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

7/9/2015

Final Score @ Grade

90.50

General Comments

#5 Observed 1 A/C vent with debris present in room 107. Continue to keep all A/C filters clean and in good repair.#15 When asked on site where water was received from, staff at nursing station stated that sometimes it is from the kitchen and others it from the hand washing sink at front nurses station. Water shall be provided from kitchen and pitcher shall be cleaned daily. #17 Observed water fountain collecting dark residue around base and nozzle. Observed water fountain was slow draining. Water fountain in need of cleaning.Ms. Itestal Pulliam and Alexandra Cassell was present during inspeciton.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
6	1.50	No evidence of microbial growth	No	No	No	Repeat Non Compliance: Observed build up on tile/grout on floors and walls in 100 shower hall. Other shower rooms were in good condition. Continue to clean grout in walls and ceilings. **Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d).
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat Non Compliance: Observed loose toilet seats in following areas: 107, 400 hall shower, and room 219. Observed ripped shower curtain in 400 hall shower, and urine present on bathroom floor of room 209. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).**Keep all hand washing facilities clean and in good repair. 15A NCAC 18A .1312 (b)
14	2	Disinfectant accessible, properly used	No	No	No	Repeat Non Compliance: Observed disinfectant not present in 100 and 200 hall shower rooms. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).
28	1	Adequate storage, area clean, items properly stored	No	No	No	Repeat Non Compliance: Observed clothes stored on floor in room 107 and several other rooms throughout facility. Repeat Non Compliance: The rear shed not accessible due to excessive amounts of items being stored.**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).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Repeat Non Compliance: 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).
33	2	Linen changed when soiled. Soiled linen handled properly	No	No	No	Repeat Non Compliance: Observed soiled linen in salon cabinet. Repeat Non Compliance: Observed rip in pillow in room 107, stain on linen and on pillow in room 219, and soiled linen in room 202.**Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).