Greenbrier Nursing & Rehabilitation Center Of Tyle

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

change. Resident #1's Family still had noticeable body odor when she visits. During an interview on 8/13/25 at 9:40 a.m. LVN A said he was familiar with Resident #1. LVN A said he had been given instruction regarding monitoring to ensure residents received their showers. LVN A said monitoring of showers was done by CNAs completing shower sheets and the nurses signing the shower sheets. During an interview on 8/13/25 at 9:55 a.m. the DON said showers were documented in the electronic medical records. The DON said Resident #1's family would occasionally give him his showers. The DON said the CNAs did not document when the family gave Resident #1 his showers. The DON said the only place showers were documented was in the electronic medical records. The DON said some CNAs used to fill out paper showers sheets, but she had not seen any paper shower sheets in a long time. The DON said if a date of a scheduled shower was left blank then it meant the shower was not provided or not documented. The DON said there was not a way to prove a shower was given if it was not documented. The DON said if 8, 8 was documented on a scheduled shower day it indicated activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity. The DON said there was no way to differentiate whether or not the activity occurred or the care was provided by non-facility staff. The DON said nurses monitored to ensure showers were given with paper showers sheets, visually, verbally, and in the electronic medical records. During an interview on 8/13/25 at 10:38 a.m. the DON said they had looked and could not find any paper shower sheets for Resident #1. During an interview on 8/13/25 at 10:57 a.m. the SW said when a grievance came to her she wrote up the complaint in the electronic medical records and distributed

it to the appropriate department. The SW said she usually followed-up in 1-2 days to see if the grievance had been resolved. The SW said she ensured a grievance has been resolved by speaking with the staff responsible for the grievance, ensuring there had been a response entered into the electronic medical records, and speaking with the resident/resident family. The SW said if the grievance was not resolved she would then elevate the issue to the Administrator. The SW said regarding the grievance on 4/26/25 about Resident #1 not receiving his showers that he had been receiving bed baths since the grievance had been filed. The surveyor pointed out that neither showers or bed baths were being documented as having been provided. The SW said if showers or bed baths were not documented it could not be proven they were being provided to Resident #1. The SW said the importance of ensuring grievances were addressed was to ensure issues were resolved and because residents' rights need to be respected. Record review of the facility's Grievances policy last revised 11/2/16 indicated, The resident has the right to voice grievances to

the facility or other agency or entity that hears grievances without discrimination or reprisal and without fear of discrimination or reprisal.The resident has the right to and the facility must make prompt efforts by the facility to resolve grievances the resident may have.The grievance official of this facility if the Administrator or their designee. The grievance official will: Oversee the grievance process, Receive and track grievances to their conclusion, Lead any necessary investigations by the facility.

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If continuation sheet

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greenbrier Nursing & Rehabilitation Center of Tyle

3526 W Erwin St Tyler, TX 75702

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

give him his showers. The DON said the CNAs did not document when the facility gave Resident #1 his showers. The DON said the only place showers were documented was in the electronic medical records.

The DON said some CNAs used to fill out paper showers sheets, but she had not seen any paper shower sheets in a long time. The DON said if a date of a scheduled shower was left blank then it meant the shower was not provided or not documented. The DON said there was not a way to prove a shower was given if it was not documented. The DON said if 8, 8 was documented on a scheduled shower day it indicated activity itself did not occur or family and/or non-facility staff provided care 100% of the time for that activity. The DON said there was no way to differentiate whether or not the activity occurred, or the care was provided by non-facility staff. The DON said nurses monitored to ensure showers were given with paper showers sheets, visually, verbally, and in the electronic medical records. The DON said the importance of ensuring residents received their scheduled showers was for skin inspections, to reduce skin breakdown, cleanliness, and for the residents to just feel better overall. During an interview on 8/13/25 at 10:38 a.m. the DON said they had looked and could not find any paper shower sheets for Resident #1.

During an interview on 8/13/25 at 11:15 a.m. the DON said Resident #1's family did not provide him showers 100% of the time and the dates documented 8,8 for bathing would indicate activity did not occur due to family not providing bathing 100% of the time as the documentation survey report indicates those are the 2 reason to document 8,8. Record review of the facility's undated Bath, Tub/Shower policy indicated, Bathing by tub bath or shower is done to remove soil, dead epithelial cells (a type of cell that forms the protective covering for the body's surfaces, cavities, and organs), microorganisms from the skin, and body odor to promote comfort, cleanliness, circulation, and relaxation.The aging skin becomes dry, wrinkled, thinners, and blemished with various aging spots over time and is easily affected by environmental temperature and humidity, sun exposure, soaps, and clothing fabrics.Although a daily bath or shower is preferred and necessary for some, the aging skin can be maintained by bathing every two days or with partial bathing as needed.The resident will receive assistance with bathing according to their resident centered plan of care.

Event ID:

Facility ID:

If continuation sheet

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

08/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Greenbrier Nursing & Rehabilitation Center of Tyle

3526 W Erwin St Tyler, TX 75702

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

some situations that require hand hygiene.Before and after assisting a resident with toileting.After handling soiled or used linens, dressings, bedpans, catheters, and urinals.After removing gloves or aprons.Consistent use by staff of proper hygienic practices and techniques is critical to preventing the spread of infections. Record review of the facility's Perineal (the area of skin and tissue between the vulva (the external female genital organs) (in females) or scrotum (in males) and the anus) Care policy dated 4/25/22 indicated, An incontinent resident of urine and/or bowl should be identified, assessed, and provided appropriate treatment and services to restore as much normal bladder/bowel function as possible.Procedure Content.Start: 10. Perform Hand Hygiene 11. [NAME] (put on) gloves and all other PPE per standard precautions.Back.21. Gently perform care to the buttocks and anal area, working from front to back without contaminating the perineal area.24. Doff (take off) gloves and PPE 25. Perform Hand Hygiene.

Conclude: 26. Provide resident comfort and safety by re-clothing (if applicable-incontinence pad(s) and briefs), straightening bedding, adjusting bed and/or side rails, and placing call light within resident's reach.

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If continuation sheet