Health inspection·March 19, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to ensure all alleged violations involving abuse, neglect, exploitation, or mistreatment, including injuries of unknown sources are reported not later than 24 hours to the administrator of the facility and to other officials, including to the State Survey Agency in accordance with State law through established procedures, for 1 of 3 Residents (Resident #1) reviewed for Abuse, in that: The facility did not report an allegation of abuse not later than 24 hours to the State Survey Agency (HHSC) when Resident #1 fell off the bed. This deficient practice could affect any resident and could contribute to further abuse. The findings were: Review of Resident #1's face sheet, dated 3/19/25, revealed a [AGE] year old female admitted to the facility on [DATE] with diagnoses that included: Major Depressive Disorder (a mental health condition that causes a persistently low or depressed mood and a loss of interest), Epilepsy (a brain disease where nerve cells don't signal properly). Review of Resident #1's quarterly MDS assessment, dated 1/30/25, revealed a BIMS score of 10, which indicated that cognition was moderately intact. Record review of Resident # 1's quarterly MDS dated [DATE] revealed section GG - Functional Abilities/section toileting hygiene number 1 was selected, indicating that the resident is dependent - and requires the assistance of 2 staff. Record review of Resident # 1's care plan dated 4/4/24 revealed [resident's name] is at risk for falls with interventions X 2 staff assistance for all ADLs. Record review of Texas Unified Licensure Information Portal (TULIP) on 3/19/25 at 10:30 A.M. revealed that no self-reported incidents regarding allegations of abuse were reported. Interview with CNA A on 3/18/25 at 11:20 A.M. revealed that on 3/14/25 at approximately 4:30 AM, she was providing incontinence care for Resident # 1, turning her on her left side when Resident # 1 fell on the floor. Interview with Resident #1 on 3/19/25 at 9:20 A.M. revealed when CNA A was providing incontinent (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 03/19/2025 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)