Silas Creek Rehabilitation Center

In the surveyor’s words

From the most serious findings on record at Silas Creek Rehabilitation Center, in the surveyor’s own words.

• No harm, potential for more than minimal, isolatedF760Jun 12, 2026

  Based on record review, Nurse Practitioner (NP) #1, Regional Clinical Consultant, and staff interviews the facility failed to prevent a significant medication error by failing to transcribe and administer Furosemide (a diuretic, a medication used for excess fluid elimination) which resulted in five consecutive missed doses for 1 of 5 residents reviewed for medications (Resident #6). The findings included:Record review revealed Resident #6 (prior to hospitalization on 05/04/26) was taking Spironolactone Tablet 25 milligram (mg) give 0.5 tablet by mouth (po) one time a day for congestive heart failure (CHF) take a half tablet (12.5mg) po and Furosemide Tablet 40mg give 1 tablet po one time a day for fluid retention. […]

• No harm, potential for more than minimal, isolatedF825Jun 12, 2026

  Based on record review, observation and staff interviews, the facility failed to conduct an evaluation to determine therapy needs. This was for 1 of 1 resident reviewed for rehabilitation services (Resident #10). The findings included:Resident #10 was readmitted to the facility on [DATE] with a diagnosis of stroke affecting the left side, contracture of left elbow and left hand and aphasia (a communication disorder caused by damage to the brain which results in the inability to speak, read, or write). The quarterly Minimum Data Set, dated [DATE] revealed Resident #10 was severely cognitively impaired with impairment to both sides of her upper and lower body. […]

• No harm, potential for more than minimal, isolatedF644Dec 21, 2022

  Based on resident and staff interviews and record review, the facility failed to complete a Preadmission Screening and Resident Review (PASRR) application for a resident who exhibited new behaviors which resulted in additional psychiatric diagnoses for 1 of 1 resident (Resident #38) reviewed for PASRR. Findings included: Resident #38 was admitted to the facility on [DATE] with diagnoses that included, in part, convulsions and congestive heart failure. She had a level one PASRR number upon admission. The medical record indicated Resident #38 was seen by psychiatry services in the facility on 10/7/21 and was noted to have a new onset of auditory delusions . and subsequently diagnosed with brief psychotic disorder and major depressive disorder. […]

• No harm, potential for more than minimal, isolatedF677Dec 21, 2022

  Based on observations, record reviews and staff interviews the facility failed to provide nail care to 1 of 2 residents reviewed for Activities of Daily Living (ADLs) (Resident #17). The findings included: Resident #17 was admitted to the facility on [DATE] with diagnoses which included: vascular dementia, generalized muscle weakness, transient cerebral ischemic attack, and cognitive communication deficit. Review of Resident #17's most recent Minimum Data Set (MDS) revealed a annual assessment with an Assessment Reference Date (ARD) of 11/23/22 revealed the resident's cognition was severely impaired. The resident required extensive or total staff assistance for all activities of daily living (ADLs). […]

• No harm, potential for more than minimal, isolatedF558Apr 15, 2021

  Based on observations, record review and resident and staff interviews, the facility failed to provide residents access to turn on and off the overbed lighting as desired for 2 of 13 residents sampled. (Resident #21 and Resident #13). The findings included: 1. Resident #21 was admitted to the facility on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . An observation was made of Resident #21 ' s room on 4/13/21at 9:22 AM. Resident #21 was observed lying in her bed. The overbed light had a chain attached and a string attached to the chain but, was out of the resident ' s reach. During an interview conducted with Resident #21 on 4/13/21 at 9:22 AM, she stated she was unable to reach the chain and string attachment on the overbed light. […]