Inspection·July 15, 2025

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 interview and record review, the facility failed to develop and implement comprehensive person-centered care plans for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 3 residents (Resident #1) reviewed for comprehensive care plans. The facility failed to develop a care plan for Resident #1's Foley catheter. This failure placed resident at risk of not receiving appropriate care. Findings included:Record review of Resident #1's MDS dated [DATE] reflected the resident was [AGE] year-old male admitted to the facility on [DATE] and discharged [DATE]. The MDS reflected Resident #1's cognition was intact with a BIMS score of 15, and his diagnoses included quadriplegia (a condition characterized by the loss of function or paralysis in all four limbs and sometimes the torso), neurogenic bladder (a dysfunction that results from interference with the normal nerve pathways associated with urination), and Stage 2 pressure ulcer of the right buttock (a shallow open wound, where the skin has broken down, revealing the dermis (the second layer of skin). The MDS reflected the resident was dependent upon staff for toileting hygiene, and he had a catheter for the entire 7 days of the assessment. Record review of Resident #1's care plan, dated 05/16/25, reflected it did not address the resident's Foley catheter.Record review of Resident #1's physician orders, dated 05/09/25, reflected there were no physician orders addressing the resident's Foley catheter.Record review on 07/15/25 at 11:07 AM of the Nurse Practitioner Notes, dated 05/21/25, reflected: ensure catheter securement device is in place to prevent pressure.Interview on 07/15/25 at 1:40 PM, LVN A revealed Resident #1 had been a resident at the facility for over a month. She stated she was aware the resident had a Foley catheter, but she was not sure of the orders to change the Foley catheter. She stated she knew he had once gone to be seen by the urologist, but she did not document any notes. She stated she remembered Resident #1 telling her his Foley catheter was changed at the doctor's office. LVN A further stated staff was aware of Foley catheter care, which consisted of emptying the catheter bag each shift and cleansing the catheter even if it had not been cared planned. She stated it was the responsibility of the ADON and DON to care plan the Foley catheter for Resident #1. Interview attempted via telephone on 07/15/25 at 3:24 PM with Resident #1; however, the attempt was not successful. Interview on 07/15/25 at 4:36 PM, the Regional Compliance Nurse revealed it was the nurse's responsibility to initiate a baseline care plan upon a resident's admission. She stated she and the interdisciplinary team were responsible for updating care plans, since the facility did not have a Director of Nursing. She stated the interdisciplinary team was responsible for initiating care plans according to their disciplines. She stated to have a Foley catheter care planned there were supposed to be orders and assessments in the resident's record, and they were missed from admission. She stated she was supposed to have followed up to ensure the care plans were updated, but the care plan was missed. She stated the purpose of the care plan to ensure (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 3 Event ID: 455819 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 455819 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arlington Heights Health and Rehabilitation Center 4825 Wellesley St Fort Worth, TX 76107 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)