Inspection·May 26, 2023

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to ensure that the daily nurse staffing was posted as required. Residents Affected - Many The facility failed to post the daily staffing information on 05/26/23. This failure could place the residents, families, and visitors at risk of not having access to information regarding the daily nurse staffing data and facility census. Findings included: Observation on 05/26/23 at 5:31 am of each of the facility's nursing stations and facility entrance revealed the daily staffing posting was not posted throughout the facility. Observation on 5/26/23 at 8:27 am of each of the facility's nursing stations and facility entrance revealed the daily staffing posting was not posted throughout the facility. Observation on 05/26/23 at 10:03 am of each of the facility's nursing stations and facility entrance revealed the daily staffing posting was not posted throughout the facility. An interview with the ADM on 05/26/23 at 10:22 am revealed she was not aware the daily nurse staffing information was not posted. The ADM emailed the form to the staffing coordinator to ensure the information was posted. The Staffing Coordinator was responsible for ensuring the information was posted daily. An interview with the DON on 05/26/23 at 11:18 am revealed that the staffing coordinator was responsible for posting the nursing staffing information. The DON stated the information was in the staffing book at each nurse station. However, residents and or visitors did not have access to that information. An interview with the Staffing Coordinator on 05/26/23 at 11:31 am revealed she had been the staffing coordinator at the facility for 2 months. She had not posted the nurse staff information for residents or visitors since being hired in the position. The Staffing Coordinator had received a document to display for the public from the ADM but had not posted the information. The Staffing coordinator only provided the information in the staffing book. She revealed the staffing book was not accessible to residents or visitors. Review of the staffing information for 05/25/23 and 05/26/23 located in the staffing book located inside of the Staffing Coordinator's office. The staffing information did not reveal staffing for (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: 675759 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 675759 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stonegate Nursing and Rehabilitation 4201 Stonegate Blvd Fort Worth, TX 76109 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)