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

4/15/2015

Final Score @ Grade

General Comments

2. Observed debris and single service items on the floor in the nurse storage. Clean.Keep all flooring clean. 15A NCAC 18A .1309 (a).16. Obseved no backup water supply plan. Guidline form emailed.Observed no backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f). 36. -Observed buildup and old popcorn in the popcorn machine (2nd floor).-Observed the interior of the refrigerator in the HV Living room and in room 113 collecting residue.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).43. Observed no thermometer in the refrigerator in room 113, and a moldy thermometer in the HV living room refrigerator.All refrigerators shall have a thermometer and situated so that the thermometer can be easily read. 15A NCAC 18A .1323 (b).Mr. Elvin was present at the beginning of the inspection. Mr. Matthew Fowler was present for the remainder of the inspection.Report and the Instatution Rule Book emailed to Mr. Fowler and Ms. Tammy Mullins.

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	-Repeat Non-Compliance: Observed water stains on ceiling in upstairs hallway.-Observed the wall over the shower in 132 in need of caulk.Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310.
4	1	Lighting at least 10 foot candles 30 inches above floor	No	No	No	Repeat Non-Compliance: Observed the light in the nurse storage closet very dim. Provide more lighting.All areas shall have sufficient illumination. Maintain 10 foot candles of light at 30 inches above the floor in all areas other than food service areas. 15A NCAC 18A .1311 (a).
8	1	Facilities conveniently located, clean and in good repair	No	No	No	-Repeat Non-Compliance: Observed soiled (brown on the bottom) shower curtain in room 132.Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).-Observed loose toilet seat in room 113.Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). -Observed room labeled "Storage" with 2 large trash cans containing bags of soiled briefs, bed pads, etc. Room has a very strong odor.Handwashing sinks shall be accessible to all areas where personnel may be exposed to bodily excretions or secretions. 15A NCAC 18A .1312 (d).
19	1	Ice protected, dispensed, equipment clean in good repair	No	No	No	Observed ice stored on the counter top in the Dining room (HV side). At certain times no staff was supervising the area. (Pitcher of juice was also on the counter. Ensure it is protected against contamination also).Ice shall be handled, transported, stored, and dispensed in such a manner as to be protected against contamination. 15A NCAC 18A .1314 (b).
28	1	Adequate storage, area clean, items properly stored	No	No	No	-Repeat Non-Compliance: Observed briefs and/or bed pads stored on the floor in the restrooms and closets in multiple rooms.All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).-Observed towels stored under the restroom handsink in 210.Patient care or consumable items shall not be stored below exposed sewage lines. 15A NCAC 18A .1318 (a).
30	2	Medication carts clean, sharps containers affixed, food and utensils handled properly	No	No	No	-Repeat Non-Compliance: Observe single service items (pill cups & utensils) stored unprotected on the med carts.Unused medication cups shall be kept covered or inverted. 15A NCAC 18A .1318 (c).-Observed residue collecting in the bottom of drawers in one of the two medication carts.Medication carts shall be cleaned when visibly soiled. 15A NCAC 18A .1318 (c).
32	1	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	-Observed soiled mattress cover in 105.-Observed stain couch cushion in room 212.-Observed the bottom of the vanities in the salon with water damage.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).