Premises Information


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Name

PINEVILLE REHABILITATION AND LIVING CENTER

Address

1010 LAKEVIEW DR

City/State/ZIP

PINEVILLE

28134

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

4/30/2015

Final Score @ Grade

General Comments

~11. Per a nurse, she refills her water pitcher in the handsink in the nourishment room. Ensure drinking water is received from any food prep sink, drinking fountain, or water dispenser.Except for the stipulations stated in rule .1312 (d), handwashing sinks shall only be used for handwashing. 15A NCAC 18A .1312 (d). 8. Observed items stored in and on the handsink in the salon. Ensure handsinks are not blocked so that hands may be washed at any time.Toilet, handwashing, and bathing facilities must be conveniently located and readily accessible to residents and staff. 15A NCAC 18A .1312 (a).24. Observed ants in the outside storage building. Provide pest control.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).28. Observed clothes and other items stored on the closet floor in room 16. Ensure all items are arranged to facilitate cleaning.All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).30. -Observed soiled drawers in one of the med carts.Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).-Observed pill cups stored with the mouthpiece unprotected and/or not inverted on several med carts.Unused medication cups shall be kept covered or inverted. 15A NCAC 18A .1318 (c).31. Observed the syringe for the feeding tube stored together & wet. After the syringe has been cleaned, it must be stored disassembled in order to air dry.Feeding syringes which are reused shall be labeled with the patient's name and date opened, shall be disassembled and rinsed after each use, and shall be disposed of within 24 hours of first use. 15A NCAC 18A .1318 (d).Mr. Dwight Madsen present during the inspection.Report emailed to ljohs@pinevillerehab.com, dmadsen@pinevillerehab.com

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	-Observed multiple water stained ceiling tiles in bedrooms, hall, and common areas (i.e. activity room).-Observed wall damage in multiple areas/rooms.Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
10	1	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Repeat Non-Compliance: Observed unlabeled bed pans in multiple rooms.Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c).
19	1	Ice protected, dispensed, equipment clean in good repair	No	No	No	-Observed ice coolers setting unattended in the halls.Ice shall be handled, transported, stored, and dispensed in such a manner as to be protected against contamination. 15A NCAC 18A .1314 (b).-Observed debris in the container the ice scoop is stored in (on the ice cooler cart).Ice machines, buckets, other containers, and scoops shall be protected from the elements, splash, drip, dust, vermin, other contamination, and from use by unauthorized personnel. 15A NCAC 18A .1314 (b).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat Non-Compliance: -Observed rips mattress in rooms 16.-Observed stains on side of mattress in room 64. Observed soiled pillow in room 39.-Observed stain on the dividing curtain in room 39.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	Repeat Non-Compliance: Observed stained sheets in room 16, 5, torn comforter in room 5, and stained pillow & case in room 39.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	-Observed old food debris residue collected in the microwave in the nourishment room.-Observed the feeding tube pump with old food debris residue.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).