Silver Tree Nursing And Rehabilitation Center
SILVER TREE NURSING AND REHABILITATION CENTER in SCHERTZ, TX — inspection on June 12, 2026.
Found 10 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
The facility failed to
at risk of not receiving care or attention needed.
Findings include:
Record review of Resident #44's electronic face sheet dated 06/10/2026 reflected a [AGE] year-old male admitted on [DATE].
His diagnoses included: Parkinsonism (clinical syndrome that presents with various neurodegenerativediseases which manifest motor symptoms such as rigidity, tremors, and unstable posture, leading to gait impairment),muscle spasms (sudden, involuntary contraction of one or more muscles) and seizures (sudden burst of electrical activityin the brain which can cause changes in behaviors and movement and levels of consciousness).
Record review of Resident #44's quarterly MDS assessment dated [DATE] reflected he was able to be understood andable to understand others.
He scored 12 of 15 on his BIMS which signified his cognitive status was moderately impaired.He required substantial assistance to total dependence for most of his ADLs. He used a manual wheelchair and required.maximal assistance for locomotion and mobility.
Record review of Resident #44's comprehensive care plan dated 05/01/2026 reflected Focus, resident has an ADL selfcare.performance deficit r/t Parkinsons, muscle weakness, Interventions/Tasks, encourage the resident to use call bell forassistance.
Observation on 06/09/2026 at 10:45 am of Resident #44 revealed he was sitting in a tall wheelchair in his room.approximately 3 feet away from his bed.
His sensor pad was lying on his bed.
During an interview on 06/09/2026 at 10:47 am, Resident #44 stated he would use his sensor pad to call someone if heneeded help. He stated he could not reach or get to the sensor pad and would have to yell if he needed help.
During an interview on 06/12/2026 at 1:03 pm, CNA A, who was assigned to care for Resident #44 on 06/09/2026, shestated she could not remember who helped Resident #44 out of bed, but that he would not be able to reach his sensor pad.if it was on his bed and he was in his chair a few feet away.
She stated if he had an emergency, he would not be able toget help.
During an interview on 06/12/2026 at 1:16 pm, RN B, who was assigned to care for Resident #44 on 06/09/2026 stated.She did not notice Resident #44's sensor pad placement that morning.
She stated it was important for residents to have.their call lights or devices within reach in case they needed help quickly.
During an interview on 06/12/2026 at 2:30 pm, the DON who was new at the facility stated residents needed to have call.lights or devices within reach when they were in their rooms in case an emergency arose.
During an interview on 06/12/2026 at 2:40 pm, the ADM stated staff needed to check for call light or device placement sothat residents had a way to get help.
Record review of the facility's policy and procedure titled Resident Rights (undated) reflected the right to reside andreceive services in the facility with reasonable accommodation of resident needs and preferences except when to do so.would endanger the health or safety of the resident or other residents.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
During an interview with the DON on 06/12/2026 at 12:25 p.m., the DON stated a discharge MDS should have been completed, encoded, and transmitted for Resident #83 upon the resident's discharge from the facility.
During an interview with the MDS Coordinator on 06/12/2026 at 2:00 p.m., the MDS Coordinator stated a discharge MDS should have been completed, encoded, and transmitted for Resident #83 upon the resident's discharge from the facility and stated the omission was an oversight.
Record review of the facility policy, Minimum Data Set (MDS) Policy for MDS Assessment Data Accuracy, dated 08/2025, revealed, Federal regulations.require that: 1.
The assessment accurately reflects the resident's status.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
MDS Nurse stated if the MDS was inaccurate, resident care could not be delivered correctly and
Record review of the facility's policy and procedure titled Minimum Data Set (MDS) Policy for MDS
each resident receives an accurate assessment by qualified staff to address the needs of the resident who are familiar with his/her physical, mental, and psychosocial well-being.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
Review of the facility policy on PASSR level 1 screening revised 3/6/2019 indicated . 3.
The Facility will review the PASRR level 1 Screening form for completion and correctness prior to admission and submit the PL1 form per regulations.
The Type of admission is reviewed for correctness.
Ensure the Name, SS number, Medicare/Medicaid numbers, and DOB is correct.
The Date of the PL1 is correct (i.e., correct day, month, and year) and review each item on the PL1 to ensure accuracy and prevent a regulatory problem.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
Observation on 06/09/2026 at 11:30 am of Resident #81
oxygen tubing unbagged secured around the top.
During an interview on 06/09/2026 at 11:32 am, Resident #81 stated he used oxygen at night to help him to breath because of his respiratory failure.
He stated he put his oxygen on and took it off himself. He stated he would turn the concentrator on and off. He stated he was on oxygen between 2 and 4 L/min.
During an interview on 06/12/2026 at 12:51, RN C stated Resident #81 could take off his own nasal canula and put it on.
She stated she did not know if it was in his care plan.
During an interview on 06/12/2026 at 1:41 pm, the MDS Nurse stated Resident #7's hospice services, Resident #44's sensor pad and Resident #81's behaviors of putting on and taking off his oxygen canula needed to be reflected in their care plans, and she did not know why they were not.
She stated the wrong type of care or missed care could result with an inaccurate care plan.
She stated behaviors needed to be communicated to other direct care staff so they would be aware.
During an interview on 06/12/2026 at 2:30 pm, the DON who was new at the facility stated the comprehensive care plan should show what care the residents required and what they could or could not do to include behaviors and preferences.
She stated she was accountable for many parts of the care plan process.
During an interview on 06/12/2026 at 2:40 pm, the ADM stated care plans needed to show the residents' needs, preferences and goals.
Record review of the facility's policy and procedure titled Comprehensive Care Planning (undated) reflected The facility will develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident's rights that includes measurable objectives and timeframes to meet resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
During an interview with the DON on 06/12/2026 at 12:25 p.m., the DON stated Resident #1's diagnoses of frequent urinary tract infections, bleeding hemorrhoids, traumatic brain injury, pneumonia, chronic kidney disease, and diverticulitis were being address by the facility and should have been included in the resident's care plan.
The DON also stated that Resident #8's physician order for biannual blood tests to check drug levels and screen for potential side effects of valproic acid should have been included in the resident's care plan.
During an interview with the MDS Coordinator on 06/12/2026 at 2:00 p.m., the MDS Coordinator stated Resident #1's diagnoses of frequent urinary tract infections, bleeding hemorrhoids, traumatic brain injury, pneumonia, chronic kidney disease, and diverticulitis should have been included in the resident's care plan, that Resident #8's physician order for biannual blood tests to check drug levels and screen for potential side effects of valproic acid should have been included in the resident's care plan, and that the omission was an oversight.
Record review of the facility policy, Comprehensive Care Planning, undated, revealed, the resident's care plan will be reviewed.and revised based on changing goals, preferences, and needs of the resident and in response to current interventions.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
one nurse and a Med Tech or equivalent as allowed by your State regulatory agency and is
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
During an interview with the DON on 6/12/26 at 2:30 PM, the DON stated there
or appropriately wasted.
The DON stated a resident might not have received the therapeutic benefit of
stated all lock boxes for controlled medication storage should be affixed to the refrigerator in the medication rooms.
The DON stated if the lock boxes were not affixed, drug diversion could occur and residents might not receive therapeutic care if their medications are unavailable.
During an interview with the Administrator on 6/12/26 at 2:56 PM, the Administrator stated his expectation for lock boxes was that they be affixed to the refrigerator and that narcotics needed to be locked up securely for the safety of residents and staff.
The Administrator stated his expectation for medication carts was that they contained no loose pills, and that loose pills could indicate a nurse dropped a medication.
The Administrator stated if a medication had been dropped in a cart unnoticed, a resident might not get the benefit of their drug, or a resident could experience a negative effect if they received a medication for which they were not prescribed.
Record review of Resident #51's admission sheet dated 3/18/2026 with an original admission date of 4/19/2023 documented a [AGE] year-old male resident with diagnoses including depression, anxiety, seizures, and diabetic neuropathy (a common complication of diabetes characterized by nerve damage that can lead to pain, numbness and various dysfunctions in the body).
Record review of Resident #51's MDS dated [DATE] documented a BIMS score of 14 indicating intact cognition and recorded the use of opioid medications in Section N - Medications N0415 High-Risk Drug Classes: Use and Indication.
Record review of Resident #51's order summary included an order for Hydrocodone-Acetaminophen 10-300 mg with an order date of 5/06/2026 with directions to give 1 tablet by mouth every 6 hours as needed for pain, Hydrocodone-Acetaminophen 10-325 mg with an order date of 6/11/2026 with directions to give 1 tablet by mouth every 6 hours as needed for moderate pain, and Hydrocodone-Acetaminophen 10-325 mg with an order date of 3/20/2026 with directions to give 1 tablet by mouth two times a day for moderate pain.
Record review of Resident #51's care plan with an initiation date of 4/23/2026 documented The resident is on Pain medication Therapy ., with interventions including Administer medication as ordered.
Record review of the facility policy titled Medication Labels, dated 2025, noted Medications are labeled in accordance with facility requirements, state, and federal laws ., 1.
Each prescription medication label includes: Specific direction for use, including route of administration ., Nursing can request a ?refer to order change' sticker to affix to label until updated supply/label is provided.
Record review of the facility policy titled Medication Storage in the Facility, dated 2025, noted Medications and biologicals are stored safely, securely, and properly following manufacturer's recommendations or those of the supplier.
The pharmacy dispenses medications in containers that meet legal requirements including requirements of good manufacturing practices where applicable.
Medications are kept and stored in these containers.
Record review of the facility policy titled Controlled Medications - Administration, dated 2025, noted Medications included in the Drug Enforcement Administration (DEA) classification as controlled substances are subject to special handling, storage, disposal, and record keeping in the facility, in accordance with federal and state laws and regulations ., Medications listed in Schedules II are stored under double lock in a locked cabinet or safe designed for that purpose, separate from all other medications.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
During an interview with the DON on 06/12/2026 at 12:25 p.m., the DON confirmed Resident #8's orders to notify the medical doctor or nurse practitioner of potentially high blood sugar levels were conflicting and stated she would contact Resident #8's physician for clarification.
The DON on 06/12/2026 at 12:25 p.m., the DON stated Resident #11's diagnoses of insomnia and anxiety should have been included in the resident's list of diagnoses and therefore listed on the resident's facesheet.
The DON confirmed that diagnoses from outside providers such as psychological services should be included in the resident's facility clinical record so that the resident's physician and facility care team could coordinate appropriately.
The DON also confirmed that the resident's facesheet was utilized as a means of communicating the resident's status to hospitals and other providers outside of the facility and should accurately reflect the resident's status.
The DON further stated the facility's annual survey commenced on her second day of employment with the facility and that she would ensure a system of communication and coordination between the facility and outside providers was in place.
The facility policy regarding clinical records was requested on 06/12/2026 and was not received by the time of survey exit.
676121 06/12/2026
Silver Tree Nursing and Rehabilitation Center 930 Roy Richard Dr Schertz, TX 78154
Precautions (undated) reflected A variety of infection control measures are used for decreasing the
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.