Greenville Post Acute

In the surveyor’s words

From the most serious findings on record at Greenville Post Acute, in the surveyor’s own words.

• Immediate jeopardy, isolatedF803Jul 30, 2026

  Based on review of facility policy, record review, and interview, the facility failed to follow Resident (R)138's diet order which resulted in R138 choking and dying. This failure had the possibility to negatively impact the 34 residents on a mechanical soft diet residing in the facility. On 07/30/26 at 4:46 PM, the Administrator and Director of Nursing were provided with a copy of the CMS Immediate Jeopardy (IJ) Template and informed the facility IJ existed as of 06/26/26. The IJ was related to 483.60 - Food and Nutrition Services. On 07/30/26, the facility provided an acceptable plan for removal of the IJ. The survey team verified all elements of the facility's removal plan and determined that the facility put forth due diligence in addressing the noncompliance. […]

• Immediate jeopardy, isolatedF600Mar 30, 2022

  Based on interviews and record review, the facility failed to protect 1 of 5 residents (R2) from neglect. R2 had an successful elopement from the facility on 03/26/22 at approximately 3:10 PM. Certified Nursing Aide (CNA) 1 and Registered Nurse (RN) 1 failed to provide adequate care or supervision during their shift, so the resident was not noted as missing until approximately 9:15 PM that same day - 6 hours later. The facility called a Code Pink (missing resident alert) and the police found the resident on 03/27/22 at 2:30 AM approximately 1.5 miles from the facility. The neglect had the potential to result in serious bodily harm or death. R2 was admitted to the facility on [DATE] for respite care with diagnoses [MEDICAL RECORD OR PHYSICIAN ORDER] . […]

• Immediate jeopardy, isolatedF689Mar 30, 2022

  Based on interview and record review, the facility failed to protect 1 of 5 residents (R2) from accidents and hazards. R2 had an successful elopement from the facility on 3/26/22 at approximately 3:10 PM. Certified Nursing Aide (CNA) 1 and Registered Nurse (RN) 1 failed to provide adequate care or supervision during their shift, the resident was not noted as missing until approximately 9:30 PM that same day - 6 hours later. The facility called a Code Pink (missing resident alert) and the police found the resident on 03/27/22 at 2:30 AM approximately 1.5 miles from the facility. […]

• No harm, potential for more than minimal, widespreadF803Apr 24, 2025

  Based on observation, interview, and facility policy review, the facility failed to ensure that menus were followed in regard to serving sizes. This had the potential to affect 120 of 124 residents who consumed meals from the facility's kitchen and placed them at nutritional risk. The facility identified four resident who were nothing by mouth (NPO). Findings include: Review of policy titled Diet Accuracy with a revision date 2/23, revealed Tray cards are to be used on the tray line for service and checked prior to leaving the kitchen for accuracy. Proper portions are to be served according to menu extensions. […]

• No harm, potential for more than minimal, widespreadF804Apr 24, 2025

  Based on observation, interview, and test tray sample, the facility failed to provide food that was palatable and at the proper temperature. This had the potential to affect 120 of 124 residents who consumed food from the kitchen and for them to be at nutritional risk. The facility identified four residents who were nothing by mouth. (NPO). Findings include: 1.Review of R89's admission Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 03/11/25 and located under the MDS tab in the electronic medical record (EMR) revealed R89 had a Brief Interview for Mental Status (BIMS) score of 12 out of 15, which indicated the resident was moderately impaired in cognition. During an interview on 04/22/25 at 11:15 AM with R89, R89 indicated that the food was served cold. 2. […]