Premises Information


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Name

CARMEL HILLS

Address

2801 CARMEL RD

City/State/ZIP

CHARLOTTE

28226

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

9/7/2017

Final Score @ Grade

91.50

General Comments

NO POINTS: 16. Observed water supply plan without detailed procedures for appropriate hand washing for food preparation. An alternate plan for water supply shall be in place for hand washing. Alternative source of water shall be provided for essential functions such as FOOD PREPARATION, HAND WASHING, bathing, cleaning, dish washing, laundry and disposal of bodily fluids. ** Observed an incomplete backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f). 24. Observed temporary air conditioning unit used in family room, PIC stated unit was supposed to be sealed to the window. The connection of the air conditioning unit had fallen, leaving a large space open to pests, no window screen was present or any other means of protection from inflow of flies, insects, or rodents. Observed boiler room vent in poor repair, from outside, ensure that vent is properly sealed using 16-mesh if directly connected to the inside. Ensure all openings to outer air are protected. **All openings to the outer air shall be protected against the entrance of flies and other flying insects by self closing doors, closed windows, 16-mesh or finer screening, controlled air currents, or other effective means. 15A NCAC 18A .1317 (a). 30. Observe spoon in med cart stored with handle down, allowing for food contact surface to be exposed. **Food and utensils used on medication carts shall be handled in a sanitary manner. 15A NCAC 18A .1318 (c). 32. Observed chairs and recliner in family room with heavy staining, arms of chairs are in need cleaning. **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).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	1	Walls and ceilings cleanable, clean, good repair	No	No	No	Observed several pin holes on walls in room 108. Observed wall in dining room with deep scrapes as well as with scrape marks. Observed some patches on wall in shower room that were scraping off, material used was not washable. Observed unfinished ceiling near room 106, directly above door way. Ensure walls and ceilings are clean and in good repair. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. REPEAT
5	1	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	Observed dust build up on air conditioning vents in rooms 108, and 106. Observed dust build up on vent returns in laundry room and in dining room. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). REPEAT
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Observed loose toilet seat in bathroom of room 118. Observed soiled toilet chair and seat of room 106. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed shower head in shower room broken. Observed mesh in shower chair fraying. Observed bottom of shower chair with pink build up in shower room and in room 122. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Observed no hand soap available in laundry room. Ensure soap provided at all hand washing sinks. PIC had nurse provide hand soap. **Provide liquid soap and disposable towels at all hand washing sinks. 15A NCAC 18A .1312 (d).
13	2	Lavatory and bathing hot water between 100 and 116 F	No	No	No	Observed water temperature in dining/kitchen room, and in shower room at 118F. PIC had maintenances to adjust mixing valve at water heater. **Maintain the hot water at all resident accessible hand washing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). REPEAT
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed toileting, and other patient care items stored on the floor in storage closet and in room 108. **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a). Observed unidentified white powder in cabinet in dining room. PIC removed powder. Ensure storage space is available. 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). REPEAT
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Observed stained, soiled, and ripped linen in rooms 108, and 122. Observed stained pillows and pillow cases in room 108 and in 122. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). REPEAT
40	0.50	Food brought by employees or visitors handled properly	No	No	No	Observed bag with food in patient dining room without name or date the food was received. PIC stated that it was not facility food. PIC removed food from refrigerator. **Food brought from home by employees or visitors of patients or residents shall be stored separately from the institution's food supply and shall be labeled with the name of the person to receive the food and the date the food was brought into the facility. 15A NCAC 18A .1321 (b). REPEAT