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

3/1/2017

Final Score @ Grade

General Comments

#3 - Observed stained and missing ceiling tiles in 1099D laundry room. #4 - Observed lights out in B and C hall soiled utility rooms. Replace lights to ensure rooms are well-lit. #19 - Observed build-up around the shoot and water dispenser of ice machine in Blue jay Lane kitchen. Ensure ice machine is washed, rinsed, and sanitized with a food grade sanitizer at the proper concentration. #28 - Observed toilet paper stored on the floor in the House keeping closet on the Cardinal Trail hall. Observed boxed juice being stored on the floor in the Hummingbird Cafe. Keep patient care items 8 inches above the floor. #33 - Observed one soiled linen cart unlabeled in the soiled linen room on the Cardinal Trail hallway. #35 - Observed build-up of hair in the brushes used in the salon. Ensure brushes are cleaned after each resident. Inspection completed by Savannah Parker with supervision by Tasharra Kenion, REHS

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
5	1	Ambient air temperature 65 to 85 F, equipment clean	No	No	No	Repeat: observed heavy build-up of dust accumulating on vent in 1099D laundry room. **Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b).
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Observed cleaning needed in shower floor in the bathrooms of room 3D. Observed hoppers throughout the facility in need of flushing and clean even if not used. Observed cleaning needed on the bottom of shower chair seat in room 24D. Observed leaking faucet in the Mallard Way laundry room hand sink. Observed brown build-up in kitchen hand sink on the Cardinal Train hallway. 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)