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

9/21/2018

Final Score @ Grade

95.50

General Comments

No points were deducted for the following: 10. Observed disposable urinal with no labels underneath the toilet in room 313. Urinal was discarded. Ensure that urinals are being properly labeled. **Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c). 12. Observed handwashing sink in the hallway restroom on lower level west hall missing soap. **Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). 14. Observed no disinfectant in bathing room on lower level west hall. Bathing room is not currently being used. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). 42. Observed thickener stored on medicine cart that stated should be refrigerated after opening. Ensure that ice baths are provided if thickener will be stored on the cart. Also date when opened. **All potentially hazardous food products shall be maintained at 45°F, or below, or 140°F or above except during necessary periods of preparation and serving. 15A NCAC 18A .1323 (a). 43. Observed refrigerator in activity room without a thermometer. **All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b).

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	Observed water stained ceiling tiles throughout. Ensure that leaks are not ongoing. Needs to be replaced. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
5	1	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	Observed HVACs and filters in need of cleaning during inspection. Ensure that systems and filters are being cleaned more frequently. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Observed debris underneath couch cushions in the common area on the lower level west side. Needs to be cleaned. Observed positioning pad torn in therapy room. **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).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed stained mattress cover in rooms 322 West and 351 East. Ensure linen is being removed once soiled. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).
35	0.50	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	Observed hair rollers with hair still in them from previous person in the beauty salon. Needs to be thoroughly cleaned more frequently. **Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c).