Silver Tree Nursing And Rehabilitation Center

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

PM, Resident #3's RP revealed Resident #3 could be manipulative when she got mad and did not get her way. She revealed Resident #3 had a history of making up stories about her care in order to make it seem like Resident #3 had to come home instead of staying at the facility. Interview on 10/10/25 at 04:37 PM, the ADM and DON revealed they should have documented Resident #2 refused wound treatments in his care plan because care plans were person centered and reflected what care resident received. They further revealed for Resident #3 they did not document in her care plan that she made accusations and allegations of her care. (The ADM revealed these accusations and allegations were not reportable events.) They revealed Resident #3 had a history of making allegations about staff, and they had been working on helping

this resident with these behaviors through psychiatric and psychological services. Interview on 10/13/25 at 03:54 PM, [Mental Health Organization] counselor revealed Resident #3 did not like being in the facility because she wanted to go home. She revealed Resident #3 had a history of making up accusations about care. She revealed if Resident #3 got into a bad mood, anything bothered her. She revealed the facility and

she had been working on these behaviors with her. Record review of the facility's policy, titled Comprehensive Care Planning, undated, reflected The comprehensive care plan will describe the followingThe services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; and the right to refuse treatment

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Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/10/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Silver Tree Nursing and Rehabilitation Center

930 Roy Richard Dr Schertz, TX 78154

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 0689 Level of Harm - Immediate jeopardy to resident health or safety

had these behaviors. They further revealed they would report elopements to the ADM immediately. The noncompliance was identified as PNC. The Immediate Jeopardy began on 08/28/25 and ended on 08/29/25. The facility had corrected the noncompliance before the investigation began.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

10/10/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Silver Tree Nursing and Rehabilitation Center

930 Roy Richard Dr Schertz, TX 78154

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure resident medical records were kept in accordance with accepted professional standards and practices, the facility must maintain medical records on each resident that are complete and accurately documented for 1 of 6 residents (Resident #2) reviewed for clinical records. The facility failed to ensure Resident #2's wound treatment was accurately documented from 10/01/25 to 10/06/25. These failures could place residents at risk of not receiving the care and services needed due to inaccurate or incomplete clinical records. The findings included:Record review of Resident #2's admission record, dated 10/10/25, revealed resident was an [AGE] year-old male resident admitted [DATE REDACTED] with diagnoses to include protein-calorie malnutrition. Record review of Resident #2's admission MDS assessment, dated 09/11/25, revealed Resident #2's had a BIMS score of 06 out of 15, indicating severe cognitive impairment. Record review of Resident #2's care plan reflected a focus The resident has a potential for pressure ulcer development., initiated 09/10/25, with interventions . [Resident #2] with hx of wound care refusal, initiated 10/07/25. Record review of Resident #2's October 2025 Wound Administration Record reflected WOUND CARE: unstageable PI to right buttock. one time a day for WOUND HEALING for Lib A (liberal in the AM shift meaning wound treatment could be done any time

during the morning shift) did not have anything documented for 10/01/25 to 10/06/25. Interview on 10/09/2025 at 11:59 AM, LVN AD revealed in the last 2 weeks, Resident #2 had a history of refusing wound care and had to get Resident #2's family member to help Resident #2 agree to wound treatment. Interview

on 10/09/25 at 02:50 PM, RN C revealed she did wound treatment for Resident #2 from 09/30/25 to 10/03/25 and 10/06/25. She revealed Resident #2 had a history of refusing wound care. She revealed she tried 2 or 3 times for wound treatment, but he continued to refuse wound treatment. She revealed they had to educate family member and Resident #2 every day about importance of wound treatment. Interview on 10/10/25 at 04:37 PM, the ADM and DON revealed Resident #2 refusing wound treatment should be documented in his administration record. They revealed this was important, so his records were accurate.Record review of the facility's policy Wound Treatment Management, dated 2021, reflected 7.

Treatments will be documented on the Treatment Administration Record.Record review of facility's policy Documentation, undated, reflected 1. The facility will maintain complete and accurate documentation for each resident on all appropriate clinical record sheets.

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Facility ID:

If continuation sheet