Health inspection·June 6, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. Based on and biologicals were stored properly for 2 of 6 medication carts (400 hall medication cart, 100 hall nurse medication cart). 1. An expired bottle of medication was stored in the drawer of the 400-hall medication cart . 2. The medication cart assigned to hall 100 had a loose pill. This failure could place residents at risk of not receiving prescribed medications as ordered, receiving medications that were less effective or have altered composition, and drug diversions. The findings included : 1. During an observation on 06/05/24 at 9:37 AM of the medication cart for hall 400 with CMA A, an expired bottle of Healthy Eyes Mineral Supplement with Lutein and Antioxidants was found in the cart drawer. The expiration date on the bottle was observed to be 2/2024. CMA A removed the expired medication bottle from the cart and stated it would be given to the DON for destruction. During an interview on 06/05/24 at 02:48 PM with CMA A, he stated there should not be expired medications on the cart. He stated he put the expired bottle of medication in the bottom cart drawer with the intention to remove it from the cart but failed to do so. He stated it was the responsibility of the nursing staff and CMA's to ensure medications on the cart were within date and removed when out of date. He stated he has been trained by the facility DON to monitor the expiration dates for medications on the cart. He stated a potential negative outcome of expired medications on the cart was that the medications could be administered and cause harm to a resident. During an interview on 06/06/24 at 10:30 AM, the DON stated it was the responsibility of the CMA's and nursing staff to ensure expired medications were removed from the medication cart. He stated the staff were trained annually and as needed on proper storage of medications. He stated his expectation of staff was to stay on top of cart checks and monitor for expired medications daily. The DON stated the nurse auditor, pharmacy consultant, and the weekend supervisor each conduct cart audits monthly. He stated a potential negative outcome of expired medications on the cart was that an expired medication could be administered to a resident. During an interview on 06/06/24 at 11:20 AM, the ADM stated there should not be any expired medications stored on the cart. She stated staff were trained on proper medication storage by the DON. The ADM stated her expectation of staff was that all medications were properly labeled and expired (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 4 Event ID: 455652 Printed: 05/15/2026 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 455652 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Creek Nursing and Rehabilitation 9014 Timber Path San Antonio, TX 78250 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)