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

8/6/2019

Final Score @ Grade

91.50

General Comments

No Points taken: #2 - Keep all flooring clean. 15A NCAC 18A .1309 (a). Observed sticky floor in Rm 354. Clean floor around base of wall in the closet in Rm 320. #28 - All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed resident's briefs and blanket stored on the floor in resident's Rm 332 ; observed patients pillow on the floorin the closet in Rm 337. #30 - Medication cart clean. 15A NCAC 18A .1318 (c). Observed crumbs in the bottom of the cup, spoon, and strawer conpartment of the medication cart. #43 - Replace thermometer in refrigerator in Rm 337; in the refrigerator in the nurse's station on the 1st floor and medication room on the 2nd floor.

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 water spots on ceiling in 1st floor toilet, mop room and 2nd floor West hall. Observed hole in wall in the 1st floor toilet. Observed wall paper peeling at the base of the wall in the 1st floor shower.
8	1	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 feces on toilet seat in Rm 332 on the 2nd floor in resident's bathroom and in Rm 303 on the 1st floor. Repair leaking toilet in the women restroom & replace lid on toilet in men's restroom on the 2nd floor. 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. Rm 354 has pink build up at the bottom of shower curtain.
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 the resident's bathroom on the West hall 1st and in the shower room on the West hall 2nd floor.
32	2	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). Clean crumbs in the bottom of the sofa on the 2nd floor resident's sitting area and in Rm 332.
33	2	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 urine stains on resident's sheets in Rm 318 and on blanket in Rm 337.
35	1	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). Clean and remove crumbs off of wheel chair in Rm 337
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	Observed sticky residue in bottom of refrigerator in library/common area for residents use. 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).