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Complaint Investigation

Greenbrier Nursing & Rehabilitation Center Of Pale

April 30, 2026 · Palestine, TX · 2404 State Highway 155
Citations 1
CMS Rating 4/5
Beds 120
Provider ID 675816
Healthcare Facility
Greenbrier Nursing & Rehabilitation Center Of Pale
Palestine, TX  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

Greenbrier Nursing & Rehabilitation Center of Pale in PALESTINE, TX — inspection on April 30, 2026.

Found 1 citation. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0684
Quality of Life and Care Deficiencies

During an interview on 4/30/26 at 8:55 a.m., CNA A said she could not recall specifically

CNA A said she did not notice any EKG electrodes on resident's skin. CNA A said she should have noticed and removed them if she was giving resident an appropriate bed bath. An interview was attempted with CNA C on 4/30/26 at 9:47 a.m.; CNA C's available phone number was not a good contact number.

During an interview on 4/30/26 at 9:53 a.m., LVN D said she completed a skin assessment of Resident #1 on 4/15/26. LVN D said she completed an observation of all of resident's skin and she did not note any EKG electrodes on resident's skin during her skin assessment. LVN D said she should have seen EKG electrodes and removed them to perform a proper skin assessment.

During an interview on 4/30/26 at 10:45 a.m., the DON said she would not normally expect EKG electrodes to still be in place after a resident received a shower/bedbath. DON said she would expect the electrodes to have been removed or at least attempted to be removed and documented if they were adhered too firmly.

The DON said during a skin assessment she would expect the nurse to remove the EKG electrodes and document the finding.

The DON said the nurses typically only chart new findings in skin assessments.

The DON said she planned to introduce changes including assigning the treatment nurse to assess resident's skin anytime they came back from the hospital to document all new concerns including adhered medical devices.

The DON said previously no one person was assigned this task and it fell to the charge nurse on the floor.

During an interview on 4/30/26 at 10:52 a.m., the ADM said she was ultimately responsible for supervision of all staff, including nursing staff.

The ADM said she expected CNAs when bathing a resident to complete the ask appropriately and document the care, or document the care refusal and report it to the charge nurse for assistance.

The ADM said she would not expect to find EKG electrodes or other devices adhered to resident skin after a shower or bed-bath.

The ADM said she expected nurses performing skin assessments to remove any items adhered to resident's skin such as EKG electrodes.

The ADM said the risks to residents from improper baths or skin assessments could be skin integrity concerns/skin break down.

The ADM said the facility had already begun inservicing staff.

Review of an undated facility policy titled Bedbath, Complete indicated The resident will be clean and free of dryness, irritation, or pruritic(itching).The Resident will verbalize a feeling of comfort and well-being.

A skin assessment policy was requested from the facility but a wound management policy was supplied.

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 PALESTINE, 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 Greenbrier Nursing & Rehabilitation Center of Pale or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.