PruittHealth-Durham

In the surveyor’s words

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

• Immediate jeopardy, patternF580Oct 27, 2022

  Based on record review, staff interviews, physician assistant and physician interview, the facility failed to notify the physician of the development of an open wound to a resident's right leg on 7/27/22 that deteriorated in condition through 8/13/22 for 1 of 3 residents (Resident #293) reviewed for notification of change. This failure resulted in no physician evaluation of the wound and no physician ordered treatments to the wound. On 8/12/22 the wound was assessed by Nurse #7 with a foul odor and on 8/13/22 Nurse #7 notified the physician of the wound, a change in the resident's condition, and the physician ordered for the resident to be transferred to the hospital. […]

• Immediate jeopardy, patternF684Oct 27, 2022

  Based on record review, staff interviews, physician assistant and physician interviews, the facility failed to identify/assess a wound for 1 of 3 residents (Resident #293). Nurse #11 identified a wound on Resident's right leg on 7/27/22. There were no orders for wound care. From 7/27/22 to 8/12/22 Nurses failed to complete the weekly body observations that included wound observations and measurements. On 8/12/22 Nurse # 7 noted an open wound to posterior right leg with foul smelling odor with some bleeding and, Nurse #7 failed to address/communicate/report/document the condition/status/size/appearance of the wound. On 8/13/22 Resident #293's condition changed, and Resident #293 was hospitalized . […]

• Immediate jeopardy, isolatedF600Feb 17, 2023

  Based on record review and interviews with staff and the Physician Assistant, the facility to protect Resident #1's right to be from a suspicious injury for 1 of 1 resident sampled for abuse (Resident #1). Resident #1 told staff he was hit in the eye and was later discovered with a bruise around the left eye. The findings included: Resident #1 was admitted to the facility on [DATE] with diagnoses which included dementia with behavioral disturbance and Alzheimer's disease. A review of a quarterly Minimum Data Set (MDS) dated [DATE] indicated Resident #1's cognition was severely impaired for daily decision making and required total assistance with activities of daily living. […]

• Immediate jeopardy, isolatedF610Feb 17, 2023

  Based on record review and interviews with staff and the Physician Assistant (PA), the facility failed to report an allegation of abuse to the administrator immediately per policy, assess Resident #1 when the left eye was observed to be red and swollen, assess other residents who were under the care of Nurse Aide #4, and protect all residents from physical abuse by allowing Nurse Aide #4 to continue working the entire shift. This deficient practice was discovered for one of one resident sampled for abuse, however the deficient practice had the high likelihood to impact multiple residents. […]

• Actual harm, isolatedF583Jun 12, 2026

  Based on observation, record review, resident and staff interviews, the facility failed to maintain personal privacy and dignity for 3 of 5 residents reviewed for resident rights. The facility failed to ensure privacy when a Resident #17 was left naked with his genitals exposed and visible to the public. Resident #17 stated he felt angry, embarrassed, and as though he was on display as a result of the incident. The facility also failed to treat Resident #57 in a dignified manner when staff did not provide privacy during activities of daily living, exposing Resident #57's buttocks and private areas during bathing and wound care. […]