Silver Stream Rehabilitation and Nursing Center

Inspectors wroteBased on review of facility policy, review of facility documentation, review of clinical records, and staff interviews it was determined that the facility failed to ensure a complete and thorough investigation was completed related to neglect allegations for two out of 3 residents reviewed (Resident R2 and Resident R3).

Inspectors wroteBased on observations and staff interviews it was determined that the facility failed to provide a clean, safe, comfortable and homelike environment on 1 of the 2 Nursing Units observed (2nd floor Nursing Unit).

Inspectors wroteBased on review of clinical records and staff interviews, it was determined that the facility failed to provide appropriate pain management services for one of two residents reviewed for pain management (Resident R1).

Inspectors wroteBased on staff interviews and the review of clinical records, it was determined the facility failed to conduct a complete and through investigation for an allegation of abuse for 1 out of 3 residents reviewed (Resident R1).

Inspectors wroteBased on interviews and the review of clinical records, it was determined that the facility failed to ensure that 1 resident (Resident R2) with an allegation of inappropriately touching a cognitively impaired resident (Resident R1) was properly supervised for 1 out of 3 residents reviewed.

Inspectors wroteBased on clinical record review and interviews with staff it was determined that the facility did not ensure that the resident was provided needed care and services related to turning and repositioning for one of ten residents reviewed (Resident R2).

Inspectors wroteBased on observation, staff and resident interviews, it was determined that the facility failed to ensure that call bells were available and operable for resident use for one of nine residents interviewed. (Residents R7)

Inspectors wroteBased on observations and resident interviews, it was determined that the facility failed to maintain the facility in a clean, comfortable and homelike condition for three of 22 residents reviewed (Resident R1, R55, R56).

Inspectors wroteBased on interviews and the review of clinical records, it was determined that the facility failed to ensure that a complete and through investigation was completed to rule out neglect for 1 out of 22 residents reviewed (Resident R8).

Inspectors wroteBased on review of clinical records, review of facility policy and interview with residents, it was determined that the facility failed to develop a person-centered resident care plan for one of twenty-two residents reviewed (Resident R77) Findings Include: Review of facility policy on care plans comprehensive persons-centered dated December 2016 Under section policy statement a comprehensive present-centered care plan that includes measurable goals and timetables must meet the residents physical psychological and functional needs is developed and implemented for each resident. [...]

Inspectors wroteBased on interviews, and reviews of clinical records, facility documentation and employee records, the facility failed to ensure that staff assigned to supervise residents during dining and provided cardio-pulmonary resuscitation (CPR) to a resident who was choking were certified in cardio-pulmonary resuscitation (CPR). One of 22 residents reviewed. Findings Include:Review of facility policy Cardiopulmonary Resuscitation (CPR) dated 2025, revealed that Personnel have completed training on the initiation of cardiopulmonary resuscitation (CPR) and basic life support (BLS), including defibrillation, for victims of sudden cardiac arrest. Obtain and/or maintain American Red ' Cross or American Heart Association certification in Basic Life Support (BLS)/ Cardiopulmonary Resuscitation (CPR) for key clinical staff members who will direct resuscitative efforts. [...]

Inspectors wroteBased on review of facility policies, clinical record review and interviews with staff, it was determined that the facility failed to follow the physician orders related to Medication Administration for one of 23 residents reviewed (Resident R53) Review facility policy on administering medications dated December 2012 reveal that under section policy statement medication shall be administered in a safe and timely manner and as prescribed. [...]

Inspectors wroteBased on the review of clinical records, it interviews with staff, it was determined that the facility failed to prevent accident hazards for 1 out of 22 residents reviewed (Resident R8).

Inspectors wroteBased on interviews and the review of facility documentation, it was determined that the facility failed to ensure that a resident's significant weight loss was addressed in a timely manner for 1 out of 22 residents reviewed (Resident R6).

Inspectors wroteBased on review of facility policy and clinical records, resident and staff interviews, it was determined that the facility failed to offer routine dental services for one of 22 residents reviewed (Resident R74).

Inspectors wroteBased on observations and an interview with staff it was determined that the facility did not ensure that garbage and refuse was disposed of properly.

Inspectors wroteBased on the review of facility documentation, clinical records and staff and resident interviews, it was determined that the facility failed to provide necessary pharmaceutical services for one of five residents reviewed. (Resident R1).

Inspectors wroteBased on clinical record reviews, interviews with staff and hospital record and policy and procedure review, it was determined that the facility failed to ensure that breathing treatments were prescribed upon admission and that medications were administered as order by the physician for one of fourteen residents reviewed. (Resident R1)

Inspectors wroteBased on observations of the Food and Nutrition Services Department, interviews with residents and staff, reviews of clinical records and policies and procedures, it was determined that essential pieces of food service equipment used for the transportation, holding and delivery of hot foods from the dietary services department to the nursing units, resident rooms and dinning areas were not in use, to ensure consistently safe and satisfactory food temperatures of foods for the residents. (Residents R11, R57, R56, R5, R55, R28, R64, R46, R37, R34, R41, R27, R14 and R19).

Inspectors wroteBased on review of facility financial and accounting documentation and interview with administrative staff, it was determined that the facility failed to demonstrate the maintenance of a complete, separate, and accurate accounting of each residents personal funds entrusted to the facility on the residence behalf for one of 24 residents reviewed (resident R28).

Inspectors wroteBased on observations, interviews with resident and staff, review of clinical records, and facility policy, it was determined that the facility failed to ensure one of 24 residents records reviewed were free from abuse/neglect (Residents 25).

Inspectors wroteBased on interviews with residents and staff, clinical record and and policy and procedure reviews, it was determined that the facility failed to evaluate each resident for their discharge needs upon admission and throughout the resident's stay to ensure a successful individualized discharge plan was implemented for three of seven residents reviewed. (Residents R11, R34 and R46)

Inspectors wroteBased on clinical record reviews, interviews with residents and staff, observations of care and services and policy and procedure reviews, it was determined that for one of three residents reviewed the facility failed to provide safe and comfortable adaptive equipment to ensure activities of daily living were maintained for mobility. (Resident R34)

Inspectors wroteBased on interviews with residents and staff, review of clinical records and facility documentation and policies it was determined that the facility failed to provide the necessary treatment for opioid addiction for two residents (Resident R56 and R61) in a timely manner which resulted in and/or a potential to cause the residents experiencing unwanted discomfort and withdrawal symptoms and failed to adequately assess a resident (Resident R61) in accordance with professional standards of practice and failed to inform the medical director when services were not rendered for two residents reviewed (Resident R56 and R61) and failed to properly assess and provide bowel care for one resident (Resident R81) of the 24 resident records reviewed.

Inspectors wroteBased on the review of facility documentation, clinical records, staff and resident interviews, it was determined that the facility failed to provide necessary pharmaceutical services for two of 24 residents reviewed. (Resident R56 andR61).

Inspectors wroteBased on clinical record review, interviews with staff and policy and procedure reviews, it was determined that the facility failed to use, monitor and assess one of six residents for continued psychotropic drug use. (Resident R88)

Inspectors wroteBased on review of clinical records, and staff and resident interviews, it was determined that the facility failed to ensure two residents were free from significant medication errors for 2 of 8 residents reviewed. (Residents R69 and R64)

Inspectors wroteBased on the review of facility policies, resident interviews, and interview with staff, it was determined that the facility failed to maintain proper infection control practices related to wound care for one of three residents reviewed for wound care. (Resident R47)

Inspectors wroteBased on a review of facility documentation, facility policies, Centers for Disease Control and Prevention (CDC) guidelines and staff interview, it was determined that the facility failed to maintain an effective antibiotic stewardship program that includes a system to effectively monitor antibiotic usage for four or four months of antibiotic stewardship program data reviewed. (August 2024, September 2024, October 2024, and November 2024)

Inspectors wroteBased on observations of the physical environment of the food and nutrition department, reviews of the pest control operators reports and interviews with staff, it was determined that the facility failed to maintain an effective pest control program so that the facility was free of common household pests and rodents.

Inspectors wroteBased on observations, interviews with staff, and a review of facility policies and documentation, it was determined that the facility did not ensure that food was stored, prepared, distributed, and served in accordance with professional standards for food service safety.

Inspectors wroteBased on observations and an interview with staff it was determined that the facility did not ensure that garbage and refuse was disposed of properly.

Inspectors wroteBased on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that there was sufficient nursing staff to complete residents' comprehensive and quarterly assessments in a timely manner. for eight of eight residents reviewed. (Resident R79, R59, R15, R3, R38, 6, R1 and R50) Findings Include: Refer to citation: 636, 638. Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a comprehensive assessment was completed every 12 months as required. Based on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a quarterly assessment was completed not less frequency than once every 3 months as required. [...]

Inspectors wroteBased on review of facility documentation and staff interview, it was determined that the facility failed to ensure that licensed nursing staff had the proper competencies including intravenous (IV) catheter care, trach care and total parenteral nutrition (TPN) administration care for six of six licensed nurse training records reviewed (E11, E13, E14, E15, E21 & E22).

Inspectors wroteBased on the review of facility policy, review of facility documentation and interview with staff, it was determined that the facility failed to establish an antibiotic stewardship program that included antibiotic use protocols and a system to monitor and track the antibiotic use for seven of nine months of antibiotic data requested for review (June, July, August, September, October, November and December, 2023). Finding Include: Review of facility policy Antibiotic Stewardship- Review and Surveillance of Antibiotic use and outcome dated December 2016, revealed that Antibiotic usage and outcome data will b collected and documented using a facility-approved antibiotic surveillance racking form. The data will be used to guide decisions for improvement of individual resident antibiotic prescribing practices and facility-wide antibiotic stewardship. [...]

Inspectors wroteBased on interviews with residents and staff, and review of clinical records, it was determined that the facility failed to ensure a resident had the right to be informed of their care plan meeting for one out of 21 residents reviewed (Resident R59).

Inspectors wroteBased on observations and resident interviews, it was determined that the facility failed to ensure that personal belongings were accounted for three of 21 residents reviewed (Resident R83, R58 and R60).

Inspectors wroteBased on staff interviews and review of the clinical record, it was determined that the facility failed to ensure that the physician was notified of a fall incident sustained by a resident for one out of 21 residents reviewed (Resident R89).

Inspectors wroteBased on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a comprehensive assessment was completed every 12 months as required for two of eight residents reviewed. (Resident R1 and R50) Findings Include: Review of clinical record for Resident R50 revealed that the resident had an admission MDS (Assessment of Resident Care Needs) assessment completed on January 27, 2023. Further review of the clinical record the revealed that the annual assessment was scheduled with an assessment reference date (ARD) of January 10, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 19, 2024. Review of clinical record for Resident R1 revealed that the resident had a modification admission MDS assessment completed on January 18, 2023. [...]

Inspectors wroteBased on the review of clinical records and interview with staff, it was determined that the facility failed to ensure that a quarterly assessment was completed not less frequency than once every 3 months as required for six of eight residents reviewed. (Resident R79, R59, R15, R3, R38, R6) Findings Include: Review of clinical record for Resident R79 revealed that the resident had an admission MDS (Assessment of Resident Care Needs) assessment completed on October 13, 2023. Further review of the clinical record the revealed that the quarterly assessment was scheduled with an assessment reference date (ARD) of January 10, 2024. Continued review of the clinical record revealed that the assessment was not completed until February 19, 2024. Review of clinical record for Resident R59 revealed that the resident had a quarterly MDS assessment completed on October 18, 2023. [...]

Inspectors wroteBased on staff interviews and the review of clinical records, it was determined that the facility failed to ensure that the State mental health authority and/or the State intellectual disability authority was notified of a significant change in resident's mental health status which required admission into a psychiatric facility for one out of 21 residents reviewed (Resident R48).

Inspectors wroteBased on observations, interviews, and the review of clinical records, it was determined that the facility failed to ensure that resident received activities of daily living care related to shaving and haircuts for 2 out of 21 residents reviewed (Resident R58 and R60).

Inspectors wroteBased on review of policies and clinical records, observations and resident and staff interviews, it was determined that the facility failed to ensure that foot care needs were provided timely for one of 48 residents reviewed (Resident 73).

Inspectors wroteBased on observations, interviews with staff and residents, review of clinical records and facility documentation, it was determined that the facility failed to ensure adequate supervision during medication administration for one out of 21 residents reviewed (Resident R59).

Inspectors wroteBased on observations, review of facility policies, clinical record review and interviews with residents and staff, it was determined that the facility failed to administer intravenous (IV) nutrition in accordance with physician orders and professional standards of practice for one of one resident reviewed on IV therapy (Resident R245).

Inspectors wroteBased on the review of clinical records, and interviews with staff, it was determined that the facility failed to ensure that pain management was provided consistent with physician orders for two of 21 residents reviewed. (Resident R89 and Resident R81)

Inspectors wroteBased on the review of facility documentation, clinical records, staff and resident interviews, it was determined that the facility failed to provide necessary pharmaceutical services for one of 21 residents reviewed. (Resident R89)

Inspectors wroteBased on observations and interview with staff, it was determined that the facility failed to store, label, and dispense drugs according to professional standards of practice for one of 28 resident medication observations. (Resident R15) Findings Include: During a medication administration observation on February 22, 2024, at 8:54 a.m. with Employee E24, Licensed Practical Nurse, for Resident R15. It was observed that staff took an unlabeled clear 30 ml medication cup from the cart. Inside the cup there were white colored tablets. Staff administered the medication to the resident. [...]

Inspectors wroteBased on interviews, review of facility's policy and the review of clinical records, it was determined that the facility failed to ensure that complete and accurate documentation for one out of 21 residents reviewed (Resident R89).

Inspectors wroteBased on a review of facility documentation and staff interview, it was determined that the facility failed to ensure its nurse aide staff was receiving in-service training to be proficient and competent and that the training be no less that 12 hours annually for two of six nurse aides reviewed (Employees E19 and E16). Findings Include: Review of the nurse aide annual training information provided for nurse aide Employee E19 during the survey revealed that there were only six hours of annual training documentation to review and did not meet the twelve hours of annual training requirement. Review of the nurse aide annual training information provided during the survey revealed that nurse aide Employee E16 had only eight hours of training documentation to review and did not meet the twelve hours of annual training requirement. [...]

Inspectors wroteBased on clinical record review, observations, and interviews with residents and staff, it was determined that the facility failed to ensure resident dignity for one out of seven residents reviewed (Resident R1).

Inspectors wroteBased on observation, clinical record review, review of facility policy and staff interview, it was determined that the facility failed to provide appropriate respiratory care and services for one of seven residents reviewed (Resident R1).

Inspectors wroteBased on observation, review of facility policy, clinical record review, review of facility records and documents and staff interview, it was determined that the facility failed to implement a system of records of receipt and disposition of all controlled drugs between shifts to enable an accurate reconciliation and accountability for four of four medication carts observed. (1st Floor front cart and back cart, Second Floor front cart and back cart)