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

3/13/2019

Final Score @ Grade

General Comments

NO POINTS WERE TAKEN FOR THE FOLLOWING: #1 - Observed missing tile in entry way of med room on 3rd floor. Observed re-caulking needed where shower meets floor in restroom of 114. **Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). #2 - Observed floor cleaning needed under beds and along walls behind beds in memory care rooms. Observed staining on carpet in 212 and 226. Observed cleaning needed on carpet in closet of 226. **Keep all flooring clean. 15A NCAC 18A .1309 (a). #13 - Observed hot water reach 118F in room 330. Water spiked to 118F when shower was turned on along with hand sink and then it tempered back down. **Maintain the hot water at all resident accessible hand washing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). #17 - Observed water fountains with build-up on the first floor. EHS suggested using food grade sanitizer and scrubber to remove build-up. **Drinking fountains shall be kept clean and properly regulated. 15A NCAC 18A .1314 (a). #19 - Observed cooler full of ice in memory care without lock on it. Scoop was left in cooler and handle was submerged in ice. **Ice machines, buckets, other containers, and scoops shall be protected from the elements, splash, drip, dust, vermin, other contamination, and from use by unauthorized personnel. 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). CONTINUED FROM #42 - Observed gallon of milk at 52F in memory care refrigerator. Milk voluntarily discarded. Gasket was not sealing on the refrigerator and internal ambient air thermometer was reading 58F. Maintenance adjusted temperature on refrigerator and thermometer eventually read 39F. EHS recommended fixing gasket to seal. **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) NOTE: CNA of memory care was unsure of how shared baby dolls are cleaned. See following rule: **Shared toys subject to mouthing shall be washed and rinsed with soap and water and disinfected with 70 percent alcohol or 100 ppm chlorine after each day's use. 15A NCAC 18A .1319 (c). Ensure staff is properly trained on how to clean these items. NOTE: Observed house keeper cleaning rooms on 3rd floor, per discussion, house keeper is using a yellow liquid in a spray bottle labeled "glass cleaner" for disinfectant. Maintenance director showed EHS chemical he believed was actually in the bottle on the service hallway where house keepers fill up. Yellow cleaner in this area was floor cleaner. Disinfectant bottle was empty. Ensure house keepers are using disinfectant for tubs and toilets. Disinfectant was replaced. Observed chemical spray bottle in service hall janitors closet to be mislabeled. ENSURE ALL CHEMICALS ARE PROPERLY LABELED.

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 water stained ceiling tiles in hallways, janitorial closet of 2nd floor, clean linen closet of 3rd floor, service hallway, beauty salon closet, and memory care closet. Observed wall damage on the corner of wall in room 114. **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 loose toilet seats in 330 and 212. Observed cleaning needed on the back of shower chair in 310 and shower chair leg of 114. Observed cleaning needed on the underside of toilet chair in 310 and cleaning needed in toilet bowl of 212. Observed hoppers to be soiled in areas throughout. Observed hand sink counters with water damage in memory care restrooms. Observed cleaning needed under the hand sink in room 114. Observed recaulking needed around the backs of hand sinks in memory care. 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). **Keep all hand washing facilities clean and in good repair. 15A NCAC 18A .1312 (b)
28	1	Adequate storage, area clean, items properly stored	No	No	No	Repeat Observed briefs being stored on the floor of closets in 310, 212, and 226. Observed wipes being stored under hand sink in room 114 of memory care. Observed box of paper towels being stored on the floor of 2nd floor activity room closet. Suitable rooms or spaces shall be provided for the storage of all necessary equipment, furniture, and supplies, and kept clean. 15A NCAC 18A .1318 (a). 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).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat Observed stained mattresses in room 310 and room of memory care. Observed pillow with staining and soil in room 226. Observed couch with staining in room 226. Observed crumbs under couch cushions of 2nd floor hallway. **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	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Repeat Observed mattress pad with staining in room 226 and stained mattress pad and sheets in 114. Observed foot skin particles left on the edge of the bed in 114. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	Repeat Observed cleaning needed in the refrigerator and freezers of 310 and 212. Observed cleaning needed in the microwave of 212. **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 open container of thickener on med cart of 3rd floor that was at 76F. Packaging states to refrigerate after opening and to leave product at room temperature for 8 hours after opening and then discard. Observed container of yogurt in memory care med cart drawer that was above 45F. Yogurt was labeled for 9am. All TCS (Temperature Control Required for safety) foods must be held at 45F or below at all times or be under a time procedure. Rule states that TCS foods must be discarded two hours after opening or removing from temperature control. EHS advised labeling items when they are opened or removed from temperature control for them to be discarded 2 hours later. CONTINUED ON BACK PAGE