Autumn Lake Healthcare at Silver Spring

In the surveyor’s words

From the most serious findings on record at Autumn Lake Healthcare at Silver Spring, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Mar 27, 2026

  Based on observation and interview, it was determined facility dietary staff failed to maintain proper infection control procedures by using serving warming plates and cloches that had been wet nesting and were still wet with standing water when the residents' plates of food were placed in them. Wet nesting is a sanitation hazard occurring when recently washed, wet, or damp items (like plates, pots, or bowls) are stacked together. This practice restricts airflow, creating a dark, moist environment that promotes rapid bacterial growth and mold.During the survey observation of the lunch plating, it was observed that the warming plates and cloches that were being used were very wet with the warming plates having standing water in them. […]

• No harm, potential for more than minimal, widespreadF801Dec 6, 2024

  Based on observation, interview, job description review, document review and policy review, the facility failed to employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition department having the potential to affect all residents. The facility failed to ensure adequate oversight of dietary/nutrition services from the Registered Dietitian (RD), who worked part time, had not been to the facility since July of 2024. In addition, the facility failed to ensure the Food Service Director (FSD) was qualified. […]

• No harm, potential for more than minimal, widespreadF812Dec 6, 2024

  Based on observations, interview, document review, and policy review, the facility failed to ensure that the kitchen was maintained in a sanitary manner to prevent the potential spread of foodborne illness to 126 out of 129 residents (three residents received nutrition via feeding tubes). Specifically, dietary staff did not adhere to hand hygiene/glove use requirements for ready to eat food and the dishwasher was not operating in accordance with manufacturer's specifications. Findings include: Review of the facility's policy titled, Dishwasher Temperature dated 01/31/23 and provided by the facility revealed, It is the policy of this facility to ensure dishes and utensils are cleaned under sanitary conditions through adequate dishwasher temperatures . […]

• No harm, potential for more than minimal, widespreadF814Dec 6, 2024

  Based on observations, interview, and policy review, the facility failed to maintain the outdoor garbage area in a sanitary manner for three of three days of the survey creating the potential for the harborage of pests which could affect all 129 residents. Findings include: Review of the facility's policy titled, Safe and Homelike Environment dated 01/27/23 and provided by the facility revealed, the facility will provide a safe, clean, comfortable and homelike environment . Sanitary includes, but is not limited to , preventing the spread of disease-causing organisms . 1. […]

• No harm, potential for more than minimal, patternF730Mar 27, 2026

  Based on review of employee files and interviews with facility staff, it was determined that the facility failed to conduct required performance reviews of Geriatric Nursing Assistants (GNAs) at least once every 12 months. This was evident for 4 (GNA #17, #19, #20, #5) out of 5 GNAs' employee files reviewed during the Sufficient and Competent Nursing Staffing portion of the facility's recertification survey. The findings include:Performance reviews are to be completed for each GNA at least every 12 months to identify specific, in-service education based on the outcome of those individual performance reviews. On 3/24/26 at 10:02 AM the surveyor requested the complete employee files for GNA #17, GNA #18, GNA #19, GNA #20, and GNA #5. […]