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

10/1/2018

Final Score @ Grade

93.50

General Comments

NO POINTS WERE TAKEN FOR THE FOLLOWING: #1 - Observed transitional moulding missing from entry to restroom of memory care. **Keep all flooring in good repair. 15A NCAC 18A .1309 (a) and (b). #2 - Observed stained carpet in room 226, 103, and in stairwell. Observed cleaning needed on the floor in bathroom of room 216, on the floor in memory care dining/activity room, and behind toilet in room 132. **Keep all flooring clean. 15A NCAC 18A .1309 (a). #3 - Observed caulking needed on top of shower in room 216 and 132. Observed wall and baseboard to be soiled in room 132. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. #11 - Observed maintenance director state that hands are washed in beauty salon hair washing sink. Facility was built prior to 2003. EHS advised PIC to have caregivers use hand sanitizer in lieu of hand washing in beauty salon. **Except for the stipulations stated in rule .1312 (d), hand washing sinks shall only be used for hand washing. 15A NCAC 18A .1312 (d). #27 - Observed pet records to be expired for pony that visits facility. Obtain updated records. **Maintain adequate vet records for all animals. 15A NCAC 18A .1317 (f). #32 - Observed debris left in mattress of room 132. Observed improvement. **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). #33 - Observed stained pillow case, mattress cover, and stained chair pad in room 116. Observed stained pillow case and sheets in room 132. Observed mattress cover with debris in room 132. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	2	Facilities conveniently located, clean and in good repair	No	No	No	REPEAT Observed cleaning needed on underside of toilet chair in room 216 and 103. Observed toilet in need of cleaning in 103 and in restroom of memory care. Observed pink build-up on shower floor in room 216. 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).
16	1	Quantitiy and hot water sufficient, backup water supply plan	No	No	No	REPEAT Observed no backup water supply plan on site. Checklist emailed. **Observed no backup water supply plan. Provide a written plan that meets all parts of 15A NCAC 18A .1313 (f).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	REPEAT Observed single-service cups being stored on floor in upstairs nurses closet. Observed briefs being stored on the floor in room 216. Observed toilet paper and paper towels being stored on shelf under engine oil in housekeeping closet of first floor. **All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
36	1	Approved utensils and equipment, cleaned and sanitized	No	No	No	REPEAT Observed microwave in need of cleaning in memory care dining room. Observed improvement. **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).
42	2	Food protected. Potentially hazardous food maintained at 45 F or below, or 140 F for above, consumed or discarded within 2 hours of being removed from temperature control	No	No	No	Observed yogurt in refrigerator of room 216 at 49F thermometer read 49F. Observed refrigerator in room 211 at 56F with yogurt. Check thermometers daily. **All potentially hazardous food products shall be maintained at 45°F, or below, or 140°F or above except during necessary periods of preparation and serving. 15A NCAC 18A .1323 (a).