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

8/21/2015

Final Score @ Grade

92.50

General Comments

2. Observed the floor by the stove in the activity room with built up residue.Keep all flooring clean. 15A NCAC 18A .1309 (a).8. Observed the toilet chipped in room 18 and soiled in room 22.Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).14. -Per a CNA, a chemical called 'Urine Cleaner" is used to clean the whirlpool by spraying it in and wiping it out. Ensure the correct chemical is used and the manufacturer's instructions are followed.The manufacturer's instructions shall be followed for cleaning equipment with pumps. See rule .1312 (f).-Observed an empty chemical bottle in the whirlpool. Replace.A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).*NOTE: It is strongly suggested to print out the manufacturer's instructions for cleaning the whirlpool and post them in the room. The directions must coincide with the particular chemical that is to be used.27. Therapy pets are allowed in the facility. Ensure a copy of the rabies vaccinations are kept onsite.Maintain adequate vet records for all animals. 15A NCAC 18A .1317 (f).Mr. Dwight & Mrs. Cassandra present during the inspection.Report emailed to dmadsen@pinevillerehab.com & cdorty@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	Repeat Non-Compliance: -Observed multiple water stained ceiling tiles in storage rooms, therapy, etc.-Observed wall damage in areas (restrooms, bedrooms, mop laundry room).-Observed the popcorn ceiling in the hallway chipping.Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	-Observed soap dispenser not working in the med room (West side).-Observed no soap and the paper towel dispenser not working in room 63.Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Repeat Non-Compliance: -Observed heavy residue buildup in the med cart drawers.Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).-Observed pill cups stored with the mouthpiece unprotected on med carts.Unused medication cups shall be kept covered or inverted. 15A NCAC 18A .1318 (c).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat Non-Compliance:-Observed rips mattress in rooms 18 and 22.-Observed rips/holes in pillows in rooms 8, 39, 22, and in the therapy gym. .-Observed the drawers in the supply room with residue.-Observed the raw wood exposed on the table in room 18.-Observed sticky residue under the bedside table.-Observed a shelf with a large amount of residue stored beside the stove in the therapy room.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 and/or debris in the beds in rooms 8 and 63.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).