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

10/8/2018

Final Score @ Grade

General Comments

NO POINTS WERE TAKEN FOR THE FOLLOWING: #3 - Observed water stained ceiling tiles in therapy storage room, therapy room, and activity room. Observed wall damage on corner of wall where metal is exposed in room 9, and in nourishment room under soap dispenser. Observed touch-up paint needed on door frames in several areas throughout hallway and rooms. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. #9 - REPEAT Observed wheel chair with pillow on it being stored in the restroom of room 32. **Toilet rooms shall not be used for storage. See rule .1312 (b). #12 - Observed no soap present in med room of rehab. **Provide liquid soap and disposable towels at all hand washing sinks. 15A NCAC 18A .1312 (d). #15 - Observed air-gap needed behind washing machine in laundry room. **Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d). #18 - Observed water cups without labeling in several rooms throughout including 46 and 9. **Label all disposable water pitchers with the resident’s/patient’s first name and last name. 15A NCAC 18A .1314 (a). #33 - Observed soiled linen carts in hallway labeled "linen." Ensure carts are labeled to indicate that linen is soiled. **Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b). #34 - Observed briefs being stored with clean linen on clean linen cart in therapy 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). #43 - Observed refrigerator without thermometer in room 43. EHS spoke with director about all refrigerators needing thermometers and how thermometers should be checked periodically to ensure they are reading at 45F or below. **All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	1	Facilities conveniently located, clean and in good repair	No	No	No	REPEAT Observed soiled toilet in rooms 1 and 46 and cleaning needed in hoppers of both soiled utility rooms. Observed utility sink in need of cleaning in long term care soiled utility room. Observed cleaning needed on the bottom of shower chair in room 46. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). **Keep all hand washing facilities clean and in good repair. 15A NCAC 18A .1312 (b)
10	1	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	REPEAT Observed bed pan without labeling in room 1. **Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c).
28	1	Adequate storage, area clean, items properly stored	No	No	No	REPEAT Observed cleaning needed in cabinets and drawers of beauty salon and in clean supply. Observed several shared rooms where residents have shavers, deodorant, and toothbrushes without labeling. Ensure patient contact items are properly stored separately and labeled. EHS recommended labeling individual storage shelving in restrooms. Observed resident food and drink being stored on the floor in room 32. 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). All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	REPEAT Observed debris on mattress in room 1 and room 46. Ensure debris is cleaned off of mattress before bed is made. Observed torn pillow in room 1, room 32, and room 46. Observed chair in hallway with rips and tears. Observed cleaning needed on fall pad in room 62. **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).
42	2	Food protected. Potentially hazardous food maintained at 45 F or below, or 140 F for above, consumed or discarded within 2 hours of being removed from temperature control	No	No	No	Observed med pass liquid on one med cart to be 55F and 66F on the other. Product states to "refrigerate after opening" and to "discard after 4 hours of opening if not refrigerated." Liquid was being stored on top of ice in coolers. Ensure product is stored to the level of product. **All potentially hazardous food products shall be maintained at 45°F, or below, or 140°F or above except during necessary periods of preparation and serving. 15A NCAC 18A .1323 (a).