F 0565
Honor the resident's right to organize and participate in resident/family groups in the facility.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview, and record review the facility failed to provide a private meeting space for
residents' monthly council meetings for 8 of 8 residents (Residents #13, #14, #15, #17, #21, #23, #38, and
#39) reviewed for resident council.
Residents Affected - Some
The facility failed to provide a private space for resident council meetings for Residents #13, #14, #15, #17,
#21, #23, #38, and #39.
This failure could place residents, who attended resident council meetings, at risk of not being able to voice
concerns due to a lack of privacy.
Findings included:
Observation and interview during a confidential resident group interview on 10/05/2022 at 10:10 AM with
Residents #13, #14, #15, #17, #21, #23, #38, and #39 in attendance revealed the meeting was held in an
open dining room, near the entrance to the facility's secured unit. There were no doors that could be closed
to ensure the residents' privacy during the meeting. Staff and visitors were observed walking through the
area while the meeting was in progress. During the confidential group meeting, all eight residents revealed
they always met in an open dining room area. They stated they have never been offered an opportunity to
meet in a private area. Residents #21 and #23 stated residents had not always vocalized what they felt at
meetings because staff could overhear them.
Interview on 10/06/2022 at 8:12 AM with the Administrator revealed he had worked at the facility for three
years and during that time resident council had always met in the open dining room near the secured unit.
He said the facility did not have a private area for the group to meet. He stated he knew the group should
have access to a private meeting space to ensure they were able to voice any concerns without fear of staff
hearing them. He said the residents had a right to privacy and to hold private meetings. He said he would
provide the facility's policy related to the resident's rights to meet privately.
Interview on 10/06/2022 at 3:00 PM with the Director of Community Life Services revealed the last three
resident council meetings were held in the open dining room. She said she had worked at the facility for the
past three years and during that time all resident council meetings were held in an open dining room area.
She stated the facility did not have a closed area to facility private meetings. She said she knew that the
residents had a right to hold private meetings.
Record review of the resident council minutes for July 2022, August 2022, and September 2022 revealed
no location of the resident council meeting.
(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 7
Event ID:
675565
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
675565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkwood Village
2600 Parkview Dr
Bedford, TX 76022
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 0565
Level of Harm - Minimal harm
or potential for actual harm
Record review of the facility's current, undated Resident Council policy reflected: the names of residents
making comments should not be part of the Resident Council minutes. A show of hands to determine a
given comment or complaint is common should be noted. No other policy was provided.
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675565
If continuation sheet
Page 2 of 7
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
675565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkwood Village
2600 Parkview Dr
Bedford, TX 76022
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 0638
Assure that each resident’s assessment is updated at least once every 3 months.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure a quarterly Minimum Data Set
assessment was completed no less than once every three months as required for one of 18 residents
(Resident #4) reviewed for comprehensive assessments.
Residents Affected - Few
The facility failed to ensure a quarterly assessment was completed for Resident #4.
This failure could place residents at risk of not having their care and treatment needs assessed to ensure
necessary care and services were provided.
Findings included:
Record review of Resident #4's Face Sheet dated 10/06/2022 revealed the resident was a [AGE] year-old
female admitted on [DATE] with diagnoses including major depressive disorder, sepsis, unspecified
organism (a life-threatening complication of infection), muscle wasting, essential (primary) hypertension
(high blood pressure) and gastroesophageal reflux disease (a digestive disease in which stomach acid or
bile irritates the food pipe lining).
Review of Resident #4's Electronic MDS tab revealed a Quarterly MDS assessment completed 05/15/2022
and a quarterly MDS assessment dated [DATE] was still in process.
Observation on 10/05/2022 at 12:40 PM revealed Resident 4 was in her room in her wheelchair. The
resident was alert and oriented to person and place.
Interview on 10/05/2022 at 2:13 PM with MDS Nurse C revealed she was responsible for completing the
annual and quarterly MDS assessments accurately, efficiently, timely, and expedited. She stated the MDS
assessments should be completed annually and quarterly or if there was a change in condition. She stated
Resident #4 did not have a quarterly assessment completed in a timely manner on 08/15/2022 although the
assessment was started. She stated a quarterly assessment should have been completed in August 2022
within 14 days since it was showing in process, but she could have missed it.
Interview on 10/05/2022 at 3:46 PM with the DON revealed her expectation was for all MDS assessments
to be completed accurately, efficiently, and timely. She stated the MDS Coordinator was responsible for
completing the MDS accurately and timely. She stated she was not responsible for signing the MDS after
assessment, the facility had a Corporate RN responsible for signing the MDS after the assessment was
completed.
Interview on 10/05/2022 at 4:22 PM with the Administrator revealed his expectation was for all MDS
assessments to be completed accurately, efficiently, and timely as per the guidelines. He stated the MDS
Coordinator was responsible for assisting and guiding MDS Nurse C and not having the MDS competed it
was an opportunity that was missed.
Interview on 10/06/2022 at 3:33 PM with the MDS RN D revealed she was responsible for signing the MDS
after the MDS nurse had completed assessment. She stated once the assessment was completed it would
reflect on her screen as open. She stated she checked every day for the completed assessment so that she
can sign for process completion. The MDS coordinator was called, and she did not respond or call back.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675565
If continuation sheet
Page 3 of 7
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
675565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkwood Village
2600 Parkview Dr
Bedford, TX 76022
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 0638
Level of Harm - Minimal harm
or potential for actual harm
Review of the facility's current MDS Completion and Submission Timeframe policy, revised July 2017,
reflected:
Our facility will conduct and submit resident assessments in accordance with current federal and state
submission timeframes.
Residents Affected - Few
1. The assessment coordinator or designee is responsible for ensuring that resident assessment are
submitted to CMS' OIES Assessment submission and processing (ASAP) system in accordance with
current federal and state guidelines.
2. Timeframes for completion and submission of assessment is based on the current requirements
published in the resident Assessment Instrument manual.
3. Submission of MDS records to the QIES ASAP is electronic. A hard copy of each record submitted is
maintained in the resident's clinical record for a period of (15) months from the date submitted.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675565
If continuation sheet
Page 4 of 7
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
675565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkwood Village
2600 Parkview Dr
Bedford, TX 76022
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, and record review the facility failed to store, prepare, distribute, and serve
food in accordance with professional standards for food safety in the facility's only kitchen.
Residents Affected - Many
1. The facility failed to ensure food items and clean dishes were kept away from airborne contaminants.
2. The Facility failed to ensure food items were properly labeled, dated, and thawed in accordance with
professional standards.
These failures could place residents who receive food from the kitchen, at risk for food contamination and
food-borne illness.
Findings included:
Observation on 10/04/2022 at 9:15 AM revealed, a large fan on the floor inside the entrance to the kitchen.
The fan was blowing toward a food preparation area of the kitchen. The grill on the front of the fan and fan
blades were covered with clumps of fuzz and dust. The clumps were fluttering from the propulsion of the
fan. In the same area, a film of tacky substance covered with dust and food crumbs was observed on the
shelves of the racks which contained clean insulated meal delivery plate covers and bases. A juice
dispensing machine, in the same preparation area, was observed with dust adhered to the machine's top
and sides with a tacky substance.
Interview on 10/04/2022 at 9:20 AM with the Director of Culinary Services revealed the tacky substance on
the juice dispenser and place cover rack was likely grease. She said the dust and crumbs stuck to the
equipment could become dislodged and contaminate food or clean dishes. She stated the fan had been in
the kitchen for about two weeks to help with keeping the kitchen food prep area cooler. She said dust and
fuzz on the fan cover and blades could blow off and get into food at the steam table. She said this placed
resident at risk of food borne illnesses.
Observation and interview on 10/04/2022 at 9:30 AM revealed an unlabeled or dated package of frozen red
meat wrapped in plastic wrap on the prep table. [NAME] A said she did not know who took the meat out of
the freezer and was not sure what it was. She said the meat was not labeled or dated. The Director of
Culinary Services said she was not sure what the meat was or how old it was because it was not labeled or
dated. She stated food items should always be dated and labeled to ensure freshness and thawing should
occur in the refrigerator or under cold running water to ensure the meat maintains a food safe temperature.
She was observed throwing it into the trash.
Observation and interview on 10/04/2022 at 9:35 AM revealed two ceiling vents, adjacent to the
dishwashing area, covered with dust and fuzz. A rack that contained clean pots and stainless-steel inserts
was under the vents. [NAME] B stated the dust and fuzz hanging from the vents could become dislodged
and contaminate the clean dishes on the rack below. He said this could cause a risk of food borne illness to
residents in the facility.
Observation and interview on 10/04/2022 at 9:50 AM revealed food crumbs and dirt on the floors under the
racks in the dry food storage area. The floor in the corners of the room were thick with
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675565
If continuation sheet
Page 5 of 7
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
675565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkwood Village
2600 Parkview Dr
Bedford, TX 76022
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 0812
Level of Harm - Minimal harm
or potential for actual harm
buildup of black dirt and food particles. The Director of Culinary Services stated staff clean the floors after
they have received a food order. She said the dirty floors could attract pests. She said she was responsible
for ensuring the kitchen was kept clean. She said there was an issue with pests in the room, but pest
control was coming weekly to address the issue. She said she had a daily cleaning schedule and was
working on a deep cleaning schedule.
Residents Affected - Many
Interview with the Administrator on 10/05/2022 at 3:45 PM revealed there should not be any dust or grease
on any of the kitchen equipment. He said the Director of Culinary Services was responsible for ensuring the
kitchen was clean. He stated dust could be dislodge from the racks, vents, or fan and contaminate dishes
and food which would pose a risk of food-borne illness to residents who ate food from the kitchen.
Record review of the facility's Weekly Cleaning Schedule dated 10/02/2022 - 10/08/2022 revealed staff
signed off on all the cleaning tasks noted. No tasks were listed for vents, shelves, or the juice machine.
Record review of the facility's current Cleaning and Sanitation of Dining and Food Service Areas policy,
dated 2019, reflected:
The food and nutrition services staff will maintain the cleanliness and sanitation of the ding and food
service areas through compliance with a written, comprehensive cleaning schedule. The director of food
and nutrition services will determine all cleaning and sanitation tasks needed for the department. The
facility's policy titled Food Storage dated 2019 revealed Sufficient storage facilities will be provided to keep
foods safe, wholesome, and appetizing. Food will be stored in an area that is clean, dry, and free from
contaminants. Food will be stored, at approximate temperatures and by methods designed to prevent
contamination or cross contamination. Frozen Foods - all foods should be covered, labeled, and dated. All
foods will be checked to assure that foods will be consumed by their safe use by dates or discarded. Safe
Thawing - thawing frozen meat, poultry, and fish in a refrigerator.
Record review of Food and Drug Administration Food Code dated 2017 Section 4-601.11 reflected:
.Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils
(A) EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch.
(B) The FOOD-CONTACT SURFACES of cooking EQUIPMENT and pans shall be kept free of encrusted
grease deposits and other soil accumulations.
(C) NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt,
FOOD residue, and other debris.
3-305.11 Food Storage.
(A) Except as specified in (B) of this section, FOOD shall be protected from contamination by storing the
FOOD: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination; and
(3) At least 15 cm (6 inches) above the floor. (B) FOOD in packages and working containers may be stored
less than 15 cm (6 inches) above the floor on case lot handling EQUIPMENT as specified under §
4-204.122. 3-305.14 Food Preparation. During preparation, UNPACKAGED FOOD shall
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
675565
If continuation sheet
Page 6 of 7
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
675565
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/06/2022
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Parkwood Village
2600 Parkview Dr
Bedford, TX 76022
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 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
FORM CMS-2567 (02/99)
Previous Versions Obsolete
be protected from environmental sources of contamination. 3-307.11 Miscellaneous Sources of
Contamination. FOOD shall be protected from contamination that may result from a factor or source not
specified under Subparts 3-301 - 3-306. 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD
ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR
317 Labeling, marking devices, and containers. 92 3-501.13 revealed Thawing: TIME/TEMPERATURE
CONTROL FOR SAFETY FOOD shall be thawed: (A) Under refrigeration that maintains the FOOD
temperature at 5 [degrees] C[elsius] (41 [degrees] F) or less; or (B) Completely submerged under running
water: (1) At a water temperature of 21 [degrees] C (70 [degrees F) or below, (2) With sufficient water
velocity to agitate and float off loose particles in an overflow.
Event ID:
Facility ID:
675565
If continuation sheet
Page 7 of 7