Greenhill Villas
Inspection Findings
F-Tag F0686
F 0686 Level of Harm - Actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
signature sheet for the ADHOC QAPI meeting that was held on 10/29/25 indicated the medical director and
the IDT team were in attendance. Record review of the 1:1 in-service provided to the Administrator, DON, and ADON completed on 10/29/25 indicated they were in-serviced over the pressure prevention policy, the skin assessment policy, documentation, notifying change of condition, abuse and neglect, and rounding in
the facility. Record review of the staff in-services related to the IJ provided indicated the staff that had been to work were in-serviced over the pressure prevention policy, the skin assessment policy, documentation, notifying change of condition, abuse and neglect, and rounding in the facility. The Administrator was informed that the Immediate Jeopardy was removed on 10/30/2025 at 1:57 PM. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that was not Immediate Jeopardy and a scope of isolated due to the facility's need to monitor the implementation of the plan of removal. Evaluate the effectiveness of the corrective systems that were put into place.
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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
10/30/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Greenhill Villas
2530 Greenhill Rd Mount Pleasant, TX 75455
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-Tag F0880
F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
term care (LTC) facilities. Many residents in nursing homes are at increased risk of becoming colonized and developing infections with MDROs. Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed toreduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high contact resident care activities.EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing. A single set of PPE cannot be used for more than 1 patient. EBP are indicated for residents with any of the following:Colonization with a CDC-targeted MDRO when Contact Precautions do not otherwise apply (see MDRO list on page 3); orWounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO.Wounds generally include chronic wounds, not shorter-lasting wounds, such as skin breaks orskin tears covered with an adhesive bandage (e.g., Band-Aid(R)) or similar dressing.
Examples of chronic wounds include, but are not limited to, pressure ulcers, diabetic foot ulcers, unhealed surgical wounds, and venous stasis ulcers.Indwelling medical device examples include central lines, urinary catheters, feeding tubes, andtracheostomies. A peripheral intravenous line (not a peripherally inserted central catheter) is not considered an indwelling medical device for the purpose of EBP.The facility will ensure PPE and alcohol-based hand rub are readily accessible to staff prior to entry to their room .Communication to Staff The facility will utilize postings outside the room and Point Click Care to communicate to staff if a resident requires EBP.
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GREENHILL VILLAS in MOUNT PLEASANT, 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 MOUNT PLEASANT, 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 GREENHILL VILLAS or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.