Premises Information


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Name

BROOKDALE SOUTH PARK

Address

5326 PARK RD

City/State/ZIP

CHARLOTTE

28209

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

2/15/2019

Final Score @ Grade

90.50

General Comments

NO POINTS WERE TAKEN FOR THE FOLLOWING: #1 - Observed floor tile missing under washing machine in laundry room of Boat House. **Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). #2 - Observed sweeping needed on floor under beds and in linen closets. **Keep all flooring clean. 15A NCAC 18A .1309 (a). #5 - Observed dusty ceiling vents in several spa restrooms. Observed damaged screens on exterior of windows. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). #15 - Observed back-flow prevention missing from shower wand in spa of Cottage Place. **Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d). #21 - Observed dumpster door to have been left open. Observed sweeping needed around dumpster area.**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. 15A NCAC 18A .1319 (b). #33 - Observed urine stain on pad and underside of sheet in room 24A/B. Observed soiled linen bin not labeled in laundry room of Cottage Place. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). **Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b). #34 - Observed clean linen being stored on the floor in linen closet of Garden Path. Observed clean linen being stored with other items in cabinet in beauty salon. **Clean linen shall be stored and handled in a separate room or area, or in another manner that will prevent contamination of clean linen. 15A NCAC 18A .1319 (b). #40 - Observed date but name missing from residents orange juice brought from home. **Food brought from home by employees or visitors of patients or residents shall be stored separately from the institution's food supply and shall be labeled with the name of the person to receive the food and the date the food was brought into the facility. 15A NCAC 18A .1321 (b). #43 - Observed thermometers in refrigerators to be reading different temperatures when picked up and moved. Observed thermometers in the back of refrigerator. Store thermometers in the warmest part of refrigerators. **43. All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b).

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	Repeat Observed base boards, walls, doors, door frames throughout building (hallways, rooms, common areas, and spas) with damage and scuffing in need of repair or touch-up paint. Observed cleaning needed on the wall in room 12. Observed water stained ceiling in living area of Country Lane and water damaged ceiling in bathroom of Boat House. Observed rotting door framing around exterior of building. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat Observed cleaning needed in spa tub and on base of toilet of Garden Path. Observed cleaning needed under shower chair of Garden Path spa and under toilet chair of Boat House spa. Observed re-caulking needed on base of toilet in Boat House spa. Observed dried urine on toilet seat room 4. Observed cleaning needed in hopper of soiled utility closet of main hallway. Observed re-caulking needed around hand sink in main hallway restroom and in bathroom of Boat House. Observed tape residue collecting debris on hand sink in Boat House restroom. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). **Keep all hand washing facilities clean and in good repair. 15A NCAC 18A .1312 (b)
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Repeat Observed briefs being stored on the floor in room 51A/B, activity room storage closet, 24 A/B, and 39. Observed patient contact items being stored under hand sink in room 39. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Patient care or consumable items shall not be stored below exposed sewage lines. 15A NCAC 18A .1318 (a).
30	2	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Repeat Observed pill crushers on med carts with heavy build-up in need of scraping and routine cleaning. **Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat Observed ripped pillow in room 12 and room 4. Observed stained chair cushion in room 12. Observed heavy debris and food build-up in the couch cushions of common areas throughout neighborhoods. Observed debris collecting on mattresses in room 12, 51A/B, and 39. EHS reminded facility to brush out debris before placing clean linen on beds. Observed heavy build-up and rips on box spring cover in room 4. Observed cleaning needed under couch cushion in room 4. Observed dresser missing drawer pulls in room 51A/B. Observed damaged blinds in room 51A/B. Observed cleaning and touch-up paint needed on cabinet faces of satelite kitchens. **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).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	Observed water dispenser nozzles in all neighborhoods with black and thick white build-up on interior. EHS explained that water nozzles need to be disassembled and cleaned using scrub brush to prevent such build-up. Observed sippy-cups in Boat House Neighborhood with lids screwed shut while water was left in them. EHS reminded that items need to be air-dried before being stored with lids on. Observed cleaning needed in refrigerator of Garden Path. All kitchenware and food contact surfaces of equipment, exclusive or cooking of equipment, used in preparation or serving of food or drink, and all food storage utensils, shall be cleaned after each use. 15A NCAC 18A .1320 (c). Non-food contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. See rule .1320 (c).
42	2	Food protected. Potentially hazardous food maintained at 45 F or below, or 140 F for above, consumed or discarded within 2 hours of being removed from temperature control	No	No	No	Observed yogurt on med cart of Country Lane that CNA stated had been left out over night at 75F. CNA was currently using an opened yogurt for administering medication at 74F. EHS also observed yogurt being used on Garden Path hallway that was at 68F. CNA had removed yogurt from refrigeration more than 2 hours prior. EHS explained in detail that potentially hazardous foods need to be under temperature or time control for safety. If keeping foods at 45F or below, use ice and keep items completely submerged in ice for duration of use. If using temperature, mark exact time item was removed from temperature control on product and then discard two hours later. All potentially hazardous food products shall be maintained at 45°F, or below, or 140°F or above except during necessary periods of preparation and serving. 15A NCAC 18A .1323 (a). Potentially hazardous foods served shall be either consumed or discarded within two hours of being removed from temperature control. 15A NCAC 18A .1323 (a)