Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Silver Creek Rehab And Healthcare Center during CMS and state inspections, most recent first.
A fire occurred in a resident's room due to improper clearance between a reclining chair and an electric baseboard heater. The facility failed to maintain the required 6-inch clearance, leading to charring on the chair and wall. Despite the fire, many rooms still had combustible items too close to heaters, posing a risk to residents.
The facility failed to provide proper ostomy care for three residents, leading to issues such as peristomal skin breakdown, inconsistent appliance sizing, and a lack of documented treatment plans. One resident experienced pain and bleeding due to an improperly sized appliance, while another had a prolapsed stoma without proper treatment documentation. Staff interviews revealed inconsistencies in care and a lack of communication with physicians.
The facility failed to maintain proper infection control practices for Enhanced Barrier Precautions (EBP) and COVID-19 precautions. A resident with an MDRO did not receive care with the required PPE, as staff were unsure about EBP requirements. Another resident with COVID-19 was not protected by full PPE use, as a staff member entered the room without eye protection. Interviews confirmed a lack of adherence to infection control guidelines.
A facility failed to provide necessary treatment and services for a resident with deep tissue injuries (DTIs) on both heels. Despite a care plan and physician's order for daily skin prep, the facility did not document weekly assessments of the DTIs, including measurements, staging, exudate, pain, wound bed, or wound edges. Interviews with an LPN and the DON confirmed the lack of documentation for three consecutive weeks, contrary to facility policy and expectations.
The facility failed to protect residents from abuse, as a resident with severe cognitive impairment was involved in two incidents of physical abuse. One resident was found with a sheet over their head, and another reported feeling scared of the same perpetrator. Despite these incidents, the facility's staff did not conduct a thorough investigation, and a non-ambulatory resident was moved into the same room as the alleged perpetrator.
A facility failed to investigate an alleged abuse incident involving a resident who reported feeling scared of their roommate, who allegedly put a blanket over their face. Despite being aware of this allegation, the ADNS and a social worker did not conduct an investigation. Subsequently, another incident occurred where the same resident was found on top of another resident, holding a sheet over their face, causing the resident to scream. The second resident, who was severely cognitively impaired and receiving hospice services, was at risk due to the facility's failure to investigate the initial allegation.
A resident with a history of dysphagia and on a minced and moist diet was left unsupervised with whole pizza slices, leading to a fatal choking incident. Despite being aware of the resident's dietary restrictions, staff failed to provide necessary supervision, resulting in the resident's death after unsuccessful resuscitation efforts.
A resident on a minced and moist diet due to dysphagia was given whole pizza slices by another resident, leading to a fatal choking incident. Despite staff awareness, the resident was left unsupervised while eating, resulting in choking. Attempts to clear the airway were unsuccessful, and the resident later died at the hospital. The facility lacked a policy for outside food, contributing to the incident.
A resident with severe cognitive impairment became aggressive during a coloring activity, causing a skin tear on another resident's hand and kicking them. Despite the incident, no interventions were added to the aggressive resident's care plan. The facility's Director of Nursing acknowledged the incident as physical abuse but could not demonstrate that the facility had protected the resident from abuse.
Fire Incident Due to Improper Clearance from Baseboard Heaters
Penalty
Summary
The facility failed to maintain a safe environment for residents, resulting in a fire incident. A nursing assistant discovered a piece of paper on fire in a resident's room, which was unoccupied at the time. The fire was extinguished after a code red was initiated. The fire was attributed to a lack of clearance between a reclining chair and an electric baseboard heater, which was positioned too close to the heater, causing charring on the chair and the wall above the heater. Surveyor observations and interviews revealed that the facility had not ensured the required 6-inch clearance between furniture and electric baseboard heaters, as specified by the manufacturer's instructions. Many resident rooms had combustible items, such as beds, chairs, and bedding, in direct contact with or too close to the heaters. This was observed even after the fire incident, indicating a failure to address the hazard promptly. The residents involved included one with dementia and moderate cognitive impairment, and another with intact cognition. The latter resident reported that furniture had been rearranged in their room, possibly due to cold weather, which led to the unsafe placement of the recliner. The facility's inability to provide evidence of maintaining a hazard-free environment was noted during the surveyor's interviews with the administration.
Deficiencies in Ostomy Care and Documentation
Penalty
Summary
The facility failed to provide care consistent with professional standards of practice for three residents with ostomies. Resident ID #99, who was readmitted with a diagnosis including necrotizing fasciitis, experienced pain and bleeding around the stoma site. The record review revealed that the stoma site had mild peristomal skin breakdown due to an improperly sized stoma appliance and inadequate drainage of irrigation fluids. Despite these issues, there was no evidence that the physician was contacted or that a treatment plan was implemented for the skin breakdown. Additionally, there was no documentation indicating when the ostomy appliances should be changed or the type and size of appliances to be used. Resident ID #60, admitted with an ileostomy, also lacked specific orders for changing the ostomy appliance. Interviews with staff revealed inconsistencies in the care provided, with different staff members cutting the appliance to different sizes. The resident was unsure of who changed the ostomy appliances or how often they were changed, indicating a lack of communication and documentation regarding the resident's care plan. Resident ID #24, with a colostomy, had a prolapsed stoma, but there was no evidence that the prescribed treatment of applying granulated sugar was documented as administered. Staff were unable to provide specific information on when the ostomy appliance should be changed, and there was a lack of communication with the physician regarding the treatment plan. The physician was unaware of the prolapsed stoma and the treatment involving sugar, highlighting a significant gap in the coordination of care and communication within the facility.
Inadequate Infection Control Practices for EBP and COVID-19 Precautions
Penalty
Summary
The facility failed to maintain an effective infection prevention and control program, specifically regarding Enhanced Barrier Precautions (EBP) and COVID-19 precautions. For Resident ID #76, who was readmitted with a diagnosis requiring assistance with personal care and tested positive for an MDRO, staff members were observed not wearing the required personal protective equipment (PPE) such as gowns during high-contact activities like transferring and providing personal care. Despite signage indicating the need for EBP, staff members were unsure about the requirements and mistakenly believed the precautions were for the resident's roommate. Interviews with staff confirmed a lack of understanding and adherence to the EBP guidelines. In another instance, the facility failed to adhere to COVID-19 precautions for Resident ID #78, who tested positive for COVID-19 and was placed on droplet contact precautions. A nursing assistant entered the resident's room without wearing the required eye protection, despite facility signage and expectations for full PPE use, including a gown, gloves, N95 mask, and eye protection. Interviews with staff, including the Director of Nursing Services, confirmed the expectation for full PPE use, highlighting a deficiency in the facility's infection control practices.
Failure to Document and Monitor Deep Tissue Injuries
Penalty
Summary
The facility failed to provide necessary treatment and services to promote wound healing and prevent new ulcers from developing for a resident with a deep tissue injury (DTI). The resident, who was readmitted to the facility with diagnoses including muscle weakness and obesity, had a care plan indicating a risk for impaired skin integrity. The care plan included interventions such as evaluating the wound for size, depth, margins, exudate, edema, granulation, infection, necrosis, eschar, gangrene, and documenting the progress of wound healing on an ongoing basis. Despite a physician's order to apply skin prep to the DTIs on the resident's right and left heels daily, the facility failed to document weekly assessments of the DTIs, including measurements, staging, exudate, pain, wound bed, or a description of wound edges on specified dates. Interviews with a Licensed Practical Nurse and the Director of Nursing Services confirmed the lack of documentation for three consecutive weeks, which was against the facility's policy and the Director's expectations.
Failure to Protect Residents from Abuse
Penalty
Summary
The facility failed to protect residents from physical abuse, as evidenced by two incidents involving a resident with severe cognitive impairment. The first incident occurred when a resident with dementia, anxiety, and depression was found on top of another resident, who was non-ambulatory and receiving hospice services, with a sheet over their head. This incident was reported to the Rhode Island Department of Health, and it was revealed that the perpetrator had a history of severe cognitive impairment, as indicated by a BIMS score of 4 out of 15. The victim, who had a BIMS score of 0, was dependent on others for all activities of daily living. A second incident involved another resident who reported feeling scared of the same perpetrator, claiming that a blanket was put over their face. This resident, who had intact cognition with a BIMS score of 15, was moved to another room for safety. Despite these allegations, the facility's Assistant Director of Nursing and Social Worker did not conduct a thorough investigation, citing being too busy. The Social Worker also moved the non-ambulatory resident into the same room as the alleged perpetrator, despite the previous accusation of abuse. The Regional Director of Nursing acknowledged the failure to keep the non-ambulatory resident free from abuse.
Failure to Investigate Alleged Resident-to-Resident Abuse
Penalty
Summary
The facility failed to investigate an alleged abuse incident involving resident-to-resident abuse. On 7/31/2024, Resident ID #3 reported feeling scared of their roommate, Resident ID #1, and alleged that Resident ID #1 had put a blanket over their face. Despite being aware of this allegation, the Assistant Director of Nursing (ADNS) and the Social Worker, Staff C, did not conduct an investigation. Instead, Resident ID #3 was moved to another room for safety reasons. The facility's policy requires immediate reporting and investigation of any suspected abuse, but this was not followed. On 8/1/2024, another incident occurred where Resident ID #1 was found on top of Resident ID #2, holding a sheet over their face, causing Resident ID #2 to scream. Resident ID #2, who was severely cognitively impaired, non-ambulatory, and receiving hospice services, was at risk due to the facility's failure to investigate the initial allegation. Staff B, a Nursing Assistant, witnessed this incident but was unaware of the previous allegation against Resident ID #1. The Regional Director of Nursing acknowledged that no investigation was initiated on 7/31/2024, despite multiple staff members being aware of the initial abuse allegation.
Resident Chokes on Unsupervised Meal
Penalty
Summary
The facility failed to ensure adequate supervision for a resident who required assistance while eating, leading to a fatal choking incident. The resident, who had a history of Barrett's esophagus, hemiplegia, hemiparesis, and dementia, was on a minced and moist diet due to dysphagia and was documented to require supervision during meals. Despite these needs, the resident was left unsupervised with whole pizza slices, which were not part of the prescribed diet, resulting in a choking incident. On the day of the incident, another resident gave the resident two whole pizza slices, which the resident began to eat unsupervised. A registered nurse, aware of the dietary restrictions, attempted to educate the resident about the choking hazards but left the resident alone twice. The resident was later found choking, and despite attempts by staff to perform the Heimlich maneuver and CPR, the resident's airway remained obstructed until EMS arrived and removed the blockage. Unfortunately, the resident did not survive the incident. Interviews with staff and family members revealed that the resident had previously been supervised while eating a specially prepared minced and moist pizza for their birthday. However, on the day of the incident, the lack of supervision and failure to adhere to the resident's dietary restrictions directly contributed to the choking event. The facility's failure to provide the necessary supervision and dietary adherence resulted in the resident's death.
Resident Chokes on Unsupervised Meal, Resulting in Fatality
Penalty
Summary
The facility failed to ensure that a resident received food in the appropriate form, leading to a fatal choking incident. The resident, who had a history of Barrett's esophagus, hemiplegia, hemiparesis, and dementia, was on a minced and moist texture diet due to dysphagia and being edentulous. Despite these dietary restrictions, the resident was given whole pizza slices by another resident, which was not part of the prescribed diet. The resident was left unsupervised while consuming the pizza, which led to a choking incident. The incident occurred when a pizza delivery was made to another resident, who then shared the pizza with the resident in question. A staff member, RN Staff C, was aware that the resident had received whole pizza slices and attempted to educate the resident about the choking hazard. However, the resident reacted defensively, and the staff member left the resident unsupervised twice. During this time, the resident consumed most of the pizza, leaving only the crust, before choking. When the choking incident occurred, staff attempted the Heimlich maneuver and CPR, but were unsuccessful in clearing the airway. EMS was called and continued resuscitation efforts, eventually removing the obstruction, but the resident was pronounced deceased at the hospital. The facility lacked a policy for food brought in from outside, and the Director of Nursing Services acknowledged that the resident should have been supervised while eating the pizza.
Failure to Protect Resident from Physical Abuse
Penalty
Summary
The facility failed to protect a resident from physical abuse, as evidenced by an incident involving two residents during a coloring activity. Resident ID #5, who has severe cognitive impairment, became agitated and aggressive towards Resident ID #4, who has moderate cognitive impairment. During the altercation, Resident ID #5 grabbed a pen and caused a skin tear on Resident ID #4's hand, which required medical treatment. Additionally, Resident ID #5 was observed kicking Resident ID #4 in the legs. The incident was reported to the Rhode Island Department of Health, and the facility's policy on abuse prohibition was not effectively implemented to prevent this occurrence. The facility's records revealed that Resident ID #4 was admitted with dementia and anxiety, while Resident ID #5 was admitted with dementia and depression. Despite the incident, there was no evidence of interventions being put in place in Resident ID #5's care plan to address the physical aggression. The Director of Nursing Services acknowledged the incident as physical abuse according to the facility's policy but could not provide evidence that the facility had kept Resident ID #4 free from such abuse.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 511 citations issued within 25 miles in the last 12 months — including the 22 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Bristol
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| The Dawn Hill Home For Rehab And Healthcare | 0.7 mi | — | 5 | 0 |
| Warren Operations Ri, Llc Dba Warren Center | 2.4 mi | — | 3 | 0 |
| Grace Barker Nursing Center | 3.4 mi | — | 0 | 0 |
| Crestwood Nursing & Rehabilitation Center Inc | 3.8 mi | — | 3 | 0 |
| Mill Brook Rehabilitation And Healthcare Center | 5.5 mi | — | 0 | 0 |
Every risk area ranked, a do-first checklist, and your local survey patterns
Built specifically for Silver Creek Rehab And Healthcare Center.
100% money-back within 48 hours.
Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.