97.5/ 100

WILLOW RIDGE ASSISTED LIVING

Name: Willow Ridge Assisted Living
Address: 2040 Milton Rd., Charlotte, NC, 28215, US

2040 MILTON RD., Charlotte, NC 28215

Rest/Nursing Homes · NC permit/State ID 2060400125

Directions Open in Google Maps What else is nearby

Latest result97.5 / 100

Last inspectedOct 21, 2026

Inspections on record27

On record sinceAug 21, 2013

Score history

Aug 21, 2013Higher is betterOct 21, 2026

Inspections & violations

Oct 21, 2026 97.5 / 100 · 5 violations

Inspector comments: Report emailed to the following: director@willowridgememorycare.com

#1 · Floors and carpets cleanable, clean, good repair; carpet odor free −1

1309 (a) and (b) The floors in an institution shall be made of smooth, non-absorbent materials and shall be kept clean and in good repair. When carpet is present, it must be kept clean, odor free, and in good repair. Observed flooring damaged in the toilet room of room 107. Repair.

#7 · Facilities provided, accessible, clean, good repair −1

.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair. Observed flooring damaged in both shower rooms. Slight improvement from previous inspection.

#8 · Toilet rooms free of storage, handwash signs posted

.1312 (b) Bathrooms shall not be used for storage of items not currently in use. Observed 2 pillows stored in tub of shower room located on 100 hallway. -General comment.

#26 · Premises properly maintained

.1316 (d) An institution's exterior premises, including parking lots, lawns, and walkways, and interior premises within the institution's building or buildings, shall be kept free of garbage, solid waste, yard trash, and pest harborages. Observed dilapidated furniture stored near outdoor dumpsters. Remove. -General comment.

#28 · No pest presence; effective pest control measures −0.5

.1317 (a) Pests shall not be present in an institution's building or buildings. Observed gnats in room 207 near handsink and in room 211 near entry door.

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Apr 9, 2026 97 / 100 · 4 violations

Inspector comments: *NOTE: Head of Maintanance, Jonathan Reed, was present during inspection. Report emailed to the following: director@willowridgememorycare.com Memorycare@willowridgememorycare.com Maintenance@willowridgememorycare.com

#1 · Floors and carpets cleanable, clean, good repair; carpet odor free −2

1309 (a) and (b) The floors in an institution shall be made of smooth, non-absorbent materials and shall be kept clean and in good repair. When carpet is present, it must be kept clean, odor free, and in good repair. Observed floor tile damage in laundry room and in shared spa rooms.

#7 · Facilities provided, accessible, clean, good repair −1

.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair. Observed loose toilet seat in rooms 106 and 205. Observed shower floor tiles with minor black build up in shared spa rooms.

#10 · Handwashing facilities properly located and equipped

.1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices. Observed no disposable towels at handsink in shared spa room on 100 hallway. Disposable towels were supplied to handsink during time of inspection. -General comment.

#33 · Bed linens in good repair; soiled linens changed, properly handled, containers properly labeled

.1319 (b) A resident's bed linens shall be changed when no longer clean. Observed staining on fitted sheet and pillow case in room 205. -General comment.

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Sep 4, 2025 96.5 / 100 · 4 violations

Inspector comments: Report emailed to Administrator, TaQuevious Rice, at: director@willowridgememorycare.com

#1 · Floors and carpets cleanable, clean, good repair; carpet odor free

1309 (a) and (b) The floors in an institution shall be made of smooth, non-absorbent materials and shall be kept clean and in good repair. When carpet is present, it must be kept clean, odor free, and in good repair. Observed floor tiles damaged in shared spa room located on unit 100. Observed damaged floor tiles in laundry room. Repair. -General comment.

#2 · Walls and ceilings clean, good repair −1

.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair. Observed popcorn ceiling peeling and in need of repair above main entrance door.

#7 · Facilities provided, accessible, clean, good repair −2

.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair. Observed general cleaning needed to shower floor tiles in both shared spa rooms (units 100 and 200). Observed toilet let off toilet in room 110. Repair. Observed handsink leaking in room 110. Repair.

#32 · Furnishings clean and in good repair; mattresses dry, clean, good repair −0.5

.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair. Observed chair cushions damaged in main activity room, repair/replace.

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Apr 3, 2025 97 / 100 · 4 violations

#2 · Walls and ceilings clean, good repair −2

Observed touch up paint needed in rooms 108, 205, 206, 207 and in the restroom between 205 and 207. Observed black microbial growth on the ceiling in spa 100. Observed baseboard in need of repair in the bathroom in room 206. **.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair.

#5 · Ventilation equipment clean, good repair

Observed vent in 100 spa not operating properly. **.1311 (b) Ventilation equipment shall be kept clean and in good repair.

#7 · Facilities provided, accessible, clean, good repair

Observed one loose toilet seat in 200 spa. **.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair.

#32 · Furnishings clean and in good repair; mattresses dry, clean, good repair −1

Observed torn blinds in rooms 108 and 206. Observed staining on the furniture in the tv room. **.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair.

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Oct 2, 2024 97 / 100 · 4 violations

#1 · Floors and carpets cleanable, clean, good repair; carpet odor free −1

Observed floor in need of repair in the restroom in room 107. **1309 (a) and (b) The floors in an institution shall be made of smooth, non-absorbent materials and shall be kept clean and in good repair. When carpet is present, it must be kept clean, odor free, and in good repair.

#2 · Walls and ceilings clean, good repair −2

Observed walls in need of cleaning and repair during the inspection (spa 100, room 108, room 208 and spa 200). **.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair.

#7 · Facilities provided, accessible, clean, good repair

Observed loose toilet in the restroom in room 213. Tightened during the inspection. **.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair.

#10 · Handwashing facilities properly located and equipped

Observed no paper towels at the handwashing sink in shower room on 100 hall. Provided during the inspection. **.1312 (d) Handwashing facilities shall be supplied with soap and disposable towels or hand-drying devices.

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Apr 17, 2024 96.5 / 100 · 4 violations

#2 · Walls and ceilings clean, good repair −1

Observed walls in need of cleaning and repair during the inspection (spa 100, room 108 and spa 200). **.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair.

#5 · Ventilation equipment clean, good repair

Observed vent build up in room 109. **.1311 (b) Ventilation equipment shall be kept clean and in good repair.

#7 · Facilities provided, accessible, clean, good repair −2

Observed sink in need of recaulking in room 101 and toilet seat peeling in spa 200. Observed toilet loose in room 207. **.1312 (a) All institutions shall provide toilet, handwashing, and bathing facilities that are available for use by residents and staff. These facilities shall be kept clean and in good repair.

#32 · Furnishings clean and in good repair; mattresses dry, clean, good repair −0.5

Observed blinds broken in room 108, dresser peeling in rooms 109 and 207. **.1319 (a) Furnishings in an institution, including furniture, curtains, rugs, and blinds, shall be kept clean and in good repair. Mattresses shall be kept clean, dry, and in good repair.

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Oct 26, 2023 96.5 / 100 · 3 violations

#1 · Floors and carpets cleanable, clean, good repair; carpet odor free −2

REPEAT 1309 (a) and (b) The floors in an institution shall be made of smooth, non-absorbent materials and shall be kept clean and in good repair. When carpet is present, it must be kept clean, odor free, and in good repair. Observed flooring throughout facility and inside resident rooms damaged in need of repair.

#2 · Walls and ceilings clean, good repair −1

.1310 (a) The interior walls of the institution, including doors, windows and window trim, and ceilings, shall be kept clean and in good repair. Observed walls scuffed throughout all patient rooms in need of touch-up painting.

#8 · Toilet rooms free of storage, handwash signs posted −0.5

.1312 (b) Bathrooms shall not be used for storage of items not currently in use. Observed misc storage in 200 hall bathroom in need of removal.

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Apr 20, 2023 96.5 / 100 · 6 violations

Inspector comments: Report emailed to the following: director@willowridgememorycare.com Memorycare@willowridgememorycare.com

#1 · Floors and carpets cleanable, clean, good repair; carpet odor free −1

#7 · Facilities provided, accessible, clean, good repair −1

#16 · Hot water between 105°F and 116°F −1.5

.1313 (d) Institutions shall provide water heating facilities. Hot and cold running water under pressure shall be provided to carry out all operations. Hot water shall be provided at temperatures between 105 degrees Fahrenheit and 116 degrees Fahrenheit at handwashing and bathing facilities. Observed hot water ranging between 70F-75F throughout facility (handsinks at residents rooms).

#17 · Back-up water supply plan available and complete

.1313 (e) The institution shall have a written plan to obtain a backup water supply in the event that the institution's primary water supply is interrupted for more than four consecutive hours. The written plan shall identify a backup water supply or alternate source of water that provides two liters of potable water per day per resident and institution employee for drinking and potable water for food preparation, hand washing, bathing, cleaning, dishwashing, laundry, and disposal of bodily waste. This may include a plan for relocating residents to a facility with a water supply that satisfies Paragraph (a) of this Rule. If an institution's primary water supply or backup water supply becomes unsafe for human consumption, then the water sources within the institution, such as sink faucets, shall be labeled or hooded to prevent their use, and the administrator shall provide potable water for use by the institution's residents and employees. Facility could not locate back up water supply plan during time of inspection.

#34 · Linens provided by the institution properly cleaned and sanitized

.1319 (c) Linens provided by the institution that are not clean shall be cleaned and sanitized in accordance with this paragraph. When hot water in washing machines is used to sanitize linens provided by the institution, the washing machines shall be operated in accordance with the manufacturer's instructions. 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 that is registered in accordance with 40 C.F.R. 152 and that is used in accordance with the manufacturer's instructions. Observed no documents detailing the notated requirements.

#52 · Vomitus and diarrheal clean up supplies; written clean up procedures available and complete

.1324 (d) The institution shall have gloves, personal protective equipment, disinfectant, individual disposable towels, and a coagulating agent on-site for employees to use and a written procedure for employees to follow when responding to vomitus or fecal matter on institution surfaces. The procedure shall specify the actions that employees shall take to minimize the exposure of employees, residents, guests, food, and additional surfaces to vomitus or fecal matter. Observed no vomitus/diarrheal plan or clean up supplies readily available for notated rule.

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Nov 9, 2022 95 / 100 · 4 violations

Inspector comments: NO POINTS FOR THE FOLLOWING VIOLATIONS: #9. Toilet rooms shall not be used for storage. See rule .1312 (b). Observed large bins being stored in shared spa room near laundry room. #11. Except for the stipulations stated in rule .1312 (d), handwashing sinks shall only be used for handwashing. 15A NCAC 18A .1312 (d). Observed sanitary pads being stored in hand sink of hallway 100 spa. #28. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a) Observed containers for patient personal items being stored on floor in storage room. *NOTE: Inspection was lead by EHS James Limer. Report emailed to Director, Keyshia Fuller at: director@willowridgememorycare.com

#1 · Floors easy to clean, no obstacles, drains where needed −1

Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). Observed brown staining to flooring in laundry room. REPEAT VIOLATION.

#8 · Facilities conveniently located, clean and in good repair −2

Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f) Observed soiled toilet chair in room 101 and fecal matter on floor in bathroom of room 105.

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −1

#33 · Linen changed when soiled. Soiled linen handled properly −1

Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed stained pillow and pillow case in room 213 and soiled bed sheet in room 105.

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May 11, 2022 94 / 100 · 4 violations

Inspector comments: NO POINTS FOR THE FOLLOWING VIOLATION: #9. Toilet rooms shall not be used for storage. See rule .1312 (b). Observed large gray bins on wheels stored in both shared spa rooms that are used for trash and soiled linen. #35. Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c). Observed hair accumulation inside of brushes and razor guard in beauty salon. Per conversation with staff, the person who does hair for the residents was not finished doing hair for the day and had not had an opportunity to properly clean patient items. #43. All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b). Observed no thermometer in refrigeration labeled “residents only” in medication room. *NOTE: Staci Clark was present during time of inspection along with Assistant Administrator Mindy:

#1 · Floors easy to clean, no obstacles, drains where needed −1

Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). Observed flooring in laundry room with brown staining and in need of detailed cleaning.

#3 · Walls and ceilings cleanable, clean, good repair −2

Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed touch up paint needed to walls, wall joints, and baseboards throughout facility. Observed chipping paint on walls and door paint in room 109. Observed laminate flooring in restroom located in room 107 peeling up under toilet chair and in need or repair. Observed wall tile missing under handsink in shared spa room on 200 hallway.

#8 · Facilities conveniently located, clean and in good repair −2

Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed detailed cleaning needed tubs stored in shower spa located on 100 and 200 hallways. Observed black build up inside the shower grout in both 100 and 200 hallways. Observed bathroom near room 206 with a sign stating “do not use due to active leak” per conversation with staff, they are aware of issue and are working to have it repaired. Observed shower chair in 100 shared spa with heavy rusting and in need or replacing. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed 1 loose toilet seat in 200 spa room. Observed detailed cleaning needed to the outside and corners of toilet bowl’s throughout facility.

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −1

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 cushions in activity rooms with staining and railings on chair in need of resurfacing/replacing. Observed bed frame chipping in room 109. Observed refrigerator in mediation room in need of detailed cleaning to shelving and flooring of inside of unit.

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Nov 19, 2021 95 / 100 · 4 violations

Inspector comments: NO POINTS FOR THE FOLLOWING VIOLATIONS: #16. Observed an incomplete backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f). EHS emailed facility a guidance document on what information is needed in backup water supply plan. #32. 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 dresser drawer missing in room on 200 hallway. Over all major improvement from previous inspection thus no points deducted.

#3 · Walls and ceilings cleanable, clean, good repair −1

Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed stained ceiling and in need of repair in room 104.

#8 · Facilities conveniently located, clean and in good repair −2

Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed build up under toilet chair in 100 spa room. Observed black build up inside the shower tile in 100 spa room. EHS advises facility to increase cleaning frequency of shower rooms throughout facility. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed loose toilet seats in room 104, 204, and 210. Observed build in inside of toilet in room 104 and 210. EHS advises facility to increase detailed cleaning of toilets throughout center.

#26 · Premises clean, no breeding places or rodent harborage −1

The premises shall be kept neat, clean, and free of litter. 15A NCAC 18A .1317 (c). Observed dilapidated chair and table stored outside of dumpster area. EHS advises facility to remove dilapidated structures.

#33 · Linen changed when soiled. Soiled linen handled properly −1

Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed minor staining on bed linen in the following rooms 104 and 204. EHS advises facility to change residence linen when soiled.

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May 14, 2021 93.5 / 100 · 4 violations

Inspector comments: NO POINTS DEDUCTED FOR THE FOLLOWING: #5 Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). Observed dirty A/C filters in rooms 219 and 204. #24 Effective measures shall be taken to keep flies, rodents, cockroaches, and other vermin out of the establishment and to prevent their breeding or presence on the premises. 15A NCAC 18A .1317 (a). Observed water bug in bathroom of room 219. Observed roach in housekeeping room. PIC stated housekeeping room has not been in use since water backed up in mop sink. #30 Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c). Observed small buildup in pill crusher on both med carts in med rooms. #33 Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed stained pillows in rooms 204 and 109.

#3 · Walls and ceilings cleanable, clean, good repair −2

Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed wall damage in rooms 219 and 104. Observed damaged wall with missing tiles in 100 and 200 hall spa rooms. Observed ceiling peeling in room 206 Rehab. Observed wall stains and ceiling peels throughout facility. Observed outlet falling off from wall in activity room. REPEAT VIOLATION

#8 · Facilities conveniently located, clean and in good repair −1

Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed loose toilet seats in rooms 200 hall spa, 110, and 104. Observed missing lid at back of toilet in 100 hall spa. Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b) Observed caulk around back of sink peeling in room 110 and 100 hall spa that PIC stated is not being in used.

#12 · Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device −1.5

Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). Observed no paper towels in 100 spa room and room 109. No point escalation due to improvement from last inspection. REPEAT VIOLATION.

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −2

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 drapes with stains in 100 and 200 hall spas. Observed both box springs with stains in room 204. REPEAT VIOLATION

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Dec 4, 2020 95.5 / 100 · 3 violations

Inspector comments: No points were deducted for the following: 1. Observed bathroom floor in need of repair in room 105. **Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). 14. Observed no disinfectant in either spas. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). 28. Observed boxes of disposable underwear stored on the floor. Delivery was today. **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).

#3 · Walls and ceilings cleanable, clean, good repair −2

Observed wall damage in the spa on both 100 and 200 halls. Needs to be repaired. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#12 · Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device −1.5

Observed no papertowels at the handwashing sink in the hair salon, room 105, and in both spas. **Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d).

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −1

Observed mattresses torn in rooms 105 and 203. **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).

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Sep 13, 2019 92 / 100 · 5 violations

Inspector comments: (continued from page 2) 8. Observed lid on the back of toilet broken. Needs to be repaired. **Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). REPEAT. No points were taken for the following: 24. Observed what appeared to be roaches in the 100 hall spa. Increase pest management to reduce the occurrence of pest. **Effective measures shall be taken to keep flies, rodents, cockroaches, and other vermin out of the establishment and to prevent their breeding or presence on the premises. 15A NCAC 18A .1317 (a). 32. Observed handles missing on dresser in room 219 and 213. Needs to be replaced. Observed torn pillow in rooms 219 and 107. Pillows were removed. Observed torn cushion on wheelchair in the 200 spa. Observed mattress torn in room 213. Observed torn blinds in room 107. **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).

#2 · Floors clean, carpet clean, dry, odor free −1

Observed floor in need of cleaning in the electrical closet. REPEAT. **Keep all flooring clean. 15A NCAC 18A .1309 (a).

#3 · Walls and ceilings cleanable, clean, good repair −2

Observed wall staining in room 219. Needs to be cleaned. Observed wall damage in room 213 and the spa on the 100 wall. Needs to be repaired. REPEAT **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#8 · Facilities conveniently located, clean and in good repair −2

Observed soap dispenser broken in 200 hall utility closet and 200 hall spa. Needs to be repaired. **Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b) Observed wall within the shower in 200 hall shower with black build up. Needs to be cleaned. Observed brown staining on the curtain within the spa on the 100 hall. Needs to be cleaned. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). (continued on last page)

#9 · Toilet rooms free of storage, hand wash signs posted −1

Observed wheel chairs stored within the spas on both 100 and 200 hall. Needs to be removed. REPEAT. **Toilet rooms shall not be used for storage. See rule .1312 (b).

#20 · Wastewater disposed of properly −2

Observed mop sink near the 100 hallway clogged with standing water. Until drain is unclogged, do not dump water in mop sink. Needs to be repaired as soon as possible. **All wastewater shall be disposed of in accordance with 15A NCAC 18A .1900 or 15A NCAC 02H .0200

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Feb 1, 2019 90.5 / 100 · 7 violations

Inspector comments: No demerits were issued for the following: 7. Women's restroom on the 200 hallway smelled of cigarette smoke. Ensure that no one is smoking outside of designated areas. **Smoking shall be limited to designated smoking areas. 15A NCAC 18A .1311 (e).

#2 · Floors clean, carpet clean, dry, odor free −1

Observed debris on the boiler room floor. Needs to be swept. Observed used disposable underwear on the floor in the spa on the 200 hallway. Observed stained blanket and wheelchair cushion on the floor in the small shower/toilet room on the 100 hallway. Keep all the flooring clean. **Keep all flooring clean. 15A NCAC 18A .1309 (a).

#3 · Walls and ceilings cleanable, clean, good repair −2

Observed wall damage around the sink in room 207. Observed baseboard missing tiles in the spa on the 200 hallway. Observed wall damage on the 100 hallway. Observed wall damage near the toilet in the spa on the 100 hallway. Needs to be repaired. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#5 · Ambient air temperature 65 to 85 F, equipment clean −1

Observed build up on the vent cover in the spa on the 200 hallway. Needs to be cleaned. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).

#8 · Facilities conveniently located, clean and in good repair −2

Observed loose handwashing sink in room 207. Observed soiled sink in the storage room on the 200 hallway. **Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b) Observed stained hopper in the storage room on the 200 hallway. Observed toilet chair stain in room 207, soiled toilets in 200 hall shower room, 100 hall spa and room 110. Observed loose toilet in 200 hall spa. **Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed shower wall with black build in hall shower on 200 hall. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).

#9 · Toilet rooms free of storage, hand wash signs posted −0.5

Observed wheel chairs stored in the spa on the 100 hallway. **Toilet rooms shall not be used for storage. See rule .1312 (b).

#14 · Disinfectant accessible, properly used −2

Observed no disinfectant spray in the spa on the 100 hallway. Ensure that disinfectant is readily accessible and in the spa. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).

#28 · Adequate storage, area clean, items properly stored −1

Observed boxes stored on the floor in the storage room with hopper on the 100 and 200 hall. Ensure that boxes are stored above the floor. Observed bag of patient clothing stored on the floor in the storage room on the 100 hall. **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).

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Sep 18, 2018 86 / 100 · 10 violations

Inspector comments: No Points Deducted: 6. Observed black buildup (what appears to be mold) on the walls and ceiling in the small 200 shower room. Clean. Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d). 9. Observed wheelchairs stored in the shower room on the 200 hall. Follow the rule below. Toilet rooms shall not be used for storage. See rule .1312 (b). 24. Observed a live roach in room 102. Continue pest control. Effective measures shall be taken to keep flies, rodents, cockroaches, and other vermin out of the establishment and to prevent their breeding or presence on the premises. 15A NCAC 18A .1317 (a). 26. -Observed the grass high in the outside common area. Cut. -Observed a stove, couch, etc on the ground behind the dumpster. Remove from premises. The premises shall be kept neat, clean, and free of litter. 15A NCAC 18A .1317 (c). ED, Ms. Shimika Bowers present during the inspection. Report and Backup Water Supply Plan Checklist emailed to wral.adm@affinitylivinggroup.com Inspection lead by Nykesse Roberts. Sarah Coppa present during the inspection.

#3 · Walls and ceilings cleanable, clean, good repair −2

Repeat: -Observed water damage to the back/bottom of the doors in the small shower rooms- peeling and splitting. Repair. -Observed the popcorn ceiling peeling in room 101. -Observed the cove base tiles missing in the 200 spa near the handsink. Replace. Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#4 · Lighting at least 10 foot candles 30 inches above floor −2

Repeat: Observed insufficient lighting in residence rooms throughout the building. All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a).

#5 · Ambient air temperature 65 to 85 F, equipment clean −1

Repeat: Observed the AC unit filters in every room very dusty. Clean. Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).

#8 · Facilities conveniently located, clean and in good repair −2

Repeat: -Observed pink residue on shower chair in both shower rooms. -Observed pink and black build up in shower grout in shower rooms. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). -Observed the handsink separated away from the wall- 200 small shower room. Resecure and regrout. Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b)

#14 · Disinfectant accessible, properly used −1

-Observed no cleaning chemical in the shower room on the 100 hall. A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). -Per an employee on the 100 hall, she cleans the shower equipment by spraying the chemical on and immediately washing it off. -Per another employee on the 200 hall, she sprays soap on the equipment and washes it off. *Per the Virex 256 bottle, the contact time is 10 minutes. The manufacturer's instructions shall be followed for cleaning equipment with pumps. See rule .1312 (f).

#16 · Quantitiy and hot water sufficient, backup water supply plan −1

Observed no backup water supply plan present. Checklist emailed to ED (Ms. Bowers). Observed an incomplete backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f).

#17 · Water fountains clean, good repair, properly regulated −1

Observed heavy black buildup on the water fountain. Clean. Drinking fountains shall be kept clean and properly regulated. 15A NCAC 18A .1314 (a).

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −2

Repeat: -Observed stains and debris on chairs and couches as well as under the cushions in the common areas. -Observed ripped mattresses in rooms 101 & 208. -Observed torn and/or stained pillows in rooms 101 & 213. -Observed stained chair cushion in room 213. -Observed handles missing from the drawer in room 205. -Observed torn mattress cover in room 102. 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 · Linen changed when soiled. Soiled linen handled properly −1

Repeat: -Observed stains on the sheets in room 102. Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). -Observed bins of soiled linen stored uncovered in the 100 hall spa, and soiled linen on the floor in the 200 hall spa. Soiled linen shall be placed in a covered container or bag at the point of use and stored and handled so as to contain and minimize aerosolization of and exposure to any waste products. 15A NCAC 18A .1319 (b).

#35 · Patient contact items in good repair, properly stored, cleaned and disinfected −1

Repeat: -Observed adult diapers on the floor in storage room and room 208. -Observed hair in curlers and drawers in the beauty salon. Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c).

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Jan 29, 2018 91.5 / 100 · 5 violations

Inspector comments: No Points Taken: 5. **Keep all ventilation equipment clean and in good repair. See rule .1311 (b). Observed vents on ac/heat units with build up in 203, 107, and 209. Observed build up on top of the ac/heat unit in room 203 and 107. 8. **Facilities in operation prior to March 1, 2003 that do not have handwashing lavatories in all areas required shall have an approved hand hygiene program established. See rule .1312 (d). Observed no handsink in the laundry room. **Ensure hand hygiene procedure is properly followed: hands must be sanitized in the laundry room before washing hands in the employee restroom across the hall. 12. **Provide liquid soap and disposable towels at all handwashing sinks. See rule .1312 (d). Observed no paper towels in room 209 and shower room and beauty room. 13. **Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100 F to 116 F. See rule .1312 (e). Observed hand sink in shower room at 118 degrees F 33. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. See rule .1319 (b). Observed soiled linens in 203, 209, and 107. Observed tore linen in 107 and 203. Observed soiled shower curtain in both shower rooms. 33. **Soiled linen shall be placed in a covered container or bag at the point of use and stored and handled so as to contain and minimize aerosolization of and exposure to any waste products. See rule .1319 (b). Observed no soiled linen covered bin in beauty shop. Inspection led by Samantha H Pepper under Jamil Blackmon's supervision

#3 · Walls and ceilings cleanable, clean, good repair −2

**Keep all walls and ceilings clean and in good repair. See rule .1310. Observed hall bath room with build up on the ceiling. Observed wall beside residence bed in room 107 with build up.

#4 · Lighting at least 10 foot candles 30 inches above floor −2

Observed lighting levels at * foot candles (30 inches above the floor) in *. **All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. See rule .1311 (a). Observed lights not working in linen room and storage room in common area. Observed without sufficient lighting in residence rooms throughout the building.

#8 · Facilities conveniently located, clean and in good repair −2

**Keep all toilet equipment clean and in good repair. See rule .1312 (b). Observed soiled toilets in rooms 209 and 107 and shower room. Observed loose toilet in mens bathroom. **Keep all bathing equipment clean and in good repair. See rule .1312 (a) and (f). Observed pink residue on shower chair in both shower rooms. Observed pink and black build up in showers in shower rooms. **Keep all handwashing facilities clean and in good repair. See rule .1312 (b) Observed significant build up in sink in storage room.

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −2

**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. See rule .1319 (a). Observed chairs and couches in common area with debris on top and under cushions. Observed stains on chairs and couches in common areas. Observed door in shower room pealing and splitting.

#35 · Patient contact items in good repair, properly stored, cleaned and disinfected −0.5

Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c). Observed adult diapers on the floor in storage room, 107, and 209. Observed hair in several brushes and curlers in the beauty salon.

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Aug 3, 2017 90.5 / 100 · 8 violations

Inspector comments: Spring Neal was present during the inspection. NO POINTS DEDUCTED FOR THE FOLLOWING: 8. Observed no hand washing sink in the laundry room. **Ensure hand hygiene procedure is properly followed: hands must be sanitized in the laundry room before washing hands in the employee restroom across the hall. 24. Observed on live baby roach in the 100 hall shower room. **Facilities in operation prior to March 1, 2003 that do not have hand washing lavatories in all areas required shall have an approved hand hygiene program established. 15A NCAC 18A .1312 (d). 35. Observed hair in several brushes in the beauty salon. **Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c). 36. Observed both microwaves with excessive amount of dried food residue. **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).

#1 · Floors easy to clean, no obstacles, drains where needed −1

Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). Observed the floor was not clean in the 200 hall storage closet, and a floor tile was missing in the hallway near the dining room.

#3 · Walls and ceilings cleanable, clean, good repair −1

Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed the restroom walls were damaged in room 205, a section of cove base was separated from the wall in the employees restroom (medication area), and the lower walls in the dining room with black smudge marks.

#4 · Lighting at least 10 foot candles 30 inches above floor −1

All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a). Observed several light were not working throughout the building: 200 hall spa room, laundry room had no overhead light, storage room (living room),room 104 restroom.

#8 · Facilities conveniently located, clean and in good repair −2

Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed the shower chair with pink residue in the joints, shower curtains with mildew/ black residue in the 200 hall spa, 100 hall shower, the shower tile and grout with mildew in the 100 hall shower room, the bathtub was not clean in the 200 hall spa room. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed an elevated toilet chair was not clean in room 205 restroom, and the toilet seat was soiled in room 104 restroom.

#9 · Toilet rooms free of storage, hand wash signs posted −0.5

Toilet rooms shall not be used for storage. See rule .1312 (b). Observed a resident personal belonging were stored in the 200 hall shower room/restroom. (Repeat) Keep hand washing signs posted in all staff restrooms. 15A NCAC 18A .1312 (b). Observed no hand washing sign was posted in the employee restrooms: Salon and medication room.

#28 · Adequate storage, area clean, items properly stored −1

All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed briefs were stored on the floor in the storage closet in the living room (Repeat). 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). Observed a resident closet with personal items stored piled on the floor in room 205

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −2

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 the couch upholstery in the living room need cleaning, a sitting chair cushion in the living room with brown residue, a couch with a disposable brief beneath the cushioning the multipurpose room, and a bedside table with debris in room 205.

#34 · Laundry area and equipment clean, linen disinfected, clean laundry stored and handled separately −1

All common linen including sheets, pillow cases, absorbent pads, towels, and wash cloths provided by the facility must be sanitized between users with an EPA registered laundry sanitizer or by other methods described in 15A NCAC 18A .1319 (b). Observed no records for laundry sanitizer. Provide and maintain records for washing machine temperatures and/or chlorine sanitizer concentrations. 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 stuffed animal and blankets left from previous residents were stored with the common linen.

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Feb 2, 2017 88 / 100 · 8 violations

Inspector comments: CONTINUED FROM PAGE 2 #8. Observed stained shower grout, mildew in te shower, and a dirty sink in the 200 hall shower room. Toilet, handwashing, and bathing facilities must be conveniently located and readily accessible to residents and staff. 15A NCAC 18A .1312 (a). Observed no handsink in the laundry room. No Points: #2 Observed several hallway closet floors were not clean. #5 Observed crumbs in the activity room AC unit and dusty filters in the AC unit for room 208. #9 Observed several elevated toilet chairs and wheelchair stored in 100 hall spa bathroom, as well as another wheelchair stored in the 200 hall spa room. #26 Observed multiple items, such as mattresses, bed frames, and chairs stored in dumpster area; and litter scattered at the edge of treeline. #34 Observed personal laundry mixed with facility linens in dryer ***Inspection lead by David Rollick with supervision by Tasharra Kenion. **Connie DIckerson was present during the inspection.

#3 · Walls and ceilings cleanable, clean, good repair −1

Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed black spots on the ceiling above the shower in he 200 hall shower room, water damage to the ceiling in the 100 hall storage room, and poor patch job to ceiling and the restroom wall was soiled in room 102.

#4 · Lighting at least 10 foot candles 30 inches above floor −1

All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a). Observed 2 lights out in the dining room and lights out with less than 10 foot candle of illumination in the 100 hall spa. Observed dusty lights in 100 hall spa and in 200 hall spa room.

#8 · Facilities conveniently located, clean and in good repair −2

Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed shower tiles missing around the drain, pink residue on the underside of shower chairs, black and pink stained grout, shower curtains with red stains, a broken towel rod, a dirty tub stained blue holding dead bugs, and a floor drain filled with hair and debris all in the 200 spa room. Observed black stained grout, shower head with residue, a missing toilet seat, and moldy debris under the hand sink in the 100 hall shower room. Observed missing floor tiles in shower, black stained shower grout and a shower chair with pink residue in the 100 hall spa room. Observed soiled toilets in room 107, 102, and 208, a loose toilet seat n room 102, and a dirty sink in room 208. CONTINUED ON PAGE 5

#12 · Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device −3

Provide liquid soap and disposable towels at all hand washing sinks. 15A NCAC 18A .1312 (d). Observed no paper towels in 200 hall shower room, 200 hall spa room, and room 102 (REPEAT).

#14 · Disinfectant accessible, properly used −1

A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f). Observed no disinfectant in the 200 hall spa room (REPEAT).

#28 · Adequate storage, area clean, items properly stored −1

All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed patient briefs stored on the floor in outdoor storage shed and in 100 hall storage room (REPEAT). 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). Observed items stored within the splash zone of hand sink in med room.

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −2

#33 · Linen changed when soiled. Soiled linen handled properly −1

Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed uncovered soiled linen bins in the 100 hall spa, torn pillow and a soiled sheet in room 102.

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Nov 3, 2016 93.5 / 100 · 4 violations

Inspector comments: (NO POINTS DEDUCTED) 4. Observed light cover in need or repair in family room. 16. Observed disinfectant not present in shower rooms. All shower rooms must have EPA registerd disinfectant.

#8 · Facilities conveniently located, clean and in good repair −2

Observed loose toilet seat in therapy and 100 All shower. Observed residue present on toilet seat of 100 All shower. Cleaning required. Observed showere curtains, tile grout in need of cleaning throughout. Observed sink leaking at hallway restoom (100). Mold and odor present underneath sink. **Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). **Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b)

#12 · Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device −3

Repeat Non Compliance: Observed paper towel dispensors present, but paper towels jammed and not dispensing properly. Observed soap not present in 100 All spa. **Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d).

#28 · Adequate storage, area clean, items properly stored −0.5

Observed multiple items on room floors throughout. **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −1

Observed few chairs in front family room with stains present. Observed pillow in room 101 in need of replacing. **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).

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Jan 14, 2016 91 / 100 · 6 violations

Inspector comments: 1) 15A NCAC 18A .1309(a) All floors in intensive care units, bathrooms, showers, hydrotherapy areas, operating rooms, soiled utility rooms and laundry areas shall be free of obstacles to cleaning, and shall be kept clean and in good repair. Observed a missing tile in the 200 hall shower/spa. Observed rip on laminate located in front activity room underneath cabinet. 5) Observed multiple blinds ripped in resident rooms, living room and other areas throughout facility. Keep all blinds in good repair. Ms. Gloria was present during inspection. Alex Torres followed with during the inspection and verified report.

#6 · No evidence of microbial growth −1.5

15A NCAC 18A .1311 (d) Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. Observed slight microbial growth in the ceiling in one shower in the 200 hall. REPEAT VIOLATION

#8 · Facilities conveniently located, clean and in good repair −2

Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed loose toilet seat in room 108. Observed soiled toilet in the 100 hall shower room. REPEAT VIOLATION. Observed tile grout in multiple restrooms collecting residue. Observed shower curtain with dark residue present in the 100 hall. Observed diaper on floor in 100 hall restroom.

#12 · Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device −1.5

Provide liquid soap and disposable towels at all handwashing sinks. 15A NCAC 18A .1312 (d). Observed no paper towels for the handsinks in the beauty shop, room 108, and 200 hall spa. Observed no soap in 200 hall bathroom.

#13 · Lavatory and bathing hot water between 100 and 116 F −1

Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). Observed water in the Bathroom in the 100 hall at 140F. Advised to turn down for burn hazards.

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −1

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 couches and arm chairs in the living room in the front of the building have stains and debris under the cushions. Observed spilled food in the top drawer of the dressor furniture in the front living room. Mattresses shall be kept clean, dry, and odor free. 15A NCAC 18A .1319 (a). Observed a dirty mattress in room 204.

#33 · Linen changed when soiled. Soiled linen handled properly −2

Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed soiled linen in room 113. REPEAT VIOLATION

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Jul 9, 2015 90.5 / 100 · 6 violations

Inspector comments: #5 Observed 1 A/C vent with debris present in room 107. Continue to keep all A/C filters clean and in good repair.#15 When asked on site where water was received from, staff at nursing station stated that sometimes it is from the kitchen and others it from the hand washing sink at front nurses station. Water shall be provided from kitchen and pitcher shall be cleaned daily. #17 Observed water fountain collecting dark residue around base and nozzle. Observed water fountain was slow draining. Water fountain in need of cleaning.Ms. Itestal Pulliam and Alexandra Cassell was present during inspeciton.

#6 · No evidence of microbial growth −1.5

Repeat Non Compliance: Observed build up on tile/grout on floors and walls in 100 shower hall. Other shower rooms were in good condition. Continue to clean grout in walls and ceilings. **Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d).

#8 · Facilities conveniently located, clean and in good repair −2

Repeat Non Compliance: Observed loose toilet seats in following areas: 107, 400 hall shower, and room 219. Observed ripped shower curtain in 400 hall shower, and urine present on bathroom floor of room 209. **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)

#14 · Disinfectant accessible, properly used −2

Repeat Non Compliance: Observed disinfectant not present in 100 and 200 hall shower rooms. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).

#28 · Adequate storage, area clean, items properly stored −1

Repeat Non Compliance: Observed clothes stored on floor in room 107 and several other rooms throughout facility. Repeat Non Compliance: The rear shed not accessible due to excessive amounts of items being stored.**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).

#30 · Medication carts clean, sharps containers affixed, food and utensils handled properly −1

Repeat Non Compliance: Observed med cart with debris in container holding packaged medicines. Containers shall be free of debris.**Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).

#33 · Linen changed when soiled. Soiled linen handled properly −2

Repeat Non Compliance: Observed soiled linen in salon cabinet. Repeat Non Compliance: Observed rip in pillow in room 107, stain on linen and on pillow in room 219, and soiled linen in room 202.**Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).

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Feb 4, 2015 90 / 100 · 9 violations

Inspector comments: 1: Observed: The flooring in the 100 Spa damaged around the floor drain. Flooring transition damaged at the Salon/restroom. **Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b).9: Observed: Wheelchair storage in the restroom of room 203. No hand washing sign in the staff restroom. No storage shall be in toilet rooms. Hand washing signs shall be posted at all staff hand washing sign. Corrected on site.15: Observed: No backflow prevention device on the shower wand in the 100 hall spa. **Move vacuum breaker and shower wand from 200 hall spa tub to the shower stall.30: Observed: Single service drinking cups not protected on the med carts. **Keep in bags. Corrected during inspection.Itestal Pulliam present.

#3 · Walls and ceilings cleanable, clean, good repair −1

Observed: Wall damage behind several hand washing sinks (point of wall connection). Wall and ceiling damage in the 200 hall Spa.Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#5 · Ambient air temperature 65 to 85 F, equipment clean −1

Observed: Most AC unit filters dirty.Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).

#6 · No evidence of microbial growth −1.5

Observed: Excessive mold growth on the shower floor and walls in the 200 hall shower room.Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d).

#8 · Facilities conveniently located, clean and in good repair −1

Observed: A loose toilet seat in 107. The shower chair dirty in the 100 hall Spa. No hand sanitizer in the laundry room. Loose toilet seat in the 200 hall Spa. Dirty toilet seat in 204.Keep all bathing equipment, sinks, and toilets clean and in good repair. 15A NCAC 18A .1312 (a), (b), and (f).Facilities in operation prior to March 1, 2003 that do not have hand washing lavatories in all areas required shall have an approved hand hygiene program established. 15A NCAC 18A .1312 (d).

#14 · Disinfectant accessible, properly used −2

Repeat: Observed: No disinfectant in the 100 and 200 shower rooms.A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).Provide correct spray bottle for solution. Do not use a sanitizer bottle.

#26 · Premises clean, no breeding places or rodent harborage −1

Observed: Cigarette butts around rear of building.The premises shall be kept neat, clean, and free of litter. 15A NCAC 18A .1317 (c).

#28 · Adequate storage, area clean, items properly stored −0.5

Repeat: Observed: The storage room floors dirty. The rear shed not accessible due to excessive amounts of items being stored. The drawers and cabinets in the salon collecting debris and hair. 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).

#32 · Furniture clean and in good repair. Mattresses clean, dry, odor free −1

Repeat: Observed: Living room furniture collecting stains. Some end tables in resident rooms damaged. Damaged mini blinds in rooms. A damaged mattress corner in 204.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 · Linen changed when soiled. Soiled linen handled properly −1

Observed: Soiled linen in the salon cabinet. Stained linen on the beds in room 108 and 204. Damaged linen in room 203.Soiled linen shall be placed in a covered container or bag at the point of use and stored and handled so as to contain and minimize aerosolization of and exposure to any waste products. 15A NCAC 18A .1319 (b).Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).

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Jul 22, 2014 94.5 / 100 · 5 violations

Inspector comments: #.6 Observed microbial residue built up on shower head in small shower room 100 hall in need of cleaning. **Moisture shall be controlled such that there is no evidence of microbial growth on interior surfaces and objects. 15A NCAC 18A .1311 (d).#32 Observed chairs with stains present in living room with crumbs present on side lining. **All furniture shall be kept clean and in good repair. 15A NCAC 18A. .1319 (a).#4 Observed lights in need of replacement in 200 spa, 103, 217 **All areas shall be provided with sufficient illumination to effectively perform all operations, including cleaning. #24 Observed multiple dead insects throughout facility. Pest management for facility in place and properly working. Areas where insects present in need of cleaning. **Effective measures shall be taken to keep insects out of establishment to prevent breeding or presence on the premises. #27 Observed Vet records not present on site. Records are required on site when animals visit. **Copies of vetinary records for all animals shall be kept on premises. 15A NCAC 18A .1317 (f).#30 Observed med cart with debris in container holding packaged medicines. Containers shall be free of debris. **Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).#34 Observed documentation missing to indicate temperature/ chemical concentration present during wash cycle. Records shall be provided to ensure proper cleaning procedure. ** If hot water used items shall be washed in water at least 160 F for 25 minutes. If low temperature laundry cycles are used, linens shall be washed with at least 50 parts per million chlorine or an EPA Listed laundry sanitizer.#35 Observed holes present in linen throughout in need of repair. **Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c)

#3 · Walls and ceilings cleanable, clean, good repair −1

Observed multiple holes, dings, dents in walls, baseboards, and ceilings throughout facility in need of patching, repair, or maintenance. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#8 · Facilities conveniently located, clean and in good repair −1

Observed loose toilet seats in rooms: 200 Spa, 200 shower, 110, 100 (small shower room) in need of tightining or replacement, soiled bathroom chair in 103, soiled lid in 202 in need of proper cleaning. **Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b).Observed caulk lining in room 103 peeling away from wall in need of reappliance. **Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b)Repeat Non Compliance: Observed brown residue on underside of shower chair in 200 spa, 100 spa, shower curtains visibly soiled on bottom side in 200 spa, 100 spa, small 100 bathing room. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).

#14 · Disinfectant accessible, properly used −2

Repeat Non Compliance: Observed disinfectant missing from 200 spa. Disinfectant shall be present. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. 15A NCAC 18A .1312 (f).

#28 · Adequate storage, area clean, items properly stored −0.5

Observed bins of clothes in laundry room on floor in need of replacing to another area. Back storage shed overloaded with boxed items without organization in need for cleaning. **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).

#33 · Linen changed when soiled. Soiled linen handled properly −1

Observed linen, pillow cases, soiled with debris present in sheets in rooms: 217, 202, 110, in need of repair, replaced, cleaned also including linen in clean linen closet. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).

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Jan 21, 2014 94 / 100 · 4 violations

Inspector comments: 4. Observed light out in the 200 hall shower room (over the shower).All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a). 9. Observed wheel chair in room 101 restroom.Toilet rooms shall not be used for storage. See rule .1312 (b). 28. -Observed boxes of briefs stored on the floor in both storage rooms on 100 hall, room 113, and an open bag of briefs stored on room 113 closet floor.-Observed clothes, bags, boxes, etc stored on the floors of the closets in rooms 202, 101, and clean linen stored on the floor of the clean linen room on the 100 hall.All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).32. Observed torn pillow in room 221.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. Observed torn fitted sheet in room 211.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).*Note: Observed all chemical spray bottles labeled as Sanitizer. Ensure the spray bottles have the same label as the original source.Mr. Rick present during the inspection.

#3 · Walls and ceilings cleanable, clean, good repair −1

-Repeat Non-Compliance: Observed popcorn ceilings in 100 & 200 halls peeling and splitting.-Observed walls in room 202 stained.-Observed the ceiling in disrepair in the 200 hall spa.Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.

#8 · Facilities conveniently located, clean and in good repair −2

Repeat Non-Compliance: -Observed brown residue on the shower chair on the 200 hall.**Keep all bathing equipment clean and in good repair. See rule .1312 (a) and (f).-Observed soiled toilet seats in 202, 211, and 100 hall spa room.**Keep all toilet equipment clean and in good repair. See rule .1312 (b).

#14 · Disinfectant accessible, properly used −2

Repeat Non-Compliance: -Observed shower rooms and 100 hall spa missing disinfectant/cleaner. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. See rule .1312 (f).-Spoke with employee who stated that the showers/spas are cleaned by spraying the disinfectant on the surface, wiping it off, taking the resident back to their room, spraying more disinfectant, then wipe it off again. Instructions on the disinfectant/cleaner stated there is a 10 minute contact time.**Skin contact surfaces of all shared bathing equipment shall be cleaned with a detergent solution and then disinfected with an EPA registered hospital disinfectant between patient uses. See rule .1312 (f).

#30 · Medication carts clean, sharps containers affixed, food and utensils handled properly −1

-Repeat Non-Compliance: Observed med cart on 100 hall with chemical bottle stored on patient items. Upon lifting the bottle, a leak was observed.Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).-Observed cups stored with mouthpieces unprotected on 2 med carts. Nurses were informed to keep cups in their sleeve or store them in plastic bags to protect the mouth pieces.Unused medication cups shall be kept covered or inverted. 15A NCAC 18A .1318 (c).

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Jan 21, 2014 no score published · 0 violations

Inspector comments: *Upon full, routine inspection, an inspection was done in reference to the service request #45400- Norovirus-like illness.-Spoke with Pate Wilkerson.-Per Pate, no one has been ill since 1/16/2014. 1/17/2014 morning, everyone was well.-Per Pate, everything was cleaned with 1500ppm bleach, all common activities were stopped, and all residents were requested to stay in their rooms.-Handwashing and Sanitiation was discusses with Pate as well as staff on the halls during the routine inspection.-Facility has not changed any chemicals since previous inspections.It has been pointed out to Mr. Wilkerson to ensure that #8 and #14 on the routine inspection both are communicated to the staff.Refer to inspection sheet completed on 1/21/14 for further information.

No violations were recorded for this inspection.

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Aug 21, 2013 95 / 100 · 4 violations

Inspector comments: 3. Observed popcorn ceiling peeling in room 113.**Keep all walls and ceilings clean and in good repair. See rule .1310.18. Observed a few disposable water pitchers and cups unlabeled.**Label all disposable water pitchers with the resident’s/patient’s first name and last name. See rule .1314 (a).32. Observed wet towel under refrigerator in room 207. Residue and black build up is collecting on the towel and dresser.Observed knob hanging off of dresser in room 202.**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. See rule .1319 (a).Pate Wilkerson & Morgan White present.

#5 · Ambient air temperature 65 to 85 F, equipment clean −1

Observed AC filters dusty throughout bedrooms, common rooms, etc.**Keep all ventilation equipment clean and in good repair. See rule .1311 (b).

#8 · Facilities conveniently located, clean and in good repair −1

-Observed pink build up on the shower chairs.**Keep all bathing equipment clean and in good repair. See rule .1312 (a) and (f).-Observed loose toilet seats in multiple areas on the 100 and 200 halls. -Observed urine on the toilet seat in room 207.**Keep all toilet equipment clean and in good repair. See rule .1312 (b). -Observed loose handsink faucet in 100 hall spa.**Keep all handwashing facilities clean and in good repair. See rule .1312 (b)

#14 · Disinfectant accessible, properly used −2

Repeat Non-Compliance: Observed shower rooms/spas missing disinfectant/cleaner. **A cleaning detergent and an EPA registered hospital disinfectant shall be accessible to all bathing areas. See rule .1312 (f).Spoke with employee who stated that the showers/spas are cleaned by spraying the disinfectant on the surface, let stand for about 5 minutes, then wiped off. Instructions on the disinfectant/cleaner stated there is a 10 minute contact time.**Skin contact surfaces of all shared bathing equipment shall be cleaned with a detergent solution and then disinfected with an EPA registered hospital disinfectant between patient uses. See rule .1312 (f).

#30 · Medication carts clean, sharps containers affixed, food and utensils handled properly −1

Observed med carts with residue in the bottom of the areas holding the cups and spoons. **Medication carts shall be cleaned when visibly soiled. See rule .1318 (c).

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Source: Mecklenburg County Public Health – Environmental Health public inspection portal (search for “WILLOW RIDGE ASSISTED LIVING” or State ID 2060400125). Inspection type (routine vs. follow-up) is not published in the county's data.