Premises Information


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Name

BROOKDALE CARRIAGE CLUB PROVIDENCE

Address

5804 OLD PROVIDENCE RD

City/State/ZIP

CHARLOTTE

28226

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

10/9/2013

Final Score @ Grade

General Comments

Mr. Cam Cecil present during inspection.**Supply record of ppm available chlorine for washing machines.GC # 42: Health shakes in container without temperature control. Shakes still in temperature and returned to refrigerator.**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).**Potentially hazardous foods served shall be either consumed or discarded within two hours of being removed from temperature control. 15A NCAC 18A .1323 (a)GC # 21. Keep compactor doors closed.GC # 32: Replace fall mat, room 228.GC #8: Repair faucet drips in common bathrooms on 1st floor.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
9	0.50	Toilet rooms free of storage, hand wash signs posted	No	No	No	Observed isolation carts stored in biohazard/bath room.**Toilet rooms shall not be used for storage. See rule .1312 (b).
13	1	Lavatory and bathing hot water between 100 and 116 F	No	No	No	Observed hot water in PT room at 120F.**Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed boxes stored on floor in records room, 1st floor.**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).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed soiled linen carts not labeled in common/activity room. Clean linen cart not labeled in laundry.Observed torn bedspread room 224.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b).
34	1	Laundry area and equipment clean, linen disinfected, clean laundry stored and handled separately	No	No	No	Repeat Non-Compliance Observed several cart covers in disrepair in clean linen room and laundry.**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).
35	1	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	Repeat Non-Compliance: Observed loose/peeling non-slip stickers in showers in rooms 228, 234, 224.**Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c).