Premises Information


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Name

TERRABELLA LITTLE AVENUE

Address

7745 LITTLE AV

City/State/ZIP

CHARLOTTE

28226

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

11/11/2013

Final Score @ Grade

92.50

General Comments

Mr. Carlos Huertas present during inspection.GC # 15: Observed no backflow preventer at sink in salon.**Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d).GC # 24: Observed ants in women's bathroom, hall 1st floor.**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).GC # 16: New maintenance director couldn't locate back-up water supply plan (ED off-site). Plan given does not sufficiently spell out the required details (it's ambiguous).**Observed no backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f).**The backup water supply plan shall provide for two liters of water per day perperson for drinking. The backup water supply plan shall include a plan for either relocating residents or providingan alternative source of water for essential functions such as food preparation, hand washing, bathing, cleaning,dishwashing, laundry and disposal of bodily waste. The amount of water provided for uses other than drinking maybe reduced if the plan includes alternatives for water use for services such as laundry and dishwashing. If anassessment determines that tap water is not to be used for drinking, sources shall be prominently labeled or hoodedto restrict use and potable water shall be provided.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
2	1	Floors clean, carpet clean, dry, odor free	No	No	No	Observed carpets not being vacuumed in storage closets. Flooring with build up/staining in laundry room.**Keep all flooring clean. 15A NCAC 18A .1309 (a).
8	1	Facilities conveniently located, clean and in good repair	No	No	No	Observed sink in memory care (kitchenette) not being cleaned frequently enough. Plumbing leak at wash sink in salon. Bath mat and floor of shower under bath mat with residue build-up, room 122.** 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 handwashing 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 unlabeled comb (with hair in it) in cabinet of hall bathroom, memory care.**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).
30	2	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	Repeat Non-Compliance: Observed single service cups and pill cups not protected on assisted living and memory care halls. Med cart drawers in memory care needed cleaning out.Unused medication cups shall be kept covered (on a clean surface) or inverted. 15A NCAC 18A .1318 (c).Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	Repeat Non-Compliance: Observed lots of trash under cushions of furniture in common areas. Chair in salon needs cleaning of product build-up.**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).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	Observed drawers and cabinets in memory care need wiping out, food and debris spills. One drawer off it's track, memory care, kitchenette.**All kitchenware and food contact surfaces of equipment, exclusive or cooking surfaces of equipment, used in preparation or serving of food or drink, and all food storage utensils, shall be cleaned after each use. 15A NCAC 18A .1320 (c).