Premises Information


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Name

WILLOWBROOKE COURT SC CTR AT MATTHEWS GLEN

Address

740 PAVILION VIEW DR

City/State/ZIP

MATTHEWS

28105

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

11/10/2022

Final Score @ Grade

General Comments

Carts used for soiled laundry shall be labeled for soiled laundry use only. 15A NCAC 18A .1319 (b). Observed soiled linen bins in beauty salon without a soiled label. 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). Observed chair in room 315 with debris and build up accumulating. 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). Observed pillow in room 127 with staining. Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c). Observed debris in med cart on 2nd floor. In need of cleaning. Clean linen shall be stored and handled in a separate room or area, or in another manner that will prevent contamination of clean linen. 15A NCAC 18A .1319 (b). Observed linens being stored on carts in linen closets on floors 1, 2, 3 with the protectant cover flipped up and exposing clean linens. Inspection lead by Grace Rutledge.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
1	1	Floors easy to clean, no obstacles, drains where needed	No	No	No	Floors shall be free of obstacles to cleaning. 15A NCAC 18A .1309 (a). Observed boxes of items in storage closet on 3rd floor and 2nd floor not allowing for the floor to be cleaned. Observed another storage closet on the 2nd floor in need of cleaning and organizing.
3	1	Walls and ceilings cleanable, clean, good repair	No	No	No	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed scuffs on walls in rooms 322, 118, 127 and in halls on 1st floor near med rooms and storage. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed ceiling tile not in place in 1st floor linen closet. Observed water stains on ceiling in bathroom in room 118.
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Toilet, handwashing, and bathing facilities must be conveniently located and readily accessible to residents and staff. 15A NCAC 18A .1312 (a). Observed hand sinks not accessible due to waste bins being stored in front of it in 2nd floor and 3rd floor soiled utility rooms. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed toilet in room 315 with damage on seat. Observed loose toilet seating in room 216