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

3/8/2016

Final Score @ Grade

94.50

General Comments

(NO POINTS DEDUCTED) Ms. Mary Ellison and Tonia Brewer were present during inspection. #3 Observed water stained ceiling tiles present in laundry room A and B, A hall. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. #4 Observed light fixture falling in B hallway. Observed light out in restroom in room 15 of A wing. **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 Observed HVAC vent with dust accumulation in laundry room A, living room B unit, A/C vent room #15. Observed blinds torn in room 15 A wing, with residue build up in same room. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). #33 Observed stained/soiled linen present in room 14 A wing. Observed soiled linen trash cans placed in outside closet with labeling on door. Provide labeling on frontside of actual trash can itself. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). **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).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	2	Facilities conveniently located, clean and in good repair	No	No	No	Repeat Non Compliance: Observed hand sink items located in splash zone of laundry room B. Keep hand sink splash zones free of storage. Repeat Non Compliance: Observed loose toilet seat in room 18 B wing. Toilet seat in need of tightening. Observed underside of toilet chairs soiled in need of cleaning in room 14 and 15 A wing Observed pink residue collecting on shower head of room 15 A wing. 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)
12	1.50	Lavatories have mixing faucet or tempered water, soap hand towel and hand drying device	No	No	No	Observed paper towels not present at hand sinks in laundry room B & C. Provide paper towels **Provide liquid soap and disposable towels at all hand washing sinks. 15A NCAC 18A .1312 (d).
18	1	Drinking utensils properly handled	No	No	No	Observed care giver state water pitchers were cleaned in kitchenette areas. **Ensure that all drink water pitcher are washed, rinsed, sanitized properly in the main kitchen.
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Observed stain on pillows in living room B. Improvement seen from last inspection. **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).