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

5/14/2021

Final Score @ Grade

General Comments

NO POINTS FOR THE FOLLOWING: #3 Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed walls in room 1092D Soiled Utility in need of repaint. Observed wallpaper in therapy room by the window peeling. Observed wall behind headboard of bed in need of repair and repaint in room 58. #8 Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed stain on toilet seat in room 9D. Observed stain in toilet bowl in room 27D. Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f). Observed caulking on the floor of the shower lifting in 30D. #24 Effective measures shall be taken to keep flies, rodents, cockroaches, and other vermin out of the establishment and to prevent their breeding or presence on the premises. 15A NCAC 18A .1317 (a). Observed live water bug and dead insects in shower and bathroom floor in room 26D. Maintenance person was aware during inspection. #32 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). Observed red couch in Livingroom in Oriole place with debris. Observed orange couch in Livingroom in Cardinal Trail with debris. Observed small rip on corner of mattress in room 9D.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
13	2	Lavatory and bathing hot water between 100 and 116 F	No	No	No	Maintain the hot water at all resident accessible handwashing sinks and bathing facilities within the temperature range of 100°F to 116°F. 15A NCAC 18A .1312 (e). Observed in room 30D with hot water temperature of 96F and 97F in room 26D. REPEAT VIOLATION
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed stain on pillow in room 30D, 27D, 47, and 58. Observed stain on sheets in room 47 and 50. Observed stain on couch in room 47.