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

7/22/2014

Final Score @ Grade

94.50

General Comments

#.6 Observed microbial residue built up on shower head in small shower room 100 hall in need of cleaning. **Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d).#32 Observed chairs with stains present in living room with crumbs present on side lining. **All furniture shall be kept clean and in good repair. 15A NCAC 18A. .1319 (a).#4 Observed lights in need of replacement in 200 spa, 103, 217 **All areas shall be provided with sufficient illumination to effectively perform all operations, including cleaning. #24 Observed multiple dead insects throughout facility. Pest management for facility in place and properly working. Areas where insects present in need of cleaning. **Effective measures shall be taken to keep insects out of establishment to prevent breeding or presence on the premises. #27 Observed Vet records not present on site. Records are required on site when animals visit. **Copies of vetinary records for all animals shall be kept on premises. 15A NCAC 18A .1317 (f).#30 Observed med cart with debris in container holding packaged medicines. Containers shall be free of debris. **Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).#34 Observed documentation missing to indicate temperature/ chemical concentration present during wash cycle. Records shall be provided to ensure proper cleaning procedure. ** If hot water used items shall be washed in water at least 160 F for 25 minutes. If low temperature laundry cycles are used, linens shall be washed with at least 50 parts per million chlorine or an EPA Listed laundry sanitizer.#35 Observed holes present in linen throughout in need of repair. **Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c)

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	Observed multiple holes, dings, dents in walls, baseboards, and ceilings throughout facility in need of patching, repair, or maintenance. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Observed loose toilet seats in rooms: 200 Spa, 200 shower, 110, 100 (small shower room) in need of tightining or replacement, soiled bathroom chair in 103, soiled lid in 202 in need of proper cleaning. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).Observed caulk lining in room 103 peeling away from wall in need of reappliance. Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b)Repeat Non Compliance: Observed brown residue on underside of shower chair in 200 spa, 100 spa, shower curtains visibly soiled on bottom side in 200 spa, 100 spa, small 100 bathing room. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).
14	2	Disinfectant accessible, properly used	No	No	No	Repeat Non Compliance: Observed disinfectant missing from 200 spa. Disinfectant shall be present. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed bins of clothes in laundry room on floor in need of replacing to another area. Back storage shed overloaded with boxed items without organization in need for cleaning. **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).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed linen, pillow cases, soiled with debris present in sheets in rooms: 217, 202, 110, in need of repair, replaced, cleaned also including linen in clean linen closet. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).