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

6/7/2017

Final Score @ Grade

88.50

General Comments

Chris Brides was present during the inspection. CONTINUED FROM PAGE 2: #8 - Observed the sink was blocked by soiled linen bins in the soiled utility room (short term care), sinks blocked in spa rooms with excess storage of lifts, wheelchairs, reliners etc., no hand sink or hand higene procedure for beautician in the salon. Ensure that the beautician has hand sanitizer to clean hands before washing her hands in the hallway restroom. **Handwashing sinks shall be accessible to all areas where personnel may be exposed to bodily excretions or secretions. 15A NCAC 18A .1312 (d). **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. 15A NCAC 18A .1312 (d). NO POINTS WERE DEDUCTED FOR THE FOLLOWING: 4. Observed the lights not working in the restrooms in rooms 108, 502. **Ensure there is adequate lighting in all areas. 10. Observed a bedpan was not labled in room 712. **Ensure that all bedpans are labeled with the resident's name and date issued. 15. Observed the condensate line (top) of the ice machine is directly plumbed in the nourishment room; the bottom condensate line needs an air-gap. **Properly install pump, so that waste water in the top condensate line pumps to drain. 28. Observed boxes of medical supplies were stored on the floor in a long term wing storage closet.**All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). 36. Observed a microwave that runs while the door is open, and had damaged interior surface. Keep all food service equipment in good repair.

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	Observed the floors were not clean in 502, 609, the ceiling was not cleaning room 502 restroom. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. NOTE: Finish all repaired walls where they are smooth and painted.
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Observed a bedside commode was not cleaned after use in room 406, the toilet was not clean in room 807, Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed shower chairs, shower stretchers with pink residue and mildew in the community spa rooms throughout the facility, the shower grout with mildew in the community shower rooms throughout the facility, a broken shower head in a shower in the spa room . Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).
14	2	Disinfectant accessible, properly used	No	No	No	(REPEAT)Observed no disinfectant solution available in to community spa/shower rooms, and no disinfectant used by the housekeepers in the showers on 3 different hallways. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).
16	1	Quantitiy and hot water sufficient, backup water supply plan	No	No	No	(REPEAT) Observed the back-up water supply plan was not complete. It was missing the amount of water supplied for each resident per day, how toilets would be flushed, etc. A guidance document including a checklist for creating a complete document was provided by email. **Observed an incomplete backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f).
19	1	Ice protected, dispensed, equipment clean in good repair	No	No	No	(REPEAT) Observed several unattended ice chest carts on the hallways. Ice carts should always be attended when on the hallway, or locked up. Ice shall be handled, transported, stored, and dispensed in such a manner as to be protected against contamination. 15A NCAC 18A .1314 (b). All ice machines and storage chests which are accessible to the residents and the public shall be automatic ice dispensing machines. 15A NCAC 18A .1313 (b).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	(REPEAT) Observed sticky residue in some med cart drawers, some single service drinking cups were stored unprotected on med cart. Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c). Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c). NOTE- Ensure that all water pitchers are thoroughly washed, rinsed, and sanitized daily.
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Observed living room couches with food debris beneath the cushions, several blue mattresses with worn/damaged surfaces, several reclining chairs with damaged surfaces, and a separation curtain was soiled in room 502. **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).
33	2	Linen changed when soiled. Soiled linen handled properly	No	No	No	(REPEAT) Observed the soiled linen bins in the salon were not labeled. **Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b). Observed sheets with holes in room 609,
40	0.50	Food brought by employees or visitors handled properly	No	No	No	Observed several food items from outside sources were not labeled in long term care nourishment room refrigerator. 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). Food brought from home by employees or visitors of patients or residents shall be kept only as long as it is clean, and free from spoilage. 15A NCAC 18A .1321 (b).