Greenbrier Nursing & Rehabilitation Center of Tyle
3526 W Erwin St · Tyler, TX · 75702 · 9035936441
120 certified beds For profit - Corporation Chain: Creative Solutions in Healthcare
Why this verdict
- Inspection results are getting worse cycle over cycle, not better.
- No federal fines or payment denials in CMS’s 3-year window.
The complete Safety Report — $19
Everything on this page plus the full citation-by-citation history with inspector findings, the complete penalty record, staffing vs benchmarks, side-by-side nearby comparisons, and the printable tour checklist. One PDF, emailed in minutes, yours to keep and share with family.
Red flags
Cited under the freedom-from-abuse rule
Cited 1 time under F600 (freedom from abuse/neglect) below the actual-harm level — worth asking about on a tour.
RN staffing in the bottom 10% nationally
0.24 registered-nurse hours per resident per day, vs a 0.58 national median and 0.75 benchmark.
Score breakdown
Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.
CMS ratings & staffing
Overall: 2 of 5 Inspections: 3 of 5 Staffing: 1 of 5 Quality measures: 3 of 5
| Total nurse hours / resident-day | 3.32 | 3.48 min · 4.1 strong |
|---|---|---|
| RN hours / resident-day | 0.24 | 0.55–0.75 |
| Weekend hours / resident-day | 2.85 | ≈ weekday level |
| Nursing turnover / year | — | median 45% |
| Fines (3-yr window) | none |
Inspection citations (28 in the current record)
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Potential for harm · D March 25, 2026
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
Corrected April 17, 2026 · Resident Rights
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Potential for harm · D March 25, 2026
Assure that each resident’s assessment is updated at least once every 3 months.
Corrected March 26, 2026 · Resident Assessment and Care Planning
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Potential for harm · D March 25, 2026
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected April 16, 2026 · Resident Assessment and Care Planning
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Potential for harm · D March 25, 2026
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected March 26, 2026 · Quality of Life and Care
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Potential for harm · E March 25, 2026
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected March 26, 2026 · Quality of Life and Care
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Potential for harm · E March 25, 2026
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Corrected April 2, 2026 · Nursing and Physician Services
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Potential for harm · E March 25, 2026
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected March 26, 2026 · Pharmacy Service
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Potential for harm · D March 25, 2026
Ensure medication error rates are not 5 percent or greater.
Corrected March 26, 2026 · Pharmacy Service
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Potential for harm · D March 25, 2026
Ensure that residents are free from significant medication errors.
Corrected March 26, 2026 · Pharmacy Service
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Potential for harm · D March 25, 2026
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Corrected March 26, 2026 · Pharmacy Service
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Potential for harm · D March 25, 2026
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Corrected March 26, 2026 · Nutrition and Dietary
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Potential for harm · D March 25, 2026
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected March 26, 2026 · Nutrition and Dietary
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Potential for harm · D March 25, 2026
Provide and implement an infection prevention and control program.
Corrected March 26, 2026 · Infection Control
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Potential for harm · D March 25, 2026
Put firmly secured handrails on each side of hallways.
Corrected March 26, 2026 · Environmental
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Potential for harm · D March 25, 2026
Have policies on smoking.
Corrected March 26, 2026 · Environmental
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Potential for harm · D August 13, 2025 · found via complaint
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.
Corrected August 14, 2025 · Resident Rights
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Potential for harm · D August 13, 2025 · found via complaint
Provide care and assistance to perform activities of daily living for any resident who is unable.
Corrected August 14, 2025 · Quality of Life and Care
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Potential for harm · D August 13, 2025 · found via complaint
Provide and implement an infection prevention and control program.
Corrected August 14, 2025 · Infection Control
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Potential for harm · E December 18, 2024
Ensure each resident receives an accurate assessment.
Corrected January 8, 2025 · Resident Assessment and Care Planning
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Potential for harm · D December 18, 2024
Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Corrected January 8, 2025 · Quality of Life and Care
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Potential for harm · D December 18, 2024
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Corrected January 8, 2025 · Pharmacy Service
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Potential for harm · D December 18, 2024
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected January 8, 2025 · Environmental
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Potential for harm · D October 6, 2024 · found via complaint
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
Corrected October 7, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D October 6, 2024 · found via complaint
Protect each resident from the wrongful use of the resident's belongings or money.
Corrected October 7, 2024 · Freedom from Abuse, Neglect, and Exploitation
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Potential for harm · D October 6, 2024 · found via complaint
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected October 7, 2024 · Resident Assessment and Care Planning
Showing the 25 most recent. The Safety Report includes every citation with full findings.
Family & resident reviews — a separate signal, never mixed into the score
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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 675267 · certified since February 14, 1994. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.