Provider Name: PAVILION HEALTH CENTER AT BRIGHTMORE
Address: 10011 PROVIDENCE ROAD WEST, CHARLOTTE, NC 28277
Phone: (980) 245-8500
County: Mecklenburg (590)
Ownership Type: For profit - Corporation
Certified Beds: 108
Average Residents Per Day: 90.8 ()
Provider Type: Medicare and Medicaid, Resides in Hospital: No
Legal Business Name: LIBERTY HEALTHCARE GROUP, LLC
First Approved Date: March 20, 2014
Affiliated Entity: LIBERTY SENIOR LIVING (310)
Retirement Community: N, Special Focus Status:
Ownership Change in Last 12 Months: N
Resident Family Council: Resident
Sprinkler System Status: Yes
Overall Rating: 3 ()
Health Inspection Rating: 3 ()
QM Rating: 2 ()
Long Stay QM Rating: 4 ()
Short Stay QM Rating: 2 ()
Staffing Rating: 2 ()
Staffing Report Note:
PT Staffing Note:
Nurse Aide Staff Hours Per Day, per resident: 1.83256, LPN Staff Hours Per Day: 0.7835, RN Staff Hours Per Day: 0.5265, Licensed Staff Hours Per Day: 1.3101
Total Nurse Staff Hours Per Day, per resident: 3.14267
Weekend Nurse Staff Hours: 3.02906, Weekend RN Staff Hours: 0.4464
PT Staff Hours Per Day, per resident: 0.1143
Nurse Staff Turnover: 60.0, Nurse Turnover Note:
RN Turnover: 56.3, RN Turnover Note:
Admin Left Number: 0, Admin Turnover Note:
Case Mix Nurse Aide Hours Per Day, per resident: 2.0013, Case Mix LPN Hours Per Day: 0.7435, Case Mix RN Hours Per Day: 0.3663
Adjusted Nurse Aide Hours Per Day, per resident: 1.86542, Adjusted LPN Hours Per Day: 0.7777, Adjusted RN Hours Per Day: 0.5415
Total Adjusted Nurse Hours Per Day, per resident: 3.18392
Adjusted Weekend Nurse Hours Per Day, per resident: 3.06881
Health Survey Dates and Scores: Cycle 1: 2022-09-29 (Score: 64), Cycle 2: 2021-05-07 (Score: 0), Cycle 3: 2019-05-23 (Score: 16)
Total Weighted Health Score: 34.667
Reported Incidents: 0, Substantiated Complaints: 11
Infection Control Citations:
Fines and Penalties: Number of Fines: 1, Total Fines in Dollars: 7796.75, Payment Denials Number: 0, Total Penalties Number: 1
Location and GPS: 10011 PROVIDENCE ROAD WEST,CHARLOTTE,NC,28277 (35.0372, -80.832)
Process Date: 2024-03-01
Each record details specific health deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Health, Deficiency: Ensure each resident receives an accurate assessment.
Severity: B - Level 1: No actual harm with potential for minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has plan of correction on 2022-10-17
Type: Health, Deficiency: Provide enough food/fluids to maintain a resident's health.
Severity: G - Level 3: Actual harm that is not immediate jeopardy. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-10-17
Type: Health, Deficiency: Provide and implement an infection prevention and control program.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-10-17
Type: Health, Deficiency: Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Severity: G - Level 3: Actual harm that is not immediate jeopardy. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-10-17
Type: Health, Deficiency: Provide care and assistance to perform activities of daily living for any resident who is unable.
Severity: G - Level 3: Actual harm that is not immediate jeopardy. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-10-17
Type: Health, Deficiency: Ensure each resident receives an accurate assessment.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-06-10
Type: Health, Deficiency: PASARR screening for Mental disorders or Intellectual Disabilities
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-06-10
Type: Health, Deficiency: Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-06-10
Each record details specific fire safety deficiencies found during inspections, categorized by type, severity, and whether they were corrected. Below are the severity levels and their implications:
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2022-12-09
Type: Fire Safety, Tag: 0918, Version: New
Description: Have generator or other power source capable of supplying service within 10 seconds.
Severity: D - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2021-06-03
Type: Fire Safety, Tag: 0321, Version: New
Description: Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Severity: E - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-08-10
Type: Fire Safety, Tag: 0352, Version: New
Description: Properly install and monitor supervisory attachments on automatic sprinkler systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-08-10
Type: Fire Safety, Tag: 0353, Version: New
Description: Inspect, test, and maintain automatic sprinkler systems.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-08-10
Type: Fire Safety, Tag: 0521, Version: New
Description: Ensure heating and ventilation systems that have been properly installed according to the manufacturer's instructions.
Severity: F - Level 2: No actual harm with potential for more than minimal harm. Plan of Correction required.
Corrected: Deficient, Provider has date of correction on 2019-08-10