Silver Healthcare Center

Inspectors wroteComplaint #: 2734069 Based on interviews, record reviews, and review of facility documents, it was determined that the facility failed to provide adequate monitoring and supervision to prevent a fall that caused a skin tear, facial bruising, and admission to the hospital for subdural hematoma (collection of blood in the tissues of the body outside of the blood vessels) to a resident who was assessed as a high risk for falls, had two previous falls in the facility, and was on one-to-one monitoring. This deficient practice occurred for 1 of 4 residents (Resident #2) reviewed for accidents. This deficient practice was evidenced by the following:Resident #2 no longer resided at the facility. A closed record review was conducted. A review of the admission Record revealed that Resident #2 was admitted to the facility with diagnoses including but not limited to: [...]

Inspectors wroteBased on interviews, and review of pertinent facility documents on 10/29/25, it was determined that the facility failed to provide adequate supervision for a cognitively impaired resident (Resident #2) with documented history of exit seeking behaviors; and who eloped from the facility on 10/16/2025. The deficient practice was identified for 1 of 5 residents reviewed (Resident #2). Review of facility document dated 10/16/2025 titled Incident-Elopement-Reference #2645660 revealed that on 10/16/2025 at approximately 10:20 a.m., staff went to invite the resident to join an activity program and noticed the resident was not in their room. Review of multiple staff statements revealed that staff saw Resident #2 pacing around the unit and hallways earlier in the morning prior to their elopement. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to maintain kitchen equipment in a clean and sanitary manner as evidenced by the following: On 6/5/25 at 9:35 AM, in the presence of the Food Service Director (FSD), the surveyor observed the following: 1. The microwave had multicolored dried stuck on debris on the interior ceiling of the unit. The FSD acknowledge it was not properly cleaned according to facility policy. 2. Two of two upper and lower convection ovens were soiled with baked on brown coloring on the glass doors making them opaque and not transparent. There were baked on debris on the interior corners of the units. The FSD acknowledged and stated, it was not cleaned according to facility policy. 3. The steamer unit had brown and crusted debris on the interior door and seal of door. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to ensure that oxygen was administered in accordance with a physician's order. This deficient practice was identified for 1 of 2 residents (Resident #40) reviewed for respiratory care and was evidenced by the following: On 6/6/25 at 8:45 AM, the surveyor observed Resident #40 lying in bed with his/her eyes closed. Resident #40 had a tracheostomy tube [a surgical opening in the neck directly into the trachea (windpipe)] and a tracheostomy (trach) collar with oxygen tubing attached to an oxygen concentrator (a medical device that extracts and concentrates ambient air. The surveyor observed that the oxygen concentrator was set to three (3) liters. On 6/9/25 at 12:26 PM, the surveyor observed Resident #40 lying in bed with his/her eyes closed. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to ensure that medications were administered timely and in accordance with the medication's cautionary statement, manufacturer specifications, and physician's orders. This deficient practice was identified for 1 of 2 nurses who administered medications to 1 of 3 residents (Resident #55) on 1 of 5 nursing units (Court One) during the medication administration pass observation. This deficient practice was evidenced by the following: On 6/9/25 at 9:28 AM, the surveyor met with Licensed Practical Nurse (LPN) #1 who stated that she needed to obtain vital signs for Resident #55 prior to medication administration. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to maintain proper infection control practices during the medication administration pass observation. This deficient practice was identified for 1 of 2 nurses who administered medications to 2 of 3 residents (Resident #55 and Resident #123) on 1 of 5 nursing units (Court One) during the medication administration pass observation. This deficient practice was evidenced by the following: On 6/9/25 at 9:27 AM, the surveyor observed Licensed Practical Nurse (LPN) #1 sanitize her hands with alcohol based hand rub (ABHR) and donn (put on) gloves before she placed an automated blood pressure cuff on Resident #55's left upper extremity. [...]

Inspectors wroteBased on interview, record review, and review of facility documents, it was determined that the facility failed to ensure that all Drug Enforcement Administration (DEA) 222 forms were completed with sufficient detail to enable accurate accountability and reconciliation for controlled medications. This deficient practice was identified for 6 of 6 DEA 222 forms reviewed in 1 of 1 back up controlled medication storage area and was evidenced by the following: On 12/17/24 at 1:01 PM, the surveyor reviewed the facility's DEA-222 records for the back up controlled medication storage and noted that on 8/15/24, 9/4/24, 9/30/24, 11/1/24, 11/27/24, and 12/16/24, Part 5 of the forms that were required to be filled in by the purchaser failed to include the number of controlled medications received by the facility and the date that they were received. [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to: a.) follow a physician's order and b.) adhere to professional standards of nursing practice during the medication administration observation. This deficient practice was identified for 2 of 2 nurses who administered medications to 2 residents (Residents #34 and #49) on 2 of 4 nursing units (Court 1 and Court 2) and was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on observation, interview, record review, and review of facility documents, it was determined that the facility failed to adhere to proper infection control practices during the medication administration observation. This deficient practice was identified for 1 of 2 nurses on 1 of 2 units (Court Two) observed for medication administration and was evidenced by the following: On 12/17/24 at 8:59 AM, the surveyor observed Licensed Practical Nurse (LPN) #1 as she prepared medications for Resident #33. LPN #1 donned (applied) gloves and obtained the resident's blood pressure (BP). LPN #1 then doffed (removed) her gloves before she returned to the computer to review the resident's physcians orders (PO) before she administered the medications to the resident. LPN #1 then proceeded to wash her hands for 15 seconds. LPN #1 stated that there was no paper towels available to dry her hands. [...]

Inspectors wroteBased on observation, interview, and review of other pertinent facility documents, it was determined that the facility failed to handle potentially hazardous foods and maintain sanitation in a safe and consistent manner to prevent food borne illness. This deficient practice was evidenced by the following: On 05/29/2024 from 09:32 to 10:06 AM, the surveyor, accompanied by the interim Food Service Director (FSD) observed the following in the kitchen: 1. In the dry storage area of the kitchen on a middle shelf an opened bag of rainbow pasta had no open or use by date. The bag had a hole in it and was exposed to contamination. The FSD removed the pasta from the dry storage. 2. In the rear of the walk-in freezer an opened box of frozen pancakes and an opened box of frozen French Toast slices were placed on top of milk crates. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documents, it was determined that the facility failed to keep all areas clean and safe. The deficient practice was identified on 4 of 4 Units (Court 1, Court 2, Pavilion, and Vent). The deficient practice was evidenced by the following: On 05/29/2024 at 10:37 AM during the initial tour of the facility on Court 1, the surveyor visited Resident # 5 in their room. At that time, the surveyor observed a trash receptacle. There was not a bag liner in the receptacle. On the other side of the room, a clear trash bag was left on the floor. There was various items of trash within the bag. On the same date at 10:48 AM during the initial tour of the facility on Court 1, surveyor # 1 visited Resident # 24 in their room. At that time, the surveyor observed food debris such as crumbs on the floor. The surveyor also observed the bathroom. [...]

Inspectors wroteRepeat deficiency from the recertification survey of 12/12/2023. Based on observation, interview, review of the medical record and review of other facility documentation, it was determined that the facility failed to develop a comprehensive resident centered care plan for 2 of 35 sampled residents (Resident #28 and Resident #116). This deficient practice was evidenced by the following: 1. During the initial tour on 05/29/2024 at 11:07 AM, Resident #28 was observed lying in bed with the head of the bed elevated. Resident #28 had a tracheostomy (trach) (an incision in the windpipe made to relieve an obstruction to breathing) to the ventilator (a machine or device used medically to support or replace the breathing of a person who is ill, injured, or anesthetized). A review of the admission Record revealed Resident #28 was admitted to the facility with diagnoses including but not limited to: [...]

Inspectors wroteBased on observations, interviews, and review of pertinent facility documents, it was determined that the facility failed to promote resident dignity and ensure a safe, clean, comfortable, homelike, environment when a resident was transferred into a private room without a functional bathroom or accessible handwashing sink. This deficient practice was identified on 1 of 4 Units (Pavilion) and for 1 of 1 resident (Resident #37) observed for accommodation of needs. This deficient practice was evidenced by the following: On 05/29/2024 at 10:07 AM, the surveyor entered Resident #37's room and noted that the room smelled of dampness and the resident's bathroom had a sign posted on the door that depicted a toilet and the door was bolted shut from the outside. The resident was not in the room at the time of the observation. The surveyor observed Maintenance outside of the room in the hallway. [...]

Inspectors wroteBased on observation, interviews, review of medical records and other facility documentation, it was determined that the facility failed to follow physician's orders following hospitalization to ensure that a resident who was readmitted to the facility with a closed fracture of the fourth metacarpal bone (the bones that form the intermediate part of the hand between the fingers and wrist bones) was scheduled for a follow-up appointment with an Orthopedic Surgeon (treats muscoskeletal injuries) and resident usage of a prescribed splint. This deficient practice was identified for 1 of 1 resident (Resident #108) reviewed for a change in condition. This deficient practice was evidenced by the following: Reference: New Jersey Statutes Annotated, Title 45. Chapter 11. Nursing Board. The Nurse Practice Act for the State of New Jersey states: [...]

Inspectors wroteBased on observation, interview, record review, and review of pertinent facility documents, it was determined that the facility failed to ensure that a resident received appropriate care and sufficient services based upon current standards of practice for a urinary catheter. The deficient practice was identified for 1 of 1 residents (Resident # 64) investigated under the Urinary Catheter investigation. This deficient practice was evidenced by the following: On 05/29/2024 at 10:21 AM, during the initial tour of the facility, the surveyor observed Resident # 64 in bed in their room. At that time, the surveyor observed a catheter drainage bag (collection bag for urine from an indwelling catheter) inside a blue, privacy bag in contact with the floor. The catheter drainage bag plastic hook was not secured to the bed frame. [...]

Inspectors wroteBased on observations, interviews, review of medical records and other facility documentation, it was determined that the facility failed to ensure: a) continuous oxygen was administered to an oxygen dependent resident in accordance with physician's orders in a safe and sanitary manner b) residents who were dependent upon oxygen via a tracheostomy tube (a surgically created hole (stoma) in the windpipe (trachea), received oxygen in accordance with professional standards of practice, ensured respiratory equipment was properly dated and obtained a physician order for oxygen delivery. This deficient practice was identified for 2 of 4 residents (Resident #37 and Resident #33) reviewed for respiratory care. This deficient practice was evidenced by the following: 1. [...]

Inspectors wroteBased on observation, interview, and pertinent record review, it was determined that the facility failed to ensure the accountability of the narcotic Shift Count logs were completed in accordance with facility policy. This deficient practice was identified for 2 of 4 medication carts reviewed and was evidenced by the following: On 5/30/24 at 9:29 AM, the surveyor, in the presence of the Licensed Practical Nurse (LPN #1), reviewed the Pavilion nursing unit's medication cart #1 and the narcotic logbook for that cart. The following was observed: May 2024 Narcotic Book Shift to Shift Signature Sheet missing a nursing signature for 5/5 3-11 Out column and 5/30 pre-signed nursing signatures in the 7-3 Out and 3-11 In columns. [...]

Inspectors wroteBased on observation, interview, and review of pertinent facility documentation, it was determined that the facility failed to properly store and properly label opened multidose medications. This deficient practice was identified in 1 of 4 medication carts and 1 of 2 medication storage rooms reviewed for medication storage and labeling and was evidenced by the following: On 5/30/24 at 10:51 AM, the surveyor, in the presence of Licensed Practical Nurse (LPN #2), observed the Vent nursing unit's medication cart #2. The following was observed: Three (3) opened prescription fluticasone propionate nasal spray bottles (medication used to treat seasonal allergies), which were not dated with opened date or labeled with resident identifying information on the medication container. [...]

Inspectors wroteBased on observation, interview, and record review, it was determined that the facility failed to a) adhere to accepted standards of infection control practices for the proper storage of respiratory tubing after use, and b) perform proper hand hygiene during respiratory care treatment. This deficient practice was observed for 2 of 4 residents (Resident #33 and Resident #42) reviewed for respiratory care. This deficient practice was evidenced by the following: a.) During the initial tour of the facility on 05/29/2024 at 10:07 AM, the Surveyor #1 observed Resident #33 in his/her bedroom, lying in bed. Surveyor #1 observed a portable suction machine on the bedside table with tubing leading to the bottom drawer of the table. The suction catheter (Yankauer) used to orally suction secretions from the mouth, was found lying exposed, open to air, touching the contents of the drawer. [...]

Inspectors wroteBased on interview and record review, it was determined that the facility failed to ensure that the pneumococcal vaccination was offered to all residents upon admission to the facility to prevent incidence of pneumonia for 1 of 5 residents (Resident #100) reviewed for immunization administration. This deficient practice was evidenced by the following: On 05/29/2024 at 10:44 AM, during the initial tour of the facility, the surveyor observed Resident #100 lying in bed with stitches noted over their left eyebrow. When interviewed, the resident was unable to state how the injury occurred. A review of Resident #100's admission record revealed that the resident was admitted to the facility with diagnosis which included but were not limited to: Alzheimer's Disease, unspecified, altered mental status, unspecified, and a personal history of COVID-19. [...]

Inspectors wroteBased on interview, and review of other facility documentation, it was determined that the facility failed to notify CMS (Centers for Medicare & Medicaid Services) and apply for a change in name to include Doing Business As in accordance with 42 CFR (Code of Federal Regulations) 424.516. This deficient practice was evidenced by the following: According to 42 CFR 424.516 Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare Program: (a) Certifying compliance. CMS enrolls and maintains an active enrollment status for a provider or supplier when that provider or supplier certifies that it meets, and continues to meet, and CMS verifies that it meets, and continues to meet, all of the following requirements: (1) Compliance with title XVIII of the Act and applicable Medicare regulations. [...]

Inspectors wroteBased observation, interview, and pertinent facility documents it was determined that the facility failed to maintain services necessary to maintain a sanitary, orderly, and comfortable interior specifically by but not limited to leaving stains on the floor and wall, wrappers, and a soiled brief in a resident bathroom. The deficient practice was observed for 1 of 3 residents (Resident #48) during the Environmental Task. The deficient practice was evidenced by the following: On 11/28/2023 at 10:45 AM during the initial tour of the facility, the surveyor observed the bathroom in Resident 48's room. At that time, the surveyor observed a brown substance on the floor adjacent to the toilet. On 11/29/2023 at 10:38 AM, the surveyor observed the bathroom in Resident 48's room. At that time, the surveyor observed a brown substance on the floor adjacent to the toilet. [...]