Inspection·July 18, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality for 2 of 10 residents (#1, #2) observed for dignity during lunch service: RN A and CNA B stood up to feed Residents #1 and #2 during lunch. This deficient practice could affect 10 residents that reside in memory care. The findings included: Review of Resident #1's admission Record undated revealed he was admitted to the facility on [DATE] with principal diagnoses of CENTRAL DISLOCATION OF RIGHT HIP, SUBSEQUENT ENCOUNTER; DEMENTIA IN OTHER DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE (severe mental health conditions that cause abnormal thinking and perceptions), MOOD DISTURBANCE (mental health conditions affecting mood), AND ANXIETY and ALZHEIMER'S DISEASE, UNSPECIFIED. Review of Resident #2's admission Record undated revealed [AGE] year-old male admitted on [DATE] with a primary diagnoses of METABOLIC ENCEPHALOPATHY (condition where brain function is disturbed due to different diseases); ALZHEIMER'S DISEASE WITH LATE ONSET. Review of Resident #1's Care Plan dated 07/09/2024 revealed; ADL 's Mobility; Goal: Resident will be able to: (Specify); Interventions *EATING; The resident will be able to (Specify) Review of Resident #2's Care Plan dated 02/29/2024 revealed; ADL Goal; Intervention: EATING: The resident requires (Supervision-limited assistance) by (X1) staff to eat. Review of Resident #1's Resident Assessment and Care Screening dated 07/14/2024 revealed; No BIMS score entered for Resident #1. Section GG- Functional Abilities and Goals; Eating: The ability to use suitable utensils to bring food and/or liquid to the mouth and swallow food and/or liquid once the meal is placed before the resident. Resident admission performance: 03 Partial/Moderate assistance- Helper does LESS THAN HALF the effort. Observation on 07/18/2024 at 11:42 am, in the memory care day room revealed RN A assisting Resident #1 with lunch. He stood next to him holding the eating utensil for Resident #1 offering him food. (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 4 Event ID: 675650 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 675650 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden Terrace Healthcare Center of Fort Worth 7500 Oakmont Blvd Fort Worth, TX 76132 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)