Baylor Scott and White Surgical Hospital Fortworth
An acute care hospital in Fort Worth, Texas 76110
1800 Park Place Avenue, Fort Worth, Texas 76110. (682) 703-5600.
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The short answer
Record last released by CMS on Oct 20, 2026.
- Not rated CMS’s overall rating
- 4of 5 patient survey rating
- 1 deficiency cited in the last three years
- 34 beds
Each figure’s source sits beside it, in its section below.
What these words mean3
- Star ratings
- CMS rates some kinds of place from 1 to 5 stars, more stars meaning better on CMS’s own measures for that kind: for a nursing home, its health inspections, staffing and quality measures. A rating is CMS’s summary of those measures; it doesn’t promise good care. Source: CMS, Care Compare and the Five-Star Quality Rating System.
- Inspection (survey)
- A visit by state inspectors, often unannounced, who check a place against the rules it must meet. For nursing homes and other places Medicare pays, CMS calls these visits surveys: a standard survey of a nursing home comes at least every 15 months, and a complaint survey whenever a complaint calls for one. Source: CMS; 42 CFR 488.308.
- Deficiency, citation, violation
- What inspectors write up when a place didn’t meet a rule: the rule, what they saw, and when. CMS calls it a deficiency; states may say citation or violation. It is the inspectors’ finding, not a court’s, and the place is usually asked for a plan to correct it. Source: CMS, statement of deficiencies (Form CMS-2567); each state’s licensing agency.
What did inspectors find?
The last inspection on record was on Sep 16, 2024: a complaint inspection.
1 deficiency cited in the last three years.
CMS, QCOR Hospital 2567 statements of deficiencies. Released Oct 20, 2026. Updated monthly.
When those deficiencies happened
1 deficiency in 1 month of the last 36. Last cited Sep 2024. Most serious: Standard-level. The last 3 years, to Nov 5, 2026.
| Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2023 | Dec | |||||||||||
| 2024 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec |
| 2025 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec |
| 2026 | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov |
Hover or focus a month to read it.
Hearth Record drew this from the dates and levels in the source’s own records.
Each deficiency, as cited
Rule titles as CMS’s inspectors cite them, set in sentence case.
CMS, QCOR Hospital 2567 statements of deficiencies. Released Oct 20, 2026. Updated monthly.
Sep 16, 2024: complaint inspection1 deficiency
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Patient Rights: Care In Safe Setting
The inspectors’ words, 480 words
“PATIENT RIGHTS: CARE IN SAFE SETTING CFR(s): 482.13(c)(2) The patient has the right to receive care in a safe setting. This Standard is not met as evidenced by: 46427 Based on record review and interview, the facility failed to ensure the right to receive care in a safe setting, in that one of one patient (patient #1) did not have a documented post fall assessment as required by facility policy. Findings included: Patient #1 was a 75-year-old female who was admitted to the facility on 05/02/2024 for left hip osteoarthritis. Patient #1 underwent a Left Total Hip Arthroplasty on 05/02/2024 and sustained a fall without injury on 05/03/2024 at 1:42 PM. Record review of patient #1 medical record did not evidence an immediate post fall assessment was performed. Per facility policy a post fall assessment would include objective and factual information of the fall, vital signs, a physical assessment, and neuro checks. Record review revealed a “MIDAS Edge Fall Risk Event” was not completed as required by facility policy. During an interview with personnel #1 and personnel #2 on 09/16/2024 confirmed the above findings Policy and Procedure titled Falls Prevention and Resources, USPI-PC-204-C, effective 10/17/2016, revised on 01/2024, “ ...I. Post-Fall Management ...3. Complete Post-Fall Assessment and document the objective, Factual information in the medical record.4. Obtain vital signs, a physical assessment and neuro checks after every fall and following doctor orders ...5. Notification of fall: o physician (if not previously called) o patient’s emergency contact o Midas EDGE (Trademark) Fall Risk Event. 6. Objective documentation in the medical record should include, but is not limited to: * description of the fall episode to include: -- witnesses to the fall (if any)- position in which the patient was found- assessment post-fall (changes in ROM, neuro status, etc.)- interventions initiated- persons notified - follow-up activities- did the patient attempt to break the fall? - was there a warning? - can the patient follow directions? - is there sensory impairment? - is the patient less than 24 hours post anesthesia? - was there a history of fracture? - was there a history/ diagnosis of osteoporosis? - were there harm risk factors in the clinician’s judgment present prior to the fall?...8. Report the fall to the charge nurse and at shift reports. 9. Complete an Event Report. Facility document titled Patient Rights & Responsibilities document ...” Your Rights ...You have the right to safe, respectful, and dignified care at all times ...As a patient, you have the right to Respectful and considerate care in a safe environment. Policy and procedure titled “Assessment and Reassessment, PC-007-F, Effective 09/29/2014, revised 12/2023, “ ...3. Assessment and Reassessment-Post Surgical Unit ...c. Any change in patient condition requires an immediate reassessment with changes in the interdisciplinary plan of care reflecting the change in condition. c. PSU ...PRN condition changes ... Neurovascular ...PRN condition changes ...Neurological ...PRN condition changes.”
The one inspection in the last three years
| Date | Visit | What the record says |
|---|---|---|
| Sep 16, 2024 | Complaint inspection | 1 deficiency cited |
How do patients fare?
- CMS gives no overall CMS rates some kinds of place from 1 to 5 stars, more stars meaning better on CMS’s own measures for that kind: for a nursing home, its health inspections, staffing and quality measures. A rating is CMS’s summary of those measures; it doesn’t promise good care. Source: CMS, Care Compare and the Five-Star Quality Rating System.: “There are too few measures or measure groups reported to calculate a star rating or measure group score.”
- Of the measures behind its CMS rates some kinds of place from 1 to 5 stars, more stars meaning better on CMS’s own measures for that kind: for a nursing home, its health inspections, staffing and quality measures. A rating is CMS’s summary of those measures; it doesn’t promise good care. Source: CMS, Care Compare and the Five-Star Quality Rating System., CMS counts against the national value: mortality, 0 better and 0 worse of 1; safety of care, 0 better and 1 worse of 2; readmission, 0 better and 1 worse of 3.
- Patients rate it 4 of 5 in CMS’s patient survey (296 surveys completed, Oct 1, 2024 to Sep 30, 2025): 75% rated it 9 or 10 out of 10, and 74% would definitely recommend it.
- CMS’s patient safety composite for serious complications, PSI 90, Jul 1, 2022 to Jun 30, 2024: no different than the national value.
- Readmissions within 30 days, as CMS gives them (Jul 1, 2023 to Jun 30, 2025): hip or knee replacement 6.3%. CMS gives no comparison with the national rate for them in this release.
- After outpatient care, compared by CMS: unplanned hospital visits after outpatient surgery, no different than expected.
- Emergency department patients spent a median of 110 minutes there before leaving (Oct 1, 2024 to Sep 30, 2025), and 0% left before being seen.
- Medicare’s spending per patient here is 0.93 times the national median (Jan 1, 2024 to Dec 31, 2024).
CMS, Hospital General Information, Patient survey (HCAHPS) - Hospital, Healthcare Associated Infections - Hospital, Timely and Effective Care - Hospital and Medicare Spending Per Beneficiary - Hospital. Released Aug 13, 2026. Updated quarterly.
CMS, Complications and Deaths - Hospital and Unplanned Hospital Visits - Hospital. Released Sep 30, 2026. Updated quarterly.
| Measure | Rating |
|---|---|
| Overall ratingCMS’s overall hospital quality star rating, 1 to 5 | Not rated |
| Patient survey ratingCMS star rating from its survey of the hospital’s patients (HCAHPS), 1 to 5 | 4 of 5 |
Is it certified, and in good standing?
- Medicare-certified acute care hospital since Apr 29, 2004.
- Ownership: physician.
- It is accredited by The Joint Commission, whose surveys stand in for the state’s routine inspections.
- No For hospices, home health agencies, hospitals and dialysis facilities, CMS writes deficiencies at two levels. Standard is the usual one; condition-level is the more serious, when a problem is serious enough that the provider doesn’t meet a whole condition of taking part in Medicare. Source: CMS, State Operations Manual. deficiency on record in the last three years.
- Physician.
CMS, Provider of Services File - Hospital & Non-Hospital Facilities. Released Oct 14, 2026. Updated quarterly.
CMS, Hospital General Information. Released Aug 13, 2026. Updated quarterly.
CMS, QCOR Hospital 2567 statements of deficiencies. Released Oct 20, 2026. Updated monthly.
Has it been penalized?
- CMS doesn’t publish fines or other penalties for hospitals.
- Not among the hospitals whose Medicare payments CMS cut under the Hospital-Acquired Condition Reduction Program for fiscal year 2026.
- 1 deficiency cited in the last three years came from an inspection that included a complaint investigation.
CMS, Hospital-Acquired Condition (HAC) Reduction Program. Released Aug 13, 2026. Updated yearly.
CMS, Provider of Services File - Hospital & Non-Hospital Facilities. Released Oct 14, 2026. Updated quarterly.
CMS, QCOR Hospital 2567 statements of deficiencies. Released Oct 20, 2026. Updated monthly.
What do patients say about their care?
- CMS doesn’t publish staffing levels for hospitals.
- In CMS’s patient survey, patients rate how well its nurses communicated 2 of 5.
- 70% of its health care workers got a flu shot (Oct 1, 2024 to Mar 31, 2025).
CMS, Patient survey (HCAHPS) - Hospital and Timely and Effective Care - Hospital. Released Aug 13, 2026. Updated quarterly.
Who owns it?
- Usp North Texas Inc. owns an unstated share directly since Sep 8, 2009; Thvg Ft. Worth Gp, LLC owns an unstated share directly since Jul 1, 2006.
- Texas Health Ventures Group LLC runs it.
- 6 owners or officers are people: Donita A Fleming (corporate officer); Donita A Fleming (corporate director); Steven M Schaefer (corporate officer); Steven M Schaefer (managing employee (on the payroll)); Susan Callaway (corporate officer); Susan Callaway (managing employee (on the payroll)).
- CMS’s Provider of Services file records no change of ownership.
- No private-equity firm among the owners CMS lists.
- No real-estate investment trust among the owners CMS lists.
CMS, Hospital All Owners and Hospital Enrollments. Released Sep 29, 2026. Updated monthly.
CMS, Provider of Services File - Hospital & Non-Hospital Facilities. Released Oct 14, 2026. Updated quarterly.
| Organisation | Role | Share | Since |
|---|---|---|---|
| Baylor University Medical Center | Other role (CMS gives no detail) | 1.26% | Sep 1, 2018 |
| United Surgical Partners International Inc. | Owns 5% or more through other companies | Mar 1, 2004 | |
| Tenet Healthcare Corporation | Owns 5% or more through other companies | Jun 16, 2015 | |
| Usp Domestic Holdings Inc. | Owns 5% or more through other companies | Mar 1, 2004 | |
| United Surgical Partners Holdings Inc. | Owns 5% or more through other companies | Jul 1, 2006 | |
| Usp North Texas Inc. | Owns 5% or more directly | Sep 8, 2009 | |
| Usp North Texas Inc. | Owns 5% or more through other companies | Sep 8, 2009 | |
| Thvg Ft. Worth Gp, LLC | Owns 5% or more directly | Jul 1, 2006 | |
| USPI Holding Company Inc. | Owns 5% or more through other companies | Jun 16, 2015 | |
| Texas Health Ventures Group LLC | Owns 5% or more through other companies | Jul 1, 2006 | |
| Texas Health Ventures Group LLC | Runs it (operational or managerial control) | Jul 1, 2006 | |
| USPI Group Holdings Inc. | Owns 5% or more through other companies | Apr 19, 2007 | |
| USPI Holdings Inc. | Owns 5% or more through other companies | Apr 19, 2007 | |
| Hcn Surgery Center Holdings Inc. | Owns 5% or more through other companies | Jun 16, 2015 |
How does it compare nearby?
- Of the 30 hospitals CMS lists in Tarrant County, 17 have an overall star rating from CMS: 3 rated 5 of 5, 9 rated 4 of 5, 2 rated 3 of 5, 3 rated 2 of 5.
- CMS gives this hospital no overall star rating to compare.
CMS, Hospital General Information. Released Aug 13, 2026. Updated quarterly.
What the record doesn’t say
- CMS doesn’t publish fines or other penalties for hospitals, so none are shown. The one payment cut CMS publishes for each hospital, under its Hospital-Acquired Condition Reduction Program, is shown where it applies.
- Only complaints that led to a citation appear; complaints that didn’t aren’t published.
- Most hospitals are accredited by a private organisation (The Joint Commission, DNV and others) whose routine inspections stand in for the state’s; those reports aren’t public, and QCOR holds only the state’s surveys: no inspection on record here doesn’t mean none took place.
- QCOR says its hospital inspection data are complete only through September 17, 2026, while it moves to a new system.
- CMS doesn’t publish staffing levels for hospitals.
- In its September 2026 release CMS gives no comparison with the national rate for death and readmission rates, though it gives the rates.
Sources
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Centers for Medicare & Medicaid Services, Hospital General Information (xubh-q36u).
Released Aug 13, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Patient survey (HCAHPS) - Hospital.
Released Aug 13, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Healthcare Associated Infections - Hospital (77hc-ibv8).
Released Aug 13, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Complications and Deaths - Hospital (ynj2-r877).
Released Sep 30, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Unplanned Hospital Visits - Hospital (632h-zaca).
Released Sep 30, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Timely and Effective Care - Hospital (yv7e-xc69).
Released Aug 13, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Medicare Spending Per Beneficiary - Hospital (rrqw-56er).
Released Aug 13, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Hospital-Acquired Condition (HAC) Reduction Program (yq43-i98g).
Released Aug 13, 2026 and checked Nov 5, 2026. Updated yearly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Provider of Services File - Hospital & Non-Hospital Facilities (Hospital_and_other.DATA.Q3_2026.csv).
Released Oct 14, 2026 and checked Nov 5, 2026. Updated quarterly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, QCOR Hospital 2567 statements of deficiencies (Hospital_2567s_2010_to_2026YTD.xlsx).
Released Oct 20, 2026 and checked Oct 27, 2026. Updated monthly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Hospital All Owners (Hospital_All_Owners_2026.09.29.csv).
Released Sep 29, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).
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Centers for Medicare & Medicaid Services, Hospital Enrollments (Hospital_Enrollments_2026.09.29.csv).
Released Sep 29, 2026 and checked Nov 5, 2026. Updated monthly. Public domain (U.S. Government work).
If you believe something here is wrong, a correction starts with the agency whose record this copies: CMS. CMS’s own record is on Care Compare. If Hearth Record copied something wrongly, it will fix it and log the correction publicly, with its date: how corrections work.
This copy of the record was made on Nov 5, 2026.
From the hospital
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Replies
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Paid listing
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