Premises Information


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Name

JANICE INGRAM HOME

Address

511 W ROCKY RIVER RD

City/State/ZIP

CHARLOTTE

28213

Premise Type

43 - Residential Care

County

Mecklenburg

Inspection Date

11/14/2014

Final Score @ Grade

General Comments

#4. Observed food debris present on surfaces in microwave. Observed residue present on plastic shoot that distributes ice on fridge. **After cleaning and until use, food-contact surfaces of equipment shall be protected from contamination. 15A NCAC 18A .1618 (f).**All equipment and utensils shall be so constructed as to be easily cleaned and shall be kept in good repair. 15A NCAC 18A .1618 (a).#9 Observed rip in pillow case in very back room. Keep all linen 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).Ms. Ingram 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 white calcium build up on shower head with tub faucets pitting. Observed loose toilet seat in hall bathroom. **Toilet, handwashing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).
11	1	FLOORS: In good repair 1; kept clean 2 (.1607)	No	No	No	Repeat Non Compliance: Observed carpet loose in front bedroom near kitchen. **All floors shall be easily cleanable and shall be kept clean and in good repair. 15A NCAC 18A .1607.