Premises Information


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Name

BROOKDALE CARRIAGE CLUB PROVIDENCE I

Address

5802 OLD PROVIDENCE RD

City/State/ZIP

CHARLOTTE

28226

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

6/17/2015

Final Score @ Grade

General Comments

General Comment 42. Potentially hazardous foods served shall be either consumed or discarded within two hours of being removed from temperature control. 15A NCAC 18A .1323 (a) - Observed hummus out in at room temp. in room 319.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
4	1	Lighting at least 10 foot candles 30 inches above floor	No	No	No	All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a). - Observed a burnt out light in the shower room on the bottom floor. Replace burnt out bulb.
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). - Observed pink slime under the shower chair in room 336 and 306. Observed pink slime on the legs of the shower chair in room 310. Clean chairs.
28	1	Adequate storage, area clean, items properly stored	No	No	No	Repeat violation. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). - Observed personal care items stored on the floor of the bathroom in room 341.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). - Observed a wheel chair stored in the shower room on the top floor. Observed a wheel chair and walker stored in the shower room on the bottom floor. Store those items in other areas that are not related to bathing or toileting.
35	0.50	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c). - Employee in physical therapy room was not aware of the proper cleaning process of equipment between patients. Proper cleaning procedure was explained.
43	0.50	Food storage units with thermometers, maintain temperatures	No	No	No	All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). - Observed rooms 324, 352, 308 and the activity kitchen with thermometers reading 0F. Replace thermometers.