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

11/20/2018

Final Score @ Grade

94.50

General Comments

NO POINTS: #14 A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). Observed no disinfectant present in 2 spa room. #21 All solid wastes containing food scraps or other decomposable materials shall, prior to disposal, be kept in leak-proof, non-absorbent containers, which shall be kept covered with tight fitting lids when filled or stored, or not in continual use. 15A NCAC 18A .1316 (a). Observed broken drain plug at dumpster. #28 All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed patient care items that were stored on the floor in storage room. In room 203 observed patient care items not labeled and items not separated between patients. #34 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). Observed staff personal items co-mingled in with clean linen in clean linen storage room. ***Inspection co led by Imani Grimes and Kiana Chrisp***

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	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed dinged and marred surfaces of walls and door frames throughout. Observed a soiled wall in Spa #1. REPEAT.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	#8 Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed rusty shower chair in room 414 and 103. Observed soiled shower seat in room 318. Observed black staining on bottom of shower curtain in room 203. Observed brown stains on floor around toilet in room 418. Observed scale buildup on shower head in rooms 414 and 103 Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed yellow stains on toilet and brown stains on toilet seat in room 418. Observed yellow stains on toilet in room 318. Observed the shower bed in the SPA #1 with hair and debris.
10	0.50	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c). In room 318 and 103 observed bed pans not labeled. All bedpans/urinals/emesis basins shall be cleaned after each use. 15A NCAC 18A .1312 (c). In room 318 observed soiled unlabeled bed pan. Where facilities for cleaning bedpans are not provided in patient rooms, bedpans shall be taken to a soiled utility room and be cleaned and disinfected using an EPA registered hospital disinfectant after each use. 15A NCAC 18A .1312 (c). Observed no facility to clean bedpans inside of room and PIC stated that they cleaned bedpans inside of rooms.
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c). Observed pill crusher with heavy build-up. REPEAT. Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c). On med cart observed water pitcher with pink slime around the handle and also black residue on the inside around top portion.
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	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). Observed a ripped mattress in room 103. Observed a ripped pillow in room 209. REPEAT.