Premises Information


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Name

UNIVERSITY PLACE NURSING AND REHABILITATION CENTER

Address

9200 GLENWATER DR

City/State/ZIP

CHARLOTTE

28262

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

10/21/2015

Final Score @ Grade

84.50

General Comments

2. Observed debris collecting on floor around oxygen storage. Observed debris on floor in several storage rooms throughout facility. Observed bathroom floor collecting reisdue in 100 hall bath.Keep all flooring clean. 15A NCAC 18A .1309 (a).13. Observed hot water at 97.8 degrees in 100 hall bath hand sink.Maintain the hot water at all resident accessible hand washing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e).15. Observed no backflow prevents on shower wands in baths throughout. Observed no backflow preventers on removable eye wash sprayers throughout. Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d).16. Observed no complete backup water supply plan available.Observed an incomplete backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f).21. Observed dumpster side door open and trash collecting on ground infront of dumpster.All solid wastes containing food scraps or other decomposable materials shall, prior to disposal, be kept in leak-proof, non-absorbent containers, which shall be kept covered with tight fitting lids when filled or stored, or not in continual use. 15A NCAC 18A .1316 (a).24. Observed silverfish in resident room on SPARK unit.Effective measures shall be taken to keep flies, rodents, cockroaches, and other vermin out of the establishment and to prevent their breeding or presence on the premises. 15A NCAC 18A .1317 (a).39. Observed food not labeled in nourishment refrigerator with resident name or date.All food and food supplies provided by an institution shall be from sources that comply with 15A NCAC 18A. 2600.44. Observed 5 gallon water container stored on floor, used for backup water supply.Containers of food shall be stored above the floor, on clean racks, dollies, slatted shelves, or other clean surfaces in such a manner as to be protected from splash or other contamination. 15A NCAC 18A .1323 (c).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
1	1	Floors easy to clean, no obstacles, drains where needed	No	No	No	Repeat non-compliance: Observed floor damaged in carnation dining room.Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b).
3	2	Walls and ceilings cleanable, clean, good repair	No	No	No	Observed stained ceilings in hallways and closets throughout facility. Observed damaged wall paper in hallways. Observed damage in 812, Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
5	1	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	Observed dusty vents in bathrooms throughout facility.Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat non-compliance: Observed damaged shower stretcher mat in 800 bath. Observed dirty shower stretchers, shower chairs, and shower stall walls in bathrooms throughout facility. Observed several toilet collecting residue in resident rooms. Observed one loose toilet seat in 800 hall. Observed toilets dirty in maintenance rooms, converted guest rooms.Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).
9	1	Toilet rooms free of storage, hand wash signs posted	No	No	No	Repeat non-compliance: Observed maintenance storage in converted resident rooms.Toilet rooms shall not be used for storage. See rule .1312 (b).
10	1	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Repeat non-compliance: Observed bedpans with no label, or only room and bed number in resident rooms throughout.Observed dirty bed pans stored as clean in 304/306 restroom.Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c).All bedpans/urinals/emesis basins shall be cleaned after each use. 15A NCAC 18A .1312 (c).
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Observed no paper towels in 100 bath.Provide liquid soap and disposable towels at all hand washing sinks. 15A NCAC 18A .1312 (d).
18	1	Drinking utensils properly handled	No	No	No	Observed disposable water pitchers labeled with room number only.Label all disposable water pitchers with the resident's/patient's first name and last name. 15A NCAC 18A .1314 (a).
19	1	Ice protected, dispensed, equipment clean in good repair	No	No	No	Observed ice chest accessible to residents on 700 hall.All ice machines and storage chests which are accessible to the residents and the public shall be automatic ice dispensing machines. 15A NCAC 18A .1313 (b).
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Observed several damaged mattresses in resident rooms.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).\|
33	2	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed sheets on several resident beds stained and collecting debris. Observed soiled linen not covered in soiled room for laundry intake.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).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).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	Observed residue collecting on refrigerators in nourishment rooms throughout.Non-food contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. See rule .1320 (c).