Premises Information


	Return to Inspections

Name

WHITE OAK MANOR - CHARLOTTE

Address

4009 CRAIG AV

City/State/ZIP

CHARLOTTE

28211

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

11/20/2020

Final Score @ Grade

General Comments

NO VIOLATIONS FOR THE FOLLOWING VIOLATIONS: #8. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed loose toilet seat in room W1. #32. 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. 15A NCAC 18A .1319 (a). Observed interior of refrigerator in room W1 damaged. *NOTE: Matthew Davison Housekeeping Manager was present during time of inspection. Inspection report was emailed to Ms. Pack and Assistant Director Brittany Grigg apack@whiteoakmanor.com;bgrigg@whiteoakmanor.com;

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	1	Walls and ceilings cleanable, clean, good repair	No	No	No	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed chipping to baseboards to door frames throughout facility. Observed scuff marks to walls in residents rooms throughout facility (room S12).
5	1	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). Observed ceiling air vents throughout facility with heavy dust accumulation. Clean.
9	1	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 shared spa rooms throughout facility (wheelchair's, furniture, and linen rolling baskets).
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 pillow stained in room S12. Observed pillow case stained in room W1.