Premises Information


	Return to Inspections

Name

EASTOVER NURSING CENTER

Address

2616 E 5TH ST

City/State/ZIP

CHARLOTTE

28204

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

9/20/2019

Final Score @ Grade

General Comments

NO POINTS TAKEN FOR THE FOLLOWING VIOLATIONS: #16. Observed an incomplete backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f). EHS emailed administrator Joshua Wood a guidance document for the back up water supply plan. #17. Drinking fountains shall be kept clean and properly regulated. 15A NCAC 18A .1314 (a). Observed heavy black build up around water fountain nozzle located within therapy center. #24. Effective measures shall be taken to keep flies, rodents, cockroaches, and other vermin out of the establishment and to prevent their breeding or presence on the premises. 15A NCAC 18A .1317 (a). Observed flies in rooms 111 and 222. #32. 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 staining to pillows in residents rooms throughout facility (129, 212). #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 employee drink stored on clean linen cart with clean linen on it inside of general living area on the East Wing of facility. #42. All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). Observed no thermometer in resident room 111. *NOTE: Inspection report was signed by Joshua Wood and emailed to jwood@pelicanhealth-charlotte.com

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 severe damage to walls behind beds in rooms 129 and 212. Observed walls throughout facility in residences rooms with scuffing and in need of repainting.
5	2	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). Observed vents in residents rooms throughout with heavy dust accumulation (129 and 212). Clean.
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed black build up around the grout of toilets throughout facility. Clean. Observed pink build up inside of toilet basin in room 212. Clean. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed the grout in East Wing 1 spa room shower with black and pink build up. Clean/replace grout throughout where black and pink build up is forming.
14	1	Disinfectant accessible, properly used	No	No	No	A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). Observed no EPA registered hospital disinfectant inside of any shared spa room within facility.
26	2	Premises clean, no breeding places or rodent harborage	No	No	No	The premises shall be kept neat, clean, and free of litter. 15A NCAC 18A .1317 (c). Observed bags of trash outside of dumpster during building inspection. Observed heavy litter around dumpster area. Clean. Observed mattresses, broken dressers, and other pieces of furniture no longer in use stored within dumpster area. Remove all dilapidated furniture and clean around dumpster area.
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed staining on bed linen in rooms 129, 212 and 222.