Location: 5219 OLD WAKE FOREST RD RALEIGH, NC 27609 Facility Type: Nursing Homes Inspection Date: 06/28/2024
Score: 99
#
Comments
Points
17.
Note: The backup water supply plan consists of a letter from US Foods stating they will provide the "daily requirement of water" for the facility--if they are able--and a 72 hour emergency checklist that states a minimum amount of 3 gallons of water per person a day should be on hand. The facility only has 78 gallons of backup water and approximately 70 residents. A more detailed plan should be written that explains how the water will be used per person (such as for handwashing, bathing, food prep, etc) and the determined amount should be held on hand or discussed in the supply contract. Guidance document sent.
0.0
30.
.1318 (a); One of the med carts had a disposable utensil holder that contained debris/residue on the bottom. Food and utensils on medication carts shall be kept clean.
1.0
34.
Note: The facility uses chlorine to sanitize laundry in the washing machine but there is no service log available to determine the concentration of chlorine. Have the service provider leave a log to provide proof that the machine is properly supplying chlorine.
0.0
39.
Note: .1320 (b); Conversation had about returning utensils to the main kitchen for washing and sanitizing or making sure that the utensils are sanitized using the second basin of the sink in the activity kitchen.
Location: 5219 OLD WAKE FOREST RD RALEIGH, NC 27609 Facility Type: Nursing Homes Inspection Date: 06/28/2023
Score: 97
#
Comments
Points
10.
.1312(d)- Paper towels were missing at the handwashing sinks in a few of the resident rooms and at the handwashing sink in the activity kitchen in Hall B. Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices. Corrected during inspection- Paper towels were supplied.
1.5
28.
.1317(a)- Several live roaches were found in the storage closet located in the activity kitchen in memory care. Pests shall not be present in an institution`s building or buildings. Person in charge stated that the facility currently receives weekly professional pest control. Increase pest control measures to ensure there are no pests in establishment.
0.5
32.
.1319(a)- Cloth chairs in common areas have accumulated stains and require cleaning. Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair.
0.5
43.
.1321(b)- Employee food in activity kitchen refrigerators lacking a name and date. Food brought from home by employees or visitors of patients or residents shall be stored separately from the institution`s food supply as described in Paragraph (a) of this Rule. Such food shall be labeled with the name of the resident or employee that the food belongs to and the date the food was brought into the institution.
0.5
General Comments
*Areas inspected include: Rm A-14, Rm B-1, Rm C-1, Rm D-2 and all common areas, beauty salon, storage closets, soiled utility, facility laundry, resident laundry, and community restrooms.
Location: 5219 OLD WAKE FOREST RD RALEIGH, NC 27609 Facility Type: Nursing Homes Inspection Date: 06/21/2022
Score: 96.5
#
Comments
Points
2.
In the activity room in memory care unit, the floors around all equipment were very sticky and had residue buildup on them.- Floors shall be clean.- Please have the floors cleaned.
1.0
5.
In every room visited, the air conditioning filters had heavy dust buildup in them.- Ventilation equipment shall be kept clean.- Please clean all of the air conditioning units.
1.0
28.
In the memory care unit storage, blankets and sheets were being stored in bags directly on the floor.- Patient contact items shall be stored at least 8 inches above the floor.- Please have items moved off the floor. (repeat)
0.5
30.
Please ensure that medication carts are locked when not in use and when no one is able to keep a constant watch of cart.
0.0
33.
Observed blood on comforter of bed in room A-13.- Linen shall be changed when soiled.- Please have the comforter cleaned.
0.0
34.
There are no labels on the carts or tables for clean/soiled laundry.- Carts used for soiled laundry shall be labeled for soiled laundry use only.- Please label the carts.
1.0
General Comments
Due to COVID 19, Please follow CDC guidelines regarding social distancing, quarantine, and disinfecting. PIC cannot sign due to COVID-19 concerns
Location: 5219 OLD WAKE FOREST RD RALEIGH, NC 27609 Facility Type: Nursing Homes Inspection Date: 07/27/2021
Score: 98
#
Comments
Points
28.
Store all patient contact items at least 8 inches above the floor in storage closets. Items observed on floor and on shelving that was only 2 inches above the floor.
0.5
36.
Cleaning needed on cabinets in memory care activity kitchen and in both activity kitchen refrigerators. Clean under sink in memory care kitchen and monitor for a current leak.
1.0
40.
Numerous foods in activity refrigerators were missing names and/or dates. All foods brought in by residents or employees must be labeled with name and date.
Location: 5219 OLD WAKE FOREST RD RALEIGH, NC 27609 Facility Type: Nursing Homes Inspection Date: 06/03/2021
Score: 98
#
Comments
Points
4.
General Comment: One resident room (not currently occupied) had no functional lighting in the restroom. Please replace/repair this lighting fixture before allowing this room to be occupied.
0.0
30.
Repeat; Single-use cups on med cart were being stacked highly. Keep cup drinking surface lower than level of protective surround or keep in original plastic sleeve. Points will be taken if this item is repeated.
0.0
39.
Milk was being stored inside of the refrigerator with an expiration date of 4/28/2021. This milk was visibly spoiled. All food supplies shall be free from spoilage. This milk was discarded during the inspection.
Location: 5219 OLD WAKE FOREST RD RALEIGH, NC 27609 Facility Type: Nursing Homes Inspection Date: 12/04/2020
Score: 98
#
Comments
Points
14.
Ecolab Peroxide disinfectant used for spa tub and bathrooms does not list concentration required per contact time. Test kit was not available on site for this product. Facility currently uses 5 minute disinfectant contact time. Where disinfectants are mixed on site, the concentration of the mix shall be assured by use of a metering pump, measuring device, or chemical test kit. Obtain documentation from Ecolab for proper usage of their Peroxide product, what concentration/contact time, to kill Norovirus and COVID and maintain it onsite. Obtain test kit for this product.
1.0
16.
Backup Water Supply Plan is incomplete. Each Institution shall have a plan to obtain a backup water supply in the event that the water supply is lost for more than four hours. The local health department shall be immediately notified if the primary water supply is interrupted for more than four hours. The backup water supply plan shall provide for two liters of water per day per person for drinking. The plan shall also include a plan for either relocating residents or providing an alternative supply of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing, laundry, and disposal of waste. Specify in your emergency plan what to do (stay in place vs. evacuate) and when (after 4 hrs, 24 hrs..), list important contact phone numbers (utilities, health department, evacuation site contact, facility manager contact info) verified regularly, what emergency supplies should be maintained on site, and calculate how much Drinking water needs to be maintained on site based on number of people (residents, employees, other).
1.0
30.
Single-use cups on med carts stacked too high. Keep cup drinking surface lower than level of protective surround or keep in original plastic sleeve.
0.0
34.
Sanitizer auto-dispenser in use, with no records available of concentration used to verify required concentration achieved. Maintain copy of monthly laundry sanitizing records from Ecolab. Maintain laundry sanitizer to at least 50ppm chlorine residual.
0.0
40.
Individuals juice jugs not labelled with person name in D-hall craft room shared refrigerator. Food brought from home by employees, visitors, or residents shall be labeled with the name of the person to receive the food and date the food was brought in when kept in shared storage space. Add labeling to these products.
0.0
General Comments
Due to COVID 19, Please follow CDC guidelines regarding social distancing, quarantine, and disinfecting. No PIC signature today due to COVID-19 precautions. Inspection report is emailed to PIC. Increase touch surfaces sanitation and maintain social distancing as much as possible. CDC recommending all general public to wear face covering when out interacting to reduce community spread of COVID-19. Rooms visited today include: Laundry, storage, janitor closet, electrical, country kitchen, bathrooms, craft room, C-dining, C-Seating area, A17, A16, A4, B12, B5, B10, D1/D2, C13. Your inspector today is Joanne Rutkofske, 919-623-0459.
