Inspection·November 5, 2024

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for two (Resident #1 and Resident #2) of 2 residents, reviewed for pharmaceutical services, in that: Medications must be released to residents only on the written or verbal authorization of the attending physician. When a resident is transferred directly to another nursing facility or discharged to home, the resident's medications must be released to the new facility or to the resident or his family, respectively. The facility failed to provide the correct medications to Resident #1 upon discharge and failed to provide the correct medication to Resident #2 upon discharge. The facility nurse failed to check for correct medication before releasing to the resident and/or family member. This failure could place residents at risk for the consequences of drug diversion. The findings included: Record review of Resident #1's face sheet dated 11/05/2024, revealed she was admitted [DATE] with diagnosis Other Acute or Osteomyelitis, Right Ankle and Foot (Bone Infection); Methicillin susceptible Staphylococcus Aureus Infection as the cause of Diseases Classified (A group of [NAME]-positive bacteria that are genetically distinct from other strains of Staphylococcus, MRSA) Essential (Primary) Hypertension (High blood pressure that is multi-factorial and doesn't have one distinct cause). Record review on 11/05/2024 revealed Resident #1's medication list dated 09/30/2024 from the Summary of Episode Form and the Physician Orders noted no narcotics included on the Physician orders. Record review of Resident #2's face sheet dated 11/05/2024, revealed she was admitted [DATE] with diagnosis Acute Respiratory Failure with Hypoxia (occurs when the body does not have enough oxygen in the tissues); Malignant (Primary) Neoplasm, Unspecified (A rare cancer diagnosis that occurs when the origin of the cancer is unknown); Benign Neoplasm of Meninges, unspecified (A benign tumor in the meninges, which are the membranes that cover and protect the brain and spinal cord). Record review on 11/05/2024 revealed Resident #2's medication list dated 09/30/2024 from the Summary of Episode Form and the Physician Orders noted no narcotics included on the Physician orders. (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 3 Event ID: 676405 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 676405 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Forum Parkway Health & Rehabilitation 2112 Forum Parkway Bedford, TX 76021 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)