Premises Information


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Name

PINES AT DAVIDSON, THE

Address

400 AVINGER LN

City/State/ZIP

DAVIDSON

28036

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

2/7/2014

Final Score @ Grade

97.50

General Comments

6. Observed small area of mold on wall under cabinet of soiled utility room on 100 hall near Purcell wing. Wall area was under cabinet were bed pan sanitizer was previously.Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d). 15. Observed no backflow prevention on hose bib in garden area.Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d).32. Observed 2 damaged vinyl pillows on 100 hall.All furniture, bed springs, mattresses, sleeping mats, draperies, curtains, shades, venetian blinds, or other furnishings in institutions shall be kept clean and in good repair. 15A NCAC 18A .1319 (a).28. Observed linens stored closer than 8 inches to the floor in 100 linen closet. Observed mouth swabs stored closer than 8 inches to the floor in the storage closet near Purcell wing.All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).42. Nursing director stated that ice in placed in a trash bag in a cooler and dispensed. Bag was not food grade.All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. 15A NCAC 18A .1323 (a).Ice must be put in a food grade bag and cooler must be kept clean. If no bag is to be used the cooler must be washed rinsed and sanitized after each use.Ice must be dispensed at a frequency so that water does not collect in the cooler.Mr. Muller received inspection.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Observed shower chairs in 270 and 296 with pink buildup. Observed shower wand track in Purcell spa loose. Observed shower hand rail paint damaged in spa on 100 hall. Observed casters collecting debris around wheels in spas on 100 halls. Improvement from last inspection.Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed single service cups stored on med cart uncovered. in 100 hall. Observed single service cups stored uncovered in Purcell nourishment room.Suitable rooms or spaces shall be provided for the storage of all necessary equipment, furniture, and supplies, and kept clean. 15A NCAC 18A .1318 (a).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed sheets stained in Purcell wing resident room near custodial closet. Observed debris collecting on sheets in 198. Observed damaged bed pad in one resident room. Observed one towel not covered in soiled laundry in soiled utility closet on first floor.Soiled linen shall be placed in a covered container or bag at the point of use and stored and handled so as to contain and minimize aerosolization of and exposure to any waste products. 15A NCAC 18A .1319 (b). Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).