TexasFort Worth

Ignite Medical Resort Fort Worth, LLC

6301 Oakmont Blvd, Fort Worth, TX 76132 · Tarrant County · 70 certified beds · avg 48 residents/day · certified since Jun 21, 2018

Part of chain: IGNITE MEDICAL RESORTS (22 facilities, chain avg rating 2.7★)

1/5
Health inspection rating (on-site)
9
Serious findings on record
$141,703
Fines, last 3 years
3.61
Nurse hours/resident/day (adjusted)

What health inspectors found (on-site government inspections — the most independent evidence available)

Health inspection rating: ★☆☆☆☆1/5 · CMS overall rating: 2/5

The health inspection star above is graded on a curve within each state — a set share of each state's facilities gets each star level — so a facility can have few citations and still rate 2–3 stars if others in its state did even better. The overall rating combines that inspection score with staffing and self-reported quality measures.

Most serious findings (actual harm or immediate jeopardy)

▲ Immediate jeopardy, one-off · May 31, 2025 · F-0686 · triggered by a complaint

The facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving.

Why it matters: Bedsores are painful, can become deeply infected, and in serious cases can be life-threatening.

Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.

Corrected: Jun 1, 2025 (Deficient, Provider has date of correction)

▲ Immediate jeopardy, repeated · Jun 28, 2024 · F-0697 · triggered by a complaint

The facility did not provide safe and appropriate pain management for a resident who needed it.

Why it matters: Untreated pain causes needless suffering and can lead to depression, poor sleep, and declining health.

Severity (K): A life-threatening or extremely dangerous situation affected several residents. Among the most serious findings an inspection can produce.

Corrected: Aug 2, 2024 (Deficient, Provider has date of correction)

▲ Immediate jeopardy, one-off · Nov 2, 2023 · F-0600 · triggered by a complaint

The facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors.

Why it matters: Abuse and neglect cause direct physical and emotional harm and are among the most serious failures a nursing home can have.

Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.

Corrected: Nov 20, 2023 (Deficient, Provider has date of correction)

▲ Immediate jeopardy, one-off · Nov 2, 2023 · F-0607 · triggered by a complaint

The facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection.

Why it matters: Without working prevention policies, mistreatment is more likely to happen and less likely to be caught.

Severity (J): Inspectors found a situation that put a resident's life or safety in immediate danger, affecting one or a few residents. The facility must fix it immediately — these citations often come with large fines.

Corrected: Nov 20, 2023 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Feb 7, 2026 · F-0698 · triggered by a complaint

The facility did not provide safe, appropriate care for residents who need dialysis — the treatment that filters the blood when kidneys fail.

Why it matters: Mistakes in dialysis care can quickly become life-threatening for residents with kidney failure.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Feb 10, 2026 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Sep 4, 2024 · F-0697 · triggered by a complaint

The facility did not provide safe and appropriate pain management for a resident who needed it.

Why it matters: Untreated pain causes needless suffering and can lead to depression, poor sleep, and declining health.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Sep 30, 2024 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Sep 18, 2023 · F-0580 · triggered by a complaint

The facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away.

Why it matters: A family could learn about a serious injury or decline days later, after the chance to act has passed.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Oct 15, 2023 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Sep 18, 2023 · F-0684 · triggered by a complaint

The facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals.

Why it matters: Care that strays from doctor's orders or ignores the resident's wishes can lead to declining health and avoidable harm.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Oct 15, 2023 (Deficient, Provider has date of correction)

▲ Actual harm, one-off · Sep 18, 2023 · F-0777 · triggered by a complaint

The facility did not provide or obtain x-rays and other imaging tests when ordered, or did not promptly tell the ordering doctor the results.

Why it matters: A missed or delayed x-ray can leave a fracture or illness untreated while a resident is in pain.

Severity (G): One or a few residents were actually harmed — physically or emotionally — though not put in immediate danger of serious injury or death.

Corrected: Oct 15, 2023 (Deficient, Provider has date of correction)

All citations in the current public record (43)

CMS publishes roughly the last three inspection cycles plus recent complaint investigations. Older surveys drop out of the record as new ones are completed.

DateSeverityWhat the facility was cited for
Feb 12, 2026F · Potential for harm, facility-wideThe facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Feb 12, 2026F · Potential for harm, facility-wideThe facility did not dispose of garbage and refuse properly.
Feb 12, 2026E · Potential for harm, repeatedThe facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock.
Feb 12, 2026E · Potential for harm, repeatedThe facility did not serve food and drinks that were appetizing, attractive, and at a safe and pleasant temperature.
Feb 12, 2026D · Potential for harm, one-offThe facility did not make sure residents were fully informed about their own health, care, and treatments in a way they could understand.
Feb 12, 2026D · Potential for harm, one-offThe facility did not make reasonable adjustments to fit each resident's individual needs and preferences — things like call buttons within reach, preferred wake-up times, or accessible room setups.
Feb 12, 2026D · Potential for harm, one-offThe facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide.
Feb 7, 2026▲ G · Actual harm, one-offThe facility did not provide safe, appropriate care for residents who need dialysis — the treatment that filters the blood when kidneys fail. · from a complaint
Dec 8, 2025E · Potential for harm, repeatedThe facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. · from a complaint
Dec 8, 2025D · Potential for harm, one-offThe facility did not accurately assess a resident's health and needs. Assessments are the foundation for all the care a resident receives. · from a complaint
Dec 8, 2025D · Potential for harm, one-offThe facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. · from a complaint
Jul 10, 2025D · Potential for harm, one-offThe facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
May 31, 2025▲ J · Immediate jeopardy, one-offThe facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. · from a complaint
May 31, 2025E · Potential for harm, repeatedThe facility did not treat residents with dignity and respect, or did not honor their rights to make their own decisions and communicate freely. This is one of the most fundamental resident rights. · from a complaint
May 31, 2025D · Potential for harm, one-offThe facility did not provide the help residents need with basic daily activities — like bathing, dressing, eating, and using the bathroom — for residents who cannot do these things on their own. · from a complaint
May 31, 2025D · Potential for harm, one-offThe facility did not provide appropriate care related to bladder and bowel needs — including care for residents who use catheters and steps to prevent urinary tract infections. · from a complaint
Feb 5, 2025E · Potential for harm, repeatedThe facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint
Feb 5, 2025D · Potential for harm, one-offThe facility did not provide proper care for pressure ulcers (bedsores) or did not do enough to prevent new ones from forming. Bedsores develop when residents stay in one position too long without help moving. · from a complaint
Feb 5, 2025D · Potential for harm, one-offThe facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it. · from a complaint
Nov 7, 2024E · Potential for harm, repeatedThe facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Nov 7, 2024D · Potential for harm, one-offThe facility did not provide safe and appropriate respiratory care — such as oxygen, breathing treatments, or care for residents on breathing equipment — for residents who needed it.
Nov 7, 2024D · Potential for harm, one-offThe facility did not regularly inspect bed frames, mattresses, and bed rails for safety, or the rails and mattresses were not attached safely to the frames. · from a complaint
Sep 4, 2024▲ G · Actual harm, one-offThe facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint
Sep 4, 2024D · Potential for harm, one-offThe facility did not provide proper care for residents with a colostomy, urostomy, or ileostomy — surgical openings in the abdomen that let waste leave the body into a pouch. These require regular, skilled attention to stay clean and healthy. · from a complaint
Sep 4, 2024D · Potential for harm, one-offThe facility used feeding tubes without a valid medical reason or the resident's agreement, or did not provide proper care to residents who have feeding tubes. · from a complaint
Sep 4, 2024D · Potential for harm, one-offThe facility did not label drugs according to professional standards or did not store them in locked compartments, with controlled drugs (medications with a high risk of misuse) kept under a separate lock. · from a complaint
Sep 4, 2024D · Potential for harm, one-offThe facility did not protect residents' personal information or did not keep complete, accurate medical records that meet professional standards. · from a complaint
Sep 4, 2024D · Potential for harm, one-offThe facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Jun 28, 2024▲ K · Immediate jeopardy, repeatedThe facility did not provide safe and appropriate pain management for a resident who needed it. · from a complaint
Mar 14, 2024E · Potential for harm, repeatedThe facility did not provide pharmacy services that meet each resident's needs, or did not employ or contract with a licensed pharmacist. · from a complaint
Nov 2, 2023▲ J · Immediate jeopardy, one-offThe facility did not protect residents from abuse or neglect. This covers physical, mental, and sexual abuse, physical punishment, and neglect, by anyone — staff, other residents, or visitors. · from a complaint
Nov 2, 2023▲ J · Immediate jeopardy, one-offThe facility did not develop and follow policies and procedures to prevent abuse, neglect, and theft. These written safeguards are the foundation of resident protection. · from a complaint
Nov 2, 2023D · Potential for harm, one-offThe facility did not report suspected abuse, neglect, or theft to the proper authorities quickly enough, or did not report the results of its investigation. · from a complaint
Nov 2, 2023D · Potential for harm, one-offThe facility did not provide proper care for residents with a colostomy, urostomy, or ileostomy — surgical openings in the abdomen that let waste leave the body into a pouch. These require regular, skilled attention to stay clean and healthy. · from a complaint
Oct 24, 2023D · Potential for harm, one-offThe facility did not have or follow an effective program to prevent and control infections — such as proper hand washing, cleaning, and isolation practices. This is the most commonly cited deficiency nationwide. · from a complaint
Sep 18, 2023▲ G · Actual harm, one-offThe facility did not immediately notify the resident, their doctor, and a family member when something significant happened — such as an injury, a decline in health, or a room change. Families and doctors are entitled to know right away. · from a complaint
Sep 18, 2023▲ G · Actual harm, one-offThe facility did not provide treatment and care that follows the doctor's orders and matches the resident's own preferences and goals. · from a complaint
Sep 18, 2023▲ G · Actual harm, one-offThe facility did not provide or obtain x-rays and other imaging tests when ordered, or did not promptly tell the ordering doctor the results. · from a complaint
Sep 18, 2023F · Potential for harm, facility-wideThe facility did not get its food from approved, safe sources, or did not store, prepare, and serve food according to professional food safety standards.
Sep 18, 2023E · Potential for harm, repeatedThe facility did not keep the environment free of accident hazards, or did not provide enough supervision to prevent accidents like falls. · from a complaint
Sep 18, 2023E · Potential for harm, repeatedThe facility used bed rails without first trying safer alternatives, or without assessing the resident's safety risk, discussing the risks and benefits with the resident or family, getting consent, and installing the rails correctly.
Sep 18, 2023D · Potential for harm, one-offThe facility did not safely and appropriately administer IV fluids (fluids given through a vein) for residents who needed them.
Sep 18, 2023D · Potential for harm, one-offThe facility did not make sure its nurses and nurse aides had the skills and training needed to properly care for every resident.

Inspection trend by year

Citations from standard inspections increased between the last two inspection cycles (3 → 7).

YearCitationsSerious (G–L)Worst severity that year
2023135J ▲
2024112K ▲
2025111J ▲
202681G ▲

Counts reflect the current CMS public record (~3 inspection cycles plus complaint investigations); years with no surveys show no row. Inspection frequency varies, so compare severity as well as counts.

Fines and enforcement (last 3 years)

6 fines totaling $141,703.

DateTypeAmount / length
Feb 7, 2026Fine$12,425
May 31, 2025Fine$12,428
Sep 4, 2024Fine$12,048
Jun 28, 2024Fine$80,760
Oct 24, 2023Fine$14,518
Sep 18, 2023Fine$9,524

Nurse staffing (from payroll records, adjusted for how much care residents need)

MeasureThis facilityTexas avgU.S. avgWhere it stands
Total nurse staffing (hours per resident per day)3.613.463.95top 30% in Texas; bottom 42% in the U.S.
Registered Nurse hours0.770.440.69top 7% in Texas; top 30% in the U.S.
Weekend total nurse staffing3.223.043.50top 28% in Texas; bottom 43% in the U.S.
Weekend RN hours (not acuity-adjusted)0.600.340.48top 8% in Texas; top 23% in the U.S.
Total nursing staff turnover (%)54.555.345.8bottom 44% in Texas; bottom 26% in the U.S.
RN turnover (%)62.554.642.9bottom 38% in Texas; bottom 19% in the U.S.

Hours are per resident per day, case-mix adjusted by CMS so facilities caring for sicker residents can be compared fairly (same basis as the CMS staffing star). "Top X%" means better than most facilities: more staffing hours, or lower turnover. Raw (unadjusted) reported hours: total 4.36, RN 0.93, weekend 3.90. Staffing rating: 2/5.

Self-reported quality measures

Note: these ratings are based on data the facility reports about itself to CMS. They are not independently verified by inspectors, and can look better than inspection findings. Give more weight to the inspection results above.

Quality measures rating: 5/5 · long-stay residents: —/5 · short-stay residents: 5/5

Who owns this facility

For profit - Corporation

Owner / managerTypeRoleStakeSince
Berger Fam Tr Ua 06252014OrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Blue Pearl Financial LLCOrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Carr, JaredIndividualIndirect Ownership InterestNOT APPLICABLE01/01/2025
Gillis, KarenIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
Gobst, RyanIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
Gold Pearl, LLCOrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Ignite Fort Worth JV LLCOrganizationDirect Ownership InterestNOT APPLICABLE04/01/2022
Ignite Post Acute Solutions LLCOrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Ignite-Villa Holdco LLCOrganizationDirect Ownership InterestNOT APPLICABLE04/01/2022
Israel Family Investment TrustOrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Israel Investment TrOrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Jablonski, NicoleIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
McFarlane, JohnIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
Prestige Worldwide Fort Worth, LLCOrganizationDirect Ownership InterestNOT APPLICABLE04/01/2022
Rose, MarcIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
Shearer, RachelIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
Stern Family Investment TrOrganizationIndirect Ownership InterestNOT APPLICABLE04/01/2022
Thengil, MathewIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
White, JimIndividualIndirect Ownership InterestNOT APPLICABLE04/01/2022
Berger, AvivaIndividualIndividual Is an Owner, Partner or Trustee of Any ADP of the SNFNOT APPLICABLE07/17/2025

Questions to ask on your visit

Generated from this facility's actual citation record — bring them to a tour and ask the administrator directly.

Nearby facilities (within 20 miles)

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Ft. Worth Southwest Nursing Center1.3 miFort Worth, TX★★★☆☆2/5
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Benbrook Nursing & Rehabilitation Center3.6 miBenbrook, TX★☆☆☆☆1/5abuse
Stonegate Nursing and Rehabilitation3.6 miFort Worth, TX★★★★★4/5
Arlington Heights Health and Rehabilitation Center4.4 miFort Worth, TX★☆☆☆☆2/5abuse
Estates Healthcare and Rehabilitation Center5.0 miFort Worth, TX★☆☆☆☆1/5abuse
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Facility data as of CMS processing date 2026-08-01. CCN 676449.