Average — CMS composite of the measures below.
A standard survey is most likely before around October 2026
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Silver Creek Nursing And Rehabilitation during CMS and state inspections, most recent first.
The facility did not obtain food from approved or satisfactory sources and failed to store, prepare, distribute, and serve food according to professional standards.
The facility did not establish or maintain an infection prevention and control program as required, resulting in a deficiency identified by surveyors.
Surveyors identified multiple environmental deficiencies, including dusty ceiling vents, non-functioning lights, missing floor molding, and a rusted sprinkler head in two resident hallways and two shower rooms. The Maintenance Director reported not receiving any work orders for these issues, and both the Administrator and Maintenance Director agreed that addressing these repairs would improve the environment.
A resident with multiple unstageable pressure ulcers and cognitive decline did not receive the required repositioning every two hours as outlined in the care plan. Observations showed the resident remained in the same position for several hours, and staff interviews revealed confusion about documentation procedures. The facility's policy required documentation and communication of such interventions, but records did not reflect compliance.
A resident with chronic heart failure and a physician-ordered fluid restriction did not have his fluid intake properly monitored or documented. Staff provided fluids in excess of meal-specific limits, were inconsistently aware of the restriction details, and did not communicate or record intake amounts across shifts, resulting in a lack of compliance with the care plan and physician orders.
A resident's personal refrigerator contained unlabeled and undated food items brought by family, and the temperature log was not updated as required. The DON confirmed that food should be labeled and dated, and that the temperature log should be maintained daily, in accordance with facility policy.
A resident fell off the bed while receiving incontinence care, and the facility failed to report the incident to the State Survey Agency within the required 24-hour timeframe. The resident, with a history of Major Depressive Disorder and Epilepsy, was assessed and sent to the hospital due to being on blood thinners. The Administrator misunderstood the reporting timeframe, leading to the deficiency.
A resident, dependent on two staff for assistance, fell off the bed during incontinent care when a CNA failed to follow the care plan requiring two-person assistance. The resident, with a history of major depressive disorder and epilepsy, was on blood thinners and was sent to the ER for evaluation. The facility's policy on assistive devices was not followed.
The facility did not ensure a safe and sanitary environment in four resident hallways, as surveyors observed dirty ceiling tiles and rusted air vents in multiple locations. The Maintenance Director confirmed these issues were due to uncleaned air ducts and lack of maintenance prioritization, while the Administrator was unaware of the problems and reported no related work orders.
The facility failed to accurately document treatment administration records for seven residents, leading to incomplete TARs. Despite staff assertions that wound care was performed, the TARs were not initialed on specific dates, indicating a lack of proper documentation. The DON and Administrator acknowledged the issue as human error, emphasizing the importance of completing TARs to ensure physician orders are followed.
A resident with a surgical wound on the right ankle did not receive wound care according to professional standards. LVN C failed to label and date the wound dressing and did not follow the physician's order for treatment, using normal saline and kerlix instead of the prescribed Medi-honey and alginate. This was confirmed through observations and interviews with the resident, RN A, and LVN C.
A facility failed to implement its infection control program by not placing a sign on a resident's door indicating the need for enhanced barrier precautions. The resident, with a surgical wound and colonized urine, required these precautions, but the absence of signage meant the necessary precautions were not visibly communicated to staff. Interviews confirmed the oversight, which was against the facility's policy, potentially increasing infection risk.
The facility failed to ensure proper storage of medications in two medication carts. An expired bottle of Healthy Eyes Mineral Supplement was found in one cart, and a loose pill identified as Gabapentin was found in another. Staff acknowledged their responsibility to check for expired and loose medications, and the facility's policy requires proper storage and removal of expired medications.
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards. During puree meal preparation, a cook did not allow processor parts to air dry after washing, causing liquid to drip onto surfaces. The Dietary Manager confirmed the need for air drying, but the cook was pressed for time and improperly trained. The Administrator was unaware of the requirement, despite the facility's policy stating the necessity of air drying to prevent cross-contamination.
Failure to Follow Food Procurement and Handling Standards
Penalty
Summary
The facility failed to procure food from sources that are approved or considered satisfactory and did not store, prepare, distribute, and serve food in accordance with professional standards. This deficiency was identified during the survey process, indicating that the facility did not meet regulatory requirements for food safety and handling. No additional details about specific residents, staff, or events are provided in the report.
Failure to Implement Infection Prevention and Control Program
Penalty
Summary
The facility failed to provide and implement an infection prevention and control program. This deficiency was identified during the survey process, indicating that the required measures to prevent and control infections were not established or maintained as per regulatory standards. The report notes the absence of a comprehensive infection prevention and control program but does not provide further details regarding specific actions, inactions, or events, nor does it mention any particular residents or staff involved.
Environmental Deficiencies in Resident Hallways and Shower Rooms
Penalty
Summary
Surveyors observed that the facility failed to maintain a safe, functional, sanitary, and comfortable environment in multiple areas, specifically in two resident hallways and two shower rooms. During walkthroughs with the Administrator and Maintenance Director, several deficiencies were identified, including bathroom ceiling vents covered with dust in multiple rooms, a non-functioning bathroom light bulb, missing floor molding near a bathroom entrance, and a bedroom side wall light that would not turn on. In the shower rooms, additional issues were found such as dust-covered ceiling vents, a rusted sprinkler head base cover, and multiple non-functioning light bulbs. Interviews with the Maintenance Director revealed that no work orders had been received for the identified repairs in the resident rooms and shower rooms. Both the Maintenance Director and Administrator acknowledged that completing these repairs would contribute to a more homelike environment for residents. A review of the facility's maintenance policy indicated that the Maintenance Department is responsible for ensuring all areas of the building, grounds, and equipment are maintained in a safe and operable manner at all times.
Failure to Implement and Document Pressure Ulcer Repositioning Schedule
Penalty
Summary
A resident with significant cognitive decline and multiple unstageable pressure ulcers, including a deep tissue injury, did not receive the necessary treatment and services to promote healing and prevent new ulcers. The resident's comprehensive care plan required extensive assistance from one to two staff members to turn and reposition her in bed every two hours and as necessary. However, review of the scheduled tasks and treatment record for the relevant month did not show documentation of repositioning. Observations on a single day revealed the resident remained in the same position for at least four hours, with no evidence of repositioning. Interviews with staff indicated a lack of clarity and consistency regarding the documentation and oversight of repositioning. A CNA acknowledged the resident required repositioning every two hours but was unsure where to document this intervention. An RN stated that CNAs were responsible for repositioning and that she had communicated this expectation, while the DON confirmed that staff were expected to follow the turning schedule, but the medical record did not have a designated place for documentation. The facility's policy required interventions to be documented in the care plan and communicated to staff, with compliance documented in weekly summary charting.
Failure to Monitor and Document Fluid Restriction for Resident with Heart Failure
Penalty
Summary
The facility failed to provide adequate nutritional and hydration care for a male resident with chronic diastolic heart failure who was under a physician-ordered fluid restriction of 1500mL per day, divided between nursing and dietary services. Despite clear care plan interventions and physician orders specifying the fluid restriction and the need to document non-compliance and notify the physician, there was no documentation of the resident's fluid intake in the progress notes for several months. During observation, a CNA provided the resident with two glasses of water totaling 480mL at one meal, and staff interviews revealed inconsistent awareness and understanding of the fluid restriction details. Some CNAs and nurses were unsure of the specific limits or how to track cumulative intake, and there was no consistent communication of intake amounts during shift reports. The resident reported that staff reminded him to limit his intake but did not specifically monitor or ask about the amount he consumed. Staff interviews further indicated that fluid intake was not systematically tracked or communicated across shifts, and there was uncertainty among staff about how to determine if the resident exceeded his daily fluid limit. The facility's policy required care to be provided according to professional standards and the resident's care plan, but these standards were not met in the monitoring and documentation of the resident's fluid intake.
Failure to Label and Date Resident Food Brought by Family
Penalty
Summary
The facility failed to implement its policy regarding the use and storage of foods brought in by family and visitors for residents. During an observation, a personal refrigerator in a resident's room contained ham in an unlabeled and undated clear plastic bag, as well as green salsa in three small, clear, unlabeled, and undated containers. The temperature log for the refrigerator had not been updated for several days. The Director of Nursing (DON) confirmed that food in resident refrigerators should be labeled and dated, and that the temperature log should be filled out daily. The DON also stated she was responsible for checking the refrigerator and updating the log. Record review showed that the facility's policy required all food brought by family or visitors and left with residents to be labeled and stored in a manner distinguishable from facility-prepared food, and that perishable foods should be discarded by the nursing staff on or before the expiration date. The policy also required all foods stored in refrigerators or freezers to be covered, labeled, and dated. The failure to follow these policies was observed for a resident with dementia, muscle wasting, and Type 2 Diabetes Mellitus, who required supervision with eating and maximal assistance with dressing and transfers.
Failure to Timely Report Alleged Abuse Incident
Penalty
Summary
The facility failed to report an alleged violation involving abuse, neglect, exploitation, or mistreatment within the required 24-hour timeframe to the State Survey Agency. This deficiency was identified in the case of a resident who fell off the bed while receiving incontinence care from a CNA. The incident occurred when the CNA was turning the resident on her left side, resulting in the resident falling to the floor. The resident, who had a history of Major Depressive Disorder and Epilepsy, was assessed by an LVN and sent to the hospital for evaluation due to being on blood thinners. The Director of Nursing (DON) and the Administrator were interviewed regarding the incident. The DON stated that the Administrator was responsible for reporting such allegations to the State Survey Agency, but there was a misunderstanding about the reporting timeframe. The Administrator admitted to not reporting the fall because it was witnessed by a staff member, but later acknowledged that the fall should have been reported within two hours according to the abuse guidelines from the Health and Human Services Commission (HHSC). The facility's policy on abuse, neglect, and exploitation required reporting all alleged violations within specified timeframes, which was not adhered to in this case.
Failure to Provide Adequate Supervision and Assistive Devices
Penalty
Summary
The facility failed to ensure adequate supervision and use of assistive devices for a resident, leading to an accident. A resident, who was dependent on two staff members for assistance with activities of daily living, fell off the bed during incontinent care provided by a CNA. The CNA was aware that the resident required two-person assistance but forgot to follow the care plan, resulting in the resident falling and being sent to the emergency room for evaluation. The resident, who had a history of major depressive disorder and epilepsy, was on blood thinners, which necessitated a precautionary hospital evaluation after the fall. The incident was reported by the CNA, and the resident was assessed for injuries by an LVN before being sent to the hospital. The facility's policy required the use of assistive devices and equipment based on comprehensive assessments documented in the resident's plan of care, which was not adhered to in this instance.
Failure to Maintain Clean and Safe Environment in Resident Hallways
Penalty
Summary
The facility failed to maintain a safe, functional, sanitary, and comfortable environment for residents, staff, and the public in four out of five resident hallways. Observations revealed dirty ceiling tiles and rusted air vents in multiple locations, including across from storage rooms, nurse stations, therapy rooms, and resident rooms on hallways 100, 200, 400, and 500. These environmental concerns were consistently noted during early morning rounds and during a walkthrough with the Maintenance Director. Interviews with the Maintenance Director confirmed that the dirty ceiling tiles were due to dirt from air ducts that had not been cleaned in several years, and that the rusted vents required cleaning or repainting. The Maintenance Director acknowledged responsibility for these tasks but stated they had not been prioritized. The Administrator was unaware of the issues and reported no pending work orders related to ceiling tiles or vents. Facility policy requires the Maintenance Department to keep the building in good repair and free from hazards at all times.
Deficient Documentation of Treatment Administration Records
Penalty
Summary
The facility failed to maintain clinical records in accordance with accepted professional standards and practices, specifically in the documentation of treatment administration records (TAR) for seven out of eight residents reviewed. The TARs for these residents did not reflect accurate documentation of the administration of treatment orders. This deficiency was identified through interviews and record reviews, which revealed that the TARs were not initialed off on specific dates, indicating a lack of proper documentation of wound care treatments. For instance, Resident #1, a male with multiple diagnoses including Parkinsonism and diabetes, had several pressure ulcers requiring specific wound care treatments. However, the TAR for these treatments was not initialed on a particular date, despite the treatment nurse's assertion that she completed the wound care. Similar issues were found with other residents, such as Resident #2, who had a surgical wound and reported receiving daily wound care, yet the TAR was not initialed on multiple dates. Interviews with staff, including the treatment nurse and LVN, confirmed that wound care was performed, but the documentation was incomplete. The Director of Nursing (DON) and the Administrator acknowledged the issue, attributing it to human error and emphasizing the importance of completing the TARs to ensure physician orders are followed for the residents' wellbeing. The facility's policy on wound care documentation requires the name and title of the individual performing the wound care to be recorded in the resident's medical record, which was not consistently adhered to in these cases.
Failure to Follow Wound Care Protocols
Penalty
Summary
The facility failed to ensure that a resident received wound care treatment in accordance with professional standards of practice. Specifically, LVN C did not label and date the resident's wound dressing after completing wound care on two occasions. Additionally, LVN C did not follow the physician's order for the resident's wound treatment, as she did not use the prescribed Medi-honey and alginate dressing but instead used normal saline and kerlix. This oversight was confirmed during interviews with the resident, RN A, and LVN C, and was observed during a wound treatment session where the dressing was found without a date or initials. The resident involved was an elderly female with a history of metabolic encephalopathy, type 2 diabetes, a displaced avulsion fracture of the right talus, bipolar disorder, and dementia. Her quarterly MDS assessment indicated no cognitive impairment, and she required staff assistance for various activities. The resident had a surgical wound on her right ankle, which was being monitored for signs of infection. The facility's policy required wound dressings to be dated and initialed, and the physician's order specified a particular treatment regimen, which was not followed by LVN C, potentially placing the resident at risk for inadequate treatment and worsening of the wound.
Failure to Implement Enhanced Barrier Precautions
Penalty
Summary
The facility failed to maintain an infection control program by not ensuring that enhanced barrier precaution procedures were followed for a resident. Specifically, Resident #2, who required enhanced barrier precautions due to a surgical wound and colonized urine, did not have a sign on her room door indicating these precautions, as per the facility's policy. This oversight was observed during a survey when staff members were seen donning personal protective equipment (PPE) before entering the resident's room, despite the absence of the required signage. Resident #2, a female with multiple diagnoses including metabolic encephalopathy, type 2 diabetes, and dementia, was on enhanced barrier precautions due to a surgical wound and colonized urine. Her care plan and physician orders specified the need for these precautions, which included wearing gowns and gloves during high-contact activities. However, the lack of a sign on her door meant that the necessary precautions were not visibly communicated to all staff, potentially increasing the risk of infection spread. Interviews with staff, including RN A, CNA B, and the facility's Infection Preventionist, confirmed that the absence of the sign was contrary to the facility's policy. The staff acknowledged the importance of the signage in preventing infection transmission. The Director of Nursing (DON) also confirmed that the facility had educated staff on the use of signs for enhanced barrier precautions, but an audit revealed that three residents, including Resident #2, did not have the required signage on their doors.
Improper Storage of Medications
Penalty
Summary
The facility failed to ensure that drugs and biologicals were stored properly in two of six medication carts. An expired bottle of Healthy Eyes Mineral Supplement with Lutein and Antioxidants was found in the drawer of the 400-hall medication cart. The expiration date on the bottle was observed to be 2/2024. The CMA responsible for the cart admitted to placing the expired bottle in the drawer with the intention to remove it later but failed to do so. The DON confirmed that it was the responsibility of the nursing staff and CMAs to ensure medications on the cart were within date and removed when expired. The facility's policy requires that medications and biologicals be stored in the packaging or containers in which they are received and that expired medications be removed and destroyed as per the dispensing pharmacy's instructions. Additionally, a loose pill was found in the medication cart assigned to hall 100. The RN responsible for the cart was unsure how the loose pill ended up in the drawer but acknowledged it was her responsibility to check for loose medications. The DON identified the loose pill as Gabapentin and took it for destruction. The facility's policy mandates that medications be stored in an orderly manner to prevent mixing and that nursing staff maintain medication storage areas in a clean, safe, and sanitary manner. The DON and ADM both emphasized that staff were trained on proper medication storage and that their expectation was for staff to monitor and remove expired or loose medications daily.
Improper Food Handling Procedures
Penalty
Summary
The facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety. During an observation of puree meal preparation, Cook A was seen cleaning the processor bowl, lid, and blade in a 3-compartment sink and then reassembling them while they were still wet, causing liquid to drip onto the floor and countertop. This process was repeated multiple times for different food items, including garlic bread sticks, spaghetti, and vegetables. Cook A admitted to not being trained on allowing the puree processor parts to air dry before use until the day before the interview and was unsure of the reasons behind this requirement, despite having completed her safe serve certificate. The Dietary Manager (DM) confirmed that all items washed in the 3-compartment sink needed to air dry before use and acknowledged that the cook was pressed for time, which led to the improper procedure. The DM also mentioned that all staff were trained during orientation. The Administrator (ADM) was unaware of the need for items washed in the 3-compartment sink to air dry before use and stated that the DM was responsible for training all staff. The facility's policy on sanitization, revised in November 2022, clearly stated that food preparation equipment and utensils that are manually washed should be allowed to air dry whenever practical to avoid cross-contamination. The failure to adhere to this policy could place residents at risk for food contamination and foodborne illness.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near San Antonio
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Las Colinas Of Westover | 1.8 mi | ★★★★★ | 18 | 0 |
| Windemere At Westover Hills | 1.9 mi | ★★★★★ | 6 | 0 |
| Mystic Park Nursing & Rehabilitation Center | 2.7 mi | ★★★★★ | 11 | 0 |
| Westover Hills Rehabilitation And Healthcare | 2.9 mi | ★★★★★ | 6 | 0 |
| Lakeside Nursing And Rehabilitation Center | 3.7 mi | ★★★★★ | 0 | 0 |
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