Premises Information


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Name

EASTOVER NURSING CENTER

Address

2616 E 5TH ST

City/State/ZIP

CHARLOTTE

28204

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

10/5/2022

Final Score @ Grade

General Comments

No points were deducted for the following: 2. Keep all flooring clean. 15A NCAC 18A .1309 (a). - Observed floor tile missing in the environmental room on east hall. Observed tile missing in the soiled room on west hall. 5. Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). - Observed build up on vent cover in spa east 2. Observed vent filters in need of cleaning 121. Observed light shield missing in the restroom in room 216. 12. Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). - Observed no soap in the med room on east hall. Observed no paper towels in the med room on the west hall. 28. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). - Observed boxes of supplemental shakes stored on the floor in the back storage room. 35. Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c). - Observed hair in rollers in the beauty salon. Needs to be cleaned. 42. 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). - Observed milk at 50F and turkey sandwich at 51F in the pantry refrigerator on the east hall. Discarded.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	2	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 hole in the wall in environmental room on east hall. Observed wall damage in room 112. Observed wall stain in the pantry and soiled room on west hall. Observed wall damage in room 211. Observed ceiling damage in west day room.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). - Observed showed bed in need of cleaning in spa east 2 , west 1 and west 2. Observed shower chair in need of cleaning in east 2. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). - Observed toilet in need of caulking in rooms 116, 130, west spa 1 and room 222. Observed soiled toilet in room 216. Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b) - Observed slow drain in room 130.
9	0.50	Toilet rooms free of storage, hand wash signs posted	No	No	No	Toilet rooms shall not be used for storage. See rule .1312 (b). - Observed wheelchair stored in the restroom in room 104 and wheelchair parts stored in the spa on west hall.
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). - Observed urinals/bedpans not labeled in rooms 104, 116 and 121.
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 cabinet floor in need of repair in the pantry on east hall. Observed pillow torn in rooms 216 and privacy curtain stained and in room 222. Observed socket covers missing in the day room on west hall.
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 linen torn in room 216. Observed soiled pillow case in room 130.
43	1	Food storage units with thermometers, maintain temperatures	No	No	No	All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). - Observed pantry refrigerator missing thermometer on the east hall. All refrigerators shall maintain a temperature of 45°F or below. 15A NCAC 18A .1323 (b). - Observed food items holding around 50F in the refrigerator on the east hall in the pantry.