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

10/29/2019

Final Score @ Grade

95.50

General Comments

NO POINTS FOR THE FOLLOWING VIOLATIONS: #3. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed wall in need of repair in room W34 behind bed. Observed minor scuffing to walls throughout in residents rooms. #14. A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). Observed no EPA registered hospital disinfectant accessible to South central spa room. #17. Drinking fountains shall be kept clean and properly regulated. 15A NCAC 18A .1314 (a). Observed pink build up around nozzle of drinking fountain on South wing. EHS recommends facility cleans all water fountains in facility with more detail #18. Label all disposable water pitchers with the resident's/patient's first name and last name. 15A NCAC 18A .1314 (a). Observed several pitchers throughout residents rooms not labeled. #43. All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). Observed no thermometer in pantry refrigerator located in East wing. *NOTE: Matthew Davison Housekeeping Manager was present during time of inspection. Inspection report was signed by Amanda Pack and emailed to apack@whiteoakmanor.com

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	Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed rusted toilet chairs in rooms W7and W15. Replace. Observed the caulking around toilet seat in room S23 with heavy black build up. Clean. Observed soiled toilet basins in rooms S23 and S10. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed shower tile broken in central spa rooms West and East. Repair.
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 storage in West central and East central spa rooms.
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed staining on bed linen in rooms S23, S10, and E3. Clean.
34	1	Laundry area and equipment clean, linen disinfected, clean laundry stored and handled separately	No	No	No	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). Observed clean linen carts throughout facility with wipes, diapers, and hygienic items stored on them.