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

11/20/2019

Final Score @ Grade

General Comments

No Points Deducted: 1. Observed items stored on the floor in the activity room upstairs behind the counter. Floor can not be seen. Organize and clean. Floors shall be free of obstacles to cleaning. 15A NCAC 18A .1309 (a). 5. Observed dust buildup on the filters in the laundry and mop rooms. Clean Keep all ventilation equipment clean and in good repair. 15A NCAC 18A .1311 (b). 13. Observed water at 121F in room 218, 122F in the therapy restroom, and 118F in the MC dining room & 115. Repair. 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). REMINDER: Ensure score card is visible as permitted by law.

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 stained toilet seat in room 201, rusted toilet riser in room 218, and very loose toilet seat in room 208. Keep all toilet equipment clean and in good repair. 15A NCAC 18A .1312 (b). -Observed clogged sinks in rooms 120 and 201. Repair. Keep all handwashing facilities clean and in good repair. 15A NCAC 18A .1312 (b)
9	0.50	Toilet rooms free of storage, hand wash signs posted	No	No	No	REPEAT: Observed wheelchairs stored in the therapy restroom. Follow the rule below. Toilet rooms shall not be used for storage. See rule .1312 (b).
26	2	Premises clean, no breeding places or rodent harborage	No	No	No	REPEAT: Observed ants in rooms 120, 128, and 218. Provide pest control. There shall be no fly or mosquito breeding places, rodent harborages, or undrained areas on the premises. 15A NCAC 18A .1317 (c).
28	1	Adequate storage, area clean, items properly stored	No	No	No	REPEAT: Observed boxes of ABD pads, gloves, and paper towels stored on the floor: Housekeeping closet, Nurse's storage closet. All patient care or consumable items shall be stored at least 8 inches above the floor. 15A NCAC 18A .1318 (a).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	REPEAT: Observed stains on the mattress cover and/or sheets in room 218,128, 201, 208, & 231, hole in the sheets in rooms 120 and 115. 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).
35	0.50	Patient contact items in good repair, properly stored, cleaned and disinfected	No	No	No	REPEAT: Observed hair in multiple of the brushes in the beauty salon. Follow the rule below. Patient contact items that become contaminated during use shall be cleaned and disinfected after each use. 15A NCAC 18A .1319 (c).
36	2	Approved utensils and equipment, cleaned and sanitized	No	No	No	REPEAT: Observed buildup inside of the refrigerators in rooms 109 and 201, in the memory care dining room refrigerator, and in the microwave in room 231. Clean. Non-food contact surfaces of equipment shall be cleaned at such intervals as to keep them in a clean and sanitary condition. See rule .1320 (c).