paralysis in lower half of body) and right femur (large bone in upper leg) chronic osteomyelitis (bone infection). Review of Resident #5's Physician Order, dated 12/20/24, reflected an order for Vancomycin (antibiotic that treats infection caused by bacteria) intravenous (administer directly into a person's vein) solution 750 mg plus 500 mg = 1250 mg intravenously every 12 hours (at 09:00 AM and 09:00 PM) for osteomyelitis until 01/07/25. Review of Resident #5's Comprehensive Care Plan, dated 12/04/24, reflected Resident #5 had intravenous access and received antibiotics for osteomyelitis. One intervention was to administer the intravenous medications as ordered and flush lines/ports as ordered. Review of Resident #5's Quarterly MDS (tool used to assess health status) Assessment, dated 11/28/24, reflected Resident #5 was cognitively intact with a BIMS (tool to assess cognitive status) score of 15 and treated with intravenous antibiotics for a surgical wound. Record review of Resident #5's Medication Administration Record, dated 12/23/24, reflected Resident #5 did not receive the scheduled 09:00 PM dose of Vancomycin on 12/21/24. Resident #5's physician and infection disease doctor were notified of the missed dose and the ADON documented it in Resident #5's chart. During an interview on 12/23/24 at 03:15 PM, the ADON opened Resident #5's medication administration record and stated Resident #5 did not receive the 09:00 PM dose of Intravenous Vancomycin on 12/21/24. The ADON stated the nurse on Resident #5's hall worked from 6:00 AM-08:00 PM on 12/21/24. She stated the nurse verified the medication counts and handed the facility keys to the unit nurse at (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: 455651 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 455651 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Downtown Health and Rehabilitation Center 424 S Adams St Fort Worth, TX 76104 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)