Premises Information


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Name

BROOKDALE CARRIAGE CLUB PROVIDENCE II

Address

5816 OLD PROVIDENCE RD

City/State/ZIP

CHARLOTTE

28226

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

9/19/2018

Final Score @ Grade

95.50

General Comments

NO POINTS: #15: Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d). Observed no backflow preventer on shower wand in room 102. #21: All solid wastes containing food scraps or other decomposable materials shall, prior to disposal, be kept in leak-proof, non-absorbent containers, which shall be kept covered with tight fitting lids when filled or stored, or not in continual use. 15A NCAC 18A .1316 (a). Observed small amount of trash under the compactor. Keep area picked up.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
2	1	Floors clean, carpet clean, dry, odor free	No	No	No	Keep all flooring clean. 15A NCAC 18A .1309 (a). Observed flooring in corners blocked by furniture and behind washer/dryers need cleaning. Carpeting in main rooms stained and needs cleaning.
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 several rusted toilet chairs and 1 elevated toilet seat that needs cleaning between the seat and the toilet. Riser chair cracked on seat, needs replacing. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed central shower with tub and sink needing cleaning.
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Patient care or consumable items shall not be stored below exposed sewage lines. 15A NCAC 18A .1318 (a). Observed diapers and other patient care items stored below hand sinks in several rooms.
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c). Observed soiled pill crushers on med carts. Keep interiors clean even when using plastic pill sleeve
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 torn mattress protector in room 129. Chairs in common areas need wiping down (near dolls) Broken cabinet in bathroom, 2nd floor.