Inspection visit
Health inspection
5 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 5 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to provide housekeeping and maintenance
services necessary to maintain a sanitary, orderly, and comfortable interior for 1 of 4 (Resident #13)
Resident's rooms observed for environmental conditions.
The facility failed to ensure that Resident # 13's blinds were free from dust.
The facility's failure placed the residents at risk for diminished quality of life and discomfort.
The findings included:
Record review of Resident #13's face sheet dated 11/07/2024 revealed a [AGE] year-old female admitted
on [DATE] with most recent admission on [DATE] with the following diagnoses: Encephalopathy (central
nervous system diseases located in brain), Hypothyroidism, Type 2 Diabetes, Hypertension, Heart failure
and anxiety.
Record review of Resident #13's Quarterly MDS assessment dated [DATE] revealed: Section C- Cognitive
Patterns Resident #13 had a BIMS of 13, meaning she was cognitively intact.
Record review of Resident #13's care plan dated revealed Resident #13 had oxygen therapy prn related to
her Congestive Heart Failure.
During an observation and interview on 11/06/24 at 2:51 PM Resident #13 stated she wished that her
blinds were cleaned and did not have dust on them. Resident #13 stated the dust on the blinds irritated her
allergies. The blinds were observed to have a layer of dust on them.
During an interview on 11/07/24 at 1:44 PM the HK DM stated her expectation was resident's rooms were
to have been dusted at least every other day; she stated there should not have been dust on the blinds. The
HK DM stated the housekeepers were responsible to ensure that blinds were cleaned daily and ultimately it
was the HK manager 's responsibility. The HK DM stated the effect on residents could have been
Resident's allergies being agitated by breathing in the dust. The HK DM stated what led to the failure was
staff getting in a hurry and skipping steps.
During an interview on 11/07/2024 at 1:55 PM the ADMN stated his expectation was that housekeeping
clean residents' room daily. The ADMN stated there should not have been dust on the blinds. The ADMN
stated it was the responsibility of the housekeeper and housekeeper manager to ensure that blinds were
being cleaned. The ADMN stated dust on blinds could have caused residents' allergies to be
(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 10
Event ID:
676376
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
agitated by dust in the room. The ADMN sated lack of supervision of the housekeeping staff, by the
housekeeping supervisor, led to the failure.
Record review of facility form tilted 5- step Daily Room Cleaning revealed: Horizontal surfaces- disinfected
Using a solution of properly diluted germicide, sanitize all horizontal surfaces. As you enter the room, work
clockwise around the room hitting all surfaces. Use your high duster to dust hard to reach areas, such as
the tops of closets, high lights, and ceilings areas as needed. Tabletops, headboards, windowsills.
Event ID:
Facility ID:
676376
If continuation sheet
Page 2 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0638
Assure that each resident’s assessment is updated at least once every 3 months.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review the facility failed to assess a resident using the quarterly review instrument
specified by the State and approved by CMS not less frequently than once every 3 months for 3 of 18
Residents (Resident #1, Resident #3, and Resident #6) reviewed for assessments.
Residents Affected - Some
The facility failed to complete a quarterly assessment for Resident #1, #3, and #6 every 3 months.
This failure could place residents at risk for not getting an accurate assessment and could result in lack of
care.
Findings include:
Resident #1
Review of Resident #1's electronic face sheet revealed a [AGE] year-old female admitted on [DATE] with
diagnoses to include: Urinary Tract Infection, Bladder dysfunction, and Depression.
Review of Resident #1's last completed MDS assessment dated [DATE] revealed a BIMS score of 09 which
indicated moderate cognitive impairment. Further review of Resident #1's MDS tracking record revealed the
last completed MDS was completed on 07-11-2024. The next MDS listed was a quarterly dated 10-31-2024
that was in progress as of 11/07/2024.
Resident #3
Review of Resident #3's electronic face sheet revealed a [AGE] year-old male admitted [DATE] with
diagnoses to include: Bipolar Disorder, Anxiety, and Dementia.
Review of Resident #3's last completed MDS assessment dated [DATE] revealed a BIMS score of 11 which
indicated moderate cognitive impairment. Further review of Resident #3's MDS tracking record revealed the
last completed MDS was completed 06-22-2024. The next MDS listed was a quarterly dated 9-22-2024 that
was in progress as of 11/07/2024.
Resident #6
Review of Resident #6's electronic face sheet revealed a [AGE] year-old female admitted to the facility on
[DATE] with diagnoses to include: Dementia, Depression, and heart failure.
Review of Resident #6's last completed MDS assessment dated [DATE] revealed with a BIMS score of 10
which indicated moderate cognitive impairment. Further review of Resident #6's MDS tracking record
revealed the last completed MDS was an annual completed 07-05-2024. The next MDS listed was a
quarterly dated 10-05-2024 that was in progress as of 11/07/24.
During an interview on 11/07/24 at 10:54 AM, the ADMN stated MDS assessments were to be completed
annually and quarterly. He stated he was unsure as to the timeframe requirement for submission. He stated
his expectation was for MDS assessments to be completed and submitted within the required time frame.
He stated he was unaware that the facility was behind on MDS assessment completions and submissions,
and he was not sure as to what caused the failure. He stated this failure did not directly
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 3 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0638
affect the residents but did affect the facility with reimbursement.
Level of Harm - Minimal harm
or potential for actual harm
During an interview on 11/07/24 at 11:03 AM, the DON stated she was not aware that MDS assessments
were not being completed and submitted within a timely manner. She stated that it was the MDS
Coordinator's responsibility to monitor MDS completions and submissions. The DON stated it was not her
responsibility to ensure the completion of MDS assessments in a timely manner.
Residents Affected - Some
During an interview on 11/07/24 at 02:09 PM, the MDS Coordinator stated that MDS assessments should
have been completed and submitted within 14 days of their due date. She stated they should have been
done annually and quarterly. She stated she was responsible for ensuring they are completed in a timely
manner. She stated the facility had a flood at the beginning of the year and that was her reasoning for being
behind. MDS nurse stated this failure did not directly impact the residents.
Review of facility policy titled, Resident Assessment Instrument, revised September 2010, revealed in part:
.Policy Interpretation and Implementation: 1. The Assessment Coordinator is responsible for ensuring that
the Interdisciplinary Assessment Team conduct a timely resident assessments and reviews according to the
following schedule: a. Within fourteen days of resident's admission to the facility; b. Where there has been a
significant change in the resident's condition; c. At least quarterly; and d. Once every twelve months .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 4 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
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 observation, interview, and record review, the facility failed to ensure medications were stored in
locked compartments and only authorized personnel were permitted to have access to the keys for 1 cart
(medication cart Hall 500) of 3 medication carts reviewed for storage.
The facility failed to ensure medication cart Hall 500 was locked and secured when unattended.
These failures could place all residents at risk of harm or decline in health due to lack of ,
medications/biologicals or misappropriation of medications, or drug diversions.
Findings included:
During an observation on 11/05/2024 at 11:24 AM the medication cart was unlocked and not secured and
left in the middle of the 500 hallway. RN A was in a resident's room with resident's door closed. The
medication cart was not within eyesight of the nurse and narcotics were under one lock, instead of two. The
unlocked medication cart contained prescription and OTC medications that included eye medications, stool
softeners, antipsychotics, Insulins, Blood Pressure Medications, Narcotics, antibiotics, diuretics, lidocaine
cream, and nasal sprays. One resident and one visitor were observed to have walked past the unlocked
medication cart while it was unattended.
During an interview on 11/05/2024 at 11:24 AM RN A stated she was responsible for this medication cart
and there were 8 residents' medications on the cart. RN A stated that she knew better and did not know
why she left the medication cart unlocked. RN A stated someone could access the cart and take
medications that were not prescribed for them. RN A stated this could have caused harmful side effects
such as allergic reaction for the residents. RN A stated she had been trained on locking the medication cart
when not in use.
During an interview on 11/07/24 at 02:05 PM the DON stated medications carts should be locked when not
in use, unattended and not in line of sight. The DON stated she believed the nurse being distracted led to
this failure. The DON stated nurses are trained upon hire and with routine education on security of
medication carts. The DON stated possible harm to residents would be if a resident accessed the
medication cart and took a medication that was not prescribed for them. The DON stated if a resident took
a medication not prescribed for them there could have been adverse side effects. The DON stated locked
medication carts were monitored by the two ADON's, herself and the ADMN.
Review of facility's policy titled Security of Medication Cart dated Revised April 2007:
Policy statement
The medication cart shall be secured during medication passes.
1.
The nurse must secure the medication cart during the medication pass to prevent unauthorized entry.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 5 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0761
2.
Level of Harm - Minimal harm
or potential for actual harm
The medication cart should be parked in the doorway of the resident's room during the medication pass.
The cart doors and drawers should be facing the resident's room.
Residents Affected - Few
3.
When it is not possible to park the medication cart in the doorway, the cart should be parking in the hallway
against the wall with doors and drawers facing the wall. Medication carts must be securely locked at all
times when out of the nurse's view.
4.
When the medication cart is not being used, it must be locked and parked at the nurses' station or inside
the medication room.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 6 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observations, interviews, and record reviews the facility failed to properly store, prepare,
distribute, and serve food in accordance with professional standards for food service safety for 1 of 1
kitchen reviewed.
The facility failed to ensure that spoiled food items were disposed of properly.
These failures could place residents that eat out of the kitchen at risk for food borne illnesses.
The findings included:
During observation on 11/05/2024 at 10:00 AM in the kitchen:
Refrigerator
1)
2 cucumbers with a white substance on them
2)
An unopened clear bag of broccoli that contained broccoli that had turned brown.
3)
An unopened clear bag of lettuce that had turned brown.
4)
A box that contained red bell peppers, 3 of the red bell peppers had black spots and soft spots on them.
5)
A box that contained yellow bell peppers, 2 of the yellow bell peppers had black spots and soft spots on
them.
During an interview on 11/07/24 at 11:06 AM the DM stated her expectation was when food appeared to
have spoiled it needed to be thrown out. The DM stated all kitchen staff were responsible to throw out food
that was spoiled or expired, but she was ultimately responsible to ensure food had been discarded when it
had spoiled. The DM stated that if residents were to receive spoiled food it could have caused them to
become sick. The DM stated what led to failure was there had been some staff turnover and staff calling in
and she had been working extra hours to cover shifts.
During an interview on 11/07/2024 at 1:13 PM the ADMN stated his expectation was that food that was
spoiled or expired should be discarded. The ADMN stated the DM was responsible to ensure that spoiled
food was discarded. The ADMN stated if residents received food that was spoiled it could cause
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 7 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
food borne illness. The ADMN stated lack of oversight by the DM led to the failure of spoiled items not being
discarded.
Record review of facility policy titled, Receiving dated 2/2023 revealed: Safe food handling procedures for
time and temperature control will be in the transportation, delivery, and subsequent storage of all food
items.
Event ID:
Facility ID:
676376
If continuation sheet
Page 8 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observations, interviews and record reviews, the facility failed to maintain an infection prevention and
control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the
development and transmission of communicable diseases and infections for 2 of 3 (CNA-E and LVN-F) staff
observed during incontinent care and wound care.
Residents Affected - Few
The facility failed to ensure that staff (CNA-E) performed proper peri-care (incontinent care) using improper
hand hygiene for Resident #33.
The facility failed to ensure that staff (LVN-F) performed proper wound care for Resident #33.
These failures placed residents of the facility at risk of infections from incontinent care and wound care.
Findings included:
Record Review of Resident #33's Face Sheet dated 11/06/2024 revealed a [AGE] year-old male admitted
on [DATE] and his original admission on [DATE]. Review of Resident #33's diagnoses revealed: Type 2
Diabetes, multiple Pressure Ulcer of unspecified stages, and Muscle Weakness.
Record review of Resident # 33's MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior
a BIMS score of 08 (moderately impaired cognition). Section H-Bladder and Bowel, Indwelling catheter, and
always incontinent.
During observation and interview on 11/06/2024 at 10:04 AM, CNA-E had not changed her gloves or
perform hand hygiene from dirty to clean during the peri care of Resident #33. CNA E was observed to
touch the clean linens and to reposition the resident while wearing her soiled gloves. CNA E stated she was
supposed to have done hand hygiene between dirty and clean gloves as well as not touching clean linens
or the resident before taking her dirty gloves off. CNA-E stated there could have possibly been cross
contamination between residents with the possibility of infections.
Record Review of CNA-E's Perineal Care training dated 09/11/2024 revealed: CNA-E's performance
Criteria was completed and met.
During observation on 11/06/2024 at 10:41 AM, while having clean gloves on, LVN-F removed her unclean
pen and unclean scissors from her scrub pant pockets and proceeded with performing wound care with
dirty gloves for Resident #33.
During an interview on 11/07/2024 at 2:17 PM, LVN-F stated she should have washed her hands and put
on new gloves after she touched the pen and scissors from her pant pockets. She stated it could have
caused crossed contamination between residents. LVN-F stated she should have had those items cleaned
with other supplies needed for her wound care.
Record Review of LVN-F's Wound Care Competency dated 09/09/2024 revealed: LVN-F's performance
Criteria was completed and met.
During an interview on 11/07/2024 at 2:20 PM the DON stated the wound care staff should not have
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 9 of 10
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
676376
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
11/07/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Silver Spring
1690 N. Treadway Blvd.
Abilene, TX 79601
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)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
retrieved her pen and scissors out of her pocket. The DON stated in doing so, her clean gloves became
contaminated prior to dressing the wound which could have been caused the wound to have been infected.
The DON also stated, she monitored the staff and observed during rounds. She stated the negative impact
for residents could have possibly led to infection or bacteria with distraction and nervousness being what
led to the failure. The DON stated her expectations were for staff to have washed their hands between
treatments when changing their contaminated gloves between procedures. She stated staff should not
touch clean linen or touch resident with contaminated gloves .
Record review of the policy titled Perineal Care dated 12/2011 revealed:
Purpose: The purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent
infections and skin irritation, and to observe the resident skin condition.
Precedure : .12. Remove gloves and discard into designated container. Wah and dry your hands thoroughly.
13. Put on clean gloves and place new brief and secure in place 18. Remove gloves, and 19. Wash and dry
your hands thoroughly.
Record review of the policy titled Wound Care dated with 12/2011 revealed:
Purpose: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing
.6. Put on gloves. 7. Use no-touch technique 14. Be certain all clean items are on clean field
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676376
If continuation sheet
Page 10 of 10
Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.
Back to topCitations
5 citations recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F638 - Quarterly Review Assessment
Assure that each resident’s assessment is updated at least once every 3 months.
F761 - Labeling of Drugs and Biologicals
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.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F880 - Infection Control
Provide and implement an infection prevention and control program.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
FAQ · About this visit
Common questions about this visit
What happened during the November 7, 2024 survey of Silver Spring?
This was a inspection survey of Silver Spring on November 7, 2024. The surveyor cited 5 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at Silver Spring on November 7, 2024?
Yes, 5 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Assure that each resident’s assessment is updated at least once every 3 months."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.