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

9/20/2017

Final Score @ Grade

General Comments

Kendra Johnson was present during the inspection. The exterior storage shed was locked and inaccessible during the inspection; key was missing. Ensure all storage areas are made accessibole for inspections. NO POINTS WERE ISSUED FOR THE FOLLOWING: #2 - (CRITICAL) Observed the septic tank lid was cracked. **Replace lid. #3 - Observed no indicating thermometer inside of the refrigerator. Although the refrigerator had a build in thermostat, An indicating thermometer shall be located in each refrigerator.

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	Observed the shower head with pink residue in the hallway bathroom. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).
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 a pillow case on a resident's bed was stained, some dresser knobs were missing on bedroom furniture, the chair rail with chipping paint near the kitchen table, and the surface was damaged on the living room recliner. **All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). '
11	1	FLOORS: In good repair 1; kept clean 2 (.1607)	No	No	No	Observed the bathroom (laminate) floor was water damaged and was soft. Repair flooring and subfloor. All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.x
13	1	LIGHTING AND VENTILATION: Windows and fixtures in good repair 1; kept clean 2 (.1609)	No	No	No	Observed the floor vent (HVAC) with chipping paint and rust in bathroom (inside bedroom). Repair or replace vent and maintain in good repair. Ventilation equipment shall be kept clean and in good repair. 15A NCAC 18A .1609 (b).