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

12/9/2015

Final Score @ Grade

General Comments

3) Observed opened bag of ceral not in zip loc bag. All opened food shall be protected from contamination. 8b) Observed slight build up on bottom of shower curtain left side hall restroom. Observed corrosion beginning on faucets in same restroom. Keep bathing items and lavatory fixtures clean and in good repair. Ms. Kendra Johnson was present during inspection.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
8	2	TOILET: HANDWASHING: LAUNDRY AND BATHING FACILITIES: Toilet, lavatory and bathing facilities adequate 4; fixtures in good repair and kept clean 2; soap and towels provided 2 (.1610)	No	No	No	Repeat Non Compliance: Observed paper towels not present in back right hall restroom. Paper towels provided during inspection. **Each resident will be provided soap and individual towels. These towels will be stored separately after being used. 15A NCAC 18A .1610 (b).
9	2	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	Observed slight stain at top of comforter in back left bed room. Keep all linene clean and in good repair. **Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. 15A NCAC 18A .1617 (b).