PruittHealth- Columbia

In the surveyor’s words

From the most serious findings on record at PruittHealth- Columbia, in the surveyor’s own words.

• Immediate jeopardy, patternF578Jun 30, 2023

  Based on review of the facility policy, interviews and record reviews, the facility failed to ensure that Advanced Directives were correctly documented and/or implemented for 3 of 3 residents reviewed, Resident (R)5, R9, and R20. On [DATE] at 5:52 PM, the Interim Administrator (IA) was notified that the facility's failure to maintain and implement written policies and procedures regarding advanced directives caused a resident to not receive Cardiopulmonary Resuscitation, the IA was then notified that the allegation constituted Immediate Jeopardy (IJ) at F 578, with an effective date of [DATE] and the IJ template was presented. On [DATE] at 2:27 PM, the Director of Nursing (DON) provided an acceptable IJ removal plan for F 578. […]

• Immediate jeopardy, patternF600Jun 30, 2023

  Based on interviews, record review, and facility policy the facility failed to ensure Resident (R)5 and R6 were free from sexual abuse. Additionally, the facility failed to give report to another Licensed Nurse to ensure residents needs were met before leaving the facility for break. Specifically, R10 On 1/23/23 at 7:45 PM, a staff member observed R5 lying on top of R6 with his genitals exposed. After separating the residents and body audits completed, the facility conducted interviews with both residents. The investigation revealed R5 stated that R6 was a woman and that he knew her from the past. R6 was interviewed and made sexual references that occurred by showing with happened with his hands. Both residents were fully clothed at the time of the incident. […]

• Immediate jeopardy, isolatedF689Jan 7, 2022

  Based on record reviews and staff interviews, the facility failed to ensure 1 of 3 residents' environment was free of accident hazards/supervision/devices. Specifically, Resident (R) 1 left the facility unattended on 12/26/21. Staff were unaware of R1's whereabouts or condition until he was found by Emergency Medical Staff (EMS) at a nearby hospital. This failure had the potential to place R1's health and safety at risk for serious injury, harm, impairment, or death. The facility's failure substituted substandard quality of care. Resident (R)1 had a successful elopement from the facility on 12/26/21. A nurse's note on 12/26/21 by the Licensed Practical Nurse on duty, indicated on 12/26/21 at 10 PM, resident was not in his room. […]

• No harm, potential for more than minimal, widespreadF802Jul 18, 2025

  Based on review of facility policy, direct observations, and staff interviews, the facility failed to ensure resident meals were served and distributed in a timely manner. This failure to adhere to established meal service protocols had the potential to impact residents' nutritional intake, satisfaction, and overall quality of care.Review of facility policy titled Mealtimes with a revision date of 10/18/2017 revealed: .2. Meals must be established at regular intervals comparable to those in the community.Review of designated mealtimes revealed the following schedule: Breakfast is served from 7:45 AM to 8:45 AM, Lunch from 11:40 AM to 1:00 PM, and Supper from 5:00 PM to 6:15 PM.An observation on 07/16/25 at 9:17 AM revealed a resident in room [ROOM NUMBER] yelling out, Give me something to… […]

• No harm, potential for more than minimal, widespreadF812Jul 18, 2025

  Based on a review of the facility's dietary policies, observations, and staff interviews, the facility failed to ensure proper sanitation of kitchen equipment, maintain overall cleanliness of the main kitchen, and properly label and discard expired foods in the 1/1 main kitchen. This deficiency posed a potential risk to the health and safety of the 140 residents who reside in the facility and consume food prepared in the kitchen.Review of facility policy titled Labeling, Dating, and Storage with a revision date of 11/11/2022 states, 1. Food and beverage items will have an identifying label as well as a received date and opening date, as applicable; for items prepared on site, a 'use by' date will also be indicated. 2. […]