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

2/15/2016

Final Score @ Grade

94.50

General Comments

Dwight Madsen was present during the inspection. Cassandra Dority accepted the report. NO POINT DEDUCTION: 2. Observed the floor beside the toilet with dried urine in room 48. **Keep all flooring clean. 15A NCAC 18A .1309 (a). 8. Observed the shower curtain with pink and brown residue in room 61. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). 14. Per houskeeping staff the shpwers are disinfected once a day. Ensure that the shoers in shared rooms are disinfected after each resident's use. **Skin contact surfaces of all shared bathing equipment shall be cleaned with a detergent solution and then disinfected with an EPA registered hospital disinfectant between patient uses. 15A NCAC 18A .1312 (f). 33. Observed the soiled linen container used for bibs and cloth napkins was not labeled in the activities room. **Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b). 34. Observed no documentation for chlorine level. Unable to assess chlorine level. **Provide documentation from Webb Chemical for chlorine sanitizer concentration at both washing machine on maintenance visit record. **All common linen including sheets, pillow cases, absorbent pads, towels, and wash cloths provided by the facility must be sanitized between users with an EPA registered laundry sanitizer or by other methods described in 15A NCAC 18A .1319 (b).

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) Observed the ceiling with wet/stained tiles in the closet near rehab, and the main hallway. Observed door frames and walls with damage (chipping paint), and some popcorn texture separating from the ceiling. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
10	0.50	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Observed a bedpan was not labeled in room 18, and had only a name in room 5. **Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c).
18	1	Drinking utensils properly handled	No	No	No	Observed issued drinking cups in several resident rooms (5, 13, 18, 48) were not labeled. **Label all disposable water pitchers with the resident's/patient's first name and last name. 15A NCAC 18A .1314 (a).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed boxes of disposable briefs and gowns were stored on the floor in the maintenance room closet. **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Observed a box of clean gloves was store on top of the sharps container, and a stack of drinking cups were un covered on a medication cart. Drinking cup must be protected while stored. **Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c).
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Observed dinette tables in the private rooms (5, 13, 18) with damaged surfaces, and some phone with residue. **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).
35	0.50	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	Observed several brushes stored with hair in them in the salon. **Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c).