Health inspection·March 12, 2025

F 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure within 14 days after a facility completed a resident's assessment, electronically transmit encoded, accurate, and complete MDS data to the CMS System including a subset of items upon a resident's transfer, reentry, discharge, and death for 2 of 2 residents (Residents #16 and #115) reviewed for MDS assessments. Residents Affected - Some 1. The facility failed to transmit to the CMS system Resident #16 's discharge MDS assessment, dated 01/10/25. 2. The facility failed to transmit to the CMS system Resident #115 's discharge MDS assessment, dated 11/16/24. These failures could place residents at risk of not having their assessments completed and submitted in a timely manner and having their Medicaid payments and/or services interrupted. Findings include: 1. Record review of Resident #16's face sheet, dated 03/13/25, indicated an [AGE] year-old female who was admitted to the facility on [DATE] and discharged on 01/11/25. Resident #16 had diagnoses which included right femur fracture (a break in the thigh bone), multiple sclerosis (numbness, weakness, trouble walking, and vision changes caused by a breakdown of the nerves protective covering), and hypertension (high blood pressure). Record review of Resident #16's electronic health records, under the MDS tab, indicated the discharge MDS was dated 11/19/24. The discharge MDS status indicated the assessment was transmitted and accepted on 03/12/25. 2. Record review of Resident #115's face sheet, dated 03/13/25, indicated a [AGE] year-old female who was admitted to the facility on [DATE] and discharged on 11/06/24. Resident #115 had diagnoses which included surgery on the digestive system, ileus (slowing of the digestive tract that can prevent the passage of food), sepsis (blood infection), and dementia (loss of cognitive function that affects memory, thinking and social abilities). Record review of Resident #115's electronic health records, under the MDS tab, indicated the discharge MDS was dated 11/06/24. The discharge MDS status indicated the assessment was transmitted and accepted on 03/12/25. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 676443 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 676443 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Center at Grande 3219 East Grande Boulevard Tyler, TX 75707 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)