Premises Information


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Name

PAVILION HEALTH CENTER AT BRIGHTMORE

Address

10011 PROVIDENCE RD W

City/State/ZIP

CHARLOTTE

28277

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

3/19/2015

Final Score @ Grade

94.50

General Comments

2. Observed several of the soiled utility room floors collecting debris and residue.Keep all flooring clean. 15A NCAC 18A .1309 (a). 28. Observed chemicals stored over paper towels and toilet paper in multiple storage and/or housekeeping closets. Rearrange (chemicals under the single service items) to prevent possible contamination.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).30. Observed residue (a red liquid) collecting in the bottom of a drawer in a medicine cart.Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).32. -Observed a soiled couch cushion in the common area by the 100 & 200 halls.-Observed soiled and torn pillows in the rehab gym.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).36. -Observed residue collecting in the freezer and refrigerator in the nourishment room.-Observed residue collecting in the nourishment cabinets and spice packet containers.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).Ms. Myrna & Mr. Tom present during the inspection.Inspection emailed to mgibson@liberty-ltc.com*Awaiting on the laundry hot water information. Facility does not use bleach. Fax the information from the service company to Nykesse Roberts as soon as it is received.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
10	1	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Repeat Non-compliance: Observed unlabeled bed pans.Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c).
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Observed no soap at the handsinks in a soiled utility room near the 100/200 hall and in both of the spas.Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d).
14	1	Disinfectant accessible, properly used	No	No	No	-Per an CNA, the bathing equipment is sprayed with disinfectant, wiped off, then rinsed with water. Ensure the manufacturer's instructions are followed (10 minute contact time etc).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).-No one knew how to clean the tubs in the spas. After finding the instruction booklet, the correct chemical was located as well as the cleaning instructions. Per Tom, the instructions will be copied and posted in the spas.The manufacturer's instructions shall be followed for cleaning equipment with pumps. See rule .1312 (f).
18	2	Drinking utensils properly handled	No	No	No	Repeat Non-Compliance: Observed unlabeled disposable water pitchers in rooms in a few rooms.Label all disposable water pitchers with the resident's/patient's first name and last name. 15A NCAC 18A .1314 (a).