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

1/29/2018

Final Score @ Grade

91.50

General Comments

No Points Taken: 5. **Keep all ventilation equipment clean and in good repair. See rule .1311 (b). Observed vents on ac/heat units with build up in 203, 107, and 209. Observed build up on top of the ac/heat unit in room 203 and 107. 8. **Facilities in operation prior to March 1, 2003 that do not have handwashing lavatories in all areas required shall have an approved hand hygiene program established. See rule .1312 (d). Observed no handsink in the laundry room. **Ensure hand hygiene procedure is properly followed: hands must be sanitized in the laundry room before washing hands in the employee restroom across the hall. 12. **Provide liquid soap and disposable towels at all handwashing sinks. See rule .1312 (d). Observed no paper towels in room 209 and shower room and beauty room. 13. **Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100 F to 116 F. See rule .1312 (e). Observed hand sink in shower room at 118 degrees F 33. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. See rule .1319 (b). Observed soiled linens in 203, 209, and 107. Observed tore linen in 107 and 203. Observed soiled shower curtain in both shower rooms. 33. **Soiled linen shall be placed in a covered container or bag at the point of use and stored and handled so as to contain and minimize aerosolization of and exposure to any waste products. See rule .1319 (b). Observed no soiled linen covered bin in beauty shop. Inspection led by Samantha H Pepper under Jamil Blackmon's supervision

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	2	Walls and ceilings cleanable, clean, good repair	No	No	No	**Keep all walls and ceilings clean and in good repair. See rule .1310. Observed hall bath room with build up on the ceiling. Observed wall beside residence bed in room 107 with build up.
4	2	Lighting at least 10 foot candles 30 inches above floor	No	No	No	Observed lighting levels at * foot candles (30 inches above the floor) in . *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. See rule .1311 (a). Observed lights not working in linen room and storage room in common area. Observed without sufficient lighting in residence rooms throughout the building.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Keep all toilet equipment clean and in good repair. See rule .1312 (b). Observed soiled toilets in rooms 209 and 107 and shower room. Observed loose toilet in mens bathroom. Keep all bathing equipment clean and in good repair. See rule .1312 (a) and (f). Observed pink residue on shower chair in both shower rooms. Observed pink and black build up in showers in shower rooms. **Keep all handwashing facilities clean and in good repair. See rule .1312 (b) Observed significant build up in sink in storage 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. See rule .1319 (a). Observed chairs and couches in common area with debris on top and under cushions. Observed stains on chairs and couches in common areas. Observed door in shower room pealing and splitting.
35	0.50	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c). Observed adult diapers on the floor in storage room, 107, and 209. Observed hair in several brushes and curlers in the beauty salon.