Premises Information


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Name

SHELBURNE PLACE

Address

2524 SHELBURNE PL

City/State/ZIP

MINT HILL

28227

Premise Type

43 - Residential Care

County

Mecklenburg

Inspection Date

7/24/2013

Final Score @ Grade

General Comments

Kartrina Roberson was preent during the inspection.#1 - Observed no back-flow preventer on the front hose bib. **No backflow connections or cross connections with unapproved supplies shall exist. See rule .1611 (c ).#3 - Observed raw chicken(frozen) stored above ready-to-eat food in the freezer. **Do not store raw meat and poultry above ready-to-eat food. Store raw meat, eggs, and poultry according to cook temperatures. Food storage handout was provided.#15 - Observed mop water had been dumped onthe ground in the back yard. **Properly dispose of waste water in the sanitiary sewer.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
9	4	BEDS: LINEN: FURNITURE: All furniture, mattresses, linen, drapes, blinds and similar items in good repair and clean 2; bed linen changed as required 2; clean and soiled linens properly stored and handled 2 (.1617)	No	No	No	A: Observed the couch, love seat and chair in the Den with worn/peeling surface. All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. See rule .1617 (a).B: Observed a pillow case in one of the resident bedrooms was soiled. Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. See rule .1617 (b).
13	1	LIGHTING AND VENTILATION: Windows and fixtures in good repair 1; kept clean 2 (.1609)	No	No	No	A: Observed the HVAC floor vent in the hall bathroom with rust (REPEAT). **Ventilation equipment shall be kept clean and in good repair. See rule .1609 (b).