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

10/8/2021

Final Score @ Grade

General Comments

No points deducted for the following: 8.Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). Observed a loose toilet seat in Cardinal trail room 54. Ensure toilet seat is repaired by maintenance. 33.Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). Observed residents personal pillows inside of pillow case with mild staining in Blue Jay room 7D, Oriole Place room 2D, Mallard way room 35D, and Cardinal trail room 61. REHS recommended PIC to let family members of residents know to replace personal pillows that are soiled. Inspection led by Dora sanders

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	1	Walls and ceilings cleanable, clean, good repair	No	No	No	Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. Observed water stained ceiling tiles in Mallard Way laundry room. REHS advised PIC to put a work order in place to have ceiling tiles repaired or replaced.