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

1/16/2019

Final Score @ Grade

General Comments

No Points Deducted. #2 Keep all flooring clean. 15A NCAC 18A .1309 (a) Observed carpet stain in resident room 315. #9 Toilet rooms shall not be used for storage. See rule .1312 (b) Shower room on 2nd floor being used as storage room. Water continued to be supplied to shower and able to be used for intended purposes. #10 Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c). Bed pan located in bathroom of resident room 315 in need of proper label to include residents name and the date. #13 Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). Handsinks located in Shower Rooms on both 1st and 2nd floor recording hot water temperature of 90F and 88F. 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). IF VIOLATION IS NOTATED ON THE NEXT INSPECTION, POINTS WILL BE DEDUCTED (even if the area is not in use at current time). #28 All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed briefs stored on the floor in patient rooms 307, 315, and 333. 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 draws and cabinets throughout general areas such as med rooms and beauty salon in need of cleaning. Inspection done and typed by Madeline Rawson, REHS #2775

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	REPEAT: Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed stained ceiling tiles at nursing station oxygen room and in 2nd floor stairwell. (Improvement shown). Observed the wallpaper in the 2nd floor spa hall area peeling. Repair.
5	2	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	REPEAT: Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). Observed air filters for AC units in resident rooms 307, 315, 333, and 334. Increase cleaning frequency of air filters.
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). Bathtub and shower in 1st floor shower room with debris in bottom. Shower in need of cleaning in resident room 333. Shower heads with pink build up at nozzle in several resident rooms. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed build up in and around toilets located in the 1st floor shower room, resident room 307, and resident room 333.
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	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 build up on salon chair in need of cleaning. Observed large stain in middle of the mattress located in resident room 333. Observed stained chairs in common areas on both 1st and 2nd floors.
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	REPEAT: Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed stained bedding in resident rooms 334 and 340. (Improvement shown).
35	1	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	REPEAT: Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c). Observed hair rollers in beauty salon with hair still in them from previous person. Increase cleaning frequency and clean rollers more thoroughly between each person.
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	All kitchenware and food contact surfaces of equipment, exclusive or cooking surfaces of equipment, used in preparation or serving of food or drink, and all food storage utensils, shall be cleaned after each use. 15A NCAC 18A .1320 (c). Microwave located in beauty salon and 2nd floor Med room in need of cleaning. Refrigerator in activity room in need of cleaning. Refrigerators located in resident rooms 315 and 333 in need of cleaning. Coffee maker in oxygen room located in nurses station with build up in need of cleaning. Increase cleaning frequency of all kitchenware and food contact surfaces of equipment throughout facility.