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

5/13/2022

Final Score @ Grade

95.50

General Comments

#1. Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). Observed damaged flooring in bathroom within room 36 on boathouse hall between vanity stand and toilet. Repair flooring in bathroom. #4. 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 light bulb not operating in light fixture above hand washing sink in several residents bathrooms within rooms. Replace blown light bulbs/ light bulbs not working in light fixtures. #26. There shall be no fly or mosquito breeding places, rodent harborages, or undrained areas on the premises. 15A NCAC 18A .1317 (c). Observed standing water with mosquito larvae present in trash can within the dumpster corral. Trash can containing standing water emptied at time of inpection. Keep premises free of standing and collecting water. #42. Potentially hazardous foods served shall be either consumed or discarded within two hours of being removed from temperature control. 15A NCAC 18A .1323 (a). Observed several plates of breakfast items sitting on the counter and in the microwave in small kitchenette area on two wings. The CNA informed me that the food were for resident that were sleeping late. Provide some way of tracking time on food products that is not being held either hot or cold. Have food service director to complete TPHC application and implement procedures on application to maintain food products from either being kept hot or cold.

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 walls and door framing damaged and missing paint throughout. Repair corners of walls. Replace missing outlet covers. Secure phone wiring cover plate to wall. Repair walls, door framing and repaint throughout.
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 base of shower curtain, underside of shower chair/shower bench soiled in common bath/shower. Observed base of spa tub soiled. Thoroughly clean and disinfect shower curtains, shower chairs/shower bench and base of spa tub. Repair leaking faucet on spa tub. Replace broken/missing shower wand holder in common bath/shower area.
28	0.50	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 diapers/briefs stored on the floor in residents closet and storage on the floor in med supply room. No storage on the floor. Store patient care items on shelving.
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). Refurbish or replace chair in main lobby area, Wipe/clean exterior of cabinet door in kitchen/common sitting area. Refurbish/touch up cabinets in common sitting/kitchen area. Replace missing laminate on shelving/ledge at nurse work stations. Tighten loose handle on cabinet doors. Replace missing handle on cabinet doors. Clean area under couch cushions. Observed arm rest damaged on residents personal chair. Contact resident family and have them to repair or replace damged arm rest on chair. Points where kept at half points deduction, due to the fact there were issue but not much related to the residents.