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

6/11/2015

Final Score @ Grade

General Comments

#2 Observed 1 room (235) with carpet fray. Carpet shall be kept in good repair. Per Mr. Cam Cecil room is scheduled for upcoming reno.#3 Observed slight wall damage with residue present in room 243. Walls shall be kept clean and in good repair. #19 Observed ice chest stored in activity room unattended. Ice that is in reach of residents shall only be dispensed from machine. #32 Observed stained curtain dividers in rooms 243, 235 and 232. Keep all furniture items clean and in good repair.#36 Observed activity room fridge with residue present on bottom shelving and inside door in need of cleaning. Mr. Cam Cecil was present during the inspection.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat Non Compliance: Observed leak at girls hand sink downstairs with corroded faucets in same restroom. Observed slow drain sink in room 232. Observed underside of shower bench with residue present in room 235. **Keep all hand washing facilities clean and in good repair. 15A NCAC 18A .1312 (b)
28	1	Adequate storage, area clean, items properly stored	No	No	No	Repeat Non Compliance: Observed diaper stored on closet floor in room 243, 232.**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	2	Linen changed when soiled. Soiled linen handled properly	No	No	No	Repeat Non Compliance: Observed soiled linen cart in activities kitchen not labeled.Observed hole in linen in room 243.Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b).Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 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 all purpose cleaner being used to disinfect items down stairs in physical therapy room. Provide proper disinfectant. **Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c).