Premises Information


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Name

PEAK RESOURCES-CHARLOTTE

Address

3223 CENTRAL AV

City/State/ZIP

CHARLOTTE

28205

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

12/4/2015

Final Score @ Grade

General Comments

l#5) Observed dusty air vent in common area living room. Keep all ventilation clean and in good repair.#19) Observed ice dispensing station left unattended. Ice shall be protected from potential contamination.#16) Observed water in room 305 at 90F. Maintain hot water at 100-116F.#28) Observed single box of patient care items stored on floor in storage room. Box was relocated. #30) Observed med cart drawer 300 with slight debris build up. Drawers in need of routine cleaning.Inspection completed by Devonna Hendrix reviewed and signed off by Alex Torres REHS

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat Non-compliance. Observed shower chairs with pink residue on underside in Spa in 600 Hall. Observed soiled toilet in room 907 and 600 spa room. Observed red residue on floor in 600 Hall Spa room. Observed urine stains on toilet in rooms 907 and 203. Observed soiled bathing mats in 600 Hall Spa Room. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).
10	1	Bedpans, urinals, bedside commodes and emises basins properly cleaned and disinfected	No	No	No	Observed unlabeled bed pans in rooms 104, 203, 812, 907, 403. Observed soiled bed pan in room 104Label all disposable bed pans with the residents/patients name and date. 15A NCAC 18A .1312 (c).All bedpans/urinals/emesis basins shall be cleaned after each use. 15A NCAC 18A .1312 (c).
14	2	Disinfectant accessible, properly used	No	No	No	Repeat Non-Compliance. Observed no EPA registered disinfectant in 600 Hall Spa room.**A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).
33	2	Linen changed when soiled. Soiled linen handled properly	No	No	No	Repeat Non-Compliance. Observed soiled linen, ripped comforter and stained pillowcases on beds in rooms 104, 203, 907, 305, 403. Observed no linen on the bed in room 907.**Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).