Matlock Place Health & Rehabilitation Center

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

facility to get the statements from the nurse and CNA about what happened. The Administrator said the CNA told her she was nearby Resident #2 who walked towards Resident #1 and started grabbing her neck.

The Administrator said the CNA quickly removed Resident #2's hands from Resident #1 and then separated the residents. The Administrator said Resident #2 was placed on every 15-minute checks by the nurse after everything was settled. The Administrator said the DON started an abuse in-service with staff that went over who to report abuse to, the types of abuse, and how quickly staff were supposed to report abuse. The Administrator said she did not look to see if Resident #1 had any injuries from Resident #2 or not. The Administrator said the 6 AM to 2 PM nurse, LVN B, came to the morning clinical meetings and would explain the resident got agitated with staff and she would be redirected and kept away from other residents. The Administrator said no other shift nurses reported to the clinical meetings, it was only the 6 AM to 2 PM shift nurses. The Administrator said other shift nurses reported things on the 24-hour report or would call the DON to let her know what was going on, such as if a resident began to have behaviors. The Administrator said she knew CNA's were told to redirect Resident #2 and get her involved in some type of activity, take her outside, or play some music. The Administrator said she heard Resident #2 pushed another resident a few days ago but the resident did not have any injuries from the situation. The Administrator said she was not told Resident #2 had been swinging at or trying to hit other residents. The Administrator said she could only intervene if she knew what was happening and since she did not know about Resident #2's behaviors, she could not put things in place. The Administrator said she expected staff to communicate with her when a resident showed signs of increased agitation and behaviors. The Administrator said if she knew about the extent of Resident #2's behaviors she could have taken other steps to ensure the residents' safety, such as transferring her to be evaluated. The Administrator said Resident #2's care plan was not updated either to reflect her behaviors because the management staff did not know about it. The Administrator said she was the abuse coordinator for the facility, and this situation was considered physical abuse. The Administrator said all residents had the right to be free from abuse and all staff were responsible for making sure they were. The Administrator said if residents were not free from abuse they would be harmed or have some type of trauma happen to them up to and including death.

Review of the facility's policy, revised 06/24/24, and titled Abuse, Neglect and Exploitation reflected: Definitions: ‘Abuse' means the willful infliction of injury, unreasonable confinement, intimidation, or punishment

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Matlock Place Health & Rehabilitation Center

7100 Matlock Rd Arlington, TX 76002

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)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

happening and since she did not know about Resident #2's behaviors, she could not put things in place.

The Administrator said she expected staff to communicate with her when a resident showed signs of increased agitation and behaviors. The Administrator said if she knew about the extent of Resident #2's behaviors she could have taken other steps to ensure the residents' safety, such as transferring her to be evaluated. The Administrator said Resident #2's care plan was not updated either to reflect her behaviors because the management staff did not know about it. The Administrator said she was the abuse coordinator for the facility, and this situation was considered physical abuse. The Administrator said all residents had

the right to be free from abuse and all staff were responsible for making sure they were. The Administrator said if residents were not free from abuse they would be harmed or have some type of trauma happen to them up to and including death. Phone interview on 08/28/25 at 9:32 AM with the Psych NP revealed Resident #2 was physically aggressive during moments of agitation and was difficult to redirect. The Psych NP said staff had been communicating with him about the increase in her behaviors and he had added orders for a PRN Ativan gel and Seroquel more recently. The Psych NP said he noticed during his meetings with her that she was uncooperative, non-compliant, and had disorganized speech and he was not sure what was causing all of these behaviors. The Psych NP said staff also explained to him how difficult Resident #2 was to manage and control, that she had taken off the tank to the toilet and the soap dispensers from the walls, she was wheeling another resident down the hall in her wheelchair in an aggressive manner, and now she had choked another resident. The Psych NP said Resident #2's behaviors were quite frequent and often from what he had witnessed and was told. The Psych NP said from what he was told and understood, staff were trying to minimize her behaviors the be

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Matlock Place Health & Rehabilitation Center

7100 Matlock Rd Arlington, TX 76002

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)

F 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

chart. The DON said the purpose of this was so that the medication was given for the right reason. The DON said if this was not done, the medication may be given for an inappropriate reason. The DON said all staff had been trained to ensure the diagnosis was always included with a medication order. Review of the facility's Psychotropic Medication Use policy, dated 2001, reflected it did not address having a diagnosis for

a medication order. Review of the manufacturer's information, dated January 2025, for Seroquel (quetiapine fumarate) reflected the following black box warning: Increased Mortality in Elderly Patients with Dementia-Related Psychosis; and Suicidal Thoughts and Behaviors Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death.Seroquel (quetiapine) is not approved for the treatment of patients with Dementia-Related Psychosis.

Event ID:

Facility ID:

If continuation sheet