Premises Information


	Return to Inspections

Name

WILLOW RIDGE ASSISTED LIVING

Address

2040 MILTON RD.

City/State/ZIP

CHARLOTTE

28215

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

2/2/2017

Final Score @ Grade

General Comments

CONTINUED FROM PAGE 2 #8. Observed stained shower grout, mildew in te shower, and a dirty sink in the 200 hall shower room. Toilet, handwashing, and bathing facilities must be conveniently located and readily accessible to residents and staff. 15A NCAC 18A .1312 (a). Observed no handsink in the laundry room. No Points: #2 Observed several hallway closet floors were not clean. #5 Observed crumbs in the activity room AC unit and dusty filters in the AC unit for room 208. #9 Observed several elevated toilet chairs and wheelchair stored in 100 hall spa bathroom, as well as another wheelchair stored in the 200 hall spa room. #26 Observed multiple items, such as mattresses, bed frames, and chairs stored in dumpster area; and litter scattered at the edge of treeline. #34 Observed personal laundry mixed with facility linens in dryer ***Inspection lead by David Rollick with supervision by Tasharra Kenion. **Connie DIckerson was 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	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed black spots on the ceiling above the shower in he 200 hall shower room, water damage to the ceiling in the 100 hall storage room, and poor patch job to ceiling and the restroom wall was soiled in room 102.
4	1	Lighting at least 10 foot candles 30 inches above floor	No	No	No	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). Observed 2 lights out in the dining room and lights out with less than 10 foot candle of illumination in the 100 hall spa. Observed dusty lights in 100 hall spa and in 200 hall spa room.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed shower tiles missing around the drain, pink residue on the underside of shower chairs, black and pink stained grout, shower curtains with red stains, a broken towel rod, a dirty tub stained blue holding dead bugs, and a floor drain filled with hair and debris all in the 200 spa room. Observed black stained grout, shower head with residue, a missing toilet seat, and moldy debris under the hand sink in the 100 hall shower room. Observed missing floor tiles in shower, black stained shower grout and a shower chair with pink residue in the 100 hall spa room. Observed soiled toilets in room 107, 102, and 208, a loose toilet seat n room 102, and a dirty sink in room 208. CONTINUED ON PAGE 5
12	3	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 hand washing sinks. 15A NCAC 18A .1312 (d). Observed no paper towels in 200 hall shower room, 200 hall spa room, and room 102 (REPEAT).
14	1	Disinfectant accessible, properly used	No	No	No	A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). Observed no disinfectant in the 200 hall spa room (REPEAT).
28	1	Adequate storage, area clean, items properly stored	No	No	No	All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed patient briefs stored on the floor in outdoor storage shed and in 100 hall storage room (REPEAT). 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 items stored within the splash zone of hand sink in med room.
32	2	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 stained and soiled furniture in living room and soiled table in activity room (REPEAT).
33	1	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 uncovered soiled linen bins in the 100 hall spa, torn pillow and a soiled sheet in room 102.