Silver Tree Nursing: Record Errors Obscured Care - TX
What they found in the medical records of two residents was straightforward to document and, according to the director herself, straightforward to confirm: a diabetic resident's chart carried two contradictory instructions for when staff should call a doctor about dangerous blood sugar levels, and a second resident's diagnoses of insomnia and anxiety had never made it onto her official medical record at all.
The first resident, identified in the inspection report only as Resident 8, was admitted to Silver Tree with unspecified dementia, type 2 diabetes, and heart failure. A cognitive assessment placed her in the severe impairment range, with a score of 6 on a scale where anything below 8 signals serious deficits in memory and decision-making. She could not be expected to track her own blood sugar or flag a problem herself.
Her chart contained two separate physician orders governing what staff should do when her blood sugar climbed. One, dated February 2025, instructed nurses to call the doctor or nurse practitioner if her reading exceeded 250. A second order, added in December 2025, laid out an insulin sliding scale and told staff to call the doctor only if her reading exceeded 400. The two orders had coexisted in her chart for nearly six months before inspectors flagged them.
The gap between 250 and 400 is not a minor clinical detail. A blood sugar reading of 300 or 350 can signal a body in serious metabolic distress. Whether a nurse at Silver Tree would have called the doctor at 300, or administered insulin and moved on, depended entirely on which order she happened to follow. The chart did not resolve that question.
The director of nursing, interviewed by inspectors on June 12, confirmed the orders were conflicting. She said she would contact Resident 8's physician to get clarification.
The second resident, Resident 11, had been living with vascular dementia, a history of cerebral infarction, and paranoid personality disorder since her admission. A psychological services provider who evaluated her in January 2026 documented two additional diagnoses: primary insomnia and anxiety disorder. Her care plan, updated as recently as May 2026, noted that she was receiving anti-anxiety medication because of her anxiety disorder.
None of that appeared on her facesheet.
The facesheet is the document a facility sends with a resident when she is transferred to a hospital or seen by an outside provider. It is, in the director of nursing's own words, the primary tool for communicating a resident's status to anyone outside the building. For Resident 11, any emergency room physician or specialist who received that facesheet would have seen dementia, stroke history, and paranoid personality disorder. They would not have seen the anxiety disorder that was actively being treated with medication, or the insomnia diagnosis her own psychologist had recorded five months earlier.
The director of nursing confirmed to inspectors that diagnoses from outside providers like psychological services were supposed to be incorporated into the facility's clinical record so that the care team could coordinate appropriately. She confirmed Resident 11's facesheet should have listed both diagnoses. She also noted, without apparent irony, that the annual survey had begun on her second day of employment, and said she would put a system in place to ensure outside providers' findings were captured going forward.
Inspectors requested the facility's written policy on clinical records before they left on June 12. The policy had not been provided by the time the survey closed.
Thirty-two residents' records were reviewed during the inspection. Problems were found in two of them. Both residents had moderate to severe cognitive impairment. Neither was in a position to notice that her own chart was incomplete or contradictory, or to say so if she had.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Silver Tree Nursing and Rehabilitation Center from 2026-06-12 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 19, 2026 · Our methodology
SILVER TREE NURSING AND REHABILITATION CENTER in SCHERTZ, TX was cited for violations during a health inspection on June 12, 2026.
She could not be expected to track her own blood sugar or flag a problem herself.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.