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

6/10/2015

Final Score @ Grade

General Comments

3. Observeed wall damged in linen closet in memory care, door knob through wall.Keep all walls in good repair.5. Observed one vent dusty in oxygen storage room in the health care area.Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).14. Caregiver did not know the contact time for the disinfectant used for cleaning shower chairs and bathing equipment.A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). EPA contact time for disinfectant in use was 2 minutes.34. Observed mesh clean linen storage cart stored in laundry room in memory care. Clean linen shall be stored and handled in a separate room or area, or in another manner that will prevent contamination of clean linen. 15A NCAC 18A .1319 (b). A solid barrier must be present on the linen cart.40. Observed staff food stored in refrigerator with bottled water for the facility.Food brought from home by employees or visitors of patients or residents shall be stored separately from the institution's food supply and shall be labeled with the name of the person to receive the food and the date the food was brought into the facility. 15A NCAC 18A .1321 (b).42. Observed bowls in refrigerator with assorted butter spreads, one container real butter and requiring refrigeration. Butter is a potentially hazardous food and must be kept on time or temperature control at all times.All perishable foods shall be stored at temperatures which will protect against spoilage. See rule .1323 (a).Potentially hazardous foods served shall be either consumed or discarded within two hours of being removed from temperature control. 15A NCAC 18A .1323 (a)

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 casters for shower chairs collecting hair in health care. Obseved shower chair collecting residue on track for catch basin. Observed toilet seat soiled in one assisted living room restroom. Observed damage toilet seat in health care 163.Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed one set of sheets with tear, one set with debris, one with stain in rooms throghout faclity.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).