Premises Information


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Name

WILLOW RIDGE ASSISTED LIVING

Address

2040 MILTON RD.

City/State/ZIP

CHARLOTTE

28215

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

1/21/2014

Final Score @ Grade

General Comments

4. Observed light out in the 200 hall shower room (over the shower).All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a). 9. Observed wheel chair in room 101 restroom.Toilet rooms shall not be used for storage. See rule .1312 (b). 28. -Observed boxes of briefs stored on the floor in both storage rooms on 100 hall, room 113, and an open bag of briefs stored on room 113 closet floor.-Observed clothes, bags, boxes, etc stored on the floors of the closets in rooms 202, 101, and clean linen stored on the floor of the clean linen room on the 100 hall.All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).32. Observed torn pillow in room 221.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. Observed torn fitted sheet in room 211.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).*Note: Observed all chemical spray bottles labeled as Sanitizer. Ensure the spray bottles have the same label as the original source.Mr. Rick present during the inspection.

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 Non-Compliance: Observed popcorn ceilings in 100 & 200 halls peeling and splitting.-Observed walls in room 202 stained.-Observed the ceiling in disrepair in the 200 hall spa.Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat Non-Compliance: -Observed brown residue on the shower chair on the 200 hall.Keep all bathing equipment clean and in good repair. See rule .1312 (a) and (f).-Observed soiled toilet seats in 202, 211, and 100 hall spa room.Keep all toilet equipment clean and in good repair. See rule .1312 (b).
14	2	Disinfectant accessible, properly used	No	No	No	Repeat Non-Compliance: -Observed shower rooms and 100 hall spa missing disinfectant/cleaner. A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. See rule .1312 (f).-Spoke with employee who stated that the showers/spas are cleaned by spraying the disinfectant on the surface, wiping it off, taking the resident back to their room, spraying more disinfectant, then wipe it off again. Instructions on the disinfectant/cleaner stated there is a 10 minute contact time.Skin contact surfaces of all shared bathing equipment shall be cleaned with a detergent solution and then disinfected with an EPA registered hospital disinfectant between patient uses. See rule .1312 (f).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	-Repeat Non-Compliance: Observed med cart on 100 hall with chemical bottle stored on patient items. Upon lifting the bottle, a leak was observed.Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).-Observed cups stored with mouthpieces unprotected on 2 med carts. Nurses were informed to keep cups in their sleeve or store them in plastic bags to protect the mouth pieces.Unused medication cups shall be kept covered or inverted. 15A NCAC 18A .1318 (c).