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

12/21/2017

Final Score @ Grade

General Comments

No Points Deducted for the following: 5. Observed dust building up on overhead vent in Beauty Salon. Needs to be cleaned more frequently. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). 33. Observed linen on made up bed with debris on sheets in Room 8. Observed made up bed in with wet stain in Room 45. Sheets were removed from bed. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). 36. Observed microwave with food debris in nourishment room. Needs to be cleaned. **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). 39. Observed disinfectant wipes stored with food in storage room. Wipes were relocated. **All food and food supplies shall be clean, free from spoilage, free from adulteration and misbranding, and safe for human consumption. 15A NCAC 18A .1321 (a).

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 light shield bowing and collecting insects in Activity Room. Needs to be repaired and have dead insects cleaned out. Observed ceiling tile pushed up into ceiling in Janitor's Closet. Needs to be set back in place. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Observed hopper not operating in Soiled Room. Observed sink backed up in Room 59. Observed loose toilet seat in Rooms 59 and 45. Needs to be repaired. Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b) Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).
10	0.50	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Observed bed pan not labeled in Room 8 and missing the date in Room 57. Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c). Observed pink basin stored in plastic bag in shower with brown residue on exterior in Room 57. Observed disposable bed pan with residue stored unprotected on the floor underneath the toilet in Room 57. All bedpans/urinals/emesis basins shall be cleaned after each use. 15A NCAC 18A .1312 (c).
19	1	Ice protected, dispensed, equipment clean in good repair	No	No	No	Observed cooler of ice left unattended and unlocked on hallway. **Ice shall be handled, transported, stored, and dispensed in such a manner as to be protected against contamination. 15A NCAC 18A .1314 (b).
28	1	Adequate storage, area clean, items properly stored	No	No	No	Observed several items stored in Physical Therapy closet. Needs to be more organized to help facilitate adequate cleaning. Observed several items stored on the hallway and a shower room being used as for storage. Facility is currently going through renovations. 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 several items including tracheotomy equipment stored on the floor in storage closets during the inspection. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
35	0.50	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	Observed hair in rollers stored as clean in Beauty Salon. Needs to be thoroughly cleaned. **Patient contact items shall be kept clean and in good repair. See rule .1319 (c).