Inspection·November 8, 2023

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Minimal harm or potential for actual harm Based on record reviews and interviews, the facility failed to transmit MDS data for 3(Resident #64, 41, 26) of 5 residents reviewed for MDS transmission. Residents Affected - Some The facility failed to transmit a Discharge MDS for Residents # 64, 41, and 26. This failure could place residents at risk of facility not providing complete and specific information for payment and quality of measure purposes. Findings included: Record review of Resident #64's Face sheet dated 11/08/23 revealed an admission date of 5/24/23 and a discharge date of 06/02/23. Record review of Resident #64's MDS list dated 11/08/23 revealed a Discharge with Return Anticipated MDS completed on 06/02/23 that had not been transmitted. Record review of Resident #41's Face sheet dated 11/08/23 revealed an admission date of 06/21/23 and a discharge date of 07/11/23. Record review of Resident #41's MDS list dated 11/08/23 revealed a Discharge with no Return Anticipated finalized on 07/11/23 that had not been transmitted. Record review of Resident #26's Face sheet dated 11/08/23 revealed an admission date of 05/25/23 with a discharge date of 06/09/23. Record review of Resident #26's MDS list dated 11/08/23 did not reveal a Discharge MDS finalized, completed, and/or transmitted. During an interview on 11/08/23 at 11:31 with CRN, DON, and ADM, CRN said she usually signed the MDS that it had been completed. She said she did not check that they were submitted. DON said that she did not handle or work with the MDS's for the facility. ADM and CRN both said no person oversaw that MDS's were submitted other than the MDS coordinator. CRN said the MDS coordinator went on vacation last Thursday (11/02/23) so they should have already been submitted. ADM said they did a triple check every month so the MDS's would have been flagged and they would not have been able to complete the triple check without those being transmitted. CRN said she would attempt to get on the MDS submission website and see if she could find out although she did not have access to this facility's submissions. (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: 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 11/08/2023 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)