Green Valley Healthcare And Rehabilitation Center
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
it was their responsibility to implement and monitor the effectiveness of all interventions put in place.
Observation on 09/05/25 of Resident #2 revealed staff followed the facility's policy while transferring the resident using a mechanical lift. Interviews on 09/05/25 from 12:35-3:30 PM with RPs and Residents #3, #4, #5, #6, #7, #8, and #9 revealed there were no concerns for safety or quality of care regarding transfers at the facility. Record Reviews of Residents #2, #3, #4, #5, #6, #7, #8, and #9 care plans revealed they were all updated and included appropriate transfer procedures and interventions. Record review of a 1:1 in-service titled Utilization of Mechanical Lift, dated 09/04/25, reflected DON was educated on transfer policy to include the utilization of a mechanical lift. DON was also educated on following MD order and what to do if resident, family or RP had concerns or refusal regarding the transfer. Record review of an in-service titled Utilization of Mechanical Lift, dated 09/04/25, reflected all nursing staff were educated on the facility's mechanical lift policy, following MD orders and what to do in the event the resident, family or RP has concerns or refusals regarding the transfer status. Record review of an in-service titled Transfer Residents Properly, dated 09/04/25, reflected all nursing staff were educated on properly transferring residents according to MD orders. Staff were also educated on using two staff with mechanical lift transfers and educating resident, family, or RP on safety and following the care plan. Record review of a document provided by the Administrator titled Audit Attestation, dated 09/04/25, reflected all residents who required transfer assistance were audited to ensure proper transfer procedures were care planned and being implemented. Record review of a document provided by the Administrator titled QIPP QAPI Worksheet, dated 09/05/25, reflected a QAPI meeting was held regarding the correction plan for the facility's deficiency.
In a follow-up interview on 09/05/25 at 02:47 PM, DON stated she ensured nursing staff were trained on transfers. She stated staff are to follow MD orders to ensure the safety of resident. She also stated if there was refusal from the resident, family or RP staff are to educate, document and inform a supervisor.An Immediate Jeopardy (IJ) was identified on 09/04/25 at 04:00 PM and an IJ Template was provided to the DON at 04:41PM. While the IJ was removed on 09/05/25, the facility remained out of compliance at a scope of isolated with the severity level of potential for more than minimal harm that was not immediate due to the facility's need to evaluate the effectiveness of the corrective systems.
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Green Valley Healthcare and Rehabilitation Center in Fort Worth, TX inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in Fort Worth, TX, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Green Valley Healthcare and Rehabilitation Center or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.