Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 07/30/2024
Score: 95.5
#
Comments
Points
5.
Observed dusty a/c vents and filters in rooms inspected. Ventilation equipment shall be kept clean and in good repair. Increase cleaning of vents.
0.5
17.
Back up water supply only consists of cooking and drinking/handwashing water supply. The backup water supply plan shall include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing, laundry and disposal of bodily waste. Guidance provided for backup water supply plan.
0.5
33.
In room 410, observed bed cover and sheet were soiled. A resident`s bed linens shall be changed when no longer clean. Clean bed cover and sheet.
0.0
34.
In laundry room, observed chlorine concentration of laundry washing machine at 0ppm. When chemicals are used to sanitize
linens provided by the institution, linens shall be washed in accordance with the following:
(1) using a solution of at least 50 parts per million chlorine; or
(2) using laundry sanitizer
Contact rep to come service chlorine sanitizer in laundry washing machine.
1.5
44.
In nourishment room on 500 wing, Observed thermometer was reading 60F and food had molded in fridge. All TCS(Time/Temperature Control for Safety) foods shall be maintained at 41F or below. Corrected during inspection-All food was discarded from fridge
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 08/10/2023
Score: 97.5
#
Comments
Points
5.
Observed dusty a/c vents and filters in rooms inspected. Ventilation equipment shall be kept clean and in good repair. Increase cleaning of vents
0.5
16.
Observed hot water temperature in rooms 207 and 108 at 117F and 119F. Hot water shall be provided at temperatures between 105 degrees Fahrenheit and 116 degrees Fahrenheit at handwashing and bathing facilities. Adjust hot water to appropriate temperature.
1.5
17.
Back up water supply only consists of cooking and drinking/handwashing water supply. The backup water supply plan shall include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing, laundry and disposal of bodily waste. Provide essential functions listed above in backup water supply plan.
0.0
33.
Observed holes in top bed covers in rooms inspected. Bed linens that are provided by the institution for use by residents shall be free from holes and tears. Replace bed covers.
0.5
34.
Facility was unable to provide laundry service paperwork indicating laundry chlorine concentration. When chemicals are used to sanitize linens provided by the institution, linens shall be washed in accordance with the following:(1) using a solution of at least 50 parts per million chlorine; or (2) using laundry sanitizer. No point deducted; Provide paper work next visit
0.0
General Comments
No signature captured. Inspection report emailed to michelle.baldwin@choice.health.net
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 09/06/2022
Score: 95.5
#
Comments
Points
2.
Observed soiled flooring in bathroom(room 315) and behind tub in Central Bathing room short 400 hall. Tiles in central bathing room short 100 conference hall are cracked and damaged in shower rooms. Floors shall be free of obstacles to cleaning, and shall be kept clean and in good repair. Increase cleaning in these areas. Repair/replace broken tiles.
1.0
3.
Observed soiled walls in soiled utility room. The walls and ceilings of all rooms and areas shall be kept clean and in good repair.
1.0
13.
Hot water in halls closest to water heater temperatures were 116-126F. Hot water must be maintained at 100-116F.
1.0
14.
Disinfectant accessible in shower rooms. Showers must be disinfected in between each resident. Keep disinfectant accessible for convenient use.
1.0
16.
Back up water supply only consists of drinking water supply. The backup water supply plan shall include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing, laundry and disposal of bodily waste. Provide backup water supply plan.
0.0
35.
Packages of adult diapers stored on the floor in storage room. Store all patient contact items at least 8 inches above the floor.
0.5
40.
Observed two bags of food in resident refrigerator in Nourishment room not labeled with patient`s name or dated. 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 in.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 07/15/2021
Score: 94
#
Comments
Points
3.
Repair tile in as needed in shower rooms.
0.0
12.
Handsinks out of paper towels in med room 1 and public restroom in 100 hall. Keep all handsinks stocked with paper towels for effective handwashing.
1.5
13.
Hot water at 119-137F in halls 1-4. Hot water must be maintained at 100-116F.
1.0
14.
Disinfectant accessible in shower rooms. Showers must be disinfected in between each resident. Keep disinfectant accessible for convenient use. Disinfectant not hooked up in tubs. Tubs are required to be disinfected according to manufacturer`s instructions after each use.
1.0
16.
Back up water supply plan shows drinking water supply. The backup water supply plan shall include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing, laundry and disposal of bodily waste.
0.0
19.
Keep ice coolers stored behind nurse`s station or another area that prevents residents/guests from dispensing themselves. Ice machine needs cleaning.
1.0
31.
Tube feeding bags are not labeled to identify time and date to be able to identify discard time.
1.0
34.
Per maintenance director, washing machines are checked by service company to make sure they are sanitizing as required but no documentation was able to be provided. Make sure service records are available on site at all times that show machines are sanitizing as required.
0.0
35.
Cases of patient consumable items stored on the floor in storage areas. Store all patient contact items at least 8 inches above the floor.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 01/15/2021
Score: 95
#
Comments
Points
1.
In laundry room, several floor tiles were damaged...Floors shall be in good repair and easy to clean...Replace the damaged floor tiles.
0.0
2.
Some flooring was soiled in janitorial rooms, oxygen storage room and other storage rooms...Flooring shall be maintained clean...Increase cleaning frequency of floors.
1.0
4.
In 400 hallway central bathing room, lighting in one shower stall was very dim...Lighting shall be at least 10 foot-candles of 30 inches above floor...Replace burned out/nonfunctioning light fixtures in shower stall.
0.0
5.
A few ceiling vents in bathrooms and hallways were soiled/dusty...Ventilation fixtures shall be maintained clean...Increase cleaning frequency of vent fixtures.
0.0
8.
In 400 hallway central bathing room, shower heads in one shower stall were not working--only dripping...Bathing facilities shall be maintained in good repair...Repair the improperly functioning shower heads.
1.0
9.
Some extra equipment is being stored in toilet rooms...Toilet rooms shall be free of storage...Remove all non-toileting items from toilet rooms.
0.0
13.
In one med room, tempered water did not exceed 48F. Hot water at other med room, laundry area and bathroom handsinks ranged from 121-133F...Water heating facilities shall provide hot water within the temperature range of 100 degrees F to 116 degrees F at all lavatories and bathing facilities...Adjust hot water temperature to proper range.
1.0
19.
Ice scoop in one nutrition room was sitting in standing water...Scoops shall be cleaned on a regular schedule so they are kept free of contamination...Store ice scoop on clean, dry surface or container.
0.0
30.
Several med cart drawers had soiled drawers and stray pills...Medication carts shall be maintained clean...Increase cleaning frequency of med carts drawers.
1.0
32.
In laundry room, some laundry carts were torn with holes...Laundry carts shall be maintained in good repair so they are easy to clean...Replace the damaged laundry carts.
1.0
General Comments
DISCUSSION REGARDING BACKUP WATER SUPPLY PLAN: Facility has parts of a backup water supply plan (evacuation procedures in case of disruption in water supply, US Foods agreement to assist with emergency water needs) but some parts should have more information. According to 15A NCAC 18A.1313, the local health department shall be immediately notified if the primary water supply is interrupted for more than four hours (this should be included in your plan). 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 backup water supply plan shall provide for two liters of water per day per person for drinking (specify in your plan where this water is available). The backup water supply plan shall include a plan for either relocating residents or providing an alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning, dishwashing, laundry and disposal of bodily waste. The amount of water provided for uses other than drinking may be reduced if the plan includes alternatives for water use for services such as laundry and dishwashing. If an assessment determines that tap water is not to be used for drinking, sources shall be prominently labeled or hooded to restrict use and potable water shall be provided...Inspection report sent to PIC via email, and EHS verified it was received before leaving establishment. No recipient signature due to COVID-19 precautions.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 08/26/2019
Score: 93
#
Comments
Points
2.
.1309 (a) Trash/plastic tabs covering floor in air tank storage room in 100 hall. Caulking around toilet discolored/soiled in room 214. Debris on floor in room 209. Employee break room bathroom floor dirty. All floors in intensive care units, bathrooms, showers, hydrotherapy areas, operating rooms, soiled utility rooms
and laundry areas shall be of smooth, non-absorbent materials and so constructed as to be easy to clean. Floors shall
be free of obstacles to cleaning, and shall be kept clean and in good repair. Carpeting shall be maintained clean,
odor free, dry and in good repair. Clean floors. Replace caulking around toilet if necessary.
0.0
3.
.1310 Wall in chlorine storage closet for laundry room eroding and has holes in the wall. The walls and ceilings of all rooms and areas shall be kept clean and in good repair. All walls shall be easily
cleanable and shall have washable surfaces to the highest level reached by splash or spray in rooms or areas where
such occur. Repair wall.
0.0
8.
.1312 (a) Hand sink in room 106 is slow draining and the sink plug/stopper in room 403 remains closed resulting in soiling ring in the sink. Pink residue accumulation on shower head in room 514 and a black ring around the sink drain in this room. Low water flow for hand sink in room 502 and another 500 hall room. Shower head leaking in 100 hall bathing facility, a shower head with pink residue accumulation, as well as some tiles in the showers broken or missing. All institutions shall be provided with toilet, handwashing, and bathing facilities that are conveniently located
and readily accessible to residents and staff. These facilities, and laundry facilities when provided, shall be kept
clean and in good repair. Clean bath facilities and necessary repairs.
1.0
9.
.1312 Some chairs stored in bathrooms and clothes and other personal items stored in room 302. Toilet rooms shall be free of storage. Remove all non toileting items.
0.5
12.
.1312 (d) Hand sink in bathroom of 100 hall bathing facilities lacking soap or a soap dispenser. All
lavatories shall be supplied with hot and cold running water through a mixing faucet, or with tempered warm water,
soap, and sanitary towels or hand-drying devices. Install soap dispenser.
1.5
14.
.1312 (f) Disinfectant spray bottle in 100 hall bathing facility bathroom empty. Shared
bathing equipment that has contact with patient`s skin shall be cleaned with detergent and an EPA registered hospital
disinfectant between patient uses. Manufacturer`s instructions shall be followed for cleaning equipment with pumps.
A supply of cleaning and disinfectant agents shall be accessible to bathing areas. 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. Refill spray bottle and use between each resident.
0.0
19.
.1314 (b) Ice machine in nourishment room in 300 hall has pink/orange residue accumulation in the top of the ice machine. Ice machines, buckets, other containers, and scoops shall be cleaned on a regular schedule such that they are kept free of scum, rust, mold or other contamination. Clean ice machine more frequently.
1.0
30.
.1318 (c) New boxes of gloves stored on top of sharps containers on sides of carts. Medication carts shall be cleaned when visibly soiled. Food and utensils used on medication carts shall be
handled in a sanitary manner. Unused medication cups shall be kept covered or inverted. Sharps containers on
medication carts shall be affixed or secured to prevent spillage. Store clean items separate from soiled items.
0.0
32.
.1319 (a) Small tear in chair in room 311. Crumbs in couch in room 113. Marks on chair in room 107 and tape on chair stored in bathroom in room 101. 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. Repair/replace and clean items.
1.0
33.
.1319 (b) Soiled linen/yellow spots on sheets in room 304. Holes in sheet in room 509. Pillow case soiled in room 403. Spots on sheets in 500 hall room. Hair on sheets in room 410. Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. Change linen more frequently.
1.0
34.
.1319 (b) Debris inside clean linen cart and cart has tears/held together with plastic. Phone and other employee personal items stored on folding table used for clean items. Laundry areas and equipment shall be kept clean. Clean linen carts shall be kept clean. Replace torn fabric or cart. Store items separately to protect linens from contamination.
1.0
35.
.1319 (c) Toilet chairs rusty in room 302, and physical therapy room closest to main office. Patient contact items shall be kept clean and in good repair. Replace sheets with holes and clean shower and bathroom chairs.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 11/13/2018
Score: 94.5
#
Comments
Points
3.
.1309 Wall in laundry room corroded/hole from chlorine. The walls and ceilings of all rooms and areas shall be kept clean and in good repair. Repair wall.
0.0
5.
.1311 (b) Dusty HVAC vents in rooms throughout facility. Ventilation equipment shall be kept clean and in good repair. Clean vents more frequently.
1.0
8.
1312 (a) Shower leaking in central bath #1. All institutions shall be provided with toilet, handwashing, and bathing facilities that are conveniently located and readily accessible to residents and staff. These facilities, and laundry facilities when provided, shall be kept clean and in good repair. Repair leak.
0.0
19.
.1314 (b) Both ice machines in nutrition rooms have pink and black mold accumulation in the top of the ice machine and on the guard of the ice machine. Ice machines, buckets, other containers, and scoops shall be cleaned on a regular schedule such that they are kept free of scum, rust, mold or other contamination. Clean ice machine more frequently.
1.0
28.
.1318 (a) Wheel chair storage room has items on the floor and soil spots on the floor. Items on the floor in activity supply room. Suitable rooms or spaces shall be provided for the storage of all necessary equipment, furniture and supplies, and kept clean. All patient care or consumable items shall be stored at least eight inches above the floor to prevent water contamination from cleaning floors and shall not be stored below exposed sewer lines.
0.5
32.
.1319 (a) Crumbs and spill on reclining chair in bathroom of room 417. 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.
0.0
33.
.1319 (b) Soiled linen in room 308. Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. Change linen more frequently.
1.0
34.
.1319 (b) Dirt inside clean linen carts and carts are torn. Laundry areas and equipment shall be kept clean. Clean linen carts shall be kept clean. Replace torn fabric or cart.
1.0
35.
.1319 (c) Holes in linen in room 308 and room 101 (bed closest to window). Toilet chair in central bathroom #1 soiled with fecal material. Toilet chairs rusty in room 516, and physical therapy room closest to main office. Patient contact items shall be kept clean and in good repair. Replace sheets with holes and clean shower and bathroom chairs.
1.0
41.
.1323 (a) Protein drink on medicine carts sitting on an ice pack at 70 degrees F. Package states refrigerate after opening and contains milk and soy. All food while being stored, prepared, transported, displayed, and served, shall be protected from contamination. All perishable foods shall be stored at temperatures which will protect against spoilage. All potentially hazardous food shall be maintained at safe temperatures (45 degrees F. or below, or 140 degrees F. or above) except during necessary periods of preparation and serving. Potentially hazardous foods served shall be either consumed or discarded within two hours of being removed from temperature control. Store in ice bath to maintain proper temperature or serve/discard within 2 hours. PIC was unable to provide with time frame that item was on medicine cart. Record time on container when opened/removed from fridge.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 06/01/2018
Score: 95
#
Comments
Points
1.
.1309 (a) Boxes of files in storage room on 100 hall and items on floor in central supply closet on 300 hall. Floors shall be free of obstacles to cleaning, and shall be kept clean and in good repair. Store items off of the floor.
0.0
3.
.1310 Ceiling by laundry room patched with cardboard as temporary fix until piping is repaired due to a break in the pipe late last night. Wall in laundry room where chemicals are stored is corroded and heavily damaged due to corrosive agents in the room. The walls and ceilings of all rooms and areas shall be kept clean and in good repair. Repairs are in progress for sprinkler pipe breaking, repair walls in laundry chemical storage room.
0.0
5.
.1311 (b) HVAC vents dusty in rooms 213, and 202/308 (slight dust). Ventilation equipment shall be kept clean and in good repair. Clean vents.
0.0
8.
.1312 (a) Pink residue in grout of tiles in resident bath room near 200 hall and in shower head of room 102. Handsink draining slowly in room 102, and 305. All institutions shall be provided with toilet, handwashing, and bathing facilities that are conveniently located and readily accessible to residents and staff. These facilities, and laundry facilities when provided, shall be kept clean and in good repair. Clean restroom/shower room and repair slow draining sinks.
1.0
11.
.1312 (a) In resident shower room near 200 hall, toilet paper and other toiletries in the hand sink. All institutions shall be provided with toilet, handwashing, and bathing facilities that are conveniently located and readily accessible to residents and staff. Remove items so that the hand sink is readily accessible.
1.0
13.
.1312 (e) Handsink in hallway restroom by front physical therapy room 120F, 121F in therapy bathroom. Corrected to 111 degrees F prior to conclusion of inspection. Room 102 handsink temperature 120 degrees F. Room 211 at 118F, 206 at 121F, employee break room 121F, room 401 at 130F, room 500 at 119F, and room 502 at 121F. Water heating facilities shall provide hot water within the temperature range of 100 degrees F to 116 degrees F at all lavatories and bathing facilities. Continue to monitor water temperature to achieve 100-116F at all hand sinks.
1.0
30.
.1318 (c) Gloves stored directly sitting on top of sharps container and several carts and observed stethoscope on top of sharps container on one cart. Medication carts shall be cleaned when visibly soiled. Food and utensils used on medication carts shall be handled in a sanitary manner.
1.0
32.
.1319 (a) Stained couches in room 213, 405, and 409. Food crumbs under couch cushion in room 202, and 112. Chair handle torn in 500 hall dining room. 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.
0.0
34.
.1319 (b) Clean rags for housekeeping stored in bins on the soiled side of the laundry room next to containers of soiled linen. Soiled laundry shall be handled and stored separately from clean laundry using separate cleanable carts or bags. Store cart with clean rag and all clean clothes/linen only on the clean side of the laundry room. Keep items separate to avoid recontamination. Laundry cart torn and in bad repair. Laundry equipment shall be maintained in good repair. Replace cart.
0.0
35.
.1319 (c) Wheel chair stored in wheel chair storage room near 100 hall with ripped seat and arm cushion. Shower bed mat in bathing room stained with pink and green residue. Patient reclining chairs in hallway soiled with food and yellow splash. Rusted toilet chair in room 320, and 506. Patient contact items shall be kept clean and in good repair. Clean patient contact items and replace items in poor repair.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 02/26/2016
Score: 97.5
#
Comments
Points
3.
0 points; Replace door is disrepair in Nurses` Station 2 Nourishment Room. Repair wall at Nurses' Station 2 Clean Linen room.
0.0
8.
0 points; Dust behind toilets.
0.0
10.
Repeat Violation-Disposable bedpans were not labeled throughout facility, even in rooms with two occupants. Disposable bedpans must be labeled with a name and date.
1.0
14.
The central bath was used this morning to wash all residents, as needed. Today, it was left with improperly disinfected fixtures after use. One shower head had resident hair on it and another had fresh feces on it. Fixtures must be disinfected after each resident use. CDI-Staff cleaned both items with disinfectant.
1.0
16.
0 points; Backup water supply plan was written since last inspection and is complete except it does not explain how food service will be accommodated. If food it to be brought in, write that in the plan. Plan also needs to state that Wake County Environmental Services Department will be contacted in the event that water is lost for more than 4 hours. Otherwise, plan looks excellent.
0.0
32.
0 points; Scrub sofas throughout facility to get rid of staining. If no improvement by next inspection, points will be taken.
0.0
35.
Quite a few patient-contact mats, shower chair mats, gurneys mats, etc. had large tears in them making them no longer easily cleanable. Some mats were discarded before inspector left. Replace Central Bath 1 shower gurney mat and bariatric shower chair mat in central bath 1.
0.5
36.
0 points; Clean both nourishment ice machines to remove mold accumulation on inside panel.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 07/23/2015
Score: 98.5
#
Comments
Points
1.
Repeat Violation-Floor tile in 100 hall central bath is broken./Door threshold to both central baths is missing overlay on concrete./Central Laundry Room has baseboard damage next to washers./Replace missing floor tiles in 400 hall chemical room. Floors must be smooth, easily cleanable and in good repair. Repair as needed.
1.0
3.
0 points; Overall walls are in excellent shape, however minor wall damage due to wheel chairs was found in rooms 416, 301, and 319./Replace door is disrepair in Nurses' Station 1 Nourishment Room. Repair wall damage as needed. Maintenance was repainting areas before inspection ended.
0.0
9.
0 points; A few handwashing sinks throughout facility have no handwashing signs posted. Post handwashing signs as needed throughout facility (at every handwashing sink).
0.0
10.
Disposable bedpans were not labeled throughout facility, even in rooms with two occupants. Disposable bedpans must be labeled with a name and date.
0.5
11.
0 points; Nurse stated that she filled pitchers of water, stored on medication carts, for the residents in the handwashing sink in a nourishment room. Water for residents must come from a prep sink in the kitchen or water fountains. Handwashing sinks are not approved for filling food/beverage pitchers/containers and must be used for handwashing only. This will be points on next inspection if not in compliance.
0.0
14.
0 points; All central baths were provided with disinfectant except for the one that has no showers and is only used for weighing residents. All central baths rooms must be provided with an approved disinfectant. CORRECTED-Operator brought in a bottle of disinfectant.
0.0
16.
0 points; Backup water supply plan was written since last inspection and is complete except it does not explain how food service will be accommodated. If food it to be brought in, write that in the plan. Otherwise, plan looks excellent.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 11/21/2014
Score: 96.5
#
Comments
Points
1.
Repeat-Floor tile in main central bath is broken. Door threshold to both central baths is missing. One janitor closet is missing overlay on concrete. Floors must be smooth, easily cleanable and in good repair. Repair as needed.
1.0
3.
0 points; Repair hole in wall in room 107 around water pipe to shower. Repair minor peeling wallpaper as needed.
0.0
19.
0 points; Clean ice machines in both nourishment rooms to remove calcium build up.
0.0
30.
Nurse stated that she filled pitchers of water, stored on medication carts, for the residents in the handwashing sink in a nourishment room. Water for residents must come from a prep sink in the kitchen. Handwashing sinks are not approved for filling food/beverage pitchers/containers./Do not overstack single-service articles on medication carts. Keep cups in sleeves or below rims of their container.
1.0
32.
Replace broken drawer handles throughout facility so that residents can open their own drawers to access their belongings.
1.0
35.
Make sure to store bedding and all other patient contact items off of the closet floors.
0.5
36.
0 points; Make sure to keep microwaves, refrigerators, and cabinets clean in all nourishment rooms.
0.0
43.
0 points; Room 405 and the Rehabilitation room did not have thermometers in their refrigerators. A thermometer has already been placed into Rehabilitation room. Ensure that all refrigerators have thermometers in them.
Defrost refrigerators has needed. Remove nonfunctional bathtub from central bath. Replace burned out bulbs as needed. Replace pillow in room 313.
Backup water supply plan is incomplete. A comprehensive backup water supply plan must be in place. The plan must account for the amount of water needed to perform the following functions: food preparation, hand washing, bathing, cleaning, dishwashing, laundry, disposal of bodily waste. A reduction in the amount of water needed may be used if laundry is outsourced during the outage and food is served with a single service plates and utensils. The plan must indicate that the local health department is to be notified if the outage lasts more than 4 hours. Additionally, the plan must account for 2 liters of drinking water per resident, per day. If laundry is not outsourced it is recommended to allot 15-20 gallons per resident per day. Email backup water supply plan to Jo Farmer at johanna.farmer@wakegov.com when plan has been drafted to ensure that it is complete. Points will be taken on next inspection of plan is not in compliance.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 04/28/2014
Score: 95
#
Comments
Points
1.
The floor title in shower room 2 on the 400 wing is damaged and the floor tile is separating from the floor. All floors must easy to clean and in good repair.
1.0
3.
Clean the door frames and walls on the chemical closets to remove the dust. Reattach the shoe molding in room 416. There was stained ceiling title in the beauty shop. Clean the walls in several patient`s room to remove the cobwebs. There was damage to the walls in the chemical storage rooms. Clean the walls in the janitor`s closet. There was water damage to walls in the laundry room near the washing machines. Clean the walls in the recreation rooms. All walls and ceilings must be cleanable and in good repair.
1.0
10.
There were several bedpans and urinal pans that were not labeled. When disposable bedpans are reused they shall be labeled with the patient`s name and date and shall not be used by more than one patient.
0.5
19.
Clean ice machine in both nourishment rooms to remove the pink algae. Ice is considered a food and must be stored in a clean area.
1.0
28.
In the laundry room keep all clean linen above the floor. In several storage closet and keep all storage above the floor. Patient care and consumable items must be stored at least 8 inches above the floor.
0.5
34.
In the laundry room the clean linen was stored in cardboard boxes and they were on the floor. laundry must be stored in cleanable carts and bags. Clean linen must be stored in a manner to prevent contamination.
1.0
General Comments
4.Replace the blown light bulbs in the following area: shower room on the 400 hall, replace the blown in room 116, and replace all broken light balances in the shower rooms and hallways. There must at least 10 foot candles of light 30 inches above the floor. 9.There were no hand washing signs posted in the restrooms. All toilet rooms must have a durable,legible signs that are posted or stenciled in a conspicuously in each restroom for employees directing them to wash their hands before they return to work. Hand signs were left on site. 32. Repair the bed frame in room 100. There were a few table tops that had water damage in several of the rooms. Several of the floor mats had holes on the sides. All furniture, mats, and other furnishing in the nursing facility must be kept clean and in good repair.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 09/05/2013
Score: 97
#
Comments
Points
1.
There are some busted and or missing floor tiles around shower drains and coving in the Central Bathing 400 hall.
0.0
2.
Room 308 had an area close to the window that had some feces splashed up on it. There was also a little bit on the wall. There was dried urine on the floor next to one of the beds due to a leaking catheter bag in room 100. There are spider webs from the floor to the wall next to the sofa in room 107. Floors must be maintained clean.
1.0
3.
There were a few Cob webs in some of the residents rooms in upper corners. Some resident room walls have damage due to tape and hangers being removed. The ceiling and vents in the Medical Prep Room in 400 hall are dusty and need a good cleaning. There are water stains around the HVAC ceiling vents in the beauty salon. There is some kind of splash on the wall behind the bed in room 103. Walls and ceilings must be maintained clean and in good repair. Clean, repair and paint as needed to maintain walls in good condition.
0.0
12.
The laundry room hand sink was not stocked with paper towels. One staff member was observed performing very good hand washing procedures but there were no towels for drying. Towels were restocked immediately.
0.0
28.
Shelving in Medical Prep Room 400 hall is only about 5 inches above the floor. Patient care and consumable items must be stored at least 8 inches above the floor.
1.0
30.
One of the medication carts had food/med disposable cups stored on top of a cloth towel. The towel was not clean. Medication carts shall be kept clean. Food, utensils and cups must be handled in a sanitary manner. It is best practice to not use absorbent materials when storing anything associated with food or meds.
1.0
35.
The bed style mat used when bathing residents that cannot sit up has several small cracks in the surface. This should be replaced as it cannot be properly cleaned and disinfected. All toilet style shower seats used in the central bathing room(s) must be lifted and properly cleaned on the bottom sides. Pay close attention to the pivot points.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 04/08/2013
Score: 98.5
#
Comments
Points
10.
Bedpans are being dumped and cleaned between use in patient bathrooms that are not equipped with bedpan lugs or sprayarms. Bedpans should be taken to the closet with the spray arm for cleaning.
0.5
28.
All patient care and consumable items must be stored at least 8 inches above the floor. Most of these items throughout the facility are closer to 4 inches above the floor. Correct as needed.
0.5
43.
The North wing nutrition station refrigerator does not have a thermometer as required (one was not readily observable and could not be located by staff). Ensure all refrigeration units are equipped with accurate thermometers located in an uppers section / the warmest part of the unit.
0.5
General Comments
One of the styling chairs in the saloon is badly cracked and should be replaced even though it is not often used.
The swinging table in room 408 is missing the Formica all the way around the edges and cannot be properly cleaned. Replace or repair.
All rooms had hot water between 100 and 116 degrees as required except room 209 where it was only 95 degrees. The cold water is leaking over to the hot supply because when the cold valve on the supply line was shut off, the hot water temp increased to 111 degrees. Repair as needed.
Single service spoons on one of the med carts were not inverted. Ensure single service items are inverted to ensure the food contact ends are not touched when retrieved for service.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 06/25/2012
Score: 95
#
Comments
Points
8.
The laminate counter top edges and backsplashes surrounding handwash sink at linen handling room were damaged, creating absorbent/difficult to clean surfaces. One of the toilet chairs in resident room had peeling paint and rust on the seat frame (rm 312). In Laundry room,the hand wash sink faucet had corrosion and build-up of mineral deposits on the surfaces.
1.0
10.
Urine bottles and bedpans were not labeled with the resident's name, as required. [Where disposable bedpans are reused, they shall be labeled with the resident's name and date and shall not be used by more than one resident.]
0.5
12.
In Central Bathing: Soap was not available for hand washing.
1.5
14.
In Central Bathing: There was no disinfectant available for disinfecting shared tub. The tub had been used, there was soap foam in bottom, but it had not been disinfected after use.
1.0
18.
Individual water pitchers in residents' rooms were not consistently labeled with residents' names [Individual water pitchers shall be marked with the resident's name.]
1.0
General Comments
1. In Central Supply Office: Supply shelf was too low to floor to allow ease of cleaning. Dust and debris build-up was on the floor under the low shelf.
19. Ice scoop handle was stored in contact with the ice,inside ice storage cooler.
3. Most wall damage in resident rooms, noted on previous inspection, has been patched but still needs to be painted with a washable paint.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 06/30/2011
Score: 92.5
#
Comments
Points
8.
The laminate counter top edges and backsplashes surrounding handwash sinks, at nurse stations,laundry rooms,nutrition rooms,and employee lounge are damaged, creating absorbent/difficult to clean surfaces. Some of the toilet chairs in resident rooms have peeling paint and rust on the seat frames.
1.0
10.
Bedpans and urine collection bottles can not be cleaned in resident`s rooms handsinks or toilets. Bedpans must be cleaned after each use, in designated sinks/facilities, which are located `soiled laundry` rooms at hall junctures. Urine bottles and bedpans were not consistently labeled with the resident's name, as required. Urinal bottle sitting on bedside table in room 305 ,had mold growth on interior and exterior surfaces.
0.5
14.
Disinfectant for tubs,shower chairs,and skin contact surfaces was not available/accessible in all shower rooms. Some disinfectant storage cabinets were locked and keys not available. [Approved disinfectants must be accessible and used in bathing areas to disinfect skin contact surfaces.].
1.0
18.
The disposable pitchers in resident`s rooms are not consistently labeled with the patients` name. Some pitchers are labeled with room numbers, which were not the room they were being used in. Some pitchers have no labels. Nurses stated that they no longer label the water pitchers. [Individual water pitchers stored in the resident`s room shall be marked with the patient`s name and used only by that patient.].
1.0
19.
The ice scoop holsters have pooled water and slime mold on interior surfaces.
1.0
28.
In nurse station supply closet there were single service spoons,cups, and medical supplies stored directly on floors [These items must be stored at least 8 inches above the floor.].
0.5
30.
The cup holders on medication carts have build-up of debris on surfaces. Some of the cup holders have been lined with paper towels, but under the paper towels is debris build-up.
1.0
33.
Carts used for soiled linen are not identified by labels [Carts used for soiled linens must be labeled for soiled laundry only.].
1.0
40.
Foods brought to the facility from outside sources and stored in nurse station refrigerators were not consistently labeled [Foods brought in from outside sources must be labeled with the person`s name and the date the food was brought in.].
0.5
General Comments
One dumpster does not have the required drain plug. Electrical socket box is missing cover plate in room 402. Refrigerator in nourishment station 2, has build-up of food spills on interior. There are damaged wall surfaces in patient room`s, mostly behind bedframes/headboards, where paint is peeling and/or sheetrock is gouged.
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 02/10/2010
Score: 94
#
Comments
Points
5.
clean the HVAC filters
1.0
8.
common bath near nurse station 2 was not cleaned after use; feces under the blue shower mat, and white powder on the mat; common bath near nurse station 1 had a used diaper and wet wash cloth on a pile of clean cloth in the tub; very strong urine odor in bath 1
2.0
9.
keep the storage inside bathrooms to bathroom-related items ( no wheel chairs or other furniture )
0.5
10.
urinals need to be labeled with the resident`s name and should not be stored in a manner that contaminates the furniture in the room ( used urinal on night stand; urinals wedged onto arm rests of chairs and hand rails; used , not properly cleaned, urine collection cups placed upside down on flush tanks causing yellow rims on the flush tank lids )
0.5
30.
the cups on the med carts need to be treated like drinking cups in the kitchen; the cup holders need to be cleaned regularly, and items like clip boards cannot be stored in contact with clean cups ( cups will become contaminated with whatever the clip board was sitting on )
1.0
33.
a housekeeper was walking down the hallway with an armful of soiled linen; handle soiled linen in a manner that will prevent contamination, and wash hands after handling soiled linen ( on the halls as well as in the laundry room ); the hand sinks in the soiled linen rooms are not accessible ( blocked with carts )
1.0
General Comments
GC # 4 : increase lighting in all bathrooms to 10 foot candles ; GC # 32 : the backsplash pieces of the sinks in nourishment stations and rehab need to be replaced ; GC # 1,2,3 : the walls have minor damage from the furniture and wheel chairs; the floors in smaller storage rooms and closets need to be cleaned and waxed
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 05/14/2009
Score: 96
#
Comments
Points
6.
there is some mold growth around a ceiling vent cover near room 115; this was mentioned on the previous inspection
1.5
8.
the shared bathroom near 115 had not been completely cleaned after the last use; personal items left in the tub; brown spots on the floor
1.0
9.
keep the storage inside bathrooms to bathroom-related items ( no wheel chairs or other furniture )
0.5
19.
a visitor walked into a nutrition room and helped himself to ice from the ice chest without washing hands first; anyone taking ice from the ice maker or the ice chest must wash hands first
1.0
General Comments
GC # 1,2,3 : the walls have minor damage from the furniture and wheel chairs; the floors in smaller storage rooms and closets need to be cleaned and waxed; in the housekeeping storage room, the bottom shelf of the storage racks sits on the floor and prevents floor cleaning ; GC # 5 : clean the A/C filters ; GC # 4 : increase lighting in all bathrooms to 10 foot candles
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 08/13/2008
Score: 96
#
Comments
Points
4.
increase lighting in all bathrooms to 10 foot candles
1.0
6.
there is some mold growth around a ceiling vent cover near room 115
1.5
9.
keep the storage inside bathrooms to bathroom-related items ( no wheel chairs or other furniture )
0.5
14.
no disinfectant available in the community bathrooms; the community bathrooms must be cleaned and disinfecated after each user; the disinfectant needs to be an EPA registered hospital grade disinfectant; clean the bathroom first and then spray on the disinfectant and let it air dry
1.0
General Comments
GC # 30 : one sharps container on a med cart was not locked ; GC # 28 : sweep the storage rooms and keep all storage organized and off the ground ; GC # 8 : re-caulk commode bases and replace missing bolt covers ; GC # 3 : scratches from wheel chairs and furniture on several doors
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 01/17/2008
Score: 96
#
Comments
Points
1.
in the laundry room, the bottom shelf of the linen racks is on the floor; dust and debris are building up under the shelves; many larger barrels of liquids are stored on pallets; the floor under a pallet cannot be cleaned; replace the pallets with dunnage racks or movable dollies; raise the bottom shelves of all storage racks to 12 inches above the ground to allow for easy floor cleaning
1.0
4.
increase lighting in all bathrooms to 10 foot candles
1.0
8.
feces left under the blue mat on one shower bed; caulk commodes where needed; repair the faucet in the nourishment station; replace the backsplash behind the hand sink in rehab
1.0
14.
one bathroom did not have cleaner or disinfectant ( the same one that had the unclean shower bed ); the shared bathrooms have to be cleaned and disinfected after each user
1.0
General Comments
GC # 3 : the walls have scratch marks from furniture and wheel chairs; paint as needed ; GC # 30 : wipe out the cup holders on the med carts ; GC # 35 : replace torn linen ; GC # 2 : clean the floor in the nourishment station ( especially under the ice machine ); clean the central supply room floor ; GC # 9 : limit storage in the bathrooms to toileting-related items ; GC # 34 : DO NOT BLOCK THE HAND SINK IN THE LAUNDRY ROOM;
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 04/25/2007
Score: 95
#
Comments
Points
4.
increase lighting in resident bathrooms to 10 foot candles
1.0
5.
clean the A/C filters frequently
1.0
8.
central bath across room 115 needs to be cleaned; used gloves and other items on the floor; an unlocked sharps container with razor blades also left in this bath
1.0
14.
disinfectant bottles in the central baths contained glass cleaner ( bottles are labeled disinfectant )
1.0
28.
keep all storage off the floor ( additional pallets are needed ) and clean the storage room floors
0.5
35.
replace toilet chairs once they develop rust spots; remove all tape or gloves tied to toilet chairs
0.5
General Comments
GC # 30 : unlocked sharps container in bath across room 115 ; GC # 36 : replace gray ice chest ( broken lid ); Note : minor damage to walls due to equipment and wheel chairs; wall damage around soap dispensers
Location: 5201 Clarks Fork Dr RALEIGH, NC 27616 Facility Type: Nursing Homes Inspection Date: 07/27/2006
Score: 96.5
#
Comments
Points
4.
increase lighting in resident bathrooms to reach 10 ftcd; replace missing light shield in one bathroom
1.0
5.
clean A/C filters
1.0
19.
clean and sanitize scoop holders frequently; if the ice scoop is stored in the ice, it needs to be with the handle facing up
1.0
28.
keep all storage off the floor and keep floors under and around storage pallets clean
0.5
General Comments
GC # 14 : use a separate disinfectant ( same as in the kitchen ) after using the cleaner; GC # 35 : one shower chair cushion needs to be replaced; clean metal parts of recliners Note :
mold around one outlet in 317; wheel chair damage to the walls and door frames; floor in one housekeeping room needs repair; dust ceiling around vents above nursing stations
