Premises Information


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Name

SUMMIT PLACE OF SOUTHPARK

Address

2101 RUNNYMEDE LN

City/State/ZIP

CHARLOTTE

28209

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

3/12/2018

Final Score @ Grade

94.50

General Comments

No Points Deducted Today: 10. Observed urine still in the urinal in room 339. Follow the rule below. All bedpans/urinals/emesis basins shall be cleaned after each use. 15A NCAC 18A .1312 (c). 15. Observed no back flow preventer on the shower wand in room 310. Provide. Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d). 33. Observed stains on the bedding in room 108. Change. Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). 36. Observed buildup inside of the microwave and refrigerator in rooms 236, 339, and MC ref. 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. Observed unprotected apples on the floors for grab and go. Ensure the apples are washed and wrapped or provide a sign that informs the consumers to wash before consumption. All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. 15A NCAC 18A .1323 (a). 43. Observed no thermometers in the refrigerators in room 236 and 2nd floor med room. Provide. All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). NOTE: Observed the dumpster lids broken in and the doors open. Replace broken lids and keep close.

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: -Observed stains on the shower chair in rooms 339 and 120 (MC unit). -Observed stains on the shower curtain in room 110 on the MC unit. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). -Observed the toilet seat riser rusted in room 110 and loose toilet seat in the 2nd floor hall restroom. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	-Observed a box of caths on the floor in the closet of 339 and briefs on the floor in other rooms/bathrooms. -Observed towels and cloths stored unprotected below the sink pipe in room 339. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
30	1	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	-Observed drawers soiled in the med carts on the 2nd floor. Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c). -Observed a personal drink stored on a med cart on the 2nd floor. Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat: Observed couches with debris and crumbs under cushion in the 1st floor common room and in the halls of the MC unit. **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).