Health inspection·November 16, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to immediately notify the resident's physician when there was a need to alter treatment for 1 of 4 residents reviewed for physician notification. (Resident #1) The facility failed to immediately notify the physician on 9/24/25 when they were unable to draw the blood successfully on Resident #1 for labs. This failure could place residents at risk for delayed diagnosis or altered medical management.Findings included: Record review of an admission record, dated 9/30/25, indicated Resident #1 was a 68 year female who admitted on [DATE] and discharged home with home health services on 9/28/25 with diagnoses including acute kidney failure (when the kidneys suddenly stop functioning, leading to a build-up of waste products in the blood), arthropathic psoriasis (a form of inflammatory arthritis that can affect people with psoriasis, causing joint pain, swelling, stiffness, and fatigue), congestive heart failure (a condition where the heart muscle is damaged and cannot pump blood efficiently to meet the body's needs), anemia (a condition where the body lacks enough healthy red blood cells or hemoglobin, which can cause symptoms like fatigue, weakness, and shortness of breath), hypertension (or high blood pressure, a condition where the force of blood against artery walls is consistently too high), and hypothyroidism (a common condition where the thyroid gland in your neck does not make enough hormones). Record review of an active orders summary report, dated 9/16/25, indicated Resident #1 had admission Labs CBC, CMP, TSH, Vit.D one time only for one week post admission for two days follow up with results with an order date of 9/16/25, start date of 9/23/25, and end date of 9/25/25. Record review of Physician order detail report, dated 9/16/25, and completed by LVN B, indicated Resident #1 had verbal orders for admission labs: CBC, CMP on admission and one week post admission: CBC, CMP, TSH, Vit.D. This order was signed by Resident #1's Physician and dated 9/17/25. Record review of admission MDS assessment, dated 9/20/25, indicated Resident #1 had clear speech, was able to make her self-understood by expressing ideas and wants; had clear comprehension. She had a BIMS score of 12 out of 15 indicating she had moderate cognitive impairment with thinking and memory. She required supervision or moderate assistance with most ADLs. Record review of Resident #1's undated revised care plan indicated the following:-Focus (initiated 9/16/25): [Resident #1] respiratory risk related to respiratory conditions. Goal: Respiratory risks related to pulmonary conditions/function will be minimized with interventions. Intervention (initiated 9/24/25): Notify physician of change in status. -Focus (initiated 9/24/25): [Resident #1] was at risk for cardiac complications due to Hypertension. Goal: will have no cardiac complications through review date. Interventions: and monitor lab work as ordered by physician and report results.-Focus (initiated 9/24/25): [Resident #1] had potential for complications from chronic kidney disease. Goal: [Resident #1] will have minimized risk for progression of comorbidities due to CKD. Intervention: Monitor lab values per physician's orders.-Focus (initiated 9/24/25): [Resident #1] at risk for complications r/t Hypothyroidism (under active thyroid). Goal: No (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 11/16/2025 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)