Health inspection·November 26, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to adhere to the federal requirements regarding residents' rights. The facility failed ensure a safe and decent living environment for two (Resident #2 and Resident #3's rooms) of five rooms reviewed for decent living environment. 1. The facility failed to ensure Resident #2's room was free of dirt, debris, and sticky floors on 10/10/25.2. The facility failed to ensure Resident #3's broken window was repaired. These failures could place residents at risk or diminished quality of life due to the lack of a well-kept environment. Findings included: Record review of Resident #2's face sheet, dated 10/10/25, reflected a [AGE] year-old male, with an admission date of 03/31/25. Resident #2 had a diagnosis of Convulsions (involuntary, uncontrollable muscle contractions), Dysarthria (difficult or unclear articulation of speech), Need for Assistance with Personal Care, Chronic Viral Hepatitis C (long term infection of the liver), and Vascular Dementia (changes in thinking and memory) Record review of Resident #3's face sheet, dated 10/14/25, reflected a [AGE] year-old female, with an admission date of 06/30/25. Resident #3 had a diagnosis of Dementia (changes in thinking and memory), Muscle Weakness, Depression (mood disorder that causes a persistent feeling of sadness and loss of interest), Acute Respiratory Failure (lungs cannot adequately exchange oxygen and carbon dioxide), and Emphysema (chronic lung disease that causes irreversible damage to air sacs in the lungs). In an observation and interview on 10/10/25 at 8:30 AM, Resident #2's room had many large brown crumbs on the floor near the television area, cheese balls under the edge of his bed, and had a sticky fall mat with crumbs on it. Resident #2 did not reply back to Surveyor when Surveyor attempted to speak with him. In an observation on 10/10/25 at 10:27 AM, in Resident #2's room, reflected the large crumbs near the television were gone and the floor looked like it was recently swept and mopped, but there were still cheese balls at the edge of his bed. The floor mat still had sticky spots and crumbs on it.In an interview on 10/10/25 at 2:18 PM, the Administrator stated the expectation was for the resident rooms to be cleaned well. She stated the risk of a resident's room not being cleaned was the responsible staff member having to speak with her regarding the violation of resident rights.In an interview on 10/10/25 at 3:05 PM, Housekeeping Supervisor E stated he would check to see who was responsible for cleaning Resident #2's room. Housekeeping Supervisor E stated he was not sure why the room was not cleaned properly, but his staff were trained on how to properly clean a resident's room. He stated Resident #2's room was now fully cleaned. Housekeeping Supervisor E stated the risk of an uncleaned room was infection control and pest issues. In an observation on 10/10/25 at 4:00 PM, from the parking area, outside of the facility, Surveyor noticed a resident room window with large cracks about a foot in diameter, with pink curtains that covered the inside of the window. The specific resident room was not identifiable from the parking area. In an interview on 10/14/25 at 1:15 PM, The Maintenance Director stated he was new at the facility and had a lot of work to complete. (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: 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 11/26/2025 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)