NOVANT HEALTH MATTHEWS MEDICAL CENTER

Inspector comments: EHS, Jamil Blackmon, and Shannon Pierce and Mallory Lowder were present time of inspection. Report emailed to the following: Sepierce@novanthealth.org Mmlowder@novanthealth.org Zslandry@novanthealth.org Sfgenica@novanthealth.com

Inspector comments: No violations were observed during time of inspection. EHS Jamil Blackmon was present during time of inspection. Report emailed to the following: Sepierce@novanthealth.org Zslandry@novanthealth.org Sfgenica@novanthealth.com Mmlowder@novanthealth.org

Inspector comments: *NOTE: No violations observed during time of inspection. EHS Jamil Blackmon was present during time of inspection. Report emailed to the following:

Inspector comments: *NOTE: EHS Jamil Blackmon, Maddie Denoncour, and Jonathan Clay-Hanson were present during time of inspection.

Inspector comments: #3. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.Oberved wall damaged in soiled utility room. Repair wall in soiled utility room. Tightly secure loose corner/edges of wall paper. Touch-up paint throughout in rooms and storage rooms. Touch-up paint door framing to rooms. Refurbish/restain doors to room where paint/varnish is worn and wearing off. #4. 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). Replace blown light bulb in light fixture or repair light fixture in bathroom within patient room. #8. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Replace broken wall holder on shower wand holder. Re-grout and seal grout around top of bath tub in room on maternity wing. #9. Toilet rooms shall not be used for storage. See rule .1312 (b). Observed chair stored in bathroom in common shower. Chair removed from shower at time of inspection. #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 a stack of clean linen uncovered stored on top of transfer cart in a procedure room within imaging. Keep clean linen covered or stored in a cabinet area within imaging to prevent contamination of clean linen.

Inspector comments: #1.Floors shall be free of obstacles to cleaning. 15A NCAC 18A .1309 (a). Observed loose rubber flooring along seam in hallway area on first floor where section of rubber flooring join. Seal along seam of rubber flooring. #23.All medical waste shall be handled and disposed of as required in 15A NCAC 13B .1200 Medical Waste Management. Observed biohazard bin/sharp container completely full in biohazard room in ER/ED. Do not over fill sharp containers!

Inspector comments: General Comments: #1. Tightly secure rubber flooring around floor drain in nutrition room on 3rd floor. **Keep all flooring in good repair. See rule .1309 (a) and (b). #3. Wipe/clean walls throughout where needed; if needed. Continue to clean scuff marks from walls throughout where needed. Continue to touch-up paint and address wall damage from wheel chairs throughout where needed. Address condensation on ceiling ventilation at main entrance and water stains on ceiling at main entrance. ****Keep all walls and ceilings clean and in good repair. See rule .1310. #8. Leak on P trap on hand washing sink repaired at time of inspection. Slow draining hand washing sink in nutrition room was also addressed at time of inspection. ****Keep all handwashing facilities clean and in good repair. See rule .1312 (b)

Inspector comments: #32. Clean tape adhesive from mattress in room 326 and (1) room in cardio plumonary. Clean and replace damaged over bed table in room 326. 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). #3. Touch up paint wall and door framing throughout where needed. Monitor water stain on ceiling in shower area of room 326 and area near window in hallway area upon entering 3rd floor and repair any leaks if needed.

Inspector comments: General Comment: #3. Tightly secure loose wall paper in room 340 and anywhere else needed. Observed minor scuffing on the wall and baseboards in soiled utility roomson 4th and 5th floor. ** Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. #32. Clean underside of overbed table in 439. Repair damaged arm rest on chair in 214. Continue to replace scuffed head boards throughout rooms. Facility is in the process of replacing wooden scuffed head board with hard plastic head boards. ** 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).

Inspector comments: General Comment: #1. Repair damaged floor in hallway area on 4th floor.**Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). #3. Repair wall in ED near bay. Continue to touch-up paint throughout where needed.**Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. #36. Observed interior top of microwave soiled in hospice waiting/nourishment room. Thoroughly clean interior of microwave.**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).

Inspector comments: No points were deducted for the following: 3. Observed water stain on the ceiling near the door in room 423. Needs to be repaired/replaced. Ensure that leak is not ongoing. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. 17. Observed staining around the mouth piece of water fountain across from visiting waiting room on 4th floor. Ensure that water fountains are routinely cleaned. **Drinking fountains shall be kept clean and properly regulated. 15A NCAC 18A .1314 (a). 32. Observed one torn pillow in radiology department. Pillow was removed and discarded. **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).

Inspector comments: No points deducted: #3-Wall damage in 519, 316(at sink), 315 (sink), CTU rooms 6/7 at bed, and nourishment at trash can. #11—maternity biohazard bin stored in hank sink in Maternity OR. #34—Observed laundry equipment used for NICU blankets, with no record of sanitizing. Blankets shared.

Inspector comments: No points deducted: 18- 3rd floor 303 water pitcher not labeled, 329 water pitcher was initial only 42- GC-patient food in covered container in domestic fridge- 303 36-5th floor nourishment area microwave food residue, 3rd floor also and large fridge 3- Observed water damaged ceiling tile in ED exam room 26, wall damage in ED clean supply room and behavior health room(crayon marks on wall). Note: Verify milk and sandwiches are delivered in a cold container** Add notification to health Dept after 4 hours on backup water suppy plan, as well as, more detail on how cleaners that needs mix in water will made.

Inspector comments: 3. Observed a ceiling leak in room 311 bathroom. **Repair leak. **Keep all floors walls and ceiling clean and in good repair. 10. Observed a bed pan with only the room number and date. **Label all issued bed pans with patient's name and date. 19. Observed an ice machine chute with pink residue, women's center nourishment room. **Keep ice dispensing equipment clean and in good repair. 33. Observed one soiled linen bin was not labeled in room 209, and a soiled infant hat was stored in a cradle drawer in a clean room (413). Stained sheet on bed in OR 2. Torn pillow OR back hallway. **Label all soiled linen storage containers with "soiled linen". 36. Observed the refrigerator door shelf with sticky residue in 5th floor nourishment, and residue on some coffee makers. Refrigerator needs defrosting and cleaning of spills, ER green side nourishment room. **Keep all food service equipment clean.

Inspector comments: #4 - Observed one light was not working (possible leak) in the Lab's storage closet. **Keep all lighting in good repair.#9 - Observed hand sink blocked by lift **Keep hand sinks accessible.#42 - Observed unlabeled and undated protein salad in 3rd floor nourishment room.#17 - Observed water fountain with too high water pressure on 5th floor and fountain with pink residue on nozzle on 3rd floor. **Keep water fountains clean and properly regulating.#28 - Observed boxes of IV fluids stored on wooden pallets (less than 8 inches from the floor) in the pharmacy storage area, and boxes of new procedure kits were stored in the floor in the soiled utility room in the Imaging Department (1st floor). **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).#40 - Observed an employee drink was stored in a patient nourishment refrigerator was not labeled, ED. **Food/drink brought in by employees/patients must be labeled with name and date.#36 - Observed two refrigerators with food residue on the interior surfaces in ED. **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).

Inspector comments: Chris Hutter received the report.#2 - Observed the floors were dusty and had debris in the pharmacy storage room. **Keep all flooring clean. 15A NCAC 18A .1309 (a).#3 - Observed wall damaged inthe nurishment area behind the ice machine in LD, wall paper/built in couch damage in room 437, and wall damaged in Heart Cath (3rd)soiled utility. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.#28 -Observed equipment stored within the splash zone of the sink in CTU. **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 dusty Pyxis machine in Med Surge (5th floor) med room, and a drawer with debirs/residue in Intermediate Med room (5th floor). **Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).#31 - Observed a used feeding syringes was rinsed and stored assembled. **Feeding syringes which are reused shall be labeled with the patient's name and date opened, shall be disassembled and rinsed after each use, and shall be disposed of within 24 hours of first use. 15A NCAC 18A .1318 (d).#34 - Observed an uncovered/unprotected clean beds on hallway in Med Surg (3rd floor). **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).

Inspector comments: Chris Hutter received the report.#3 - Observed the ceiling was damaged in 2nd floor PreOp clean holding closet. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.#4 - Observed the light did not work in a CT Scan dressing room. **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). #8 - Observed a hand washing sink was not accessible in 4th floor soild utility. **Handwashing sinks shall be accessible to all areas where personnel may be exposed to bodily excretions or secretions. 15A NCAC 18A .1312 (d).Observed toilet base caulk in need of replacement in 1st floor ED resroom, and shower tile in need of grout in 338. **Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). #18 - Observed a drinking cup was not labeled in room 321. **Label all disposable water pitchers with the resident’s/patient’s first name and last name. 15A NCAC 18A .1314 (a). •#32 - Observed rusted bed frames in rooms 430 and 415, chipped laminate near the couch in 430 and chipped laminat on a countertop in 3rd floor soiled utility,and a mattress cover was damaged in 511. **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 cabinets, drawers and microwave was dirty in Intermediate Nourishment. **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 - Observed apples were not wrapped in hospice famitly room. **All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. 15A NCAC 18A .1323 (a).

Inspector comments: #12 - Observed no soap at a hand washing sink in LD. **Provide liquid soap a disposable towels at all hand washing sinks. 15A NCAC 18A . 1312(d).#28 - Observed an extra pad for the X-ray imaging table was stored on the floor in Radiology, and clean items (gift wrap) were stored in the 5th floor soiled utility room. **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).#32 - Observed laminate damage on sofa unit in room 408, a cracked bassinette in 415, and flaking paint/rusted bed frames pans in two 4th floor rooms. **All furniture, bed springs, mattresses, sleeping mats, draperies, curtains, shades, blinds, or other furnishings in institutions shall be kept clean and in good repair. 15A NCAC 18A .1319 (a).#40 - Observed visitor food not labeled in 5th floor hospice waiting room. **Food brought from home by employees or visitors of patients or residents shall be stored separately from the institution's food supply and shall be labeled with the name of the person to receive the food and the date the food was brought into the facility. 15A NCAC 18A .1321 (b).

Inspector comments: #2 - Observed the floor grout in the restrooms was discolored in rooms 403 and 305. **Keep all flooring clean. See rule .1309 (a).#13 - Observed the hot water at the hand washing sink in the 5th flor Oncology hall restroom was at 72F, and the sterile core OR scrub sinks had very low hot water flow **Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100 F to 116 F. See rule .1312 (e).#15 - Observed no backflow prevention device on shower wands in L&D rooms 201 and 207. **Provide back flow preventers on all long shower wands. **Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. Seer rule .1313 (d).#32 - Observed a stain on a couch in room 305, a damaged vinyl chair in room 207, and damaged/rusted/cracked bed frame and damaged matress in CTU **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. See rule .1319 (a).#36 - Observed a dirty refrigerator in ADA nourishment area. **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).