Sprenger Health Care: Immediate Jeopardy Finding - SC
His arm was bruised. He had two significant scrapes. A nurse told the family he had just fallen. It was, according to a family member who spoke to inspectors, "the umpteenth time."
Federal inspectors who arrived on November 25, 2025, cited the facility for immediate jeopardy to resident health or safety, the most serious level of harm CMS assigns.
The family member's account was blunt: her father had just left the building on his own, with nobody watching, and then he fell. The inspection record does not say how far he got or how long he was outside before anyone noticed.
The facility's response came fast, at least on paper. Within hours of the incident on November 22, the Director of Nursing conducted a whole-house audit of elopement risk assessments and confirmed that residents identified as at-risk were housed in the secured unit with wander guard orders in place. No concerns were noted, the facility reported. An emergency quality assurance meeting that same evening pulled in the Administrator, the Regional Administrator, the Director of Clinical Services, the Chief Operating Officer, the Chief Executive Officer, and the Executive Director of Quality Assurance by phone.
By 8:30 that night, the Director of Nursing had educated all nursing staff on elopement policies. By 8:45, the medical director had been notified.
The facility committed to daily audits of elopement assessments for four weeks, weekly audits of four residents' elopement risk levels, and two months of monitoring nurses' notes for documentation of significant changes in condition.
What none of that paperwork addresses is the man who bled on his way back inside.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Sprenger Health Care of Port Royal from 2025-11-25 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 19, 2026 · Our methodology
Sprenger Health Care of Port Royal in Port Royal, SC was cited for immediate jeopardy violations during a health inspection on November 25, 2025.
He had two significant scrapes.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.