Premises Information


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Name

WALTONWOOD COTSWOLD

Address

5215 RANDOLPH RD

City/State/ZIP

CHARLOTTE

28211

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

10/27/2017

Final Score @ Grade

General Comments

Steve Engle was present during the inspection. CONTINUED FROM PAGE 2: #28 - Observed single service cups were not protected on the hydration cart. Stored in cart cabinet or protective bag or container. Observed single service coffee cup lids were overfilled (taller than the rim of the protective basket) at the coffee station. **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). No points were deducted for the following: 8. Observed the shower curtain liner with pink residue and mildew on the shower curtain liner. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). 14. Observed no disinfectant solution available in the salon for the foot/pedicure tub. The disinfectant in for the spa tub was in a concentrated state. Mix disinfectant for the spa tub as directed and supply to the spa tub room in ready-to-use form. 22. Observed the trash compacter was out-of-order and employees unable to dump trash. Observed no flies or insects. **Repair trash compactor as soon as possible. 34. Observed clean linen were stored 40. Observed one bag of food in the refrigerator was not labeled. **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).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
12	3	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	(REPEAT) Observed no soap in the nourishment/medical records room (memory care), observed soap dispenser had fallen from the hand washing area a soiled utility room, no paper towels in the AL activity room hand washing sink. Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed clean paper towels were stored beneath the sink drain in the memory care kitchenette, drinking water/ice pitchers were stored within the spalsh zone of the hand washing sink in the med-room, hair rollers and other supplies used by the salon were stored on the floor in the salon closet. **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A . CONTINUED ON PAGE 5
43	0.50	Food storage units with thermometers, maintain temperatures	No	No	No	Observed the thermometers were not working properly in the memory care kitchenette refrigerator, and no thermometers present in the resident room refrigerators. *All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b).