Below average — CMS composite of the measures below.
The next survey window likely opens around January 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Pruitthealth- Rock Hill during CMS and state inspections, most recent first.
A refuse cart containing visible waste was observed positioned next to clean plate covers and near clean tray assembly areas during active dishwashing and lunch tray preparation. Facility policy required garbage disposal areas to be separate from food prep areas, but the Dietitian and KM stated the cart was kept there due to limited staffing and lack of another location, and the Administrator acknowledged the placement was not appropriate.
Open Dumpster Doors in Refuse Area: The facility failed to keep refuse containers closed in the garbage storage area. Surveyors observed two dumpsters with doors open and a cardboard compactor with its lid flipped back, exposing contents to environmental elements. The Housekeeping Supervisor stated the doors were supposed to be closed and closed them during the tour, but the same dumpster was later observed open again. The Administrator stated dumpster doors are expected to remain closed and refuse areas should be kept clean and sanitary.
Dirty Washer Filters Not Maintained: Surveyors observed 2 washer filters on the UniMac washer dusty and filled with black debris, despite a posted sign directing that the filter be cleaned daily. Manufacturer guidance reviewed by surveyors called for end-of-day cleaning of the AC invert drive filter. During interviews, the Laundry Assistant said she was unaware washer filters needed cleaning, the floor tech/maintenance assistant said laundry staff were responsible for washer and dryer filters, and the Laundry Supervisor acknowledged the filters were dirty and said there was no cleaning log sheet for the washer.
Inaccurate Advance Directive and Code Status Documentation: The facility failed to keep the EMR consistent with residents’ advance directives and physician code status orders. One resident with hospice involvement had a DNR authorization and care plan reflecting DNR/Allow Natural Death, but the active physician order remained Full Code. Another resident’s banner showed DNR while the physician order listed Full Code, and staff interviews confirmed the mismatches between the orders, banner, and advance directive documents.
Failure to Provide Bed Hold Policy Notification: A resident was transferred to the hospital by EMS and did not return, but the record lacked documentation that the required written bed hold notice, including reserve bed payment requirements, was given to the resident or representative at transfer, sent with transfer paperwork, or provided within 24 hours. The SSW and Administrator both confirmed they could not locate evidence that the notice had been provided.
A resident admitted with multiple diagnoses, including a left femur fracture, dementia, encephalopathy, dysphagia, and cerebral infarction, did not have the admission MDS completed within the required timeframe. The EMR showed the MDS remained in process, and the MDS Nurse and DON acknowledged it had not been completed on time.
Failure to initiate a baseline care plan for wound care and therapy services for a resident with a nonhealing surgical site, cellulitis, DM2 with neuropathy, and CP. The EMR showed no baseline care plan was started for wound care or therapy, and the MDS nurse confirmed there was no care plan addressing the resident’s wound progress or treatments; the DON stated the IDT should have initiated the baseline care plan within 24 to 48 hours of admission.
Failure to complete and implement an activities care plan for a resident. The resident was cognitively intact and had diagnoses including DM, HTN, and dysarthria, but no activities assessment was completed and the care plan did not address activities. The resident said no one had offered activities, no activities calendar was present in the room, and observations showed the resident remained in bed with only the TV for activity. The AD could not locate documentation and acknowledged the resident had no activities assessment or care plan.
Failure to Provide and Document ADL Bathing Care: A resident with cognitive impairment and multiple medical diagnoses did not receive bathing care consistent with her preferences. Her RP stated she had not had a shower or hair wash since admission and had only been offered bed baths, while observations found her in a hospital gown with greasy, unkempt hair. A CNA said showers were only given when staffing allowed and the schedule was not followed. Review of shower sheets and the ADL log showed no documented showers or hair washing, and no refusals were documented.
A resident who was cognitively intact and had stated preferences for reading, music, animals, news, group activities, favorite activities, and religious services was not assessed for activity needs and did not have an activities care plan. She reported that no one had invited her to activities, and observations showed her staying in her room and in bed with only her TV for company. The AD could not locate activity documentation and acknowledged the resident had no activities assessment or care plan.
The facility failed to consistently provide snacks when residents wanted them. Two residents had MDS preferences stating that snacks between meals were very important, yet staff described snack distribution as limited to designated residents on a list and routine times. Residents reported not being offered snacks at night or being told none were available, and a family friend stated one resident relied on outside snacks because facility snacks were not provided. Although nourishment rooms contained some food and beverages, interviews showed residents did not have reliable access outside scheduled times.
A resident with an indwelling urinary catheter, UTI, DM2, and Alzheimer's disease was observed multiple times with the catheter drainage bag resting directly on the floor. An LPN confirmed the condition, and the unit manager could not explain why the bag remained on the floor after the resident had fallen and broken the hook. The DON stated staff know the bag should stay off the floor, and the administrator said there was no catheter-related infection control policy.
A resident with cognitive impairment and partial dependence for ADLs was found in a room with a spill under the bed and an extension cord lying on the floor, despite facility policies prohibiting extension cords due to safety hazards. Staff were unaware of the extension cord's presence or purpose, and the spill was not promptly addressed, resulting in a failure to maintain a hazard-free environment and provide adequate supervision.
Refuse Cart Stored Near Clean Food Service Items
Penalty
Summary
The facility failed to maintain sanitary conditions in the kitchen by allowing a garbage/refuse cart containing visible waste to be positioned in close proximity to clean food service items during active tray assembly. Facility policy stated that garbage disposal areas should be separate from food prep areas, and that the dish room must be maintained in a clean and sanitary condition, with dish racks stored on a dolly, cart, or under a shelf in the dish room and not on the floor. During observation on 2/17/2026, a large trash/garbage cart with visible waste was seen adjacent to a rack of clean plate covers on the kitchen floor near the food service area during active dishwashing. On 2/18/2026, the same trash/garbage cart was again observed adjacent to clean plate covers stored on the kitchen floor and near racks of clean food service trays and the active lunch tray assembly area, while the Dietitian was assisting with tray preparation. The Dietitian stated the trash bin was kept there because there was no alternative location while the Kitchen Manager removed food debris and loaded the dishwasher. The Kitchen Manager later stated the bin was in that location temporarily because he was working alone and said it was not standard procedure. The Administrator stated garbage was expected to be stored outside of the kitchen and acknowledged the refuse bin was not appropriately placed.
Open Dumpster Doors in Refuse Area
Penalty
Summary
The facility failed to maintain the refuse disposal area in a sanitary and safe manner by not ensuring dumpster doors remained closed in two of two dumpsters observed. Review of the facility policy titled, Waste Disposal: Dietary Services, last revised 04/11/2016, stated that waste is to be disposed of in an effective manner to prevent a breeding place for insects, rodents, and transmission of diseases, and that garbage disposal areas should be separate from food prep areas. On 2/18/2026 at approximately 10:15 AM, the Housekeeping Supervisor escorted the surveyor to the refuse area, where two garbage dumpsters were observed with doors open and one cardboard compactor had its black lid flipped over the back of the container, exposing cardboard contents to environmental elements. One dumpster had a single door open, and the dumpster closest to the facility had both side doors open. The Housekeeping Supervisor stated the doors were supposed to be closed and immediately closed them, but no attempt was made to close the cardboard compactor lid. Later observations on 2/18/2026 and 2/19/2026 showed the same dumpster visible from a hallway window with the door open again. During interview on 2/19/2026 at approximately 6:45 PM, the Administrator stated dumpster doors are expected to remain closed and refuse areas should be maintained in a clean and sanitary condition to prevent contamination.
Dirty Washer Filters Not Maintained
Penalty
Summary
The facility failed to maintain 1 of 1 laundry washers in safe operating condition by not ensuring that 2 filters on the UniMac washer were cleaned daily. During an observation of the laundry room, surveyors found both washer filters dusty and filled with black debris, despite a manufacturer sign posted below the filters stating to clean the filter daily. Manufacturer guidelines reviewed by surveyors directed that the AC invert drive filter be cleaned at the end of the day by removing the external plastic cover, removing the foam filter, and washing or vacuuming it clean. During interviews, the Laundry Assistant stated she was unaware washer filters were to be cleaned and said maintenance cleans dryer lint filters. The floor tech/maintenance assistant stated laundry staff were responsible for keeping dryer and washer filters clean, while also stating his main job was floor tech work. The Laundry Supervisor acknowledged the washer filters were dirty and needed cleaning and stated she had educated staff on cleaning the washer filters with a small brush, but did not have a cleaning log sheet for the washer at the time of the observation.
Inaccurate Advance Directive and Code Status Documentation
Penalty
Summary
The facility failed to ensure the EMR accurately reflected residents’ advance directives and code status orders. Review of the facility policy stated that advance directives executed in accordance with state law would be honored and that any change or termination of an advance directive known to the facility would be entered into the medical record. Surveyors found that the physician orders, banner, care plan, and advance directive documents did not consistently match for two residents. R128 was admitted with diagnoses including peripheral vascular disease, heart failure, anxiety disorder, acute kidney failure, and plural effusion. Her admission MDS showed a BIMS score of 13, indicating she was cognitively intact. Records showed she decided to receive hospice care, and a DNR authorization form signed by the physician documented that she requested CPR not be initiated. Her care plan listed Allow Natural Death/Do Not Attempt Resuscitation, but her February 2026 physician orders still showed Full Code. Staff interviews confirmed the discrepancy, with the MDS nurse stating the resident had been made DNR and that a Full Code order remained active, and the DON stating the nurse should enter hospice-related orders and Social Services should update the banner within 24 hours. R23 was admitted with diagnoses including hypertension, dementia, insomnia, and depression, and his quarterly MDS showed a BIMS score of 05, indicating cognitive impairment. His physician orders for February 2026 listed Full Code, while his EMR banner identified him as DNR and advance directive documents showed his responsible party elected DNR. An LPN confirmed the code status did not match between the orders and the banner, Social Services confirmed the inaccuracy in the documentation, and the DON and Administrator stated the medical record was expected to be accurate.
Failure to Provide Bed Hold Policy Notification
Penalty
Summary
The facility failed to ensure written notification of the bed hold policy, including reserve bed payment requirements, was provided to the resident and/or the resident's representative for one resident reviewed for hospitalization. The facility policy stated that two notices related to the bed hold policy are to be issued: one during admission and a second at the time of transfer, with written notification within 24 hours in emergency transfers or sent with the transfer paperwork. A closed record review showed the resident was admitted to the facility and later transferred via EMS to the hospital, after which the resident did not return. The record contained no documentation showing that written notice of the bed hold policy was provided at the time of transfer, sent with the transfer paperwork, or issued within 24 hours. During interviews, the Social Services Worker stated she could not locate documentation of a bed hold notification, and the Administrator confirmed that neither she nor the Social Services Worker could find or provide evidence that the required written notice had been given.
Late Completion of Admission MDS
Penalty
Summary
The facility failed to complete the admission MDS within 14 calendar days after admission for one resident. R130 was admitted on 01/30/26 with diagnoses including displaced intertrochanteric fracture of the left femur, dementia, encephalopathy, dysphagia, and cerebral infarction. Review of the EMR showed the admission MDS dated 02/05/26 remained in process, and during interview the MDS Nurse stated the admission MDS had not been completed and should have been completed by then. The DON also stated that the MDS Nurse schedules the completion dates for the MDS and should make sure they are completed on time.
Failure to Initiate Baseline Care Plan for Wound Care and Therapy Services
Penalty
Summary
The facility failed to initiate a baseline care plan related to therapy services and wound care for one resident, R123, within the required timeframe after admission. The facility policy titled, Care Plans, stated that upon a new admission, a baseline care plan is to be developed by the admitting nurse in conjunction with the IDT, the resident, and/or the resident representative, and that it should be initiated in 24 hours and completed and implemented within 48 hours of admission. R123 was admitted with diagnoses including cellulitis of the left lower limb, type 2 diabetes mellitus with diabetic neuropathy, and cerebral palsy. The resident’s admission MDS showed a BIMS score of 15 out of 15, indicating cognitive intactness. Review of the EMR showed that a baseline care plan was not initiated for wound care or therapy services. During interview, the MDS nurse stated that R123 had a surgical site that would not heal and verified there was no care plan addressing the resident’s wound progress or treatments. The DON stated that the MDS nurses and IDT team should initiate the baseline care plan within 24 to 48 hours after admission and said, "They dropped the ball here."
Failure to Complete and Implement Activities Care Plan
Penalty
Summary
The facility failed to ensure a care plan was completed and implemented for a resident related to activities. Review of the facility policy stated that a comprehensive person-centered care plan is to be developed by the interdisciplinary team within seven days after completion of the comprehensive assessment and is to include measurable goals and timeframes to meet the resident’s medical, nursing, and psychosocial needs. The resident’s face sheet showed diagnoses including diabetes, hypertension, and dysarthria, and the admission MDS indicated a BIMS score of 15, showing the resident was cognitively intact. Review of the resident’s assessments in the EMR revealed no activities assessment was completed, and the care plan did not identify activities or a need for activities as a problem. The resident stated she was unaware of what activities the facility provided and said no one had ever offered to take her to activities. Observation showed no activities calendar in the resident’s room, and during continuous observations on multiple days the resident remained in her room and in bed with no activities in place other than her television. The Activities Director stated she typically completes an assessment on admission and visits daily, but she was unable to locate documentation for the resident and acknowledged the resident did not have activities assessments or care plans. The Administrator stated it was her expectation that all residents have activities assessments completed within 48 hours of admission and care plans as required.
Failure to Provide and Document ADL Bathing Care
Penalty
Summary
The facility failed to ensure a dependent resident received adequate ADL care consistent with her preferences. The resident was admitted with diagnoses including urinary tract infection, cognitive communication deficit, type 2 diabetes, and hypertension, and her MDS showed a BIMS score of 3, indicating cognitive impairment. Her MDS preference interview indicated that choosing between a tub bath, shower, bed bath, or sponge bath was somewhat important to her. Her care plan addressed ADL decline and included approaches to ensure her hair was combed, provide assistance when needed, and provide showers per schedule. The resident’s responsible party stated the resident had not had a shower or had her hair washed since admission and had only been offered bed baths. During observations, the resident was found lying in bed in a hospital gown with greasy, unkempt hair. A CNA stated showers were only given when there was enough staff and that the shower schedule was not followed. Shower room observations showed functioning shower space, and review of shower sheets from the admission period showed no dates signed off as showers given. The LPN confirmed there was no documentation of showers or hair washing and no documented refusals, and the resident’s POC ADL log reflected bed or partial baths rather than showers. The Unit 2 shower schedule did not indicate when the resident was scheduled for showers.
Failure to Assess and Provide Individualized Activities
Penalty
Summary
The facility failed to assess Resident 2 for activity needs and failed to provide activities that met her interests. Resident 2 was admitted with diagnoses including diabetes, hypertension, and dysarthria, and her MDS showed a BIMS score of 15, indicating she was cognitively intact. Her MDS Section F indicated that books, music, animals, keeping up with the news, group activities, favorite activities, and religious services or practices were somewhat important to her. During interview, Resident 2 stated she was unaware of what activities the facility provided and said no one had ever invited her to attend activities, although she could hear activities occurring elsewhere in the facility. Review of her EMR showed no Activities assessment had been completed, and her care plan did not identify activities or the need for activities as a problem. Observations over several days showed Resident 2 remained in her room and in bed with no activities in place other than her television. The Activities Director stated she typically completes an assessment on admission and visits residents daily, but she was unable to locate documentation for Resident 2 and acknowledged that Resident 2 did not have activity assessments or care plans. The Administrator stated it was her expectation that all residents have activities assessments completed within 48 hours of admission and care plans as required.
Failure to Provide Snacks When Residents Requested Them
Penalty
Summary
The facility failed to provide snacks for two residents, R8 and R22, despite both residents’ MDS assessments indicating that having snacks available between meals was very important to them. Facility policy stated that dietary staff would stock nourishment rooms with a variety of food and beverage items and that nursing staff would offer HS snacks to all residents except those not receiving oral nutrition. However, the report documented that snack distribution was handled as a designated list for specific residents, and the CNA interviewed stated that snacks were usually distributed at about 2:00 P.M. and 7:00 P.M. and that staff used a list of residents identified as wanting snacks. Observations of the nourishment rooms on 02/19/2026 showed food and beverages present in the units, including snack cakes, crackers, applesauce, supplements, and soda, but interviews indicated that availability did not translate into routine access for all residents. During the Resident Council Meeting, R8 stated that residents do not get offered snacks at night. R22 stated that she asks for snacks at night and is told there are no snacks, or sometimes receives them, and that she stopped asking because she does not receive them and instead buys from the canteen. Additional interviews supported that residents who wanted snacks outside the routine distribution times were not consistently provided them. A family friend of R13 stated that if she did not bring snacks, the resident would not receive one, and that R13 relied on snacks because she did not eat large meals and typically did not eat well without them. The Dietitian stated that the kitchen closed at 8:00 PM and that if snacks were not available in the nourishment room after that time, residents would have to wait until the next day. The DON stated that snacks should always be available day and night and that residents should have snacks when and as they want them, but the facility did not consistently meet those needs.
Urinary catheter drainage bag left on the floor
Penalty
Summary
The facility failed to ensure appropriate infection control practices were followed for one resident with an indwelling urinary catheter. The resident was admitted with diagnoses including urinary tract infection, type 2 diabetes mellitus, and Alzheimer's disease, and had an order for a chronic urinary retention catheter with a 16 FR 10 cc bulb. During observations, the resident was seen lying in bed while the catheter drainage bag was resting directly on the floor, including on 02/17/26 at 1:40 PM and again at 4:50 PM. An LPN confirmed at 4:55 PM that the catheter bag was on the floor. The resident was observed again on 02/18/26 at 11:00 AM lying on the floor beside the bed, and the catheter bag was still resting on the floor. The unit manager stated the resident had broken the hook that hangs the bag when she fell, which was why the bag was on the floor on 02/17/26, but could not explain why it was still on the floor on 02/18/26. The unit manager said a new privacy bag would keep the catheter bag off the floor. The DON stated that nurses and CNAs know the catheter bag should always remain off the floor, and the administrator stated there was no policy related to catheter care or infection control in regard to a catheter.
Failure to Prevent Accident Hazards Due to Spill and Extension Cord in Resident Room
Penalty
Summary
A deficiency was identified when a resident who required partial assistance with activities of daily living and was unable to communicate verbally was found in a room with a spill under the bed, which was covered with a sheet, and an extension cord plugged into the wall lying on the floor next to the bed. The resident's medical record indicated cognitive impairment, as evidenced by an incomplete BIMS assessment. During observation, staff were unaware of the presence or purpose of the extension cord, and the RN/Unit Manager acknowledged that extension cords should not be in resident rooms. The Maintenance Director confirmed that extension cords had previously been removed from the room and that staff had been educated on the prohibition of extension cords due to fire and safety hazards, in accordance with NFPA guidelines. These conditions demonstrated a failure to ensure the environment was free from accident hazards and to provide adequate supervision to prevent accidents.
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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.
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Nursing homes near Rock Hill
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| White Oak Manor - Rock Hill | 0.5 mi | ★★★★★ | 0 | 0 |
| Rock Hill Post Acute Care Center | 0.9 mi | ★★★★★ | 2 | 0 |
| Magnolia Manor - Rock Hill | 1.1 mi | ★★★★★ | 1 | 0 |
| Westminster Health & Rehab Center | 1.4 mi | ★★★★★ | 3 | 0 |
| Willow Brooke Court At Park Pointe Village | 2.5 mi | ★★★★★ | 0 | 0 |
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