Health inspection·January 29, 2026

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some understood with a BIMS score of 0 which was severe cognitive impact. He required substantial/maximal assistance with personal hygiene. He was always incontinent of urine/bowel.Record review of Resident #8's care plan, dated 4/1/2024, indicated he was on enhanced barrier precautions. Interventions included to perform hand sanitation before entering the room and prior to leaving the room. During an observation on 01/28/2026 at 9:01 AM, revealed CNA B and CNA D were present in the hallway and gathered supplies to perform incontinent care and placed them in a plastic bag. Both donned (put on) a gown in the hallway at the door of Resident #8. Staff entered the room, and CNA D placed a draw sheet on the over bed table as a barrier and placed the plastic bag on top of it. Both placed gloves on their hands without washing or sanitizing them. CNA D opened Resident #8's brief and placed it between his thighs. CNA D removed a wipe from the bag and wiped his penis in a circular motion and placed the wipe in the trash. CNA B removed her gown and gloves and exited the room to get more wipes because they did not have enough to complete care. CNA B brought back in supplies and donned a gown and placed gloves on her hands without washing or sanitizing them. CNA D removed wipes from the bag and wiped his inner thighs and placed the wipe in the trash x2. Resident #8 was rolled onto his right side and CNA D removed a wipe from the plastic bag and wiped his rectal area from front to back x2 and placed the wipes in the trash. CNA D rolled the brief underneath his buttocks and placed a clean brief under the brief and rolled the resident onto his left side over the dirty brief and CNA B removed the brief and placed it in the trash. CNA D secured the brief and repositioned the resident in bed. CNA D removed her gloves and placed them in the trash and placed gloves on her hand without washing or sanitizing them. CNA B removed her gloves and placed them in the trash and sanitized her hands and placed gloves on her hands. The resident was pulled up in bed and repositioned again in bed. Both staff removed their gloves and gowns and placed them in the trash. Both sanitized their hands.During an interview on 1/28/2026 at 9:13 AM, CNA D said she had been employed at the facility for 4 months. She said during care that was provided to Resident #8 she did not wash or sanitize her hands before care was started. She said she was nervous and forgot. She said she did not wash or sanitize her hands between glove changes either. She said she should have removed her gloves when she changed from dirty to clean when the brief was removed and she touched the clean brief and placed it underneath the resident and the brief should have been removed before the clean brief was placed. She said she had a skills check-off when she was hired. She said there was a risk for residents to get bacteria, germs and cross contamination if staff did not perform hand hygiene. During an interview on 1/28/2026 at 2:05 PM, CNA B said she had been employed at the facility for 5 years. She said during the care that was provided to Resident #8 she should have removed the dirty brief before CNA D placed the clean brief. She said she should have washed or sanitized her hands before the care was started. She said she forgot. She said residents could be at risk of infections if staff did not wash or sanitize their hands before and after care.3. Record review of Resident #21's facility face sheet, dated 1/28/26, a [AGE] year-old female who was admitted to the facility on [DATE] with a diagnosis which included cystitis (inflammation of the bladder).Record review of Resident #21's quarterly MDS assessment, dated 1/1/26, indicated a BIMS score of 15, which indicated she was cognitively intact. She required substantial/maximum assistance for toileting and personal hygiene.Record review of Resident #21's comprehensive care plan, dated 12/29/25, indicated she had an ADL self-care performance deficit and required staff assistance times one person for toileting.During an observation on 1/28/26 at 9:35 AM revealed CNA C performed perineal care on Resident #21. She was observed to wash her hands upon entrance to the room. During care, she was observed changing her gloves three times during care without performing hand hygiene.During an interview on 1/28/26 at 9:50 AM, CNA C said I normally don't (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675816 If continuation sheet Page 2 of 3 Printed: 05/15/2026 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 675816 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Greenbrier Nursing & Rehabilitation Center of Pale 2404 Hwy 155 Palestine, TX 75803 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete do this with y'all. I have not been watched by state before When asked if she knew why hand hygiene should be performed between glove changes, she replied No.During an interview on 1/29/2026 at 8:40 AM, the DON said she was the IP for the facility and was responsible for training staff on infection control on hire and annually thereafter. She said hand hygiene should be done before care, after care, and before gloves were donned. She said staff should never touch clean items with dirty gloves as it was a risk for contamination. She said EBP was for residents who had MDROs, foley catheters, PICC lines, wounds, and gastric tubes. She said if a resident was on EBP staff should wear a gown and gloves. She said there was a risk of infections if staff did not perform hand hygiene appropriately. She said they started retraining staff yesterday, 1/28/2026, on infection control with hand hygiene and EBP.During an interview on 1/29/2026 at 9:00 AM, the Administrator said the DON was responsible for training staff on infection control. She said hand hygiene should be done every time they touched something. She said for residents who were on EBP, staff should wear gowns and gloves when care was provided. She said residents who required EBP included residents with MDROs, wounds, g-tubes, foley catheters and open areas. She said there was a risk of infections if staff did not follow infection control measures and it protected the residents and staff. She said going forward they planned to in-service the staff with return demonstrations on infection control. Record review of a CNA proficiency audit, dated 9/15/25, for CNA C indicated she had been checked off on female perineal care and handwashing.Record review of the facility's policy, dated 4/01/2024, titled Enhanced Barrier Precautions indicated, .Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high contact resident care activities. Indwelling medical device examples include central lines, urinary catheters, feeding tubes, and tracheostomies. A peripheral intravenous line (not a peripherally inserted central catheter) is not considered an indwelling medical device for the purpose of EBP Record review of the facility's, undated, policy titled Fundamentals of Infection Control Precautions indicated, .1. Hand Hygiene continues to be the primary means of preventing the transmission of infection. When coming on duty; after removing gloves . Event ID: Facility ID: 675816 If continuation sheet Page 3 of 3