General Information: VILLAGE CREEK NURSING HOME
Nursing home name VILLAGE CREEK NURSING HOME
Address3825 VILLAGE CREEK RD
FORT WORTH, TX 76119
Phone number (817) 534-9933
Located within a hospital No
Type of ownership For profit - Corporation
Owner operates multiple homesNo
Accept Medicare or Medicaid Medicare and Medicaid
Continue Care Retirement CommunityNo
Resident and family councils Resident
Certified number of beds 100
Total number of residents 80
Perc of occupied beds 80
Sprinkler status Yes
Number of Facility Reported Incidents0
Number of Substantiated Complaints1
Number of Fines2
Total Amount of Fines$4550
Total Number of Penalties0
Total Number of Penalties2
Ratings Summary: VILLAGE CREEK NURSING HOME
Overall rating 3
3
Nursing Home Staffing 1
1
Registered Nurses only 1
1
Health Inspections 4
4
Quality Measures 4
4
Nursing Home Staffing Info: VILLAGE CREEK NURSING HOME
National AverageTexas AverageVILLAGE CREEK NURSING HOME
Overall staff rating NA NA 1
1
Registered Nurses only rating NANA 1
1
Total Number of Residents NA NA 80
Total Number of Nurse Staff Hours per Resident per Day 4.11 hours 3.79 hours 2.75 hours
Total Number of Licensed Nurse Staff Hours per Resident per Day 1.64 hours 1.49 hours 0.98 hours
Registered Nurses Hours per Residents per Day 0.81 hours 0.57 hours 0.26 hours
Licensed Practical or Vacation Nurses Hours per Resident per Day 0.83 hours 0.92 hours 0.72 hours
Certified Nursing Assistants Hours per Residents per Day 2.47 hours 2.3 hours 1.77 hours
Physical Therapy Staffing Hours per Resident Per Day 0.1 hours 0.08 hours 0.0 hours
Health Survey: VILLAGE CREEK NURSING HOME
Heath Survey Summary on 2013-03-07
Total Number of Health Deficiencies 2
Scope and Severity of most Severe Health Deficiency Isolated/Minimal harm or potential for actual harm
Heath Survey Summary on 2012-02-23
Total Number of Health Deficiencies 4
Scope and Severity of most Severe Health Deficiency Isolated/Actual harm
Heath Survey Summary on 2011-04-14
Total Number of Health Deficiencies 3
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Health Survey Details: VILLAGE CREEK NURSING HOME
Inspection Results: 03/07/2013
Corrected Deficiency Scope and Severity
04/15/2013 Provide necessary care and services to maintain or improve the highest well being of each resident . Isolated/Minimal harm or potential for actual harm
04/15/2013 Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. Isolated/Minimal harm or potential for actual harm
Inspection Results: 02/23/2012
Corrected Deficiency Scope and Severity
03/28/2012 Ensure that a nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents. Pattern/Minimal harm or potential for actual harm
03/28/2012 1) Review the work of each nurse aide every year; and 2) give regular in-service training based upon these reviews. Pattern/Potential for minimal harm
03/28/2012 Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. Pattern/Minimal harm or potential for actual harm
03/28/2012 Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. Isolated/Actual harm
Inspection Results: 04/14/2011
Corrected Deficiency Scope and Severity
05/28/2011 Store, cook, and serve food in a safe and clean way. Widespread /Minimal harm or potential for actual harm
05/28/2011 Provide routine and emergency drugs through a licensed pharmacist and only under the general supervision of a licensed nurse. Widespread /Minimal harm or potential for actual harm
05/28/2011 Make sure that nurse aides show they have the skills and techniques to be able to care for residents' needs. Pattern/Minimal harm or potential for actual harm

Fire Safety Survey: VILLAGE CREEK NURSING HOME
Fire Safety Survey Summary on 2013-03-06
Total Number of Fire SafetyDeficiencies 5
Scope and Severity of most Severe Health Deficiency Pattern/Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2012-02-22
Total Number of Fire SafetyDeficiencies 5
Scope and Severity of most Severe Health Deficiency Widespread /Minimal harm or potential for actual harm
Fire Safety Survey Summary on 2011-04-13
Total Number of Fire SafetyDeficiencies 3
Scope and Severity of most Severe Health Deficiency Widespread/Potential for minimal harm
Fire Safety Survey: VILLAGE CREEK NURSING HOME
Fire Safety Survey Results: 03/06/2013
Corrected Deficiency Severity
04/15/2013 Corridor and hallway doors that block smoke. Pattern/Minimal harm or potential for actual harm
04/15/2013 Smoke barrier doors that can resist smoke for at least 20 minutes. Isolated/Minimal harm or potential for actual harm
04/15/2013 Exits that are accessible at all times. Pattern/Minimal harm or potential for actual harm
04/15/2013 Record of quarterly fire drills for each shift under varying conditions. Widespread/Potential for minimal harm
04/15/2013 Properly protected cooking facilities. Pattern/Minimal harm or potential for actual harm
Fire Safety Survey Results: 02/22/2012
Corrected Deficiency Severity
03/30/2012 Exits that are accessible at all times. Pattern/Minimal harm or potential for actual harm
03/30/2012 Portable fire extinguishers. Widespread/Potential for minimal harm
03/30/2012 Special areas constructed so that walls can resist fire for one hour or an approved fire extinguishing system. Widespread /Minimal harm or potential for actual harm
03/30/2012 Heating and ventilation systems that have been properly installed according to the manufacturer's instructions. Widespread/Potential for minimal harm
03/30/2012 Proper medical gas storage and administration areas. Pattern/Minimal harm or potential for actual harm
Fire Safety Survey Results: 04/13/2011
Corrected Deficiency Severity
05/28/2011 Walls that prevent smoke from passing through and would resist fire for at least one hour. Pattern/Potential for minimal harm
05/28/2011 Weekly inspections and monthly testing of generators. Widespread/Potential for minimal harm
05/28/2011 Properly installed electrical wiring and equipment. Pattern/Potential for minimal harm

Resident Complaints: VILLAGE CREEK NURSING HOME
Date Complaint Substantiated: 06/04/2012
CorrectedCategoryDeficiencySeverity
06/30/2012Prepare food that is nutritional, appetizing, tasty, attractive, well-cooked, and at the right temperature. F
Date Complaint Substantiated: 03/28/2012
CorrectedCategoryDeficiencySeverity
04/20/20121) Hire only people with no legal history of abusing, neglecting or mistreating residents; or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of residents. E
04/20/2012Develop and implement policies for 1) screening and training employees; and the 2) prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property. E

Quality Measures: VILLAGE CREEK NURSING HOME
Quality Measures National Average Texas Average VILLAGE CREEK NURSING HOME
Overall quality rating NA NA 4
4
Long-Stay Residents
Percent of Long Stay Residents Whose Need for Help with ADLs has Increased 15.4% 19.2% 23.4%
Percent of Long Stay Residents Who Self Report Moderate to Severe Pain 8.3% 9.1% 3.6%
Percent of High Risk Long Stay Residents With Pressure Ulcers 6.1% 6.8% 3.0%
Percent of Long Stay Residents Who Lose Too Much Weight 7.2% 6.0% 3.1%
Percent of Low Risk Long Stay Residents Who Lose Control of Their Bowel or Bladder 43.9% 43.2% 30.9%
Percent of Long Stay Residents with a Catheter Inserted and Left in Their Bladder 3.2% 3.2% 1.3%
Percent of Long Stay Residents With a Urinary Tract Infection 6.2% 7.2% 9.0%
Percent of Long Stay Residents Who Have Depressive Symptoms 6.3% 8.1% 0.5%
Percent of Long Stay Residents Who Were Physically Restrained 1.4% 1.2% 0.0%
Percent of Long Stay Residents Experiencing One or More Falls with Major Injury 3.2% 3.5% 2.6%
Percent of Long Stay Residents Assessed and Appropriately Given the Seasonal Influenza Vaccine 92.7% 90.4% 99.0%
Percent of Long Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 94.3% 89.7% 75.9%
Percent of Long Stay Residents Who Received an Antipsychotic Medication 20.7% 27.1% 50.8%
Short-Stay Residents
Percent of Short Stay Residents Who Self Report Moderate to Severe Pain 19.2% 18.8% 8.0%
Percent of Short Stay Residents With Pressure Ulcers That Are New or Worsened 1.2% 1.2% 11.9%
Percent of Short Stay Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine 83.4% 74.3% %
Percent of Short Stay Residents Assessed and Appropriately Given the Pneumococcal Vaccine 82.4% 73.2% 24.4%
Percent of Short Stay Residents Who Newly Received an Antipsychotic Medication 2.6% 3.6% %

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