Health inspection·October 28, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interviews the facility failed to ensure the resident's right to receive services in the facility with reasonable accommodation of resident needs and preferences for 5 (Residents #1, #2, #3, #4, #5) of 30 residents observed for accommodation of needs. Residents Affected - Some The facility failed to ensure Residents #1, #2, #3, #4, and #5 had call lights within reach. This failure could place the residents at risk of not being able to request assistance when needed. Findings included: Review of Resident #1's undated admission Record revealed the resident was a [AGE] year-old male who had been admitted to the facility on [DATE] with diagnoses that included muscle wasting, depression and anxiety. Review of Resident #1's annual MDS, dated [DATE], revealed a BIMS score of 4, indicating severe cognitive impairment. His Functional Status revealed he required limited assistance with his ADLs. Review of Resident #1's care plan, dated 08/30/23, revealed he had an ADL deficit related to impaired cognition. Review of Resident #2's undated admission Record revealed the resident was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included dementia, depression, anxiety, and cognitive communication deficit. Review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 1, indicating severe cognitive impairment. Her Functional Status revealed she required limited assistance with her ADLs. Review of Resident #2's care plan, dated 09/13/23, revealed she was dependent on staff for activities and interactions. Review of Resident #3's undated admission Record revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included muscle wasting, bipolar disorder, and contractures. Review of Resident #3's yearly MDS, dated [DATE], revealed a BIMS score not calculated. Her Functional Status indicated she required extensive assistance with her ADLs. (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: 675817 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 675817 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE FT Worth Southwest Nursing Center 5300 Alta Mesa Blvd Fort Worth, TX 76133 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)