Premises Information


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Name

ECHELON 3

Address

4724 CARRIAGE DRIVE CR

City/State/ZIP

CHARLOTTE

28205

Premise Type

43 - Residential Care

County

Mecklenburg

Inspection Date

10/12/2017

Final Score @ Grade

General Comments

Richard Campbell was present during the inspection. CONTINUED FROM PAGE 2: #3 - Observed the refrigerator temperature was 47F and several food items above 45F; bologna (52F), cheese (46F), raw shell eggs (48F), fish and rice (47F). Refrigerator temperature was adjusted to 44F during the inspection. Food items were discarded. **All perishable foods shall be stored at such temperatures as will protect against spoilage. All potentially hazardous food shall be maintained at safe temperatures (45° F. or below, or 140° F. or above) except during necessary periods of preparation and serving. 15A NCAC 18A .1620 (a). #10 - Observed toilet paper was stored on the floor in the bathroom closet and chemicals (bleach/detergent) above toilet paper. Rearrange closet so chemicals are not stored above paper supply and paper supply in not on the floor. NO DEMERITS WERE ISSUED FOR THE FOLLOWING: #3 - Observed half eating container of fish/rice, green beans was stored in the refirgerator for re-serving. Portions of food once served to an individual shall not be served again. 15A NCAC 18A .1620 (a). #12 - Observed walls repairs with unfinished. Finish all repaired walls with non absorbant (cleanable) paint.

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
3	11	FOOD SUPPLIES PROTECTION: All food clean, wholesome, no spoilage 6 (.1619) Adequate during storage/preparation/serving, potentially hazardous food 45° or 140°F above 5; refrigerators with temps 2; meat products cooked; meat products handled as required, no re-serving food 4; food stored above floor protected 2; No animals 4 (.1620)	No	No	No	(CRITICAL) Observed cooked/cooled ravioli with bacteria growth in the kitchen refrigerator. The ravioli was discarded. **Salads made of meat, poultry, potatoes, fish, shellfish, or eggs, and other potentially hazardous prepared food shall be prepared, preferably from chilled products, with a minimum of manual contact, and on surfaces and with utensils which are clean. 15A NCAC 18A .1620 (a). CONTINUED ON PAGE 4
4	4	FOOD SERVICE UTENSILS/EQUIPMENT: Utensils/Equipment in good repair, clean 4; eating and drinking utensils clean, cleaned after each use; approved facilities 4; clean utensils properly stored 2; substances containing poisonous material not used 6; disposable properly stored/handled, used once 2 (.1618)	No	No	No	Observed drinking cups were tightly stacked and stored in the cabinet. Completely dry all dishes before storing and stacking; frying pans with non-stick coating coming off, and several plastic containers with rough / stained surfaces. **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).
8	6	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 no paper towels in the hallway bathroom, and one single towels shared for hand drying; shower curtain liner with accumulated soap residue and pink residue. Each resident will be provided soap and individual towels. These towels will be stored separately after being used. 15A NCAC 18A .1610 (b). Toilet, hand washing, bathing, and laundry facilities shall be kept clean and in good repair. 15A NCAC 18A .1610 (a).
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	Observed sheets and pillow casing were stained and in need of washing and / or changing, some dresser drawers with missing knobs, a bent / damaged curtain rod, window troughs with dead beds/debris, and the front room couch with damage surface. All furniture, mattresses, curtains, draperies, and other furnishings shall be kept clean and in good repair. 15A NCAC 18A .1617 (a). Clean bed linen in good repair shall be provided for each resident and shall be changed when soiled. 15A NCAC 18A .1617 (b).
10	6	STORAGE: MISCELLANEOUS: Rooms or areas provided for storage of clothes, personal effects, luggage, supplies and equipment kept clean 2; medications, cleaning supplies, pesticides and other hazardous products properly stored as required 4 (.1616)	No	No	No	Observed "home defense" pesticide, moth balls, and detergent pods were stored in the unlocked laundry area; bleach stored in an unlocked cabinet, aerosol air freshener in the bathroom. Items were stored behind lock and key during the inspection. Pesticides, herbicides and other substances which may be hazardous if ingested, inhaled, or handled, shall be stored in a closet, cabinet or box not accessible to young children unless otherwise required in the rules of the licensing agency. 15A NCAC 18A .1616 (b). Household cleaning agents such as bleaches, detergents and polishes shall be stored out of the reach of young children unless otherwise required in the rules of the licensing agency. 15A NCAC 18A .1616 (c ).