Inspection·April 24, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to develop and implement a comprehensive person-centered care plan for 2 of 25 sampled residents to meet the residents nursing needs that are identified in the comprehensive assessment. (Resident #31 & #2) The findings include: Resident #31 On 04/21/25 at approximately 11:05 AM, Resident #31 was seen sitting in his wheelchair wearing a cardiac Life Vest (The LifeVest is a wearable cardiovascular defibrillator designed to protect individuals at risk of sudden cardiac death). A record review for Resident #31 revealed no orders for the cardiac Life Vest, and no mention of the cardiac Life Vest in the cardiac care plan. (photographic evidence obtained) On 04/23/25 at approximately 03:25 PM, an interview the Director of Nursing (DON) was conducted. The DON was asked what documentation is expected from nursing for a resident with a cardiac Life Vest. The DON stated there should be a cardiac care plan that would include the cardiac Life Vest. However, when shown that the cardiac care plan for Resident #31 did not contain language regarding the cardiac Life Vest, the DON stated, It should have been in the care plan. Resident #2 On 4/22/2025, a record review was conducted for Resident #2. The record indicated that Resident #2 was hospitalized on [DATE]-[DATE] with acute chronic respiratory infection. The physicians' orders included an order for Cefdinir Oral Capsule 300 MG (an antibiotic), give 300 mg by mouth two times a day for infection, ordered 3/28/25 and stopped 4/23/25. The care plan for Resident #2 did not include infection or antibiotic use. A review of Resident #2's diagnosis list included, ACUTE RESPIRATORY FAILURE WITH HYPOXIA and PNEUMONIA DUE TO METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS. The quarterly minimum data set (MDS) were positive for Infections (Pneumonia) and antibiotic use. On 04/23/25 at approximately 02:16 PM, an interview with Staff E, a registered nurse (RN)/MDS coordinator, was conducted about Resident #2's infection and if there should be a care plan for infection/antibiotic use. The RN/MDS coordinator stated Resident #2 has been in and out of the hospital (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 5 Event ID: 105612 Printed: 05/28/2026 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 105612 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silvercrest Health and Rehabilitation Center 910 Brookmeade Drive Crestview, FL 32539 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)