This Fort Worth nursing home is one of the ’worst of the worst,’ feds say

A Fort Worth nursing home has been added to the government’s list of “worst of the worst” nursing homes.

The Fort Worth Southwest Nursing Center, at 5300 Altamesa Blvd., was designated a “special focus facility” by the federal government last year. There are just 88 special focus facilities in the nation, or about 0.5% of all nursing homes, according to the Centers for Medicare & Medicaid Services. The designation is reserved for nursing homes with the most serious or most prolonged health and safety violations.

The nursing home, which has 198 beds, has been cited repeatedly for endangering residents or for violating health and safety protocols.

The facility’s most serious issues were identified in July 2021, when state surveyors found a string of dangerous violations. The inspection report included instances of confirmed violations and neglect for multiple residents.

▪ One certified nursing assistant told inspectors that nursing home staff regularly neglected one woman, who required “total assistance from staff for all activities of daily living.” The woman received nutrition through a stomach tube and oxygen from a nasal cannula, according to the report. When inspectors viewed the woman in her room, she was “unable to speak, move or respond to her surroundings.” During the inspection, the nursing assistant removed a cloth boot from the woman’s foot revealing “a fluid saturated dressing that caused (the assistant) and both surveyors to gasp and turn their heads away from the foul odor coming from the right foot.” The boot was covered in dark brown stains, according to the report, and the assistant said staff routinely neglected the woman and didn’t change her brief and her wound dressings.

▪ One resident, whose diagnosis included paranoid personality disorder and pneumonia, left the facility on a pass. The resident told staff he would only be gone for several hours, but was absent for an unknown amount of time, possibly days, before he returned. Inspectors wrote that “no documentation was provided” regarding resident’s return to the nursing home, and that “the facility took no action to locate the resident or ensure his safety.”

▪ In another instance, a woman asked a nurse to change her brief because it was wet. The woman told the nurse that her brief had not been changed since earlier in the day, according to the woman’s boyfriend, who was visiting her at the time and witnessed the exchange. In response, the nurse called the resident a liar and made the woman cry. A certified nursing assistant also witnessed the exchange, according to the report, and failed to report the interaction to supervisors. The experience left the woman in tears and “made her feel like she was worth nothing,” according to the woman’s boyfriend.

During a more recent health inspection in September, there were no health deficiencies found.

The Fort Worth Southwest Nursing Center is owned by Coryell County Memorial Hospital Authority, and is managed by a company called Southwest Nursing & Rehab Center LLC, which in turn is managed by a company called Oasis HCP LLC. The CEO of the hospital authority did not respond to emails or a phone call asking him to comment for this story. The Star-Telegram left voice mails for both management companies, but did not receive a response.

In October, the Biden administration announced new rules for these nursing homes as part of a larger re-evaluation of homes and assisted living facilities. According to the new rules, special focus facilities could lose federal funding immediately if they are found to have one dangerous violation. The government will “continue close scrutiny” of the facility for at least three years.

An updated list of special focus facilities is expected to be released later this week.