Premises Information


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Name

AUTUMN CARE OF CORNELIUS

Address

19530 MT ZION PY

City/State/ZIP

CORNELIUS

28031

Premise Type

40 - Rest/Nursing Homes

County

Mecklenburg

Inspection Date

4/4/2018

Final Score @ Grade

93.50

General Comments

NO POINTS WERE TAKEN FOR THE FOLLOWING: #3 - Observed wall damage in the 500-600 hall equipment storage closet, in room 706, and in the restroom of 604. **Keep all walls and ceilings clean and in good repair. 15A NCAC 18A .1310. #8 - Observed shower chair in need of cleaning in 800 hall spa. Observed bottom of shower chair with soil being stored as clean with plastic wrap over it in 200 hall spa. Observed caulking needed around hand sink in restrooms of rooms 706 and 303. **Keep all bathing equipment clean and in good repair. 15A NCAC 18A .1312 (a) and (f).**Keep all hand washing facilities clean and in good repair. 15A NCAC 18A .1312 (b) #15 - Observed wastewater pipes on laundry machines to be directly drained. Provide an air-gap. **Cross-connections with sewage lines, non-potable water supplies, or other potential sources of contamination are prohibited. 15A NCAC 18A .1313 (d). #35 - Observed bed remote in unused room 303 with build-up in the cracks and crevices. Ensure bed remotes are cleaned before resident occupies room. **Patient contact items shall be kept clean and in good repair. 15A NCAC 18A .1319 (c). #12 - Observed no hand soap at the hand sink of the soiled utility closet on 300-400 hallway. Soap was present at all other hand sinks. **Provide liquid soap and disposable towels at all hand washing sinks. 15A NCAC 18A .1312 (d).

Violations

CDI=Corrected During Inspection

R=Repeat Violation

VR=Verification Required

Violation Item	Demerits	Violation Description	CDI	R	VR	Comments
11	1	Hand sinks used only for intended purpose	No	No	No	REPEAT Observed ice in the hand sinks of nourishment kitchens on the 700-800 and 100-200 hallway. Observed ice and dark liquid in the nourishment kitchen of the 500-600 hall. EHS suggested having a dump bucket for drinks to be taken back to the kitchen for proper disposal. **Except for the stipulations stated in rule .1312 (d), hand washing sinks shall only be used for hand washing. 15A NCAC 18A .1312 (d).
19	2	Ice protected, dispensed, equipment clean in good repair	No	No	No	REPEAT Observed heavy pink build-up on ice machine shoots throughout. Maintenance stated they are cleaned every 6 months when the filters are changed. EHS advised that shoots be cleaned more frequently to prevent such build-up. **Ice machines, buckets, other containers, and scoops shall be cleaned on a regular schedule such that they are kept free of scum, rust, mold or other contamination. 15A NCAC 18A .1314 (b).
28	0.50	Adequate storage, area clean, items properly stored	No	No	No	REPEAT Observed cleaning needed in cabinet of nourishment room on 300-400 hallway where cereal has spilled. Observed boxes of patient care items being stored on the floor of central supply. Items were delivered on Monday, employee in this area is on vacation, ensure someone places patient care items on shelving. **Suitable rooms or spaces shall be provided for the storage of all necessary equipment, furniture, and supplies, and kept clean. 15A NCAC 18A .1318 (a).
32	2	Furniture clean and in good repair. Mattresses clean, dry, odor free	No	No	No	REPEAT Observed debris left under the sheet on the mattress in rooms 804, 604, 508, 706, 704, and 204. Beds observed today had already been made by staff. Ensure staff are cleaning debris from mattress before placing clean sheet on mattress. Observed cracking and peeling plastic on pillows in rooms 604, 704, and a ripped pillow being stored as clean in the clean linen closet of 100-200 hall. PIC stated residents do not make their own beds. Mattresses shall be kept clean, dry, and odor free. 15A NCAC 18A .1319 (a). All furniture, bed springs, mattresses, sleeping mats, draperies, curtains, shades, venetian blinds, or other furnishings in institutions shall be kept clean and in good repair. 15A NCAC 18A .1319 (a).
33	1	Linen changed when soiled. Soiled linen handled properly	No	No	No	Clean bottom sheet needs to be provided to every resident. Observed stain on mattress pad in room 804, soil on comforter and stain on sheet in room 604, stain on sheet in 704, and stained sheet on bed in room 204. Beds observed today had already been made by staff. Ensure staff are removing soiled/stained linen to replace with clean. **Clean bed linen in good repair shall be provided for each individual and shall be changed when soiled. 15A NCAC 18A .1319 (b). NOTE: Observed missing bottom sheets where residents are sleeping directly on top of mattress in rooms 706 and 804. Facility stated that linen cannot be placed on this type of therapy mattress. Provide documentation from manufacturer.