Premises Information


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Name

WHITE OAK MANOR - CHARLOTTE

Address

4009 CRAIG AV

City/State/ZIP

CHARLOTTE

28211

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

8/1/2013

Final Score @ Grade

90.50

General Comments

2. Observed strong urine smell in E11 restroom.Observed black build up around base of toilet in E11.**Keep all flooring clean. See rule .1309 (a).3. Observed ceiling in the South hall parlor peeling.**Keep all walls and ceilings clean and in good repair. See rule .1310.10. Observed unclean urinal in E11.**All bedpans/urinals/emesis basins shall be cleaned after each use. See rule .1312 (c). 15. Observed no back flow preventer on the shampoo bowls in the salon.**Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. Seer rule .1313 (d).42. Observed unlocked unattended ice (igloo) cooler on West hall. Observed pink build up in ice machine on West hall.**All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. See rule .1323 (a).Ms. Juanita & Mr. Raymond 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 rusting toilet chairs in W7 and S1.Repeat Non-compliance: observed stained (BM &/or Urine) on toilet seats in South hall Women's shower room and E26.Keep all toilet equipment clean and in good repair. See rule .1312 (b).Observed residue on stretcher in East hall women's shower room.Keep all bathing equipment clean and in good repair. See rule .1312 (a) and (f).
9	0.50	Toilet rooms free of storage, hand wash signs posted	No	No	No	Repeat Non-Compliance: Observed wheelchairs and geri chairs stored in West & East hall women's shower room.**Do not use toilet rooms for general storage. See rule .1312 (b).
14	1	Disinfectant accessible, properly used	No	No	No	Repeat Non-Compliance: Observed no cleaners in shower rooms to properly clean and disinfect the jacuzzi tubs. **The manufacturer's instructions shall be followed for cleaning equipment with pumps. See rule .1312 (f).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	-Repeat Non-Compliance: Observed pill crushers collecting residue on multiple med carts.-Observed med carts throughout with residue in the drawers.**Medication carts shall be cleaned when visibly soiled. See rule .1318 (c).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	-Repeat Non-Compliance: Observed damaged mattresses in rooms on each hall.-Observed stained dividing curtains throughout facility.-Observed closet door off track in room W7.**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).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed soiled linen and pillow cases throughout facility.**Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. See rule .1319 (b).
36	2	Approved utensils and equipment, cleaned and sanitized	No	No	No	Repeat Non-Compliance: Observed pink build up in water pitchers on multiple med carts.**All utensils and food contact surfaces of equipment used in the preparation, service, display, or storage of potentially hazardous foods shall be cleaned and sanitized prior to each use. See rule .1320 (c).