The Harrison At Heritage

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Resident #1 and the call light around his neck. The Clinical Unit Manager stated that Resident #1 was distraught at the time and stated that no one wanted him and that he was not going to get better. The Clinical Unit Manager said that she and the DON removed all items out of Resident #1's room that could be used to harm himself. The Clinical Unit Manager also stated she and the DON placed Resident #1 on one-on-one supervision until emergency transport arrived to take him to the hospital for a psychiatric evaluation. The Clinical Unit Manager said Resident #1 did not have suicidal ideations or mentioned that he felt like hurting himself prior to the incident. The Clinical Unit Manager revealed the Administrator was responsible for reporting incidents to the State. The Clinical Unit Manager also said that if the Administrator was not available to report to the State, the DON could report to the State when needed. Interview on 10/09/25 at 4:38 PM, the DON revealed that she was notified by LVN A that Resident #1 was stating that he was going to kill himself. The DON stated that she responded and went to Resident #1's room immediately.

The DON said that Resident #1 was told by his daughter that he was useless during a visit. The DON said that she talked to Resident #1 calmly and took the things out of his room that could be a harm to him such as cords. The DON said the facility received an order to send Resident #1 out for a psychiatric evaluation.

The DON stated the Administrator was responsible for reporting unusual events and she (DON) would be responsible if the Administrator was out of the building. The DON stated Resident #1 was picked up by emergency transportation later that day. However, Resident # 1 was placed on one-one-one until emergency transport arrived and the resident did not return from the hospital. Interview on 10/09/25 at 5:28 PM, the Administrator revealed that she was immediately notified of Resident #1's incident. The Administrator stated, Resident #1 did not appear depressed prior to this incident, and he had not expressed suicidal ideations. The Administrator stated that Resident #1 was placed on one-on-one supervision after

the incident and then sent out for a psychiatric evaluation and did not return from the hospital. The Administrator also revealed that a head-to-toe assessment had been completed, and no redness or red marks were found on the resident's neck. The Administrator also stated that after the resident was found,

they developed a new assessment which would have the resident placed on one-on-one supervision, would be referred to psychiatric serviced, and sent out for psychiatric evaluation. The Administrator stated they in-serviced immediately on this new policy after Resident #1 was found in his room. The Administrator stated she reviewed the regulations with her upper management, and felt this incident was not reportable.

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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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

The Harrison at Heritage

4600 Heritage Trace Parkway Fort Worth, TX 76244

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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

was out of the building. The DON stated Resident #1 was picked up by emergency transportation later that day. However, Resident # 1 was placed on one-one-one until emergency transport arrived and the resident did not return from the hospital. Interview on 10/09/25 at 5:28 PM, with the Administrator revealed that she was immediately notified of Resident #1's incident. The Administrator stated , Resident #1 did not appear depressed prior to this incident, and he had not expressed suicidal ideations. The Administrator stated that Resident #1 was placed on one-on-one supervision after the incident and then sent out for a psychiatric evaluation and did not return from the hospital. The Administrator also revealed that a head-to-toe assessment had been completed, and no redness or red marks were found on the resident's neck. The Administrator also stated that after the resident was found, they developed a new assessment which would have the resident placed on one-on-one supervision, would be referred to psychiatric serviced, and sent out for psychiatric evaluation. The Administrator stated they in-serviced immediately on this new policy after Resident #1 was found in his room. The Administrator stated she reviewed the regulations with her upper management, and felt this incident was not reportable. Record review of the facility's current Abuse Prohibition Protocol policy, dated 08/25, revealed the following: .5. The Abuse Prevention Coordinator will assure that all Facility staff is in-serviced on recognizing abuse, abuse prevention and abuse reporting upon employment, and as necessary to maintain an abuse free environment. 7. i. Adverse event. An adverse event is an untoward, undesirable, and usually unanticipated event that causes death or serious injury, or

the risk thereof.

Event ID:

Facility ID:

If continuation sheet