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

12/2/2015

Final Score @ Grade

92.50

General Comments

2. Carpet shall be maintained clean, odor free, dry and in good repair. 15A NCAC 18A .1309 (a) Observed pink stain on the carpet in the common room area. 3. The walls and ceilings of all rooms and areas shall be kept clean and in good repair 15A NCAC 18A .1310. Observed stains on the ceiling tiles in the common room/lobby and DON's office34 Observed several linen cart covers in disrepair in laundry room. Observed dirty shoes stored on shelf in clean linen area. Keep cart covers down when non-linen items are stored in same room.**Clean linen shall be stored and handled in a separate room or area, or in another manner that will prevent contamination of cleanlinen. 15A NCAC 18A .1319 (b)Kyle Keller led inspection.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
1	1	Floors easy to clean, no obstacles, drains where needed	No	No	No	Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). Observed the shower drain in room 229 broken off of the drain. Observed the non slip tape in the shower in room 220 and in room 233 peeling away, thus making the shower not easily cleanable. Advised to re-tape with new non slip tape.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed soiled toilet seats: in room 220, soiled toilet seat in the common room, and in room 233.Handwashing sinks shall be accessible to all areas where personnel may be exposed to bodily excretions or secretions. 15A NCAC 18A .1312 (d). Observed that the handsink in the biohazard room was not accessible.
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 the soiled utility room being used as the biohazrad storage room. Corrected during inspection: made clear that the biohazard storage will be used in another room and that room will be used only for cleaning soiled urinals and bedpans.
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 bedpan in room 233 that has gone through a cleaning procedure and was labeled incorrectly without a date. Make sure that staff cleans all bedpans and urinals in the soiled utility area. Cannot be rinsed/washed using sink or shower.
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). Observed no soap in room 233 bathroom, and no soap in the bathroom at the Spa area.
13	1	Lavatory and bathing hot water between 100 and 116 F	No	No	No	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). Observed the water temperature in the rehab room with a water temperature of 120 F. Also observed the Salon hot water above 116F.
28	1	Adequate storage, area clean, items properly stored	No	No	No	All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed patient contact items on the floor in room 220.