Premises Information


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Name

CUTHBERTSON VILLAGE

Address

3200 BISHOPS WAY LN

City/State/ZIP

CHARLOTTE

28215

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

10/15/2013

Final Score @ Grade

95.50

General Comments

.Mercedes Doss was present during the inspection.General Comments:#2 - Observed the carpet on the A wing with stains. **Keep all flooring clean. See rule .1309 (a).#15 - Observed the new ice machine in the Soda Shop is directly drained. Ensure that the equipment has built-in backflow prevention or provide an air-gap for drainage. Observed some shower wands without backfloe prevention devices. **Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. Seer rule .1313 (d).#36 - One staff member stated that the water pitchers on the med carts were washed at the kitchenette 2 comp sink. Ensure the all water dispensing pitchers cleaned in the kitchen. **All utensils and food contact surfaces of equipment used in the preparation, service, display, or storage of potentially hazardous foods shall be cleaned and sanitized prior to each use. See rule .1320 (c).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Observed the paper towel dispenser in the soiled utility hand washing sink on the B/C Wing and the Soda Shop were not working, some areas had dispensers without power. Observed the paper towel dispenser in the A wing soiled utility room was next to the hopper (across the room from the hand washing sink). Move paper towel dispenser to the hand washing area. **Provide liquid soap and disposable towels at all hand washing sinks. See rule .1312 (d).
27	1	Pet areas clean, veterinary records available	No	No	No	Observed floor(carpet) around the litter box with pet stains and litter, and the bird cage in the court yard needed cleaning. **Animal pens, litter boxes, bird cages and other areas on the premises shall be cleaned to minimize accumulation of animal wastes, pet dander and allergens. See rule .1317 (e).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed a box of snack were stored on a cart less than 8 inches of the floor in the Soda Shop, and bags of candy were stored on the floor in the Five an d Dime storage closet. The bags of candy were properly stored during the inspection. **All patient care or consumable items shall be stored at least 8 inches above the floor. See rule .1318 (a).
34	1	Laundry area and equipment clean, linen disinfected, clean laundry stored and handled separately	No	No	No	Observed a bag of bed linen was stored on the floor in the B wing laundry room closet. **Clean linen shall be stored and handled in a separate room or area, or in another manner that will prevent contamination of clean linen. See rule .1319 (b).
43	0.50	Food storage units with thermometers, maintain temperatures	No	No	No	(Repeat Non-compliance) Observed no thermometer in the Soda Shop refrigerator. **All refrigerators shall maintain a temperature of 45 F or below. See rule .1323 (b).