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

12/5/2014

Final Score @ Grade

General Comments

15. Observed no backflow preventer in room 273.Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d).17. Observed pink residue collecting on mouth guard for water fountain in assisted living hall.Drinking fountains shall be kept clean and properly regulated. 15A NCAC 18A .1314 (a).28. Observed clean incontence supplies with packages open stored in soiled utility room in assisted living unit.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).32. Observed decorateve pillow soiled in 191. Observed gray spot on top of chair in 191. Observed couch in common area in assistled living collecting food debris.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).Mr. Muller present during 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	Repeat non-compliance: Observed residue collecting on shower chair in memory care. Observed caulk damaged in room 154 and in 182 backslpash. Observed shower head collecting residue in meempory care spa.Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b) Improvement from previous inspection.
42	2	Food protected. Potentially hazardous food maintained at 45 F or below, or 140 F for above, consumed or discarded within 2 hours of being removed from temperature control	No	No	No	Observed food not discarded in refrigerator with discared date of 12/4/14.Observed vacutube specimine in medication refrigerator stored over wine bottle.All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. 15A NCAC 18A .1323 (a).