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

11/9/2016

Final Score @ Grade

95.50

General Comments

(NO POINTS DEDUCTED) #3 Observed water stained ceiling tile present in A wing/laundry and in B wing hallway. #5 Observed ceiling vent in A wing laundry collecting heavy debris build up #33 Observed several soiled linen carts not labeled. Label soiled linen carts #36 Observed several microwaves collecting debris build up in need of cleaning including paper line in A wing kitchenette. #30 Observed pill crusher collecting debris in C wing. Keep pill crushed clean. #12 Observed soap not provided in soiled utility closet D wing. Provide soap. #3 Observed hole in wall of A wing house keeping. Keep walls/ceiling clean and good repair.

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, Beauty salon hand sink. Keep all items out of splash zone Repeat Non Compliance: Observed shower head with debris build up in room 21D, 28D. Observed shower curtain ripped in 28D. Keep all bathing equipment clean and in good repair. Repeat Non Compliance: Observed soiled toilet seats located in rooms: 46, 32D, 28D. 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)
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	Observed items stored in shower area in spa upfront. Items need to be removed. Observed storage closet outside in need of cleaning in common area. **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	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat Non Compliance: Observed stained, ripped, and or soiled furniture in following areas: A common room, B common room, C common room, and D wing. Observed kleenex in between cushions in common area in C wing. Observed knob missing at cabinet in room 46 & 61. Observed PT table ripped along with push chair in same location. Keep all furniture items clean and in good repair. **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).