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

3/2/2018

Final Score @ Grade

General Comments

No Points Deducted: 1. Observed the floors being renovated and incomplete in some areas. Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). 3. -Observed some of the cove bases and chair rails removed due to the renovations. -Observed stained ceiling tiles in the laundry room. Replace. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. 9. Observed several items in relation to the renovation stored in the spa room. Remove items to comply to the rule below. Toilet rooms shall not be used for storage. See rule .1312 (b). 12. -Observed no soap at the med room handsink- west hall. Provide. -Observed no paper towels at the supply room handsink- west hall. Provide. Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). 30. Observed an employees cup stored in a drawer of a med cart with medications. CDI- Removed. Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c). 32. Observed holes in the mattress in room 46. Replace. 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). 34. Observed boxes of comforters and clothes stored on the floor in the laundry room. Clean linen shall be stored and handled in a separate room or area, or in another manner that will prevent contamination of clean linen. 15A NCAC 18A .1319 (b). 36. Per a Med Tech, she washes the water pitcher in the sink in the nourishment room. She has been educated to take the pitcher to the kitchen to be cleaned properly. All kitchenware and food contact surfaces of equipment, exclusive or cooking surfaces of equipment, used in preparation or serving of food or drink, and all food storage utensils, shall be cleaned after each use. 15A NCAC 18A .1320 (c).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat: -Observed stains on toilet seats in room 46. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). -Observed stains under the shower chair in room 6 and 46. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).
10	1	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	-Repeat: Observed an unlabeled bed pan in room 6. Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c). -Observed a full urinal in room 20. Per the CNA, it must have been from last night's shift. Clean after each use. All bedpans/urinals/emesis basins shall be cleaned after each use. 15A NCAC 18A .1312 (c).
19	2	Ice protected, dispensed, equipment clean in good repair	No	No	No	Repeat: Observed 2 coolers of ice left unattended and unlocked on the 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	Repeat: -Observed trash, debris, and other items out of the packages on the floor in the supply room- E Wing. 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 a bag of gauze stored on the floor in the supply room- E Wing. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	Repeat: Observed the 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).