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

1/14/2016

Final Score @ Grade

General Comments

1) 15A NCAC 18A .1309(a) All floors in intensive care units, bathrooms, showers, hydrotherapy areas, operating rooms, soiled utility rooms and laundry areas shall be free of obstacles to cleaning, and shall be kept clean and in good repair. Observed a missing tile in the 200 hall shower/spa. Observed rip on laminate located in front activity room underneath cabinet. 5) Observed multiple blinds ripped in resident rooms, living room and other areas throughout facility. Keep all blinds in good repair. Ms. Gloria was present during inspection. Alex Torres followed with during the inspection and verified report.

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	15A NCAC 18A .1311 (d) Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. Observed slight microbial growth in the ceiling in one shower in the 200 hall. REPEAT VIOLATION
8	2	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 loose toilet seat in room 108. Observed soiled toilet in the 100 hall shower room. REPEAT VIOLATION. Observed tile grout in multiple restrooms collecting residue. Observed shower curtain with dark residue present in the 100 hall. Observed diaper on floor in 100 hall restroom.
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). Observed no paper towels for the handsinks in the beauty shop, room 108, and 200 hall spa. Observed no soap in 200 hall bathroom.
13	1	Lavatory and bathing hot water between 100 and 116 F	No	No	No	Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). Observed water in the Bathroom in the 100 hall at 140F. Advised to turn down for burn hazards.
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 couches and arm chairs in the living room in the front of the building have stains and debris under the cushions. Observed spilled food in the top drawer of the dressor furniture in the front living room. Mattresses shall be kept clean, dry, and odor free. 15A NCAC 18A .1319 (a). Observed a dirty mattress in room 204.
33	2	Linen changed when soiled. Soiled linen handled properly	No	No	No	Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed soiled linen in room 113. REPEAT VIOLATION