Premises Information


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Name

BROOKDALE SOUTH CHARLOTTE

Address

5515 REA RD

City/State/ZIP

CHARLOTTE

28226

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

1/17/2019

Final Score @ Grade

93.50

General Comments

No Points Deducted: #3 Keep all walls and ceilings clean and in good repair. See rule .1310. Observed wall damage in resident room 103. Observed paint peeling on wall located by window in resident room 218. Observed stained ceiling in resident room 104B. #11 Except for the stipulations stated in rule .1312 (d), handwashing sinks shall only be used for handwashing. Provide an additional utility sink for servicing equipment. See rule .1312 (d). Observed handsink in activity area for memory care unit being used to store dirty dishes. Use bus tub or other container to stack, store and transported dirty dishes. #14 A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. See rule .1312 (f). Observed shower room in memory care unit without cleaning detergent and an EPA registered hospital disinfectant. Both shall be kept in shower room at all times. #36 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. See rule .1320 (c). Observed microwave and coffee maker located in activity kitchen in memory care unit. #34 Laundry areas and equipment shall be kept clean and in good repair. See rule .1319 (b) and .1312 (a). Observed evidence of leak coming from washer in resident washing room. PIC stated he would look into repairing washer leak. Observed build up around doors on washers in 2nd and 3rd floor laundry rooms. All common linen including sheets, pillow cases, absorbent pads, towels, and wash cloths provided by the facility must be sanitized between users with an EPA registered laundry sanitizer or by other methods described in .1319 (b). Documentation required, per maintenance report that linens are being properly sanitized at minimum of 50ppm chlorine OR washed at 160F for a minimum of 25 minutes. Inspected 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
8	2	Facilities conveniently located, clean and in good repair	No	No	No	REPEAT: Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed toilet and toilet seats in need of cleaning in resident rooms 218 and 320. Observed hopper located in Soiled Linen area with build up around bowl. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed shower chairs located in shower room (memory care) and shared resident bathroom for 103 and 104B. Observed stained shower curtains in resident rooms 306 and shared resident bathroom for 103 and 104B.
28	1	Adequate storage, area clean, items properly stored	No	No	No	REPEAT: 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 floor in resident room 218. Observed pillows stored on floor in Clean Linen room. 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 mattresses stored in custodial closet with operable mop sink. Store mattresses in a clean storage area.
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	REPEAT: 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 stained chair cushions in a majority of common areas throughout the facility. Observed stained mattress in resident room 104B. Observed ripped padding on weigh station located in common room.
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 306, 320, and 202. Observed ripped pillows in resident rooms 104B and 218.
43	0.50	Food storage units with thermometers, maintain temperatures	No	No	No	REPEAT: All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). Observed resident refrigerators without thermometers in rooms 202 and 306.