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

6/11/2019

Final Score @ Grade

General Comments

5) Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). Observed vent fan in 195 bathroom to be dusty. Observed heating ballast/cover loose on one side in room 292. 19) Ice machines, buckets, other containers, and scoops shall be cleaned on a regular schedule such that they are kept free of scum, rust, mold or other contamination. 15A NCAC 18A .1314 (b). Observed some build up on back of ice chute in AL kitchenette. 27) Retain veterinary records for pets, including therapy animals. 15A NCAC 18A .1317 (f). Observed rabies records for two therapy dogs expired within 30 days ago. Ensure updated records are received before animals return to facility. 28) All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed briefs stored on floor in room 285. 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). Observed equipment storage room in need of organizing. REPEAT VIOALTION Improvement from previous inspection. 30) Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c). Observed drawers of med cart in AL with some debris accumulation. NOTE: Observed facility is using H2Orange product only, in single resident bathrooms. This product is not approved as a disinfectant. EHS strongly recommends using disinfectant on all bathing and toileting surfaces to reduce the risk of spreading bacteria and viruses including but not limited to norovirus and shigella. NOTE: Observed pimento cheese, egg salad, and chicken salad in containers from the main kitchen in kitchenettes that are date marked for 8 days. Ensure product is properly date marked for 7 days, per food code, when leaving the kitchen. Products were within 7 day date mark during inspection today.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	1	Walls and ceilings cleanable, clean, good repair	No	No	No	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed baseboards in AL in hallways and dining room in need of touch up paint. Observed baseboard in room 180 in need of painting. Observed wall damaged in memory care spa at entrance to shower. Observed paint peeling on bathroom door in room 195. Observed floor in healthcare dining closets with debris accumulation. REPEAT VIOLATION Some improvement from previous inspection }
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed grout in shower of memory care spa with black build up. Observed shower chair in memory care spa with rust and pink build up underneath and on legs. Observed Chipped shower in room 285. Observed pink build up on bottom of shower curtain in room 285. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed hoppers in soiled linen room in AL and in eyewash room in need of cleaning.
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	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). Observed worn finish on end table in room 271. Observed mattress in room 285 with body fluid on it that went through the sheet. Observed stained pillow in room 198. Observed cushion in AL dining with stain. Observed stained couch in living room of AL and debris under the couch as well. Observed chair on 90's hall by housekeeping closet with stains.
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed stained sheets in room 285 on bed. Observed stained top sheet in room 278 on bed. Observed sheets with debris in room 164 on bed. Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b). Observed unlabeled carts in healthcare soiled utility room. CDI: Carts labeled.