Silver Springs Care Center

In the surveyor’s words

From the most serious findings on record at Silver Springs Care Center, in the surveyor’s own words.

• Actual harm, isolatedF600Oct 31, 2024

  Based on clinical record review, staff interviews, and facility documentation review for two of three residents (Resident #2, Resident #3) review for abuse, the facility failed to ensure the residents were free from abuse. Residents #2 and #3 had a physical altercation, resulting in both residents with injuries to their faces, and were transferred to the hospital for treatment. The finding includes: 1. a. Resident #2 had a diagnosis of malignant neoplasm of the brain, bipolar disorder, and schizoaffective disorder. The quarterly Minimum Data Set (MDS) assessment dated [DATE] identified Resident #2 had a Brief Interview for Mental Status (BIMS) score of 13 indictive of an intact cognition and was independent with mobility and had no behaviors. […]

• Actual harm, isolatedF600Jul 12, 2022

  Based on clinical record review, observation, facility documentation, facility policy, and interviews for 1 of 3 residents (Resident #28) reviewed for abuse, the facility failed to ensure a resident was free from physical injury by another resident (Resident #133). The findings include: Resident #28 was admitted on [DATE] with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . Resident #28 was responsible for self. The admission Minimum Data Set (MDS) assessment dated [DATE] identified Resident #28 was without cognitive impairment and required physical assist of one with ambulation on and off the unit with wheelchair support. The care plan dated 3/31/22 identified Resident #28 had a concern with Activities of Daily Living (ADL) and fracture of pelvis and sacrum. […]

• No harm, potential for more than minimal, widespreadF812Aug 31, 2026

  Based on observations, interviews, and facility policy, the facility failed to ensure facial hair was covered when prepping food and that a soiled fan facing the food preparation area was not in use when food was being prepared. The findings include: 1. Observation and interview with the Director of Dietary Services on 8/25/26 at 11:30 AM identified that Dietary Aide (DA) #1 was standing at the food preparation area whisking yellow liquid in a large rectangular pan without the benefit of wearing a beard cover. DA # had facial hair on his chin approximately 1/2 inch to 1 inch in length (goatee). The Director of Dietary Services indicated that he was unsure of the length of facial hair that required a beard cover. […]

• No harm, potential for more than minimal, widespreadF921Aug 31, 2026

  Based on initial tour, observations, record reviews and interviews for the 3 out of 3 nourishment rooms, the facility failed to ensure no items were stored under the sinks, and for the facility environment, the facility failed to provide a safe, sanitary environment in various common areas noted throughout the building. The findings include: 1. A tour of all 3 nourishment rooms on 8/28/26 at 12:30 PM with the Director of Dietary Services identified that the cabinets under the sink had storage of multiple items and the bottom of the cabinets had dust and small amounts of debris. In the first-floor nourishment room there were several sleeves of unused large Styrofoam cups stored under the sink. […]

• No harm, potential for more than minimal, widespreadF925Aug 31, 2026

  Based on observations, interviews and facility documentation, the facility failed to maintain an effective pest control program, as evidenced by the presence of multiple gnat/fruit fly type flying insects observed in the kitchen and throughout multiple areas of the facility. The findings include: Observation and interview with the Director of Dietary Services on 8/25/26 at 11:00 AM identified gnats/fruit fly type flying insects were noted to be in food prepping areas, near the 3 bay sinks, and in the dry food storage area. The Director of Dietary stated that he was aware of the flying insect issues and had attempted to treat the drains himself but did not have the proper chemicals. […]