Premises Information


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Name

NOVANT HEALTH PRESBYTERIAN MEDICAL CENTER

Address

200 HAWTHORNE LN

City/State/ZIP

CHARLOTTE

28204

Premise Type

41 - Hospitals

County

Mecklenburg

Inspection Date

5/20/2015

Final Score @ Grade

General Comments

1. Observed 5C C574 floor damaged. ENDO floor damaged near hand washing sinks. Hallway floor tiles damaged near waiting room at Maternity area. Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). 3. Observed window sill damaged in 7E 930. 5C C553 wall damaged near toilet. Repair wall at Birthing Center nourishment and housekeeping closet. Clean wall behind coffee dispenser in Labor and Delivery area. Ultra Sound rooms 2 and 3, X-Ray, Nuclear Med room 3 with wall damaged. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.4. Observed 6F light not functioning in shower room 6806. All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a). 5. Observed HVAC vent with dust and debris in 4C C454. Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).10. Observed bed pan being washed in a restroom without a spray rinse toilet in ENDO area. Unlabeled bed pans in 6A room 620 and 7F room 7806. Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c). Where bedpans are cleaned in patient/resident rooms, bedpan cleaning facilities shall consist of a water closet with bedpan lugs or spray arms. 15A NCAC 18A .1312 (c).15. Observed backflow missing from Portable RO unit water lines on 3D. Observed 6C EVS closet backflow prevention device missing the bell cover. Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d).18. Observed a water pitcher not labeled with patients name in pediatrics room 214. Label all disposable water pitchers with the resident’s/patient’s first name and last name. 15A NCAC 18A .1314 (a).21. Clogged floor drain and residue collecting at dumpster area. Solid waste containers, rooms, or designated areas shall be kept clean. 15A NCAC 18A .1316 (c).33. Soiled sheets in 6D 698 and 694. Observed soiled linen bin with no label in Pediatrics observation room. 5A soiled linen room and ENDO soiled utility with exposed soiled linen. Soiled linen shall be placed in a covered container or bag at the point of use and stored and handled so as to contain and minimize aerosolization of and exposure to any waste products. 15A NCAC 18A .1319 (b). Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b).36. Observed microwave collecting residue in 3C, 4C, Hemby Theatre nourishment rooms. 4C and Hospice refrigerator collecting residue. 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).42. In 3C nourishment observed pre-made sandwich with discard date of 5/18/15. Observed food stored under sewage line in 3C storage cabinet. All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. 15A NCAC 18A .1323 (a).43. Damaged thermometers in nourishment refrigerators on 6C and 7F. 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	Observed hot water button stuck in staff restroom on 6D. Shower grout with mold and vanity missing edging E904 on 7E. Ring of residue observed in 7E 930. Push button faucets throughout behavioral health with short run times. Observed loose toilet seat in 3D patient restroom. Loose bath hand rail and a slow draining sink in Pediatrics room 221. Observed sink blocked in pediatrics soiled utility room. 5A A513 slow draining sink. Vanity cabinet damaged in 5A A512 and A513. ENDO custodial room being used as soiled utility. A hand washing sink will be required in this area since this is a new change. Toilet, handwashing, and bathing facilities must be conveniently located and readily accessible to residents and staff. 15A NCAC 18A .1312 (a). 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).
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Repeat Non-Compliance. Observed Hospice soiled utility room, 1st floor Ultra Sound Room 3, Radiology Holding soap dispenser not functioning. Paper towels missing at sink Ultra Sound room 4 on 1st floor. Sterile processing and decontamination area missing soap and disposable towels at all hand washing sinks. Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). Observed Blume play room hand washing sink with no hot water. All lavatories shall be supplied with hot and cold running water through a mixing faucet, or with tempered warm water. 15A NCAC 18A .1312 (d).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed the following: 3C 363 with patient care items stored at sink. Personal drink with supplies on housekeeping cart on 3C. 3C med room bin with debris. Chemical stored above clean items in 4C med room. Med room cabinets collecting tape residue in Hospice Med room. Drawers collecting debris and residue in 3C nourishment. 5F med room disinfectant wipes next to medications. Single service cups on floor in supply room floor 1st floor diagnostic x-ray. 6A EVS closet with bag of clean pillows stored on the floor. ED clean supply room with catheters left on the floor. ED care station C with patient contact items on the floor. 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	Observed rusty bed frames in 3C C381, C371, beds in 3D, 4C C457, Pediatrics 215, 221, H37, 5D 586 and 594, 5F 5814 and 5807. Bed with residue in 3C C381. 4C C457 room locker with rust. Couch with debris- 3rd floor hospice H37. Sheet with holes on a pediatrics procedure table. Pediatrics room 215 cabinet at refrigerator collecting residue. OR room A3 with torn mattress. ENDO room 7 with torn pillow. OR 013 with tape on bed rails. Used IV caps left on countertop in a room that hand been cleaned in ACU bay 27. Dust on high fixtures Maternity room 803. Hair dryer cord with residue Maternity room 803. Observed bassinets in Maternity and NICU with worn surfaces. Maternity 844 with damaged seam birthing mattress. 1st floor CT mattress damaged. All furniture, bed springs, mattresses, sleeping mats, other furnishings in institutions shall be kept clean and in good repair. 15A NCAC 18A .1319 (a).